An analysis of anemia and pregnancy-related maternal mortality

The relationship of anemia as a risk factor for maternal mortality was anal yzed by using cross-sectional, longitudinal and case-control studies becaus e randomized trials were not available for analysis. The following six meth ods of estimation of mortality risk were adopted: I) the correlation of mat ernal mortality rates with maternal anemia prevalence derived from national statistics; 2) the proportion of maternal deaths attributable to anemia; 3 ) the proportion of anemic women who die; 4) population-attributable risk o f maternal mortality due to anemia; 5) adolescence as a risk factor for ane mia-related mortality; and 6) causes of anemia associated with maternal mor tality. The average estimates for all-cause anemia attributable mortality ( both direct and indirect) were 6.37, 7.26 and 3.0% for Africa, Asia and Lat in America, respectively. Case fatality rates, mainly for hospital studies, varied from <1% to >50%. The relative risk of mortality associated with mo derate anemia (hemoglobin 40-80 g/L) was 1.35 [95% confidence interval (GI) : 0.92-2.00] and for severe anemia (<47 g/L) was 3.51 (95% CI: 2.05-6.00). Population-attributable risk estimates can be defended on the basis of the strong association between severe anemia and maternal mortality but not for mild or moderate anemia. In holoendemic malarious areas with a 5% severe a nemia prevalence (hemoglobin <70 g/L), it was estimated that in primigravid ae, there would be 9 severe-malaria anemia-related deaths and 41 nonmalaria l anemia-related deaths (mostly nutritional) per 100,000 live births. The i ron deficiency component of these is unknown.