Between 1900 and 2000, infant mortality in the United States declined by 90 percent, and maternal mortality by 99 percent. This was one of the greatest achievements of public health in the twentieth century. However, the goal, established in 1994 by the International Conference on Population and Development, of every pregnancy being healthy has not been achieved. Current efforts to ensure healthy pregnancy work at three different levels of prevention.
Primary prevention involves efforts to prevent diseases from occurring during pregnancy. Examples of primary prevention during pregnancy include family planning, preconceptional care, and health promotion during prenatal care. By preventing unintended pregnancies, family planning can prevent morbidity associated with unintended pregnancies. Preconceptional care has been shown to reduce certain birth defects. Proper nutrition and cessation of tobacco, alcohol, and drug use during pregnancy can prevent low birth weight and other complications.
Secondary prevention involves efforts to facilitate early detection and treatment of diseases during pregnancy. Prenatal care provides early and continuous assessment of the pregnant woman, and includes early detection of preeclampsia, syphilis, and tuberculosis.
Tertiary prevention attempts to avert severe complications resulting from diseases during pregnancy. Examples of tertiary prevention include the administration of antibiotics in the treatment of puerperal infection, magnesium to prevent eclampsia (convulsions) in women affected by severe preeclampsia, and transfusion of blood products when obstetrical hemorrhage occurs. Regionalization of perinatal health services, so that high-risk women deliver only in hospitals equipped to deal with potential complications, plays an important role in tertiary prevention.
Much of the improvement in maternal and infant health is attributable to improved health conditions such as better sanitation, sewage control, and safer water supplies. Continued improvement is likely to come from social and behavioral changes rather than from advancement in medical care. Such developments as the expansion in the availability of legal abortions, increased education for women, and better family planning practices have all contributed to improved maternal and infant health. It is important, therefore, for public health professionals to learn how to better address social and behavioral determinants of health. For example, because smoking cigarettes during pregnancy can cause low birth weight and prematurity, it is important to find out how to stop women from smoking during pregnancy.
Because the health of a baby is tied to health of the mother, efforts to improve pregnancy outcomes must begin with women’s health. Current efforts fall short by doing too little too late—to expect prenatal care to reverse all the cumulative effects of risk exposures over the course of a woman’s life may be expecting too much. Future efforts should promote health not only during pregnancy, but during all of a woman’s life.
Tags: Healthy Pregnancy, Pregnancy
