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Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy.
Cochrane Database Syst Rev 2009; (4):CD004736CD

Abstract

BACKGROUND

Intake of supplements containing iron or a combination of iron and folic acid by pregnant women may improve maternal health and pregnancy outcomes. Recently, intermittent supplementation regimens have been proposed as alternatives to daily regimens.

OBJECTIVES

To assess the effectiveness and safety of daily and intermittent use of iron or iron+folic acid supplements by pregnant women.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2009) and contacted relevant organisations for the identification of ongoing and unpublished studies.

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

We assessed the methodological quality of trials using the standard Cochrane criteria. Two authors independently assessed which trials to include in the review and one author extracted data.

MAIN RESULTS

We included 49 trials, involving 23,200 pregnant women. Overall, the results showed significant heterogeneity across most prespecified outcomes and were analysed assuming random-effects. The trials provided limited information related to clinical maternal and infant outcomes.Overall, daily iron supplementation was associated with increased haemoglobin levels in maternal blood both before and after birth and reduced risk of anaemia at term. These effects did not differ significantly between women receiving intermittent or daily iron or iron+folic acid supplementation. Women who received daily prenatal iron supplementation with or without folic acid were less likely to have iron deficiency at term as defined by current cut-off values than those who received no treatment or placebo. Side effects and haemoconcentration (a haemoglobin level greater than 130 g/L) were more common among women who received daily iron or iron+folic acid supplementation than among those who received no treatment or placebo. The risk of haemoconcentration during the second and third trimester was higher among those on a daily regimen of iron supplementation. The clinical significance of haemoconcentration remains uncertain.

AUTHORS' CONCLUSIONS

Universal prenatal supplementation with iron or iron+folic acid provided either daily or weekly is effective to prevent anaemia and iron deficiency at term. We found no evidence, however, of the significant reduction in substantive maternal and neonatal adverse clinical outcomes (low birthweight, delayed development, preterm birth, infection, postpartum haemorrhage). Associated side effects and particularly haemoconcentration during pregnancy may suggest the need for revising iron doses and schemes of supplementation during pregnancy and adjust preventive iron supplementation recommendations.

Authors+Show Affiliations

Reduction of Micronutrient Malnutrition Unit, Department of Nutrition for Health and Development, World Health Organization, 20 Avenue Appia, Geneva 27, Switzerland, 1211.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19821332

Citation

Peña-Rosas, Juan Pablo, and Fernando E. Viteri. "Effects and Safety of Preventive Oral Iron or Iron+folic Acid Supplementation for Women During Pregnancy." The Cochrane Database of Systematic Reviews, 2009, p. CD004736.
Peña-Rosas JP, Viteri FE. Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev. 2009.
Peña-Rosas, J. P., & Viteri, F. E. (2009). Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. The Cochrane Database of Systematic Reviews, (4), p. CD004736. doi:10.1002/14651858.CD004736.pub3.
Peña-Rosas JP, Viteri FE. Effects and Safety of Preventive Oral Iron or Iron+folic Acid Supplementation for Women During Pregnancy. Cochrane Database Syst Rev. 2009 Oct 7;(4)CD004736. PubMed PMID: 19821332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. AU - Peña-Rosas,Juan Pablo, AU - Viteri,Fernando E, Y1 - 2009/10/07/ PY - 2009/10/13/entrez PY - 2009/10/13/pubmed PY - 2010/1/28/medline SP - CD004736 EP - CD004736 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - BACKGROUND: Intake of supplements containing iron or a combination of iron and folic acid by pregnant women may improve maternal health and pregnancy outcomes. Recently, intermittent supplementation regimens have been proposed as alternatives to daily regimens. OBJECTIVES: To assess the effectiveness and safety of daily and intermittent use of iron or iron+folic acid supplements by pregnant women. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2009) and contacted relevant organisations for the identification of ongoing and unpublished studies. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating the effect of supplementation with iron or iron+folic acid during pregnancy. DATA COLLECTION AND ANALYSIS: We assessed the methodological quality of trials using the standard Cochrane criteria. Two authors independently assessed which trials to include in the review and one author extracted data. MAIN RESULTS: We included 49 trials, involving 23,200 pregnant women. Overall, the results showed significant heterogeneity across most prespecified outcomes and were analysed assuming random-effects. The trials provided limited information related to clinical maternal and infant outcomes.Overall, daily iron supplementation was associated with increased haemoglobin levels in maternal blood both before and after birth and reduced risk of anaemia at term. These effects did not differ significantly between women receiving intermittent or daily iron or iron+folic acid supplementation. Women who received daily prenatal iron supplementation with or without folic acid were less likely to have iron deficiency at term as defined by current cut-off values than those who received no treatment or placebo. Side effects and haemoconcentration (a haemoglobin level greater than 130 g/L) were more common among women who received daily iron or iron+folic acid supplementation than among those who received no treatment or placebo. The risk of haemoconcentration during the second and third trimester was higher among those on a daily regimen of iron supplementation. The clinical significance of haemoconcentration remains uncertain. AUTHORS' CONCLUSIONS: Universal prenatal supplementation with iron or iron+folic acid provided either daily or weekly is effective to prevent anaemia and iron deficiency at term. We found no evidence, however, of the significant reduction in substantive maternal and neonatal adverse clinical outcomes (low birthweight, delayed development, preterm birth, infection, postpartum haemorrhage). Associated side effects and particularly haemoconcentration during pregnancy may suggest the need for revising iron doses and schemes of supplementation during pregnancy and adjust preventive iron supplementation recommendations. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/19821332/Effects_and_safety_of_preventive_oral_iron_or_iron+folic_acid_supplementation_for_women_during_pregnancy_ L2 - https://doi.org/10.1002/14651858.CD004736.pub3 DB - PRIME DP - Unbound Medicine ER -