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Published in: BMC Pregnancy and Childbirth 1/2012

Open Access 01-12-2012 | Research article

Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews

Authors: Jacqui A Parker, Filipa Barroso, Simon J Stanworth, Helen Spiby, Sally Hopewell, Carolyn J Doree, Mary J Renfrew, Shubha Allard

Published in: BMC Pregnancy and Childbirth | Issue 1/2012

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Abstract

Background

Anaemia, in particular due to iron deficiency, is common in pregnancy with associated negative outcomes for mother and infant. However, there is evidence of significant variation in management. The objectives of this review of systematic reviews were to analyse and summarise the evidence base, identify gaps in the evidence and develop a research agenda for this important component of maternity care.

Methods

Multiple databases were searched, including MEDLINE, EMBASE and The Cochrane Library. All systematic reviews relating to interventions to prevent and treat anaemia in the antenatal and postnatal period were eligible. Two reviewers independently assessed data inclusion, extraction and quality of methodology.

Results

27 reviews were included, all reporting on the prevention and treatment of anaemia in the antenatal (n = 24) and postnatal periods (n = 3). Using AMSTAR as the assessment tool for methodological quality, only 12 of the 27 were rated as high quality reviews. The greatest number of reviews covered antenatal nutritional supplementation for the prevention of anaemia (n = 19). Iron supplementation was the most extensively researched, but with ongoing uncertainty about optimal dose and regimen. Few identified reviews addressed anaemia management post-partum or correlations between laboratory and clinical outcomes, and no reviews reported on clinical symptoms of anaemia.

Conclusions

The review highlights evidence gaps including the management of anaemia in the postnatal period, screening for anaemia, and optimal interventions for treatment. Research priorities include developing standardised approaches to reporting of laboratory outcomes, and information on clinical outcomes relevant to the experiences of pregnant women.
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Literature
1.
go back to reference McLean E, Egli I, Cogswell M, De Benoist B, Wojdyla D: Worldwide prevalence of anaemia in preschool age children, pregnant women and non-pregnant women of reproductive age. Nutr Anaemia. 2007, 1: 1-12. McLean E, Egli I, Cogswell M, De Benoist B, Wojdyla D: Worldwide prevalence of anaemia in preschool age children, pregnant women and non-pregnant women of reproductive age. Nutr Anaemia. 2007, 1: 1-12.
3.
go back to reference Lone F, Qureshi R, Emmanuel F: Maternal anaemia and it’s impact on perinatal outcome in a tertiary care hospital in Pakistan. East Mediterr Health J. 2004, 10 (6): 801-807.PubMed Lone F, Qureshi R, Emmanuel F: Maternal anaemia and it’s impact on perinatal outcome in a tertiary care hospital in Pakistan. East Mediterr Health J. 2004, 10 (6): 801-807.PubMed
4.
go back to reference Letsky E: Maternal anaemia in pregnancy, iron and pregnancy – a haematologists viewpoint. Fetal Matern Med Rev. 2001, 12 (3): 159-175.CrossRef Letsky E: Maternal anaemia in pregnancy, iron and pregnancy – a haematologists viewpoint. Fetal Matern Med Rev. 2001, 12 (3): 159-175.CrossRef
5.
go back to reference Vora M, Gruslin A: Erythropoietin in obstetrics. Obstet Gynecol Surv. 1998, 53 (8): 500-508. 10.1097/00006254-199808000-00023.CrossRefPubMed Vora M, Gruslin A: Erythropoietin in obstetrics. Obstet Gynecol Surv. 1998, 53 (8): 500-508. 10.1097/00006254-199808000-00023.CrossRefPubMed
6.
go back to reference Beard J, Hendricks M, Perez E, Murray-Kolb L, Berg A, Vernon-Feagans L, et al: Maternal iron deficiency anaemia affects postpartum emotion and cognition. J Nutr. 2005, 135: 267-272.PubMed Beard J, Hendricks M, Perez E, Murray-Kolb L, Berg A, Vernon-Feagans L, et al: Maternal iron deficiency anaemia affects postpartum emotion and cognition. J Nutr. 2005, 135: 267-272.PubMed
7.
go back to reference Corwin E, Murray-Kolb L, Beard J: Low Haemoglobin level is a risk factor for postpartum depression. J Nutr. 2003, 133: 4139-4142.PubMed Corwin E, Murray-Kolb L, Beard J: Low Haemoglobin level is a risk factor for postpartum depression. J Nutr. 2003, 133: 4139-4142.PubMed
8.
go back to reference Scholl T: Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005, 81: 1218S-1222S.PubMed Scholl T: Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005, 81: 1218S-1222S.PubMed
9.
go back to reference Offerhaus P, Fleuren M, Wensing M: Guidelines on anaemia: effect on primary-care midwives in the Netherlands. Midwifery. 2005, 21 (3): 204-211. 10.1016/j.midw.2004.10.005.CrossRefPubMed Offerhaus P, Fleuren M, Wensing M: Guidelines on anaemia: effect on primary-care midwives in the Netherlands. Midwifery. 2005, 21 (3): 204-211. 10.1016/j.midw.2004.10.005.CrossRefPubMed
10.
go back to reference Milman N: Serum ferritin in Danes: studies of iron ststus from infancy to old age, during blood donation and pregnancy. Int J Hematol. 1996, 63 (2): 103-135.CrossRefPubMed Milman N: Serum ferritin in Danes: studies of iron ststus from infancy to old age, during blood donation and pregnancy. Int J Hematol. 1996, 63 (2): 103-135.CrossRefPubMed
12.
go back to reference Shea B, Grimshaw J, Wells G, Boers M, Andersson N, Hamel C, et al: Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2005, 7: 10-CrossRef Shea B, Grimshaw J, Wells G, Boers M, Andersson N, Hamel C, et al: Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2005, 7: 10-CrossRef
13.
go back to reference Scholl T, Hediger M, Belsky D: Prenatal care and maternal health during adolescent pregnancy: a review and meta-analysis. J Adolesc Health. 1994, 15 (6): 444-456. 10.1016/1054-139X(94)90491-K.CrossRefPubMed Scholl T, Hediger M, Belsky D: Prenatal care and maternal health during adolescent pregnancy: a review and meta-analysis. J Adolesc Health. 1994, 15 (6): 444-456. 10.1016/1054-139X(94)90491-K.CrossRefPubMed
14.
go back to reference Dodd J, Dare M, Middleton P: Treatment for women with postpartum iron deficiency anaemia. Cochrane Database Syst Rev. 2004, 4: CD004222-PubMed Dodd J, Dare M, Middleton P: Treatment for women with postpartum iron deficiency anaemia. Cochrane Database Syst Rev. 2004, 4: CD004222-PubMed
15.
go back to reference Kotto-Kome A, Calhoun D, Montenegro R, Sosa R, Maldonado L, Christensen R: Effect of administering recombinant erythropoietin to women with postpartum anemia: a meta-analysis. J Perinatol. 2004, 24 (1): 11-15. 10.1038/sj.jp.7211017.CrossRefPubMed Kotto-Kome A, Calhoun D, Montenegro R, Sosa R, Maldonado L, Christensen R: Effect of administering recombinant erythropoietin to women with postpartum anemia: a meta-analysis. J Perinatol. 2004, 24 (1): 11-15. 10.1038/sj.jp.7211017.CrossRefPubMed
16.
go back to reference Fishman S, Christian P, West K: The role of vitamins in the prevention and control anaemia. Public Health Nutr. 2000, 3 (2): 125-50.CrossRefPubMed Fishman S, Christian P, West K: The role of vitamins in the prevention and control anaemia. Public Health Nutr. 2000, 3 (2): 125-50.CrossRefPubMed
17.
go back to reference Villar J, Merialdi M, Gulmezoglu M, Abalos E, Carroli G, Kulier R, et al: Nutritional interventions during pregnancy for the prevention or treatment of maternal morbidity and preterm delivery: an overview of randomized controlled trials. J Nutr. 2003, 133 (5 Suppl1): S1606-S1625. Villar J, Merialdi M, Gulmezoglu M, Abalos E, Carroli G, Kulier R, et al: Nutritional interventions during pregnancy for the prevention or treatment of maternal morbidity and preterm delivery: an overview of randomized controlled trials. J Nutr. 2003, 133 (5 Suppl1): S1606-S1625.
18.
go back to reference Haider B, Bhutta Z: Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2006, 4: CD004905-PubMed Haider B, Bhutta Z: Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2006, 4: CD004905-PubMed
19.
go back to reference Haider B, Yakoob M, Bhutta Z: Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Publ Health. 2011, 11 (Suppl 3): S19-10.1186/1471-2458-11-S3-S19.CrossRef Haider B, Yakoob M, Bhutta Z: Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Publ Health. 2011, 11 (Suppl 3): S19-10.1186/1471-2458-11-S3-S19.CrossRef
20.
go back to reference Faisel H, Pittrof R: Vitamin A and causes of maternal mortality: association and biological plausibility. Public Health Nutr. 2000, 3 (3): 321-7.CrossRefPubMed Faisel H, Pittrof R: Vitamin A and causes of maternal mortality: association and biological plausibility. Public Health Nutr. 2000, 3 (3): 321-7.CrossRefPubMed
21.
go back to reference Van Den Broek, Kulier R, Gulmezoglu M, Villar J: Vitamin A supplementation during pregnancy. Cochrane Database Syst Rev. 2002, 4: CD001996- Van Den Broek, Kulier R, Gulmezoglu M, Villar J: Vitamin A supplementation during pregnancy. Cochrane Database Syst Rev. 2002, 4: CD001996-
22.
go back to reference Rumbold A, Crowther C: Vitamin E supplementation in pregnancy. Cochrane Database Syst Rev. 2005, 2: CD004069-PubMed Rumbold A, Crowther C: Vitamin E supplementation in pregnancy. Cochrane Database Syst Rev. 2005, 2: CD004069-PubMed
23.
go back to reference Rumbold A, Crowther C: Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev. 2005, 2: CD004072-PubMed Rumbold A, Crowther C: Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev. 2005, 2: CD004072-PubMed
24.
go back to reference Gulmezoglu M, De Onis M, Villar J: Effectiveness of interventions to prevent or treat impaired fetal growth. Obstet Gynecol Surv. 1997, 52 (2): 139-149. 10.1097/00006254-199702000-00023.CrossRefPubMed Gulmezoglu M, De Onis M, Villar J: Effectiveness of interventions to prevent or treat impaired fetal growth. Obstet Gynecol Surv. 1997, 52 (2): 139-149. 10.1097/00006254-199702000-00023.CrossRefPubMed
25.
go back to reference Kulier R, De Onis M, Gulmezoglu M, Villar J: Nutritional interventions for the prevention of maternal morbidity. Int J Gynaecol Obstet. 1998, 63 (3): 231-246. 10.1016/S0020-7292(98)00163-5.CrossRefPubMed Kulier R, De Onis M, Gulmezoglu M, Villar J: Nutritional interventions for the prevention of maternal morbidity. Int J Gynaecol Obstet. 1998, 63 (3): 231-246. 10.1016/S0020-7292(98)00163-5.CrossRefPubMed
26.
go back to reference De Onis M, Villar J, Gulmezoglu M: Nutritional interventions to prevent intrauterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998, 52 (Suppl1): S83-S93.PubMed De Onis M, Villar J, Gulmezoglu M: Nutritional interventions to prevent intrauterine growth retardation: evidence from randomized controlled trials. Eur J Clin Nutr. 1998, 52 (Suppl1): S83-S93.PubMed
27.
go back to reference Milman N, Bergholt T, Byg K, Eriksen L, Graudal N: Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand. 1999, 78 (9): 749-757. 10.1080/j.1600-0412.1999.780902.x.CrossRefPubMed Milman N, Bergholt T, Byg K, Eriksen L, Graudal N: Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand. 1999, 78 (9): 749-757. 10.1080/j.1600-0412.1999.780902.x.CrossRefPubMed
28.
go back to reference Rasmussen K: Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality?. J Nutr. 2001, 131 (2 suppl 2): S590-S603. Rasmussen K: Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality?. J Nutr. 2001, 131 (2 suppl 2): S590-S603.
29.
go back to reference Sloan N, Jordan E, Winikoff B: Effects of iron supplementation on maternal hematologic status in pregnancy. Am J Public Health. 2002, 92 (2): 288-293. 10.2105/AJPH.92.2.288.CrossRefPubMedPubMedCentral Sloan N, Jordan E, Winikoff B: Effects of iron supplementation on maternal hematologic status in pregnancy. Am J Public Health. 2002, 92 (2): 288-293. 10.2105/AJPH.92.2.288.CrossRefPubMedPubMedCentral
30.
go back to reference Agency for Healthcare Research and Quality: Screening for iron deficiency anemia in childhood and pregnancy update of the 1996 U.S. Prev Task Force Rev. 2006, 50: Agency for Healthcare Research and Quality: Screening for iron deficiency anemia in childhood and pregnancy update of the 1996 U.S. Prev Task Force Rev. 2006, 50:
31.
go back to reference Reveiz L, Gyte G, Cuervo L: Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database Syst Rev. 2007, 2: CD003094-PubMed Reveiz L, Gyte G, Cuervo L: Treatments for iron-deficiency anaemia in pregnancy. Cochrane Database Syst Rev. 2007, 2: CD003094-PubMed
32.
go back to reference Peña-Rosas J, Viteri F: Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev. 2009, 4: CD004736-PubMed Peña-Rosas J, Viteri F: Effects and safety of preventive oral iron or iron+folic acid supplementation for women during pregnancy. Cochrane Database Syst Rev. 2009, 4: CD004736-PubMed
33.
go back to reference Macedo A, Cardoso S: Routine iron supplementation in pregnancy. Acta Med Port. 2010, 23: 785-92.PubMed Macedo A, Cardoso S: Routine iron supplementation in pregnancy. Acta Med Port. 2010, 23: 785-92.PubMed
34.
go back to reference Yakoob M, Bhutta Z: Effect of routine iron supplementation with or without folic acid on anemia during pregnancy. BMC Publ Health. 2011, 11 (Suppl 3): S21-10.1186/1471-2458-11-S3-S21.CrossRef Yakoob M, Bhutta Z: Effect of routine iron supplementation with or without folic acid on anemia during pregnancy. BMC Publ Health. 2011, 11 (Suppl 3): S21-10.1186/1471-2458-11-S3-S21.CrossRef
35.
go back to reference Carroli G, Villar J, Piaggio G, Khan-Neelofur D, Gulmezoglu M, Mugford M, et al: WHO systematic review of randomised controlled trials of routine antenatal care. Lancet. 2001, 357 (9268): 1565-70. 10.1016/S0140-6736(00)04723-1.CrossRefPubMed Carroli G, Villar J, Piaggio G, Khan-Neelofur D, Gulmezoglu M, Mugford M, et al: WHO systematic review of randomised controlled trials of routine antenatal care. Lancet. 2001, 357 (9268): 1565-70. 10.1016/S0140-6736(00)04723-1.CrossRefPubMed
36.
go back to reference Villar J, Carroli G, Khan-Neelofur D, Piaggio G, Gülmezoglu M: Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2001, 4: CD000934-PubMed Villar J, Carroli G, Khan-Neelofur D, Piaggio G, Gülmezoglu M: Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2001, 4: CD000934-PubMed
37.
go back to reference Carroli G, Rooney C, Villar J: How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001, 15 (suppl 1): 1-42.CrossRefPubMed Carroli G, Rooney C, Villar J: How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001, 15 (suppl 1): 1-42.CrossRefPubMed
38.
go back to reference Dodd J, Crowther C: Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes. Cochrane Database Syst Rev. 2007, 2: CD005300-PubMed Dodd J, Crowther C: Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes. Cochrane Database Syst Rev. 2007, 2: CD005300-PubMed
39.
go back to reference Mathews F: Antioxidant nutrients in pregnancy: a systematic review of the literature. Nutr Res Rev. 1996, 9: 175-195. 10.1079/NRR19960011.CrossRefPubMed Mathews F: Antioxidant nutrients in pregnancy: a systematic review of the literature. Nutr Res Rev. 1996, 9: 175-195. 10.1079/NRR19960011.CrossRefPubMed
40.
go back to reference Suharno D, West C, Muhilal , Karyadi D, Hautvast J: Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia. Lancet. 1993, 342: 1325-8. 10.1016/0140-6736(93)92246-P.CrossRefPubMed Suharno D, West C, Muhilal , Karyadi D, Hautvast J: Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia. Lancet. 1993, 342: 1325-8. 10.1016/0140-6736(93)92246-P.CrossRefPubMed
44.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group: Preferred Reporting Items for systematic Reviews and Meta-Analyses: The PRISMA Statement. Open Med. 2009, 3 (3): 123-30. Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group: Preferred Reporting Items for systematic Reviews and Meta-Analyses: The PRISMA Statement. Open Med. 2009, 3 (3): 123-30.
Metadata
Title
Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews
Authors
Jacqui A Parker
Filipa Barroso
Simon J Stanworth
Helen Spiby
Sally Hopewell
Carolyn J Doree
Mary J Renfrew
Shubha Allard
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2012
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-12-56

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