{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:02:43Z","timestamp":1788368563845,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Children\u2019s Investment Fund Foundation (CIFF)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The objective is to study the trajectories of hematologic and biochemical markers in moderately anemic pregnant women receiving oral iron supplementation throughout pregnancy. Methods: This prospective cohort study was conducted from August 2021 to September 2023 involving 315 pregnant women from rural areas of Belgaum, Karnataka, India, with hemoglobin levels between 7.0 and 9.9 g\/dL and serum ferritin &lt; 30 ng\/mL and\/or TSAT &lt; 20%. Participants received iron\u2013folic acid supplementation (IFAS) as per Anaemia Mukt Bharat guidelines. Blood samples were collected to measure various hematologic and iron markers and compared across each visits. Results: We report a complete adherence rate of 95.3% for iron and 97.8% for folic acid supplementation throughout pregnancy and also observed significant improvements in hemoglobin (9.36 (8.55, 9.74) to 12.03 (11.49, 12.72)) g\/dL, hematocrit (29.93 \u00b1 2.87 to 33.71 \u00b1 3.69) %, MCV (72.16 \u00b1 7.90 to 83.47 \u00b1 7.65) fL, MCH (22.44 \u00b1 3.01 to 26.77 \u00b1 3.08) pg levels from the early second to the early third trimester of pregnancy with significant difference (&lt;0.001). Increased erythropoiesis was reported by a higher reticulocyte hemoglobin (23.30 \u00b1 3.03 to 27.84 \u00b1 3.83) pg and immature reticulocyte fractions (6.90 (4.30, 9.50) to 7.30 (4.3, 11.0)) %. Initially, iron, ferritin and TSAT levels increased but later stabilized or slightly declined towards the end of pregnancy. Conclusions: Daily IFAS in moderately anemic pregnant women improved the trajectory of iron parameters, with peak gains in early third trimester. High adherence via counselling supports targeted monitoring and trimester-specific strategies to reduce maternal anemia and may improve outcomes.<\/jats:p>","DOI":"10.3390\/jcm14196787","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T12:48:28Z","timestamp":1758804508000},"page":"6787","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Trajectory of Iron and Red Cell Parameters in Moderately Anemic Iron-Deficient Pregnant Women Receiving Daily Iron\u2013Folic Acid Supplementation: A Prospective Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9015-8316","authenticated-orcid":false,"given":"J. P.","family":"Akshaykirthan","sequence":"first","affiliation":[{"name":"Department of Biochemistry, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8871-5072","authenticated-orcid":false,"given":"Manjunath S.","family":"Somannavar","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Yogeshkumar","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2901","authenticated-orcid":false,"given":"M. S.","family":"Deepthy","sequence":"additional","affiliation":[{"name":"Women\u2019s & Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1726-2798","authenticated-orcid":false,"given":"Umesh","family":"Charantimath","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1976-2606","authenticated-orcid":false,"given":"Amaresh","family":"Patil","sequence":"additional","affiliation":[{"name":"Women\u2019s & Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrutyunjaya B.","family":"Bellad","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Derman","sequence":"additional","affiliation":[{"name":"Department of Global Affairs, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8680-7053","authenticated-orcid":false,"given":"Shivaprasad S.","family":"Goudar","sequence":"additional","affiliation":[{"name":"Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi 590010, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2001). Iron Deficiency Anemia: Assessment, Prevention, and Control, A Guide for Programme Managers."},{"key":"ref_2","unstructured":"Ministry of Health & Family Welfare Government of India (2025, March 28). National Family Health Survey 5, Available online: https:\/\/dhsprogram.com\/publications\/publication-OF43-Other-Fact-Sheets.cfm."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1567S","DOI":"10.3945\/ajcn.117.155812","article-title":"Iron Homeostasis during Pregnancy","volume":"106","author":"Fisher","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_4","first-page":"1","article-title":"Hematologic Problems in the Newborn","volume":"4","author":"Fa","year":"1982","journal-title":"Major Probl. Clin. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1017\/S0029665113003637","article-title":"Iron Deficiency during Pregnancy: The Consequences for Placental Function and Fetal Outcome","volume":"73","author":"McArdle","year":"2013","journal-title":"Proc. Nutr. Soc."},{"key":"ref_6","unstructured":"Brittenham, G. (2018). Disorders of iron metabolism: Iron deficiency and overload. Hematology: Basic Principles and Practice, Elsevier. [7th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100865","DOI":"10.1016\/j.mam.2020.100865","article-title":"Oral Iron Supplementation in Iron-Deficient Women: How Much and How Often?","volume":"75","author":"Stoffel","year":"2020","journal-title":"Mol. Asp. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1002\/ijgo.14949","article-title":"Optimizing Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Women and Girls of Reproductive Age: Clinical Opinion","volume":"162","author":"Auerbach","year":"2023","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Pe\u00f1a-Rosas, J.P., De-Regil, L.M., Garcia-Casal, M.N., and Dowswell, T. (2015). Daily Oral Iron Supplementation during Pregnancy. Cochrane Database Syst. Rev., 7.","DOI":"10.1002\/14651858.CD004736.pub5"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1186\/s13063-021-05549-2","article-title":"RAPIDIRON: Reducing Anaemia in Pregnancy in India\u2014A 3-Arm, Randomized-Controlled Trial Comparing the Effectiveness of Oral Iron with Single-Dose Intravenous Iron in the Treatment of Iron Deficiency Anaemia in Pregnant Women and Reducing Low Birth Weight Deliveries","volume":"22","author":"Derman","year":"2021","journal-title":"Trials"},{"key":"ref_11","unstructured":"(2025, March 29). Anemia Mukt Bharat. Available online: https:\/\/anemiamuktbharat.info\/programme\/interventions#link-1."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Beressa, G., Lencha, B., Bosha, T., and Egata, G. (2022). Utilization and Compliance with Iron Supplementation and Predictors among Pregnant Women in Southeast Ethiopia. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-20614-9"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Molla, T., Guadu, T., Muhammad, E.A., and Hunegnaw, M.T. (2019). Factors Associated with Adherence to Iron Folate Supplementation among Pregnant Women in West Dembia District, Northwest Ethiopia: A Cross Sectional Study. BMC Res. Notes, 12.","DOI":"10.1186\/s13104-019-4045-2"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Haruna, S., Patience Kanyiri, G., and Mogre, V. (2024). Adherence to Iron and Folic Acid Supplementation among Pregnant Women from Northern Ghana. Nutr. Metab. Insights, 17.","DOI":"10.1177\/11786388231218664"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5205","DOI":"10.4103\/jfmpc.jfmpc_721_20","article-title":"Adherence to Iron and Folic Acid Supplementation among Antenatal Mothers Attending a Tertiary Care Center, Puducherry: A Mixed-Methods Study","volume":"9","author":"Jayalakshmy","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_16","first-page":"5863737","article-title":"Adherence to Iron and Folic Acid Supplement and Its Associated Factors among Antenatal Care Attendant Mothers in Lay Armachiho Health Centers, Northwest, Ethiopia, 2017","volume":"1","author":"Agegnehu","year":"2019","journal-title":"Int. J. Reprod. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"608","DOI":"10.4103\/1119-3077.141427","article-title":"Determinants of Compliance to Iron Supplementation among Pregnant Women in Enugu, Southeastern Nigeria","volume":"17","author":"Ugwu","year":"2014","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1080\/01443610902984961","article-title":"Compliance to Iron Supplementation during Pregnancy","volume":"29","author":"Habib","year":"2009","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1182\/blood-2015-05-642223","article-title":"Oral Iron Supplements Increase Hepcidin and Decrease Iron Absorption from Daily or Twice-Daily Doses in Iron-Depleted Young Women","volume":"126","author":"Moretti","year":"2015","journal-title":"Blood"},{"key":"ref_20","first-page":"54712","article-title":"Haematological Indices in Pregnancy and Puerperium","volume":"9","author":"Oshodi","year":"2017","journal-title":"Int. J. Curr. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1136\/jcp.31.5.493","article-title":"High Mean Red Cell Volume: Its Incidence and Significance in Routine Haematology","volume":"31","author":"Davidson","year":"1978","journal-title":"J. Clin. Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s12288-012-0175-6","article-title":"Physiological Changes in Hematological Parameters during Pregnancy","volume":"28","author":"Chandra","year":"2012","journal-title":"Indian J. Hematol. Blood Transfus."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/1746-1596-7-168","article-title":"Red Blood Cell Distribution Width and Iron Deficiency Anemia among Pregnant Sudanese Women","volume":"7","author":"Abdelrahman","year":"2012","journal-title":"Diagn. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Pe\u00f1a-Rosas, J.P., De-Regil, L.M., Gomez Malave, H., Flores-Urrutia, M.C., and Dowswell, T. (2015). Intermittent Oral Iron Supplementation during Pregnancy. Cochrane Database Syst. Rev., 10.","DOI":"10.1002\/14651858.CD009997.pub2"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/cyto.990220107","article-title":"Flow Cytometric Reticulocyte Maturity Index: A Useful Laboratory Parameter of Erythropoietic Activity in Anemia","volume":"22","author":"Davis","year":"1995","journal-title":"Cytometry"},{"key":"ref_26","first-page":"14","article-title":"Reticulocyte Hemoglobin vis-\u00e0-vis Immature Reticulocyte Fraction, as the Earliest Indicator of Response to Therapy in Iron Deficiency Anemia","volume":"65","author":"Mehta","year":"2017","journal-title":"J. Assoc. Physicians India"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1182\/blood.V99.4.1489","article-title":"Clinical Utility of the Reticulocyte Hemoglobin Content in the Diagnosis of Iron Deficiency","volume":"99","author":"Mast","year":"2002","journal-title":"Blood"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/7345835","article-title":"Absolute Reticulocyte Count and Reticulocyte Hemoglobin Content as Predictors of Early Response to Exclusive Oral Iron in Children with Iron Deficiency Anemia","volume":"1","author":"Parodi","year":"2016","journal-title":"Anemia"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Noshiro, K., Umazume, T., Hattori, R., Kataoka, S., Yamada, T., and Watari, H. (2022). Hemoglobin Concentration during Early Pregnancy as an Accurate Predictor of Anemia during Late Pregnancy. Nutrients, 14.","DOI":"10.3390\/nu14040839"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/S0271-5317(02)00437-2","article-title":"A Cross Sectional Study of Maternal Iron Status of Korean Women during Pregnancy","volume":"22","author":"Lee","year":"2002","journal-title":"Nutr. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1007\/s00277-023-05481-2","article-title":"Pathophysiology and Management of Iron Deficiency Anaemia in Pregnancy: A Review","volume":"103","author":"Kirthan","year":"2023","journal-title":"Ann. Hematol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1093\/ajcn\/54.6.1077","article-title":"Serum Transferrin Receptor for the Detection of Iron Deficiency in Pregnancy","volume":"54","author":"Carriaga","year":"1991","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1146\/annurev-nutr-061021-030404","article-title":"Iron Homeostasis during Pregnancy: Maternal, Placental, and Fetal Regulatory Mechanisms","volume":"43","author":"Sangkhae","year":"2023","journal-title":"Annu. Rev. Nutr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6787\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:49:40Z","timestamp":1760035780000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":33,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196787"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196787","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]}}}