We must focus on maternal health to achieve global goals

Shobha Shukla, Citizen News Service - CNS
The XXI World Congress of Gynecology and Obstetrics, recently held in Vancouver, Canada, saw the release of two sets of important guidelines aimed at improving maternal health, decreasing the incidence of maternal, fetal and neonatal morbidity and reducing the burden of non-communicable diseases (NCDs) globally. These comprehensive guidelines, created collaboratively with international experts in GDM and maternal nutrition, and launched by the International Federation of Gynecology and Obstetrics (FIGO), provide recommendations to improve the diagnosis and care of women with GDM and to improve adolescent, preconception and maternal nutrition.

Hyperglycemia is one of the most common medical conditions women encounter during pregnancy, and is associated with the leading causes of maternal mortality and maternal and neonatal morbidity, as well as a several fold increased risk of future obesity, diabetes and cardiovascular diseases (CVDs) in both--mother and child. The International Diabetes Federation (IDF) estimates that one in six live births (16.8%) are to women with some form of hyperglycemia in pregnancy, 84% of it being due to GDM.

FIGO’s GDM Guidelines

The relevance of GDM as a priority for maternal health and its impact on the future burden of NCDs is no longer in doubt,” said Professor Moshe Hod, Chair of the Expert Group for the FIGO GDM Initiative. “Given this important fact, there needs to be a greater global action plan focused on preventing, screening, diagnosing and managing hyperglycemia in pregnancy.”

The FIGO GDM Initiative calls for greater global attention on the links between maternal health and NCDs in the sustainable developmental agenda and encourages all countries to adopt and promote strategies to ensure universal testing of all pregnant women for hyperglycemia during pregnancy. It emphasizes that all countries have an obligation to implement the best GDM testing and management practices they can.

The guidelines for public health measures to increase awareness, access, affordability, and acceptance of preconception counselling and prenatal and postnatal services for women of reproductive age, as this is likely to have lasting benefits for maternal and child health.

The document recognizes that nutrition counselling and physical activity are the primary tools in the management of GDM. Women with GDM must receive practical nutritional education and counselling to choose the right quantity and quality of food and level of physical activity, and to continue the same healthy lifestyle after delivery to reduce the risk of future obesity, T2DM (type 2 diabetes), and CVDs. However, if lifestyle modifications alone fail to achieve glucose control, metformin, glyburide, or insulin should be considered as safe and effective treatment options for GDM.

The post-partum period for women with GDM provides an important platform to initiate beneficial health practices for both mother and child.The document calls upon healthcare providers to support postpartum follow up of GDM mothers linked to the regular check-up and vaccination programme of the child to ensure continued engagement of the high risk mother-child pair with a view to reduce the future burden of several NCDs.

"The FIGO initiative on GDM has created a global framework for action to improve the diagnosis and care for women with GDM. Its pragmatic approach will encourage obstetricians and other maternal health care professionals to play a leading role in addressing this rising but hitherto neglected health issue. Its implementation will require capacity building and advocacy in many developing countries," said Dr Anil Kapur, Chairman of the WDF and member of the FIGO GDM Initiative Writing Group.

FIGO’s Adolescent, Preconception and Maternal Nutrition Guidelines

The FIGO Adolescent, Preconception and Maternal Nutrition Initiative calls for more awareness of the fact that in many societies, women and adolescent girls are poorly nourished, in terms of the level and balance of both macro-and micronutrients in their diet. This is detrimental to not only their current and future health but also to that of their children. Good health and nutrition before conception are key to a mother’s ability to meet the nutrient demands of pregnancy and breastfeeding, and are vital to the healthy development of her embryo, fetus, infant, and child. The continuum of poor maternal health and poor infant and childhood development contributes substantially to the global burden of disease and disability.

Healthcare providers need to “Think Nutrition First”— focusing on optimizing adolescent and maternal nutrition and health, starting early in the preconception years. This approach will have considerable positive benefits for ensuring women’s health and that of their children, as well as securing the health, productivity, life expectancy, and well-being of future generations. The guidelines call for greater attention to the links between poor maternal nutrition and NCDs in the next generation as a core component to meeting global health goals. Nutrition is at the core of many current issues in women’s health. This is not only because poor nutrition can lead to poor health, but because many of the socioeconomic factors that are associated with poor health and access to health care, such as poverty and low educational attainment, are those associated with poor nutrition. Poor nutrition can also have profound effects on reproductive outcomes.

“Adolescent, preconception, and maternal nutrition represent a major public health issue that affects not only the health of adolescents and women, but also that of future generations. These FIGO recommendations aim to address several issues relating to nutrition in adolescent and young women before, during and after pregnancy,” said Professor Mark Hanson, Chair of the FIGO Adolescent, Preconception and Maternal Nutrition Initiative. “They highlight the importance of balanced nutrition, for both the woman and her developing baby. FIGO is committed to making a real difference to the prevention of poor nutrition globally as a critical step in reducing the global burden of non-communicable diseases.”

These new guidelines are important and timely steps in the right direction
They set out evidence-based guidance that support the Global Goals for sustainable development that were recently adopted by the UN, especially Goal 2.2, which includes ending all forms of malnutrition by 2030 and addressing the nutritional needs of adolescent girls, pregnant and lactating women and Goal 3.4, which includes reducing by one third premature mortality from NCDs through prevention and treatment by 2030.

Shobha Shukla, Citizen News Service - CNS
October 17, 2015

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