Association of Iron Deficiency Anemia and Febrile Seizure in Asia: A Systematic Review and Meta-Analysis

Background: Current findings suggest that iron deficiency anemia (IDA) may be a predisposing factor for febrile seizure (FS), while some studies show the lower prevalence of IDA in the children with FS. The present systematic review and meta-analysis aimed to elucidate the association between IDA and FS. Methods: A comprehensive search was performed using MeSH keywords in databases such as PubMed, Scopus, Embase, ScienceDirect, Web of Science, and Google Scholar without time limit until 2017. Cochrane test and I-2 index were used for the evaluation of heterogeneity among the retrieved studies. Data analysis was performed in Comprehensive Meta-Analysis (CMA) software version 2. Results: In total, 38 studies conducted on 3,738 cases and 3,720 controls were reviewed in this meta-analysis. Considering the significant heterogeneity (I-2=87.981; P<0.001), the odds ratio (OR) was combined using the random effects model. The pooled results indicated that IDA significantly increased the risk of FS (OR=2.36; 95 confidence interval CI: 1.72-3.24; P<0.0001). Meta-analysis was performed based on the simple febrile convulsion (FC) and first febrile convulsion (FFC), and OR was estimated at 2.98 (95% CI: 1.67-5.31; P<0.001) and 2.23 (95% CI: 1.33-3.73; P<0.001), respectively. In the subgroup analysis of the studies conducted in Iran, India, and Pakistan, OR was determined at 1.06 (95% CI: 0.71-1.58), 4.21 (95% CI: 2.97-5.97), and 2.22 (95% CI: 1.70-2.90), respectively, which revealed significant differences in this regard (P<0.001). Conclusion: According to the results, IDA is a predisposing factor for FC. Therefore, children with FS must be examined for the risk of IDA.