Effect of and Interventions in Prevention and Management of Maternal Anemia in the Advent of COVID-19

Abstract

BackgroundThere were many unknowns for pregnant women during the COVID-19 pandemic. Most of these could have been silent however lethal and anemic conditions could escalate the worsening of pregnancy outcomes. Existing evidence indicate that, array of factors is associated with the ability of compromising maternal anemia, some directly and others indirectly.ObjectiveThis review aimed at ascertaining the pooled effect of several anemia interventions. Specifically, the aim of this study was to establish if pregnancy status is associated with COVID-19 severity characterized by a cytokine storm.MethodsWe searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to studies suitable for inclusion in this meta-analysis. Studies examining women of reproductive age on any maternal anemia intervention were included. The risk of bias was assessed using the Cochrane risk of bias tool. Review Manager 5.4.1 was used to calculate rate ratios (RRs) with 95% CIs, which were depicted using forest plots. Quantitative variables were summarized in total numbers and percentages. The effect on prevention, control, management and or treatment of anemia was calculated and compared between the intervention and the comparator arms. Heterogeneity was evaluated with the Cochran Q statistic and Higgins test.ResultsA total of 11 articles including data for 6,129 were included. With sensitivity analysis, the interventions had a utility of 39% on maternal anemia prevention and management (random effects model RR 0.61, 95% CI 0.43, 0.87;P= 0.006) (χ26=286.98, P<.00001; I2=97%). All the interventions against maternal anemia showed an effect of 17% (fixed-effect model RR 0.83, 95% CI 0.79-0.88; P<.00001) (χ24=2.93, P=0.57; I2=0%). Education to pregnant women showed a 28% effect (RR 0.72 95% CI 0.58, 0.89), medicinal administration 19% (RR 0.81 95% CI 0.73, 0.90), iron supplementation 17% (RR 0.83 95% CI 0.75, 0.92) and I.V Ferric Carboxy-maltose 15% (RR 0.85 95% CI 0.74, 0.97) (I2= 0%). Interventions in African region had a higher (16%) and significant effect compared to other regions (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.001) (χ25=176.53, P<.00001; I2=97%). Multiple center studies had a significant predictive effect (16%) compared to single center studies (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.00001)(χ25=176.53, P<.00001; I2=97%). The year 2020 recorded the highest effect of maternal anemia interventions at 28% (random-effects model RR 0.72, 95% CI 0.67-0.78; P<.00001) (χ23=167.34, P<.00001; I2=98%)ConclusionIn the advent of COVID-19, maternal anemia interventions were compromised demonstrated by a low effectiveness trend from the year 2020 to the year 2022. During this period, even the most effective and recommended interventions against maternal anemia were somehow affected.