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Effects of routine oral iron supplementation with or without folic acid for women during pregnancy.
Cochrane Database Syst Rev 2006; (3):CD004736CD

Abstract

BACKGROUND

It has been suggested that routine intake of supplements containing iron or combination of iron and folic acid during pregnancy improves maternal health and pregnancy outcomes.

OBJECTIVES

To assess the efficacy, effectiveness and safety of routine antenatal daily or intermittent iron supplementation with or without folic acid during pregnancy on the health of mothers and newborns.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2005). Additionally, we contacted relevant organizations for the identification of ongoing and unpublished studies.

SELECTION CRITERIA

All randomised or quasi-randomised trials evaluating the effect of routine supplementation with iron or combination of iron and folic acid during pregnancy.

DATA COLLECTION AND ANALYSIS

We assessed trials for methodological quality using the standard Cochrane criteria. Two authors independently assessed the trials for inclusion and one author extracted data. We collected information on randomisation method, allocation concealment, blinding and loss to follow up. The primary outcomes included maternal and infant clinical and laboratory outcomes.

MAIN RESULTS

Forty trials, involving 12706 women, were included in the review. Overall, the results showed significant heterogeneity across most prespecified outcomes. Heterogeneity could not be explained by standard sensitivity analyses including quality assessment; therefore, all results were analysed assuming random-effects. Very limited information related to clinical maternal and infant outcomes was available in the included trials. The data suggest that daily antenatal iron supplementation increases haemoglobin levels in maternal blood both antenatally and postnatally. It is difficult to quantify this increase due to significant heterogeneity between the studies. Women who receive daily antenatal iron supplementation are less likely to have iron deficiency and iron-deficiency anaemia at term as defined by current cut-off values. Side-effects and haemoconcentration are more common in women who receive daily iron supplementation. No differences were evident between daily and weekly supplementation with regards to gestational anaemia; haemoconcentration during pregnancy appears less frequent with the weekly regimen. The clinical significance of hemoconcentration defined as haemoglobin greater than 130 g/L remains uncertain.

AUTHORS' CONCLUSIONS

Further studies are needed to assess the effects of routine antenatal supplementation with iron or a combination of iron and folic acid on clinically important maternal and infant outcomes.

Authors+Show Affiliations

U.S. Centers for Disease Control and Prevention (CDC), International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), 4770 Buford Highway MS K25, Atlanta, GA 30341, USA. jpenarosas@cdc.govNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

16856058

Citation

Pena-Rosas, J P., and F E. Viteri. "Effects of Routine Oral Iron Supplementation With or Without Folic Acid for Women During Pregnancy." The Cochrane Database of Systematic Reviews, 2006, p. CD004736.
Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. Cochrane Database Syst Rev. 2006.
Pena-Rosas, J. P., & Viteri, F. E. (2006). Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. The Cochrane Database of Systematic Reviews, (3), p. CD004736.
Pena-Rosas JP, Viteri FE. Effects of Routine Oral Iron Supplementation With or Without Folic Acid for Women During Pregnancy. Cochrane Database Syst Rev. 2006 Jul 19;(3)CD004736. PubMed PMID: 16856058.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. AU - Pena-Rosas,J P, AU - Viteri,F E, Y1 - 2006/07/19/ PY - 2006/7/21/pubmed PY - 2006/10/17/medline PY - 2006/7/21/entrez SP - CD004736 EP - CD004736 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: It has been suggested that routine intake of supplements containing iron or combination of iron and folic acid during pregnancy improves maternal health and pregnancy outcomes. OBJECTIVES: To assess the efficacy, effectiveness and safety of routine antenatal daily or intermittent iron supplementation with or without folic acid during pregnancy on the health of mothers and newborns. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2005). Additionally, we contacted relevant organizations for the identification of ongoing and unpublished studies. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating the effect of routine supplementation with iron or combination of iron and folic acid during pregnancy. DATA COLLECTION AND ANALYSIS: We assessed trials for methodological quality using the standard Cochrane criteria. Two authors independently assessed the trials for inclusion and one author extracted data. We collected information on randomisation method, allocation concealment, blinding and loss to follow up. The primary outcomes included maternal and infant clinical and laboratory outcomes. MAIN RESULTS: Forty trials, involving 12706 women, were included in the review. Overall, the results showed significant heterogeneity across most prespecified outcomes. Heterogeneity could not be explained by standard sensitivity analyses including quality assessment; therefore, all results were analysed assuming random-effects. Very limited information related to clinical maternal and infant outcomes was available in the included trials. The data suggest that daily antenatal iron supplementation increases haemoglobin levels in maternal blood both antenatally and postnatally. It is difficult to quantify this increase due to significant heterogeneity between the studies. Women who receive daily antenatal iron supplementation are less likely to have iron deficiency and iron-deficiency anaemia at term as defined by current cut-off values. Side-effects and haemoconcentration are more common in women who receive daily iron supplementation. No differences were evident between daily and weekly supplementation with regards to gestational anaemia; haemoconcentration during pregnancy appears less frequent with the weekly regimen. The clinical significance of hemoconcentration defined as haemoglobin greater than 130 g/L remains uncertain. AUTHORS' CONCLUSIONS: Further studies are needed to assess the effects of routine antenatal supplementation with iron or a combination of iron and folic acid on clinically important maternal and infant outcomes. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/16856058/Effects_of_routine_oral_iron_supplementation_with_or_without_folic_acid_for_women_during_pregnancy_ L2 - https://doi.org/10.1002/14651858.CD004736.pub2 DB - PRIME DP - Unbound Medicine ER -