Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb 28;9(2):513-519.
doi: 10.4103/jfmpc.jfmpc_817_19. eCollection 2020 Feb.

Meta-analysis approach on iron fortification and its effect on pregnancy and its outcome through randomized, controlled trials

Ramesh Athe  1 , Rinshu Dwivedi  2 , Sanghamitra Pati  3 , Anindita Mazumder  4 , Udit Banset  4
Affiliations
Review

Meta-analysis approach on iron fortification and its effect on pregnancy and its outcome through randomized, controlled trials

Ramesh Athe et al. J Family Med Prim Care. .

Abstract

Micronutrients' deficiency is a common phenomenon among a majority of the population residing in the low- and middle-income countries (LMICs) especially among women and children. Given the widespread prevalence of micronutrients' deficiency in LMICs, iron-fortified foods could be of potential benefits for both the mother and the development of fetus. Present study aims to provide the evidence on the impact of iron fortification on hemoglobin (Hb) concentration during pregnancy and evaluates the specific maternal and pregnancy outcomes. We conducted systematic review by using search engines such as PubMed, Cochrane Library, Medline, EMbase, and secondary references. Meta-analyses were performed to calculate summary estimates on Hb during pregnancy, low birth weight (LBW), and preterm births. The weighted mean difference (WMD) and relative risk (RR) were calculated using random-effects models. Sources of heterogeneity were explored through meta-regression. Eight studies were included for the final analysis. The overall pooled estimate of Hb showed a significant increase in the fortification group compared with the control group [WMD = 4.45 g/L; 95% confidence interval (CI) = 2.73, 6.17 g/L; I 2 = 83%, τ2 = 6.80, ρ <0.00001]. There has been a notable reduction in iron deficiency anemia (IDA) among pregnant women with substantial heterogeneity. Meta-regression suggests that the duration of feeding was positively associated with the effect size. Present review provides an evidence for the substantial benefits of iron fortification during pregnancy for reducing preterm births and risk of LBW. The safety, efficacy, and effective delivery of iron fortification need further research. Systematic review registration: PROSPERO International prospective register of systematic reviews - CRD42018116931.

Keywords: Birth outcomes; deficiency; iron fortification; meta-analysis; systematic review.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram for inclusion in this study of randomized, controlled trials assessing the effect of iron-fortified foods
Figure 2
Figure 2
Effect of iron fortification on mean Hb concentration in comparison to no treatment or placebo control during pregnancy
Figure 3
Figure 3
Funnel plot of the included trials that evaluated the effect of iron fortification on Hb concentration during pregnancy
Figure 4
Figure 4
Impact of iron fortification on (a) LBW and (b) preterm birth in comparison to no intervention or placebo control
See this image and copyright information in PMC

References

    1. Lynch SR. The impact of iron fortification on nutritional anaemia. Best Pract Res Clin Haematol. 2005;18:333–46. - PubMed
    1. Fanzo J, Hawkes C, Udomkesmalee E, Afshin A, Allemandi L, Assery O, et al. 2018 Global Nutrition Report. 2019
    1. Bruner AB, Joffe A, Duggan AK, Casella JF, Brandt J. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet. 1996;348:992–6. - PubMed
    1. Lewis GD, Malhotra R, Hernandez AF, McNulty SE, Smith A, Felker GM, et al. Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency: The IRONOUT HF randomized clinical trial. JAMA. 2017;317:1958–66. - PMC - PubMed
    1. Breymann C, Dudenhausen JW. Iron Deficiency in Women. Handbook of Famine, Starvation, and Nutrient Deprivation: From Biology to Policy. 2018:1–14.