Nutrition and maternal mortality in the developing world
Rush, D.
American Journal of Clinical Nutrition 72(1 Suppl): 212s-240s
2000
ISSN/ISBN: 0002-9165 PMID: 10871588 DOI: 10.1093/ajcn/72.1.212sDocument Number: 250043
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. Haemorrhage (including, for this discussion, anaemia) and obstructed labour are different. The risk of death is greatly increased with severe anaemia (Hb<70 or 80 g/L); there is little evidence of increased risk associated with mild or moderate anaemia. Current programmes of universal iron supplementation are unlikely to have much effect on severe anaemia. There is an urgent need to reassess how to approach anaemia control in pregnant women. Obstructed labour 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 labour. In the absence of accessible obstetric services, primiparous women <1.5 m in height should be excluded from supplementary feeding programmes aimed at accelerating fetal growth. The knowledge base to model the risks and benefits of increased fetal size does not exist.