Boiled egg supplementation as an adjunct to iron–folic acid therapy for hemoglobin improvement in pregnant women with mild anemia: a randomized controlled study

Abstract

Background. Anemia in pregnancy is a common public-health problem, and iron deficiency is its leading cause. Standard care in Indonesia is daily iron–folic acid (IFA) supplementation, but hemoglobin recovery is often incomplete, and the added value of iron-rich animal-source foods over IFA alone has rarely been quantified with a control group. Objective. To measure the additional effect of two boiled chicken eggs per day, given together with standard IFA supplementation, on hemoglobin levels in pregnant women with mild anemia, compared with IFA supplementation alone. Methods. A randomized controlled quasi-experimental study and weekly repeated measurements were conducted over 21 days in Sewaka Village, Pemalang District, Central Java, Indonesia. From a source population of 65 pregnant women with mild anemia at 29–36 weeks of gestation, 34 were enrolled by purposive sampling and randomly allocated to two groups of 17. The intervention group received two boiled eggs (~100 g) daily plus IFA (60 mg elemental iron and 400 μg folic acid); the control group received the same IFA regimen without eggs. Capillary hemoglobin was measured with an Easy Touch GCHb analyzer at days 0, 7, 14, and 21. The primary analysis was the between-group difference in hemoglobin change from baseline to day 21, tested with an independent-samples t-test. Results. Baseline hemoglobin was comparable between groups (intervention 9.70 ± 0.40 g/dL; control 9.69 ± 0.41 g/dL). By day 21, hemoglobin reached 12.00 ± 0.45 g/dL in the intervention group and 11.50 ± 0.46 g/dL in the control group. Both groups improved significantly from baseline (both p < 0.001): +2.30 g/dL (95% CI 2.13 to 2.47) in the intervention group and +1.81 g/dL (95% CI 1.52 to 2.10) in the control group. The between-group difference in hemoglobin change was 0.49 g/dL (95% CI 0.17 to 0.81; t(32) = 3.10; p = 0.004; Cohen's d = 1.06), favoring egg supplementation. The gap between groups widened progressively (0.10, 0.30, and 0.50 g/dL at days 7, 14, and 21). Conclusion. Adding two boiled eggs daily to standard iron–folic acid supplementation produced a significantly larger hemoglobin increase than supplementation alone over 21 days, with a large effect size. Boiled eggs are an inexpensive, locally available food that can support anemia management in pregnancy alongside routine supplementation.