According to the World Health Organization (WHO), global maternal mortality decreased by 44% from 1990 to 2015.
Most improvements have been focused on the most common and direct causes of maternal death, which include obstetric complications like abortion or obstructed delivery.
However, indirect causes like non-communicable diseases (NCDs) and related risk factors were given lesser attention.
In fact, almost 15% of maternal deaths were caused by pre-existing medical conditions, including NCDs, according to a WHO analysis in 2014.
NCDs, also referred to as chronic diseases, develop over a long time and are caused by a combination of genetic, physiological, environmental and behavioural factors.
NCDs like diabetes, anaemia and heart diseases, can have serious and fatal effects on pregnancy.
Metabolic risk factors for NCDs like obesity, high blood glucose and hypertension can also lead to complications in both mother and baby.
Pregnant women with NCDs have to properly manage their conditions to ensure safe delivery.
Diabetes, including gestational diabetes that only occurs during pregnancy, is a common NCD among Malaysians in general, and pregnant women in particular.
These are the common complications that can arise if the pregnant woman has diabetes, or develops gestational diabetes:
• Mother: Pre-eclampsia, stillbirth and caesarean delivery.
• Infant: Preterm birth, birth trauma, respiratory distress syndrome, hypoglycaemia, congenital malformation and large for gestational age.
• Both (in the long term): Obesity, type 2 diabetes and other metabolic syndromes.
Meanwhile, if the mother is obese or gains excessive weight while pregnant, these are the possible complications that may occur:
• Mother: Gestational diabetes, pre-eclampsia, stillbirth, haemorrhage or bleeding, infection, and caesarean or instrumental delivery.
• Infant: Large for gestational age, congenital malformation, obesity and preterm birth.
Other NCDs also lead to various related complications during pregnancy. In fact, cardiac disease is the leading cause of maternal death during pregnancy in many developed countries.
Women with pre-existing heart disease are exposed to both obstetric and cardiac complications if they become pregnant, and may be advised against pregnancy.
Meanwhile, high blood pressure during pregnancy poses various risks, such as decreased blood flow to the placenta, placental abruption, intrauterine growth restriction and future cardiovascular disease in the mother.
Mild anaemia is common in pregnancy, but if severe or untreated, can lead to complications like preterm birth, low-weight baby, postpartum depression and offspring with anaemia.
Keeping a close watch
It is clear that pregnancy with NCDs is a serious health risk to mothers and their babies.
Proper management of NCDs, as well as preventive measures are important during pregnancy.
Women with NCDs have to undergo pre-conception counselling with their obstetrician when planning for pregnancy, in order to understand the risks they are taking.
If they are getting pregnant, proper and timely antenatal and postpartum care is vital to keep track of their health status.
In addition, universal screening for NCDs in pregnant women should be recommended, as many are unaware that they suffer from NCDs. This is necessary for early detection and management of NCDs.
Medications may be prescribed to pregnant women with NCDs. For example, anaemia is usually caused by a low level of iron, folate or vitamin B12 in blood, and can be treated by taking supplements or foods rich with these micronutrients.
Other than that, treatment with insulin therapy or oral antidiabetic agents is vital for diabetic pregnant women.
Women with pre-existing NCDs may be advised by doctors to change their medications when getting pregnant, as some drugs can be harmful to the baby.
Weight gain during pregnancy should also be monitored following the recommended guidelines, especially by obese or underweight mothers.
Of course, the ideal management for NCDs is prevention; it is never too late to start practising a healthy diet together with a physically active lifestyle.
Nevertheless, there is a changing trend in maternal illness and death as more women of reproductive age are being affected by NCDs.
The approach in maternal healthcare has to be realigned to address this concern.