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Medical Quality Assurance Services. This indicator is the prevalence of children with diarrhoea who received oral rehydration therapy and continued feeding. Children aged 1 y ear immunized against measles. Get Email Updates To receive email updates about this page, enter your email address: Vitamin A deficiency is a public health problem in more than half of all countries, especially those in Africa and South-East Asia, most severely affecting young children and pregnant women in low-income countries. Countries are ranked on a point scale, with 0 and being the best and worst possible scores, respectively.


Integrated Management of Pregnancy and Childbirth (IMPAC)

Prenatal marijuana use was not independently associated with lower average birthweight or gestational age. Postpartum marijuana use was associated with depressive symptoms and shorter breastfeeding duration. Surveillance of marijuana use among pregnant and postpartum women is critical to better understanding the relationship of marijuana use with birth outcomes, and postpartum experiences such as depression and breastfeeding.

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Ko a Van T. Tong a Jennifer M. Bombard a Donald K. Hayes a b John Davy c Katherine A. This contributes to insulin resistance of pregnancy and possibly striae. One theory is that high progesterone levels act as an antagonist to the cortisol. The adrenal gland also produces more aldosterone , leading to an eight-fold increase in aldosterone. The adrenal gland also produces more androgens , such as testosterone, but this is buffered by estrogen's increase in sex-hormone binding globulin SHBG.

The thyroid enlarges and may be more easily felt during the first trimester. The increased in kidney clearance during pregnancy causes more iodide to be excreted and causes relative iodine deficiency and as a result an increase in thyroid size. Estrogen-stimulated increase in thyroid-binding globulin TBG leads to an increase in total thyroxine T4 , but free thyroxine T4 and triiodothyronine T3 remain normal. A woman's breasts grow during pregnancy, usually 1 to 2 cup sizes [ citation needed ] and potentially several cup sizes.

A woman who wore a C cup bra prior to her pregnancy may need to buy an F cup or larger bra while nursing. Once lactation begins, the woman's breasts swell significantly and can feel achy, lumpy and heavy which is referred to as engorgement. Her breasts may increase in size again by an additional 1 or 2 cup sizes, but individual breast size may vary depending on how much the infant nurses from each breast.

Many people and even medical professionals mistakenly think that breastfeeding causes the breasts to sag referred to as ptosis. In February , Cheryl Cole told British Vogue that she hesitated to breastfeed because of the effect it might have on her breasts. In fact, the biggest factors affecting ptosis are cigarette smoking, a woman's body mass index BMI , her number of pregnancies , her breast cup size before pregnancy, and age.

The heart adapts to the increased cardiac demand that occurs during pregnancy in many ways. Uterine enlargement beyond 20 weeks' size can compress the inferior vena cava, which can markedly decrease the return of blood into the heart or preload. As a result, healthy pregnancy patients in a supine position or prolonged standing can experience symptoms of hypotension.

Erythropoietin , which stimulates red blood cell production, increases throughout pregnancy and reaches approximately percent of their pregnancy levels at term. The effect of pregnancy on platelet count is unclear, with some studies demonstrating a mild decline in platelet count and other studies that show no effect. A pregnant woman will also become hypercoagulable , leading to increased risk for developing blood clots and embolisms, such as deep vein thrombosis and pulmonary embolism.

Women are times more likely to develop a clot during pregnancy and in the postpartum period than when they are not pregnant. In third world countries, the leading cause of maternal death is still hemorrhage.

The increase risk of clots can be attributed to several things. Plasma levels of pro-coagulantion factors increased markedly in pregnancy, including: Edema , or swelling, of the feet is common during pregnancy, partly because the enlarging uterus compresses veins and lymphatic drainage from the legs. During pregnancy, both protein metabolism and carbohydrate metabolism are affected. One kilogram of extra protein is deposited, with half going to the fetus and placenta , and another half going to uterine contractile proteins, breast glandular tissue, plasma protein, and haemoglobin.

An increased requirement for nutrients is given by fetal growth and fat deposition. Changes are caused by steroid hormones, lactogen, and cortisol.

Maternal insulin resistance can lead to gestational diabetes. Increased liver metabolism is also seen, with increased gluconeogenesis to increase maternal glucose levels. Some degree of weight gain is expected during pregnancy. The enlarging uterus, growing fetus, placenta , amniotic fluid , normal increase in body fat, and increase in water retention all contribute weight gain during pregnancy. The amount of weight gain can vary from 5 pounds 2.

All patients are advised to take prenatal vitamins to compensate for the increased nutritional requirements. The use of Omega 3 fatty acids supports mental and visual development of infants. Progesterone causes many changes to the genitournary system.

A pregnant woman may experience an increase in the size of the kidneys and ureter due to the increase blood volume and vasculature. Later in pregnancy, the woman might develop physiological hydronephrosis and hydroureter, which are normal. The increased GFR leads to increased urinary output, which the woman may experience as increased urinary frequency.

Progesterone also causes decreased motility of the ureters, which can lead to stasis of the urine and hence an increased risk of urinary tract infection. Changes in the gastrointestinal GI system during pregnancy are caused by the enlarging uterus and hormonal changes of pregnancy.

Anatomically, the intestine and stomach are pushed up from their original positions by the enlarging uterus. Elevated levels of progesterone and estrogen mediate most of the functional changes of the GI system during pregnancy. Progesterone causes smooth muscle relaxation which slows down GI motility and decreases lower esophageal sphincter LES tone. The resulting increase in intragastric pressure combined with lower LES tone leads to the gastroesophageal reflux commonly experienced during pregnancy.

The increased occurrence of gallstones during pregnancy is due to inhibition of gallbladder contraction as result of increased smooth muscle relaxation mediated by progesterone and reduced biliary transportation of bile mediated by estrogen which results in cholestasis of pregnancy. It begins between the 4 and 8 weeks of pregnancy and usually subsides by 14 to 16 weeks.

The exact cause of nausea is not fully understood but it correlates with the rise in the levels of human chorionic gonadotropin , progesterone , and the resulting relaxation of smooth muscle of the stomach. Hyperemesis gravidarum , which is a severe form of nausea and vomiting of pregnancy can lead to nutritional deficiencies, weight loss, electrolytes imbalance and is one of the leading causes of hospitalization in the first trimester of pregnancy. Constipation is another GI symptom that is commonly encountered during pregnancy.

It is associated with the narrowing of the colon as it gets pushed by the growing uterus found adjacent it leading to mechanical blockade. Reduced motility in the entire GI system as well as increased absorption of water during pregnancy are thought to be contributing factors. Dietary cravings and dietary as well as olfactory avoidance of certain types of food are common in pregnancy. Although the exact mechanisms of these symptoms are not fully explained, it is thought that dietary cravings may arise from the thought that certain foods might help relieve nausea.

Pica , which is the intense craving for unusual materials such as clay and ice has also been reported in pregnancy. Hemorrhoids and gingival disease are two common pregnancy associated physical findings involving the gastrointestinal system.

Hemorrhoids arise as a result of constipation and venous congestion that are common in pregnancy. Gingival disease is thought to be related to gum softening and edema swelling from fluid collection that is mostly observed in pregnancy. The mechanism and reason for the gingival changes are poorly understood.

The fetus inside a pregnant woman may be viewed as an unusually successful allograft , since it genetically differs from the woman. Neuromechanical adaptations to pregnancy refers to the change in gait, postural parameters, as well as sensory feedback , due to the numerous anatomical, physiological, and hormonal changes women experience during pregnancy.

Such changes increase their risk for musculoskeletal disorders and fall injuries. Musculoskeletal disorders include lower-back pain, leg cramps, and hip pain.

Additionally, two-thirds of falls are associated with walking on slippery floors, rushing, or carrying an object. However, some factors that may contribute to these injuries include deviations from normal posture , balance , and gait. The body's posture changes as the pregnancy progresses. The pelvis tilts and the back arches to help keep balance. Poor posture occurs naturally from the stretching of the woman's abdominal muscles as the fetus grows.

These muscles are less able to contract and keep the lower back in proper alignment. The pregnant woman has a different pattern of gait. The step lengthens as the pregnancy progresses, due to weight gain and changes in posture.

On average, a woman's foot can grow by a half size or more during pregnancy. In addition, the increased body weight of pregnancy, fluid retention, and weight gain lowers the arches of the foot, further adding to the foot's length and width. The influences of increased hormones such as estrogen and relaxin initiate the remodeling of soft tissues, cartilage and ligaments. Certain skeletal joints such as the pubic symphysis and sacroiliac widen or have increased laxity.

The addition of mass, particularly around the torso , naturally changes a pregnant mother's center of mass COM. The change in COM requires pregnant mothers to adjust their bodies to maintain balance. To positionally compensate the additional load due to the pregnancy, pregnant mothers often extend their lower backs. As the fetal load increases, women tend to arch their lower backs, specifically in the lumbar region of their vertebral column to maintain postural stability and balance.

The arching of the lumbar region is known as lumbar lordosis , which recovers the center of mass into a stable position by reducing hip torque. According to a study conducted by Whitcome, et al. Postpartum, the angle of the lordosis declines and can reach the angle prior to pregnancy.

Unfortunately, while lumbar lordosis reduces hip torque, it also exacerbates spinal shearing load, [31] which may be the cause for the common lower back pain experienced by pregnant women. Given the demands of fetal loading during pregnancy and the importance of producing offspring to the fitness of human beings , one can imagine that natural selection has had a role in selecting a unique anatomy for the lumbar region in females. It turns out that there are sex differences in the lumbar vertebral column of human males and females, which ultimately helps mitigate some of the discomfort due to the fetal load in females.

e-Library of Evidence for Nutrition Actions (eLENA)