Watt Archie, Eaton Holden, Eastwick-Jones Kate, Thomas Elizabeth T, Plüddemann Annette
Oxford Medical School, Medical Sciences Division Office, Level 3 Academic Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom.
Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
Fam Pract. 2025 Jan 17;42(1). doi: 10.1093/fampra/cmae079.
Iron deficiency during pregnancy poses a significant risk to both maternal and foetal health. Current international guidelines provide discrepant advice on antenatal iron supplementation for non-anaemic women.
We aimed to quantify the benefits and harms of routine antenatal supplementation in non-anaemic women.
The Cochrane Library, MEDLINE, Embase, and clinical trial registries were searched for randomized controlled trials and observational studies comparing oral iron supplementation with placebo or no supplement in non-anaemic pregnant women. Risk of bias was assessed for each study and the results were synthesized via meta-analysis.
Twenty-three eligible studies were identified with 4492 non-anaemic pregnant women. Supplemented groups had higher haemoglobin [mean difference = 6.95 g/l, 95% confidence interval (CI): 4.81-9.09, P < .001, moderate certainty, I2 = 91%] and ferritin (mean difference = 12.22 ng/ml, 95% CI: 6.92-17.52, P < .001, moderate certainty, I2 = 87%) and were at lower risk of anaemia (relative risk = 0.50, 95% CI: 0.34-0.74, P < .001, high certainty, I2 = 42%, number needed to treat (NNT) = 10). There was no difference in birth weight, preterm birth, and rate of caesarean section. Reporting on harms was inconsistent and there was insufficient evidence to determine an association between iron supplements and any negative outcome.
Prophylactic iron supplementation likely results in a large reduction in maternal anaemia during pregnancy. Future research should qualify the impact of this benefit on women's quality of life and determine which subpopulations benefit most. Evidence surrounding the harms of iron supplementation in the non-anaemic population is poor quality and inconsistent. Randomized controlled trials quantifying the risk of gastrointestinal (GI) disturbance and iron overload are essential to inform iron supplement use and reduce unwarranted variations in international guidelines.
孕期缺铁对母婴健康均构成重大风险。当前国际指南对于非贫血女性的产前铁补充给出了不一致的建议。
我们旨在量化非贫血女性常规产前补充铁剂的益处和危害。
检索考克兰图书馆、MEDLINE、Embase及临床试验注册库，查找比较非贫血孕妇口服铁补充剂与安慰剂或不补充铁剂的随机对照试验和观察性研究。对每项研究进行偏倚风险评估，并通过荟萃分析汇总结果。
共纳入23项符合条件的研究，涉及4492名非贫血孕妇。补充铁剂组的血红蛋白水平更高[平均差值 = 6.95 g/L，95%置信区间（CI）：4.81 - 9.09，P <.001，中等确定性，I² = 91%]，铁蛋白水平也更高（平均差值 = 12.22 ng/ml，95%CI：6.92 - 17.52，P <.001，中等确定性，I² = 87%），且患贫血的风险更低（相对风险 = 0.50，95%CI：0.34 - 0.74，P <.001，高确定性，I² = 42%，需治疗人数（NNT） = 10）。出生体重、早产及剖宫产率无差异。关于危害的报告不一致，且没有足够证据确定铁补充剂与任何负面结果之间的关联。
预防性铁补充剂可能会大幅降低孕期母亲贫血的发生率。未来研究应明确这种益处对女性生活质量的影响，并确定哪些亚组人群获益最大。关于非贫血人群补充铁剂危害的证据质量差且不一致。量化胃肠道（GI）紊乱和铁过载风险的随机对照试验对于指导铁补充剂的使用及减少国际指南中不必要的差异至关重要。
