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LETTER TO EDITOR
Year : 2022  |  Volume : 3  |  Issue : 3  |  Page : 95

Alternate day iron prophylaxis: Is it time to change policy in India for pregnant and lactating women?


Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission09-Apr-2022
Date of Decision17-May-2022
Date of Acceptance28-May-2022
Date of Web Publication14-Sep-2022

Correspondence Address:
Dr. Suraj Kapoor
Department of Community Medicine, Armed Forces Medical College, Solapur Road, Wanowrie, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_14_22

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How to cite this article:
Kapoor S. Alternate day iron prophylaxis: Is it time to change policy in India for pregnant and lactating women?. J Public Health Prim Care 2022;3:95

How to cite this URL:
Kapoor S. Alternate day iron prophylaxis: Is it time to change policy in India for pregnant and lactating women?. J Public Health Prim Care [serial online] 2022 [cited 2022 Oct 1];3:95. Available from: http://www.jphpc.org/text.asp?2022/3/3/95/354813



Anemia is highly prevalent in India among women of the reproductive age group (57%) as well as among pregnant women (52%).[1] The government of India has launched Anaemia Mukt Bharat with 6 × 6 × 6 strategy[2] with an aim to reduce the prevalence of anemia among vulnerable groups. Under the scheme, all pregnant and lactating women are given oral iron (60 mg elemental iron) and (500 micrograms of folic acid) daily for 180 days. For pregnant women, iron prophylaxis is started during the second trimester. However, the current evidence suggests alternate day iron supplementation reduces the hepcidin-induced iron absorption block. Moreover, the incidence of gastrointestinal side effects is also reduced when iron supplements are given on an alternate day. A recent study suggests alternate day dosing of oral iron supplements in anemic women may be desirable because it abruptly increases the fraction of iron absorption. If the same amount of dosage is required, twice the daily target dose should be given on alternate days, as total iron absorption from a single dose of 200 mg given on alternate days was approximately twice as compared to a dosage of 100 mg given on consecutive days (P < 0.001).[3] Another study revealed that the alternate day therapy is more effective and was found to have lesser side effects, particularly of the gastrointestinal tract.[4] A study conducted in India also suggested alternate therapy may improve compliance of iron therapy to pregnant women due to lesser side effects without compromising any outcome on the pregnancy.[5]

It is proposed that health policymakers should take decision on the basis of scientific rationale of alternate day iron therapy in implementation of iron prophylaxis among pregnant and lactating women.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf?ref=inbound_article? ref=inbound_article. [Last assessed on 2020 May 17]  Back to cited text no. 1
    
2.
Available from: https://anemiamuktbharat.info/. [Last assessed on 2022 May 17].  Back to cited text no. 2
    
3.
Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica 2020;105:1232-9.  Back to cited text no. 3
    
4.
Mehta S, Sharma BS, Gulati S, Sharma N, Goyal LK, Mehta S. A prospective, randomized, interventional study of oral iron supplementation comparing daily dose with alternate day regimen using hepcidin as a biomarker in iron deficiency anemia. J Assoc Physicians India 2020;68:39-41.  Back to cited text no. 4
    
5.
Grover V, Aggarwal OP, Gupta A, Kumar P, Tiwari RS. Effect of daily and alternate day iron & folic acid supplementation to pregnant females on the weight of the newborn. Indian J Community Med 1998;23:165.  Back to cited text no. 5
    




 

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