In settings where anaemia in pregnant women is a severe public health problem (40% of higher), a daily dose of 60 mg of elemental iron is preferred over a lower dose.

If a woman is diagnosed with anaemia in a clinical setting, she should be treated with daily iron (120 mg of elemental iron) and folic acid (400 µg or 0.4 mg) supplementation until her haemoglobin concentration rises to normal (2, 21). She can then switch to the standard antenatal dose to prevent recurrence of anaemia.

Folic acid requirements are increased in pregnancy because of the rapidly dividing cells in the fetus and elevated urinary losses. As the neural tube closes by day 28 of pregnancy, when pregnancy may not have been detected, folic acid supplementation after the first month of pregnancy will not prevent neural tube defects. However, it will contribute to other aspects of maternal and fetal health. Give iron supplements even if folic acid is not available.

In addition to iron and folic acid, supplements may be formulated to include other vitamin and minerals according to the United Nations Multiple Micronutrient Preparation (16) to overcome other possible maternal micronutrient deficiencies.

In malaria-endemic areas, provision of iron and folic acid supplements should be implemented in conjunction with measures to prevent, diagnose and treat malaria (17–19).

An iron and folic acid supplementation programme should ideally form part of an integrated programme of antenatal and neonatal care (20, 21) that promotes adequate gestational weight gain, screening of all women for anaemia at antenatal and postpartum visits, use of complementary measures to control and prevent anaemia (e.g. hookworm control), and a referral system to manage cases of severe anaemia.

The implementation of a behaviour change communication strategy to communicate the benefits of the intervention and management of side- effects, along with provision of supplements of good quality and appropriate packaging, is vital to improving the acceptability of and adherence to recommended supplementation schemes. The strategy can also serve to promote the use of dietary diversity and intake of food combinations that improve iron absorption.

Oral supplements are available as capsules or tablets (soluble, tablets, dissolvable and modified-release tablets) (22). Establishment of a quality assurance process is important to guarantee that supplements are manufactured, packaged and stored in a controlled and uncontaminated environment (23).