Severe anaemia in pregnancy is rising: How a single-dose IV iron drip is a game changer

The transformative effect of IV iron

Although IV iron has been available under the government’s Anaemia Mukt Bharat programme, it required women to come back multiple times to get their drips. “But now women only need a single infusion of the new Ferric Carboxymaltose (FCM) supplement, which leads to better outcomes for both mother and child,” Dr Mehta adds.

Rajasthan is one of the few states that has introduced the new IV supplement under the national programme. “After a study across two districts in Rajasthan showed that FCM was very effective in correcting anaemia in pregnant mothers, we launched a pilot in the first half of December,” says Dr Amit Yadav, director, National Health Mission-Rajasthan.

Just like Rajasthan, Karnataka has also started rolling out IV FCM across 31 districts for pregnant women with moderate to severe anaemia. In an allied move, the government has launched a digital Garbha Sutra application to calculate the correct IV FCM dosage based on haemoglobin levels and body weight. IV iron supplementation — be it the new IV FCM or the older formulation — is required for mothers with severe anaemia or with haemoglobin levels of 5-6.9 g/dL at 13-34 weeks of pregnancy and 5-7.9 g/dL during lactation. Women with moderate anaemia need it only when oral iron is not tolerated or fails to improve iron levels. “The single dose IV FCM is especially effective for women in late stages of pregnancy whom we cannot send back with tablets to assess whether it improves the haemoglobin levels before delivery,” says Dr Mehta.

Cheaper alternatives

Importantly, it has become possible for states to bring in the IV FCM into their programmes because it came off patent in 2023. “Now, there are cheaper versions available. Earlier, IV FCM used to cost around Rs 2,300, which is expensive for a public health programme. Now, there are formulations available for as low as Rs 170, making it feasible,” says Dr Yadav. The IV FCM cannot be given to those whose anaemia is not caused by iron deficiency, who have liver disorders such as jaundice and cirrhosis, and who live with acute cardiac failure, thalassaemia or sickle cell disease.

An increase in the anaemia burden was noted despite the efforts during the last round of National Family Health Survey for which data was collected between 2019 and 2021. The survey found that in children between the ages of 6 and 59 months anaemia increased to 67.1% from 58.6% in the previous round of survey conducted in 2015-16. In women between the ages of 15 and 49 years, it increased to 57% from 53.1% and in pregnant women it went up to 52.2% from 50.4%.