Preparation for pregnancy

Preparing for your baby

Your Health   DR GITA MATHAI

A painting by Dipti Chakrabarti "My baby is small because I had typhoid / jaundice during pregnancy." "This is my third pregnancy; I lost one child and the other was born very small." "I needed interventions to get pregnant. This baby cost more than a lakh." Common but preventable events. India has a high maternal mortality rate of 450 per 1,00,000 live births. The figure, of course, does not account for women who have a lifetime of ill health after childbirth. Our country has a high infant mortality rate as well. There are 21.76 births per 1,000 every year. Out of this 1 lakh newborns die in the first 24 hours of their life and an unknown percentage has lifelong "special needs". Today many women are educated, employed and self sufficient. They no longer consider home making and child bearing their primary function in life. Despite this, it is a function many eventually have to perform. Human beings, after all, live to procreate, produce children and ensure the survival of family genes. Reproduction is the prerogative of women. They must try to remain physically fit to undertake this venture. The ability to conceive, carry a healthy child to term and then deliver normally must not be taken for granted. Thought, effort and preparation has to go into this "natural" function. All parents need to focus on the prevention of diseases that can affect the lives of their little ones. Some infectious diseases, such as German measles, can have a devastating effect on the child if acquired by the mother during pregnancy. It causes heart defects, deafness, cataract, a small head and mental retardation. Mumps, on the other hand, can cause an abortion. Chicken pox may lead to abnormal arms and legs, and eye and brain damage. All this means a lifetime of misery for the mother, who bears the brunt of caring for a child with special needs. These common infectious diseases can be prevented by timely immunisation. The MMR (measles, mumps, rubella or German measles) vaccine should be given at the age of 15 months with a booster at 9-10 years. Chicken pox can be prevented by a single dose of Varicella vaccine administered soon after the first birthday. These vaccinations are not yet part of the National Immunisation Programme (NIP) and therefore not provided free of cost by the government. Hepatitis B is a type of jaundice that is dangerous, can be fatal and is passed on to the baby by the mother. Hepatitis A causes jaundice that is usually mild and self limiting. During pregnancy, however, it can devastate a woman's health as it aggravates nausea and vomiting. It affects the liver, which is more sensitive to damage during pregnancy. Both types of jaundice are preventable with immunisation. Hepatitis B immunisation has recently been made part of the NIP. It is available free and given at birth and then along with triple antigen (DPT). Older children have not had the benefit of this programme and need to be immunised separately. Hepatitis A immunisation is not free. It is advised after the age of two years. Typhoid is a very common infection, especially in the monsoon. Again, women who develop it can become very ill. Many medicines used to treat this infection are contraindicated during pregnancy. Striking a balance between the health of the mother and that of the unborn child becomes a tricky balancing act. Again, preventive immunisation is available and consists of a single injection every three years. The Human Papillovirus (HPV) causes wart-like growths in the genital area, which requires delivery by caesarian section. The infection can later progress to cervical cancer. It is preventable with three doses of vaccine between the ages of 9-11 years. Women tend to be anaemic with haemoglobin values less than the recommended 12gm/dl. Anaemic women produce low birth weight babies who have insufficient iron at birth. This can be prevented with iron supplements. It is usually available as a combination tablet with folic acid — a vitamin that prevents defects in the baby's brain and spinal cord. This can be started (after consulting your doctor) following menarche (onset of menstruation). Regular exercise is essential for girls. It should be started at the primary school level, with jogging, cycling or swimming for 30-40 minutes a day. Stretching and yoga help the flexibility of the joints that need to "give" during labour. Hormonal imbalances, polycystic ovarian disease and many fertility problems correct themselves if ideal body weight is maintained. This endurance training is helpful during the long exhausting hours of labour. When your precious daughter is about to get married, make sure her immunisations are complete. And perhaps present her a treadmill or any other exercise machine in lieu of some jewels. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in