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Maternal anthropometry for prediction of pregnancy outcomes: memorandum from a USAID/WHO/PAHO/MotherCare meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(5):523-32.The memorandum is an abbreviated version of a prepared report on maternal anthropometry which summarizes the general recommendations of a consensus of 50 experts on field applications and priority research issues in developing countries. Consensus was reached at a meeting on Maternal Anthropometry for Prediction of Pregnancy Outcomes held in Washington, D.C. in April 1990. 15 general recommendations are identified for field applications and research priorities. Specific recommendations differentiating field applications from research priorities are provided for prepregnancy weight, weight gain in pregnancy, height, arm circumference, and weight for height and body mass index. For example, the discussion of arm circumference indicates that it is useful as an indicator of maternal nutritional status in nonpregnant women because of its correlation with maternal weight or weight for height. During pregnancy, it is useful as a screen for risk of low birth weight (LBW) and late fetal and infant mortality. Maternal arm circumference has been found to be stable during pregnancy in developing countries and is independent of gestational age. Field applications involve the use 1) to assess the nutritional status of pregnant and nonpregnant women, 2) to screen women at risk of poor maternal stores postpartum because it reflects maternal fat and lean tissue stores, for instance, 3) to screen women and refer to facilities for a more thorough assessment of nutritional risk, and 4) to assess the extent of undernutrition in an area, particularly for surveillance. Community level workers, especially birth attendants (TBA's) should be trained and have access to arm circumference tapes. The technology is simple enough also for use by women in the home. Cutoff points for assessing biological risk are fairly consistent across developing country populations, and range between 21-23.5 cm. Routine monitoring during pregnancy is not necessary because the changes are too small to detect. Where prepregnancy weight is unavailable and weight is monitored, arm circumference may serve as a proxy for prepregnancy weight. All women of childbearing age should be measured. Research priorities are to explore the functional significance with women of difference body compositions (fat versus lean upper arm), the relationship to pregnancy related outcomes, arm changes relative to stages throughout the reproductive period and to weight changes, different instruments such as color-coded tapes or 1 tape for arm measurement and uterine height, combinations of different measurements, the relationship with prepregnancy weight, and the development of arm circumference in weight gain charts as a proxy for prepregnancy weight.