Maternal Health

Maternal Health

  • Faustino R Perez-Lopez added an answer:
    Does anyone have the Pregnancy Related Anxiety Questionnaire (PRAQ)?

    A questionnaire which can assess anxiety in pregnant women.

    Faustino R Perez-Lopez

    Currently, there are no screening tools specific to anxiety and pregnancy. TheHospital Anxiety and Depression Scale (HADS) has been used as a screening instrument for anxiety and depression during pregnancy. Other tools include the State Trait Anxiety Inventory (Spielberger et al., 1970), Crown-Crisp Experiential Index (Crisp et al., 1978) and the Beck Anxiety Inventory (Beck et al., 1988). The Kessler 10 (K-10) may be the best short screening measure. There is a meta-analysis that may be intersting: Meades, R. & Ayers, S. (2011). Anxiety measures validated in perinatal populations: A systematic review. Journal of Affective Disorders, 133(1-2), pp. 1-15. I attach the full paper.

    Best regards,


  • Sujoy Dasgupta added an answer:
    How can one address the challenge of concurrent use of IVFs and diuretics in a hypotensive patient who has pulmonary oedema a low resource setting?

    A young primigavida had an unsupervised home delivery, had some bleeding at home and presented with what looked like anemic heart failure. Packed cell volume however came out to be 42% and 46% on two different occasions. she was discharged home when she appeared to have stablised only to reurn a week later with orthopnoea, pulmonary oedema and a very low blood pressure of 90/?mmHg. Within the resources available, the managing team placed her on a diuretic for the pulmonary oedema. But they also commenced her intravenous fluids for the hypotension in addition to dobutamine for inotropic effect.

    Achieving the right balance in concurrent use of diuretics and intravenous therapy in thesame patient is very challenging especially in resource constrained settings.

    We would be glad to have peoples' experiences or suggestions/recommendations in the management of such a case.

    Sujoy Dasgupta

    Ideal would be positive pressure ventilation, that is often not possible in low resource setting. So, oxygen, morphine and PRBC are mainstay of therapy here. Now regarding fluid balance, keep her on minimum fluid level- 75 ml/hour and low dose diuretics- like 20 mg furosemide 12 hourly. 

  • Khadijeh kh k Abdali added an answer:
    How should we manage the Rh negative pregnant woman with a history of her first baby dying from Rh hemolytic disease?

    This woman is at 20 weeks of gestation. She is Rh negtive and her husband is Rh positive. No Rh antibody was detected a week ago. Her first baby died from Rh hemolytic disease. What should we do for this woman?

    Khadijeh kh k Abdali

    History provided the Pregnant  mother is not perfect

    1-Incompatibility Rh (rh illness in infants) is usually not a problem at first pregnancy, because at first pregnancy, fetal blood usually can not enter the mother's circulatory system, unless there are unusual problems.          

    2- antibody screening  ;  Maternal Antibody Titration

    3-serial  Doppler ultrasound, to determine if the fetus is developing anemia and how severe it may be. This test, which is repeated every 1 to 2 weeks, measures the speed of blood flowing through an artery in the fetus  .                                                           4- Today these fetuses can be treated in the uterus as early as 18 weeks gestation with blood transfusions, which are given using cordocentesis. About 90 percent of treated babies now survive.                                                                                                            5-   Intramuscular injection of Rhogam (RHOGAM) (which is anti-D gamma globulin) to the mother once at 28 weeks of pregnancy   

  • Wolfgang Künzel added an answer:
    Is there anyone who worked on maternal health in country level?

    I am expecting all kinds of suggestions, those will help me for working on maternal health in country level. However, any crucial suggestions related to antenatal, delivery and postnatal care to find proper results by my research?

    Wolfgang Künzel

    You  will find an answer looking at  publications of Rotary International:

    Hospital report in Nigeria  2014.

    Link zur Promotion Adams

    Obstetric quality assurance to reduce maternal and fetal mortality in Kano and
    Kaduna State hospitals in Nigeria
    Hadiza Galadanci a, Wolfgang Künzel b,⁎, Oladapo Shittu c, Robert Zinser d, Manfred Gruhl e, Stefanie Adams b

    International Journal of Gynecology and Obstetrics 114 (2011) 23–28

  • Ishag Adam added an answer:
    Can you clear something up regarding maternal mortality ratio or rate ?

    Dear friends, I need your valuable suggestions / feedback on following points.

    1. Why we are not calculating (Maternal Mortality Ratio)MM-Ratio for districts / blockwise / villagewise in India specifically or developing countries?

    2. Why we are not using MM-Rate in India / developing countries?

    3. Suppose, if you want to give rankings to districts of maharashtra regarding progress in Maternal Health, which indicator we should use? Please reply

    Ishag Adam

    Thank  you very much  for all  of you for excellent comments

    One point please,  I think  maternal  near -miss is an excellent  tool for maternal  health  too.

  • Olga Lebedeva added an answer:
    Can anybody suggest any correlation between expression of antimicrobial peptides in cervix uteri and endometrium?

    Please, advise me any publications in this topic would also be helpful. 

    Olga Lebedeva

     Thank You very much, Kevin!

  • Prabhat Chandra Mondal added an answer:
    Should oxytocin be administered before or after placental expulsion?
    To prevent retention of placenta and also with reference to delayed cord clamping.
    Prabhat Chandra Mondal
    • After a long time and reading the answers, it has been seen that issue is controversial.
    • I believe that if oxytocin is given im (iv infusion) before separation of placenta and after delivery of baby, It would only contract the uterus. Palm is placed over the abdomen to feel the uterus. When uterus is contracted, give CCT to deliver the placenta without waiting for the signs of its separation. This will decrease the third stage blood loss. 
    • If you wait for placental separation and deliver it, it is not associated with increased incidence of PPH, but associated with insignificant amount of third stage blood loss.
    • If you give oxytocin before placental separation and don't apply CCT, there is insignificant number of trapped placenta. So, if you use oxytocin, you have to apply CCT when uterus is contracted.
    • Cochrane review included six studies from developed countries and found it is beneficial. WHO and other guidelines are  in favour of AMTSL (misinformation given by Niraj N Mahajan). Even it has been clearly expressed that AMTL should be incorporated in each and every women delivering baby in every country. They are also not against it.  
    • AMTSL decreases the incidence of PPH from 12% to 4%. Reverse is not correct which has been suggested several time by Kathleen Fahy. This should not be told as every society is in favour of decreasing MMR.
    • If you want to practice physiological management, then you have to be positive of BMI, Iron prophylaxis, hemoglobin level, duration of labour and other risk factors of PPH.
    • There is no difference between injecting oxytocin before and after placental delivery.
    • It has been observed that incidence of uterine inversion have been increased following incorporation of AMTSL (I am saying just observing the incidence before and after the adoption of AMTSL. It could be due to CCT before contraction of uterus. 
    • At least, this is a simple issue, there is little scope to avoid or distort the evidenced based guidelines by WHO, ACOG, RCOG and SOGC. 

    All the explanations given above are evidenced based. Just follow the methods of AMTSL of the studies included in the 'Cochrane review'.  

  • Judy Slome Cohain added an answer:
    Is there a test that can detect the chance of developing pre eclampsia early on during the pregnancy?


    Judy Slome Cohain

    I would like you to explain why you ask this question.  I think the desire to 

    predict  the chance of developing pre eclampsia early on during the pregnancy is equivalent to predicting whether your child will learn to ride a bicycle.  What is the relevance of this question?   We know what prevents preeclampsia-  adequate nutrition of protein and micronutrients.    if there is a lack of adequate protein and micronutrients, the risk of preeclampsia, while small increases.   

    It seems there continues to be a desire to define more and more women at risk of some horrible , albeit rare disease of pregnancy, rather than focusing on educating women on how to prevent those same diseases.

    If a woman has a green shake every morning, made up of every kind of green leafy vegetable , with 2 brazil nuts and some pecans,  and then for lunch eats brown rice and lentils with salad, and takes some B12, and for dinner, vary her diet depending on protein needs for that stage of pregnancy,  and that is her diet every day, she will not suffer preeclampsia.   It is bewildering to me that despite the fact that we know exactly how to eliminate preeclampsia , the focus is rather on developing ultrasound or other technology , that will not eliminate it, but rather detect a prediction of the degree of risk someone has to develop preeclampsia.

  • Maria Chifuniro Chikalipo added an answer:
    Does anyone know any contacts for population council on antenatal education services?

    I am looking for information on male involvement in antenatal education and my interest is to have information on what was delivered to men during the health talks. These projects were done in Kenya by ICAP in 2012/2013, South africa in Durban by Population Council in 2004 and another one in Nepal in 2005/2006. I know in High income countries they have organized sessions for couples and it will be good to learn as well what is in their curriculum for couple counseling. I will appreciate if I get the information or the contacts of these organizations so that I can access the information.

    Maria Chifuniro Chikalipo

    Thank you Ian

    Kind regards

  • Elizabeth Mary Skinner added an answer:
    Do we have a booklet containing antenatal education for childbearing women at ministerial level as a standard to be used in our clinics?

    I am asking this because I feel there is no such document and I am interested in designing one for childbearing women. Please midwives, obstetricians help.

    Elizabeth Mary Skinner

    Our research is observing that women are not given accurate and consistent information during the antenatal period and  significantly informed consent regarding  operative intrapartum procedures is totally neglected. Analysis so far suggests that they are often traumatized by lack of knowledge. I would be keen to see any of these documents.

     Warm regards

     Liz Skinner

    Sydney University

  • Ehsan Saboory added an answer:
    What are the 5 most important chemical or hormonal indicators of preeclampsia in human and/or rat?

    We are studying the effect of major life stressors on preeclampsia in rat and human. What must be measured in pregnant subjects to better illustrate the situation?

    Ehsan Saboory

    Dear Colleagues

    I appreciate all your valuable comments and suggestions.


    Ehsan Saboory

  • Cheryl Nikodem added an answer:
    Is the maneuver Fundal pressure - vis a tergo - expressio fetus a safe maneuver?

    I'm very interested in this maneuver because it is common practice though there is little evidence on it.

    who has interesting research ideas on this topic? who has already useful protocols and instruction tools for this maneuver?

    Cheryl Nikodem

    Fundal pressure during the second stage of labour
    RHL Summary
    30 June 2014
    Lieve Blancquaert
    Findings of the review: Fundal pressure is a widely used practice which involves the use of manual or instrumental pressure on maternal abdomen in the direction of the birth canal with the purpose of accelerating the second stage of labour. While it is used routinely in many settings, it is also considered obsolete in many countries and there is some concern about its effectiveness as well as its potential adverse consequences. The aim of this review was to determine the benefits and adverse effects (for both the mother and her baby) of fundal pressure in the second stage of labour. Only one trial, judged by the authors to be of good methodological quality, was included in this review. That trial involved 500 nulliparous women (who had received epidural analgesia) compared fundal pressure by insufflatable belt with no fundal pressure. No significant differences were found in the duration of the second stage of labour, mode of delivery, five-minute Apgar scores, neonatal arterial cord pH and admission to neonatal intensive care unit. In the intervention group there was an increase in intact perineum but also an increase in anal sphincter tears. The lack of blinding may have influenced these two opposite results, although a possible association with the intervention cannot be ruled out.

    Implementation: There is no evidence to either support or discourage the use of manual fundal pressure during the second stage of labour. Further research is needed to evaluate the effectiveness and safety of manual pressure or use of an insufflatable belt for fundal pressure during the second stage of labour.

    Cochrane review

    Citation: Verheijen EC, Raven JH, Hofmeyr GJ. Fundal pressure during the second stage of labour. Cochrane Database of Systematic Review 2009, Issue 4. Art. No.: CD006067. DOI: 10.1002/14651858.CD006067.pub2.

    Fundal pressure during the second stage of labour involves application of manual pressure to the uppermost part of the uterus directed towards the birth canal in an attempt to assist spontaneous vaginal delivery and avoid prolonged second stage or the need for operative delivery. Fundal pressure has also been applied using an inflatable girdle. A survey in the United States found that 84% of the respondents used fundal pressure in their obstetric centres.There is little evidence to demonstrate that the use of fundal pressure is effective to improve maternal and/or neonatal outcomes. Several anecdotal reports suggest that fundal pressure is associated with maternal and neonatal complications: for example, uterine rupture, neonatal fractures and brain damage. There is a need for objective evaluation of the effectiveness and safety of fundal pressure in the second stage of labour.

    To determine the benefits and adverse effects of fundal pressure in the second stage of labour.

    Search methods
    We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008).

    Selection criteria
    Randomised and quasi-randomised controlled trials of fundal pressure versus no fundal pressure in women in the second stage of labour with singleton cephalic presentation.

    Data collection and analysis
    Three review authors independently assessed for inclusion all the potential studies. We extracted the data using a pre-designed form. We entered data into Review Manager software and checked for accuracy.

    Main results
    We excluded two of three identified trials from the analyses for methodological reasons. This left no studies on manual fundal pressure. We included one study (500 women) of fundal pressure by means of an inflatable belt versus no fundal pressure to reduce operative delivery rates. The methodological quality of the included study was good.

    Use of the inflatable belt did not change the rate of operative deliveries (RR 0.94, 95% CI 0.80 to 1.11). Fetal outcomes in terms of five-minute Apgar scores below seven (RR 4.62, 95% CI 0.22 to 95.68), low arterial cord pH (RR 0.47, 95% CI 0.09 to 2.55) and admission to the neonatal unit (RR 1.48, 95% CI 0.49 to 4.45) were also not different between the groups. There was no severe neonatal or maternal mortality or morbidity. There was an increase in intact perineum (RR 1.73, 95% CI 1.07 to 2.77), as well as anal sphincter tears (RR 15.69, 95% CI 2.10 to 117.02) in the belt group. There were no data on long-term outcomes.

    Authors' conclusions
    There is no evidence available to conclude on beneficial or harmful effects of manual fundal pressure. Good quality randomised controlled trials are needed to study the effect of manual fundal pressure. Fundal pressure by an insufflatable belt during the second stage of labour does not appear to increase the rate of spontaneous vaginal births in women with epidural analgesia. There is insufficient evidence regarding safety for the baby. The effects on the maternal perineum are inconclusive.

  • Marie-Celine Farver added an answer:
    Can anyone suggest a possible method to prevent meconium aspiration in the presence of thick or thin meconium?

    As explained in these youtubes, I have been preventing all meconium aspiration by delivery on hands and knees, and waiting a minute or more between delivery of head and body. This gives a minute for meconium and vernix to drain from the lungs, trachea and nose. By the time the body is delivered, the lungs and trachea are clear of all meconium.
    • Source
      [Show abstract] [Hide abstract]
      ABSTRACT: Meconium aspiration syndrome (MAS) is a life-threatening disorder in newborn infants. Universal intrapartum suction of infants with meconium stained amniotic fluid (MSAF) and postnatal suction of vigorous infants have been used in an attempt to decrease the incidence and severity of the disease by clearing the airway. Both procedures have been proven fruitless when challenged through randomised control trials (RCTs). Endotracheal intubation and suctioning are currently recommended only for non-vigorous infants. Respiratory failure in infants with MAS is frequently treated initially with conventional or synchronized mechanical ventilation. Surfactant administration and high-frequency ventilation (HFV) are commonly used as rescue therapy for severe cases. Nitric oxide (NO) is added when severe pulmonary hypertension is demonstrated. ECMO is an option when other treatments have failed. In the pathophysiology of severe MAS, asphyxia and pulmonary hypertension are considered to be more important than the obstruction of the airways and/or damage to the lung produced by meconium.
      Early human development 10/2009; 85(10):621-6. DOI:10.1016/j.earlhumdev.2009.09.013
    Marie-Celine Farver

    As you stated above, we are only intervening if the baby is nonvigorous. Then we do not stimulate, but entubate and suction. If the cords are clear, there is no suctioning. If the baby is not vigorous after suctioning, we follow AAP NRP guidelines ( and then dry, stimulate, and provide ventilation as needed.

  • Manoj Suva added an answer:
    What dose of metformin do you use in women with PCOS (with and without prediabetes) who wish to conceive?
    What is your experience with efficacy of metformin in achieving ovulatory cycles?
    Manoj Suva

    Respected sir,

    If possible provide the reference for the myo inositol dosage for PCOS

  • Joshua Sumankuuro added an answer:
    Can anyone provide information on the current statistics for maternal mortality rate in Africa and Kenya?

    In line with achieving the MDG 5.

    Joshua Sumankuuro

    thisa link will also be useful to you:

  • Kuczyński Jarosław added an answer:
    What is the role of bearing microparticles of obstetric complications STBM in: preeclampsia, amniotic-fluid embolism, placental abruption?

    new experiences  .....cooperation.

    Kuczyński Jarosław

    STBM microparticles released from the maternal part of the bearing with the development of the fetus. In a normal pregnancy the placenta is the most-developed at 36-40 weeks. In addition, they circulate in the blood to the collapse of the spleen. In most of the microparticles is emerging STBM and pregnancy complicated: preeclamsia. In IUGR bearing is failing is probably STBM microparticle concentration in the blood is lower

  • Gerald Chinedu Nkwocha added an answer:
    How I can attain permission to use the labour agency scale (LAS) as soon as possible?

    This scale is used to describe the extent to which women feel in control during childbirth.

    Gerald Chinedu Nkwocha

    This scale is not yet in use in Nigeria. Could you please throw more light on its relevance either in research or enhancement in practice of Obstetrics

  • Alessandra Diehl added an answer:
    The abortion from a male Perspective?

    Someone could help with paper indication or reports of studies (prevalence and or qualitative) that had  evaluated somehow the abortion from a male perspective?

    Alessandra Diehl

    Thank you Dr. Emmanuel !

  • Forough Mortazavi added an answer:
    What are effects of early supplementation with formula or water based fluids on breastfeeding?

    Is there any reference indicate that the early supplementation may decrease milk production due to less frequent breastfeeding, developing breastfeeding difficulties, reduced maternal breastfeeding confidence, and perceived insufficient milk supply?

    Forough Mortazavi

    Thank you Genevieve

    I requested the full text.

  • Joan Rosen Bloch added an answer:
    Does anyone know the research gold standard of measuring telemere length to capture a biological measure of weathering in mothers?

    This is important to move forward health and social equity research.

    Joan Rosen Bloch


     Thank you very much for the information.


  • Elizabeth Mary Skinner added an answer:
    Does anyone have a good indicator scale or tool for PTSD?

    I am researching the psychological effects of birth trauma to women and an emerging theme of 40 interviews appears to be PTSD. However, it would be beneficial to examine the accuracy of this theme.

    Elizabeth Mary Skinner

    Dear Beatrice and Daniel

     Thank you so much for this great information - I will also  share this with Prof Hans Peter Dietz - the head of this research team re levator ani/ OASIS birth injuries.

  • Patricia D Ndhlovu added an answer:
    Should you treat Schistosomiasis during pregnancy?
    Schistosomiasis morbidity has been reported to be associated with adverse pregnancy outcomes like low birth weight, prenatal death and maternal death. The most implicating risk factor is anaemia. Recent studies have also stressed the poor immunogenicity of vaccine in neonates of untreated infected mothers and there have been reports on the occurrence of proinflammatory cytokines associated with Schistosoma fibrosis in neonates of infected mothers suggesting a possibility of congenital transmission and adverse effects in neonates. While the WHO has recommended the administration of praziquantel to infected mothers during pregnancy (though without many randomized control trials as at the time of the recommendation), recent evidences have however shown beneficial effects as regards non-treatment during pregnancy. In one study, the children of treated women were reported to show high prevalence of eczema! Furthermore, the most acclaimed risk factor of infection (anaemia) which is the major cause of LBW, prenatal death etc was reported not to be associated with schistosomiasis ruling out coinfection with hookworm and Plasmodium falciparum. Infact another observation showed no association between mother's infection and response to vaccination in children. I want your opinion in this regards as Schistosoma researcher. If you have done something related to this subject matter, I would love to know your findings.
    Patricia D Ndhlovu

    No you can not treat pregnant women with praziquantel.

  • Masako Fujita asked a question:
    Does anyone know the serum FOLR1 concentration equivalent to serum folate conc of 8 ug/L?

    We would like to determine the prevalence of folate deficiency in our serum samples using FOLR1 ELISA. We found the deficiency cutoff for serum folate, but no luck finding the one using FOLR1. Thank you!

    • [Show abstract] [Hide abstract]
      ABSTRACT: Folate-binding proteins of three major classes have been observed in various bodily fluids and in the plasma membrane and cytoplasm of normal and neoplastic cells. A major class, the high-affinity folate-binding proteins, show a preferential and tight binding of folic acid relative to reduced folates and methotrexate and consist of water-soluble and membrane-associated forms. Soluble forms of the high-affinity binders are present in serum and milk and in the growth medium of certain cultured cell lines, whereas membrane-associated forms are observed on the surface of various cells and tissues. The binders in serum have no clearly defined function, whereas the milk binders serve to accumulate and stabilize reduced-folate compounds in milk and they may also facilitate the absorption of folates by the intestinal mucosa of neonates. Membrane-bound forms of high-affinity folate-binding proteins mediate the transport of folate compounds across plasma membranes and appear to utilize endocytosis as the transport mechanism. Membrane-associated high-affinity binding proteins contain covalently bound phospholipids and hydrophobic C-terminal amino acid sequences that are absent in the soluble forms. The remaining protein portions of these binders show considerable sequence homology. The second class is composed of folate-binding proteins that reside solely in the plasma membrane and are structurally and mechanistically distinct from the high-affinity binders. These proteins function in transport, exhibit varied substrate specificities that accommodate reduced-folate compounds with equal or higher affinity than folate, and do not utilize endocytosis as the mechanism for substrate internalization. The third class of folate-binding proteins consists of enzymes that reside in the cytoplasm of cells.
      Annual Review of Nutrition 02/1990; 10(1):319-35. DOI:10.1146/
  • Zelalem Tafese Wondimagegne added an answer:
    Is there any association between incidence of eclamsia and the nutritional status and or the nutrient profile of a woman in developing countries?

    Eclamsia is a major cause of maternal mortality, morbidity and adverse fetal and neonatal outcome. There are research attempts to investigate the factors associated with eclamsia; but is there any recent finding that suggests the association of eclamsia with specific nutrient deficiency in developing countries.

    Zelalem Tafese Wondimagegne

    Thank you for all who respond to my question.

  • Kalkidan Hassen Abate added an answer:
    Does anyone know what the terms "redlive", "benworn" and 'dimifew" may have to do with maternal health or calcium supplementation?

    Working on a maternal health project

    Kalkidan Hassen Abate

    O' lord i barely speak English.

  • Christopher C Rout added an answer:
    Does anyone have experience with the assessment of maternal cardiac output?

    How can I manage a decrease of maternal CO during Cesarean section ?

    Christopher C Rout

     Can you provide a few more specifics? For example preoperative morbidity - has she valvular heart disease, a cardiomyopathy or what? Also, what sort of anaesthetic are you using and are you measuring cardiac output? What is causing the decrease in cardiac output?

    The simplistic (and not very helpful) answer to your question is to increase it. But depending on cause and amount by which the CO is decreased there are a number of possible options including nothing at all (i.e. watch and wait), but we need more details.

  • Arthur Fougner added an answer:
    What are the possible differential diagnostics for multilocular ovarian cyst with multifocal dermoid cysts?

    For a case of unilateral serous multilocular ovarian cyst with multifocal dermoid cysts incorporated in the wall of the cyst in a 29 years old female with 2 living children?

    what about differential diagnosis and possible ones ?

    Arthur Fougner

    Check out the lectures on - registration is free.

    These two would be a good start.


  • Jennifer L Barkin added an answer:
    Other than the Edinburgh Postnatal Depression Scale and PDSS, what other assessments measure postpartum risk?
    I am researching whether postpartum risk assessment scales are adequately measuring all risk variables that contribute to crimes of maternal infanticide.
    Jennifer L Barkin

    Sorry, this one  - the Barkin Index of Maternal Functioning

  • Clara Isaza added an answer:
    Would Histopaque 1077 interact with cell free DNA?

    We have plasma, that we kept from a previous experiment, that was obtained after separating blood using Histopaque 1077. Now we would like to use that plasma to extract cell free DNA. Would you expect to be able to recover cell free DNA from that plasma? Or would the histopaque 1077 interact with the cfDNA during the blood separation and possible deplete plasma of it?

    Clara Isaza

    Dear Dr. Mishra,

    Thank you very much for your answer.


  • Prabhat Chandra Mondal added an answer:
    How can severe postcesarean hypertension be managed?

    Severe hypertension 

    Prabhat Chandra Mondal

    Dear Sir,

           I am working in a warm country. It is my experience and observation that is very interesting. During winter season when suddenly temperature falls, we get more eclamptic mothers from rural area.  when there is heavy rainfall, we get more eclamptic mothers. There are some research articles describing this. This could be due to vasospasm  or water restriction.  In western country this has been explained as less sunlight exposure. 

About Maternal Health

Maternal health refers to the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality.

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