The increasing number of morbidities among women in the reproductive age group and the drastic changes in the clinical profile of new mothers in Kerala over the past few years have been generating much concern among public health experts, as poor maternal health has a direct bearing on the State’s maternal and neonatal mortality rates.
Maternal health is the cornerstone of various health indicators. Given the increasing burden of lifestyle diseases such as obesity, diabetes and hypertensive disorders among the new mothers, a lot many pregnancies these days are turning out to be high-risk or complicated cases, with adverse consequences for both mothers and babies.
At SAT Hospital, a tertiary-care maternity centre here, which handles 800 to 900 deliveries a month, 35-40 per cent of the cases come under the category of high-risk pregnancies. About 30 per cent of the babies born here are in the high-risk category with congenital complications. About 22 per cent are pre-term babies and almost 20 per cent have low birth weight.
“These days, I hardly see mothers who do not have either gestational diabetes or hypertensive disorders. Earlier, we were dealing with pregnant women with rheumatic heart diseases only. But now the heart diseases we see are varied and highly complicated and there is a spate of renal diseases and autoimmune thyroid conditions among women,” K.E. Elizabeth, Superintendent of SAT Hospital, says.
Drastic changes have been felt in the clinical profile of women coming to the ob-gyn clinics in hospitals in the past five years. Some changes began to be noted in 2002-03, but these began posing serious consequences by 2005, says C. Nirmala, Professor of Obstetrics and Gynaecology, SAT Hospital.
“It is not as though the age profile of women have changed much. If the average age of our mothers was 22 earlier, now it is about 24 or 25. Mothers above 35 years in our clinics constitute only 2-3 per cent and there has been only a 1 per cent increase in the deliveries in the 35-39 age group. Our annual statistics say that we have about 10-12 per cent of diabetic and 11-13 per cent of chronic and extremely hypertensive mothers and a huge number of those with autoimmune thyroid diseases – and they are mostly women of less than 30 years,” Dr. Nirmala says.
More women with congenital heart diseases are becoming mothers; primary renal problems leading to hypertension is on the increase and there are more women with a body weight of 90 kg or above attempting to become mothers.
Their deliveries become complicated and the babies born to these mothers are not healthy. But even among the “normal” mothers, many go into pre-term labour at about the eighth month of gestation, she says.
The changing environment, lifestyle and nutritional factors are all contributing to these state of affairs. The mothers who come to SAT Hospital are mostly in the below-the-poverty-line category but they are not underweight. Poor food habits have made them deficient in vitamins and micronutrients. Rather than nutritious natural foods, women seem to be eating more of bread and costly health drinks available in the market, it is pointed out.
A confidential review of 676 maternal deaths in the State, conducted by the Kerala Federation of Obstetrics and Gynaecology between 2006 and 2009, identified post-partum haemorrhage (19.38 per cent), hypertensive disorders (12), sepsis (8) and heart diseases (6.8) as the four major causes of maternal deaths in the State.
Across the State, the increasing rate of primary c-section deliveries has been leading to a higher incidence of severe obstetric complications such as placenta previa accreta or placenta previa abruptio in the women’s repeat deliveries, V.R. Rajasekharan Nair, senior consultant and KFOG member, says.
Many tertiary-care public hospitals in Kerala have reported a higher incidence of such complications, which end up in emergency hysterectomies or the death of the mother or baby or both. A senior obstetrician says that her hospital has lost 15 young women last year to placenta previa accreta.
“Most of the c-section complications referred to us are cases from the periphery, where these cases were either wrongly diagnosed or the doctors did not realise the significance of a particular clinical picture early enough,” she says on condition of anonymity.
Morbidities among women in the reproductive age group are causing concern.