The effect of universal maternal antenatal iron supplementation on neurodevelopment in offspring: a systematic review and meta-analysis

TY - JOUR

T1 - The effect of universal maternal antenatal iron supplementation on neurodevelopment in offspring

T2 - a systematic review and meta-analysis

AU - Jayasinghe, C

AU - Polson, R

AU - van Woerden, H C

AU - Wilson, Philip

PY - 2018/5/4

Y1 - 2018/5/4

N2 - BACKGROUND: Although 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.METHODS: Electronic 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.RESULTS: Seven 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.CONCLUSIONS: The 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.

AB - BACKGROUND: Although 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.METHODS: Electronic 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.RESULTS: Seven 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.CONCLUSIONS: The 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.

KW - Anemia, Iron-Deficiency/epidemiology

KW - Child

KW - Child Behavior

KW - Child Development

KW - Cognition

KW - Dietary Supplements

KW - Female

KW - Folic Acid/administration & dosage

KW - Humans

KW - Intelligence

KW - Pregnancy

KW - Pregnancy Complications, Hematologic/epidemiology

KW - Prenatal Care/methods

KW - Prevalence

U2 - 10.1186/s12887-018-1118-7

DO - 10.1186/s12887-018-1118-7

M3 - Review

C2 - 29728086

SN - 1471-2431

VL - 18

JO - BMC Pediatrics

JF - BMC Pediatrics

IS - 1

M1 - 150

ER -