Causes of maternal mortality and the link with nutrition

Maternal death is defined as death during pregnancy or within 42 days of the end of a pregnancy from any cause related to or brought on by the pregnancy, or its management but not from accidental and incidental causes [10]. Deaths from both direct (resulting from obstetric complications of pregnancy) and indirect causes (resulting from previous existing diseases or diseases that developed during pregnancy) are included in calculating maternal mortality. Measuring maternal mortality is complex due to the lack of adequate data on the timing and cause of deaths in many regions of the world where a large proportion of births do not occur in hospitals. A recent WHO systematic review of causes of maternal deaths revealed wide regional variations [11]. Hemorrhage was the most common cause, accounting for approximately a third of maternal deaths in both Africa and Asia. On the other hand, hypertensive disorders were a leading cause of maternal mortality in Latin America (25.7%), followed closely by hemorrhage (20.8%). Hypertensive disorders contributed about 9% of deaths in Africa and Asia, whereas deaths from sepsis/infections ranged from 9 to 12% in these countries. Anemia was an important cause of death in Asia (12.8%) but less so in Africa (3.7%), and Latin America (0.1%). Obstructed labor, e.g., a labor in which something is preventing the normal process of labor and delivery, contributed to 13.4% of maternal deaths in Latin America, 9.4% in Asia, and 4.1% in Africa. HIV/AIDS contributed to 6.2% of maternal deaths in Africa, although this may be an under representation, as deaths due to HIV/AIDS are often classified under "indirect causes" [12].

The sections that follow describe the evidence linking maternal nutritional deficiencies to maternal mortality. Specifically, the association between anemia and maternal mortality and hemorrhage is examined, including the efficacy of iron supplementation and other interventions in reducing maternal anemia. The role of calcium and antioxidants in the prevention of hypertensive disease and preeclampsia, and the efficacy of magnesium sulfate in the prevention of eclampsia is reviewed as well as the link between sepsis and infection and maternal vitamin A and zinc deficiencies. Finally, causes of obstructed labor and nutritional factors related to maternal stunting with focus on growth in childhood and adolescence are discussed.

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