Systematic reviewindependent cross-checkabstract checked I-SUP-109 standard review
Treating iron-deficiency anaemia in pregnancy
Treatments for iron-deficiency anaemia in pregnancy.
Overview
Reveiz L et al.. Cochrane Database Syst Rev 2011 · PMID 21975735 · DOI 10.1002/14651858.CD003094.pub3
Iron tablets improved blood counts in anaemic pregnant women but often upset the stomach; good trials on outcomes for mother and baby are scarce.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
To compare treatments for iron-deficiency anaemia in pregnancy.
- How was the study done?
Cochrane review of 23 trials.
- How many people, animals or samples were studied?
3,198 women.
- What was actually found?
Oral iron improves blood values; side effects common; little data on clinical outcomes.
- How large was the observed effect?
Anaemia RR 0.38 (0.26-0.55) in one trial.
- What do the results mean in everyday life?
Iron works to correct anaemia, but side effects need managing.
- What are the study's limitations?
Small, weak trials.
- What does it say about Elawady's specific claim?
Contradicts withholding iron from anaemic pregnant women; acknowledges side effects.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot show the best dose or route.
Scientific in-depth review
1. Full reference
- Authors
- Reveiz L et al.
- Journal
- Cochrane Database Syst Rev
- Year
- 2011
- Identifier
- PMID 21975735 DOI 10.1002/14651858.CD003094.pub3 · PMC12989263
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
none Crossref update-to: new version of an earlier Cochrane review (not a retraction).
- Extent checked
- abstract only
- Conflicts of interest and funding
COI statement in record: Ludovic Reveiz and Luis Gabriel Cuervo have contributed to this systematic review in a personal capacity and during their spare time. Most of their contributions were made before joining the Pan American Health Organization. The Pan American Health Organization does not assume responsibility for the
2. Research question
Effects of treatments for iron-deficiency anaemia in pregnancy on maternal and neonatal outcomes.
3. Study design and population
- Study design
- Systematic review – Cochrane systematic review of randomised trials of treatments for iron-deficiency anaemia in pregnancy
- Population
Pregnant women with anaemia attributed to iron deficiency (Hb <11 g/dL)
- Country
Multinational (many low-income countries)
- Period
Search to June 2011
- Sample size
23 trials, 3,198 women
- Inclusion and exclusion criteria
RCTs comparing treatments for IDA in pregnancy
4. Methods and endpoints
- Exposure / intervention
Oral, intramuscular or intravenous iron
- Comparator
Placebo or other iron regimens
- Endpoints
Haematological indices; maternal and neonatal morbidity and mortality; adverse effects
- Statistical methods
Meta-analysis where possible
5. Actual results
- Results
Trials generally small and methodologically poor. Oral iron reduced the incidence of anaemia (RR 0.38, 0.26-0.55; one trial, 125 women) and improved haematological indices vs placebo (two trials). Dose related to adverse effects; parenteral iron improved indices more than oral but clinical outcomes and safety were insufficiently assessed. Daily low-dose iron may treat anaemia with fewer gastrointestinal effects.
- Absolute risks
not reported in abstract
- Authors' conclusion
Daily oral iron improves haematological indices but causes frequent gastrointestinal adverse effects; good-quality trials with clinical outcomes are lacking.
6. Strengths
- Directly addresses treatment of diagnosed anaemia
7. Weaknesses
- Small, poor-quality trials
- Few clinical outcomes
- Old search
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Review is sound; included trials weak.
9. Assessment of the statistical interpretation
Effect on haematological indices is clear; effect on clinical outcomes unknown.
10. Relevance to the specific claim
Directly relevant population (anaemic pregnant women): iron corrects anaemia, with GI side effects; clinical-outcome evidence is weak.
11. Independent contrary findings
Gastrointestinal adverse effects are common; partly supports concerns about side effects (not a reason to withhold treatment).
12. Transferability to Germany and Europe
Applicable.
13. Overall methodological judgement
Supports iron treatment for correcting anaemia; highlights evidence gaps on clinical outcomes and side effects.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | low |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Optimal dose and route.
15. Linked fact checks
- There is no such thing as iron supplements: they are forbidden even for a pregnant woman with anaemia, because a diet that needs supplements is deficient. – Studies contradicting or limiting the claim