Efficacy of different doses of daily prophylactic iron supplementation in pregnant women: A systematic review and meta-analysis

IF 2.9 Q3 NUTRITION & DIETETICS Clinical nutrition ESPEN Pub Date : 2024-09-27 DOI:10.1016/j.clnesp.2024.09.019

Indar Kumar Sharawat , Prateek Kumar Panda , Surbhi Choudhary , Pranita Pradhan , Vivek Singh Malik , Meenu Singh

{"title":"Efficacy of different doses of daily prophylactic iron supplementation in pregnant women: A systematic review and meta-analysis","authors":"Indar Kumar Sharawat , Prateek Kumar Panda , Surbhi Choudhary , Pranita Pradhan , Vivek Singh Malik , Meenu Singh","doi":"10.1016/j.clnesp.2024.09.019","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Several randomized controlled trials (RCT) have been conducted in the past to determine the optimum dose of iron supplementation during pregnancy, but there is a lack of consensus among different guidelines regarding the appropriate dosage of iron for prophylaxis during pregnancy.</div></div><div><h3>Methods</h3><div>Relevant electronic databases were searched to identify publications describing RCTs comparing different daily dosages of iron supplementation during pregnancy. Meta-analysis for various efficacy and safety outcomes such as changes in blood hemoglobin, serum ferritin, serum iron, and serum transferrin saturation, as well as the frequency of adverse effects, was performed using random and fixed effect models suitably depending on the degree of heterogeneity. Two groups were compared: those receiving 60 mg elemental iron or less and those receiving more than 60 mg elemental iron per day. Additionally, the efficacy of those receiving 30 mg elemental iron per day and those receiving 60 mg elemental iron per day were also compared.</div></div><div><h3>Results</h3><div>A to total of 15 RCTs comprising 2726 participants were included in the meta-analysis. Change in blood hemoglobin levels was comparable between the ≤60 mg/day and >60 mg/day group (pooled estimate for mean difference, 0.01 [-0.11, 0.09], p = 0.86, I<sup>2</sup> = 96 %), but serum ferritin, iron level, and serum transferrin saturation change were higher in the >60 mg group (p < 0.0001, 0.008, and 0.02, respectively). Change in blood hemoglobin level was better in the 60 mg/day group compared to the 30 mg/day group (pooled estimate for mean difference, −0.11 [-0.21, 0.00], p = 0.04, I<sup>2</sup> = 90 %), as well as changes in serum ferritin and serum transferrin saturations (p = 0.004 and 0.0004, respectively).</div></div><div><h3>Conclusion</h3><div>Daily supplementation of 60 mg elemental iron is more efficacious than daily supplementation of 30 mg elemental iron for the prophylaxis of anemia in pregnant women (certainty of evidence-moderate), and daily supplementation of ≤60 mg elemental iron is equally efficacious compared to daily supplementation of >60 mg elemental iron for the prophylaxis of anemia in pregnant women (certainty of evidence-moderate).</div></div><div><h3>Proespero registration no</h3><div>CRD42023455485.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nutrition ESPEN","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405457724013238","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Several randomized controlled trials (RCT) have been conducted in the past to determine the optimum dose of iron supplementation during pregnancy, but there is a lack of consensus among different guidelines regarding the appropriate dosage of iron for prophylaxis during pregnancy.

Methods

Relevant electronic databases were searched to identify publications describing RCTs comparing different daily dosages of iron supplementation during pregnancy. Meta-analysis for various efficacy and safety outcomes such as changes in blood hemoglobin, serum ferritin, serum iron, and serum transferrin saturation, as well as the frequency of adverse effects, was performed using random and fixed effect models suitably depending on the degree of heterogeneity. Two groups were compared: those receiving 60 mg elemental iron or less and those receiving more than 60 mg elemental iron per day. Additionally, the efficacy of those receiving 30 mg elemental iron per day and those receiving 60 mg elemental iron per day were also compared.

Results

A to total of 15 RCTs comprising 2726 participants were included in the meta-analysis. Change in blood hemoglobin levels was comparable between the ≤60 mg/day and >60 mg/day group (pooled estimate for mean difference, 0.01 [-0.11, 0.09], p = 0.86, I² = 96 %), but serum ferritin, iron level, and serum transferrin saturation change were higher in the >60 mg group (p < 0.0001, 0.008, and 0.02, respectively). Change in blood hemoglobin level was better in the 60 mg/day group compared to the 30 mg/day group (pooled estimate for mean difference, −0.11 [-0.21, 0.00], p = 0.04, I² = 90 %), as well as changes in serum ferritin and serum transferrin saturations (p = 0.004 and 0.0004, respectively).

Conclusion

Daily supplementation of 60 mg elemental iron is more efficacious than daily supplementation of 30 mg elemental iron for the prophylaxis of anemia in pregnant women (certainty of evidence-moderate), and daily supplementation of ≤60 mg elemental iron is equally efficacious compared to daily supplementation of >60 mg elemental iron for the prophylaxis of anemia in pregnant women (certainty of evidence-moderate).

Proespero registration no

CRD42023455485.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

孕妇每日预防性补充不同剂量铁剂的功效：系统回顾和荟萃分析。

导言：过去曾进行过多项随机对照试验（RCT）以确定孕期补铁的最佳剂量，但不同指南对孕期预防性补铁的适当剂量缺乏共识：方法：对相关电子数据库进行了检索，以确定对妊娠期不同每日补铁剂量进行比较的研究性试验出版物。根据异质性程度，采用随机和固定效应模型对各种疗效和安全性结果（如血红蛋白、血清铁蛋白、血清铁和血清转铁蛋白饱和度的变化以及不良反应的频率）进行了元分析。比较了两个组别：每天摄入 60 毫克或更少元素铁的组别和每天摄入超过 60 毫克元素铁的组别。此外，还比较了每天摄入 30 毫克铁元素和每天摄入 60 毫克铁元素的疗效：荟萃分析共纳入了 15 项研究性试验，共有 2726 名参与者。血红蛋白水平的变化在≤60 毫克/天组和 >60 毫克/天组之间具有可比性（平均差异的集合估计值为 0.01 [-0.11, 0.09]，P=0.86，I2=96%），但血清铁蛋白、铁水平和血清转铁蛋白饱和度的变化在 >60 毫克组中更高（P2=90%），血清铁蛋白和血清转铁蛋白饱和度的变化也更高（分别为 P=0.004 和 0.0004）：在预防孕妇贫血方面，每日补充60毫克铁元素比每日补充30毫克铁元素更有效（证据确凿度为中度）；在预防孕妇贫血方面，每日补充≤60毫克铁元素与每日补充>60毫克铁元素具有同等疗效（证据确凿度为中度）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.