An Analysis of Anemia and Pregnancy-Related Maternal Mortality

Abstract

The relationship of anemia as a risk factor for maternal mortality was analyzed by using cross-sectional, longitudinal and case-control studies because randomized trials were not available for analysis. The following six methods of estimation of mortality risk were adopted: 1) the correlation of maternal mortality rates with maternal anemia prevalence derived from national statistics; 2) the proportion of maternal deaths attributable to anemia; 3) the proportion of anemic women who die; 4) population-attributable risk of maternal mortality due to anemia; 5) adolescence as a risk factor for anemia-related mortality; and 6) causes of anemia associated with maternal mortality. The average estimates for all-cause anemia attributable mortality (both direct and indirect) were 6.37, 7.26 and 3.0% for Africa, Asia and Latin America, respectively. Case fatality rates, mainly for hospital studies, varied from <1% to >50%. The relative risk of mortality associated with moderate anemia (hemoglobin 40-80 g/L) was 1.35 [95% confidence interval (CI): 0.92-2.00] and for severe anemia (<47 g/L) was 3.51 (95% CI: 2.05-6.00). Population-attributable risk estimates can be defended on the basis of the strong association between severe anemia and maternal mortality but not for mild or moderate anemia. In holoendemic malarious areas with a 5% severe anemia prevalence (hemoglobin <70 g/L), it was estimated that in primigravidae, there would be 9 severe-malaria anemia-related deaths and 41 nonmalarial anemia-related deaths (mostly nutritional) per 100,000 live births. The iron deficiency component of these is unknown.

Anemia in Mexican women: a public health problem

“…[5][6][7][8] Other causes include hemodilution during pregnancy, concurrent acute and chronic infections, and menstrual bleeding. 9,10 Iron deficiency also has deleterious effects on the immune response, exercise endurance, cognitive ability, and psychosocial development. 11,12 The extent to which anemia affects the health of mothers and of their newborns is not completely established, but some studies suggest that anemia during pregnancy has adverse effects on both the mother and the fetus.…”

“…13,14 Moreover, severe anemia greatly increases the risk of maternal death. 10,14 Insufficient maternal iron stores are reflected in low iron stores in the newborn, leading to increased risk of iron deficiency in the first months of life. Iron deficiency may also have long-term consequences on the health of both mother and child.…”

Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

“…Iron-deficiency also has important consequences for the future generations, as iron-deficiency anaemia increases the risk for preterm labour, low birth weight, infant mortality and predicts iron-deficiency in infants after 4 months of age [5,6]. Anaemia, of which iron-deficiency is the major contributor, accounts for 3.7% and 12.8% of maternal deaths during pregnancy and childbirth in Africa and Asia, respectively [7].…”

Rethinking WHO guidance: review of evidence for misoprostol use in the prevention of postpartum haemorrhage

“…4 There is a high prevalence of anaemia in pregnant women (48.2% and 57% in SE Asia and Africa, respectively, compared with 25.1% in Europe) 5 but in the absence of antenatal screening for anaemia, it is not possible to identify women with increased risk of significant morbidity and mortality prior to labour.…”