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Routine Iron Supplementation on Anemia during Pregnancy

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More Intervention Effect Estimate Summaries

Reference
Yakoob MY, Bhutta ZA.  Effect of routine iron supplementation with or without folic acid on anemia during pregnancy. BMC Public Health 2011; 11 (Suppl 3): S21.

Background

  • Roughly 2 billion people (30% of world’s population) are anemic, mainly due to iron deficiency (1).  
  • Globally, 56 million pregnant women (41.8% of total) are affected with anemia, mainly due to iron deficiency (2), making pregnant women susceptible to increased risk of mortality and decreased work capacity.  It may also lead to other perinatal complications like pre-eclampsia, low birth weight, prematurity and perinatal mortality (3).

Intervention Effects

Daily Iron Supplementation on Anemia at Term

  • 73% reduction in incidence of anemia at term (RR: 0.27; 95% CI: 0.17-0.42) 
  • 14 randomized controlled trials (RCTs) (moderate quality of evidence)

Daily Iron Supplementation on Iron Deficiency Anemia at Term

  • 67% reduction in iron deficiency anemia at term (RR: 0.33; 95% CI 0.16-0.69) 
  • 6 RCTs (moderate quality of evidence)

Daily Iron-folate Supplementation on Anemia at Term

  • 73% reduction in anemia at term (RR: 0.27; 95% CI 0.12-0.56) 
  • 3 RCTs (moderate quality of evidence)

Daily Iron-folate Supplementation on Iron Deficiency Anemia

  • Non-significant reduction (57%) in iron deficiency anemia (RR: 0.43: 95% CI 0.17-1.09) 
  • 1 RCT (low quality of evidence)

Intermittent Iron-folate vs. Daily Iron-folate Supplementation on Anemia at Term

  • There was no difference in rates of anemia at term with intermittent iron-folate vs. daily iron-folate supplementation (RR: 1.61; 95% CI 0.82-3.14) – 3 RCTs


Intervention Recommendation  

  • The authors recommend a 73% reduction in anemia at term with daily iron (alone) supplementation or iron/folate (combined) during pregnancy. Given the paucity of studies of intermittent iron or iron-folate supplementation, no recommendation is made for this intervention.


References from Yakoob Paper Cited Here

  1. World Health Organization. Micronutrient deficiencies. http://www.who.int/nutrition/topics/ida/en/index.html
  2. de Benoist B, McLean E, Egli I, Cogswell M, editor. Worldwide prevalence of anaemia 1993-2005. WHO Global Database on Anaemia: Geneva: World Health Organization; http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdfMurphy
  3. Murphy JF, O'Riordan J, Newcombe RG, Coles EC, Pearson JF. Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet. 1986;1(8488):992–995.

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