Advertisement

Nutrition and Maternal Survival in Low and Middle Income Countries

  • Parul Christian
Chapter
Part of the Nutrition and Health book series (NH)

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.

Keywords

Maternal mortality Causes Pregnancy Micronutrients Anemia Vitamins Supplementation Morbidity Nutrition 

References

  1. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    The millennium development goals 2015 report. New York: United Nations; 2015.Google Scholar
  4. 4.
    Ronsmans C, Graham WJ, Lancet Maternal Survival Series Steering Group. Maternal mortality: who, when, where, and why. Lancet. 2006;368:1189–200.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Starrs AM. Safe motherhood initiative: 20 years and counting. Lancet. 2006;368:1130–2.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016.Google Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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.Google Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 19.
    Perkins JM, Subramanian SV, Davey Smith G, Özaltin E. Adult height, nutrition, and population health. Nutr Rev. 2016;74:149–65.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Global nutrition report 2016: from promise to impact: ending malnutrition by 2030. Washington: International Food Policy Research Institute; 2016.Google Scholar
  24. 24.
    Rush D. Nutrition and maternal morbidity in the developing world. Am J Clin Nutr. 2000;72(1 Suppl):212S–40S.CrossRefPubMedGoogle Scholar
  25. 25.
    Brabin BJ, Hakimi M, Pelletier D. An analysis of anemia and pregnancy–related maternal mortality. J Nutr. 2001;131:604S–15S.CrossRefPubMedGoogle Scholar
  26. 26.
    Stoltzfus RJ. Rethinking anaemia surveillance. Lancet. 1997;349:1764–6.CrossRefPubMedGoogle Scholar
  27. 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. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Stafford JL. Iron deficiency in man and animals. Proc R Soc Med. 1961;54:1000–4.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Harris C. The vicious circle of anaemia and menorrhagia. Can Med Assoc J. 1957;77:98–100.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Faisel H, Pittrof R. Vitamin A and causes of maternal mortality: association and biological plausibility. Public Health Nutr. 2000;3:321–7.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Dewar MJ. Antenatal anaemia and postpartum haemorrhage. Aust N Z J Obstet Gynaecol. 1969;9:18–20.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Tsu VD. Postpartum haemorrhage in Zimbabwe: a risk factor analysis. Br J Obstet Gynaecol. 1993;100:327–33.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Selo-Ojeme DO, Okonofua FE. Risk factors for primary postpartum haemorrhage: a case control study. Arch Gynecol Obstet. 1997;259:179–87.CrossRefPubMedGoogle Scholar
  38. 38.
    Combs CA, Murphy EL, Laros RK Jr. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77:69–76.PubMedGoogle Scholar
  39. 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.CrossRefPubMedGoogle Scholar
  40. 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.PubMedPubMedCentralGoogle Scholar
  41. 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.PubMedPubMedCentralGoogle Scholar
  42. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Maine D. Role of nutrition in the prevention of toxemia. Am J Clin Nutr. 2000;72(1 Suppl):298S–300S.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Hamlin RHI. Prevention of preeclampsia. Lancet. 1962;1:864–5.CrossRefGoogle Scholar
  47. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 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: 39:505CrossRefPubMedGoogle Scholar
  51. 51.
    Sibai B, Dekker G, Kupferminc M. Preeclampsia. Lancet. 2005;365:785–99.CrossRefPubMedGoogle Scholar
  52. 52.
    Tsu VD. New and underused technologies to reduce maternal mortality. Lancet. 2004;363:75–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Roberts JM, Hubel CA. Is oxidative stress the link in the two-stage model of preeclampsia? Lancet. 1999;354:788–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Roberts JM. Nutrient involvement in preeclampsia. J Nutr. 2003;133(Suppl 2):1684S–92S.CrossRefPubMedGoogle Scholar
  55. 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.CrossRefPubMedGoogle Scholar
  56. 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.CrossRefPubMedGoogle Scholar
  57. 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.CrossRefPubMedGoogle Scholar
  58. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 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. 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. 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.CrossRefGoogle Scholar
  63. 63.
    Green HN, Pindar D, Davis G, Mellanby E. Diet as a prophylactic agent against puerperal sepsis. BMJ. 1931;2:595–8.CrossRefPubMedGoogle Scholar
  64. 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. 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.CrossRefGoogle Scholar
  66. 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.CrossRefPubMedGoogle Scholar
  67. 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.CrossRefPubMedGoogle Scholar
  68. 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.CrossRefPubMedGoogle Scholar
  69. 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.CrossRefPubMedGoogle Scholar
  70. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Christian P. Micronutrients and reproductive health issues: an international perspective. J Nutr. 2003;133:1969S–73S.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    World Health Organisation. Maternal anthropometry and pregnancy outcomes. A WHO collaborative study. Bull World Health Organ. 1995;73:1S–98S.Google Scholar
  77. 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.PubMedPubMedCentralGoogle Scholar
  78. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Haidar BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2015;(11):CD004905.Google Scholar
  82. 82.
    Schroeder DG. Malnutrition. In: Semba RD, Bloem MW, editors. Nutrition and health in developing countries. Totowa: Humana; 2001. p. 393–426.CrossRefGoogle Scholar
  83. 83.
    The EPIC study. Age at menarche in relation to adult height. Am J Epidemiol. 2005;162:623–32.Google Scholar
  84. 84.
    Tomkins A. Nutrition and maternal morbidity and mortality. Br J Nutr. 2001;85(Suppl 2):S93–S9.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 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.CrossRefGoogle Scholar
  86. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 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.CrossRefGoogle Scholar
  88. 88.
    ESHRE Capri Workshop Group. Nutrition and reproduction in women. Hum Reprod Update. 2006;12:193–207.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Bill and Melinda Gates FoundationSeattleUSA
  2. 2.Johns Hopkins University School of Public HealthBaltimoreUSA

Personalised recommendations