Sunday April 8, 2012
Nurturing a safe pregnancy
By Dr H. KRISHNA KUMAR
Let’s work together to reduce mortality rates through improved maternal health.
ACHIEVING good maternal health requires quality reproductive health services and a series of well-timed interventions to ensure a women’s safe passage to motherhood. Failure to provide affordable and quality care results in thousands of maternal deaths globally each year.
Research shows that the majority of maternal deaths can be prevented if women have access to quality family planning services, skilled care during pregnancy, childbirth and the first month after delivery.
Understanding the importance of maternal mortality reduction has become a national and global priority, reflected in the Millennium Development Goals (MDG), a series of collective priorities by the United Nations, which include improved maternal health. By 2015, world leaders pledged that the world would achieve measurable improvements by reducing the maternal mortality ratio by three-quarters and providing universal access to reproductive health.
Statistics show that Malaysia has one of lowest maternal mortality ratios amongst Asian countries at 31 per 100,000 live births in 2011. Our country’s success in reducing maternal mortality reflects improvements in access to quality maternal health services, including family planning; increased professional skills; close engagement with communities to remove social constraints; and improved maternal health services.
Safe motherhood and newborn health
The risks of childbearing for a mother and her baby can be greatly reduced if the mother is in a good state of health, is properly nourished, and has access to good antenatal care and proper confinement care.
Before deciding to get pregnant, it is important to consider common risk factors listed below that could cause complications during pregnancy and labour.
·Smoking leads to increased risk of miscarriage, bleeding, reduced birth weight, premature birth, increased risk of sudden infant death syndrome (SIDS), and stillbirth.
·Alcohol could cause foetal alcohol syndrome, with symptoms like low birth weight, and birth defects, such as heart, skeletal, kidney, ears and eyes malfunction.
·Caffeine affects the heart rate of your growing foetus and his awake time (growth occurs when foetuses sleep).
·Lack of good nutrition, which is crucial for the health of a developing foetus. Inadequate intake of vitamin B (folic acid), for instance, can cause birth defects, such as neural tube defects. These include spina bifida, where the baby’s spine does not form properly, or anencephaly, where the top part of the skull fails to form and may lead to the erosion of the foetal brain.
The combination of vitamin B12, vitamin C and iron can help increase haemoglobin levels prior to pregnancy to prepare for your developing baby’s nutritional needs.
·Women after 35 are at an increased risk of medical problems like high blood pressure, gestational diabetes, chromosomal abnormalities in the foetus, and stillbirth.
·Overweight or obese women are at a higher chance of having large babies, causing a difficult delivery, which may result in increased risks of injury to both mother and child. These women may also develop gestational diabetes, high blood pressure and preeclampsia.
Women who are underweight, however, are more likely to have small babies, who are underweight as well. The amount of weight you should healthily gain during pregnancy is relative to your pre-pregnancy body mass index (BMI). For example, if your pre-pregnancy BMI is 28, you are overweight and should aim for a weight gain of only 7-11.5 kg by the end of your pregnancy.
Infections that could harm your baby
There are certain infections that could harm you and your baby during pregnancy. Although you have probably been vaccinated as a child, they do not protect you for life, and it is important that you make sure your vaccinations are up-to-date.
Vaccinations help protect your body from infections, and you can pass this protection on to your baby. This will help keep him safe during his first few months until he gets his own vaccinations.
Most vaccinations are not safe to be taken during pregnancy, and instead should be taken as soon as you decide to get pregnant. These include:
Flu: Protects you and your baby against both the seasonal flu and H1N1. Getting the flu during pregnancy could cause complications like pneumonia.
HPV (human papillomavirus): Protects against subtypes of HPV that could cause cervical changes and most cervical cancers.
MMR (measles, mumps, rubella): Protects against measles, a serious disease that causes rashes, cough and fever. It could also cause diarrhoea, ear infection, pneumonia, brain damage, or even death in worst-case scenarios! Getting measles during pregnancy may cause miscarriages.
Tdap (tetanus, diphtheria, pertussis): Prevents pertussis, which can be easily spread, and is very dangerous to babies.
Varicella (chickenpox): Getting chickenpox during pregnancy could cause birth defects in your baby.
Ensure a healthy pregnancy, protect your child
Caring for your child starts even before he is conceived. Changing your lifestyle habits, eg quitting smoking and drinking alcohol, as well as reducing/quitting your intake of caffeine will help you have a healthy pregnancy.
Pay a visit to your doctor before getting pregnant, to get a check-up and ensure that you are fit and healthy to conceive.
Good nutrition is always important, and a balanced and varied diet is essential for the proper development of your baby. Taking vital vitamins, such as folic acid, is needed to prevent neural tube and spinal cord defects.
Approximately 400µg of folic acid should be taken at least one month prior to and throughout your pregnancy.
Being overweight or obese could increase your chances of having complications during pregnancy and labour. Thus, moderate exercises would help prevent excessive weight gain and also keep you active. Swimming, walking and certain types of yoga are favourites among pregnant women.
An issue that is almost always ignored is the failure of detecting a medical problem before pregnancy. Some women have a very strong family history of diabetes mellitus and hypertension in their family. Other common problems include bronchial asthma, heart diseases, thyroid disorders and connective tissue disorders. It is best to identify and take steps to control these diseases early or before embarking on a pregnancy.
For women with pre-pregnancy health problems, the choice of oral contraception is important as it may interfere with the medications prescribed for the other medical problems. Infections from an intrauterine contraceptive device (IUCD), for example, may be too strong for certain valvular cardiac problems. Therefore, it is highly recommended to consult your doctor and ask if your current medications are safe for your baby.
Most public and private healthcare centres also provide support and education on pregnancy-related issues to the community. Regular monitoring will help ensure a healthy pregnancy and baby!
> Dr H Krishna Kumar is consultant obstetrician & gynaecologist and president of OGSM. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme. The opinions expressed in the article are the view of the author. For further information, please visit www.mypositiveparenting.org.