The Effects of Maternal Iron and Folate Supplementation on Pregnancy and Infant Outcomes in Africa: A Systematic Review

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2024 Jul 27

PMID 39063433

Authors

Yibeltal Bekele

Claire Gallagher

Don Vicendese

Melissa Buultjens

Mehak Batra

Bircan Erbas

Affiliations

Soon will be listed here.

Abstract

Background: Iron and folate deficiency are prevalent in pregnant women in Africa. However, limited research exists on the differential effect of oral iron-only, folate-only, or Iron Folic Acid (IFA) supplementation on adverse pregnancy and infant outcomes. This systematic review addresses this gap, focusing on studies conducted in Africa with limited healthcare access. Understanding these differential effects could lead to more targeted and potentially cost-effective interventions to improve maternal and child health in these settings.

Methods: A systematic review was conducted following PRISMA guidelines. The primary exposures were oral iron-only, folate-only, or IFA oral supplementation during pregnancy, while the outcomes were adverse pregnancy and infant outcomes. A qualitative synthesis guided by methods without meta-analysis was performed.

Results: Our qualitative synthesis analysed 10 articles reporting adverse pregnancy (adverse birth outcomes, stillbirths, and perinatal mortality) and infant outcomes (neonatal mortality). Consistently, iron-only supplementation demonstrated a reduction in perinatal death. However, evidence is insufficient to assess the relationship between iron-only and IFA supplementation with adverse birth outcomes, stillbirths, and neonatal mortality.

Conclusion: Findings suggested that iron-only supplementation during pregnancy may reduce perinatal mortality in African women. However, evidence remains limited regarding the effectiveness of both iron-only and IFA supplementation in reducing stillbirths, and neonatal mortality. Moreover, additional primary studies are necessary to comprehend the effects of iron-only, folate-only, and IFA supplementation on pregnancy outcomes and infant health in the African region, considering rurality and income level as effect modifiers.

References

Doku D . Survival analysis of neonatal mortality in Ghana using three population-based surveys. Arch Public Health. 2022; 80(1):21. PMC: 8740491. DOI: 10.1186/s13690-021-00773-3. View

Caniglia E, Zash R, Swanson S, Smith E, Sudfeld C, Finkelstein J . Iron, folic acid, and multiple micronutrient supplementation strategies during pregnancy and adverse birth outcomes in Botswana. Lancet Glob Health. 2022; 10(6):e850-e861. PMC: 9309424. DOI: 10.1016/S2214-109X(22)00126-7. View

Rai R, De Neve J, Geldsetzer P, Vollmer S . Maternal iron-and-folic-acid supplementation and its association with low-birth weight and neonatal mortality in India. Public Health Nutr. 2021; 25(3):623-633. PMC: 9991695. DOI: 10.1017/S1368980021004572. View

Smith E, Shankar A, Wu L, Aboud S, Adu-Afarwuah S, Ali H . Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries. Lancet Glob Health. 2017; 5(11):e1090-e1100. DOI: 10.1016/S2214-109X(17)30371-6. View

Tadesse Arficho T . Level and factors associated with compliance to iron-folic acid supplementation among pregnant women in rural Soro district, Hadiya Zone, Ethiopia: cross-sectional study. BMC Nutr. 2023; 9(1):105. PMC: 10507828. DOI: 10.1186/s40795-023-00765-2. View

Tamirat K, Kebede F, Gonete T, Tessema G, Tessema Z . Geographical variations and determinants of iron and folic acid supplementation during pregnancy in Ethiopia: analysis of 2019 mini demographic and health survey. BMC Pregnancy Childbirth. 2022; 22(1):127. PMC: 8848817. DOI: 10.1186/s12884-022-04461-0. View

Akinyemi J, Bamgboye E, Ayeni O . Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics. BMC Pediatr. 2015; 15:36. PMC: 4395970. DOI: 10.1186/s12887-015-0349-0. View

Siekmans K, Roche M, Kungu J, Desrochers R, De-Regil L . Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women. Matern Child Nutr. 2017; 14 Suppl 5:e12532. PMC: 6865983. DOI: 10.1111/mcn.12532. View

Feresu S, Harlow S, Woelk G . Risk factors for prematurity at Harare Maternity Hospital, Zimbabwe. Int J Epidemiol. 2004; 33(6):1194-201. DOI: 10.1093/ije/dyh120. View

10.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021; 88:105906. DOI: 10.1016/j.ijsu.2021.105906. View

11.

Godha D, Tharaney M, Nanama S, Sanghvi T, Laillou A, Diop F . The Association between Iron and Folic Acid Supplementation and Malaria Prophylaxis and Linear Growth among Children and Neonatal Mortality in Sub-Saharan Africa-A Pooled Analysis. Nutrients. 2022; 14(21). PMC: 9653734. DOI: 10.3390/nu14214496. View

12.

Abioye A, Hughes M, Sudfeld C, Premji Z, Aboud S, Hamer D . The effect of iron supplementation on maternal iron deficiency anemia does not differ by baseline anemia type among Tanzanian pregnant women without severe iron deficiency anemia. Eur J Nutr. 2022; 62(2):987-1001. PMC: 9987582. DOI: 10.1007/s00394-022-03029-0. View

13.

Begum K, Ouedraogo C, Wessells K, Young R, Faye M, Wuehler S . Prevalence of and factors associated with antenatal care seeking and adherence to recommended iron-folic acid supplementation among pregnant women in Zinder, Niger. Matern Child Nutr. 2018; 14 Suppl 1. PMC: 6866102. DOI: 10.1111/mcn.12466. View

14.

Titaley C, Dibley M, Roberts C, Hall J, Agho K . Iron and folic acid supplements and reduced early neonatal deaths in Indonesia. Bull World Health Organ. 2010; 88(7):500-8. PMC: 2897981. DOI: 10.2471/BLT.09.065813. View

15.

Abekah-Nkrumah G . Trends in utilisation and inequality in the use of reproductive health services in Sub-Saharan Africa. BMC Public Health. 2019; 19(1):1541. PMC: 6873654. DOI: 10.1186/s12889-019-7865-z. View

16.

. Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019. Lancet. 2021; 398(10303):870-905. PMC: 8429803. DOI: 10.1016/S0140-6736(21)01207-1. View

17.

Titaley C, Dibley M, Roberts C, Agho K . Combined iron/folic acid supplements and malaria prophylaxis reduce neonatal mortality in 19 sub-Saharan African countries. Am J Clin Nutr. 2010; 92(1):235-43. DOI: 10.3945/ajcn.2009.29093. View

18.

Beyene S . The impact of food insecurity on health outcomes: empirical evidence from sub-Saharan African countries. BMC Public Health. 2023; 23(1):338. PMC: 9930357. DOI: 10.1186/s12889-023-15244-3. View

19.

Ansu-Mensah M, Danquah F, Bawontuo V, Ansu-Mensah P, Kuupiel D . Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review. BMC Health Serv Res. 2020; 20(1):911. PMC: 7528345. DOI: 10.1186/s12913-020-05755-9. View

20.

Hug L, Alexander M, You D, Alkema L . National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health. 2019; 7(6):e710-e720. PMC: 6527519. DOI: 10.1016/S2214-109X(19)30163-9. View