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. 2015 Jul 22;2015(7):CD004736. doi: 10.1002/14651858.CD004736.pub5

Comparison 5. Supplementation with iron+folic acid versus folic acid alone (without iron) supplementation.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Low birthweight (less than 2500 g) (ALL) 4 16143 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.78, 1.00]
2 Low birthweight (less than 2500 g): SUBGROUP ANALYSIS by gestational age at the start of supplementation 4 16143 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.78, 1.00]
2.1 Early gestational age (less than 20 weeks of gestation or pre‐pregnancy) at start of supplementation 3 13817 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.75, 1.11]
2.2 Late gestational age (20 weeks or more of gestation) at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.3 Unspecified or mixed gestational age at the start of supplementation 1 2326 Risk Ratio (M‐H, Random, 95% CI) 0.85 [0.59, 1.22]
3 Low birthweight (less than 2500 g): SUBGROUP ANALYSIS by anaemia status at the start of supplementation 4 16143 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.78, 1.00]
3.1 Anaemic at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
3.2 Non‐anaemic at start of supplementation 2 12554 Risk Ratio (M‐H, Random, 95% CI) 1.04 [0.83, 1.32]
3.3 Unspecified or mixed anaemia status 2 3589 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.72, 0.94]
4 Low birthweight (less than 2500 g): SUBGROUP ANALYSIS by dose of iron 4 16143 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.78, 1.00]
4.1 Low daily dose (30 mg elemental iron or less) 1 11827 Risk Ratio (M‐H, Random, 95% CI) 1.03 [0.81, 1.31]
4.2 Medium daily dose (31 to 59 mg elemental iron) 1 727 Risk Ratio (M‐H, Random, 95% CI) 1.21 [0.57, 2.54]
4.3 Higher daily dose (60 mg elemental iron and above) 2 3589 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.72, 0.94]
5 Low birthweight (less than 2500 g): SUBGROUP ANALYSIS by malarial status of setting 4 16143 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.78, 1.00]
5.1 Malarial setting 3 4316 Risk Ratio (M‐H, Random, 95% CI) 0.84 [0.73, 0.95]
5.2 Non‐malarial setting 1 11827 Risk Ratio (M‐H, Random, 95% CI) 1.03 [0.81, 1.31]
6 Birthweight (g) (ALL) 4 16143 Mean Difference (IV, Random, 95% CI) 19.50 [‐6.90, 45.89]
7 Birthweight (g): SUBGROUP ANALYSIS by gestational age at the start of supplementation 4 16143 Mean Difference (IV, Random, 95% CI) 19.50 [‐6.90, 45.89]
7.1 Early gestational age (less than 20 weeks of gestation or pre‐pregnancy) at start of supplementation 3 13817 Mean Difference (IV, Random, 95% CI) 22.47 [‐18.18, 63.12]
7.2 Late gestational age (20 weeks or more of gestation) at start of supplementation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
7.3 Unspecified or mixed gestational age at the start of supplementation 1 2326 Mean Difference (IV, Random, 95% CI) 20.20 [‐15.13, 55.53]
8 Birthweight (g): SUBGROUP ANALYSIS by anaemia status at the start of supplementation 4 16143 Mean Difference (IV, Random, 95% CI) 19.50 [‐6.90, 45.89]
8.1 Anaemic at start of supplementation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
8.2 Non‐anaemic at start of supplementation 2 12554 Mean Difference (IV, Random, 95% CI) 2.30 [‐11.42, 16.01]
8.3 Unspecified or mixed anaemic status at start of supplementation 2 3589 Mean Difference (IV, Random, 95% CI) 39.61 [‐3.90, 83.13]
9 Birthweight (g): SUBGROUP ANALYSIS by dose of iron 4 16143 Mean Difference (IV, Random, 95% CI) 19.50 [‐6.90, 45.89]
9.1 Low daily dose (30 mg elemental iron or less) 1 11827 Mean Difference (IV, Random, 95% CI) 1.90 [‐12.17, 15.97]
9.2 Medium daily dose (31 to 59 mg elemental iron) 1 727 Mean Difference (IV, Random, 95% CI) 10.0 [‐51.92, 71.92]
9.3 Higher daily dose (60 mg elemental iron and above) 2 3589 Mean Difference (IV, Random, 95% CI) 39.61 [‐3.90, 83.13]
10 Birthweight (g): SUBGROUP ANALYSIS by malarial status of setting 4 16143 Mean Difference (IV, Random, 95% CI) 19.50 [‐6.90, 45.89]
10.1 Malarial setting 3 4316 Mean Difference (IV, Random, 95% CI) 32.23 [0.86, 63.60]
10.2 Non‐malarial setting 1 11827 Mean Difference (IV, Random, 95% CI) 1.90 [‐12.17, 15.97]
11 Preterm birth (less than 37 weeks of gestation) (ALL) 4 16146 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.87, 1.08]
12 Preterm birth (less 37 weeks of gestation): SUBGROUP ANALYSIS by gestational age at the start of supplementation 4 16146 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.87, 1.08]
12.1 Early gestational age (less than 20 weeks of gestation or pre‐pregnancy) at start of supplementation 3 13820 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.88, 1.12]
12.2 Late gestational age (20 weeks or more of gestation) at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
12.3 Unspecified or mixed gestational age at the start of supplementation 1 2326 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.57, 1.09]
13 Preterm birth (less 37 weeks of gestation): SUBGROUP ANALYSIS by anaemia status at the start of supplementation 4 16146 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.87, 1.08]
13.1 Anaemic at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
13.2 Non‐anaemic at start of supplementation 2 12559 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.84, 1.12]
13.3 Unspecified or mixed anaemic status at start of supplementation 2 3587 Risk Ratio (M‐H, Random, 95% CI) 0.93 [0.71, 1.22]
14 Preterm birth (less 37 weeks of gestation): SUBGROUP ANALYSIS by dose of iron 4 16146 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.87, 1.08]
14.1 Low daily dose (30 mg elemental iron or less) 1 11832 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.83, 1.11]
14.2 Medium daily dose (31 to 59 mg elemental iron) 1 727 Risk Ratio (M‐H, Random, 95% CI) 1.26 [0.62, 2.56]
14.3 Higher daily dose (60 mg elemental iron and above) 2 3587 Risk Ratio (M‐H, Random, 95% CI) 0.93 [0.71, 1.22]
15 Preterm birth (less 37 weeks of gestation): SUBGROUP ANALYSIS by malarial status of setting 4 16146 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.87, 1.08]
15.1 Malarial setting 3 4314 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.78, 1.20]
15.2 Non‐malarial setting 1 11832 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.83, 1.11]
16 Neonatal death (within 28 days after delivery) (ALL) 4 16603 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.71, 1.18]
17 Neonatal death (within 28 days after delivery): SUBGROUP ANALYSIS by gestational age at the start of supplementation 4 16603 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.71, 1.18]
17.1 Early gestational age (less than 20 weeks of gestation or pre‐pregnancy) at start of supplementation 3 14108 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.71, 1.42]
17.2 Late gestational age (20 weeks or more of gestation) at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
17.3 Unspecified or mixed gestational age at the start of supplementation 1 2495 Risk Ratio (M‐H, Random, 95% CI) 0.81 [0.56, 1.19]
18 Neonatal death (within 28 days after delivery) : SUBGROUP ANALYSIS by anaemia status at the start of supplementation 4 16603 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.71, 1.18]
18.1 Anaemic at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
18.2 Non‐anaemic at start of supplementation 2 12559 Risk Ratio (M‐H, Random, 95% CI) 0.94 [0.51, 1.77]
18.3 Unspecified or mixed anaemic status at start of supplementation 2 4044 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.65, 1.19]
19 Neonatal death (within 28 days after delivery): SUBGROUP ANALYSIS by dose of iron 4 16603 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.71, 1.18]
19.1 Low daily dose (30 mg elemental iron or less) 1 11832 Risk Ratio (M‐H, Random, 95% CI) 1.10 [0.67, 1.82]
19.2 Medium daily dose (31 to 59 mg elemental iron) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.48 [0.12, 1.91]
19.3 Higher daily dose (60 mg elemental iron and above) 2 4044 Risk Ratio (M‐H, Random, 95% CI) 0.88 [0.65, 1.19]
20 Neonatal death (within 28 days after delivery): SUBGROUP ANALYSIS by malarial status of setting 4 16603 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.71, 1.18]
20.1 Malarial setting 3 4771 Risk Ratio (M‐H, Random, 95% CI) 0.85 [0.63, 1.15]
20.2 Non‐malarial setting 1 11832 Risk Ratio (M‐H, Random, 95% CI) 1.10 [0.67, 1.82]
21 Congenital anomalies (ALL) 2 13586 Risk Ratio (M‐H, Random, 95% CI) 0.78 [0.44, 1.39]
22 Maternal anaemia at term (Hb less than 110 g/L at 37 weeks' gestation or more) (ALL) 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
23 Maternal anaemia at term (Hb less than 110 g/L at 37 weeks' gestation or more): SUBGROUP ANALYSIS by gestational age at the start of supplementation 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
23.1 Early gestational age (less than 20 weeks of gestation or pre‐pregnancy) at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
23.2 Late gestational age (20 weeks or more of gestation) at start of supplementation 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
23.3 Unspecified or mixed gestational age at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
24 Maternal anaemia at term (Hb less than 110 g/L at 37 weeks' gestation or more): SUBGROUP ANALYSIS by anaemia status at the start of supplementation 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
24.1 Anaemic at start of supplementation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
24.2 Non‐anaemic at start of supplementation 1 240 Risk Ratio (M‐H, Random, 95% CI) 0.24 [0.09, 0.61]
24.3 Unspecified or mixed anaemic status at start of supplementation 1 63 Risk Ratio (M‐H, Random, 95% CI) 0.39 [0.23, 0.67]
25 Maternal anaemia at term (Hb less than 110 g/L at 37 weeks' gestation or more ): SUBGROUP ANALYSIS by dose of iron 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
25.1 Low daily dose (30 mg elemental iron or less) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
25.2 Medium daily dose (31 to 59 mg elemental iron) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
25.3 Higher daily dose (60 mg elemental iron and above) 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
26 Maternal anaemia at term (Hb less than 110 g/L at 37 weeks' gestation or more ): SUBGROUP ANALYSIS by malarial status of setting 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
26.1 Malarial setting 1 63 Risk Ratio (M‐H, Random, 95% CI) 0.39 [0.23, 0.67]
26.2 Non‐malarial setting 1 240 Risk Ratio (M‐H, Random, 95% CI) 0.24 [0.09, 0.61]
27 Maternal iron deficiency at term (as defined by trialists, based on any indicator of iron status at 37 weeks' gestation or more) (ALL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
28 Maternal iron‐deficiency anaemia at term (Hb less than 110 g/L and at least one additional laboratory indicators at 37 weeks' gestation or more) (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
29 Maternal death (death while pregnant or within 42 days of termination of pregnancy) (ALL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
30 Side effects (any reported throughout the intervention period) (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 1.10 [0.55, 2.23]
31 Maternal severe anaemia at any time during second and third trimester (Hb less than 70 g/L) (ALL) 3 1047 Risk Ratio (M‐H, Random, 95% CI) 0.06 [0.01, 0.47]
32 Maternal clinical malaria 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
33 Infection during pregnancy (including urinary tract infections) (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 1.21 [0.33, 4.46]
34 Very low birthweight (less than 1500 g) (ALL) 2 1990 Risk Ratio (M‐H, Random, 95% CI) 0.76 [0.28, 2.01]
35 Very premature birth (less than 34 weeks' gestation) (ALL) 2 3053 Risk Ratio (M‐H, Random, 95% CI) 0.58 [0.30, 1.12]
36 Infant Hb concentration in the first 6 months (in g/L, counting the last reported measure after birth within this period) (ALL) 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
37 Infant serum ferritin concentration in the first 6 months (in μg/L, counting the last reported measure after birth within this period) (ALL) 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
38 Admission to special care unit (ALL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39 Maternal anaemia at or near term (Hb less than 110 g/L at 34 weeks' gestation or more) (ALL) 2 303 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.21, 0.55]
40 Maternal iron deficiency at or near term (as defined by trialists, based on any indicator of iron status at 34 weeks' gestation or more) (ALL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
41 Maternal iron‐deficiency anaemia at or near term (Hb less than 110 g/L and at least one additional laboratory indicators at 34 weeks' gestation or more) (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
42 Maternal Hb concentration at or near term (in g/L at 34 weeks' gestation or more) (ALL) 2 771 Mean Difference (IV, Random, 95% CI) 12.44 [0.95, 23.93]
43 Maternal Hb concentration within 6 wk postpartum (in g/L) (ALL) 1 297 Mean Difference (IV, Random, 95% CI) 9.20 [5.78, 12.62]
44 Maternal high haemoglobin concentrations during second or third trimester (Hb more than 130 g/L) (ALL) 2 1042 Risk Ratio (M‐H, Random, 95% CI) 4.33 [2.26, 8.30]
45 Maternal high haemoglobin concentrations at or near term (Hb more than 130 g/L at 34 weeks' gestation or more) (ALL) 2 967 Risk Ratio (M‐H, Random, 95% CI) 1.87 [0.32, 10.84]
46 Moderate anaemia at postpartum (Hb more than 80 g/L and less than 110 g/L) (ALL) 1 353 Risk Ratio (M‐H, Random, 95% CI) 0.38 [0.18, 0.81]
47 Maternal severe anaemia at or near term (Hb less than 70 g/L at 34 weeks' gestation or more) (ALL) 2 773 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
48 Severe anaemia at postpartum (Hb less than 80 g/L) (ALL) 2 386 Risk Ratio (M‐H, Random, 95% CI) 0.08 [0.00, 1.33]
49 Puerperal infection (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.20, 4.75]
50 Antepartum haemorrhage (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 1.35 [0.43, 4.22]
51 Postpartum haemorrhage (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 3.38 [0.71, 16.15]
52 Transfusion provided (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 2.89 [0.12, 70.83]
53 Diarrhoea (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.55 [0.16, 1.87]
54 Constipation (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 1.10 [0.55, 2.23]
55 Nausea (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.47, 1.99]
56 Heartburn (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 1.65 [0.66, 4.15]
57 Vomiting (ALL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
58 Maternal wellbeing/satisfaction (ALL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
59 Placental abruption (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.24, 3.83]
60 Premature rupture of membranes (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.74, 1.34]
61 Pre‐eclampsia (ALL) 1 727 Risk Ratio (M‐H, Random, 95% CI) 3.22 [0.89, 11.59]
62 Mental development index in infants at 3 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
63 Mental development index in infants at 6 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
64 Mental development index in infants at 12 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
65 Mental development index in infants at 18 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
66 Mental development index in infants at 24 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
67 Mental development index in infants at 18 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
68 Psychomotor development index in infants at 3 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
69 Psychomotor development index in infants at 6 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
70 Psychomotor development index in infants at 12 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
71 Psychomotor development index in infants at 24 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]