Background & Aims: Iron-folic acid (IFA) supplementation is widely recommended as both a preventive and therapeutic measure for pregnant women. Despite its widespread use, there is limited research exploring adherence to IFA supplementation during pregnancy and its impact on maternal and neonatal outcomes. This study aims to assess the effectiveness of IFA supplementation in improving pregnancy and neonatal outcomes. Methods: A comprehensive search on PubMed, Google Scholar, EMbase and Trip databases was conducted for relevant studies published up to May 31, 2024. Outcomes measured were preterm birth (PTB), low birth weight (LBW), neonatal mortality, perinatal mortality, small for gestational age (SGA) and stillbirth. Pooled risk ratios (RRs) with 95% confidence intervals (CIs), sensitivity analysis, publication bias, trial sequential analysis and quality assessment of the included studies were performed. Results: Eleven studies involving a total of 42,458 pregnant women who received IFA supplementation and 16,351 women who received folic acid (FA) alone or Control (no supplementation) were included. A significant reduction in overall neonatal mortality (RR = 0.73, 95% CI: 0.61–0.87) as well as in subgroup analyses (IFA vs. control and IFA vs. FA) was observed. However, a decrease in incidence of LBW was noted only in IFA vs. control group (RR = 0.79, 95% CI: 0.69–0.90). No significant association was found for overall LBW (RR = 0.48, 95% CI: 0.08–2.76), PTB (RR = 0.56, 95% CI: 0.09–3.50), perinatal mortality (RR = 0.85, 95% CI: 0.69–1.04), SGA (RR = 0.98, 95% CI: 0.86–1.12) and stillbirth (RR = 0.75, 95% CI: 0.48–1.16) when comparing to IFA vs. control and IFA vs. FA group. Conclusions: Our findings provide strong evidence supporting the effectiveness of IFA supplementation in reducing neonatal mortality and LBW among pregnant women, highlighting its importance in prenatal care.
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