Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnancy: A Systematic Review for the U.S. Preventive Services Task ForceFREE
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Abstract
Background:
Purpose:
Data Sources:
Study Selection:
Data Extraction:
Data Synthesis:
Limitations:
Conclusion:
Primary Funding Source:
Methods
Supplementation
Screening
Data Sources
Study Selection
Data Abstraction and Quality Rating
Data Synthesis and Analysis
Role of the Funding Source
Results
Effectiveness of Routine Iron Supplementation in Pregnancy
Maternal Clinical Outcomes
Infant Clinical Outcomes
Maternal Intermediate Outcomes
Infant Intermediate Outcomes
Harms of Routine Iron Supplementation in Pregnancy
Screening for IDA
Discussion
References
Comments
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Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnancy: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med.2015;162:566-576. [Epub 21 April 2015]. doi:10.7326/M14-2932
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Routine Iron supplementation in pregnancy
To clarify, the studies in our analysis were randomized controlled trials; no observational studies were included in our results. Therefore, the exposure in the treatment group for the trials was the actual supplements, not the prescription.
We agree with Dr. Kane that it is helpful to understand the intention to treat approach to assess the benefit of iron supplementation, but also believe that to fully understand the outcomes of the trials we also need to make a distinction between the efficacy of the intervention and the effectiveness. We were reporting on effectiveness of prenatal iron supplementation, not the efficacy. In evaluating efficacy of an intervention, adherence to the assigned regimen is required as a part of the study concept. However, in evaluating effectiveness, real-world adherence, similar to using the intention to treat analysis, provides the most accurate picture. While adherence may certainly contribute to the effectiveness of iron supplementation, any issues related to lack of adherence is an assumed limitation of supplementation trials in general.
References:
1. Cantor AG, Bougatsos C, Dana T, Blazina I, McDonagh M. Routine Iron Supplementation and Screening for Iron Deficiency Anemia in Pregnancy: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162:566-576. doi:10.7326/M14-2932
2. Meier PR, Nickerson HJ, Olson KA, Berg RL, Meyer JA. Prevention of iron deficiency anemia in adolescent and adult pregnancies. Clin Med Res. 2003;1(1):29-36. PMID: 15931282.
Routine iron supplementation in pregnancy
Iron supplementation in pregnancy