Effects of Interventions for the Prevention and Management of Maternal Anemia in the Advent of the COVID-19 Pandemic: Systematic Review and Meta-Analysis.

Abstract

Background: The COVID-19 pandemic presented many unknowns for pregnant women, with anemia potentially worsening pregnancy outcomes due to multiple factors.

Objective: This review aimed to determine the pooled effect of maternal anemia interventions and associated factors during the pandemic.

Methods: Eligible studies were observational and included reproductive-age women receiving anemia-related interventions during the COVID-19 pandemic. Exclusion criteria comprised non-English publications, reviews, editorials, case reports, studies with insufficient data, sample sizes below 50, and those lacking DOIs. A systematic search of PubMed, Scopus, Embase, Web of Science, and Google Scholar identified articles published between December 2019 and August 2022. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool for randomized trials and the National Institutes of Health's assessment tool for observational studies. Pooled rate ratios (RRs) with 95% CIs were calculated in Review Manager 5.4.1. Synthesis included subgroup analysis, meta-regression, and publication bias checks to assess intervention effectiveness.

Results: This meta-analysis included 11 studies with 6129 pregnant women. Of these, 3591 (59%) were in the intervention group and 2538 (41%) were in the comparator group. Effects were recorded for 1921 (53.4%) women in the intervention group and 1350 (53.1%) in the comparator group. The cumulative impact ranged from 23% to 81%, averaging 56%. The initial analysis showed no significant effect on anemia prevention (RR 0.79, 95% CI 0.61-1.02; P=.07), with high heterogeneity (I²=97%). Sensitivity analysis excluding 4 outlier studies improved the effect size to a significant level at 39% (RR 0.61, 95% CI 0.43-0.87; P=.006). Subgroup analysis revealed substantial heterogeneity (I²=87.2%). Intravenous sucrose had a poor impact (RR 1.31, 95% CI 1.17-1.47; P<.001), while medicinal or herbal interventions showed benefit (RR 0.81, 95% CI 0.73-0.90; P=.006). Educational interventions yielded a 28% effect (RR 0.72), medicinal administration 19% (RR 0.81), iron supplementation 17% (RR 0.83), and intravenous ferric carboxylmaltose 15% (RR 0.85; P<.02). Additional sensitivity analysis confirmed a pooled positive effect of 17% (RR 0.83, 95% CI 0.79-0.88; P<.001), with minimal heterogeneity (I²=0%). Regionally, effectiveness was highest in Africa (RR 0.84, 95% CI 0.79-0.89; P<.001). Multicenter studies and those with 2020 data were predictive of better outcomes (RR 0.84 and RR 0.50, respectively). Despite initial heterogeneity and publication bias, interventions showed utility in mitigating maternal anemia in targeted subgroups and regions.

Conclusions: Maternal anemia interventions during the COVID-19 pandemic showed modest, context-specific effectiveness, with declining impact from 2020 to 2022. Although high heterogeneity and study inconsistencies limited generalizability, significant benefits were observed particularly in African and multicenter studies. The pandemic exposed gaps in maternal health systems, emphasizing the need for tailored interventions, stronger data infrastructure, and resilient care strategies in future global crises.