Become A Member

Background: Anaemia affects more than a third of pregnant women worldwide and is most common in South Asia, where iron deficiency is the predominant cause. Oral iron salts are effective but are often poorly tolerated, and adherence is low. Ayurveda describes anaemia under Pandu roga, and contemporary Ayurvedic obstetrics uses the term Garbhini pandu for anaemia in pregnancy. Iron-based herbomineral formulations, namely Lauha kalpas prepared from incinerated iron (Lauha bhasma) and Mandura kalpas prepared from processed iron oxide (Mandura bhasma), are the mainstay of treatment. Objective: To review the classical understanding of Pandu in pregnancy, the pharmaceutics of Lauha and Mandura formulations, and the clinical, experimental and safety evidence for their use in anaemia of pregnancy. Methods: Charaka Samhita and Bhaishajya Ratnavali were reviewed. PubMed was searched for systematic reviews and trials of conventional iron therapy in pregnancy and for clinical, pharmaceutical, experimental and safety studies of Ayurvedic iron formulations. Findings were synthesised narratively. Results: Systematic reviews, including a 2026 network meta-analysis of 19 randomised trials, report that several Lauha and Mandura formulations raise haemoglobin and iron indices, with Sarva-jvara-hara lauha among the most effective. A multicentre open-label study of Dhatri lauha in 400 adults showed a modest rise in haemoglobin without hepatic or renal toxicity. Evidence specific to pregnancy is limited to one small trial of Dhatri lauha and Punarnava mandura in 24 women. Rodent toxicity studies are reassuring, but heavy-metal contamination of some Ayurvedic products and isolated allergic reactions are documented. Conclusion: Lauha and Mandura formulations are plausible and partly supported haematinics, but they have not been compared with standard iron in adequately powered pregnancy trials. They should be used only as quality-tested products, alongside hemoglobin monitoring and conventional care.