Gaps in the evidence for prevention and treatment of maternal anaemia: a review of systematic reviews.
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.
Department of Obstetric Anaesthesia, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9BQ, UK. jacquismail@gmail.com
Jacqui A
JA
Parker
Filipa
F
Barroso
Simon J
SJ
Stanworth
Helen
H
Spiby
Sally
S
Hopewell
Carolyn J
CJ
Doree
Mary J
MJ
Renfrew
Shubha
S
Allard
D000740:Anemia / Q000517:prevention & control / Q000628:therapy*; D018798:Anemia, Iron-Deficiency / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control / Q000628:therapy*; D000078202:Systematic Reviews as Topic; D014131:Trace Elements / Q000008:administration & dosage
D014131:Trace Elements; D007501:Iron