Iron deficiency is the leading cause of anaemia during pregnancy in African settings. Pregnancy and HIV are important risk factors
for iron deficiency anaemia. The study assessed the occurrence of anaemia during pregnancy, the response to iron and folate
supplements and the associated factors. The assessment was based on quantitative retrospective data of 126 pregnant women who
attended antenatal care (ANC) between February and April 2014 in Roma, Lesotho and had haemoglobin (Hb) values taken at
first ANC visit (baseline) and at term of gestation. Forty (31.8%) women were HIV-positive and 23 (57.5%) of them were anaemic
at baseline. In total, 50 (39.5%) women had anaemia at baseline. The mean Hb at term was significantly higher (p<0.001) than
that at baseline. Overall, 26 (20.6%) women had sub-optimal Hb response to iron and folate supplements, fifty-percent of whom
were HIV-positive. Notably, 3 (2.4%) women developed anaemia while on supplements. Late first ANC visit (p=0.01), anaemia at
baseline (p<0.001) and HIV-positive status (p=0.024) were significantly associated with sub-optimal Hb response. There is need to
encourage early reporting for ANC and closely monitor women with HIV and/or anaemia at first ANC visit.