Iron, Folic Acid, and Vitamin B12 Supplementation for Anemic Pregnant Women

National Iron Plus Initiative recommends – anemic pregnant women be treated with 200 mg of elemental iron and 1 mg of folic acid. The last two decades have recorded greater vitamin B12 deficiency rates. 

The aim of a recent study was to assess the impact of adding vitamin B12 to iron and folic acid supplementation in anemic pregnant women.

In this hospital-based open randomized trial, anemic pregnant women were randomly divided into two groups – Group 1 received 240 mg iron + 5 mg folic acid, and Group 2 was given 240 mg iron + 1.5 mg folic acid + 15 µg vitamin B12. Hemoglobin (Hb), ferritin, folic acid, and vitamin B12 levels were measured over 8 weeks and at 38 weeks of pregnancy.

It was observed that both the groups had a 1 g/dL increase in Hb at 8 weeks and 1.5 g/dL at 38 weeks – with only 30% still anemic. Mean ferritin and folic acid levels improved in all. Vitamin B12 levels decreased in Group 1––receiving 5 mg of folic acid, while there were no significant differences in Hb, ferritin, or folic acid levels between the two groups. Higher iron doses (240 mg) did not show greater improvement in Hb or ferritin compared to lower doses but were associated with more side effects.

It was concluded that folic acid at 5 mg should be avoided due to its effect on vitamin B12 levels. The addition of vitamin B12 did not enhance Hb or vitamin B12 levels, warranting further investigation. Lower iron doses may be preferable due to fewer side effects while still achieving similar Hb improvements.

Source: Sharma A, Ravinder P, Nair K M, et al. Indian J Obstet Gynecol Res 2024;11(3):364-373