Changes in Anemia and Iron Biomarkers among Pregnant Women Receiving Care at Primary Health Centers in Puducherry, India: A Prospective Cohort Study

BACKGROUND: Anemia in pregnancy, predominantly due to iron deficiency, is a significant public health concern in India, contributing to 40% of maternal deaths. Despite initiatives like Anemia Mukt Bharat, progress in reducing anemia remains slow, particularly in states with high healthcare coverage like Puducherry. OBJECTIVE: To evaluate the changes in anemia, hemoglobin (Hb) levels, and iron biomarkers among pregnant women receiving iron supplementation at primary health centres (PHCs) in Puducherry, India. MATERIALS AND METHODS: A prospective cohort study followed 150 pregnant women from their first to third trimesters across four PHCs in Puducherry. Hb and iron parameters, including serum ferritin and transferrin saturation (TSAT), were measured in each trimester. Compliance with iron-folic acid (IFA) supplementation was assessed using pill counts. Dietary iron intake was recorded using a 24-h dietary recall. RESULTS: Anemia prevalence increased from 40.7% in the first trimester to 60% in the second, decreasing to 44% in the third trimester. Iron deficiency was prevalent in >70% of the cohort across all trimesters. Despite high compliance (90%) with IFA, anemic women received inadequate doses relative to their anemia status. Biomarkers like serum ferritin showed no significant improvement, while transferrin and TSAT levels remained suboptimal. Dietary iron intake was insufficient throughout pregnancy, highlighting the need for additional micronutrient supplementation. CONCLUSION: While IFA supplementation improved compliance, it was inadequate to reduce anemia effectively. Programmatic gaps, such as insufficient IFA supply for anemic women and lack of targeted supplementation, need to be addressed. National indicators should emphasize "screen and treat" strategies over tablet counts for anemia management.