Prevalence Of Maternal Anemia Research Articles

1344Interbirth interval and maternal anaemia in 21 sub-Saharan African countries: a multinational cross-sectional study

Abstract Background Anaemia is a global public health problem, which disproportionately affects women in sub-Saharan Africa (SSA). The causes of anaemia are multifactorial, and a short interbirth interval has been identified as a potentially modifiable risk factor. However, the current evidence for the association between interbirth interval and maternal anaemia remains inconclusive. Hence, this study aimed at examining the association between the interbirth interval and maternal anaemia in SSA. Methods We conducted a multinational cross-sectional study of interbirth interval (time between two singleton live births) and maternal anaemia for 21 SSA countries using the most recent nationally representative Demographic and Health Surveys, 2010-2017. Modified Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (CIs) after adjusting for confounding variables. Results There were 81,693 women included in the study (89.2% nonpregnant, 10.8% pregnant and 32.2% postpartum). Overall, 36.9% of women had anaemia (36.0% of non-pregnant, 44.3% pregnant, and 38.7% of postpartum women). Compared to a 24-35 months interbirth interval, maternal anaemia was not associated with short (<24 months) interbirth intervals (aRR 1.01, 95% CI; 0. 98, 1.04) or long (≥60 months) interbirth interval (aRR 1.00, 95% CI 0.96, 1. 04). Conclusions Our finding revealed insufficient evidence that both short and long birth intervals were associated with the risk of maternal anaemia in SSA. Key messages It is unlikely that the high prevalence of maternal anaemia in SSA can be reduced by avoiding short nor long interbirth intervals.

Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study.

Maternal anaemia prevalence in low‐income countries is unacceptably high. Our research explored the individual‐, family‐ and community‐level factors affecting antenatal care uptake, iron folic acid (IFA) intake and consumption of micronutrient‐rich diets among pregnant women in the plains of Nepal. We discuss how these findings informed the development of a home visit and community mobilisation intervention to reduce anaemia in pregnancy. We used a qualitative methodology informed by the socio‐ecological framework, conducting semi‐structured interviews with recently pregnant women and key informants, and focus group discussions with mothers‐in‐law and fathers. We found that harmful gender norms restricted women's access to nutrient‐rich food, restricted their mobility and access to antenatal care. These norms also restricted fathers' role to that of the provider, as opposed to the caregiver. Pregnant women, mothers‐in‐law and fathers lacked awareness about iron‐rich foods and how to manage the side effects of IFA. Fathers lacked trust in government health facilities affecting access to care and trust in the efficacy of IFA. Our research informed interventions by (1) informing the development of intervention tools and training; (2) informing the intervention focus to engaging mothers‐in‐law and men to enable behaviour change; and (3) demonstrating the need to work in synergy across individual, family and community levels to address power and positionality, gender norms, trust in health services and harmful norms. Participatory groups and home visits will enable the development and implementation of feasible and acceptable strategies to address family and contextual issues generating knowledge and an enabling environment for behaviour change.

Effects of Maternal and Early-Life Anaemia on Child Brain Development: A South African Birth Cohort Study

Background: Anaemia affects millions of women and children worldwide, particularly in low- and middle-income countries. Although anaemia in pregnancy is a well-described risk factor for poor child neurodevelopmental outcomes, little is known about the impact on the structural development of the human brain. We explored the relationship between maternal anaemia, child anaemia, and brain structure at 2-3 years of age. Methods: Pregnant women were enrolled into the Drakenstein Child Health Study, a South African population-based birth cohort. Mother-child pairs were followed prospectively and a subgroup of children had magnetic resonance imaging at 2-3 years of age. Mothers had haemoglobin measurements during pregnancy, and a group of children during early life. Linear regression models were used to analyse the effects of maternal and child anaemia on child brain volumes. Findings: Prevalence of maternal anaemia in pregnancy (haemoglobin 0.05). Associations between antenatal anaemia with child putamen and corpus callosum volumes increased in magnitude when adjusting for child anaemia. Interpretation: Maternal anaemia may influence brain development during a critical window with persistent impact. Funding: Gates Foundation, SAMRC, NIH, Wellcome Trust Declaration of Interests: No conflicts of interest. Ethics Approval Statement: The DCHS was approved by the Faculty of Health Sciences, Human Research Ethics Committee (HREC), UCT (401/2009), Stellenbosch University (N12/02/0002), and the Western Cape Provincial Health Research Committee (2011RP45). The neuroimaging sub-study was further approved by the UCT HREC (525/2012).

Mapping of anaemia prevalence among pregnant women in Kenya (2016\u20132019)

BackgroundReducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates. As more counties in Kenya commit to universal health coverage, there is a growing need for optimal allocation of the limited resources to sustain the gains achieved with the devolution of healthcare services. This study aimed to describe the spatio-temporal patterns of maternal anaemia prevalence in Kenya from 2016 to 2019.MethodsQuarterly reported sub-county level maternal anaemia cases from January 2016 – December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical negative binomial spatio-temporal conditional autoregressive (CAR) model was used to estimate maternal anaemia prevalence by sub-county and quarter. Spatial and temporal correlations were considered by assuming a conditional autoregressive and a first-order autoregressive process on sub-county and seasonal specific random effects, respectively.ResultsThe overall estimated number of pregnant women with anaemia increased by 90.1% (95% uncertainty interval [95% UI], 89.9–90.2) from 155,539 cases in 2016 to 295,642 cases 2019. Based on the WHO classification criteria, the proportion of sub-counties with normal prevalence decreased from 28.0% (95% UI, 25.4–30.7) in 2016 to 5.4% (95% UI, 4.1–6.7) in 2019, whereas moderate anaemia prevalence increased from 16.8% (95% UI, 14.7–19.1) in 2016 to 30.1% (95% UI, 27.5–32.8) in 2019 and severe anaemia prevalence increased from 7.0% (95% UI, 5.6–8.6) in 2016 to 16.6% (95% UI, 14.5–18.9) in 2019. Overall, 45.1% (95% UI: 45.0–45.2) of the estimated cases were in malaria-endemic sub-counties, with the coastal endemic zone having the highest proportion 72.8% (95% UI: 68.3–77.4) of sub-counties with severe prevalence.ConclusionAs the number of women of reproductive age continues to grow in Kenya, the use of routinely collected data for accurate mapping of poor maternal outcomes remains an integral component of a functional maternal health strategy. By unmasking the sub-county disparities often concealed by national and county estimates, our study findings reiterate the importance of maternal anaemia prevalence as a metric for estimating malaria burden and offers compelling policy implications for achieving national nutritional targets.

Maternal Compliance to Recommended Iron and Folic Acid Supplementation in Pregnancy, Sri Lanka: A Hospital-Based Cross-Sectional Study.

Iron deficiency anaemia during pregnancy is a common public health problem that negatively affects maternal and newborn health. This study aims to identify the rate of maternal compliance with the recommended iron and folic acid (IFA) supplementation during pregnancy and to identify factors associated with maternal compliance and non-compliance. A hospital-based cross-sectional study was conducted among 703 women at 0–4 days postpartum. The prevalence of anaemia at the initial antenatal clinic (ANC) visit and at the third trimester were 20.8% and 44.9%, respectively. The rate of IFA supplementation compliance during pregnancy was 80.1%. Forgetfulness (66.9%) was the major reason for non-compliance, followed by side effects (15.7%). Maternal employment [OR (95%CI): 1.7 (1.00–2.89)], history of a low birth weight infant [OR (95%CI): 0.4 (0.19–0.9)] and history of anaemia [OR (95%CI): 0.4 (0.12–0.98] were significantly associated with maternal compliance with IFA supplementation. Only 26.6% of the participants adhered to dietary recommendations during the period when IFA supplements were provided. The rate of maternal compliance with IFA supplementation was high. However, the prevalence of maternal anaemia during pregnancy was also high, which was presumably due to poor dietary compliance despite high IFA supplementation compliance.

Seasonal trends and maternal characteristics as predictors of maternal undernutrition and low birthweight in Eastern Maharashtra, India.

Few studies have assessed whether women and infants in rural and peri‐urban communities in South Asia experience seasonal fluctuations in nutritional status; however, a handful of studies have documented seasonal variability in risk factors for undernutrition including food availability, physical activity and infections. We used data from the Maternal and Newborn Health (MNH) registry, a population‐based pregnancy and birth registry in Eastern Maharashtra, India, to analyse seasonal trends in birthweight and maternal nutritional status—body mass index (BMI) and haemoglobin—in the first trimester of pregnancy. We plotted monthly and seasonal trends in birthweight, and maternal BMI and haemoglobin, and used multivariable regression models to identify seasonal and maternal characteristics that predicted each outcome. Between October 2014 and January 2018, MNH included 29,253 livebirths with recorded birthweight. BMI was assessed in 15,252 women less than 12 weeks of gestation and haemoglobin in 18,278 women less than 13 weeks of gestation. Maternal characteristics (age, education, parity and height) were significantly associated with nutritional status; however, there were minimal seasonal fluctuations in birthweight or maternal nutrition. There were significant secular trends in maternal haemoglobin; between 2014 and 2018, the prevalence of maternal anaemia decreased from 91% to 79% and moderate or severe anaemia from 53% to 37%. The prevalence of maternal underweight (45.3%) and overweight (9.8%) and low birthweight (19.1%) remained relatively constant over the study period. Our findings highlight that in some rural and peri‐urban areas in South Asia, tackling systemic drivers of malnutrition may be more effective than targeted interventions based on season.

Maternal Anaemia in Pregnancy: A Significantly Greater Risk Factor for Anaemia in Australian Aboriginal Children than Low Birth Weight or Prematurity.

To identify maternal and perinatal risk factors associated with childhood anaemia. A retrospective cohort studywas conducted in three remote Katherine East Aboriginal communities in Northern Territory, Australia. Children born 2004-2014 in Community A and 2010-2014 in Community B and C, and their respective motherswere recruited into the study.Maternal and child datawere linked to providea longitudinal view of each child for the first 1000 days from conception to 2-years of age. Descriptive analyses were used to calculate mean maternal age, and proportions were used to describe other antenatal and perinatal characteristics of the mother/child dyads. The main outcome was theprevalence of maternal anaemia in pregnancy and risk factors associated with childhood anaemia at age 6months. Prevalence of maternal anaemia in pregnancy was higher in the third trimester (62%) compared to the first (46%) and second trimesters (48%). There was a strong positive linear association (R2 = 0.46, p < 0.001) between maternal haemoglobin (Hb) in third trimester pregnancy and child Hb at age 6months. Maternal anaemia in pregnancy (OR 4.42 95% CI 2.08-9.36) and low birth weight (LBW, OR 2.62, 95% CI 1.21-5.70) were associated with an increased risk of childhood anaemia at 6months of age. This is the first study to identify the association of maternal anaemia with childhood anaemia in the Australian Aboriginal population. A review of current policies and practices for anaemia screening, prevention and treatment during pregnancy and early childhood would be beneficial to both mother and child. Our findings indicate that administering prophylactic iron supplementation only to children who are born LBW or premature would be of greater benefit if expanded to include children born to anaemic mothers.

PIH34 PREVALENCE OF ANEMIA AND IRON DEFICIENCY IN PREGNANT WOMEN LIVING IN CARTAGENA, COLOMBIA

According to the World Health Organization, anemia affects more than 40% of pregnant women worldwide. Iron-deficiency anemia is the most common type of anemia, and has been shown to have a direct impact on health and quality of life of both mother and child.Ferritin, and iron binding protein, can be used to assess the body’s stored iron and support diagnosis. This study assessed the prevalence of anemia and iron deficiency amongst pregnant women in the ESE Clinica Maternidad Rafael Calvo, a reference maternity unit in the department of Bolivar, Colombia. A total of 773 women were enrolled during the last trimester of their pregnancy, between December 2018 and December 2019. Obstetric and prenatal information was assessed, as well as personal and socio-economical background. Blood samples were taken prior to delivery and analysis was based on maternal blood count and ferritin levels. Prevalence of maternal anemia was 42.4% (95%CI: 38.9 - 45.9). Hemoglobin and ferritin levels were significantly correlated (rho=0.39, p<0.0001). Low ferritin levels were detected in 196 out of 496 (39.5%) women and in 55.6% of anemic mothers. Age [adjusted OR: 0.93, 95%CI: 0.91-0.97], affiliation to health care system [0.73(0.54-0.99], socioeconomical class [0.63 (0.40-0.99)] and prenatal care attendance [0.63 (0.46-0.85)] were protective factors for anemia, meanwhile living in the urban area [1.66 (1.13-2.41)] and previous pregnancies behaved as risk factors [One: OR: 1.7 (1.2-2.5), 2 or more: OR: 2.8 (1.8-4.3)]. Ferritin levels decreased parallel with previous pregnancies (Current = 30.8±37.9, One = 18.6±18.2, 2 or more= 17.7±25.8 ng/mL, p<0.0001). Anemia and iron deficiency are common in pregnant women. Access to adequate prenatal control allows identifying the associated risk factors to prevent anemia and maintain optimal iron levels.

Maternal Anemia Prevalence and Subsequent Neonatal Complications in Iraq

BACKGROUND: Anemia during pregnancy is still a challenge throughout the world, and it may cause severe health consequences in the maternal and fetal sides.&#x0D; AIM: This study aims to find out the prevalence of maternal anemia and potential adverse outcomes in Iraq.&#x0D; METHODS: In Medical City Tertiary Center in Baghdad, singleton pregnant ladies came for delivery were involved over 6 months’ period. Based on hemoglobin (Hb) readings; they were divided into no anemia group (Hb&gt;11 g/l) and anemia group which were further subdivided into mild, moderate, and severe (Hb =10–10.9, =7.1–9.9, and &lt;7 g/l, respectively). Full history and examination were performed by attending obstetrician and pediatrician for the upcoming babies.&#x0D; RESULTS: Maternal anemia prevalence was 84.84% out of 4473 cases. No anemia group was 15.16%, mild 40.73%, and moderate 40.73%, while severe anemia group (24.93%). Maternal occupation, educational status, and Hb levels were significantly associated with anemia (p &lt; 0.001), unlike parity, body mass index, and delivery mode. Neonatal preterm delivery, birth weight and length, small for gestational age (SGA), Apgar score, respiratory distress, and high death rate were strongly related to mothers’ anemia (p &lt; 0.001), on the contrary of septicemia, birth asphyxia, and hypoglycemia, in spite of their higher frequency rates in anemia groups. Birth weight, and length, and gestational age were lowered significantly in moderate and severe anemia, while Apgar score was low throughout all anemia categories. SGA was significant in severe anemia.&#x0D; CONCLUSION: Maternal anemia is highly prevalent in Iraq with significant adverse neonatal events and elevated rates of mortality.

Risk Factors of Childhood and Maternal Anemia in India.

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. We analyzed a sample of 112,714 mothers aged 15 to 49 years and their children younger than 5 years from the 2005–2006 Indian National Fertility and Health Survey with available data on anemia to determine the anemia statuses and risk factors associated with maternal and childhood anemia. Logistic regression analyses were used to determine factors associated with anemia. The overall prevalence of maternal anemia was 52.0%, while the overall prevalence of childhood anemia was 66.7%. Predictors of maternal anemia are a young age ( p &lt; .001), maternal health practices ( p &lt; .001), and reproductive health-related infections ( p &lt; .001), among others. On the other hand, predictors of childhood anemia included iron deficiency ( p = .007), vitamin deficiency ( p = .003), and common infections ( p = .008). Other predictors of childhood anemia included poor dietary intake ( p &lt; .01) and childcare practices ( p &lt; .001). Childcare practice has the strongest association with childhood anemia with an odds ratio of 1.67 (95% confidence interval [1.55, 1.79]). With respect to maternal anemia, the strongest risk factor was being infected with reproductive health infections with an odds ratio of 1.157 (95% confidence interval [1.11, 1.21]). Interventions designed to address prevalence of childhood and maternal anemia in India should take the risk factors in a holistic manner. A multifactorial framework should guide such interventions.

Prevalence of Maternal Anemia in A Tertiary Care Hospital in Western Nepal

Maternal anemia is a common problem in developing countries like Nepal accounting for around 30-50% of women becoming anemic during pregnancy. The present study aims to find out the prevalence of maternal anemia in a tertiary care hospital in Western Nepal. A descriptive cross-sectional study was carried out at Devdaha Medical College, Bhaluhi, Rupandehi, Nepal from October 2018 to May 2019 after taking ethical approval from the institutional review committee with the approval number: 012/2018. Three eighty three samples were taken and convenient sampling was done to reach the sample size. Data were collected from the study population after taking consent and entered in a predesigned proforma. It was then entered in an SPSS; point estimate at 95% CI was calculated along with frequency and proportion for binary data. During the study period, out of 383 mothers, 230 (60.2%) mothers were anemic at 95% CI (10.6-10.8%); of which 172 (74.8%) were moderately anemic while 58 (25.2%) were mild anemic. The mean maternal Haemoglobin was 9.5±1.76SD. The mean maternal age was 24.24±3.26 SD; mean gestational age at the time of delivery was 36.08±1.77 SD. The prevalence of maternal anemia in this study is found to be higher than the national data which implies that maternal anemia is still a public health issue which needs to be addressed in spite of safe motherhood program launched by the government of Nepal.

Adverse birth outcomes among mothers who received intermittent preventive treatment with Sulphadoxine-Pyrimethamine in the low malaria transmission region

BackgroundMalaria in pregnancy increases the risk of adverse birth outcomes such as low birth weight (LBW), maternal and foetal anemia. In Tanzania, some areas have attained low malaria transmission. However, data on the burden of preterm delivery, LBW, maternal and foetal anemia following substantial reduction of malaria transmission in recent years is still scarce in these settings.MethodsA study involving 631 pregnant women was conducted at Mwananyamala referral hospital in Dar es Salaam from April to August, 2018. Study enrollment was done prior to delivery. Structured interview and antenatal clinic cards were used to obtain data including the use of intermittent preventive therapy in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP). Infants birth weights were recorded, maternal venous and cord blood were taken for testing of malaria and determination of haemoglobin (Hb) levels. Chi-square test and regression analysis were done to identify risk factors for preterm delivery, LBW, maternal and foetal anemia.ResultsThe prevalence of malaria among mothers who used at least one dose of IPTp-SP was 0.6% (4/631). Fourteen mothers (2.2%) did not use IPTp-SP and had no malaria infection. The prevalence of maternal anemia, LBW, foetal anemia and preterm delivery was 40.6, 6.5, 5.9 and 9.2% respectively. Participants who were malaria positive had 11 times more risk of LBW compared to those who were negative (AOR, 11; 95%, CI 1.07–132.2; p = 0.04). The risk of delivering babies with LBW was 1.12 times high among mothers who were ≤ 36 weeks of gestation (AOR, 1.12; 95% CI, 0.06–0.25; p = < 0.001). The use of ≥3 doses of IPTp-SP was associated with 83% decrease in risk of LBW compared to those who did not use any dose of IPTp-SP (AOR, 0.17; 95% CI, 0.03–0.88; p = 0.05). Severe anaemia at delivery was associated with seven times increased risk of preterm delivery compared to non-anemic participants (AOR, 6.5; 95% CI, 1.49–28.16; p = 0.013).ConclusionDespite the reduced malaria transmission and use of IPTp-SP, prevalence of preterm delivery, maternal anemia, LBW and foetal anemia is still high in Tanzania. The recommended ≥3 doses of IPTp-SP should continue be provided even in areas with substantial reduction of malaria.

The Prevalence and Risk Factors for Maternal Anemia and Iron Deficiency Anemia in China (P11-042-19)

ObjectivesTo study the risk factors for maternal anemia and iron deficiency anemia (IDA) in China. MethodsThe study was a multi-stage stratified cluster randomization survey for mothers of children under 2 years of age (Chinese National Nutrition and Health Surveillance in 2013). Totally, 10 652 mothers were selected from 55 counties of 30 provinces in China, of whom 6255 were lactating mother and the other 4397 were not at the time of survey. Anemia was defined as hemoglobin level < 110 g/L. IDA was defined as plasma ferritin level < 15 ug/L and anemia. ResultsThe prevalence of anemia and IDA was 10.5% (95%CI:8.5-12.5) and 4.1% (95%CI:3.1-5.0), respectively. Maternal education level and nationality were associated with anemia (OR (95%CI): senior high school above vs junior high school or below:0.67(0.47-0.97); Han nationnality vs minority: 1.74(1.18-2.57)). Maternal age, education level, lactation and calcium supplementation during pregnancy were significantly associated with IDA (OR (95%CI:):25 years old or above vs less than 25 years: 0.44(0.26-0.75); senior high school above vs junior high school or below: 0.75 (0.58-0.98); lactated women vs lactating women: 0.76(0.68-0.98); calcium supplementation vs non-calcium supplementation: 0.82(0.68-0.98)). ConclusionsThe prevalence of maternal anemia remains high, but the prevalence of maternal IDA is at low level in China. Maternal education level and nationality are associated with anemia. Lactation status, maternal education level, age and calcium supplementation are associated with IDA. Funding SourcesNational Health and Family Planning Commission (former Ministry of Health of the People’s Republic of China) Medical Reform Major Program: Chinese Nutrition and Health Surveillance (2013).

Prevalence of infant and maternal anemia during the lactation period in Japan.

The perinatal period is associated with a high risk of infant anemia. The aim of the present study was to determine the prevalence of infant and maternal anemia during the late lactation period and the risk factors for anemia in Japan. This retrospective cohort study was based on data from health checkups of healthy infants at 6-7 and 9-10 months of age and their mothers who visited Akitsu Children's Clinic between September 2013 and August 2015. Complete blood count data from infant blood samples obtained at 6-7 months and 9-10 months and from maternal blood samples obtained at 6-7 months, information on feeding methods, and other related parameters were analyzed. Data from 388 mother-infant pairs were analyzed. The prevalence of infant anemia was 21.1% at 6-7 months and 29.1% at 9-10 months. The prevalence of anemia in exclusively breast-fed infants was 28.4% at 6-7 months and 40.0% at 9-10 months. The risk factors for infant anemia at 9-10 months were exclusive breast-feeding, lower gestational age at birth, male sex, and high weight gain. The prevalence of maternal anemia was 10.5%. There was no correlation between infant and maternal hemoglobin in exclusively breast-fed infants. Japanese infants who were breast-fed exclusively had a high prevalence of anemia. A nationwide strategy to prevent anemia is required to prevent infant anemia, even in a nutrition-rich country such as Japan.

Anaemia in Pregnancy in an African Setting after Preventive Measures

Background: Anaemia in pregnancy is a public health issue in developing countries because of its high prevalence and its maternal and perinatal bad outcomes. It affects 24.8% of the world population and 67.6% of the population in sub-Saharan Africa. In Burkina Faso, anaemia prevalence is estimated at 68.3%. In Burkina, preventive measures for anaemia in pregnancy have been implemented by the ministry of health to reduce its burden. This study aimed to assess the epidemiological, clinical and the outcomes of anaemia in pregnant women at OUAHIGOUYA REGIONAL HOSPITAL. Findings will be used to strengthen the preventives measures for anaemia in pregnancy. Methods: A cross-sectional descriptive and analytical study was conducted during a four-month period from October, 28th, 2014 to February, 28th, 2015. pregnant women with haemoglobin level below 11 g/dL was considered anaemic according to WHO criteria, and who are willing to participate and who were admitted at the obstetrics and Gynecology department of the REGIONAL HOSPITAL of OUAHIGOUYA. Results: Four hundred eighty three pregnant women were anaemic out of eight hundred eighty three women hospitalized. The prevalence of maternal anaemia was 54.7% with significant monthly variations. The mean age was 24.7 ± 6.6 years. The women without non-salary occupation (housewives and pupils) represented 90.1%. A past medical history of haemoglobin defects (6.6%), twin pregnancies (6.0%), malaria (23.6%) bleeding during pregnancy (20.3%) were the most frequent. Monitoring the pregnancy was effective in 91.1% of women. The mean haemoglobin level was 8.8 ± 2.1 g/dL. The outcome was marked with 1.7% and 18.9% maternal and perinatal death respectively. The most common contributory factors were: Occupational status, number of prenatal visits, length of treatment with iron and folic acid, history of malaria, history of haemorrhage and brachial perimeter low (p 0.05). Conclusion: Maternal anaemia is a major health issue at the OUAHIGOUYA REGIONAL HOSPITAL in Northern Burkina Faso. Maternal and perinatal outcomes could be improved by reinforcing the preventive measures but also by improving the nutritional status and the living conditions of pregnant women.

Lipid-based nutrient supplements for maternal, birth, and infant developmental outcomes.

Ready-to-use lipid-based nutrient supplements (LNS) are a highly nutrient-dense supplement, which could be a good source of macro- and micronutrients for pregnant women who need to supplement their nutrient intake. To assess the effects of LNS for maternal, birth and infant outcomes in pregnant women. Secondary objectives were to explore the most appropriate composition, frequency and duration of LNS administration. In May 2018, we searched CENTRAL, MEDLINE, Embase, 22 other databases and two trials registers for any published and ongoing studies. We also checked the reference lists of included studies and relevant reviews, and we contacted the authors of included studies and other experts in the field to identify any studies we may have missed, including any unpublished studies. We included randomised controlled trials (RCTs) and quasi-RCTs that compared LNS given in pregnancy to no intervention, placebo, iron folic acid (IFA), multiple micronutrients (MMN) or nutritional counselling. We used standard Cochrane procedures. We included four studies in 8018 pregnant women. All four studies took place in stable community settings in low- and middle-income countries: Bangladesh, Burkina Faso, Ghana and Malawi. None were in emergency settings. The oldest trial was published in 2009. Of the four included studies, one compared LNS to IFA, one compared LNS to MMN, and two compared LNS to both IFA and MMN.We considered the included studies to be of medium to high quality, and we rated the quality of the evidence as moderate using the GRADE approach.LNS versus IFAMaternal outcomes: there was no difference between the LNS and IFA groups as regards maternal gestational weight gain per week (standard mean difference (SMD) 0.46, 95% confidence interval (CI) -0.44 to 1.36; 2 studies, 3539 participants). One study (536 participants) showed a two-fold increase in the prevalence of maternal anaemia in the LNS group compared to the IFA group, but no difference between the groups as regards adverse effects. There was no difference between the two groups for maternal mortality (risk ratio (RR) 0.53, 95% CI 0.12 to 2.41; 3 studies, 5628 participants).Birth and infant outcomes: there was no difference between the LNS and IFA groups for low birth weight (LBW) (RR 0.87, 95% CI 0.72 to 1.05; 3 studies, 4826 participants), though newborns in the LNS group had a slightly higher mean birth weight (mean difference (MD) 53.28 g, 95% CI 28.22 to 78.33; 3 studies, 5077 participants) and birth length (cm) (MD 0.24 cm, 95% CI 0.11 to 0.36; 3 studies, 4986 participants). There was a reduction in the proportion of infants who were small for gestational age (SGA) (RR 0.94, 95% CI 0.89 to 0.99; 3 studies, 4823 participants) and had newborn stunting (RR 0.82, 95% CI 0.71 to 0.94; 2 studies, 4166 participants) in the LNS group, but no difference between the LNS and IFA groups for preterm delivery (RR 0.94, 95% CI 0.80 to 1.11; 4 studies, 4924 participants), stillbirth (RR 1.14; 95% CI 0.52 to 2.48; 3 studies, 5575 participants) or neonatal death (RR 0.96, 95% CI 0.14 to 6.51). The current evidence for child developmental outcomes is not sufficient to draw any firm conclusions.LNS versus MMNMaternal outcomes: one study (662 participants) showed no difference between the LNS and MMN groups as regards gestational weight gain per week or adverse effects. Another study (557 participants) showed an increased risk of maternal anaemia in the LNS group compared to the MMN group.Birth and infant outcomes: there was no difference between the LNS and MMN groups for LBW (RR 0.92, 95% CI 0.74 to 1.14; 3 studies, 2404 participants), birth weight (MD 23.67 g, 95% CI -10.53 to 57.86; 3 studies, 2573 participants), birth length (MD 0.20 cm, 95% CI -0.02 to 0.42; 3 studies, 2567 participants), SGA (RR 0.95, 95% CI 0.84 to 1.07; 3 studies, 2393 participants), preterm delivery (RR 1.15, 95% CI 0.93 to 1.42; 3 studies, 2630 participants), head circumference z score (MD 0.10, 95% CI -0.01 to 0.21; 2 studies, 1549 participants) or neonatal death (RR 0.88, 95% CI 0.36 to 2.15; 1 study, 1175 participants). Findings from this review suggest that LNS supplementation has a slight, positive effect on weight at birth, length at birth, SGA and newborn stunting compared to IFA. LNS and MMN were comparable for all maternal, birth and infant outcomes. Both IFA and MMN were better at reducing maternal anaemia when compared to LNS. We did not find any trials for LNS given to pregnant women in emergency settings.Readers should interpret the beneficial findings of the review with caution since the evidence comes from a small number of trials, with one-large scale study (conducted in community settings in Bangladesh) driving most of the impact. In addition, effect sizes are too small to propose any concrete recommendation for practice.

Development of a new model for estimating maternal mortality ratio at national and sub-national levels and its application for describing sub-national variations of maternal death in Ethiopia.

BackgroundIn developing countries lacking functional vital registration system, statistical models are being increasingly used for estimating maternal mortality ratio (MMR). Yet, most of the models have limited applicability at sub-country level. This paper introduces a new model for estimating MMR at national and sub-national levels based on maternal health-related indicators. Further, it applies the model for explaining sub-national variations of MMR in Ethiopia.MethodsCountry level data on MMR and other nine potential predictors of maternal death were extracted from 248 national Demographic and Health Surveys and other related surveys conducted in 80 low- and middle-income countries since 1990. Additional data were obtained from the World Bank and the World Health Organization databases. The potential model predictors were: contraceptive prevalence rate (CPR); utilizations of antenatal care (ANC), health institution delivery (HID), Caesarian section (CS) and postnatal care (PNC); and prevalence of maternal anemia, thinness (Body Mass Index (BMI < 18.5 kg/m2), short stature (height less than 145 cms) and HIV. Stepwise Generalized Estimating Equation (GEE) with Negative Log-binomial link was employed to model MMR as a function of the covariates.ResultsThe ultimate model comprised six significant predictors and the equation is provided as: Ln (MMR) = 6.464–0.013(CPR)– 0.006(HID)– 0.003(PNC)– 0.027(CS rate) + 0.060(HIV prevalence) + 0.011 (thinness prevalence). The variation explained by the model was 54.3%) and the mean (±SD) relative standard error (8.6±2.6%) suggested the model has a reasonable precision. Application of the model to describe sub-national variation of maternal mortality in Ethiopia indicated, in 2016 the highest MMRs per 100,000 live births were in Somali (805) and Afar (795) regions. Between 2000 and 2016, all the regions of Ethiopia have significantly reduced MMRs; yet the rate of decline was lower in the aforementioned two regions. Oromiya region contributed for 46% of all maternal deaths in Ethiopia.ConclusionIn developing countries lacking dependable maternal mortality data; the model can be used to estimate national and sub-national MMR with reasonable accuracy and precision.

The effect of universal maternal antenatal iron supplementation on neurodevelopment in offspring: a systematic review and meta-analysis

BackgroundAlthough antenatal iron supplementation is beneficial to mothers, its impact on the neurodevelopment of offspring is controversial. A systematic review and meta-analysis was undertaken to assess whether routine maternal antenatal iron supplementation confers later neurodevelopmental benefit to offspring.MethodsElectronic databases were searched using MESH terms or key words and identified papers were reviewed by two independent reviewers. The study quality was assessed using the Cochrane risk of bias assessment tool. The review was registered in the PROSPERO CRD data base.ResultsSeven publications were identified, based on four randomised trials published between 2006 and 2016. Three of the trials were in the Asian sub-continent. A range of tools were used to evaluate neurodevelopment. Meta-analysis of outcomes from the three RCTs meeting our inclusion criteria showed minimal effect of antenatal iron supplementation on the neurodevelopment of offspring, which was not statistically significant: weighted mean difference of 0.54 (95% CI: -0.67 to 1.75); test for overall effect Z = 0.87; p = 0.38; and heterogeneity 48%. Meta-analysis of outcomes of these RCTs at later stages of development produced similar results.ConclusionsThe benefit of routine antenatal iron supplementation on neurodevelopment in offspring was not statistically significant in this relatively limited set of trials, and some benefit cannot be excluded in areas with a high prevalence of maternal anaemia. A large randomized controlled trial showing significant benefit would be required to modify our conclusions.

Maternal Anemia and Iron Deficiency Anemia: Similarities and Singularities

Maternal anemia is a major global public health problem, and although widely discussed, there are few studies investigating the condition in pregnant women. In this article, issues related to the diagnosis, biological mechanism and prevalence of maternal anemia. In addition, iron deficiency anemia will be considered a proxy for maternal anemia. In previous studies, the concepts of maternal anemia have been controversial. It is also noted that isolated actions are not sufficient to combat this disease, and policies to address the primary causes of the associated nutritional deficiencies are necessary.

Prevalence of Maternal Anemia in Pregnancy: The Effect of Maternal Hemoglobin Level on Pregnancy and Neonatal Outcome

Objective: The aim of our study is to assess the prevalence of anemia in pregnant women, and to evaluate the effect of severity of anemia on maternal and perinatal outcome. Methods: This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology from hospital records. Study population of all pregnant women who had delivered in our hospital after twenty weeks gestation between July 2014 and December 2016. Results: A total of 2654 pregnant women fulfilled the inclusion criteria, 42% were anemic, 83.3% mild anemia group (I) which represents the majority of patients and 16.7% moderate to severe anemia group (II). The majority of cases were due to iron deficiency anemia 92.8%, while 7.2% were due to sickle cell trait, B-thalassemia intermedia, and other causes. The incidence of postpartum hemorrhage, cesarean delivery, and infections was significantly higher in group II compared to group I (5.4%, 40.3%, 3.8% Vs, 2.9%, 31.0%, 2.0%; p = 0.007, 0.041, 0.043 respectively). Low Apgar score, preterm labor, and low birth weight babies were significantly higher in group II compared to group I (11.8%, 12.9%, 11.3% Vs 8.7%, 9.0%, 7.4%; p = 0.034, 0.046, 0.032). Conclusions: This study clarified that anemia is prevalent among pregnant women particularly mild anemia. Early diagnosis and treatment from first trimester has an essential role in managing maternal anemia and it reflects directly on the perinatal outcome. Prematurity, low birth weight infants, and postpartum hemorrhage are the commonest maternal and neonatal complications.