Nutritional Anemia in Pregnancy and Lactation

Worldwide, maternal anemia affects over 40% of pregnant and lactating women and is considered a major public health burden. During pregnancy, anemia is associated with increased maternal infections, fatigue, decreased cognitive function, preterm birth, and elevated maternal morbidity and mortality. Risks to the child include poor fetal growth and development, premature birth, still birth, increased morbidity and mortality, and poor cognitive development. Anemia during lactation adversely affects maternal postpartum health and recovery, breast milk quality, and infant health. Maternal anemia has multiple causes including insufficient intake of specific nutrients needed to meet the demands for synthesis of hemoglobin and erythrocytes. The most crucial nutrient is iron, but others are also important, especially vitamins A, B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin), C, D, and E, folate, and copper. In addition, nutritional anemia has secondary causes including infection, poor quality of antenatal and postnatal care, food insecurity, low socioeconomic status, poor quality implementation of maternal nutrition programs, genetic factors, and the gut microbiome. The World Health Assembly (WHA) Global Nutrition Target is to reduce anemia in women of reproductive age by 50% by 2025, and current progress is lagging. The simplest and most apparent of interventions is iron supplementation or multiple micronutrient supplementation (MMS). Other interventions include food fortification, dietary diversity, agricultural and food security, and conditional cash transfer programs. Although these can be effective, they have typically modest to minimal effects due to poor implementation, even for direct supplementation programs. There is an urgent need for solutions in the context of precision medicine and precision public health and to embrace digital health and address issues of frontline health worker performance and adopt more preventive and promotive approaches with strong community engagement. Such changes will likely require a change in how programs are designed and deployed, focusing more on local innovations, e.g., from and with communities, rather than traditional top-down approaches from global organizations that have been unable to meet the needs. The post-pandemic world is an opportunity to take stock in what has worked, and not worked, and forge innovations and novel pathways to create impact at scale.