Maternal anthropometry-based screening and pregnancy outcome: a decision analysis

Area of Science:

• Maternal health and nutrition
• Public health interventions
• Developing country health systems

Background:

• Adverse pregnancy outcomes like intrauterine growth restriction (IUGR), preterm birth, and assisted delivery pose significant risks in developing countries.
• Maternal anthropometry (height, weight) is used for screening, but its effectiveness in reducing these outcomes requires evaluation.

Purpose of the Study:

• To assess the impact of screening and intervention based on maternal anthropometry in reducing adverse pregnancy outcomes in developing countries.
• To evaluate the cost-effectiveness of different screening and intervention strategies.

Main Methods:

• Decision analysis incorporating data from a WHO multicentre study on maternal anthropometry and pregnancy outcomes.
• Meta-analyses of controlled clinical trials on balanced energy/protein supplementation and caregiver support during labor.
• Analysis included pregnant women from Colombia, India, and Myanmar.

Main Results:

• Screening identified 7-45% of pregnant women, with preventive fractions ranging from 0.011 to 0.109 for adverse outcomes.
• Screening prevention ratios were high for preterm birth and assisted delivery but low for IUGR in specific settings.
• Sensitivity analyses showed decreased effectiveness with reduced intervention benefits.

Conclusions:

• A maternal anthropometry-based 'risk approach' is unlikely to substantially reduce adverse pregnancy outcomes in developing countries.
• For low-cost, risk-free interventions like caregiver support, universal treatment of all pregnant women is a more effective strategy than screening.