Background Previous studies on iron with folic acid supplementation and low birth weight indicated different findings. The aim of the current systemic review and meta-analysis was to examine the relationship between iron and folic acid supplementation and birth weight in Ethiopia. Main body The databases searched were PubMed, Google Scholar, Web of Science and Cochrane Library in January 2021. AZ, KTT and AAA carried out the data extraction and independently assessed the articles for inclusion

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... n the review using risk-of-bias tool guided by PRISMA checklist. The combined Odds ratio with 95% confidence interval was calculated using random effect model. Twenty four observational studies involving 10,989 participants, 2423 newborns who were born LBW were included. The combined effect size (OR) for low birth weight comparing women who have Iron and Folic acid supplementation versus women who did not have iron and folic acid supplementation was 0.39 (95% CI 0.27–0.59, p < 0.00001, I2 = 91%). There was significant heterogeneity (Q = 264.16, I2 = 91%, p < 0.00001). No publication bias was observed (Egger's test: p = 0.742, Begg's test: p = 0.372). Overall 69.5% of women reported having iron and folic acid supplementation during current pregnancy. And the overall proportion of low birth weight was 22.1%. Conclusions Women who were supplied with iron and folic acid during pregnancy had a 67% decreased chance of delivering low birth weight new born in Ethiopia.