The Effect of Antenatal 60 mg Iron Supplementation on Neonatal Mortality: A Meta-Analysis

Abstract

Abstract Objectives There is strong evidence that prenatal iron and folic acid supplementation reduces the risk of iron deficiency anaemia during pregnancy and low birth weight. However, evidence it reduces neonatal mortality is still inconclusive. We aim to investigate the effects of prenatal iron supplementation either alone or in conjunction with folic acid, or with other vitamins and minerals on neonatal mortality. Methods We included five studies that assessed the effect of iron supplementation either alone or in conjunction with folic acid or with other vitamins and minerals on neonatal mortality. We then undertook several subgroup meta-analyses which include supplements containing any amount of iron versus placebo/vitamin/minerals/no treatment, supplements containing 60 mg iron versus placebo/vitamin/minerals/no treatment, supplements containing 60 mg iron and folic acid versus placebo/vitamin/minerals/no treatment and supplements containing less than 60 mg iron versus placebo/vitamin/minerals/no treatment. For all analyses, we used a fixed-effect model to calculate pooled RRs and 95% CIs. Our input variables were log RR, and we later we exponentiate all effect sizes and confidence intervals. Results The meta-analysis of the effect of supplements containing any iron versus placebo/vitamin/minerals/no treatment on neonatal death showed a 20% reduction (RR 0.80, 95% CI 0.68–0.94) in neonatal mortality rate. The meta-analysis of any supplements containing 60 mg iron versus placebo/vitamin/minerals/no treatment showed a 22% (RR 0.78, 95% CI 0.64–0.95) reduction in neonatal mortality rate. The meta-analysis of supplements containing 60 mg iron and folic acid versus placebo/vitamin/minerals/no treatment showed a 33% (RR 0.67, 95% CI 0.52–0.85) reduction in neonatal mortality rate. The meta-analysis analysis of any supplements containing less than 60 mg iron versus placebo/vitamin/minerals/no treatment did not show any effect on neonatal mortality rate. Conclusions Our findings provided vital evidence that iron supplementation in pregnancy significantly reduces neonatal mortality. This evidence justifies further investments to improve that at-scale implementation of this program in low- and middle-income countries where there are high levels of maternal anaemia and high neonatal mortality rates. Funding Sources The University of Sydney.