Efficacy and Tolerability of Twice Daily Versus Alternate Day Iron Supplementation during Pregnancy with Mild To Moderate Iron Deficiency Anaemia

Abstract Background: Iron deficiency anemia (IDA) is the most prevalent cause of anemia globally, affecting over 2 billion people, with pregnant women being particularly at risk. Traditional iron supplementation often leads to gastrointestinal side effects, prompting the exploration of alternate dosing strategies. Aim: To evaluate and compare the efficacy and tolerability of twice-daily versus alternate-day oral iron supplementation in pregnant women with mild to moderate iron deficiency anemia. Methods: A randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, SMS Medical College, Jaipur, involving 90 pregnant women (aged 20–35 years) with mild to moderate IDA. Participants were randomized into two groups: Group A received twice-daily ferrous sulfate (120 mg elemental iron), and Group B received alternate-day ferrous sulfate (120 mg elemental iron). Hemoglobin (Hb), serum ferritin, and reticulocyte hemoglobin equivalent (RET-He) levels were measured before and after 42 days of treatment. Side effects were recorded. Results: Group A showed a significant increase in Hb from 9.1±1.8 to 9.8±2.03 gm%, while Group B showed a more substantial increase from 8.9±1.01 to 11.4±1.1 gm% (p<0.0001). Serum ferritin levels rose significantly more in Group B (44.5±9.06 mcg/L) compared to Group A (29.1±10.9 mcg/L) (p<0.0001). Both groups showed improvements in RET-He levels, with Group B showing a higher mean increase (p<0.0001). Side effects were similar in both groups. Conclusion: Alternate-day iron supplementation is more effective in improving anemia, with better serum ferritin levels and enhanced erythropoiesis. It also shows comparable tolerability, making it a viable treatment for mild to moderate IDA in pregnant women.