Effect of routine iron supplementation with or without folic acid on anemia during pregnancy

Effect of routine iron supplementation with or without folic acid on anemia during pregnancy

Iron deficiency is the most prevalent nutrient deficiency in the world, particularly during pregnancy. According to the literature, anaemia, particularly severe anaemia, is associated with increased risk of maternal mortality. It also puts mothers at risk of multiple perinatal complications. Numerous studies in the past have evaluated the impact of supplementation with iron and iron-folate but data regarding the efficacy and quality of evidence of these interventions are lacking. This article aims to address the impact of iron with and without folate supplementation on maternal anaemia and provides outcome specific quality according to the Child Health Epidemiology Reference Group (CHERG) guidelines.

After screening 3550 titles, 31 studies were selected for assessment using CHERG criteria. Daily iron supplementation results in 73% reduction in the incidence of anaemia at term (RR = 0.27; 95% CI: 0.17 – 0.42; random effects model) and 67% reduction in iron deficiency anaemia at term (RR = 0.33; 95% CI: 0.16 – 0.69; random model) compared to no intervention/placebo. For this intervention, both these outcomes are graded as ‘moderate’ quality evidence. Daily supplementation with iron-folate is associated with 73% reduction in anaemia at term (RR = 0.27; 95% CI: 0.12 – 0.56; random model) with a quality grade of ‘moderate’. The effect of the same intervention on iron deficiency anaemia is non-significant (RR = 0.43; 95% CI: 0.17 – 1.09; random model) and is graded as ‘low’ quality evidence. There is no difference in rates of anaemia at term with intermittent iron-folate vs. daily iron-folate supplementation (RR = 1.61; 95% CI: 0.82 –3.14; random model).

Applying the CHERG rules, the study recommends a 73% reduction in anaemia at term with daily iron (alone) supplementation or iron/folate (combined) vs. no intervention or placebo; for inclusion in the LiST model. Given the paucity of studies of intermittent iron or iron-folate supplementation, especially in developing countries, this study recommends further evaluation of this intervention in comparison with daily supplementation regimen.

[Adapted from author] 

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