Nutrition interventions and programs for reducing mortality and morbidity in pregnant and lactating women and women of reproductive age: A systematic review

Background: Improved nutrition may help to reduce maternal mortality and serious morbidity by preventing or treating disease, infections or nutritional deficiencies; by improving immune status; or by improving health-care seeking behaviour. Our aim was to assess the effects of nutrition interventions or programs, or those directed at influencing nutritional status, on women's health. Method: Mixed methods (quantitative and qualitative) synthesis using principles of the Campbell and Cochrane Collaboration; comprehensive search strategy from 1990 onwards; including studies of pregnant or lactating women (PLW) or other women of reproductive age (WRA) from low and middle income countries (LMIC). Results: We included 250 studies of various designs, spanning over 20 main intervention or topic groups and including several million women. No impact on maternal mortality was seen for various supplementation and communication interventions, although calcium reduces serious morbidity. Iron-folic acid supplementation/fortification halves anaemia risk in PLW and WRA but is sometimes poorly implemented. Combined interventions such as food supplementation and behaviour change and communication show promise. Conditional cash transfer and microcredit programs may help through alleviating poverty. Many pregnant women in LMIC experience restricted dietary intake due to discriminatory food allocation, lack of decision-making power, family support, money or access. Conclusions: Expanding coverage of iron-folic acid supplements to PLW and WRA must remain the highest of priorities, as must ensuring that as many women as possible are well-nourished when they enter pregnancy. There is emerging evidence of positive intergenerational effects such as decreased stunting; but also of increasing maternal obesity in transitional societies.