November 30, 2016

Pre-eclampsia/Eclampsia Impacts Mothers and Babies

Each year, 15 million babies are born too soon. Of these, more than one million die from complications related to preterm birth (PTB) – or birth before 37 weeks gestation. Globally, prematurity is the leading cause of perinatal death from 22 completed weeks of gestation to seven completed days after birth, death in the first four weeks after birth, and the leading cause of death among children under five years. It is also a major contributor to the burden of life-long disabilities like cerebral palsy, and cognitive impairment, as well as poor lung, vision, and hearing function. It can impact adult health due to an increased risk for hypertension, diabetes, and chronic kidney disease.

Pre-eclampsia and eclampsia are life-threatening disorders in pregnant women marked by high blood pressure, excess protein in urine, and convulsions, and are closely linked with PTB because the only cure is delivery of the baby. Despite causing 14 percent – or one in seven deaths – of maternal mortality, pre-eclampsia and eclampsia-related fetal-newborn deaths outnumber maternal deaths. Spontaneous preterm delivery and hypertensive disorders are the most common obstetric events leading to perinatal deaths (28.7 percent and 23.6 percent, respectively).

These early births and newborn deaths are preventable, which is why in 2016 the global community is rallying around the recently-established Sustainable Development Goals (SDGs). These seventeen goals build on the many accomplishments of the Millennium Development Goal era, and set the stage for further progress toward ending poverty, protecting the planet, and ensuring prosperity for all by 2030.

The health and well-being of mothers and children are fundamental to the SDGs. Goal 3, Good Health and Well Being, includes specific targets for maternal and newborn health by focusing on ending preventable deaths among newborns and children under five. The focus on preventable deaths is a sharp reminder that the vast majority of newborn, child, and maternal deaths don’t have to happen. Generally speaking, these deaths are the result of poor access to quality health services and weak health systems that can’t, and don’t, deliver basic and critical life-saving care. There is ample evidence that the effective management of maternal complications has a direct impact on improved maternal and newborn outcomes. Yet, only half of women in developing countries receive adequate health care.

Because preterm birth is intricately tied to a woman’s reproductive health lifecycle, it can provide valuable insights into the health and well-being of women, and the health care they receive before, during, and after pregnancy. The same may be said of pre-eclampsia and eclampsia. Many of the conditions that increase a woman’s risk for pre-eclampsia, i.e. obesity, hypertension, and kidney disease, may be evident prior to pregnancy and, if managed effectively during pregnancy, can prevent disastrous consequences for women and their newborns.

Antenatal care (ANC) is the most important platform for diagnosing and managing pre-eclampsia. Detection during ANC visits reduces the likelihood of pre-eclampsia progressing to eclampsia and the need for hospital-based management. Delivery is the only cure for eclampsia, and as such, quality care should also ensure improved health outcomes for newborns.

To meet SDG Goal 3, the maternal and newborn health communities need to work together to deliver effective solutions that improve maternal and newborn health outcomes. Every Preemie—SCALE (Scaling, Catalyzing, Advocating, Learning, Evidence-Driven), funded by the United States Agency for International Development (USAID), provides practical, catalytic, and scalable approaches for expanding the uptake of preterm birth (PTB) and low birth weight (LBW) interventions in 23 USAID priority countries in Africa and Asia.

To bring greater attention to the prevention of preterm birth and the relationship to maternal complications, Every Preemie—SCALE convened a PTB/LBW Global Technical Working Group on Implementation Challenges and Solutions meeting with Ending Eclampsia on May 16, 2016 just prior to the opening of the Women Deliver conference in Copenhagen. The meeting focused on the prevention of preterm birth across the LINC framework (Lifestyle, Infection, Nutrition and Contraception) and maternal complications (LINC+) with an emphasis on pre-eclampsia and eclampsia. Participants contributed to a multi-discipline forum for emerging evidence, research, and learning. The meeting also explored critical knowledge gaps to overcoming implementation bottlenecks and increasing coverage and quality of PTB and LBW care and evidence-based interventions that impact reproductive, maternal, newborn, and child health outcomes in low income countries.

 

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Authors:

 

Judith Robb-McCord, MPH, MAAS, is the Director of the Every Preemie-SCALE project at Project Concern International (PCI).  Judith brings more than twenty years of leadership and management experience in international health to this position. She started her international career with USAID in Kenya in 1994 and subsequently moved on to work with USAID in Eritrea, Cote d’Ivoire, and Ethiopia. Judith has also worked with prominent international NGOs and has extensive background in strategic planning and implementation, global leadership and the facilitation of strategic alliances to catalyze action for the scale up of maternal and newborn health, and the prevention and control of malaria and HIV/AIDS.



Dr. Jim Litch MD, DTMH is Director of the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) Perinatal Interventions Program (PIP),  and Evidence, Learning and Research Lead for the USAID-funded Every Preemie-SCALE program. He leads the PTB/LBW Global Technical Working Group for Implementations Challenges and Solutions.  Dr. Litch has 25 years of experience in global public health and medicine, including country-level and Ministry of Health experience working at community, district, and national levels and formative years providing and managing frontline healthcare in India, Nepal and the U.S.



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