It has been three decades since this writer had a haunting conversation with a friend, and the words still echo: ‘Isn’t it a miracle to give birth to a physically normal, neurologically intact baby?’ Those words ignited a profound realization — one that underscores the critical importance of perinatal care in safeguarding both mother and newborn.
The journey towards safe motherhood and safe birth must confront the stark reality that congenital anomalies and neurological challenges in newborns are more prevalent than we care to acknowledge. While not much can be done for congenital anomalies, the neurological deficit could stem from inadequate antenatal and perinatal care — a sobering truth that demands our attention.
A collective responsibility
The future of our babies and our nation rests in the hands of stakeholders across perinatal care — from obstetricians and radiologists to fetal medicine specialists, neonatologists, and more. Even frontline workers such as Accredited Social Health Activist and Anganwadi workers play pivotal roles in ensuring proper antenatal care, underscoring the collective responsibility we bear.
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The adage, ‘Life begins before birth’, holds profound significance, reminding us that what we gather antenatally affects us until our final breath. Prematurity, low birth weight, growth restriction, and pre-eclampsia consequent to hypertensive disorders of pregnancy (HDP), are among the preventable conditions that contribute to maternal and neonatal morbidity and mortality on a global scale.
There are also long-term complications of HDP on the health of a mother and the baby. They are susceptible to adulthood hypertension, metabolic syndrome, heart disease, dyslipidemia, and stroke, adding significantly to the economic burden of the health-care system. Emerging evidence suggests that pre-eclampsia is associated with 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 the mother. A focus on postnatal cardiovascular assessment after delivery would go a long way to improve the cardiovascular and cerebrovascular health of the woman.
Nevertheless, it is unfortunate that post-partum maternal cardiovascular health after pre-eclampsia is a largely neglected area of research.
The data
In India, that accounts for nearly a quarter of the world’s adverse pregnancy outcomes, addressing these health concerns is not just a moral imperative but also an economic necessity. The National Family Health Survey (NFHS-5) statistics speak volumes: perinatal mortality rates stand at 32 for 1,000 pregnancies, neonatal mortality rates at 25 for 1,000 live births, and hypertensive disorders in pregnancy remain a leading cause of maternal death.
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As we commemorate May as “PE Prevention Month” (World PE Day is on May 22), let us prioritize proactive measures for safe motherhood and birth. Pre-eclampsia is a hypertensive disorder of pregnancy leading to multiorgan dysfunction in the mother. Besides high blood pressure, usually commencing after 20 weeks of gestation, these mothers could present with swelling of the face, hands, and feet, severe headaches, changes in vision, upper abdominal pain, and difficulty in breathing.
Implementing screening for conditions such as pre-eclampsia and fetal growth restriction in the first trimester, along with managing high-risk pregnancies according to established protocols, is paramount. Since pre-eclampsia is a systemic disorder, clinical criteria alone are inadequate to predict adverse outcomes. Therefore, combined screening by maternal history, demographics, color doppler ultrasound, mean arterial pressure, placental biomarkers, and timely pharmacological intervention for the high-risk cohort in the first trimester, play a crucial role in identifying and managing these high-risk pregnancies. The second and third-trimester screening for pre-eclampsia are useful for surveillance, early identification of pre-eclampsia, and establishing time of delivery.
Comprehensive care throughout all trimesters, with color Doppler ultrasound as the cornerstone, is essential to optimize maternal and fetal outcomes.
A programme in India
The need of the hour is to combat pre-eclampsia by spreading awareness about this serious hypertensive disorder of pregnancy, which is predictable and preventable. The Indian Radiological and Imaging Association (IRIA), through its flagship programme ‘Samrakshan’, has embarked on a mission to extend the reach of safe motherhood initiatives across all districts of India. With a pledge to reduce pre-eclampsia from 8%-10% to 3%, and fetal growth restriction from 25%-30% to 10% by the turn of the decade, IRIA Samrakshan exemplifies the dedication needed to address and mitigate the risks faced by pregnant women and newborns. In this endeavor, community engagement and sustained leadership are paramount.
Let us champion the cause of safe motherhood, ensuring that every woman has the opportunity to bring forth life with confidence and security. Dr. Kavita Aneja is a fetal radiologist at Naveda Healthcare, Rohini, Delhi, and a national core member of Samrakshan
