Targeting Anemia May Lead to Better Maternal Outcomes
As 2015, the deadline to meet the Millennium Development Goals, quickly approaches we are faced with the reality that MDG 5A, which targets a reduction in the maternal mortality ratio by 75%, will not be met by most countries. Since 1990, there has been a 47% reduction in maternal deaths, but mothers continue to suffer from preventable complications, such as postpartum hemorrhage.(1) Although postpartum hemorrhage accounts for nearly 23% of maternal deaths, more research is required to illuminate the risk factors and underlying causes.(2)
One such risk factor, anemia, has been linked to increased blood loss at childbirth.(3) Anemia, the condition in which the body lacks enough healthy red blood cells, may derive from different mechanisms: blood loss, decreased production of red blood cells, and the destruction of red blood cells. Red blood cells transport oxygen throughout the body, and in the case of anemia, the body is faced with a diminished oxygen supply. This leads to fatigue, rapid heartbeat, dizziness, headache and a range of other symptoms. The most common type, iron-deficiency anemia, results from an iron-poor diet. Low iron stores inhibit the production of hemoglobin, the molecule that binds oxygen for transport. Furthermore, women of reproductive age are at an increased risk for developing anemia due to menstruation and the increased blood supply demands of pregnancy. Because prevalence remains higher in the poorest regions of the world and amongst women and children, reducing anemia presents a unique method of combating maternal mortality caused by postpartum hemorrhage.
The exact mechanism through which anemia acts to increase the likelihood of postpartum hemorrhage is not definitively known. It is thought that low iron concentration mediates decreased uterine blood flow or low uterine muscle strength, which in turn may contribute to inefficient uterine contractions. These uterine contractions normally cause the blood to clot, thereby decreasing blood flow. Without adequate uterine contractions, blood flows freely and may result in postpartum hemorrhage. Likewise, anemia may weaken a woman’s tolerance to blood loss, increasing the severity of postpartum bleeding.
Researchers are hopeful that targeting anemia may also alleviate some of the postpartum hemorrhage disease burden. Iron-deficiency anemia, which accounts for a third of all cases, is easily treated through iron supplementation. In 2012, the Sixty-fifth World Health Assembly introduced six global nutrition targets to improve maternal and child health, including a 50% reduction in the number of anemic women in their childbearing years by 2025. Through the implementation of screening and treatment programs for anemia, women will benefit indirectly from a lowered risk of mortality and morbidity associated with postpartum hemorrhage. While some programs have had success in lowering anemia prevalence by comprehensive supplementation, anemia must still be addressed effectively to impact maternal mortality for the better.(4)
Sansoni, Dominic / World Bank. 2007. Woman with newborn in post-natal ward of hospital. [Photograph]. Retrieved from https://www.flickr.com/photos/worldbank/1988367438/in/photostream/.*
1. The Millennium Development Goals report 2013 New York: United Nations; 2013.
2. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study. 2010. Lancet Glob Health.2013; 380:2095–2128.
3. Kavle JA, Stoltzfus RJ, Witter F, Tielsch JM, Khalfan SS, Caulfield LE. Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. J Health Popul Nutr.2008;26:232–40.
4. Branca F, Mahy L, Mustafa TS. The lack of progress in reducing anaemia among women: the inconvenient truth. Bull World Health Organ. 2014. 92(4):231
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