Very often high rates of MMR and IMR are due to various preventable factors. Biological maturity of the prospective mother is important for a successful pregnancy. The mother should be at least 5 years post menarchical. This is more important than chronological age. Five years after starting to menstruate, a girl is as biologically mature as she will ever become. She may not be psychologically, emotionally or educationally mature but she is as biologically mature as a 20 years old. Preparation should begin at conception minus 60 days. Pre pregnancy preparation is very essential. Protection from all preventable diseases such as German measles, tetanus etc. is important. So also it is important to control all chronic/ metabolic disorders. Diabetic mothers are required to control blood glucose and insulin levels as peri natal mortality associated with diabetic mothers is 15%. The risk of fetal congenital malformation is about 15% in children born to diabetic mothers.
All pregnancies should start with a BMI of 20-26 because maternal and fetal consequences occur at both extremes. If a woman is under weight when her child is conceived, her infant will have reduced birth weight. On the other hand if her BMI is > 29 she will be predisposed to maternal hypertension, pregnancy induced toxemia, cesarean section, diabetes and other maternal and fetal complications. All habits harmful to the fetus such as cigarette smoking and alcohol consumption by the mother should be eliminated before conception itself. Early and regular prenatal care and adequate nutrient intake is important. If adequate nutrition is provided and if all the mother’s systems are working normally – nutrients cross into the fetal blood across the placenta. If this is not so, some degree of intra uterine growth retardation ( IUGR) of fetus will occur. An undesirable situation is when the mother’s body reserves of calories, proteins, minerals and vitamins are mobilized for growth and development of fetus.
Additional risk factors:
Low Hemoglobin level. Hemoglobin should be above 11g/dl and a Hematocrit level of 33% should be maintained. Low levels indicate anemia, which is not desirable. Weight gain should be orderly. Weight gain of more than 1kg/week is a cause for concern. Weight loss is also a cause for concern. Weight gain of less than 1 kg/month is also of concern.