Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health

Abstract

The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period.

Millennium Development Goals 4 and 5: Past and future progress

“…Effective interventions in the pre-pregnancy period to improve maternal, fetal and neonatal outcomes include improving women's reproductive health through family planning to avoid unintended pregnancy and optimize inter-pregnancy intervals, and through management of sexually transmitted infections, including HIV [12]. The reproductive health of adolescent girls is of particular importance, given the increased risks of stillbirth, preterm birth, low birth weight, asphyxia, and neonatal as well as maternal mortality associated with adolescent pregnancy [13] along with its significant social costs.…”

Saberes e práticas de mães de recém-nascidos prematuros perante a manutenção do aleitamento materno Knowledge and practices of mothers of premature newborns in the mainteining of breastfeeding

“…18 Concerning the fact that eight out of ten mothers have done caesarean section, due to the medical conditions that underlie prematurity and the various risks to both the NB and the mother, it is inferred that the viability of normal delivery can be considerably less. 19 From the analysis of the discursive content by mothers in the knowledge and practices against the BF, it was possible to group the results into two themes: The consistency of the knowledge presented by mothers; Impact of Vocational guidance on the practice of milking breast milk.…”

“…In addition, it is necessary to establish strategies that provide a basis for improving communication and monitoring the mothers assisted by health professionals, and they should maintain a clear, objective language and with easy comprehension. 16,[19][20] On this, authors of Rio de Janeiro raised -from a review of the literature -that the nurse is the professional who is more prepared to perform duties related to educational practices that aim to foster the acquisition of consistent knowledge by the mothers on the BF associated with HMB. 10 To the guidelines provided to the mothers be consistent, first, it is necessary that health professionals have sound knowledge of the subject.…”

“…27 There is unanimity in the scientific, national and international evidence about the numerous benefits of the BM in the NB, particularly those in prematurity conditions and low birth weight . [1][2][3][4]11,[16][17][18][19][20] However, it is the role of nursing staff and health spending efforts to improve knowledge and practices related to breastfeeding. 10,16, …”

Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus

“…43 For women with a history of a baby with neural tube defect, folic acid reduces the recurrence by 70%. 44 LBW is a major contributor to neonatal mortality and over 95% of LBW babies are born in LMIC countries. 45 While there has been controversy about whether dietary supplementation (eg, high energy biscuits for chronically undernourished women) in pregnancy can increase birth weight, 46-49 the 5-year prospective randomised controlled trial in 28 rural Gambian villages by Ceesay et al 50 concludes that supplementation significantly reduces perinatal mortality in at-risk mothers.…”