A Comparative Assessment of the Effectiveness of Iron-Folic Acid and Multiple Micronutrient Supplements on Heamoglobin and Related Blood Indices among Pregnant Women in Nasarawa State, Nigeria

Abstract

Anemia in pregnancy is one of the most persistent nutritional challenges in low and middle-income countries. Debate concerning optimal supplementation strategy, either Iron Folic Acid (IFA) or Multiple Micronutrient Supplement (MMS) is critical for policy-making. This study is a quasi-experimental designed to compare the effects of IFA and MMS on heamoglobin and related blood indices among pregnant women in Nasarawa State, Nigeria. The study was conducted in three Primary Healthcare (PHC) facilities and community in Nasarawa State from July to October 2024. Thirty-six women, in their second trimester, were enrolled from the health facilities and assigned into three groups: IFA (n = 13), MMS (n = 13), and control group (n = 10). Interventions lasted for three months. Blood samples were taken at baseline and end line to assess Heamoglobin (HB), Red Blood Cells (RBC), Packed Cell Volume (PCV), Serum Iron, Ferritin, and White Blood Cell (WBC) Differentials. A quantitative immunoassay analyzer was used to measure HB concentration and WBC differentials. Serum iron concentration was determined using a fully automated chemistry analyzer with the ferrozine colorimetric method, and serum ferritin concentration was measured using the iCHROMATM ii analyzer. Results showed that IFA significantly improved HB (9.82 ± 0.68 to 10.93 ± 1.30 g/dl, P = .01) and RBC counts, P = .02 (3.80 ± 0.55 to 4.38 ± 0.57 ×10^12/L) while MMS showed no significant HB improvement but led to increased lymphocytes (32.53 ± 8.42 to 39.61 ± 8.87%) while neutrophils reduced from 63.00 ± 7.65 to 55.69 ± 9.01(%). In the control group, ferritin rose unexpectedly (30.89 ± 6.46 to 67.07 ± 29.88 ng/ml), though other parameters remained stable. In conclusion, IFA was more effective in improving anemia-related indices, while MMS conferred modest immunological benefits. These findings reaffirm the central role of IFA in antenatal care but also point to a potential complementary role for MMS in supporting maternal immune health.