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Oral iron‐based interventions for prevention of critical outcomes in pregnancy and postnatal care: An overview and update of systematic reviews
Author(s) -
Abraha Iosief,
Bonacini Maria Isabella,
Montedori Alessandro,
Di Renzo Gian Carlo,
Angelozzi Patrizio,
Micheli Marta,
Germani Antonella,
Carloni Danilo,
Scaccetti Augusto,
Palmieri Gianluca,
Casali Marta,
Nenz Chiara Maria Grazia,
Gargano Elisabetta,
Pazzaglia Michela,
Agea Elisabetta,
Berchicci Laura,
Tesoro Simonetta,
Albi Nicola,
Minelli Olivia,
Pasqua Barbara Luciani,
Onorato Marina,
Epicoco Giorgio,
Marchesi Mauro
Publication year - 2019
Publication title -
journal of evidence‐based medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.885
H-Index - 22
ISSN - 1756-5391
DOI - 10.1111/jebm.12344
Subject(s) - medicine , anemia , psychological intervention , pregnancy , systematic review , placebo , relative risk , cochrane library , randomized controlled trial , pediatrics , meta analysis , obstetrics , iron deficiency anemia , medline , intensive care medicine , confidence interval , alternative medicine , psychiatry , genetics , pathology , political science , law , biology
Abstract Objective The aim of this work was to summarize and update the evidence concerning oral iron‐based interventions compared to placebo or no iron‐based interventions to prevent critical outcomes in pregnancy or treat critical outcomes in the postpartum phase. Method Published systematic reviews (Feb 2018) and primary studies (from 2015 to March 2018) retrieved from MEDLINE, EMBASE, and the Cochrane Library were examined. The AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool was used to assess the quality of reviews. GRADE was used to rate the quality of the evidence for critical outcomes. Results Antenatal care: Compared to placebo/no treatment, iron‐based therapies reduced maternal anemia at term by 59% (seven trials at low risk of bias, RR 0.41, 95% CI 0.23‐0.73; I 2 = 86%; moderate‐quality evidence) and maternal iron deficiency anemia by 67% (RR 0.33, 95% CI 0.16‐0.69; I 2 = 49%). There was no evidence of difference between iron‐based therapies vs control in terms of side effects (RR 1.42, 95% CI 0.91‐2.21), preterm delivery (13 studies: RR 0.93, 95% CI 0.84‐1.03; low‐quality evidence), low birthweight (RR 0.94, 95% CI 0.79‐1.13; low‐quality evidence) and infant mortality (RR 0.93, 0.72‐1.20; low‐quality evidence). Postnatal care There was insufficient evidence to determine whether iron‐based therapies can reduce postpartum anemia. Conclusion Iron supplementation is effective in preventing maternal anemia at term but not low birthweight, preterm delivery or infant mortality.