The influence of maternal anemia on neonatal neurodevelopment: a systematic review and meta-analysis

Maternal anemia, particularly iron deficiency anemia (IDA), is a significant global health concern, affecting approximately 30% of women worldwide. Iron plays a crucial role in fetal brain development, influencing processes such as myelination, neurotransmitter synthesis, and oxygen transport. Despite theoretical links between prenatal iron deficiency (ID) and neurodevelopment, its actual effects on neonatal cognitive, motor, and socioemotional outcomes remain unclear. This study systematically evaluates the impact of maternal anemia on neonatal neurodevelopment.

A systematic literature review was conducted using PubMed, Scopus, and Web of Science, covering studies published until December 2024. Keywords related to prenatal ID, maternal anemia, and neonatal neurodevelopment were used. Eligible studies focused on maternal iron levels and neonatal outcomes, excluding animal studies, non-English publications, and reviews. Out of 1,388 screened articles, 6 studies were selected for meta-analysis. Data were synthesized using standardized methods, and pooled effect sizes were calculated. Study quality was assessed using the Newcastle-Ottawa Scale.

The meta-analysis included 6 studies, with sample sizes ranging from 178 to 636 participants. Neonatal outcomes were assessed using the Neonatal Behavioral Assessment Scale (NBAS), Bayley Scales of Infant Development, and Mullen Scales of Early Learning. No significant correlation was found between maternal anemia and neonatal outcomes, including habituation (P = 0.93), orientation (P = 0.76), state regulation (P = 0.90), motor maturity (P = 0.71), autonomic stability (P = 0.10), early learning composite (P = 0.65), and gross motor skills (P = 0.59). Heterogeneity was low to moderate, and no significant publication bias was detected. Variability in iron supplementation did not yield consistent benefits.

Maternal anemia does not significantly impact early neonatal neurodevelopment. While additional studies are unlikely to reveal meaningful effects during the neonatal period, the potential for delayed or long-term neurodevelopmental impacts remains uncertain and warrants further longitudinal research.