Knowledge, Attitudes, and Practices (KAP) of community pharmacists regarding antibiotic use and resistance: a cross-sectional study from the United Arab Emirates.

One of the main contributing factors of antibiotic resistance is the dispensing of antibiotics without prescription. This study investigated community pharmacists' knowledge, attitudes, and practices in relation to antibiotic dispensing and resistance in United Arab Emirates (UAE). A cross-sectional survey was conducted using validated questionnaire. (40.1%) had an overall positive KAP score. A total of (88%) respondents were aware of the illegality of dispensing antibiotics without a prescription. Only (31%) had good knowledge regarding amoxicillin dosage for upper respiratory tract infection. The primary misconduct found numerous pharmacists prescribing antibiotics without a prescription, even though they were aware that this should never be done. Pharmacists who attended events focused on antibiotic use and resistance were more likely to have good knowledge about antibiotics (Adjusted Odd Ratio (AOR): 1.673; 95%CI: 1.029-2.719; p = 0.038), more likely to have positive attitude (AOR: 1.889; 95%CI: 1.133-3.149; p = 0.015), and more likely to have good practice (AOR: 3.182; 95%CI: 1.541-6.572; p = 0.002).

Development and Characterization of High-Energy Protein Bars with Enhanced Antioxidant, Chemical, Nutritional, Physical, and Sensory Properties.

Protein-rich energy bars are known as an excellent nutritional supplement for athletes that help to build and repair connective tissues. The study is, therefore, aimed at developing high-protein bars using lupine seeds, wheat germ, and selected dried fruits including raisins, dates, apricots, and cranberries. Different formulations (F1, F2, F3, and F4) were performed at different ratios of ingredients to produce high-protein bars and compared them with a control bar made of whey-protein concentrate and oat flakes. For this purpose, a proximate analysis, total phenol content, total flavonoid content, DPPH radical scavenging activity, water content, nutritional, and sensory analysis was performed to evaluate the results. The proximate analysis of the produced protein bars showed a significantly higher protein content (22 ± 2) and total phenolic activity (57 ± 33) in formulation group 4 as compared to the other groups. Furthermore, the least water activity content was found in formulation group 1 (1 ± 0.0) when compared with the control group (1 ± 0.0). The results from the sensory evaluation revealed that T3 had the highest average scores in overall consumer acceptability. Our study found that total phenolic, flavonoid, and fiber content were significantly higher in the prepared protein bars indicating prospective health benefits when compared to the control group. Overall, the study demonstrates that high-protein bars using functional ingredients like dried fruit can provide enriched nutritionally valuable food options for consumers.

Zinc status or supplementation and its relation to soil-transmitted helminthiasis in children: A systematic review.

Soil-transmitted helminths (STHs) parasitic infection is known as one of the most common infections around the world affecting more than a quarter of the world's population. The relationship between STH infections and micronutrient deficiencies are closely related and often coexist among the affected population. The study, therefore, aimed to summarise the available literature focusing on the effect of zinc status/deficiency or supplementation on STH infection or reinfection in children. For this purpose, we adopted a systematic approach and searched the existing literature on PubMed, Scopus, and Cochrane Library databases. A search term was entered to retrieve the available data. A total of 12 articles were included in this review after applying the inclusion/exclusion criteria. Most of the included studies reported a lower zinc status in children affected with any parasitic infection. Regarding the effect of zinc status and supplementation on parasitic infection in children, we found only a few studies (n = 4) with inconsistent result findings. This review reported that children infected with STH have lower zinc levels; however, a limited number of studies showed the effect of zinc supplements on the risk of STH warrants the need for further studies in this regard.

Impact of Processing and Preservation Methods and Storage on Total Phenolics, Flavonoids, and Antioxidant Activities of Okra (Abelmoschus esculentus L.).

Very few studies have thus far evaluated the impact of various processing and preservation techniques (blanching, frying, freezing, dehydration, and sun drying) on the levels of total phenolics, flavonoids, and antioxidant activities of okra. The primary objective of this study was to evaluate the effects of different processing and preservation methods on the levels of phenolics, flavonoids, and antioxidant activities of okra. The ethanolic extracts of each sample were analyzed before and after preservation and storage for a period of three months. The results showed a significant improvement (p < 0.05) in total phenolic content (134.1 mg GAE/100g) and DPPH (1-1-diphenyl1-2-pricrylhydrazyl) scavenging activity (IC50 value of 3.0 mg/mL) in blanched okra when compared to fresh okra (86.35 mg GAE/100g and IC50 value of 3.8 mg/mL, respectively). Fresh okra exhibited the highest flavonoid content (105.75 mg QE/100g), while sun-dried okra samples stored for three months exhibited a decrease in total phenolic content (14.45 mg GAE/100g), total flavonoid contents (13.25 mg QE/100g), reducing power activity (23.30%), and DPPH scavenging activity (IC50 value of 134.8 mg/mL). The DPPH inhibition activities of all okra treatments showed a significant and positive correlation with the okra phenolic and flavonoid content (r = 0.702 and 0.67, respectively). The reducing power activity (%) of okra treatments exhibited a strong correlation (r) with phenolic contents (r = 0.966), and the correlation with flavonoid contents was 0.459. Generally, different processing and preservation methods of okra revealed that the impact on total phenolic and flavonoid contents, as well as antioxidant activities, was slightly significant among samples preserved using the same method during storage. In addition, blanched and frozen okra resulted in the highest retention of phenolic contents and antioxidant activities.

A comprehensive health effects assessment of the use of sanitizers and disinfectants during COVID-19 pandemic: a global survey.

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value <0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87-2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74-1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90-2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused.

Spirulina, an FDA-Approved Functional Food: Worth the Hype?

Spirulina, a blue-green microalga is an eminent functional food due to its unique nutritional and disease-mitigating properties. The main objective of this article is to present an overview of the nutritional composition of Spirulina. Along with its therapeutic potential and applications in the food industry. Studies included in this review have suggested spirulina to be a rich source of complete proteins, essential fatty acids (EFAs), vitamins, minerals and various bioactive compounds like carotenoids, chlorophyll, and xanthophylls. This makes Spirulina a promising functional food for the treatment of ailments like diabetes, cancer, cardiovascular disorders (CVDs), COVID-19, neuroinflammatory conditions and gut dysbiosis. Additionally, data from numerous studies suggest its use in food formulations, primarily in sports supplements, bakery products, beverages, dairy products, snack sources and confectionaries. It has also been used by the National Aeronautics and Space Association (NASA) for astronauts on space missions to the Moon and Mars. Furthermore, spirulina's use as a natural food additive possesses enormous potential for further research. Owing to its high nutritional profile and disease-fighting potential, it lends itself to numerous food formulations. Therefore, based on the findings of previous studies, further progress can be made considering spirulina's application in the food additive industry.

Effect of inulin, galacto oligosaccharides and iron fortification on iron deficiency anemia among women of reproductive age; a randomized controlled trial.

Iron supplementation and fortification are the well-known approaches to treat iron deficiency anemia (IDA) in women of reproductive age. The objective of the current randomized controlled trial (RCT) was to evaluate the cumulative effects of prebiotics and iron fortification among women of reproductive age. For this purpose, a total of 75 iron deficient women of childbearing age were recruited and randomly divided into 5 groups (4 treatment groups and 1 control group). Four different types of fortified wheat flour were prepared using two iron fortificants (NaFeEDTA and FeSO4) and two prebiotics [inulin and galacto oligosaccharides (GOS)], while control group was treated with iron fortified flour without any prebiotics. Blood samples were collected from overnight fasted women on monthly basis up to 90 days. Hematological indices such as Hemoglobin (Hb), Hematocrit, Red Blood Cell (RBC) Count and Mean Corpuscular Volume (MCV), as well as iron biomarkers including serum iron, ferritin, transferrin, and Total Iron Binding Capacity (TIBC) were evaluated for analyses. The results showed a considerable positive improvement in all iron biomarkers as well as hematological indices among the treatment groups (P-value < 0.05), as compared to the control group. A maximum Hb (11.86 ± 0.24 mg/dL) and hematocrit value (35.06 ± 1.32%), was reported in group G3 which was treated with fortified wheat flour at a dose of 963 mg/kg GOS + 15 ppm FeSO4. On the other hand, highest mean values for RBC Count (4.73 ± 0.41 mil/mm3), MCV (81.41 ± 3.21 fL), serum iron (75.62 ± 2.79 µg/dL), serum transferrin (16.82 ± 0.30 mg/dL), and TIBC (403.68 ± 7.27 µg/dL) were observed in G4 group receiving the fortified wheat flour at a dose of 963 mg/kg GOS + 30 ppm FeSO4 level. The study concluded that prebiotic fortification along with iron salts helps to enhance iron absorption among iron deficiency anemic women of reproductive age.

Dietary Trace Element Intake and Risk of Breast Cancer: A Mini Review.

Trace elements are essentially required for various physiological and metabolic functions, and any disturbance in the trace elements homeostasis may result in the development of chronic diseases including breast cancer. Breast cancer is the most prevalent cancer type reported in women equally affecting both the high-income and low-income countries. This review therefore aimed to evaluate the impact of dietary trace element intake in relation to the incidence of breast cancer. We focused on five trace elements, thus emphasizing dietary selenium, zinc, iron, copper, and cadmium intake and risk of breast cancer. A systematic approach was applied to perform this review through entering a search term in PubMed and Scopus databases. A total of 24 articles were included after meeting the inclusion and exclusion criteria. Most of the studies regarding dietary iron intake showed a detrimental effect of increased dietary heme iron on breast cancer incidence risk. In addition, there is a limited evidence of high dietary intake of selenium and zinc to reduce the risk of breast cancer. Also, a few studies showed a relationship between high cadmium consumption and risk of breast cancer. More studies related to cadmium and copper exposure are needed to confirm this relationship. As a result, the findings of this review suggested that high dietary heme iron is a potential risk factor for breast cancer.

A Systematic Review of Human Trials on Mycoprotein - Way towards a Sustainable Ecosystem.

Rapidly increasing global warming and world population calls for exploring untapped elements of biodiversity in a much broader sense. Though there exists much evidence on the importance of livestock and animal-derived protein, escalating challenges related to sustainability have led to finding alternatives to animal-derived proteins. Mycoprotein is an eco-friendly sustainable product.  This fungal-derived protein is high in fiber and protein content. For this particular review paper, literature was searched for human trials using PubMed, Google Scholar, and Cochrane Library. Fifteen trials, totaling 952 participants were included- 5 solely reported on cholesterol response, 3 for glycemic response and 2 for serum uric acid concentrations, while 4 studies reported the combined effect of health markers such as cholesterol, glycemic response, and uric acid concentrations and 1 study on gut health. The Jadad scale was used to assess the quality of studies. Five trails were identified to be of good quality scoring 3 or more. The results showed cholesterol lowering percentage to be ranging between 4.3 to 13%. Similarly, a significant increase of (+0.02) (P< 0.05) was observed in Lactobacillus spp from the baseline value following mycoprotein consumption. Results however were inconclusive for glucose and insulin response. Overall given the growing increase in sustainable proteins, this area should be explored further from a public health perspective.

Maternal pesticide exposure and its relation to childhood cancer: an umbrella review of meta-analyses.

This umbrella review summarizes the available meta-analyses elucidating the effects of maternal pesticide exposure on adverse health outcomes in children particularly the risk of childhood cancer. A literature search was conducted on PubMed and Scopus with 10-years temporal restriction and with search terms of ('pesticides') and ('maternal' or 'pregnancy' or 'gestational' or 'perinatal' or 'children' or 'infants' or 'birth weight' or 'gestational age' or 'cancer' or 'tumor' or 'malignancy' or 'carcinoma') and ('meta-analysis' or 'systematic review'). Using relative risk estimates, e.g., odds ratio (OR), relative risk (RR), ß coefficients, and 95% confidence interval (CI) as a prerequisite for inclusion/exclusion criteria a total of 19 eligible meta-analyses were included. The results showed that maternal domestic/occupational pesticide exposure increases the risk for childhood leukaemia. The overall OR regarding the risk of pesticide exposure and leukaemia was 1.23 to 1.57 with heterogeneity I2 values that varied between 12.9% and 73%. Some studies found that exposure to dichlorodiphenyldichloroethylene (p,p´-DDE) and polychlorinated biphenyls (PCB-153) pesticides appears to decrease infant birth weight to some extent [p,p´-DDE (ß = -0.007 to -0.008)] and [PCB-153 (ß = -0.15 to -0.17)]Needing more studies on this relationship, our study found that pesticide exposure is a risk factor for leukaemia in children.

Corrigendum: COVID-19 Vaccination: Concerns About Its Accessibility, Affordability, and Acceptability.

[This corrects the article DOI: 10.3389/fmed.2021.647294.].

COVID-19 Vaccination: Concerns About Its Accessibility, Affordability, and Acceptability.

By the mid of June 2021, after an almost 1.5-year-long COVID-19 pandemic that has significantly affected the world in multiple ways, various vaccines against COVID-19 have arrived and started worldwide. Yet, economic, (geo)political, and socio-cultural factors may influence its uptake at individual and country levels. Several issues will (and already have been reported in media) revolve around this vaccination regarding its accessibility, affordability, and acceptability at an individual level and a country level. Given that in this commentary, we provoke a discussion: Who-a country as well as the individuals-would have access to it, and who would economically afford it, and who would accept it? Centering these intriguing questions, we revisit the body of literature that explicates vaccine hesitancy, refusal, and resistance, and we also draw on the current literature and media reports about vaccination against COVID-19. We suggest that these backdrops need essential attention so that everyone can afford, accept, and have access to it. Otherwise, the current risk in the face of a year-old pandemic will continue.

Effect of maternal zinc supplementation or zinc status on pregnancy complications and perinatal outcomes: An umbrella review of meta-analyses.

Zinc is an essential trace element involved in different physiological functions. During pregnancy, it plays a crucial role in healthy embryogenesis. This umbrella review, therefore, aimed to summarize the existing literature of meta-analyses evaluating the effect of maternal zinc supplementation or zinc status on maternal and neonatal outcomes. Two databases, PubMed and Scopus, were selected to search the available literature without any temporal restriction. The literature search was performed during October 2020 and a total of 192 records were identified through the literature search. After screening the titles and applying the inclusion/exclusion criteria, finally, 15 articles were included in this umbrella review. This umbrella review showed that maternal zinc supplements reduce the risk of preterm birth. Although no substantial effect of zinc supplements was found for other feto-maternal outcomes. Also, we found a significant relationship between low maternal zinc status and risk of pregnancy complications. Zinc supplements reduce the risk of preterm birth. Long-term interventions and cohort studies are needed for future research directions. Further studies and a thorough investigation will help to decide the recommended zinc dose or intake during pregnancy.

Increasing Frequency of Antenatal Care Visits May Improve Tetanus Toxoid Vaccination Coverage in Pregnant Women in Pakistan.

OBJECTIVE: Maternal and neonatal tetanus (MNT) elimination in low-income countries is a major aim of public health endeavors, due to poor vaccination status, lack of antenatal care, and unhygienic birth practices. The objective of this study, thus, was to assess the present state and factors associated with maternal tetanus toxoid (TT) vaccination in Pakistan. METHODS: Overall, 80 pregnant women (26 ± 4 y) during their last trimester were recruited from the district hospital Khanewal, Pakistan. The prevalence of vaccination was ascertained through clinical interviews and examination of health records from each participant. A questionnaire-based interview was conducted to assess the education level, antenatal visits, and sociodemographic variables related to vaccination coverage. A generalized linear model was used for statistical analyses. RESULTS: Seventy-nine percent of pregnant women were vaccinated with two doses of TT vaccine, while 16% of women were unvaccinated. Overall, 66% of pregnant women received two or more antenatal visits. Two and more than two antenatal visits during pregnancy were associated with significantly increased odds ratios for sufficient TT vaccination (OR = 1.60, CI [95%] 1.34-1.92 and OR = 1.61, CI [95%] 1.32-1.97, respectively) as compared to no or only one antenatal visit. CONCLUSION: Regular antenatal care can improve vaccination coverage during pregnancy. Hence, reducing barriers for visiting antenatal care facilities could be key to reach the goal for MNT elimination.

Selenium, Zinc, and Manganese Status in Pregnant Women and Its Relation to Maternal and Child Complications.

Micronutrients, as essential components of prenatal care, are important to reduce the risk for maternal and child morbidity and mortality by lowering pregnancy-related complications. The present study aimed to investigate the status of the trace elements, i.e., selenium, zinc, and manganese in pregnant and non-pregnant women from a developing country and to evaluate its relationship with maternal and child complications. Selenium, zinc, and manganese concentrations were measured in the blood serum of 80 pregnant women and compared with 40 non-pregnant healthy controls. The quantitative analyses of trace elements were performed by using the inductively coupled plasma-optical emission spectrometry (ICP-OES) method. The information about the dietary habits of the study participants was recorded by using a food frequency questionnaire. The results showed significant lower selenium and zinc levels in pregnant women as compared to the controls (2.26 ± 1.09 vs. 2.76 ± 1.15 µmol/L, p = 0.031; 21.86 ± 7.21 vs. 29.54 ± 7.62 µmol/L, p < 0.001) respectively, with no difference in manganese concentrations (1.40 ± 0.09 vs.1.38 ± 0.09 log10 nmol/L, p = 0.365). Regarding maternal and child complications, higher manganese levels were associated with an increased odds ratio for maternal complications (OR = 3.175, CI (95%) 1.631-6.181; p = 0.038). Consumption of dairy products was associated with lower selenium and manganese values. Pregnant women showed a lower serum selenium and zinc status, and in addition elevated serum manganese concentrations, which might be associated with a higher risk for maternal pregnancy/birth complications, although more studies are necessary to evaluate this association.

Clinical Profile and Prognosis of Cerebral Venous Sinus Thrombosis.

Introduction Cerebral venous sinus thrombosis (CVST) is an acute cerebrovascular disease diagnosed nowadays more frequently. Magnetic resonance venogram (MRV) is the modality of choice for accurate diagnosis. Young females in their childbearing age are prone to develop CVST. Clinical presentation is mainly with headache, focal neurologic deficits, and seizures. Around one third of the patients have altered sensorium at presentation. Prognosis of CVST is good if diagnosed and treated early. Long-term deficits may remain in one quarter of patients. The aim of our study was to do clinical profiling and prognosis of CVST patients. Materials and methods This is a descriptive study conducted at the department of Neurology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Study duration was one year. Patients fulfilling inclusion and exclusion criteria were included in the study. Patients confirmed to have CVST on magnetic resonance imaging (MRI)/MRV were included in final analysis. Ethical approval was taken from the Institutional Review Board.  Results Thirty three out of 54 patients were included in the final analysis. Out of them, 29 (87.8%) were females and four (12.1%) were males. The mean age at the time of presentation was 31.36 ± 9.61. Of the 29 females, only three were pregnant and 26 were in the postpartum period at the time of presentation. Twelve (41.4%) females were primigravida. Focal deficits were present in 30 (90.9%) patients; headache was present in 26 (78.8%) patients; seizures were present in 24 (72.7%) patients on presentation; and anemia was present in 20 (60.6%) patients. Conclusion CVST is an important cause of intracranial hypertension, seizures, and stroke in young people. Clinical presentation is extremely variable, and a high index of suspicion is needed. Magnetic resonance imaging brain with MRV is the current diagnostic modality of choice. Medical management with anticoagulants and supportive measures has excellent clinical outcomes.

Iron and Iodine Status in Pregnant Women from A Developing Country and Its Relation to Pregnancy Outcomes.

Birth related complications and comorbidities are highly associated with a poor nutritional status of pregnant women, whereas iron and iodine are among especially important trace elements for healthy maternal and fetal outcomes. The study compares the status of iron, iodine, and related functional parameters in pregnant and non-pregnant women from a developing country and associates the data with pregnancy complications. The concentrations of ferritin, hemoglobin (Hb), total triiodothyronine (TT3), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) were determined in the blood serum of 80 pregnant women at the time of delivery and compared with 40 non-pregnant healthy controls. Spot urine samples were taken to evaluate the urinary iodine concentration (UIC). In pregnant women, ferritin, Hb concentrations, and UIC were significantly lower, and TT4 values were significantly higher compared to controls. Higher Hb levels were tendentially associated with a reduced risk for pregnancy complications (OR = 0.747, CI (95%) 0.556-1.004; p = 0.053). Regarding covariates, only previous miscarriages were marginally associated with pregnancy complications. High consumption of dairy products was associated with lower Hb and ferritin values. Our results suggest that pregnant women from a developing country have lower iron status with Hb levels being possibly associated with pregnancy complications.

The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses.

Nutrition is known to exert an undeniable impact on blood pressure with especially salt (sodium chloride), but also potassium, playing a prominent role. The aim of this review was to summarize meta-analyses studying the effect of different electrolytes on blood pressure or risk for hypertension, respectively. Overall, 32 meta-analyses evaluating the effect of sodium, potassium, calcium and magnesium on human blood pressure or hypertension risk were included after literature search. Most of the meta-analyses showed beneficial blood pressure lowering effects with the extent of systolic blood pressure reduction ranging between -0.7 (95% confidence interval: -2.6 to 1.2) to -8.9 (-14.1 to -3.7) mmHg for sodium/salt reduction, -3.5 (-5.2 to -1.8) to -9.5 (-10.8 to -8.1) mmHg for potassium, and -0.2 (-0.4 to -0.03) to -18.7 (-22.5 to -15.0) mmHg for magnesium. The range for diastolic blood pressure reduction was 0.03 (-0.4 to 0.4) to -5.9 (-9.7 to -2.1) mmHg for sodium/salt reduction, -2 (-3.1 to -0.9) to -6.4 (-7.3 to -5.6) mmHg for potassium, and -0.3 (-0.5 to -0.03) to -10.9 (-13.1 to -8.7) mmHg for magnesium. Moreover, sufficient calcium intake was found to reduce the risk of gestational hypertension.

Maternal and neonatal outcomes related to iron supplementation or iron status: a summary of meta-analyses.

BACKGROUND: Iron deficiency is the most abundant nutritional deficiency in the world and is discussed to be associated with adverse pregnancy outcomes. The objective of this review was to perform an umbrella summary of meta-analyses to evaluate the effects and associations of iron supplementation or iron status on maternal and birth/neonatal outcomes. METHODS: A literature search was conducted on PubMed and Scopus by two reviewers without temporal restriction. Systematic reviews and meta-analyses of studies evaluating (1) the effects of multimicronutrient compared to iron + folic acid supplementations on maternal and birth/neonatal outcomes (2), the association of dietary iron intake or hemoglobin or ferritin status regarding the risk for maternal (gestational diabetes mellitus (GDM)) and birth/neonatal outcomes, and (3) the effects of iron supplementation on pregnancy and birth/neonatal outcomes, were included in this review. RESULTS: Overall, 16 meta-analyses were included. Multimicronutrient supplements had significant risk reducing effects on low birth weight and small for gestational age compared to iron/folic acid supplements as controls. Furthermore, most of the meta-analyses showed that higher levels of hemoglobin or ferritin increased the risk for GDM. On the other hand, maternal anemia (low hemoglobin levels) was associated with adverse birth/neonatal outcomes. Finally, iron supplementation reduced the risk of iron deficiency and iron deficiency anemia and had some risk reducing effects on low birth weight newborns. CONCLUSIONS: Our summary of meta-analyses showed that multimicronutrient supplementation had beneficial effects on some neonatal outcomes. Furthermore, higher ferritin levels seem to increase the risk for GDM whereas maternal anemia was associated with adverse birth/neonatal outcomes.