ASHA ShikshaGuide
Anaemia in pregnancy: IFA tablets, diet and when to refer
How anaemia harms mother and baby, the correct use of IFA and calcium tablets, how to reduce side effects, and the haemoglobin levels that need referral.
Anaemia means there is too little haemoglobin in the blood to carry oxygen. Many women in India are anaemic even before they become pregnant. In pregnancy, anaemia makes the mother tired and breathless, increases the risk of heavy bleeding and death at delivery, and leads to babies who are born early or small. Most anaemia can be prevented and treated with iron tablets, good food and timely check-ups.
How anaemia is measured
The ANM or doctor tests haemoglobin (Hb) at every antenatal check-up. For a pregnant woman:
- Hb 11 g/dl or more: normal.
- Hb 10 to 10.9: mild anaemia.
- Hb 7 to 9.9: moderate anaemia.
- Hb below 7: severe anaemia – she must be treated in a hospital.
Signs you can see
Pale inside of the lower eyelids, pale tongue, palms and nails, tiredness, breathlessness on small effort, fast heartbeat and swelling of the feet. Very pale women and those who are breathless at rest need urgent referral.
Tablets every pregnant woman needs
- Folic acid tablet daily in the first three months. It prevents birth defects of the baby's brain and spine.
- From the 4th month: one IFA (iron and folic acid) tablet daily for at least 180 days in pregnancy, and continue for 180 days after delivery.
- Two calcium tablets daily from the 4th month, taken at a different time from the IFA tablet.
- One albendazole (deworming) tablet in the second trimester.
If she has anaemia, the doctor may increase the iron dose or give iron through an injection or drip. Help her follow the doctor's advice and get her Hb checked again.
Help her take IFA every day
Many women stop iron tablets because of side effects or because they forget. Teach them these tips:
- Take the tablet after a meal or at bedtime to reduce nausea.
- Take it with lemon water, amla or a fruit; vitamin C helps the body absorb iron.
- Do not take it with tea, coffee, milk or the calcium tablet; keep a gap of at least one to two hours.
- Black stools are normal with iron tablets and are not harmful.
- For constipation, drink more water and eat vegetables, fruits and whole grains.
- Keep the tablets in a place she sees every day, and ask a family member to remind her.
Ask to see the strip at every visit and count the tablets taken. Praise her when she is regular.
Food that builds blood
- Green leafy vegetables such as spinach, methi and drumstick leaves
- Pulses, chana, rajma, soya and sprouts
- Eggs, fish and meat if she eats them
- Fruits rich in vitamin C such as amla, guava, lemon and orange
- One extra meal a day during pregnancy
Cooking in an iron kadhai and eating vitamin C foods with meals also help. Food alone cannot correct anaemia in pregnancy, so tablets are still needed.
Other family members
Under Anemia Mukt Bharat, adolescents take one blue IFA tablet every week, children aged 5 to 9 take one pink IFA tablet every week, and young children receive IFA syrup twice a week. Women of reproductive age, pregnant women and breastfeeding mothers receive red IFA tablets. Deworming tablets are given every six months on National Deworming Day.
Refer at once if a pregnant woman has Hb below 7, is breathless at rest, has chest pain, or faints. Severe anaemia is dangerous at delivery.
Common questions
Is it safe to take iron tablets during pregnancy?
Yes. IFA tablets are safe and are needed for the mother and the baby. The dose given by the health system is correct.
She feels sick with the tablet. Can she stop?
She should not stop. Taking it after dinner or at bedtime usually helps. If nausea continues, she should talk to the ANM.
Is jaggery or pomegranate enough instead of tablets?
No. They are good foods, but they do not contain enough iron to treat or prevent anaemia in pregnancy.
Sources: Anemia Mukt Bharat operational guidelines (MoHFW); MoHFW antenatal care guidelines; NHM ASHA training modules; MCP card.