ASSESSMENT OF NUTRITIONAL STATUS AMONG PREGNANT WOMEN IN LOWER-MIDDLE-INCOME COUNTRIES: DETERMINANTS AND MATERNAL–NEONATAL OUTCOMES

Abstract

Background:

Maternal malnutrition in low- and middle-income countries (LMICs) remains a major underlying contributor to maternal and child morbidity and mortality. Malnourished women may face substantially higher risks of adverse maternal outcomes compared with adequately nourished women. This review synthesizes current evidence on the prevalence, multilevel determinants, and clinical consequences of maternal nutritional depletion, with the aim of informing integrated public health strategies in resource-constrained settings. Methods

A comprehensive literature search was conducted across electronic databases, including PubMed, Cochrane Library, CINAHL, EMBASE, and Scopus, for studies published between 2013 and 2026. Eligible studies examined maternal nutritional status using anthropometric indicators, particularly body mass index (BMI), as well as micronutrient indicators including anemia, iron, and folate status. Studies evaluating associations between maternal nutritional status, pregnancy outcomes, and offspring health in LMICs were considered for inclusion.

Results

The evidence identified three major dimensions of maternal malnutrition. First, epidemiological findings indicate a substantial global burden of maternal undernutrition, with prevalence varying considerably across LMIC settings and reaching 75.7% in some conflict-affected populations, including Mogadishu, Somalia. Second, maternal nutritional status is shaped by an interconnected range of socioeconomic, educational, cultural, and household-level determinants. Poverty (AOR = 1.49) and illiteracy (AOR = 3.6) were identified as important risk factors, while culturally rooted food restrictions, including hot-and-cold food beliefs and intentional dietary reduction during pregnancy to prevent obstructed labor, may further contribute to nutritional depletion. Third, maternal undernutrition is strongly associated with fetal growth restriction and the development of the “small vulnerable newborn” phenotype and contributes substantially to the global burden of childhood stunting.

Conclusions

Addressing maternal malnutrition in LMICs requires a multidimensional and context-specific approach extending beyond conventional iron–folic acid supplementation. Evidence supports consideration of multiple micronutrient supplementation (MMS), appropriate calcium supplementation, and culturally tailored nutrition counseling to improve adherence and address context-specific dietary practices. Sustainable improvements require nutrition-sensitive interventions targeting structural determinants of malnutrition, including poverty, limited female education, food insecurity, and restricted economic opportunities for women.