Effect of routine iron supplementation with or without folic acid on anemia during pregnancy.

The authors conducted a systematic review of published randomized and quasi-randomized trials concerning the impact of iron and iron and folic acid supplementation on iron-deficiency anemia during pregnancy. In addition, daily and weekly supplementations were assessed. It should be noted that from 3550 publications, only 31 papers were chosen for data collection (less than 1%).

This article constitutes a most important review on a major maternal health topic, namely anemia during pregnancy which is one of the top causes of morbidity and mortality worldwide. According to the authors, approximately 30% of the world population is iron deficient.

The authors shows nicely that there is a clear risk reduction of developing anemia at term by giving daily iron or iron and folate. Iron alone is already efficacious and the addition of folic acid has no additional effect concerning iron deficiency or anemia.

There are only limited data for developing countries. Actually, for these countries, the data would be most important. However, the few studies from developing countries also show the clear effect of a daily administration. This effect is not shown for weekly administration due to the low quality of study designs. Finally a problem in most studies is the important heterogeneity of data, e.g. mixed patient populations with high variations in baseline hemoglobin levels. In fact, the effectiveness of oral daily iron supplementation will depend on the frequency of severe anemia in a given population.

– Christian Breymann