Nutrition and maternal mortality in the developing world

Abstract

This review relates nutritional status to pregnancy-related death in the developing world, where maternal mortality rates are typically >/=100-fold higher than rates in the industrialized countries. For 3 of the central causes of maternal mortality (ie, induced abortion, puerperal infection, and pregnancy-induced hypertension), knowledge of the contribution of nutrition is too scanty for programmatic application. Hemorrhage (including, for this discussion, anemia) and obstructed labor are different. The risk of death is greatly increased with severe anemia (Hb <70 or 80 g/L); there is little evidence of increased risk associated with mild or moderate anemia. Current programs of universal iron supplementation are unlikely to have much effect on severe anemia. There is an urgent need to reassess how to approach anemia control in pregnant women. Obstructed labor is far more common in short women. Unfortunately, nutritional strategies for increasing adult stature are nearly nonexistent: supplemental feeding appears to have little benefit after 3 y of age and could possibly be harmful at later ages, inducing accelerated growth before puberty, earlier menarche (and possible earlier marriage), and unchanged adult stature. Deprived girls without intervention typically have late menarche, extended periods of growth, and can achieve nearly complete catch-up growth. The need for operative delivery also increases with increased fetal size. Supplementary feeding could therefore increase the risk of obstructed labor. In the absence of accessible obstetric services, primiparous women <1.5 m in height should be excluded from supplementary feeding programs aimed at accelerating fetal growth. The knowledge base to model the risks and benefits of increased fetal size does not exist.

Safety and benefits of antenatal oral iron supplementation in low‐income countries: a review

“…Against this background, it is perhaps not surprising that many studies have found that antenatal iron supplementation produces increased maternal haemoglobin concentrations and a reduced risk of anaemia at term. However, the functional significance of this haematological response has long been questioned (Beaton, 2000; Rush, 2000; Rioux & LeBlanc, 2007). It is notable that optimal pregnancy outcomes in terms of birth weight and pre‐term labour occur at a mid‐pregnancy haemoglobin of between 95 and 105 g/l (Steer, 2000), which is actually lower than the current definition of anaemia.…”

“…The associated loss of healthy life years amounts to almost 20 million disability‐adjusted life years (DALYs) from perinatal causes and almost 3·5 million from maternal causes (Stoltzfus et al , 2004). Observational studies on the relationship between anaemia and maternal mortality typically suffer from severe methodological shortcomings (reviewed by Rush, 2000) that preclude solid conclusions about causality.…”

Iron status and its association with pregnancy outcome in Korean pregnant women

“…Because of the increased iron requirements during pregnancy, pregnant women are recognized as the group most vulnerable to iron deficiency anemia. In Asia, the prevalence of anemia was estimated to be 44% in non-pregnant and 60% in pregnant women (Rush, 2000). At least 50% of the anemia has been attributed to iron deficiency (DeMaeyer and Adiels-Tegman, 1985;Singh et al, 1998).…”

Iron deficiency anaemia: Effect on congnitive development in children: A review

“…Micronutrient deficiencies are still a major public health problem in the world today with an estimated 2.5 -5 billion people so affected and specially in developing countries with infants and pregnant women especially at risk (1). In the milder form anaemia is silent without symptoms, while in the severe cases it is associated with fatigue, weakness, dizziness and drowsiness.…”