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Maternal nutrition

Better maternal nutrition will improve maternal and newborn outcomes and facilitate achievement of a continuum of good nutrition.

Effect of maternal nutrition on neontatal mortality and child growth and development

  • Neonatal mortality. Maternal undernutrition contributes to fetal growth restriction leading to small for gestational age and preterm newborns at risk of neonatal death. Maternal short stature and underweight cause an estimated 12% of neonatal deaths. [1] Factors associated with low birthweight include young maternal age, poor pre-pregnant nutritional status, short birth intervals, poor maternal dietary intake (quality, quantity, and diversity), and inadequate pregnancy weight gain. Maternal obesity leads to gestational diabetes, pre-eclampsia, hemorrhage, and higher risk of neonatal and infant death.
  • Child growth and development. About one fifth of childhood stunting is linked to growth restriction in the fetal period. [1] Babies that are small for gestational age do not respond to growth promoting feeding practices as well as normal newborns do. Adequate nutrition during pregnancy is necessary for normal brain development, laying the foundation for future cognitive and social ability, school success, and productivity. [2] 

Effect of maternal nutrition on maternal mortality and other maternal outcomes

  • Maternal mortality. Due to improving economic conditions, rising education among girls, better access to health services, and investments in the immediate causes of maternal deaths, the causes of maternal mortality have shifted (referred to as the “obstetric transition”). A  WHO multi-country review [3] suggests that indirect causes, including nutrition-related factors, are responsible for 27% of the deaths. Indirect causes rank among the top three causes of maternal deaths. The Lancet nutrition series confirms that anemia is a risk factor for maternal deaths, most likely due to hemorrhage, the leading cause of maternal deaths (23% of total deaths). Calcium deficiency increases the risk of pre-eclampsia, currently the second leading cause of maternal death (19% of total deaths).
  • Other outomes. When pregnancy outcomes other than death are considered, the burden of indirect causes is huge. In the WHO review, 21% of severe maternal adverse outcomes were found to be related to these causes. The most common indirect cause was anemia (50%). Anemia and low energy reserves can affect functional outcomes such as a woman’s ability to perform usual daily duties at specific points in time during the postpartum period that would be acceptable and expected culturally.

Evidence for life-saving nutrition interventions. A global review of the literature funded by the Bill & Melinda Gates Foundation and completed by Martorell et al. [4] synthesized the evidence for improving balanced protein and energy intake and increasing uptake of iron/folic acid and calcium supplements to address maternal and perinatal nutrition and health outcomes. New data are emerging for other interventions.

Maternal nutrition interventions scaled up to 90% coverage could save the lives of about 102,000 children under 5 years of age per year at a cost of $571 per life year saved, [5]  These interventions include:

  • Maternal multiple micronutrient supplements to all
  • Calcium supplementation to mothers at risk of low intake
  • Maternal balanced energy protein supplements as needed
  • Universal salt iodization

In the future, the largest number of maternal deaths are expected to decline with improved family planning, higher education, and better nutrition, all requiring active intervention. Prevention of adolescent pregnancies is an important intervention since they account for a high proportion of adverse outcomes such as eclampsia, systemic infections, low birthweight, and preterm delivery.

[1] Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013 Aug 3;382(9890):427-51.Choose Destination

[2] Prado E, Dewey K. Nutrition and brain development in early life. Insight series. A&T Insight Technical Brief, Issue 6. Washington, DC: Alive & Thrive, January 2012.

[3] Lumbiganon P, Laopaiboon M, Intarut N, Vogel JP, Souza JP, Gulmezoglu AM, Mori R, on behalf of the WHO Multicountry Survey on Maternal and Newborn Health Research Network. Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and newborn Health. BJOG 2014; 121 (Suppl. 1): 32-39.

[4] Special Issue: Improving maternal, newborn, and child health outcomes through better designed policies and programs that enhance the nutrition of women. Paediatr Perinat Epidemiol 2012;26(suppl 1):1–325.

[5] Bhutta ZA, Das JK, Rizvi A, Goffey MF, et al. Evidence-based interventions for improvement of maternal and child nutrition; what can be done and at what cost? Lancet  2013 Aug 3;382(9890):452-77.