Abu Hashim H, et al. - The effectiveness of daily oral bovine lactoferrin versus daily oral ferrous iron preparations for the treatment of iron deficiency anemia (IDA) amid pregnancy was examined in this study. According to the outcome obtained, daily oral bovine lactoferrin is just as good as ferrous sulfate in improving hematological parameters with fewer gastrointestinal side effects for pregnant women with iron deficiency anemia. Thereby, lactoferrin was recommended as the iron replacement agent of choice for the treatment of IDA in pregnancy.

• For this study, they designed a meta-analysis of randomized trials.
• They searched PubMed, ScienceDirect, ClinicalTrials.gov and CENTRAL databases from inception to February 2017.
• The bibliographies of retrieved articles were screened in this study.
• In this study, the PRISMA Statement was followed.
• They included published English dialect randomized trials comparing lactoferrin with oral ferrous iron preparations in pregnant women with iron deficiency anemia.
• Quasi-randomized, non- randomized or studies including other known cause of anemia, gestational or pre-existent maternal diseases were not included.
• Accordingly, 4 eligible trials (600 women) were examined.
• Primary outcome was changed in hemoglobin level at 4 weeks of treatment.
• Secondary outcomes were; change in serum ferritin and iron, rates of gastrointestinal side effects, preterm birth, low birthweight, neonatal death and mean birthweight.
• A quality assessment was performed by the Cochrane risk of bias tool.
• Odds ratio and mean difference was utilized to integrate dichotomous and continuous outcomes respectively.
• Pooled estimates for change in hemoglobin levels at four weeks favored daily oral lactoferrin over daily oral ferrous sulphate (mean difference 0.77; 95% confidence interval [CI] 0.04-1.55; P = 0.04, 4 trials, 600 women).
• However, after subgroup examination (degree of anemia), no significant difference in hemoglobin levels were seen between both groups in mild anemia (mean difference 0.80; 95% CI -0.21 to 1.82, 3 trials, 372 women), but a significant increase favoring lactoferrin was noted in moderate anemia (mean difference 0.68; 95% CI 0.53-0.83; P < 0.00001, one trial, 228 women).
• Significantly less gastrointestinal side effects were reported with lactoferrin treatment.
• There is no significant differences existed with regard to other outcomes.