1 Maternal and Child healthRawan AlOtaibi Sarah AlSeneidi Malak AlAlwan Fatimah AlAli Yara AlAnazi Munira AlGhufaily

2 Objectives 1-Health behaviors and health systems indicators that affect the health, wellness, and quality of life of women, children, and families. 2-Factors can affect pregnancy and childbirth, including: Preconception health status, Age, Access to appropriate preconception and interconception health care, Poverty 3-Health risks may include: Hypertension and heart disease, Diabetes, Depression, Genetic conditions, Sexually transmitted diseases (STDs), Tobacco use and alcohol Abuse, Inadequate nutrition, Unhealthy weight 4-Social and Physical Determinants of Maternal Health 5-Social and Physical Determinants of Infant and Child Health 6-How to improve the health and well-being of women, infants, children, and families.

3 Maternal and child health indicators :

4 Maternal and child health indicators :Before going through health indicators you should know about its definition : Definition: Health indicators are variables that reflect the state of health of persons in a community. (Oxford Dictionary of Epidemiology) They inform about the quality of health care, and access of health care, and they are considered as quantitative measures.

5 Health indicators could be used to:Assess the health care needs. Compare health status of different areas or groups of people over time, one country with other countries or worldwide. Monitoring and evaluation of health services, activities and programs-access, quality, effectiveness and equality.

6 The 11 indicators of maternal, newborn and child healthChildren under five who are stunted Under-five child mortality, with the proportion of newborn deaths Exclusive breastfeeding for six months (0–5 months) Postnatal care for mothers and babies within two days of birth Skilled attendant at birth Antiretroviral (ARV) prophylaxis among HIVpositive pregnant women Maternal mortality ratio Three doses of combined diphtheria-tetanuspertussis (DTP3) immunization coverage (12–23 months) Proportion of demand for family planning satisfied (met need for contraception) Antibiotic treatment for suspected pneumonia Antenatal care coverage (at least four times during pregnancy)

7 Definitions Under-five child mortality Maternal mortality ratioIt is the probability of a child born in a specific year or period dying before reaching the age of five. Maternal mortality ratio It is the number of maternal deaths per 100,000 live births during a specified time period usually 1 year. Children under five who are stunted It is defined as the percentage of children, aged 0 to 59 months, whose height for age is below -2 SD (moderate and severe stunting) and -3 SD (severe stunting) from the median of the WHO Child Growth Standards.  Exclusive breastfeeding for six months (0–5 months) Percentage of infants 0–5 months of age (<6 months) who are fed exclusively with breast milk. Antenatal care coverage The percent of women ages 15 to 49 with a live birth within a given time period who attended antenatal care (ANC) four or more times during their most recent pregnancy.

8 Factors and behaviors affecting maternal health and fetal developmentMaternal nutrition Smoking Drinking Diseases ( GDM, thyroid diseases , infections …etc.) Drugs Maternal age Prenatal care

9 Factors can affect pregnancy and childbirth

10 Factors can affect pregnancy and childbirthPreconception health status Age Access to appropriate preconception interconception health care Poverty

11 1-Preconception health statusA)Maternal behaviors like : Tobacco use , alcohol use , failure to consume adequate folic acid. B)Other conditions like : unintended pregnancy , experiencing physical abuse , experiencing high levels of stress. C)Certain maternal health conditions like: Diabetes , hypertension , obesity.

12 2-Age The chances of surviving the first year of life were better for infants born to mothers aged years than for those born to mothers of other ages. The most favorable survival rates were among first births to mothers aged and among first and second births to mothers aged Your risk of pregnancy complications, such as high blood pressure and gestational diabetes, increases after 35 and continues to rise in your 40s. The odds of genetic problems also jump as you get older: At 40, your chance of conceiving a child with Down syndrome is one in 100; at 45 it's one in 30.

13 3-preconception and interconception health carePreconception health care : s the medical care a woman or man receives from the doctor or other health professionals that aimed to increase the chance of having a healthy baby. Inter-conceptional health care: interconception health involves helping a woman understand the importance of being healthy between pregnancies and the need to wait at least 18 months before becoming pregnant again to help optimize birth outcome.

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15 4- antenatal care Antenatal care is the care you receive from healthcare professionals during your pregnancy.  1- folic acid and vitamin D supplements 2- nutrition, diet and food hygiene  3- lifestyle factors :  smoking, recreational drug use and drinking alcohol   4- antenatal screening tests 5-if you've had any complications or infections in a previous pregnancy  6- if you're being treated for a chronic disease. screening tests, including screening for sickle cell disease and thalassaemia, infectious diseases and screening for Down's syndrome. You should be offered screening for sickle cell disease and thalassaemia before 10 weeks.

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17 5-Poverty 1- increased total fertility rates, unintended or teenage pregnancy and being a single mother 2-hose living in poverty were more likely to smoke, to have poorer dietary habits, lower levels of education, and engage in higher risk and health-demoting practices 3- overall excess mortality risk was approximately 60% compared with infants born to women living above the poverty level. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC /

18 6- Access to appropriate preconception and interconception health care1- Talking to a health-care provider before becoming pregnant at least 6 months. Why? Because a woman might have a subsequent pregnancy, services in the postpartum period 2- ccessing services such as the Special Supplemental Nutrition Program for Women, Infants, and Children

19 High risk Factor in maternal and child health

20 Post partum depressionHTN Heart Disease GDM Tobacco & alcohol use STDs Nutrition Unhealthy weight Genetic factor Post partum depression

21 Hypertension most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. complication: preeclampsia : high BP and signs of damage to another organ system (proteinuria) ,  usually after 20 weeks of pregnancy Why is high blood pressure a problem during pregnancy? Decreased blood flow to the placenta Placental abruption Premature delivery Future cardiovascular disease Failure to thrive, seizures, , lack of energy, and difficulty in breathing  can be associated with hypertension in neonates

22 Heart disease Leading Cause of death of maternal death worldwide.-Myocardial infarction -Cardiomyopathy -Rheumatic heart disease -Congenital heart diseases.

23 Gestational Diabetes mellitusis when a woman without diabetes, develops high blood sugar levels during pregnancy Approximately 7% of all pregnancies are complicated by GDM more than 200,000 annually. in gestational diabetes, blood sugar usually returns to normal soon after delivery. But you're at risk for type 2 diabetes.

24 Gestational Diabetes mellitusRisk factors? 1-Age greater than 25 2-Excess weight (30 or higher BMI) 3-Family or personal health history. Complication Mother: Future DM - preeclampsia Baby: high birth weight - Preterm birth with respiratory distress syndrome – low Blood sugars

25 Alcohol use Can pregnant women drink small amount of alcohol or beer? Why? There is No known safe amount of alcohol use during pregnancy. All types are equally harmful, including all wines and beer. When pregnant women drinks alcohol so does her baby. Alcohol in the mother's blood passes to the baby through the umbilical cord Complication of drinking alcohol during: miscarriage, stillbirth abnormal facial features Growth and central nervous system problems

26 Fetal alcohol spectrum disordersFASD is a group of disorders caused by prenatal exposure to alcohol.

27 Smoking Why is it so dangerous to smoke during pregnancy?Cigarette smoke contains more than 4,000 chemicals, including truly nasty things like cyanide, lead, and at least 60 cancer-causing compounds. When mom smokes during pregnancy, that toxic brew gets into her bloodstream, her baby's only source of oxygen and nutrients.

28 Smoking Smoking effect: harder for a woman to get pregnant.placenta can separate Sudden Infant Death Syndrome Cleft lip or cleft palate Second smoke effect: - baby who weighs less. - Ear infections AND asthma attacks

29 STD’s 1-Perinatal HIV/AIDSIt recommends  that all women who are pregnant or planning to get pregnant should get tested for HIV as early as possible. If a woman is treated for HIV early in her pregnancy, the risk of transmitting HIV to her baby can be 1% or less. How to lower the risk of transmitting HIV from the mother to their babies? HIV medicines Cesarean delivery No pre-chewing her baby’s food.

30 STD’s 2- Chlamydia : Most women have NO symptoms and it is Easy to cure Chlamydia lesions on genitals are highly contagious and infect the baby during labor The risk in pregnancy : early delivery, eye infection or ectopic pregnancy.   3-Gonorrhea The risk in pregnancy :miscarriage,  preterm birth The risk before and after pregnancy if untreated : cause pelvic inflammatory disease Gonorrhea in newborns most commonly affects the eyes 4-Syphilis: Typically occurs during second half of pregnancy May be transmitted to baby by infected mother. It be linked to premature birth, stillbirth. death in some cases 5-Herpes simplex virus: Herpes is safe in pregnant women until she get ready to deliver. Herpes lesions on genitals are highly contagious and infect the baby during labor

31 Poor nutrition malnutrition: fail to gain weight in pregnancy Mother die while pregnant Baby :  low-birth weight -  restricted fetal growth -Micro nutrition: Iron : Preterm birth and anemia (risk of death from bleeding during childbirth) Calcium: prevent baby from draw calcium from his mother bone. Baby : Folate : neural tube defect Calcium: poor skeletal developmen Iron: low birth weight 

32 Unhealthy weight A women weight before and during pregnancy are important indicators of health for both mother and child. Recent studies showed overweight or obese before pregnancy associated with a higher pregnancy complication.

33 Genetic conditions more than 50 per cent of miscarriages in the early stages of pregnancy are due to abnormalities of the chromosomes.

34 Social and Physical Determinants of Maternal Health

35 Social and Physical Determinants of Maternal Healthrange of biological, social, environmental, and physical factors have been linked to maternal, infant, and child health outcomes. Race , Ethnicity, Age , socioeconomic factors, such as income level, educational attainment, medical insurance coverage, access to medical care, pre-pregnancy health, and general health status.

36 Why it is important? 1-To know these factors help in Improving the well-being of mothers, infants, and children . 2- educating patients in a culturally sensitive manner about steps they can take to prevent diseases.

37 1-Social Determinants of Maternal HealthRace and ethnicity Age socioeconomic factors access to medical care pre-pregnancy health general health status. -Physical Determinants of Maternal Health Common barriers to a healthy pregnancy and birth include lack of access to appropriate health care before and during pregnancy. Affecting her health directly. Affecting her ability to engage in healthy behaviors

38 Social and Physical Determinants of Child Health

39 Social and Physical Determinants of Child HealthBiological Birth Weight: low birth weight (< 2.5 kg) & high birth weight (> 4 kg) Age of The Mother : <19 years) or >over 30 years Repeated pregnancies : risk of miscarriage Birth Spacing: < 1 year = 2-4 times risk of mortality Multiple Births: more risk due to low birth weight Family Size: 3 or more children, more frequent/prolonged illness Socio-economic Factors Low income countries Rural areas Low education Nutrition Breast & formula milk use Health care quality Violence (wife beating, infanticide, child abuse) Environmental conditions Cultural Factors Religion Customs Early marriages Sex of child Quality of mothering Traditions affecting cleanliness, •eating, clothing, •child care

40 How to improve the health and well-being of women, infants, children, and families.First 24 hours : assessment of vaginal bleeding, uterine contraction, temperature and heart rate should be done routinely during the first 24 hours Breastfeeding should be assessed women should be asked about their emotional wellbeing, what family and social support they have Iron and folic acid supplementation should be provided for at least 3 months after delivery.

41 Post partum depressionAfter 10–14 days, all women should be asked about postpartum depression approximately 10 to 15% of women suffer from postpartum mood disorders (PPMDs), including postpartum depression (PPD), postpartum anxiety/OCD and postpartum psychosis

42 Post partum depressionWhat are the symptoms of PPD? loss of pleasure or interest in things you used to enjoy eating much more, or much less, Sadness, crying Feeling guilty or worthless—blaming yourself

43 Post partum depressionthe risk factors for PPD? Previous experience of depression or anxiety premature birth Isolation and lack of social support Stress

44 Post partum depressionCauses Physical changes.  Emotional issues.

45 the major reasons of maternal mortalitythe major reasons of maternal mortality? Women die from a wide range of complications in pregnancy, childbirth or the postpartum period. The four major killers are: severe bleeding (mostly bleeding postpartum), infections (also mostly soon after delivery), hypertensive disorders in pregnancy (eclampsia) and obstructed labor

46 How can maternal deaths be prevented?We should ensure that women have access to family planning and safe abortion. This will reduce unwanted pregnancies and unsafe abortions

47 How to improve infancy healthinfant Mortality for every 1,000 babies that are born, almost 6 die during their first year, 45% of child deaths under the age of 5 years take place during the neonatal period. . Most of these babies die as a result of Birth defects Preterm birth (birth before 37 weeks gestation) and low birth weight Maternal complications of pregnancy Sudden Infant Death Syndrome (SIDS) Injuries (e.g., suffocation).

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49 Improving infants health after deliveryPromote early and exclusive breastfeeding. A full clinical examination should be done 1 hour after birth. This includes giving vitamin K prophylaxis and hepatitis B vaccination (within 24 hours).

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52 References https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health https://www.ncbi.nlm.nih.gov/pubmed/ https://en.wikipedia.org/wiki/Gestational_diabetes https://www.cdc.gov/ncbddd/fasd/alcohol-use.html https://www.babycenter.com/0_how-smoking-during-pregnancy-affects-you-and-your-baby_ bc

53 Thank you Any Questions ?