Human breast milk

From Wikipedia, the free encyclopedia

Two 25ml samples of human breast milk. The left hand sample is foremilk, the watery milk coming from a full breast. The right hand sample is hindmilk, the creamy milk coming from a nearly empty breast.
[1]

Breast milk, more specifically human milk, is the milk produced by the breasts (or mammary glands) of a human female for her infant offspring. Milk is the primary source of nutrition for newborns before they are able to eat and digest other foods; older infants and toddlers may continue to be breastfed, either exclusively or in combination with other foods. The baby nursing from its own mother is the most ordinary way of obtaining breastmilk, but the milk can be pumped and then fed by baby bottle, cup and/or spoon, supplementation drip system, and nasogastric tube. Breastmilk can be supplied by a woman other than the baby's mother; either via donated pumped milk (for example from a milk bank), or when a woman nurses a child other than her own at her breastan ancient and storied practice known as wetnursing. The World Health Organization recommends exclusive breastfeeding for the first six months of life, with solids gradually being introduced around this age when signs of readiness are shown. Supplemented breastfeeding is recommended until at least age two and then for as long as mutually desired by mother and child wish. Breastfeeding continues to offer health benefits into and after toddlerhood. of Sudden Infant Death Syndrome (SIDS),
[4] [3] [2]

These benefits include; lowered risk , decreased likelihood of contracting

increased intelligence

[citation needed]

middle ear infections, cold, and flu bugs, a tiny decrease in the risk of childhood leukemia, lower risk of childhood onset diabetes, decreased risk of asthma and eczema, decreased dental problems, decreased risk of obesity later in life, and decreased risk of developing psychological disorders.
[5][6][dubious discuss]

Breastfeeding also provides health benefits for the mother. It assists the uterus in returning to its pre-pregnancy size and reduces post-partum bleeding, as well as assisting the mother in returning to her pre-pregnancy weight. Breastfeeding also reduces the risk of breast cancer later in life.
[7]

Contents
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1 Production 2 Composition 3 Storage of expressed breast milk 4 Comparison to other milks 5 Alternative uses for breast milk 6 Passing of unwanted substances o 6.1 Environmental pollutants

7 Extraordinary consumption 8 See also 9 References 10 External links

Production
Under the influence of the hormones prolactin and oxytocin, women produce milk after childbirth to feed the baby. The initial milk produced is often referred to as colostrum, which is high in theimmunoglobulin IgA, which coats the gastrointestinal tract. This helps to protect the newborn until its own immune system is functioning properly, and creates a mild laxative effect, expelling meconiumand helping to prevent the build up of bilirubin (a contributory factor in jaundice). Actual inability to produce enough milk is rare, with studies showing that mothers from developing countries who are experiencing nutritional hardship still produce similar amounts of milk of similar quality to mothers in developed countries.
[8]

There are many reasons a mother may not produce enough breast milk. Some of the most common are

an improper latch (i.e. the baby does not connect efficiently with the nipple), not nursing or pumping enough to meet supply, certain medications (including estrogen-containing hormonal contraceptives), illness, and dehydration. A rarer reason isSheehan's syndrome, also known as postpartum hypopituitarism, which is associated with prolactin deficiency; this syndrome may require hormone replacement. The amount of milk produced depends on how often the mother is nursing and/or pumping; the more the mother nurses her baby, or pumps, the more milk is produced.
[9][10][11][12][13]

It is very helpful to nurse on demand - to nurse

when the baby wants to nurse rather than on a schedule. If pumping, it is helpful to have an electric high grade pump so that all of the milk ducts are stimulated. Some mothers try to increase their milk supply in other ways - by taking the herb fenugreek, used for hundreds of years to increase supply
[14]

("Mother's Milk" teas contain fenugreek as well

as other supply-increasing herbs); there are also prescription medications that can be used, such as Domperidone (off-label use) and Reglan.
[citation needed]

Increasers of milk supply are known as galactagogues.

Composition
Composition of human breast milk[15] Fat total (g/100 ml) fatty acids - length 8C (% ) polyunsaturated fatty acids (%) Protein (g/100 ml) total casein 0.4 a-lactalbumin lactoferrin IgA IgG lysozyme serum albumin -lactoglobulin Carbohydrate (g/100 ml) lactose oligosaccharides Minerals (g/100 ml) 7 0.5 1.1 0.3 0.3 0.2 0.1 0.001 0.05 0.05 4.2 trace 14

calcium phosphorus sodium potassium chlorine

0.03 0.014 0.015 0.055 0.043

The exact integrated properties of breast milk are not entirely understood, but the nutrient content after this period
[citation needed]

is relatively consistent and draws its ingredients from the mother's food supply. If that supply is

found lacking, content is obtained from the mother's bodily stores. The exact composition of breast milk varies from day to day, depending on food consumption and environment, meaning that the ratio of water to fat fluctuates. During the first few days after delivery, the breasts produce colostrum. This is a thin yellowish fluid that is the same fluid that leaks from the breasts during pregnancy. It is rich in protein and antibodies that provide passive immunity to the baby (the baby's immune system is not fully developed at birth). Colostrum also helps the newborn's digestive system to grow and function properly. After 3 to 4 days, breasts will begin producing milk that is thin, watery, and sweet. This quenches the baby's thirst and provides the proteins, sugar, and minerals that the baby needs. Over time, the milk changes and becomes thick and creamy. This satisfies the baby's hunger.
[16]

Foremilk, the milk released at the beginning of a feed, is watery, low in fat, and high in carbohydrates relative to the creamier hindmilk, which is released as the feed progresses. The breast can never be truly "emptied," since milk production is a continuous biological process. The level of Immunoglobilin A (IgA) in breast milk remains high from day 10 until at least 7.5 months post-partum. Human milk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates, and 0.2% ash (minerals).
[18] [17]

Carbohydrates are mainly lactose; several lactose-based oligosaccharides have been identified as

minor components. The fat fraction contains specific triglycerides of palmitic and oleic acid (O-P-O triglycerides), and also quite a large quantity of lipids with trans bonds (see: trans fat) that are considered to have a health benefit. They are vaccenic acid, andConjugated linoleic acid (CLA) accounting for up to 6% of the human milk fat.
[19][20]

The principal proteins are casein (homologous to bovine beta-casein), alpha-lactalbumin, lactoferrin, IgA, lysozyme, and serum albumin. In an acidic environment such as the stomach, alpha-lactalbumin unfolds into a different form and binds oleic acid to form a complex called HAMLET that kills tumor cells. This is thought to contribute to the protection of breastfed babies against cancer.
[21]

Non-protein nitrogen-containing compounds, making up 25% of the milk's nitrogen, include urea, uric acid, creatine, creatinine, amino acids, andnucleotides.
[22][23]

Breast milk has circadian variations; some of the

[24]

nucleotides are more commonly produced during the night, others during the day.

Mother's milk has been shown to supply a type of endocannabinoid (the natural neurotransmitters that marijuana simulates), 2-Arachidonoyl glycerol.
[25]

Though it now is almost universally prescribed, in some countries in the 1950s the practice of breastfeeding went through a period where it was out of vogue and the use of infant formula was considered superior to breast milk. However, it is now universally recognized that there is no commercial formula that can equal breast milk. In addition to the appropriate amounts of carbohydrate, protein, and fat, breast milk provides vitamins, minerals, digestive enzymes, and hormones - all of the things that a growing infant will require. Breast milk also contains antibodies and lymphocytes from the mother that help the baby resist infections. The immune function of breast milk is individualized, as the mother, through her touching and taking care of the baby, comes into contact with pathogens that colonize the baby, and, as a consequence, her body makes the appropriate antibodies and immune cells. This is the reason why breast milk contains very little iron, as iron is an essential precursor to the activation of micro-bacteria and gut flora; providing iron in the milk would lead to infection. However, the internal iron supplies of the infant, held in the hepatic cells of the liver, are exhausted at 46 months, hence this is the time that complimentary feeding is introduced, as to prevent anaemia (recommended by WHO). Women breastfeeding should consult with their physician regarding substances that can be unwittingly passed to the infant via breast milk, such as alcohol, viruses (HIV or HTLV-1) or medications. Most women that do not breastfeed use infant formula, but breast milk donated by volunteers to human milk banks can be obtained by prescription in some countries.
[26]

Storage of expressed breast milk

Expressed breast milk can be stored for later use. It is recommended that the milk is stored in hard-sided containers with airtight seals. Some plastic bags specifically manufactured for the storage of expressed breast milk are designed for storage periods of less than 72 hours - others can be used for up to 6 months if frozen. it can be safely stored for use by infants in a home-based situation is given in this table.
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The amount of time that

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Place of storage

Temperature Maximum storage time

In a room

25C

77F Six to eight hours

Insulated thermal bag with ice packs

Up to 24 hours

In a refrigerator

4C

39F Up to five days

Freezer compartment inside a refrigerator

-15C 5F

Two weeks

A combined refrigerator and freezer with separate doors -18C 0F

Three to six months

Chest or upright manual defrost deep freezer

-20C -4F

Six to twelve months

Comparison to other milks

All mammal species produce milk, but the composition of milk for each species varies widely and other kinds of milk are often very different from human breast milk. As a rule, the milk of mammals that nurse frequently (including human babies) is less rich, or more watery, than the milk of mammals whose young nurse less often. Human milk is noticeably thinner and sweeter than cow's milk. Whole cow's milk does not contain sufficient vitamin E, iron, or essential fatty acids, which can make infants fed on cow's milk anemic. Whole cow's milk also contains excessive amounts of protein,sodium, and potassium, which may put a strain on an infant's immature kidneys. In addition, the proteins and fats in whole cow's milk are more difficult for an infant to digest and absorb than the ones in breast milk.
[29]

Evaporated milk may be easier to digest due to the

processing of the protein but is still nutritionally inadequate. A significant minority of infants are allergic to one or more of the constituents of cow's milk, most often the cow's milk proteins. formulas derived from cow's milk.
[30]

These problems can also affect infant

Alternative uses for breast milk

Assertions that breast milk consumption is of benefit to adult humans are questionable because many of its components undergo digestion in the adult stomach, including antibodies and other proteins.
[citation needed]

In addition to providing essential nourishment to infants, human milk; i.e., breast milk, has a number of valuable uses, especially medicinal uses, for both children and adults. It has been used medicinally for thousands of years.
[31]

The antibacterial and healing properties

[32]

[citation needed]

of breast milk are often overlooked, even by the nursing

mothers themselves.

Breast milk contains strongantibodies and antitoxins that many people believe promote

healing and better overall health. However, breast milk lacks sterile and antiseptic properties if a nursing mother is infected with certaincommunicable diseases, such as HIV and various bacterial infections like Group B streptococcus, as breast milk can transmit such diseases to infants and other people.
[33]

Breast milk has been used as a home remedy for minor ailments, such as conjunctivitis, insect bites and stings, contact dermatitis, and infected wounds, burns, and abrasions. Breast milk has also been used alternatively to

boost the immune system of ill persons having viral gastroenteritis, influenza, the common cold, pneumonia, etc., because of its immunologic properties. However, breast milk should never be seen or construed as a "cure-all". Some medical experts are convinced that breast milk can induce apoptosis in some types of cancer cells. However, more research and evidence are needed in this area of cancer treatment.
[34]

A minority of people, including restaurateur Hans Lochen of Switzerland and restaurateur Daniel Angerer of Austria, who operates a restaurant in New York City, have used human breast milk, or at least advocated its use, as a substitute for cow's milk in dairy products and food recipes.
[35][36]

Tammy Frissell-Deppe, a family counselor

specialized in attachment parenting, published a book, titledA Breastfeeding Mother's Secret Recipes, providing a lengthy compilation of detailed food and beverage recipes containing human breast milk.
[37]

The animal

rights organization known as PETA ignited a firestorm of criticism when it urged a dairy company to replace the cow's milk they use in their ice cream products with human breast milk as a way to stop cattle abuse.
[38][39]

Human breast

milk is not produced or distributed industrially or commercially, because the use of human breast milk as an adult food is considered unusual to the majority of civilized cultures around the world, and most disapprove of such a practice.
[40]

Attempts to formulate soap from breast milk have also been made, and those using it claim that its effectiveness as a cleanser is greater than, or equal to, that of traditional soaps.
[41]

Human breast milk is also a natural sexual lubricant, similar to those sold under the KY brand name.

[36]

Passing of unwanted substances

Despite the risk of substances transmitting from the mother to the child through breast milk, breastfeeding has far more advantages than infant formulas, and, with few exceptions, the WHO recommends exclusive breastfeeding for the first 6 months of life.
[42]

The milk-producing cells are most permeable to drugs during the first postpartum week. Drug characteristics that increase excretion in milk include:
[43]

[43]

1. Not plasma protein binding 2. Non-ionized 3. Low molecular weight 4. Lipid solubility rather than water solubility 5. Weakly alkaline rather than weak acid Drugs are transferred from blood plasma across ductal cells to the milk by diffusion or active transport. The latter may result in higher concentration of the drug in the breast milk than in the plasma of the mother. The amounts of most drugs in milk do not exceed 2% of the total ingested dose.
[43] [43]

Environmental pollutants
Environmental pollutants found in breast milk are usually not harmful, and should be considered only when environmental levels are unusually high. In addition, there has been a decrease in environmental levels, also resulting in a decrease breast-milk levels. Pollutants that are of most concern are pesticides, organic mercury, and lead. DDT and dieldrin are unavoidable, and can also be detected in infant formulas.
[44]

Pesticides and other toxic

substances bioaccumulate; i.e., creatures higher up the food chain will store more of them in their body fat. This is an issue in particular for theInuit, whose traditional diet is predominantly meat. Studies are looking at the effects of polychlorinated biphenyls and persistent organic pollutants in the body; the breast milk of Inuit mothers is extraordinarily high in toxic compounds.
[45]

Extraordinary consumption
Spanish king Alfonso XIII visited the region of Las Hurdes in 1922 in order to display the concern of the crown. The king and his retinue lived in military tents planted near the town of Casares de las Hurdes. During the king's visit, a strange incident took place: A local village chief, concerned that the king was drinking only black coffee (a consequence of the king's aides distrusting the quality of the local milk owing to unsanitary conditions in the area), served the king a small jug of milk saying, "Your Majesty rest assured that this milk is totally trustworthy,"
[46]

which

turned out to be breast milk from his wife who had recently given birth. The king became aware of this fact only after having had his caf con leche.
[47]

Preliminary research indicates that breast milk can induce apoptosis in some types of cancer cells.

[34]

Adults with GI

disorders and organ donation recipients can also benefit from the immunologic powers of human breast milk. In Costa Rica, there have been trials to produce cheese and custard from human milk as an alternative to weaning. A controversial Swiss restaurateur has created a menu based around foods cooked in human breast milk.
[49] [48]

An Icecreamists in London's Covent Garden started selling an ice cream named Baby Gaga in February 2011. Each serving costs 14. All the milk was donated by Mrs Hiley who earns 15 for every 10 ounces and calls it a "great recession beater".
[50]

The ice cream sold out on its first day. Despite the success of the new flavour, the Westminster

Council officers removed the product from the menu to make sure that it was, as they said, "fit for human consumption", disregarding the obvious fact that breast milk is fit for, at least, human baby consumption.
[51]

Natural family planning (NFP) is a term referring to the family planning methods approved by the Roman Catholic Church. In accordance with the Church's requirements for sexual behavior in keeping with its philosophy of the dignity of the human person, NFP excludes the use of other methods of birth control. Periodic abstinence and the natural infertility caused by breastfeeding are the only methods deemed moral by the Church for avoiding pregnancy. When used to avoid pregnancy, NFP

limits sexual intercourse to naturally infertile periods: portions of the menstrual cycle, during pregnancy, or after menopause. Various methods may be used to identify whether a woman is likely to be fertile; this information may be used in attempts to either avoid or achieve pregnancy. Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. In a precursory study into the link between nutrition and pregnancy in 1950 women who consumed minimal amounts over the eight week period had a higher mortality or disorder rate concerning their offspring than women who ate regularly, because children born to well-fed mothers had less restriction within the womb.[1] Not only have physical disorders been linked with poor nutrition before and during pregnancy, but neurological disorders and handicaps are a risk that is run by mothers who are malnourished, a condition which can also lead to the child becoming more susceptible to later degenerative disease(s).[2] The following sections refer to the pertinence of nutrition throughout pregnancy, and are thoroughly researched enough to be usable for mothers or couples planning on conceiving.

Potentially harmful pre-pregnancy determinants

It is known that good nutrition before pregnancy is important because of the amount of "resources" childbirth requires. The process of pre-pregnancy nutrition is a process of "building up" the immune system in preparation of pregnancy, and is known as being one of the major factors in determining the success rate of conceiving healthy children. There are foods that may decrease your fertility such as high mercury fish, foods that contain trans fat, and consuming too much caffeine. High levels of mercury in the body can cause challenges with fertility and it can be harmful to the developing fetus. Some high mercury fish to avoid may include swordfish, mackerel, and shark. Trans fat can also be very harmful to fertility. The more trans fat in a woman's diet, the higher her chances of developing ovulatory infertility. Trans fats are found in processed and fried foods that include packaged foods, french fries, donuts, and margarine. Too much caffeine, such as three or more cups a day, can lower fertility and increase the rate of miscarriage.[3] As with most situations, the most important factor in pre-pregnancy nutrition is ensuring that the mother is healthy and without any major factors which could worsen the chances of conceiving, factors such as anorexia or bulimia are thought to be direct links with infertility; the minimum body mass index for conceiving mothers being 20.8. Gaining weight restores fertility

and a body fat content of at least 22% is necessary for normal ovulatory function and menstruation.[4] This is also seen to be true with obese women with a BMI above 30 which is a direct result of decrementing amounts of insulin activity and sex hormones may reduce the viability of the ovum. If a woman wishing to conceive needs to gain or lose weight, it is recommended that you do so gradually, changing no more than 1 to 2 lbs/week.[5] The ideal range of weight for women wishing to conceive children is thought to be optimal at body mass indexes between 20 and 26. If this, again, is used in conjunction with good nutrition and diet before pregnancy in terms of a normal balanced diet, then reserves of micronutrients, providing materials for pregnancy, would also be maximised.[2] For more information on how BMI is calculated, please refer to the body mass index article.

Beneficial pre-pregnancy nutrients

As with most diets, there are chances of over-supplementing, however, as general advice, both state and medical recommendations are that mothers follow instructions listed on particular vitamin packaging as to the correct or recommended daily allowance (RDA).

Magnesium and zinc supplementation for the binding of hormones at their receptor sites. Folic acid supplementation, or dietary requirement of foods containing it for the regular growth of the follicle. Regular Vitamin D supplementation decreases the chances of deficiencies in adolescence. More importantly, it is known to reduce the likelihood of rickets with pelvic malformations which make normal delivery impossible.

Regular Vitamin B12 supplementation, again is known to reduce the chances of infertility and ill health. Omega-3 fatty acids can increase blood flow to reproductive organs and may help regulate reproductive hormones.[3] Consumption is also known to help prevent premature delivery and low birth weight.[4] The best dietary source of omega-3 fatty acids is oily fish. Some other omega-3 fatty acids not found in fish can be found in foods such as flaxseeds, walnuts, pumpkin seeds, and enriched eggs.[3]

Nutrition during pregnancy

The conception and the subsequent weeks afterwards is the time when it is at its most vulnerable, as it is the time when the organs and systems develop within. The energy used

to create these systems comes from the energy and nutrients in the mother's circulation, and around the lining of the womb, such is the reason why correct nutrient intake during pregnancy is so important. During the early stages of pregnancy, the placenta is not formed yet, so there is no mechanism to protect the embryo from the deficiencies which may be inherent in the mother's circulation, so it is critical that the correct amount of nutrients and energy are consumed. Supplement your diet with foods that are rich in folic acid, like orange and dark green leafy vegetables to prevent neural tube birth defects in your baby. Taking iron-rich foods like lean red meat and beans helps to prevent anemia and ensure adequate oxygen for your baby.[6]

Potentially harmful determinants during pregnancy

It is advised for pregnant women to pay special attention to food hygiene during pregnancy in addition to avoiding certain foods in order to reduce the risk of exposure to substances that may be harmful to the developing fetus. This can include food pathogens and toxic food components, alcohol, and dietary supplements such as vitamin A.[4] Dietary vitamin A is obtained in two forms which contain the preformed vitamin (retinol), that can be found in some animal products such as liver and fish liver oils, and as a vitamin A precursor in the form of carotenes, which can be found in many fruits and vegetables.[4] Intake of retinol, in extreme cases, has been linked to birth defects and abnormalities. However, regular intake of retinol is not seen as dangerous. It is noted that a 100 g serving of liver may contain a large amount of retinol, so it is best that it is not eaten daily during pregnancy, something which is also the same with alcohol intake in binge drinking. Excessive amounts of alcohol have been proven to cause Fetal alcohol syndrome. The World Health Organization recommends that alcohol should be avoided entirely during pregnancy, given the relatively unknown effects of even small amounts of alcohol during pregnancy.[7] Pregnant women are advised to pay particular attention to food hygiene and to avoid certain foods during pregnancy in order to minimize the risk of food poisoning from potentially harmful pathogens such as listeria, taxoplasmosis, and salmonella. Pregnant women are therefore advised to avoid foods in which high levels of the bacteria have been found, such as in soft cheeses. Listeria are destroyed by heat and therefore pregnant women are advised to reheat ready-prepared meals thoroughly. Pregnant women should also wash their fruit and vegetables very thoroughly in order to minimize risk. Salmonella poisoning is

most likely to come from raw eggs or undercooked poultry.[4] Maternal obesity has a significant impact on maternal metabolism and offspring development.[8]Insulin resistance, glucose homeostasis, fat oxidation and amino acid synthesis are all disrupted by maternal obesity and contribute to adverse outcomes.[8] Modification of lifestyle is an effective intervention strategy for improvement of maternal metabolism and the prevention of adverse outcomes.[8]

Recommended nutrients during pregnancy

Nutrient Recommendation (Extra = Above RDA) Increase by 200 kcal (840 kJ) per day in last trimester only. Extra 6 g per day Increase in line with energy; increase by 0.1 mg per day Needed for tissue growth; extra 0.3 mg per day Regular supplementation/diet of substance. No increase required. Maintain plasma levels; extra 100 g per day Replenish drained maternal stores; extra 120 mg per day Replenish plasma levels of vitamin 10 g per day. Needs no increase Extra 3 mg per day needed Normal supplementation or consumption. Maximum/Total amount RDA 51 g per day 0.9 mg per day 1.4 mg per day RDA 300 g per day 50 mg per day RDA RDA RDA RDA 250 g per day[9][10][11][12]

Energy Proteins Thiamin Riboflavin Niacin Folate Vitamin C Vitamin D Calcium Iron Magnesium, zinc, and copper Iodine

Extra 100 g per day.

Folate
Folic acid, which is the synthetic form of the vitamin folate, is extremely critical both in preand peri-conception.[4] Deficiencies in folic acid may cause neural tube defects; women who had 4 mg of folic acid in their systems due to supplementing 3 months before childbirth significantly reduced the risk of NTD within the fetus. This is now advocated by the UK department of health, recommending 400 g per day of folic acid. The development of every human cell is dependent on an adequate supply of folic acid. Folic acid governs the synthesis of the precursors of DNA, which is the nucleic acid that gives each cell life and character. Folic acid deficiency results in defective cellular growth and the effects are most obvious on those tissues which grow most rapidly.[13] Folate and Acute Lymphoblastic Leukemia Along with neural tube development, folate affects DNA synthesis in multiple ways. As Ball explains, folate is involved in the construction of purines and pyrimidines, the building blocks of nucleic acids.[14] Folate is also necessary to make s-adenosylmethionine (SAM), which acts as a methyl donor in the synthesis of DNA.[14] Because of its role in these important mechanisms, fetal DNA would be significantly altered if a maternal folate deficiency is present. One possible outcome is DNA mutation, which could prevent normal gene expression. For example, a tumor-suppressing gene might be turned off, altering normal immune function in preventing cancer growth.[14] Thompson et al.[15] examined the relationship between maternal supplementation of folate and iron during pregnancy and incidences of acute lymphoblastic leukemia (ALL) in their children. Increased rates of ALL were found in children whose mothers did not take iron and folate supplements. Iron alone did not seem to reduce the risk of developing ALL, however iron in combination with folate was shown to have a protective effect in decreasing the risk for ALL. Thompson and his associates (2001), concluded that maternal folate supplementation throughout pregnancy plays an important role in reducing the risk for childhood ALL.[15]

Nutrition after pregnancy

Proper nutrition is important after delivery to help the mother recover, and to provide enough food energy and nutrients for a woman to breastfeed her child. Women having serum ferritin <= 70 g/L may need iron supplements to prevent iron deficiency anaemia during pregnancy and postpartum.[16][17]

Danger Signs in Pregnancy Symptom Vaginal Bleeding Pelvic or Abdominal Pain Persistent Back Pain Gush of Fluid from Vagina Potential Problem Miscarriage, placental abruption, placenta previa Miscarriage, ectopic pregnancy, abruption Miscarriage, preterm labor Preterm labor, preterm rupture of membranes, miscarriage Pregnancy Induced Hypertension (PIH) PIH, Ecclampsia Other possible causes Hormonal bleeding, Implantation bleeding Cyst, uterine growth, ligament pain Kidney/bladder infection, cyst, normal pregnancy pain Leaky bladder, watery mucous Swelling

Swelling of the Hands/Face Severe Headaches, Blurry Vision Regular Contractions prior to Preterm labor 37 Weeks No Fetal Movement Fetal distress, Fetal Demise Other Resources

Gastric upset Slowed movements, anterior placenta