Anemia is prevalent among pregnant women, especially in developing countries. It can lead to health issues for both mother and baby like preterm birth. Providing community education to pregnant women on foods rich in iron and other nutrients may help reduce anemia and its risks. However, more evidence is still needed on the effectiveness of such educational interventions. This systematic review aims to evaluate the impact of community education in improving diets and reducing anemia and preterm birth rates among pregnant women.

1. [From 10$/Pg] Included Studies Study Id
[From 10$/Pg] Included Studies Study Id Description of the Problem Anemia is a condition
that happens when the hemoglobin level within the body is lower than the level supposed
to be. This, in turn, leads to a decreased level of oxygen being carried to the parts of the
body and also a lower case of red blood cells to other tissues. Anemia is prevalent in
affecting a wide group range of people; however, pregnant women and children are the
most prevalent ones. In a study carried out by (Stevens et al.), they reported that the
prevalence of anemia in non-pregnant women, pregnant women, and children is 29, 38, and
43%, respectively. Furthermore, in a study carried out by the WHO, in pregnant women,
anemia has been labeled with a level <110g/L. However, other sources have also showcased
that anemia is more prevalent in developing countries which have recorded 43% cases, as
to developed countries which have recorded 9% cases. However, anemia has been linked to
affecting people with different lifestyles and social-economic factors which differ from the
different cultures. One of the most common complications during pregnancy is anemia. It is
frequently regarded as a risk factor for unfavorable pregnancy outcomes and may lead to
issues like premature birth that endanger both the mother and the fetus’s lives. According
to global statistics, up to 56% of pregnant women who have recorded cases of anemia are
from countries that are still developing. However, its prevalence is higher in pregnant
women. Read more on this topic at nursing expert writers. The pregnancy chances of
preterm birth have been linked more with pregnant women who have reported to have
anemia as to pregnant women who do not have anemia. The impaired immune which the
mother is subjected to as a result of anemia, and increased cardiac diseases can increase the
chances of preterm birth and also other complications that lead to stillbirths. Furthermore,
preterm births have also been recorded to be among the leading cause of neonatal deaths.
With such increased death rates, it raises the need to be a public health issue within the
health sector. The increased costs that hospitals have to incur while taking care of the
preterm babies, has made treatment to be more expensive as the hospitals need extra costs.
Considering that it is the goal of many hospitals to reduce the cost of treatment being used,
there is also the need to reduce the cause of preterm births, which have been linked to being
from Anemia in Pregnant women. Causes of the problem The amount of blood rises during
pregnancy. Therefore, in order to produce more red blood cells, more iron and vitamins are
required. Anemia can be brought on by a lack of iron. Although the red blood cell count
drops very low, it’s not regarded as odd. The baby utilizes the mother’s red blood cells
during pregnancy for development and growth, especially in the final three months. The

2. body can utilize any excess red blood cells that are present in the bone marrow before
becoming pregnant. Iron-deficiency anemia can develop in women who don’t have enough
iron reserves. Pregnancy-related anemia of this kind is the most prevalent. Prior to
becoming pregnant, it’s crucial to eat healthfully to assist build up these reserves. Protein
and red blood cells are produced with the help of vitamin B-12. Vitamin B-12 deficiency can
be avoided by eating foods derived from animals, such as milk, eggs, meats, and poultry.
Vegan women are most prone to suffer from a vitamin B-12 shortage than other groups of
women. During pregnancy, strict vegans may require doses of vitamin B-12. B vitamin folic
acid, often known as foliate, helps in cell growth when combined with iron. Iron deficiency
may result from a lack of folate when pregnant. In the first trimester it is important for the
mother to consume the folic acid as it will help in the development of the baby and also
help the baby evade abnormalities within the spine and the brain. An alternate explanation
is that iron deficiency makes erythrocytes and the fetoplacental unit more susceptible to
oxidative damage. A key risk factor for preterm birth is maternal infections, which can boost
the formation of CRH. Iron deficiency may also raise the risk of these infections. A vitamin
B12 deficiency may increase the chance of birth malformations such as malformed neural
tubes and premature labor in pregnant women who don’t consume meat, poultry, dairy
products, or eggs. Impact of the problem Health Impacts Anemia has several impacts on the
health of the baby and also the health of the mother. Anemia in pregnancy is associated with
difficulties in breathing, fainting, and feeling tired easily. Mothers with Anemia have also
been associated with having high risks of developing perinatal infections, preeclampsia, and
also bleeding. In a study carried out by (Moreno-Fernandez & Diaz-Castro, 2019), he also
reports that some of the mothers who had anemia showed postpartum cognitive
impairments and behavioral difficulties. Anemia during pregnancy prevents the body from
receiving enough oxygen-rich blood. They may feel exhausted or weak due to the lack of
oxygen. Additionally, they could experience headaches, dizziness, shortness of breath, and
an irregular heartbeat (Kang & Sunwoo, 2020). On the child, anemia can persist and cause
Developmental delays and behavioral issues like reduced motor activity, social interaction,
and task-focused attention. Numerous studies reveal that iron shortage increases the risk of
mild or moderate mental retardation, even if it has not yet developed to the point of Anemia
(Safiri & Grieger, 2021). Through pregnancy, there are higher chances of affecting the
maternal and fetal wellbeing, which can then proceed to the death of the baby. Having
anemia during pregnancy has also been linked with low birth weights, which can also affect
the survival chances of the baby too. Iron has been named to be a key factor in the
development of the fetus. Iron is important in facilitating the production of new red blood
cells, brain cells, and also muscle development. If the baby does not get enough iron which is
supposed to come from the mother, there are higher risks that the baby might fail to have
enough red blood cells, which can lead to conditions such as anemia. Economic
impacts Anemia in pregnant women that leads to preterm birth has health effects and also
economic effects that have become a global concern. This health condition has been linked
with affecting the global economy both directly and indirectly. Preterm births have been
associated with a cost of $26 billion venery year. This is due to the fact that babies that have
been born even a week earlier have higher rates of being hospitalized. These babies will

3. currently develop breathing problems that need to be responded to quickly. However, there
is also another study carried out by (Walani, 2020), who concludes that up to 15 million
babies are born prematurely based on yearly statistics. Of the 1 million numbers that die, up
to 75% could have been saved if the current cost-effective intervention were available to all.
This shows that even the amounts that are being produced by the WHO for the premature
babies to be taken care of are not enough, which leaves others to suffer more. This has put
pressure on the World Bank to further look into and provide more money to take care of
premature babies. With such, it then conforms that the World Bank is suffering financially
while struggling to ensure that they are meeting the finical demands raised. In statistics,
children who are not born prematurely may need one or two days in the hospital; however,
the children who have been born prematurely tend to stay longer in hospitals (Maier &
Zeitlin, 2018). This shows that the medications and also oxygen for some who are not able
to breathe on their own will have to be catered for by the hospitals. Instead, if they could
have been born mature, then their medications could have been used for other
purposes. Intervention description and how it works Offering education to women who are
trying to conceive and also those who are pregnant on the importance of ensuring that they
take foods that will help them have high folic acids and also have a high level of Vitamin C
will help reduce the cases of anemia in pregnancy. However, this strategy requires high
financial support from the global perception. To offer education, there will be the need for
more health practitioners who will take the roles of offering education. This will also mean
that there will be more enrollments in the colleges to meet the demand. According to
studies done by (Saepul & Platini, 2019), many women claim that they do not take foods
rich in iron as they do not know which foods they are supposed to take to help them. In
developing countries, many families have not invested in taking balanced diets. This has
been associated with the fact that even though some might know the constitutes of a
specific food, they could not even be in a position to afford them. However, offering
education and also aligning along with more finances that are to support such poor families
in helping them have a balanced diet could help reduce the cases. Considering that after the
education, many of the people will know how serious the issue of anemia is in pregnancy
shows that it will have achieved success as people will focus more on taking the foods,
which they will have been educated on that can help them. This, in turn, will lead to reduced
rates of anemia cases as high nutrition and even healthier babies will be born, reducing the
extra costs that the World Bank submits to taking care of preterm babies. The rationale for
conducting this systematic Review The urgency of having the current systematic review on
the increase in chances of having preterm birth as a result of anemia in pregnancy has
raised the need to be familiar with anemia during pregnancy. This has also been associated
with the fact that there is currently not enough evidence. Furthermore, there is also not
enough evidence that the mothers will react well to the education to be offered to them
about taking foods with a high level of iron that is to help them reduce the chances of
anemia while pregnant; this review has been chosen to ensure that the gap that exists in the
literature has been filled. In previous studies, offering clinical books to mothers’ that
contain educational information about the dangerous effects of anemia in pregnancies has
been tackled. However, the literature has not considered the best educational ways that

4. they can employ. According to (Aston & Paynter, 2021), it has been reported that many
mothers look for the book when they are going to appointments, and when they come back,
they don’t bother reading them. (Graham, 2018) This further supports them as a large
portion of the population believes that the books are for the medical practitioners to fill in
data. However, some research (Indonesia, 2020) proves that the expectant mothers who
take the notes from the book seriously end up recording healthy pregnancies. Many studies
have, however, claimed that many of the women who are affected by anemia in pregnancies
come from poor countries, and they cannot afford a balanced diet. However (Herforth &
Masters, 2020) other literature has proved that for someone to record a balanced diet, they
do not necessarily have to go through high costs of expenditures; instead, the major
problem is that the women do not know what to eat and what benefits the basic food that
they can afford have to their bodies. With such gaps existing in literature, this research is
aiming at filling the gaps. Aims and Objectives The researcher underrating this review has
had five years of working in the maternal departments, where many cases of preterm birth
have been reported with the association of the mother having anemia. Considering the
reviewer’s previous background, many of the mothers do not know how to help boost their
immunities by taking. However, the organization of communal education to the mothers on
the basic foods that can help them improve their iron deficiency without them having to go
an extra coin will help solve eth challenge. Hence with this at hand, the research is aiming at
reviewing the effectiveness of offering communal education to mothers on how they can
balance their diet to ensure they fight iron deficiency during pregnancies. The main
objectives are: To review the effectiveness of communal education to help boost iron
deficiency in pregnant mothers by reducing preterm births. To review the
main cause of anemia in preterm births. LITERATURE REVIEW Up to half of women
experience anemia during pregnancy, the most noticeable hematological manifestation of
pregnancy that mostly affects those of low class position globally. In affluent nations like
Australia, the United States, the United Kingdom, and Germany, the number of anemia in
women reported ranges from 9% to 51% (Baldi & Pasricha, 2020), (Malinowski & Daru,
2019). These statistics stand in contrast to those of developing nations like Ghana, Sudan,
Nepal, Bangladesh, Pakistan, and India, as the prevalence of anemia ranges from 44% to 81
% (Baig-Ansari & Goldenberg, 2008).). Between 40 and 72 percent of the load is shared
across the states in India (Sohail & Raziuddin, 2015). Jharkhand has one of the highest
recorded rates of anemia during pregnancy, just over 71 percent of any Indian state (Iips,
2017). Previously published data shows substantially higher prevalence in the state, with
pregnant and postpartum women experiencing 86 percent and 72 percent, respectively. A
worldwide issue for mothers and babies, anemia during pregnancy and in labor results in
roughly 115,000 deaths and 590,000 perinatal infant deaths each year (Feleke & Feleke,
2018). Due to compromised immunity and differences in hormonal orchestration, anemia
during pregnancy and delivery increases the risk of bleeding, labor difficulties, and
abnormal delivery, as well as infection to both the mother and growing embryo (Robinson
& Klein, 2012). In the majority of developing nations, especially in south-east Asia, the
significant effects of anemia during pregnancy include gestational problems, maternal
deaths, low birth weight, and bad birth outcomes (Rahman & Shibuya, 2016). Anemia

5. remains a mystery for pregnant and giving challenges to mothers from countries that are
developing as India (Branca & Mustafa, 2014), despite advancements in obstetric
technology, successes in MCH-related difficulties, and nutritional awareness in MCH
campaigns for the last ten years. However there have been many interventions developed
with the aim of boosting the heath of pregnant mothers, but still 15 million babies are born
preterm each year, and their commonness is a worldwide epidemic, especially in countries
that are developing (Iams & Goldenberg, 2008). The risk of unfavorable outcomes for both
mothers and newborns is increased by anemia, which has long been recognized as a sign of
both inadequate nutrition and deteriorating health in general among women. Maternal
anemia poses a risk for preterm birth, and also a number of further prenatal problems,
including the possibility of miscarriages, stillbirths, intrauterine growth restriction, and
postpartum hemorrhage. These difficulties are brought on by a disturbed physiological
balance as well as a buildup of gynecological and obstetric variables. Preterm deliveries, low
birth weight, reduced hemoglobin concentration, and maternal mortality has all been
associated with maternal anemia throughout pregnancy and delivery. There have been
conflicting reports about how maternal anemia contributes to poor birth outcomes and low
birth weight. Anemia during pregnancy and in postpartum women has been linked to
preterm delivery, low birth weight, and maternal death, according to certain authors (Steer,
2020), whereas other authors have reported an increased risk of premature and low birth
weight. Unfortunately, despite improvements in obstetric equipment, a variety of current
public health and health check measures, with the years of preterm study, India is among
the countries with major challenges in preterm births. Preterm births and low birth weight
remain to have a major negative impact on the cost of maternity and child health (MCH)
care in this nation (Interventions, 2012). If India intends to get better its record for mother
and child wellbeing, it must address the issue of unfavorable birth outcomes, particularly
PTB, in light of its scope, associated illness, and associated death. Rarely has the relationship
between maternal early and late pregnancy hemoglobin levels and unfavorable birth
outcomes been studied. In light of the startling anemia status of 69 percent and 71 percent
in male and female, which is a high number when compared to any other states in
India. (Iips, 2017), investigated if women with anemia and/or without anemia have a high
risk of experiencing preterm birth. Because it enables the start of threat treatment for
women at risk, the identification of risk variables is useful for predicting preterm birth.
Finding these risk variables could help us better understand the processes that lead to
preterm birth. This study considered the prevalence of early labour that are caused by
susceptibility of infections, poor level of nutrition’s and low level of blood in pregnant
women. Through this research the author considered carrying out investigations and even
data collection on a regional level. To the best of our knowledge, the inquiry into maternal
health care, data collection on preterm birth and low birth weight, and the first systematic
report from its sort from the high priority and risk region, i.e., Jharkhand, is a place that is
not just mostly ignored but also understudied and neglected. The fact that the initiative and
research were taken in the first place indicates the importance of this work in supporting
the idea that healthy mothers give birth to healthy children, which is a key component of
programs for sexual and family health care. Additionally, our initial attempts to construct

6. and re-orient much-needed region-specific techniques for evaluation, diagnosis,
intervention, prevention, and treatment while providing a platform for governmental
decision-makers based on evidence. The current results promise to offer a broad range and
multidisciplinary facts that can help analyze and intervene in women issues especially in
low and middle income societies. These societies are usually affected by low healthcare
services, low funding, shortage of food that mainly contribute to effects on the health of the
mother and the child. Maternal infection, hypoxia, and oxidative stress are three of the key
molecular mechanisms that have been suggested to cause preterm birth. 16 A low-grade
chronic hypoxia caused by low hemoglobin levels may increase the risk of maternal
infections and stress in both the mother and the fetus. The hypothalamic-pituitary-adrenal
axis can be triggered in either the mother or the fetus by an immune system that is
overactive in the presence of infections and inflammation and corticotrophin-releasing
hormone or cortisol that is generated after a stress reaction. In turn, this may start labor
and ultimately lead to preterm delivery. Hong & Park, 2020 investigated if risk variables
varied between subgroups of premature labor in research regarding risk factors for
preterm birth in a healthy cohort. They discovered no correlation between anemia and
premature delivery. They came to the conclusion that the absence of a link is consistent
with other researchers’ findings, which showed that the majority of the cause of preterm
birth are still unknown. In a control-cases analysis, Xiong & Hao, 2021, found that anemia at
any point in the second trimester was positively linked with premature delivery. However,
this association did not account for the significant ethnic variation in preterm birth rates.
These same authors discovered a slight correlation between maternal anemia in the early
third trimester and preterm in another investigation (Youssry & Patel, 2018). According to
Ballestín & Bartolomé, 2021, a high hematocrit (Ht) was linked to fetal retardation and
preterm delivery, especially when the level of Ht was equal to or higher than 43% around
31 and 34 weeks gestation. Any initiative aimed at promoting nutrition must start with
nutrition education (Aramesh & Hassanzadeh, 2020). For the health of mother and fetus,
understanding good nutrition and a balanced diet throughout pregnancy is crucial.
Nutritional issues during pregnancy can affect both the mother and the fetus, necessitating
specific attention. Anemia and other nutritional deficits can result from an inadequate diet
during pregnancy. Therefore, it is essential to get enough nutrients while pregnant and
should not be ignored. A woman and her family can improve their nutrition by making
decisions and taking action with the aid of maternal nutrition counseling. This comprises
choices and behaviors on the kinds, variety, and quantities of food a woman should eat to
achieve her dietary needs, the quantity of exercise she needs, and the use of dietary
supplements. Even while dietary counseling is a strongly advised part of healthcare, many
women don’t really obtain high-quality services. With the help of this program brief,
UNICEF country offices and its partners may learn how to increase the accessibility, efficacy,
and justice of maternal nutrition counseling in low- and middle-income nations.
Preconception (for individuals intending a pregnancy), pregnancy, and postpartum care are
covered for adolescent girls and women between the ages of 20 and 49 (Govender & Taylor,
2020). The nutritional status of women is crucial to their health and wellbeing, particularly
before, during, and after childbirth. If women are free from any form of malnutrition when

7. they become pregnant, if they have nourishing diets, if they have access to necessary
nutrition services, and if they adopt ideal dietary practices during pregnancy, they are more
likely to have a healthy pregnancy that are less likely to experience life-threatening
complications. Additionally, newborns of adequately fed mothers are more likely to have a
healthy birth and grow and develop normally in infancy. Following birth, women must have
adequate nutritional care in order to meet their nutrient needs, which are high among
breastfeeding mothers, and to replenish their bodily stores of nutrients. All you need is do
my history assignment for all your history writing needs. The World Health Organization set
goals to reduce the incidence of anemia in women of reproductive age by 50% and the
prevalence of low birth weight by 30% by 2025 in recognition of the critical role that
maternal nutrition plays in health (World Health Organization, 2020). Progress towards
these goals can support worldwide efforts to fulfill the Sustainable Development Goal goals
of reducing child stunting, wasting, and overweight because maternal nutrition directly
affects the nutritional condition of children. The rate of development is currently too
sluggish to achieve the goals set by the World Health Assembly for maternal anemia and low
birth weight. An estimated 571 million women of reproductive age experienced anemia in
2019 (30%), whereas the frequency of low birth weight stayed at 15% between 2012 and
2019 (Kinyoki & Hay, 2021). Throughout 2012 and 2015, the prevalence of preterm labor
stayed at 15%. There is still a public health issue with maternal underweight (thinness),
which affected 170 million women (9%) in 2016 (Kinyoki & Hay, 2021). Poor diets, poor
access to necessary nutrient-rich services and subpar procedures continue to impede
growth. Premature birth, mother and infant mortality, and infectious illnesses have all been
linked to low hemoglobin levels suggestive of mild to severe anemia during pregnancy. In
utero and throughout time, developments may also be impacted. In contrast, adverse
pregnancy outcomes like preterm labor and low birth weight may also be linked to
hemoglobin levels higher than 130 g/l at sea level. Iron supplementation, iron-fortified
staple foods, nutrition and health education, parasite management, and hygienic
improvements are only a few of the interventions used to avoid iron deficiency and IDA in
pregnant women. Women must take in more iron throughout pregnancy to make sure they
have enough on hand to avoid an iron deficiency, as a result, in the majority of low- and
middle-income nations. Visit https://nursingexpertwriters.com/ for more. Iron
supplements are therefore widely utilized by pregnant women in the majority of low- and
middle-income nations to prevent and treat iron deficiency and anemia during pregnancy.
This recommendation was made after updating an earlier Cochrane systematic analysis that
evaluated the advantages and disadvantages of iron supplementation in healthy pregnant
women (McCauley & van den Broek, 2022). Overall, women who took daily iron
supplements had LBW babies less frequently than controls, and the average birth weight
was higher for newborns whose mothers took iron during pregnancy, at 30.81 g. Neonatal
mortality and preterm birth had no discernible impact. Daily iron supplementation
decreased the likelihood of iron deficiency and maternal anemia at term by 57 percent and
70 percent, respectively, but had no discernible impact on infection risk. A fifth of the
population of the globe carries an inherited hemoglobin problem. Because of advancements
in hematological therapy, impacted women with hemoglobinopathies frequently seek

8. conception when they reach childbearing age. Nutrition education and counseling are
common methods to enhance the nutritional status of pregnant women (NEC). NEC
strategies typically center on improving maternal diet performance by enhancing the
variety and quantity of foods consumed, achieving adequate weight gain through
consuming an adequate and balanced amount of protein and energy, and utilizing
supplements, and fortified foods consistently and continuously. Nielsen et al.’s review found
that pregnancy NEC initiatives had a beneficial effect on pregnant adolescents’
understanding of nutrition and diet quality. Interventions also slightly enhanced birth
weight and gestational weight increase. Another analysis of data, mostly from developed
nations (HIC), found that prenatal nutrition teaching decreased uncontrollable gestational
weight gain. 14 Last but not least, a Cochrane systematic review from 2010 discovered that
explicit recommendations to boost protein and energy intake while pregnant. Only two of
the five trials included in this Cochrane review had results for maternal weight increase,
birth weight, and premature delivery. 15, 16, and meta-analyses did not have any
bearing. METHODOLOGY The introduction to the systematic literature Methodology A
systematic review uses scientific methodologies in identifying, analyzing, and evaluating
evidence that has already been presented of an existing problem to ensure that it produces
an unbiased conclusion. This is an effective method of carrying out research as it is more
linked with providing comprehensive, precise, and evidence-based research (Glasziou &
Colditz, 2001) With the high number of research that is being posted on the different
websites, there is the need to evaluate the resource and classify them in relation to sources
that are more relevant and those with desired outcomes too. Hence they aim to make more
informed decisions in relation to preterm births in pregnant women with the cause of
anemia. Hence by doing a systematic review, a more advanced report will be developed.
This will also be impactful for anyone looking for data online. This will also be impactful as
it will address all the gaps that have been left by the existing literature hence improving the
quality of data available. In a study done by (Glasziou & Colditz, 2001), he concludes that
systematic review is strict on the selected questions, provides precise eligibility questions, a
more reputable approach, and offers an extensive search of the resources (McCauley & van
den Broek, 2022). Generally, conducting a comprehensive systematic review helps the
researchers advance the existing data and also advance the available in-depth data.
However, it is subjected to various limitations, such as can be time-consuming, and with
lack of awareness, there are higher chances that this could take longer time than thought it
could. Search Strategy In previous research, a systematic review has to be carried out by
more than two researchers to ensure that there is less bias. However, this research was
considered by a student underrating a master’s degree in Public health. To ensure that there
is a high level of transparency, the researchers used a PRISMA flow chart and also employed
the Cochrane handbook written for the systemic review of interventions. When carrying out
research, it is important to use a wide variety of sources to collect relevant data. This is
considered that there are many websites that offer information regarding the health of
people. For instance, considering that EMBASE, CINAHL MEDLINE Pubmed, and Sci direct
are an example of databases within healthcare, PsycINFO and ASSIA are among databases
that offer such but within social science. With a search strategy, it is easy to identify such.

9. Through the literature, we only considered data that are from peer-reviewed journals from
websites such as Pubmed, direct science, Medline, and EMbase to ensure that the outcomes
that have been reported are clinically based. Search bibliographic Databases Online sources
are easy to find as they are usually updated to meet the current changes. This makes it easy
for one to locate them. Hence with online sources, the researcher considered doing searches
for the relevant articles. Databases considered were EMBASE, CINAHL MEDLINE Pub med,
and Science Direct. Through this study, the researcher considered only articles that have
been published not older than five years, which considered a review comparison with
mothers who are pregnant with anemia and those who are pregnant without anemia.
During this search, only English work were considered. However, this was considered that
during translation, the translator could miss some words or even understand the author
wrongly, which can, in turn, lead to altering of the meaning. This is one of the bases as to
why the research only considered articles that have been written originally in English and
not in other languages. However, this raised some bias as some research (Neimann
Rasmussen & Montgomery, 2018) claimed that excluding sources that are not in English can
result in language bias. However (Delgado-Rodríguez & Sillero-Arenas, 2018) claims that
there is no noticeable language bias to be identified when carrying out a meta-analysis
outcome. To ensure that an extensive search has been attained, the author considered using
relevant keyword searches and also considered paying visits to the library to find any
sources that could help have adequate data. Search key terms and Search Strategy In a study
carried out by Boland et al. 2017, after identifying the bibliographical resources, keywords
were developed to ensure that a search strategy for every database had been developed.
Through the search strategies, various parts of research questions were developed to
ensure that a broad search has been attained. With the Cochrane review, strategy research
design population and intervention questions are to be addressed. This then promoted the
use of the PICO tool to help in identifying and searching the terms. However, synonyms of
keywords such as anemia, pregnancy, and preterm births were used for extensive results. In
a research done by (Bramer & Kleijnen, 2018), he reports that keywords and medical
subheadings are of high importance in developing a search strategy. Furthermore, there
was no limitation on the number of materials to be explored. However, in truncating
documents, the researcher used an asterisk (*) alongside an operator, which could be AND,
OR, NOT, to ensure that even though a wide search is aimed at, it is all linked to the
relevance. To ensure that ether was no bias when making the choices, all the searches were
conducted after a tutorial with the expert librarian. This then followed an immediate
screening that considered the title and the Abstract check removal of duplicates. The
remaining articles were then reviewed in full to determine the scoping review and synthesis
of the findings that met all the criteria required. Review questions for the systematic review
This review has been created to locate, analyze and synthesize available data while trying to
address the causes of anemia in prenatal women that result in preterm births. Furthermore,
this review will analyze possible interventions, especially offering communal education to
mothers on the foods that can help them fight iron deficiency. There are different
frameworks that can be used while structuring systematic review questions. In this
research, we will consider the PICO framework, which is a common framework applied

10. when dealing with quantitative analysis. PICO has proved to be an effective framework for
analyzing interventions. In analyzing the PICO, the major components to be considered are
(Lasserson & Higgins, 2019) (Population intervention counter intervention, and Outcomes).
With this, it is also easy to locate useful sources. Furthermore, this also plays an important
role in helping determent the research questions of the study. Selection of studies To
ensure that a more clear focus on the issues at hand and sources to be used have been
chosen appropriately, there is the need for precision. This then calls for inclusion and
exclusion criteria. Furthermore, having an inclusion and exclusion criteria is one of the
requirements for a systematic review that brings the difference from narrative reviews
(Siddaway & Hedges, 2019). Hence the research used the PICO framework to determine the
criteria for including and excluding resources. Type of participants (p) Expectations
mothers from the age of 20-40 were considered to be major participants of the study. This
study considered this age group as it all included mothers who just became mothers and
they have not established their lives, and also an age gap of a mother who became pregnant
and still has established their lives. However, studies that involved minors who were
pregnant and had anemia was included as they did not meet the inclusion criteria. Types of
Interventions (I) Many studies have studied on ensuring that each pregnant mother has a
clinical book that contains adequate education (Hosseini Tabaghdehi & Motaghi, 2020).
Other studies have also called for the government to come in with more funds to support
the poor families by providing supplements or even making food donations that will help
them (Siddaway & Hedges, 2019). Furthermore, this research will consider offering
communal education on how to balance the available food to ensure that the iron deficiency
has been tackled. Types of Counter Interventions (C) Blood transfusions Types of Outcomes
(O) The outcomes of anemia in pregnancy that leads to preterm births were preterm births,
breathing disorders, chest pains, delayed millstones or stillbirths, antenatal visits, number
of haemogram tests, and experience of anemia in pregnancies. However, there was also a
difference in social-economical factors such as income, level of education, and the
occupation of spouses. Types of Studies for this writing help In an evaluation of the different
qualities of the findings, there are various ranking systems that can be used. The hierarchy
of evidence has affirmed that the RCT is one among the topmost when placed in the
evidence pyramid. It is then followed by the observational studies, and then the
uncontrolled studies are at the bottom of the pyramid. Further, randomization will be used
in the studies to reduce the bias and also equalize the confounding factors within the
groups. Furthermore, only studies that are related to the major keywords will be considered
for the general study. Data Collection An excel sheet was used to portray the relevant data
collected considering met analysis data, baseline carters of the population used, a summary
of the studies that were used, and data for the narrative synthesis. Through the study, it
included The data to be extracted will include information about the sources, design of the
study, geographical location, the aim of the study, the population used, and the conclusions
made of the study. Within the baseline characteristics, the study will consider information
such as the study ID and the race, which will include all the races such as Black, white, and
others, gender, and rural-urban classification. In the third section, which is the statistical
data of the meat analysis, the research will consider the mean and standard deviation

11. statically attained from the designated groups separately. In the fourth section, data for the
narrative synthesis will include data collected for the study, ID the outcomes, the results,
and measures results. Through the data, different tables will be created for the different
sectional data. Religion Languages and date of publishing This study was not limited to a
certain geographical; hence it reviewed literature from a global perspective. However, only
articles that had been written in English as the research was limited to translating articles
considering the chances of errors while transcribing. This also included that any work that
was originally written in another language but later translated was not included too. The
study considered articles with a publication age of not more than five years. This was to
ensure that all the studies used were dated. Quality Assessment It was important to ensure
that the studies that have been chosen have also been assessed to measure the quality of the
studies being used. This is a step that was done during data extraction. This was to ensure
that the researcher was able to respond to any quality assessment questions. Furthermore,
this could also play a big role in helping avoid selection bias in such collecting data, not
minding if they support or they contradict the hypothesis. Following this procedure, it plays
an essential role in removing the poor-quality work that could affect the findings of the
researcher. Furthermore, it also saves time as it excludes the extraction of data that is not
required. Through quality assessment, it was easy for the researcher to identify reliable
research that was designed, and after evaluation, the researcher was able to conclude if the
research was relevant to answering the main question or not. Through quality assessment,
the researcher got the different perfections and the different methodologies and the
outcome that the different resources had posted that helped the researcher to know the
value and how to rate sources as poor quality and which one to be considered of high
quality. In the systematic review, there are various tools that could be put in use to
measure the quality of the sources. However, it also depends on the type of question to be
addressed. In many instances, Scales have been used, while others consider the use of a
checklist as they are more comprehensive and can also be studied by other people to
measure the quality too. Critical appraisal skill program and new castle Ottawa scales are
among the majorly used scales. Considering that many of the studies were observational,
the National Institute of health quality assessment tool was considered to be the most
appropriate tool. This tool focused on studying a source with different questions, such as
judging the clarity of the questions used in the study. What kind of population has the study
used, the participation numbers, and the inclusion/ the exclusion criteria that have been
used in the said sources. The justification of sample size, time frame, the follow-up
procedures definition validly, the rate of exposures, the measure of outcomes, and the
sufficient level of the outcomes were used. Through the analysis, the researcher considered
giving answers with no, yes, applicable, and not applicable depending on the findings that
the researchers will find after studying eth sources with the above questions. With the
procedure, which took a lot of time but yielded good results, the research had the capability
of utilizing only resources that were qualified. Characteristics of included
studies Study ID Study Design Site Population
age Study Aim Conclusion Moreno-Fernandez, & Diaz-Castro,
2019 Systematic Review – m 24 to 36

12. weeks Determine the Effects of iron status on preterm infants’
growth and development parameters Most of the
time, premature newborns need iron supplements and are prone to ID
or IDA development, which may influence postnatal behavior and
cognitive development. Kang & Sunwoo, 2020 A systematic
review and meta-analysis China 22.6 to 34.8 Utilizing a
meta-analysis to determine the association between anemia and the
risk of maternal depression. Anemia was linked to a higher
incidence of maternal depression in both the antepartum and postpartum
periods, according to a recent meta-analysis of observational
epidemiological studies. Safiri & Grieger,
2021 Quantitative Global 15-49 The current study details the
burden of anemia on a global, regional, and national scale, as well as its
underlying causes. Despite the multifaceted character of the
condition, dietary iron deficiency is still the biggest contributor to
anemia worldwide. Therefore, nutritional interventions must get
more focus, followed by efforts to reduce the burden of chronic
diseases, parasite infections, and hemoglobinopathies. Walang,
2020 Quantitative Southeast Asia and sub-Saharan
Africa. 20-42 Analyze the major causes of Preterm births among
women in developing countries The global preterm birth rate of 11% is a
result of anemia cases experienced by women before and during
pregnancies. Maier & Zeitlin, 2018 cohort
studies European Regions 22 + 0 and
31 + 6 weeks To compare the length of hospital stays for infants who were
born very preterm and extremely preterm in 10 different European
locations and track changes over time. Policies to
optimize discharge decisions in terms of baby outcomes and health
system expenditures should be informed by a better knowledge of
the discharge criteria and care practices that cause the
significant variations in the very preterm length of stay across
European areas. Sample & Platini, 2019 Quantitative
design Indonesia 15-49 This study attempts to ascertain
pregnant anemic women’s understanding of pregnancy nutrition. Based
on the findings of a study on the nutritional intake knowledge of
pregnant women with Anemia at Puskesmas (Community Health Center)
Sukamulya Garut, it can be said that nearly all of them lacked such
knowledge. Aston & Paynter, 2021 Qualitative Canada 20-40 This
study looked at how first-time moms used online and offline resources to
get help during the first six months after giving birth and how
social and institutional discourses shaped their experiences. These online
discussion boards provide useful information for medical
practitioners trying to enhance postpartum care for moms and

13. highlight the necessity of creating places where new mothers can
interact. Graham, 2018 Indonesia,
2020 Quantitative Central Sulawesi 22-48 The goal of
this study is to determine how the smart book on pregnancy-
postpartum care affects husbands’ knowledge and the incidence of
difficulties with reproductive health. The postpartum care book
educated men about pregnancy, labor, and postpartum issues. Baig-
Ansari & Goldenberg, 2008 Quantitative Pakistan 20-48 To assess the
prevalence of anemia in pregnant women residing in an urban
population in Hyderabad, Pakistan, as well as the dietary and
socioeconomic factors related to anemia. At 20 to 26 weeks
of pregnancy, a significant portion of women experienced mild to
moderate anemia. Anemia was linked to a pica, drinking tea, and eating
a few eggs and red meat. Prior to getting pregnant, in particular,
women of reproductive age should receive nutritional education about
food sources of iron and how food choices can either improve or
interfere with iron absorption. Rahman & Shibuya, 2016 systematic
review and meta-analysis South Asia sub-Saharan
Africa 15-49 systematic review and meta-analysis to calculate the
population-attributable percentage (PAF) of these outcomes that are
caused by anemia in low- and middle-income countries, the pooled
prevalence of anemia, the relationship between maternal anemia and
pregnancy outcomes, Maternal anemia continues to be a serious
health issue in low- and middle-income nations. In low-income
nations and the South Asian region, the percentage of unfavorable
pregnancy outcomes attributed to anemia was greater. Youssry
& Patel, 2018 cohort study – 20-45 Our study’s
objectives are to determine the prevalence of anemia in pregnant
women and the impact of anemia severity on maternal and perinatal
outcomes. His research made it clear that anemia, especially
mild anemia, is common among expectant mothers. Maternal anemia
must be managed, and the perinatal outcome is strongly impacted by
early diagnosis and therapy beginning in the first trimester. The most
frequent maternal and neonatal problems are prematurity, low birth
weight babies, and postpartum hemorrhage. Ballestín
& Bartolomé, 2021). Qualitative – 20-47 In this review, the
research on how nutritional deficits affect maternal and infant morbidity
will be summarized. Micronutrient deficiencies have a negative impact on
pregnant women’s health and the pregnancy’s outcome. Since there are
multiple inadequacies, repairing or supplementing one won’t have
much of an impact while there are still others that need to be
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