Differential Iron Status and Trafficking in Blood and Placenta of Anemic and Non-anemic Primigravida Supplemented with Daily and Weekly Iron Folic Acid Tablets

  • Hari ShankarEmail author
  • Neeta Kumar
  • Rajat Sandhir
  • Sanjay Pandey
  • Saurabh Singh
  • Priyanka Verma
  • M. P. Singh
  • Tulsi Adhikari
  • Suneeta Mittal
  • D. N. RaoEmail author
Original Research Article


The molecular mechanism of iron transfer across placenta in response to maternal anemic status/ iron supplementation is not clear. We hypothesized that maternal iron/ anemia status during early trimesters can be utilized as a biomarker tool to get estimates of placental iron status. Early interventions can be envisaged to maintain optimum placental/ foetal iron levels for healthy pregnancy outcomes. One hundred twenty primigravida were recruited and divided into non-anemic and anemic group on the basis of hemoglobin levels. The groups were randomly allocated to receive daily and weekly iron folic acid (IFA) tablets till six weeks postpartum. Hematological and iron status markers in blood and placenta were studied along with the delivery notes. Weekly IFA supplementation in anemic primigravidas resulted in significantly reduced levels of hematological markers (p < 0.01); whereas non-anemic primigravidas showed lower ferritin and iron levels, and higher soluble transferrin receptor levels (p < 0.05). At baseline, C-reactive protein and cortisol hormone levels were also significantly lower in non-anemic primigravidas (p < 0.05). A significantly decreased placental ferritin expression (p < 0.05); and an increased placental transferrin expression was seen in anemic primigravidas supplemented with weekly IFA tablets. A significant positive correlation was observed between serum and placental ferritin expression in anemic pregnant women (r = 0.80; p < 0.007). Infant weight, gestational length and placental weight were comparable in both the supplementation groups. To conclude, mother’s serum iron / anemia status switches the modulation in placental iron transporter expression for delivering the optimum iron to the foetus for healthy pregnancy outcomes.

Trial Registration

Clinical Trial Registry-India: CTRI/2014/10/005135.


Iron deficiency anemia Iron folic acid supplementation Iron transport Placenta Pregnancy 



The authors are highly thankful to Mr. Santosh Kurra and Dr. Mohd. Tarique from Biochemistry department and Dr. Sandeep Mathur from Pathology department, AIIMS for their inputs in carrying out immunohistochemistry work. The authors also wish to acknowledge continuous support provided by Dr. Rohini Sehgal, Dr. Arun Kumar, Mrs. Leema Maithi and Mrs. Shobha Kandpal from HRRC, AIIMS for enrolment and follow-up of the patients.


This study was funded by Indian Council of Medical Research, New Delhi, India (grant no. 5/7/165/06-RHN and 5/7/304/08-RHN).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was obtained from the Institute Ethics Committee of All India Institute of Medical Sciences, New Delhi, India.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Association of Clinical Biochemists of India 2018

Authors and Affiliations

  • Hari Shankar
    • 1
    • 3
    • 8
    Email author
  • Neeta Kumar
    • 2
  • Rajat Sandhir
    • 3
  • Sanjay Pandey
    • 4
  • Saurabh Singh
    • 4
  • Priyanka Verma
    • 1
  • M. P. Singh
    • 5
  • Tulsi Adhikari
    • 6
  • Suneeta Mittal
    • 7
    • 9
  • D. N. Rao
    • 1
    Email author
  1. 1.Department of BiochemistryAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Division of Reproductive & Child HealthIndian Council of Medical ResearchNew DelhiIndia
  3. 3.Department of BiochemistryPanjab UniversityChandigarhIndia
  4. 4.Division of Radiation BiosciencesInstitute of Nuclear Medicine & Allied SciencesDelhiIndia
  5. 5.National Institute of Malaria Research Field UnitJabalpurIndia
  6. 6.National Institute of Medical StatisticsNew DelhiIndia
  7. 7.Department of Obstetrics and GynaecologyAll India Institute of Medical SciencesNew DelhiIndia
  8. 8.National Institute of Malaria ResearchNew DelhiIndia
  9. 9.Fortis Memorial Research InstituteGurugramIndia

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