Spotlighting pre-eclampsia, ensuring safe motherhood

Relevance: GS Paper I

Why in news? 

There needs to be greater awareness of this serious hypertensive disorder of pregnancy i.e pre-eclampsia.

More about the news:  

• The journey towards ensuring safe motherhood and childbirth must confront the harsh reality that congenital abnormalities and neurological issues in infants are more prevalent than we often acknowledge. 
• While little can be done to prevent congenital anomalies, neurological impairments may result from insufficient antenatal and perinatal care, an undeniable truth that warrants our focused attention.

Pre-eclampsia: 

• Preeclampsia (PE) is a hypertensive disorder that usually begins after the 20th week of pregnancy, marked by increased blood pressure and the presence of protein (albumin) in the mother's urine. 
• The prevalence of PE during pregnancy varies from 5% to 15% in India, making it a significant contributor to maternal health complications. 
• Early-onset preeclampsia, occurring before 34 weeks of gestation, poses a heightened risk of severe illness and fetal mortality. 
• Apart from elevated blood pressure typically appearing after 20 weeks of gestation, affected mothers may experience symptoms like swelling in the face, hands, and feet, intense headaches, changes in vision, upper abdominal discomfort, and difficulty in breathing.

A collective responsibility:

• The future of both our infants and our nation lies in the hands of various stakeholders in perinatal care, ranging from obstetricians and radiologists to fetal medicine specialists, neonatologists, and beyond. Even frontline workers such as Accredited Social Health Activists and Anganwadi workers play crucial roles in ensuring proper antenatal care, highlighting the collective responsibility we all share.
• The saying, "Life begins before birth," carries profound meaning, reminding us that what we experience during the antenatal period impacts us throughout our lives. Prematurity, low birth weight, growth restriction, and pre-eclampsia resulting from hypertensive disorders of pregnancy (HDP) are among the preventable conditions that contribute to maternal and neonatal morbidity and mortality worldwide. Additionally, there are long-term implications of HDP on both maternal and infant health. 
• Individuals affected by these conditions are at heightened risk of developing adulthood hypertension, metabolic syndrome, heart disease, dyslipidemia, and stroke, significantly burdening healthcare systems economically. Recent research indicates that pre-eclampsia is linked to a four-fold increase in the risk of heart failure and a two-fold increase in the risk of coronary heart disease, stroke, and cardiovascular mortality for mothers.
• Prioritizing postnatal cardiovascular assessments following delivery could substantially enhance the cardiovascular and cerebrovascular health of women. However, it is regrettable that postpartum maternal cardiovascular health after pre-eclampsia remains a largely overlooked area of research.

The data

• In India, which accounts for nearly a quarter of the world's adverse pregnancy outcomes, addressing these health concerns is not only a moral obligation but also an economic imperative. The National Family Health Survey (NFHS-5) data paints a stark picture: perinatal mortality rates are at 32 per 1,000 pregnancies, neonatal mortality rates at 25 per 1,000 live births, and hypertensive disorders in pregnancy remain a leading cause of maternal mortality.
• As we observe May as "PE Prevention Month'' (World PE Day falls on May 22), let us prioritize proactive measures for ensuring safe motherhood and childbirth. It is crucial to implement screening for conditions like pre-eclampsia and fetal growth restriction in the first trimester and manage high-risk pregnancies according to established protocols. 
• Since pre-eclampsia is a systemic disorder, relying solely on clinical criteria is insufficient for predicting adverse outcomes. Therefore, comprehensive screening combining maternal history, demographics, color Doppler ultrasound, mean arterial pressure, placental biomarkers, and timely pharmacological interventions for high-risk cases in the first trimester are vital in identifying and managing such pregnancies.
• Screening in the second and third trimesters aids in surveillance, early pre-eclampsia detection, and determining the optimal time for delivery. Providing comprehensive care throughout all trimesters, with color Doppler ultrasound as a cornerstone, is essential for optimizing maternal and fetal outcomes.

A programme in India:

• The urgency lies in combatting pre-eclampsia by raising awareness about this serious pregnancy-related hypertensive disorder, which is both predictable and preventable. The Indian Radiological and Imaging Association (IRIA), through its flagship program "Samrakshan," has taken on the mission to expand the reach of safe motherhood initiatives across all districts of India. 
• With a commitment to reducing pre-eclampsia from 8%-10% to 3%, and fetal growth restriction from 25%-30% to 10% by the end of the decade, IRIA Samrakshan sets an example of the dedication required to address and mitigate the risks faced by pregnant women and newborns.

Conclusion:

In this effort, community engagement and sustained leadership are crucial. Let us advocate for the cause of safe motherhood, ensuring that every woman has the opportunity to embark on the journey of childbirth with confidence and security.