Table 3.
Studies on maternal iron status and child neurobehavioral outcomes.
| Study | Year | Country | Country Income | Design (S) | Risk of Bias | n | Population | Background SF, µg/L | Statistics | Mother | Child | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Iron Biomarkers | Categories Based on | Stage | Outcome | Age | ||||||||||
| No association | ||||||||||||||
| Zhou [43] | 2006 | Australia | H | Clinical trial (S) | L | 430 | General | 14 ‡ | T-test | SF | (S), SF < 12 µg/L |
III | Intelligence: reasoning, memory | 4 y |
| Davidson [44] | 2008 | Seychelles | H | Cohort (S) | L | 229 | General | NR | MLR | SF, sTfR | II | Psychomotor | 5, 9, 25, 30 m | |
| Rioux [45] | 2011 | Canada | H | Cohort (S) | M | 63 | General | NR | MLR | SF | SF < 10 µg/L | III | Cognition | 6 m |
| Lewis [46] | 2014 | UK | H | Cohort (S) | L | 11,696 | General | NA | MLR | IV | Cognition | 8 y | ||
| Tran [47] | 2014 | Vietnam | L-M | Cohort | L | 418 | General | 17.3 ‡ | MLR | SF | SF < 15 µg/L | I, III | Motor | 6 m |
| Lou [48] | 2015 | China | U-M | Cohort | L | 69 | General | 17.4 ‡ | ANCOVA | SF | SF < 16 µg/L | III | Auditory brainstem response | 3, 10 m |
| Mireku [49] | 2016 | Benin | L | Cohort (S) | L | 636 | General | NR | MLR | SF | II, PP | Cognition, motor, language, visual, perception | 12 m | |
| Higher maternal iron status associated with adverse child outcome | ||||||||||||||
| Hanieh [31] * | 2013 | Vietnam | L-M | Clinical trial (S) | L | 713 | General | 28.4 § | MLR | SF, (sTfR, sTfR/SF) | (S), SF < 15 µg/L |
III | Cognition, language, motor | 6 m |
| Higher maternal iron status associated with better child outcome | ||||||||||||||
| Vaughn [50] | 1986 | USA | H | Cohort (S) | H | 115 | General | NR | T-test | TIBC (SF, Fe) |
Irritability | III | (Neonatal behavior), Irritability | 3d (5 m) |
| Hernández [51] | 2011 | Spain | H | Cohort (S) | L | 216 | General | NR | MLR | SF, TSAT | SF < 12 µg/L | I, II, III | Neonatal behavior | Neonatal period |
| Tran [52] | 2013 | Vietnam | L-M | Cohort | L | 378 | General | NR | MLR | SF | SF < 15 µg/L | I, III | Cognition | 6 m |
| Koubaa [53] | 2015 | Sweden | H | Cohort | L | 116 | Women with eating disorders | 42.7 ‡ | corr | SF | SF < 20 µg/L | I | Memory | 5 y |
| Park [54] | 2016 | Philippines | L-M | Nested-cohort | L | 370 | Women with schistosomiasis | 6.2 § | MLR | SF, sTfR/SF (sTfR) | III | Cognition, language, motor | 12 m | |
| Berglund [55] | 2017 | Spain | H | Cohort (S) | L | 331 | General | 16.7 ‡ | ANCOVA | SF, TSAT | SF < 15 µg/L | III, PP | Cognition, language, motor | 18 m |
| Santos [39] * | 2018 | China | U-M | Clinical trial (S) | L | 1194 | General | NR | MLR | SF, sTfR | II, III | Motor | 9 m | |
| Choudhury [56] | 2015 | India | L-M | Cohort | L | 90 | General | 36.9 ‡ | MLR | SF | PP | Auditory brainstem response | 24 to 48 h | |
| ElAlfy [57] | 2018 | Egypt | L-M | Case control | L | 100 | General | 55.6 ‡ | T-test | SF (Fe, TSAT, TIBC) | SF < 15 µg/L | PP | Auditory brainstem response | 48 h, 3 m |
| Arija [58] | 2019 | Spain | H | Cohort (S) | L | 2032 | General | NR | MLR | SF | SF < 12 µg/L | I | Memory, attention, flexibility and inhibition | 7 y |
| Kupsco [59] | 2020 | Mexico | U-M | Cohort (S) | L | 571 | General | 36.7 ‡ | GAM | SF | SF < 15 µg/L | II, III, PP | Memory, motor, cognition | 4–6 y |
| Santa-Marina [60] | 2020 | Spain | H | Cohort | L | 1095 | General | 35.9 ‡ | PRM | SF | I | Symptoms of Attention deficit/hyperactivity disorder | 4–5 y | |
Country income according to World Bank classification (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519 accessed on 20 July 2020 ); corr, correlation; d, Days; I, II, III, gestational trimester; GAM, generalized additive models; H, high; IV, instrumental variable; L, low; L-M, lower-middle; U-M, upper-middle; MWU, Mann–Whitney U-test; M, medium; m, months; MLR, multiple linear regression; NA, not applicable; PP, peri-partum; PRM, Poisson regression model; SF, ferritin represents reported (or calculated); sTfR, soluble transferrin receptor; (S), maternal iron supplementation, TF, transferrin; TSAT, transferrin saturation; TIBC, total iron binding capacity; wk, week; y, year. * Studies reporting multiple outcomes; ‡, mean; §, geometric mean; values in the total study population. Studies are grouped by the direction of the association between maternal iron status and child neurobehavioral outcomes.