A 28-year-old multigravida (G3P2) from urban Delhi attends the antenatal clinic at 20 weeks of gestation. She has completed 2 doses of tetanus toxoid in her previous pregnancies. On routine examination, her blood pressure is 118/76 mmHg, weight 62 kg (pre-pregnancy 60 kg), and urine dipstick is normal. Haemoglobin is 10.5 g/dL. She is counselled about the antenatal care package and advised on iron supplementation. According to the current NRHM guidelines for antenatal care, what is the recommended iron supplementation regimen for this patient?

Explanation

## Iron Supplementation in Antenatal Care — NRHM Guidelines **Key Point:** All pregnant women in India are recommended universal iron supplementation as per NRHM guidelines, irrespective of baseline haemoglobin level, to prevent anaemia and its maternal and fetal complications. ### Iron Supplementation Regimen (NRHM Standard) | Parameter | Recommendation | | --- | --- | | **Dose** | 100 mg elemental iron daily | | **Start** | As early as possible, ideally from first trimester (or from second trimester at latest) | | **Duration** | Until **3 months postpartum** | | **Form** | Iron salt (ferrous sulphate 325 mg or ferrous fumarate 200 mg) | | **Timing** | On empty stomach (morning) for better absorption; with vitamin C if tolerated | | **Folic acid** | 500 mcg daily (combined tablet available) | **High-Yield:** The key distinguishing feature is **continuation for 3 months postpartum**, not just until delivery. This is critical because: 1. **Postpartum blood loss** (500–1000 mL in vaginal delivery) depletes iron stores 2. **Lactation** increases iron demand 3. **Postpartum anaemia prevention** reduces maternal morbidity and improves recovery ### Why 100 mg Elemental Iron? - Provides **30–60 mg absorbed iron daily** (accounting for ~30% absorption) - Sufficient to prevent anaemia in most pregnant women - Allows for increased iron demands of pregnancy (500 mg additional iron needed over 9 months) **Clinical Pearl:** Even though this patient's Hb is 10.5 g/dL (mild anaemia), the standard regimen remains 100 mg daily. Severe anaemia (Hb <7 g/dL) or iron deficiency anaemia may require higher doses or parenteral iron, but this is not the case here. **Mnemonic:** **ICP** = **I**ron **C**ontinued **P**ostpartum (3 months) — remember this to avoid the trap of stopping iron at delivery. **Warning:** Do not confuse: - ~~60 mg elemental iron~~ (this is a lower dose sometimes used in non-pregnant populations or for mild deficiency) - ~~Iron only until delivery~~ (postpartum continuation is mandatory per NRHM) - ~~First trimester start only~~ (while ideal, second trimester start is acceptable if first trimester was missed)