## Iron Supplementation in Pregnancy **Key Point:** Ferrous sulfate 325 mg once daily (providing ~65 mg elemental iron) is the gold standard and first-line iron supplement recommended by WHO, ICMR, and Indian guidelines for routine antenatal care. ### Rationale for Ferrous Sulfate | Property | Ferrous Sulfate | Ferric Salts | Iron Dextran | |----------|-----------------|--------------|---------------| | **Bioavailability** | 20–30% (best among oral forms) | 5–10% (poor) | 100% (parenteral) | | **Cost** | Minimal (affordable in India) | Moderate | High | | **Route** | Oral (convenient) | Oral | IM/IV (invasive) | | **GI side effects** | Moderate (nausea, constipation) | Lower | None (parenteral) | | **First-line status** | Yes | No | Reserved for intolerance/malabsorption | **High-Yield:** The standard dose is ferrous sulfate 325 mg once daily, which provides approximately 65 mg of elemental iron. This should be started from the second trimester (16–20 weeks) in India as per ICMR guidelines, though some guidelines recommend from first trimester itself. **Clinical Pearl:** Ferrous salts are superior to ferric salts because iron in the ferrous (Fe²⁺) state is absorbed more efficiently in the proximal small intestine. Ferric (Fe³⁺) salts require reduction to ferrous form before absorption, making them less bioavailable. **Tip:** Counsel the patient to take iron on an empty stomach or with vitamin C (orange juice) to enhance absorption. Avoid concurrent calcium, tea, or coffee as they inhibit iron absorption. [cite:ICMR Guidelines on Antenatal Care, Park 26e Ch 10]
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