Academic journal article Journal of Health Population and Nutrition

Association of Postpartum Maternal Morbidities with Children's Mental, Psychomotor and Language Development in Rural Bangladesh

Academic journal article Journal of Health Population and Nutrition

Association of Postpartum Maternal Morbidities with Children's Mental, Psychomotor and Language Development in Rural Bangladesh

Article excerpt

INTRODUCTION

Growth, development, and behaviour of children and, thus, overall future national productivity depend on several biological, psychosocial and economic factors, most of which are closely interrelated (1). For example, pre- and postnatal conditions and exposures of both mother and child to biological and environmental risks, influence children's development (2). More specifically, intrauterine growth retardation (IUGR) and preterm birth, which are the major determinants of neonatal mortality and morbidity, have long-term adverse consequences for health (3-5) and development of children (2). Morbidities in children associated with preterm birth and IUGR often extend to the later life, resulting in enormous physical, psychological and economic costs (6-9). Less is known, however, of the effect of maternal morbidities suffered by women in the postpartum period that could affect child development. These morbidities could be a result of intrapartum morbidities or of management at birth.

Morbidities in women before and during birth have been relatively well-documented. A systematic review of maternal morbidities suffered in pregnancy or at childbirth in reports from different countries published during 1997-2002 (10) showed that, hypertensive disorders of pregnancy (14.9%) were most frequently documented while other morbidities included haemorrhage (6.2%), premature rupture of the membrane (2.4%), perineal laceration (2.3%), and obstructed labour (1.7%). Most common outcomes relating to infants noted at birth included stillbirth (13.9%) and preterm delivery (8.2%). In Bangladesh, commonly-reported maternal morbidities during pregnancy and delivery include oedema, anaemia, proteinuria, high blood pressure, pre-eclampsia, premature rupture of the membrane, and bleeding (11). In this series, we report that about 10% of all women giving birth suffered from severe or less-severe maternal complications at birth (12)--primarily dystocia, haemorrhage, or pre-eclampsia/eclampsia. Those with severe complications experience a higher rate of perinatal deaths. Morbidities suffered in the postpartum period are far less studied. Ferdous et al. (13) reported in this special issue that moderate anaemia was one of the major outcomes for women who had suffered from an acute morbidity during delivery; other postpartum problems, e.g. prolapse, hernias, and haemorrhoids, were mostly mild (13).

The relationship of any of the maternal morbidities, originating either during the intrapartum or postpartum period, with development of children in Bangladesh is still unknown. It is known from an earlier study in the same area--Matlab--that women aged [less than or equal to] 18 years, those with poor obstetric history, undernutrition, pre-eclampsia, and jaundice, had a much higher risk of perinatal death (14). The fate of the surviving babies of these women was not reported; however, it can be hypothesized that they had a higher risk of developmental problems.

The few published papers relating to maternal illnesses and children's cognitive function are based on facility-based data and are primarily focused on morbidities in pregnancy or during the intra-partum period. Examples include newborn infants of diabetic mothers demonstrating subtle evidence of impairments in recognition memory (15) and children of epileptic mothers showing minor and major congenital anomalies (16). Undernourished mothers are at a risk of delivering infants with low birthweight (3), who suffer from several physical, economic and intellectual consequences later in life (8,9). At the same time, iron deficiency during pregnancy diminishes iron stores in the foetus (17) and is a risk factor for infant's anaemia (18), which, in turn, leads to poorer development of infants and children (9,19). Moreover, mothers with iron-deficiency anaemia during pregnancy had poorer interactions with their children (20). In addition, maternal depression and dissatisfaction with life suffered after delivery are associated with poorer development and behaviour of children (21). …

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