Dr Alokananda Ray
The World Health Day theme this year- Healthy beginnings, hopeful futures- comes with the promise of improving maternal and neonatal health, by effectively eliminating preventable maternal or neonatal sickness and death. This is an opportunity to draw attention of all health care facilities, the government and the general population to work collectively to improve the standard of maternal and newborn health care services, its infrastructure and most importantly its uniform accessibility to all segments of women and children across the world.
Over the last few years, several government policies and programmes such as, Pradhan Mantri Surakshit Matritva Abhiyan, Janani Suraksha Yojna and Janani Shishu Suraksha Karyakram, have gone a long way in steadily reducing the Maternal Mortality Ratio (MMR) of India to 97 per 1,00,000 live births, with some Indian states and provinces already achieving < 70 maternal deaths per 1,00,000 live births- which is the World Health Organization (WHO) Sustainable Development Goal (SDG) target for MMR by 2030.
We must understand that the key to successful pregnancy outcome is pre-conception counselling and care, in other words- all pregnancies should ideally be planned, with prior assessment of the women’s health and effective treatment of pre-existing illnesses like nutritional anaemia before pregnancy.
During pregnancy, the mother should visit the health care facility for antenatal care (ANC) with clinical examination and investigations as applicable. This should begin within the first three months of conceiving and continue at regular intervals throughout pregnancy. Nutrition is of paramount importance during pregnancy – it should meet the adequate calorie requirement with the correct amount of protein, carbohydrate and fat in a balanced diet, along with essential micro-nutrients-like vitamins and trace elements. Regular exercise and avoidance of substance abuse cannot be over-emphasised.
Supplementation with folic acid, Iron and calcium is a mandatory aspect of managing all pregnancies- as is the recommendation for vaccinations against infections like- tetanus, diphtheria, flu and whooping cough, which protects both the mother and the new-born baby. Regular ANC visits with health care providers enable detection of complications arising during pregnancy such as high blood pressure, diabetes, jaundice and other medical or obstetric conditions, which when detected in time and treated early can prevent adverse pregnancy outcomes.
Safe delivery and post-delivery care is the culmination of the beautiful journey of pregnancy leading to motherhood. In recent years, India has witnessed a remarkable increase in institutional delivery with medical attention during and post confinement. Access to an effective referral system from primary to secondary or tertiary care centres for high-risk pregnancies and for mothers with complications arising during and immediately after delivery goes a long way in preventing maternal morbidity and mortality. Post delivery, advice on follow up with health care providers, care of the newborn, breast feeding, nutrition, supplementation with iron and calcium, exercise to lose body weight gained during pregnancy and contraception for adequate spacing of childbirth, completes the circle of care.
Apart from the immediate pregnancy outcomes and effects on health of mother and newborn in pregnancy as enumerated above, in recent years, development of the baby in mother’s womb has been recognised as a critical period in the genesis of human diseases during childhood and later in adult life. This occurs when a hostile environment in the maternal womb (due to various maternal conditions) during the critical time of foetal organ development, interact with the genetic makeup of the foetus. As an adaptive measure to overcome the unfavourable intrauterine conditions, permanent alterations in some genes may occur in the foetus, leading to occurrence of diseases later in life such as skin allergy, asthma, eczema, increased risk to infections, obesity, diabetes, neuropsychiatric disorders, hypertension, heart disease, and cancer (especially blood, liver and testicular cancers). This concept is popularly known as foetal programming which suggests that maternal nutritional imbalance (both lack of or excessive nutrition) and metabolic disturbances especially maternal diabetes may have a permanent long-term effect on the health of the offspring with increased risk of diseases during childhood and later in adult life.
Maternal health during pregnancy is therefore a major public health issue, as it is not only important for immediate successful pregnancy outcome, but it is also significantly linked to prevention of several non-communicable diseases like obesity, diabetes and hypertension in adult life, which as of today, is the new global pandemic. Given this insight, we cannot agree more with the World Health Day theme – Healthy beginnings, hopeful futures.
References.
1) World Health Organization The global observatory SDG Target 3.1 Reduce the global maternal mortality ratio to less than 70 per 100 000 live births by 2030.
2) Saving Mothers, Strengthening Futures: India’s success in Reducing Maternal Mortality- Ministry of Health and Family welfare March 21 2025.
3) Aleksandra Marciniak, Jolanta Patro-Małysza, Zaneta Kimber-Trojnar etal: Fetal programming of the metabolic syndrome; Taiwanese Journal of Obstetrics & Gynecology 56 (2017) 133-138
(Author is Head Consultant and HOD Obs & Gynae, Tata Main Hospital)
