Nutritional interventions for the prevention of maternal morbidity

Objective: To review the effectiveness of nutritional interventions to prevent maternal morbidity. Methods: This is an overview of systematic reviews and individual randomized controlled trials (if no systematic review available) of nutritional interventions during pregnancy. For each nutrient intervention the main maternal morbidity data reported were extracted. These were pre-eclampsia/eclampsia, pregnancy-induced hypertension, hemorrhage, anemia, infection and obstructed labor. In addition, the trial settings, the number of trials and participants' characteristics were systematically extracted. Results: The systematic reviews considered in this paper had only few trials that reported the selected maternal outcomes. Outcome measures are based sometimes on one trial only. Most of the interventions compared single micronutrient supplementation with placebo/no treatment and did not show significant benefits for the supplementation groups. Calcium supplementation in women at high risk of pregnancy hypertension reduced the incidence of high blood pressure (RR, 0.35; 95% CI, 0.21 – 0.57) and pre-eclampsia (RR, 0.22; 95% CI, 0.11 – 0.43). Similarly, in women with low dietary calcium intake, calcium supplementation resulted in a significant reduction in the incidence of high blood pressure (RR, 0.49; 95% CI, 0.38 – 0.62) and pre-eclampsia (RR, 0.32; CI, 0.21 – 0.49). In women at low risk of pregnancy hypertension or with adequate baseline calcium intake, the beneficial effects of calcium supplementation are small and unlikely to be of clinical significance. Both, iron and folate supplementation reduced the number of women with low pre-delivery hemoglobin. Conclusions: Routine calcium supplementation seems to be a promising intervention for pregnant women at risk of developing preeclampsia or have low calcium intake, but these findings need to be confirmed with a trial with adequate power in different settings. In populations with high incidence of nutritional anemia routine iron and folate supplementation should be recommended during ante-natal care. It is unclear at this stage if adding vitamin A to iron and folate supplementation in anemia prevalent areas provides further benefits. There is inadequate data on the benefits or harms of routine iron or folate supplementation in adequately nourished populations. With regard to other micronutrient supplementation, such as zinc, magnesium and fish oil, randomized controlled trials with sufficient power to detect clinically important differences in maternal and infant outcomes are needed.