Abstract
BackgroundAlthough antenatal iron supplementation is beneficial to mothers, its impact on the neurodevelopment of offspring is controversial. A systematic review and meta-analysis was undertaken to assess whether routine maternal antenatal iron supplementation confers later neurodevelopmental benefit to offspring.MethodsElectronic databases were searched using MESH terms or key words and identified papers were reviewed by two independent reviewers. The study quality was assessed using the Cochrane risk of bias assessment tool. The review was registered in the PROSPERO CRD data base.ResultsSeven publications were identified, based on four randomised trials published between 2006 and 2016. Three of the trials were in the Asian sub-continent. A range of tools were used to evaluate neurodevelopment. Meta-analysis of outcomes from the three RCTs meeting our inclusion criteria showed minimal effect of antenatal iron supplementation on the neurodevelopment of offspring, which was not statistically significant: weighted mean difference of 0.54 (95% CI: -0.67 to 1.75); test for overall effect Z = 0.87; p = 0.38; and heterogeneity 48%. Meta-analysis of outcomes of these RCTs at later stages of development produced similar results.ConclusionsThe benefit of routine antenatal iron supplementation on neurodevelopment in offspring was not statistically significant in this relatively limited set of trials, and some benefit cannot be excluded in areas with a high prevalence of maternal anaemia. A large randomized controlled trial showing significant benefit would be required to modify our conclusions.
Highlights
Antenatal iron supplementation is beneficial to mothers, its impact on the neurodevelopment of offspring is controversial
The beneficial effect of iron supplementation during the antenatal period in relation to birth weight, physical growth and perinatal mortality has been evaluated in several studies
Another study showed that antenatal iron and folic acid supplementation reduced the prevalence of anaemia from 67% to 38. 4%, and that there was an inverted U shaped relationship
Summary
Antenatal iron supplementation is beneficial to mothers, its impact on the neurodevelopment of offspring is controversial. Iron supplementation during pregnancy is routinely provided in many countries. The WHO currently recommends that 30–60 mg of elemental iron is given daily from as early as possible during pregnancy [1]. This public health policy aims to improve pregnancy outcomes and to reduce maternal anaemia [2, 3]. A randomized trial conducted in Bangladesh supplementing iron in various doses, and providing multiple micronutrients in food items for antenatal mothers, did not shown any significant effect on motor development of offspring at seven months old [6]. Another study showed that antenatal iron and folic acid supplementation reduced the prevalence of anaemia from 67% to 38. 4%, and that there was an inverted U shaped relationship
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