Table 1 Causes of maternal deaths and evidence for preventive antenatal interventions.
Cause of death | Aetiology | Antenatal intervention | Evidence base | Grade* |
|---|---|---|---|---|
Severe hypertensive disorders (eclampsia and pre-eclampsia) | Dietary calcium deficiency | Calcium supplementation | "Calcium supplementation appears to almost halve the risk of pre-eclampsia, and to reduce the rare occurrence of the composite outcome 'death or serious morbidity"' [19]. | High |
Puerperal Sepsis | Genitourinary infection | Antibiotics | "Antibiotic prophylaxis given during the second or third trimester of pregnancy reduces the risk of pre-labour rupture of membranes when given routinely to pregnant women. Beneficial effects on birth weight and the risk of postpartum endometritis were seen for high-risk women" [22]. | Moderate |
| Â | Dietary vitamin A deficiency | Vitamin A supplementation | "Further evidence on biologically plausible mechanisms of morbidity reduction such as reduced incidence of sepsis and/or reduced markers of inflammation are needed" [60]. | Low |
| Â | Dietary micronutrient deficiencies | Multiple micronutrient supplementation | One trial in Tanzania showed no additional effect on markers of infection (C-reactive protein) compared with iron and folic acid [15]. | Low |
Anemia | P. falciparum infection | Anti-malarial drugs | "Drugs given routinely for malaria during pregnancy reduce severe antenatal anaemia in the mother, and are associated with higher birth weight in the baby and probably fewer perinatal deaths. This effect appears to be limited to low parity women" [24]. | High |
| Â | Dietary iron deficiency | Iron supplementation | "Antenatal supplementation with iron or with iron and folic acid results in a substantial reduction in the prevalence of haemoglobin levels below 10 or 10.5 g/L at term or near term. Routine daily or weekly antenatal iron or iron plus folic acid supplementation may be of benefit, especially where pre-gestational iron deficiency and anaemia are prevalent" [26]. | Moderate |
| Â | Dietary vitamin A deficiency | Vitamin A supplementation | "Further evidence on the effectiveness of adding vitamin A to iron and folic acid for treatment of anaemia is needed" [60]. "Vitamin A supplementation programmes to reduce anaemia should not be implemented in similar antenatal populations in rural sub-Saharan Africa unless evidence emerges of positive benefit on substantive clinical outcomes" [61]. | Low |
| Â | Dietary micronutrient deficiencies | Multiple micronutrient supplementation | When compared with supplementation of two or less micronutrients or no supplementation or a placebo, multiple-micronutrient supplementation resulted in a statistically significant decrease in maternal anaemia (RR 0.61; CI 0.52 to 0.71). However, these differences lost statistical significance when multiple-micronutrient supplementation was compared with iron folic acid supplementation alone [64]. | Low |
| Â | Intestinal parasitic infection | Anthelmintic/antiprotozoal drugs | Trials in Sierra Leone and Nepal showed a positive effect on haemoglobin levels [57,59]. | Moderate |