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Handbook of Nutrition and Pregnancy pp 401–421Cite as

Nutrition and Maternal Survival in Low and Middle Income Countries

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Abstract

Maternal mortality has declined globally but continues to be high in regions where maternal nutrition is poor. The specific role of nutrition in affecting maternal health and survival has received some attention, and nutrition interventions have proven to be effective against some causes of maternal mortality. Calcium supplementation during pregnancy, in populations with dietary deficiency, has been shown to reduce the risk of preeclampsia and is a context-specific recommendation by the World Health Organization (WHO). However, the recommended daily dose of 1.5–2.0 g is high, creating challenges for the implementation of large-scale distribution. Severe anemia is likely to increase the risk of cardiac shock related to postpartum hemorrhage, but its causal link to mortality remains unclear. Antenatal iron supplementation, also recommended by WHO, when done adequately, can bring about improvements in hemoglobin concentrations and reduce anemia, but programmatic success is low in many high-burden settings. Maternal night blindness due to vitamin A deficiency may be associated with an increased risk of maternal deaths, but the evidence from three vitamin A supplementation trials does not support universal antenatal use, except in high-burden vitamin A-deficient settings. Adolescent pregnancies and maternal short stature are risk factors for dysfunctional labor; prevention of premature pregnancy and nutrition support for adolescents could lead to improved attained adult height. Nutrition care through antenatal care and other platforms that are able to achieve high coverage may be an effective means for impacting maternal health and survival in undernourished populations of the world, where the burden of maternal mortality is high.

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References

  1. World Health Organization (WHO). Trends in maternal mortality: 1990-2015: estimates by WHO, UNICEF, UNFPA, World Bank and the United Nations Population Division. Geneva: World Health Organization; 2015.

    Google Scholar 

  2. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387:462–74.

    Article  Google Scholar 

  3. The millennium development goals 2015 report. New York: United Nations; 2015.

    Google Scholar 

  4. Ronsmans C, Graham WJ, Lancet Maternal Survival Series Steering Group. Maternal mortality: who, when, where, and why. Lancet. 2006;368:1189–200.

    Article  Google Scholar 

  5. Campbell OMR, Graham WJ, Lancet Maternal Survival Series Steering Group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284–99.

    Article  Google Scholar 

  6. Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, et al. Going to scale with professional skilled care. Lancet. 2006;368:1377–86.

    Article  Google Scholar 

  7. Borghi J, Ensor T, Somanathan A, Lissner C, Mills A, Lancet Maternal Survival Series Steering Group. Mobilising financial resources for maternal health. Lancet. 2006;368:1457–65.

    Article  Google Scholar 

  8. Filippi V, Ronsmans C, Campbell OMR, Graham WJ, Mills A, Borghi J, et al. Maternal health in poor countries: the broader context and a call for action. Lancet. 2006;368:1535–41.

    Article  Google Scholar 

  9. Starrs AM. Safe motherhood initiative: 20 years and counting. Lancet. 2006;368:1130–2.

    Article  Google Scholar 

  10. World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016.

    Google Scholar 

  11. Ceschia A, Horton R. Maternal health: time for a radical reappraisal. Lancet. 2016;388(10056):2064–6. https://doi.org/10.1016/S0140-6736(16)31534-3.

    Article  PubMed  Google Scholar 

  12. World Health Organization (WHO). The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. Geneva: WHO; 2012.

    Google Scholar 

  13. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323–33.

    Article  Google Scholar 

  14. Filippi V, Chou D, Ronsmans C, Graham W, Say L. Levels and causes of maternal mortality and morbidity. In: Black RE, Laxminarayan R, Temmerman M, Walker N, editors. Reproductive, maternal, newborn, and child health: disease control priorities, chap. 3, vol. 2, 3rd ed. Washington: The International Bank for Reconstruction and Development/The World Bank; 2016.

    Chapter  Google Scholar 

  15. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016;387:1377–96.

    Article  Google Scholar 

  16. Kozuki N, Katz J, Lee ACC, Vogel JP, Silveira MP, Sania A, et al. Short maternal stature increases the risk of small-for-gestational-age and preterm birth in low-and-middle income countries: meta-analysis and population attributable fraction. J Nutr. 2015;145:2542–50.

    Article  CAS  Google Scholar 

  17. Adair LS, Fall CH, Osmond C, Stein AD, Martorell R, Ramirez-Zea M, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013;382:525–34.

    Article  Google Scholar 

  18. Subramanian SV, Özaltin E, Finlay JE. Height of nations: a socioeconomic analysis of cohort differences and patterns among women in 54 low- to middle-income countries. PLoS One. 2011;2016:e18962.

    Article  Google Scholar 

  19. Perkins JM, Subramanian SV, Davey Smith G, Özaltin E. Adult height, nutrition, and population health. Nutr Rev. 2016;74:149–65.

    Article  Google Scholar 

  20. Lee SE, Talegawkar SA, Merialdi M, Caulfield LE. Dietary intakes of women during pregnancy in low- and middle-income countries. Public Health Nutr. 2013;16:1340–53.

    Article  Google Scholar 

  21. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51.

    Article  Google Scholar 

  22. Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123:615–24.

    Article  CAS  Google Scholar 

  23. Global nutrition report 2016: from promise to impact: ending malnutrition by 2030. Washington: International Food Policy Research Institute; 2016.

    Google Scholar 

  24. Rush D. Nutrition and maternal morbidity in the developing world. Am J Clin Nutr. 2000;72(1 Suppl):212S–40S.

    Article  CAS  Google Scholar 

  25. Brabin BJ, Hakimi M, Pelletier D. An analysis of anemia and pregnancy–related maternal mortality. J Nutr. 2001;131:604S–15S.

    Article  CAS  Google Scholar 

  26. Stoltzfus RJ. Rethinking anaemia surveillance. Lancet. 1997;349:1764–6.

    Article  CAS  Google Scholar 

  27. Pena-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;(7):CD004736.

    Google Scholar 

  28. Geelhoed D, Agadzi F, Visser L, Ablordeppey E, Asare K, O’Rourke P, et al. Maternal and fetal outcome after severe anemia in pregnancy in rural Ghana. Acta Obstet Gynecol Scand. 2006;85:49–55.

    Article  Google Scholar 

  29. Malhotra M, Sharma JB, Batra S, Sharma S, Murthy NS, Arora R. Maternal and perinatal outcome in varying degrees of anemia. Int J Gynaecol Obstet. 2002;79:93–100.

    Article  Google Scholar 

  30. O’Brien ME, Kupka R, Msamanga GI, Saathoff E, Hunter DJ, Fawzi WW. Anemia is an independent predictor of mortality and immunologic progression of disease among women with HIV in Tanzania. J Acquir Immune Defic Syndr. 2005;40:219–25.

    Article  Google Scholar 

  31. Chhabra S, Sirohi R. Trends in maternal mortality due to haemorrhage: two decades of Indian rural observations. J Obstet Gynaecol. 2004;24:40–3.

    Article  CAS  Google Scholar 

  32. Stafford JL. Iron deficiency in man and animals. Proc R Soc Med. 1961;54:1000–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Harris C. The vicious circle of anaemia and menorrhagia. Can Med Assoc J. 1957;77:98–100.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Faisel H, Pittrof R. Vitamin A and causes of maternal mortality: association and biological plausibility. Public Health Nutr. 2000;3:321–7.

    Article  CAS  Google Scholar 

  35. Dewar MJ. Antenatal anaemia and postpartum haemorrhage. Aust N Z J Obstet Gynaecol. 1969;9:18–20.

    Article  CAS  Google Scholar 

  36. Tsu VD. Postpartum haemorrhage in Zimbabwe: a risk factor analysis. Br J Obstet Gynaecol. 1993;100:327–33.

    Article  CAS  Google Scholar 

  37. Selo-Ojeme DO, Okonofua FE. Risk factors for primary postpartum haemorrhage: a case control study. Arch Gynecol Obstet. 1997;259:179–87.

    Article  CAS  Google Scholar 

  38. Combs CA, Murphy EL, Laros RK Jr. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77:69–76.

    CAS  PubMed  Google Scholar 

  39. Christian P, Khatry SK, LeClerq SC, Dali SM. Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal. Int J Gynaecol Obstet. 2009;106:3–7.

    Article  CAS  Google Scholar 

  40. Feerasta SH, Motiei A, Motiwala S, Zuberi NF. Uterine atony at a tertiary care hospital in Pakistan: a risk factor analysis. J Pak Med Assoc. 2000;50:132–6.

    CAS  PubMed  Google Scholar 

  41. Kavle JA, Stoltzfus RJ, Witter F, Tielsch JM, Khalfan SS, Caulfield LE. Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. J Health Popul Nutr. 2008;26:232–40.

    PubMed  PubMed Central  Google Scholar 

  42. Mukuria A, Aboulafia C, Themme A. The context of women’s health: results from the demographic and health surveys, 1994–2001. Comparative reports no. 11. ORC Macro: Calverton; 2005.

    Google Scholar 

  43. Galloway R, Dusch E, Elder L, Achadi E, Grajeda R, Hurtado E, et al. Women’s perceptions of iron deficiency and anemia prevention and control in eight developing countries. Soc Sci Med. 2002;55:529–44.

    Article  Google Scholar 

  44. Maine D. Role of nutrition in the prevention of toxemia. Am J Clin Nutr. 2000;72(1 Suppl):298S–300S.

    Article  CAS  Google Scholar 

  45. Belizan JM, Villar J. The relationship between calcium intake and edema, proteinuria, and hypertension-gestosis: an hypothesis. Am J Clin Nutr. 1980;33:2202–10.

    Article  CAS  Google Scholar 

  46. Hamlin RHI. Prevention of preeclampsia. Lancet. 1962;1:864–5.

    Article  Google Scholar 

  47. Villar J, Abdel-Aleem H, Merialdi M, Mathai M, Ali MM, Zavaleta N, et al. World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. Am J Obstet Gynecol. 2006;194:639–49.

    Article  CAS  Google Scholar 

  48. Hofmeyr GJ, Lowrie TA, Atallah AN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2014;(6):CD001059.

    Google Scholar 

  49. Omotayo MO, Dickin KL, O’Brien KO, Neufeld LM, De Regil LM, Stoltzfus RJ. Calcium supplementation to prevent preeclampsia: translating guidelines into practice in low-income countries. Adv Nutr. 2016;7:275–8.

    Article  CAS  Google Scholar 

  50. Christian P, Mullany LC, Hurley KM, Katz J, Black RE. Nutrition and maternal, neonatal, and child health. Semin Perinatol. 2015;39:361–72. Erratum in: 39:505

    Article  Google Scholar 

  51. Sibai B, Dekker G, Kupferminc M. Preeclampsia. Lancet. 2005;365:785–99.

    Article  Google Scholar 

  52. Tsu VD. New and underused technologies to reduce maternal mortality. Lancet. 2004;363:75–6.

    Article  Google Scholar 

  53. Roberts JM, Hubel CA. Is oxidative stress the link in the two-stage model of preeclampsia? Lancet. 1999;354:788–9.

    Article  CAS  Google Scholar 

  54. Roberts JM. Nutrient involvement in preeclampsia. J Nutr. 2003;133(Suppl 2):1684S–92S.

    Article  CAS  Google Scholar 

  55. Wang Y, Walsh SW. Increased superoxide generation is associated with decreased superoxide dismutase activity and mRNA expression in placental trophoblast cells in preeclampsia. Placenta. 2001;22:206–12.

    Article  CAS  Google Scholar 

  56. Chappell LC, Seed PT, Briley AL, Kelly FJ, Lee R, Hunt BJ, et al. Effect of antioxidants on the occurrence of preeclampsia in women at increased risk: a randomised trial. Lancet. 1999;354:810–6.

    Article  CAS  Google Scholar 

  57. Poston L, Briley AL, Seed PT, Kelly FI, Shennan AH, Vitamins in Pre-eclampsia (VIP) Trial Consortium. Vitamin C and vitamin E in pregnant women at risk for preeclampsia (VIP trial): randomised placebo-controlled trial. Lancet. 2006;367:1145–54.

    Article  CAS  Google Scholar 

  58. Beazley D, Ahokas R, Livingston J, Griggs M, Sibai BM. Vitamin C and E supplementation in women at high risk for preeclampsia: a double-blind, placebo-controlled trial. Am J Obstet Gynecol. 2005;192:520–1.

    Article  CAS  Google Scholar 

  59. Rumbold AR, Crowther CA, Haslam RR, Dekker GA, Robinson IS, ACTS Study Group. Vitamins C and E and the risks of preeclampsia and perinatal complications. N Engl J Med. 2006;354:1796–806.

    Article  CAS  Google Scholar 

  60. Rumbold A, Ota E, Hori H, Miyazaki C, Crowther CA. Vitamin E supplementation in pregnancy. Cochrane Database Syst Rev. 2015;(9):CD004069.

    Google Scholar 

  61. Rumbold A, Ota E, Nagata C, Shahrook S, Crowther CA. Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev. 2015;(9):CD004072.

    Google Scholar 

  62. McGanity WJ, Cannon RO, Bridgforth EB. The Vanderbilt cooperative study of maternal and infant nutrition. IV. Relationship of obstetric performance to nutrition. Am J Obstet Gynecol. 1945;67:501–27.

    Article  Google Scholar 

  63. Green HN, Pindar D, Davis G, Mellanby E. Diet as a prophylactic agent against puerperal sepsis. BMJ. 1931;2:595–8.

    Article  CAS  Google Scholar 

  64. Hakimi M, Dibley MJ, Suryono A, Nurdiati D, Th Ninuk SH, Dawiesah Ismadi S. Impact of vitamin A and zinc supplements on maternal postpartum infections in rural central Java, Indonesia. Durban, South Africa: International Vitamin A Consultative Group Meeting, 8–11 Mar 1999.

    Google Scholar 

  65. West KP Jr, Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, et al. Low dose vitamin A or β-carotene supplementation reduces pregnancy-related mortality: a double-masked, cluster randomized prevention trial in Nepal. Br Med J. 1999;318:570–5.

    Article  CAS  Google Scholar 

  66. Christian P, West KP Jr, Khatry SK, Kimbrough-Pradhan E, LeClerq SC, Katz J, et al. Night blindness during pregnancy and subsequent mortality among women in Nepal: effects of vitamin A and beta-carotene supplementation. Am J Epidemiol. 2000;152:542–7.

    Article  CAS  Google Scholar 

  67. Christian P, West KP Jr, Khatry SK, Katz J, LeClerq SC, Kimbrough-Pradhan E, et al. Vitamin A or β-carotene supplementation reduces symptoms of illness in pregnant and lactating Nepali women. J Nutr. 2000;130:2675–82.

    Article  CAS  Google Scholar 

  68. Kirkwood BR, Hurt L, Amenga-Etego S, Tawiah C, Zandoh C, Danso S, ObaapaVitA Trial Team, et al. Effect of vitamin A supplementation in women of reproductive age on maternal survival in Ghana (ObaapaVitA): a cluster-randomised, placebo-controlled trial. Lancet. 2010;375:1640–9.

    Article  CAS  Google Scholar 

  69. West KP Jr, Christian P, Labrique AB, Rashid M, Shamim AA, Klemm RD, et al. Effects of vitamin A or beta carotene supplementation on pregnancy-related mortality and infant mortality in rural Bangladesh: a cluster randomized trial. JAMA. 2011;305:1986–95.

    Article  CAS  Google Scholar 

  70. McCauley ME, van den Broek N, Dou L, Othman M. Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst Rev. 2015;(10):CD008666.

    Google Scholar 

  71. Caulfield LE, Zavaleta N, Shankar AH, Merialdi M. Potential contribution of maternal zinc supplementation during pregnancy to maternal and child survival. Am J Clin Nutr. 1998;68(2 Suppl):499S–508S.

    Article  CAS  Google Scholar 

  72. Christian P. Micronutrients and reproductive health issues: an international perspective. J Nutr. 2003;133:1969S–73S.

    Article  Google Scholar 

  73. Ota E, Mori R, Middleton P, Tobe-Gai R, Mohamed K, Miyazaki C, et al. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2015;(2):CD000230.

    Google Scholar 

  74. Graham W, Woodd S, Byass P, Filippi V, Gon G, Virgo S, et al. Diversity and divergence: the dynamic burden of poor maternal health. Lancet. 2016;388:2164–75.

    Article  Google Scholar 

  75. Dujardin B, Van Cutsem R, Lambrechts T. The value of maternal height as a risk factor for dystocia: a meta-analysis. Trop Med Int Health. 1996;1(4):510–21.

    Article  CAS  Google Scholar 

  76. World Health Organisation. Maternal anthropometry and pregnancy outcomes. A WHO collaborative study. Bull World Health Organ. 1995;73:1S–98S.

    Google Scholar 

  77. Harrison KA. Child-bearing, health and social priorities: a survey of 22,774 consecutive hospital births in Zaria, Northern Nigeria. Br J Obstet Gynaecol. 1985;92(Suppl 5):1–119.

    PubMed  Google Scholar 

  78. Lee Anne CC, Darmstadt GL, Khatry SK, LeClerq SC, Shrestha SR, Christian P. Maternal-fetal disproportion and birth asphyxia in rural Sarlahi, Nepal. Arch Pediatr Adolesc Med. 2009;163:616–23.

    Article  CAS  Google Scholar 

  79. Garner P, Kramer M, Chalmers I. Might efforts to increase birth weight in undernourished women do more harm than good? Lancet. 1992;340:1021–3.

    Article  CAS  Google Scholar 

  80. Ceesay SM, Prentice AM, Cole TJ, Foord F, Weaver LT, Poskitt EM, et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. BMJ. 1997;315:786–90.

    Article  CAS  Google Scholar 

  81. Haidar BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2015;(11):CD004905.

    Google Scholar 

  82. Schroeder DG. Malnutrition. In: Semba RD, Bloem MW, editors. Nutrition and health in developing countries. Totowa: Humana; 2001. p. 393–426.

    Chapter  Google Scholar 

  83. The EPIC study. Age at menarche in relation to adult height. Am J Epidemiol. 2005;162:623–32.

    Google Scholar 

  84. Tomkins A. Nutrition and maternal morbidity and mortality. Br J Nutr. 2001;85(Suppl 2):S93–S9.

    Article  CAS  Google Scholar 

  85. Scalone F. Effects of nutritional stress and socio-economic status on maternal mortality in six German villages, 1766-1863. Popul Stud. 2014;68:217–36.

    Article  Google Scholar 

  86. Christian P, Katz J, Wu L, Pradhan EK, LeClerq SC, Khatry SK, et al. Risk factors for pregnancy-related mortality: a prospective study in rural Nepal. Public Health. 2008;122:161–72.

    Article  Google Scholar 

  87. Sikder SS, Labrique AB, Shamim AA, Hasmot A, Mehra S, Wu L, et al. Risk factors for reported obstetric complications and near misses in rural northwest Bangladesh: analysis from a prospective cohort study. BMC Pregnancy Childbirth. 2014;4:347.

    Article  Google Scholar 

  88. ESHRE Capri Workshop Group. Nutrition and reproduction in women. Hum Reprod Update. 2006;12:193–207.

    Article  Google Scholar 

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Authors and Affiliations

  1. Bill and Melinda Gates Foundation, Seattle, WA, USA

    Parul Christian

  2. Johns Hopkins University School of Public Health, Baltimore, MD, USA

    Parul Christian

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Editors and Affiliations

  1. School of Nutrition and Food Sciences, Louisiana State University, Baton Rouge, LA, USA

    Carol J. Lammi-Keefe

  2. Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA

    Sarah C. Couch

  3. Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    John P. Kirwan

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Christian, P. (2018). Nutrition and Maternal Survival in Low and Middle Income Countries. In: Lammi-Keefe, C., Couch, S., Kirwan, J. (eds) Handbook of Nutrition and Pregnancy. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-90988-2_21

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