Maternal Serum Hemoglobin Levels Relative to Anemia Interventions in the COVID-19 era: A systematic review and meta-analysis

AimsThe purpose of this review was to investigate the effect of different types of maternal anemia interventions on serum hemoglobin levels among pregnant cohort of reproductive age during COVID-19 pandemic using a pool of studies conducted with different research designs. MethodsRelevant studies were identified from January 2020 to December 2022 by using MeSH terms in PubMed, Embase, Cochrane Library, Clinical trials, Scopus databases and gray literature. The studies were systematically reviewed, and quality assessments were evaluated by the guidelines of the Cochrane risk of bias. All the statistical analysis was performed on RevMan 5.4.1 software with a random and fixed effect models. Heterogeneity was evaluated with the Cochran Q statistic and Higgins test and publication bias assessed via funnel plots. The cumulative pooled effect of maternal anemia interventions (n = 15) on serum hemoglobin concentration was the main outcome, while effects of specific types of maternal anemia interventions; mode of administration; and the country a study was conducted were derived as secondary outcomes. In total, 6695 pregnant women of reproductive age were established from the entire pool of studies. Mean serum hemoglobin levels data were retrieved alongside their standard errors for ascertaining the effect of the said maternal anemia interventions on hemoglobin levels using f standard mean and mean differences during meta-analysis. The review component was part of registered PROSPERO: CRD-CRD42023410657:[ ResultsFifteen studies met the inclusion criteria, with the current study findings proposing that, maternal anemia interventions in overall improved serum hemoglobin levels [SMD (95% CI) = 0.93 [0.57, 1.30]; Heterogeneity: Tau-squared = 0.50; Chi-squared = 627.07, df = 14 (P < 0.00001); I-squared = 98%. The effect of specific intervention categories was; dietary iron supplement 1.16 [95% CI = -0.97, 3.28], education information 0.75 [95% CI = 0.12, 1.37], Intravenous ferric carboxy-maltose 1.33 [95% CI = 0.28, 2.38], intravenous iron sucrose 0.82 [95% CI = 0.56, 1.09] and herbal substances 0.42 [95% CI = 0.24, 0.61]. Dietary iron supplementation didnt demonstrate an improvement on hemoglobin levels (Test for overall effect: Z = 1.07 (P = 0.29). Parenterally given and via education administered interventions had better utility on hemoglobin concentrations with maternal anemia interventions among developing countries showing insignificant effect on maternal serum hemoglobin levels. ConclusionCurrent review concluded that maternal anemia interventions had a utility on serum hemoglobin, more feasible, those given as injections. Notably, dietary iron interventions were compromised especially in developing nations during COVID-19 pandemic. Multifaceted further clinical studies are crucial to substantiate current findings.