8. Maternal and newborn health

Maternal health
- Before, during and after pregnancy, including during childbirth
- Most maternal adverse outcomes are preventable
- Young, migrant, Roma, low education/low socioeconomic status -> more maternal adverse outcomes
- Diseases during postpartum period
  - Postpartum psychosis
  - Depression
  - Puerperal sepsis
- Maternal mortality
  - = number of maternal deaths in a year / number of live births that year
  - Very high in high-risk mothers and in developing countries (especially sub-Saharan Africa)
  - 800 women die every day due to complications in pregnancy and childbirth
  - Causes
    - Pre-existing maternal conditions
    - Severe bleeding
    - Pregnancy-induced hypertension (pre-eclampsia, eclampsia)
    - Infection
- Prenatal check-up
  - Timing
    - Monthly check-up during weeks 1 – 28
    - Bimonthly check-up during weeks 28 – 36
    - Weekly check-up after week 36
  - Involves
    - Measure BP, blood sugar
    - Prevent smoking, alcohol, drug use
    - Giving folic acid supplementation
    - Maternal education on good habits, poor habits, etc.
    - Testing for infectious diseases
    - Ultrasound of foetus
- Prevention of maternal diseases
  - Birth control
  - Pregnancy counselling and family planning
    - Mothers < 18 and > 35 are higher risk for both mother and child
    - Preconception counselling and assessment
  - Pregnancy care
  - Postpartum care
Newborn health
- Definitions
  - Newborn = first month of life
  - Infant = first year of life
  - Postpartum period = 4 – 6 weeks after birth
  - Perinatal period = 22 weeks gestation – 1 week after birth
- Most stillbirths are preventable
- Infant mortality
  - = number of infant deaths in a year / number of live births that year
  - Causes
    - In high socio-economic regions
      - Congenital deficiencies
      - Preterm birth
      - SIDS
    - In low socio-economic regions
      - Infectious diseases
      - Malnutrition
      - Injuries from labour complications
  - Risk factors
    - TORCH infections
    - Teratogenic agents
      - Ionizing radiation
      - Hormonal drugs
      - Cytostatic drugs
      - Vitamin A drugs
- Premature (preterm) infant survival
  - Infant survival is closely related to low birth weight
  - Preterm infants have much higher risk of diseases later, like cerebral palsy
  - Causes
    - Smoking
    - Alcohol
    - Drugs
    - Maternal diseases
  - By time
    - 21 weeks gestation – 0%
    - Survival rate increases by 2 – 4% per day between weeks 21 and 26
    - 26 weeks gestation – 80 – 90%
- Prevention of newborn diseases
  - Screening for diseases
    - Metabolic diseases
      - Phenylketonuria
      - Galactosaemia
    - Haemoglobinopathies
    - Endocrine diseases
      - Congenital hypothyroidism
    - Hearing loss
    - Hip dysplasia
  - Ophthalmic antibiotics
  - Vitamin K
  - Vitamin D (in some countries)
  - Vaccination
  - Maternal education and promotion of breast feeding
    - Breast feeding exclusively is recommended for first 6 months
    - Breast feeding combined with other foods for 2 years or longer