A Community-Based Trial on The Comparison of Efficacy, Safety and Cost Effectiveness of Ferrous Sulphate and Ferrous Ascorbate for Anaemia in Pregnancy In Madhya Pradesh, India


  • Manju Toppo Gandhi Medical College, Bhopal, India
  • Jeewan S Meena Gandhi Medical College, Bhopal, India
  • Devendra Gour Gandhi Medical College, Bhopal, India
  • Mugdha Kamble Gandhi Medical College, Bhopal, India
  • Keerthana S Gandhi Medical College, Bhopal, India
  • Ankit Chandak Gandhi Medical College, Bhopal, India
  • Sarjan Singh Gandhi Medical College, Bhopal, India
  • Nainshree Bhunjiya Gandhi Medical College, Bhopal, India
  • Ravindra Singh Norway India Partnership Initiative, Maternal Health, National Health Mission, Bhopal, India




Ferrous ascorbate, Ferrous sulphate, Oral iron supplementation, Antenatal mothers, Cost effective analysis


Background: Anaemia has significant impact on health of the fetus as well as that of mother. Increased need of iron during pregnancy especially after 2nd trimester makes iron supplementation mandatory. Ferrous ascorbate is known to exist intact inside the gastrointestinal tract due to the stable chelation of iron with ascorbate. This compound does not dissociate due to any of the food inhibitors. The aim is to study the effectiveness of Ferrous Ascorbate and Ferrous sulphate in terms of compliance and cost effectiveness of management of anaemia in pregnancy.

Methodology: Study design: Quasi Experimental study, Study area: District Vidisha, Study participants: Pregnant women of first trimester registered during the study period in the selected Anganwadis/ Gram Arogya Kendra (GAK), Sample size: 240 antenatal mothers.

Results: Baseline mean haemoglobin was 11.31±1.05 gm/dl. The mean increase in Ferrous Sulphate was 0.55 gm/dl, and in Ferrous ascorbate was 1.27 gm/dl. Ferrous Sulphate was less compliant than Ferrous ascorbate, and has higher efficacy and lesser side effects. Only Rs. 10.2 additional cost per antenatal mothers for increase of ≥1gm% in Hb will be borne by government if Ferrous Sulphate is replaced by Ferrous Ascorbate.

Conclusions: Study results show statistically significant difference in rise of haemoglobin amongst the antenatal mothers consuming Ferrous ascorbate over Ferrous Sulphate.


Saha L, Pandhi P, Gopalan S, Malhotra S, Saha PK. Comparison of efficacy, tolerability, and cost of iron polymaltose complex with Fer-rous sulphate in the treatment of iron deficiency anemia in pregnant women. MedGenMed Medscape Gen Med. 2007 Jan 2;9(1):1.

Antenatal iron supplementation [Internet]. [cited 2023 Feb 7]. Available from: https://www.who.int/data/nutrition/nlis/info/antenatal-iron-supplementation

World Health Organization. Guideline: daily iron and folic acid supplementation in pregnant women [Internet]. Geneva: World Health Organization; 2012 [cited 2023 Feb 7]. Available from: https://apps.who.int/iris/handle/10665/77770

World Health Organization. Guideline: Intermittent iron and folic acid supplementation in non-anaemic pregnant women [Internet]. Geneva: World Health Organization; 2011 [cited 2023 Feb 7]. Available from: https://apps.who.int/iris/handle/10665/75335

Global nutrition monitoring framework: operational guidance for tracking progress in meeting targets for 2025 [Internet]. [cited 2023 Feb 7]. Available from: https://www.who.int/publications-detail-redirect/9789241513609

Iron Deficiency and Other Hypoproliferative Anemias | Harrison's Principles of Internal Medicine, 21e | AccessMedicine | McGraw Hill Medical [Internet]. [cited 2023 Feb 6]. Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=3095&sectionid=263547538

Santiago P. Ferrous versus ferric oral iron formulations for the treatment of iron deficiency: a clinical overview. Sci World J. 2012;2012. Doi: https://doi.org/10.1100/2012/846824 PMid:22654638 PMCid:PMC3354642

I B, H D, Ma E, I A, E K, I K. Evaluation of ferric and Ferrous iron therapies in women with iron deficiency anemia. Adv Hematol [In-ternet]. 2014 [cited 2023 Feb 7];2014. Available from: https://pubmed.ncbi.nlm.nih.gov/25006339/

[cited 2023 Feb 7]. Available from: http://pharmaceuticalcompanyindia.in/advantages-of-Ferrous-ascorbate-on-other-forms-of-iron-salts/

Ganguly S, Dewan B, Philipose N, Samanta T, Paul DK, Purkait R. Comparison between Ferrous Ascorbate and Colloidal Iron in the Treatment of Iron Deficiency Anemia in Children from Kolkata, India. J Adv Med Med Res. 2012 Mar 14;195-205. Doi: https://doi.org/10.9734/BJMMR/2012/900

Final Compendium of fact sheets_India and 14 States_UTs (Phase-II).pdf [Internet]. [cited 2023 Feb 7]. Available from: http://rchiips.org/nfhs/NFHS-5_FCTS/Final%20Compendium%20of%20fact%20sheets_India%20and%2014%20States_UTs%20(Phase-II).pdf#toolbar=0&navpanes=0

MadhyaPradesh.pdf [Internet]. [cited 2023 Feb 7]. Available from: http://rchiips.org/nfhs/NFHS-4Reports/MadhyaPradesh.pdf

Edlin R, Round J, Hulme C, McCabe C. Cost-effectiveness analysis and efficient use of the pharmaceutical budget: the key role of clini-cal pharmacologists. Br J Clin Pharmacol. 2010 Sep;70(3):350. Doi: https://doi.org/10.1111/j.1365-2125.2010.03617.x PMid:20716234 PMCid:PMC2949906

Cost-Effectiveness Analysis | POLARIS | Policy and Strategy | CDC [Internet]. 2021 [cited 2023 Feb 7]. Available from: https://www.cdc.gov/policy/polaris/economics/cost-effectiveness/index.html

Rakanita Y, Syamsunarno MRAA, Sinuraya RK, Suradji EW, Abdulah R, Suwantika AA. Cost-Effectiveness of Ferrous Fumarate-Folic Acid and Ferrous Gluconate-Multivitamins in a High Prevalence Area of Iron Deficiency Anemia in Indonesia. Ther Clin Risk Manag. 2021;17:1075-81. Doi: https://doi.org/10.2147/TCRM.S328226 PMid:34629872 PMCid:PMC8493107

Gafni A, Birch S. Incremental cost-effectiveness ratios (ICERs): The silence of the lambda. Soc Sci Med. 2006 May 1;62(9):2091-100. Doi: https://doi.org/10.1016/j.socscimed.2005.10.023 PMid:16325975

Drug and Therapeutics Committee Training Course. Session1: Drug and Therapeutics Committee- Overview. Participants Guide. Ra-tional Pharmaceutical Management Plus Program; 2001

Eesha A, Yogita K, Manju T, Girija W, Vijaya P. Pharmacoeconomic evaluation of Ferrous ascorbate, Ferrous fumarate and iron poly-maltose complex in 14 to 24 weeks of gestation. Inte J Health Sci Res. 2015;5(11):339-44.

Mistry N, Joshi H, Sood S, Shah S, Malhotra S. Efficacy and tolerability of Ferrous sulphate vs iron peptone+ Ferrous ascorbate in pregnancy: An observational study. Natl J Integr Res Med. 2018;9(5).

Kriplani A, Pal B, Bhat V, Swami O. Ferrous Ascorbate: Current Clinical Place of Therapy in the Management of Iron Deficiency Ane-mia. J South Asian Fed Obstet Gynaecol. 2021 Sep 9;13(3):103-9. Doi: https://doi.org/10.5005/jp-journals-10006-1896

Langstaff RJ, Geisser P, Heil WG, Bowdler JM. Treatment of iron-deficiency anaemia: a lower incidence of adverse effects with Fer-rum Hausmann than Ferrous sulphate. Br J Clin Res. 1993;4.

Tolkien Z, Stecher L, Mander AP, Pereira DIA, Powell JJ. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PloS One. 2015;10(2):e0117383. Doi: https://doi.org/10.1371/journal.pone.0117383 PMid:25700159 PMCid:PMC4336293

Habib F, Alabdin EHZ, Alenazy M, Nooh R. Compliance to iron supplementation during pregnancy. J Obstet Gynaecol J Inst Obstet Gynaecol. 2009 Aug;29(6):487-92. Doi: https://doi.org/10.1080/01443610902984961 PMid:19697194

Panchal PJ, Desai MK, Shah SP, Solanki MN. Evaluation of efficacy, safety and cost of oral and parenteral iron preparations in patients with iron deficiency anemia. J Appl Pharm Sci. 2015;5(3):066-72. Doi: https://doi.org/10.7324/JAPS.2015.50311

Murugesan S. Comparative study on efficacy, tolerability, and cost of different iron supplements among antenatal women with iron-deficiency anemia. 2022;13(04). Doi: https://doi.org/10.5455/njppp.2023.13.09427202218092022




How to Cite

Manju Toppo, Meena JS, Gour D, Kamble M, Keerthana S, Ankit Chandak, Sarjan Singh, Bhunjiya N, Ravindra Singh. A Community-Based Trial on The Comparison of Efficacy, Safety and Cost Effectiveness of Ferrous Sulphate and Ferrous Ascorbate for Anaemia in Pregnancy In Madhya Pradesh, India. Natl J Community Med [Internet]. 2023 Feb. 28 [cited 2023 Mar. 25];14(02):74-81. Available from: https://njcmindia.com/index.php/file/article/view/2583



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