HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rush, D. Search for Related Content PubMed PubMed Citation Articles by Rush, D. Agricola Articles by Rush, D.

Nutrition and maternal mortality in the developing world^1,2,3

¹ From the School of Nutrition Science and Policy, Tufts University, Boston.

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.

Key Words: Maternal mortality • pregnancy • developing world • nutrition • obstetric care • operative delivery • obstructed labor • toxemia of pregnancy • iron • anemia • nutrient requirements • supplementation • menarche • maternal height • fetal size • zinc • uterine rupture • maternal weight • maternal body mass index

This article has been cited by other articles:

				G.-F. von Tempelhoff, L. Heilmann, L. Rudig, K. Pollow, G. Hommel, and J. Koscielny Mean Maternal Second-Trimester Hemoglobin Concentration and Outcome of Pregnancy: A Population-Based Study Clinical and Applied Thrombosis/Hemostasis, January 1, 2008; 14(1): 19 - 28. [Abstract] [PDF]

				R. I. Diaz de la Garza, J. F. Gregory III, and A. D. Hanson From the Cover: Folate biofortification of tomato fruit PNAS, March 6, 2007; 104(10): 4218 - 4222. [Abstract] [Full Text] [PDF]

				D. DellaPenna Biofortification of plant-based food: Enhancing folate levels by metabolic engineering PNAS, March 6, 2007; 104(10): 3675 - 3676. [Full Text] [PDF]

				T. H. FARAG, R. J. STOLTZFUS, S. S. KHALFAN, and J. M. TIELSCH HELICOBACTER PYLORI INFECTION IS ASSOCIATED WITH SEVERE ANEMIA OF PREGNANCY ON PEMBA ISLAND, ZANZIBAR Am J Trop Med Hyg, March 1, 2007; 76(3): 541 - 548. [Abstract] [Full Text] [PDF]

				L. Hoj, P. Cardoso, B. B. Nielsen, L. Hvidman, J. Nielsen, and P. Aaby Effect of sublingual misoprostol on severe postpartum haemorrhage in a primary health centre in Guinea-Bissau: randomised double blind clinical trial BMJ, October 1, 2005; 331(7519): 723. [Abstract] [Full Text] [PDF]

				T. O Scholl Iron status during pregnancy: setting the stage for mother and infant Am. J. Clinical Nutrition, May 1, 2005; 81(5): 1218S - 1222S. [Abstract] [Full Text] [PDF]

				P. Christian, K. P West, S. K Khatry, S. C Leclerq, E. K Pradhan, J. Katz, S. R. Shrestha, and A. Sommer Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal Am. J. Clinical Nutrition, December 1, 2003; 78(6): 1194 - 1202. [Abstract] [Full Text] [PDF]

				H. Li, A. D Stein, H. X Barnhart, U. Ramakrishnan, and R. Martorell Associations between prenatal and postnatal growth and adult body size and composition Am. J. Clinical Nutrition, June 1, 2003; 77(6): 1498 - 1505. [Abstract] [Full Text] [PDF]

				D. Makola, D. M. Ash, S. R. Tatala, M. C. Latham, G. Ndossi, and H. Mehansho A Micronutrient-Fortified Beverage Prevents Iron Deficiency, Reduces Anemia and Improves the Hemoglobin Concentration of Pregnant Tanzanian Women J. Nutr., May 1, 2003; 133(5): 1339 - 1346. [Abstract] [Full Text] [PDF]

				P. Nestel and F. Davidson Introduction Am. J. Clinical Nutrition, July 1, 2000; 72(1): 209S - 211. [Full Text] [PDF]

				G. H Beaton Iron needs during pregnancy: do we need to rethink our targets? Am. J. Clinical Nutrition, July 1, 2000; 72(1): 265S - 271. [Abstract] [Full Text] [PDF]

				R. Yip Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition Am. J. Clinical Nutrition, July 1, 2000; 72(1): 272S - 279. [Abstract] [Full Text] [PDF]

				O. A Ladipo Nutrition in pregnancy: mineral and vitamin supplements Am. J. Clinical Nutrition, July 1, 2000; 72(1): 280S - 290. [Abstract] [Full Text] [PDF]

				J. C Konje and O. A Ladipo Nutrition and obstructed labor Am. J. Clinical Nutrition, July 1, 2000; 72(1): 291S - 297. [Abstract] [Full Text] [PDF]