by Awake! writer in Mexico

ACCORDING to the United Nations Population Fund, each year more than half a million women die of pregnancy-related causes. In addition, the United Nations Children�s Fund (UNICEF) notes that annually more than 60�million women suffer acute complications from pregnancy and that nearly a third of these sustain lifelong injuries or infections. In developing countries many women are trapped in a cycle of pregnancies, deliveries, and self-neglect, leaving them worn out and ill. Yes, pregnancy can be harmful�even dangerous. Is there anything a woman can do to make her pregnancy safer?

Health Care Before Pregnancy

Planning. Husbands and wives may need to discuss how many children to have. In developing countries it is common to see women with small children nursing a baby and, at the same time, expecting another. Careful planning and consideration might allow time to elapse between the birth of one child and the next, resulting in relief for the woman, who would then be able to recuperate after giving birth.

Nutrition. According to the Coalition for Positive Outcomes in Pregnancy, before becoming pregnant a woman needs at least four months to recover from exposure to harmful substances and to build a good nutritional supply. For example, the risk of spina bifida, caused by a defective closing of the neural tube, is greatly reduced when the expectant mother has an ample supply of folic acid. Since the embryo�s neural tube closes between the 24th and 28th day after conception�long before many women realize that they are pregnant�some women who are planning to become pregnant take folic acid. Another crucial nutrient is iron. Indeed, a woman�s iron requirement doubles during pregnancy. If her reserve is low�which is true of many women in developing countries�she can come to have iron-deficiency anemia. This condition can be worsened by repeated pregnancies, as the woman may not have time between them to replenish her iron reserve.

Age. Risk of death in pregnant girls under 16 is 60�percent greater than in those in their 20�s. On the other hand, women over 35 are more likely to give birth to babies with congenital abnormalities, such as Down�s syndrome. Mothers who are very young or are in their later childbearing years are more prone to preeclampsia. This disorder, characterized by high blood pressure after the 20th week of gestation along with the presence of edema and an increased amount of protein in the urine, increases the risk of mortality in both baby and mother.

Infections. Urinary, cervicovaginal, and gastrointestinal infections can worsen during pregnancy and can increase the risk of premature birth and preeclampsia. Any infection is best treated before pregnancy.
Health Care During Pregnancy

Prenatal care. Regular visits to a doctor throughout pregnancy lower the risk of maternal death. Even in countries where regular access to clinics and hospitals is limited, properly trained midwives may be available. Prenatal care can alert trained personnel to situations that could make special care necessary. These include multiple gestation, hypertension, heart and kidney problems, and diabetes. In some countries a pregnant woman can receive tetanus toxoid vaccine to prevent neonatal tetanus. She may also be tested for group B streptococcus between the 26th and the 28th week of gestation. These bacteria, if present in the lower intestinal tract, can infect the baby during delivery. The mother-to-be should be prepared to provide health professionals with all the information she can, including her medical history. She should also freely ask questions. Immediate medical assistance should be sought if there is vaginal bleeding, sudden inflammation of the face, strong or continuous headaches or pain in the fingers, sudden impaired or blurred vision, strong abdominal pain, persistent vomiting, chills or fever, changes in frequency or intensity of fetal movements, loss of liquid through the vagina, pain while urinating, or abnormal lack of urine.

Alcohol and drugs. A mother�s use of alcohol and drugs (including tobacco) increases her child�s risk of mental retardation, physical abnormalities, and even behavioral disorders. Babies of drug-addicted mothers have even been known to show signs of withdrawal. Although some people believe that an occasional glass of wine is not harmful, experts usually recommend total abstinence during pregnancy. Expectant mothers should also beware of second-hand smoke
.
Medicines. No medicine should be taken unless specifically prescribed by a doctor who is aware of the pregnancy and who has carefully weighed the risks. Some vitamin supplements can also be harmful. An excess of vitamin A, for instance, can cause fetal deformities.

Weight gain. A pregnant woman should avoid extremes. According to Krause�s Food, Nutrition and Diet Therapy, a low-birth-weight baby�s risk of death is 40 times greater than that of a normal-weight newborn. On the other hand, eating for two only promotes obesity. Proper weight gain�more evident from the second trimester on�indicates that the expectant mother is eating the right amount for her increased demands.

Hygiene and other considerations. Baths and showers can be taken normally, but vaginal douches should not be used. A pregnant woman should avoid contact with anyone who suffers from a viral infection, such as rubella, also called German measles. Furthermore, in order to prevent toxoplasmosis, undercooked meat and contact with the feces of cats must be carefully avoided. Basic hygiene procedures, such as the washing of hands and of raw foods, are essential. Sexual relations do not usually pose a risk, except during the last weeks of pregnancy or in the case of hemorrhage, cramps, or previous miscarriage.

A Successful Delivery

A woman who takes care of herself during pregnancy will be less prone to complications upon delivery. Naturally, she will have planned whether she prefers to deliver at home or in a hospital. She will also know, to a good degree, what to expect and how to cooperate with the skilled midwife or physician. This person, in turn, will know the woman�s informed preferences�where a choice is possible�on such issues as delivery position, episiotomy, and the use of forceps, analgesics, and electronic fetal monitoring. There must also be agreement on other issues: To what hospital or clinic will they go if the home delivery becomes complicated? What exactly will be done in case of excess blood loss? Since hemorrhage causes many maternal deaths, blood substitutes must be readily available for patients who do not accept transfusions. Also, forethought should be given as to what will be done if a cesarean section is required. The Bible says that children are a blessing from God, an �inheritance.� The more a woman knows about her pregnancy, the better off she will be. By taking care of herself before and during pregnancy and by giving adequate forethought to the various aspects of delivery, a woman will be doing all she can to ensure a safer pregnancy.

[Footnotes]

Some sources of folic acid and iron are liver, legumes, green leafy vegetables, nuts, and fortified cereals. For absorbing iron-rich foods, it may help to combine them with sources of vitamin C, such as fresh fruits. The recommended gain for a woman who begins pregnancy with a healthy weight is between 20 and 25�pounds [9 and 12�kg] by the end of gestation. Nevertheless, adolescents or undernourished women should gain between 25 and 30�pounds [12 and 15�kg], while those who are overweight should gain only between 15 and 20�pounds [7 and 9�kg].

TIPS FOR PREGNANT WOMEN
� Normally a pregnant woman�s daily diet should include fruits, vegetables (especially dark-green, orange, and red ones), legumes (such as beans, soybeans, lentils, and chick-peas), cereals (including wheat, corn, oats, and barley�preferably whole grain or fortified), food from animal sources (fish, chicken, beef, eggs, cheese, and milk, preferably skimmed milk). Fats, refined sugars, and salt are best consumed in moderation. Drink plenty of water. Avoid caffeinated beverages, as well as foods containing preservatives and additives (such as artificial colorings and flavorings). Starch, clay, and other nonedible substances can cause malnutrition and toxicity. � Beware of possible environmental hazards, such as overexposure to X-rays and harmful chemicals. Limit use of sprays and other household substances. Do not become overheated because of exposure to excessive temperatures or overexercise. Avoid prolonged standing and overexertion. Use proper seat belt positioning.