Mrs FG was recently delivered of a baby from her third pregnancy. In all three pregnancies, she did not attend antenatal care clinics. Her three vaginal deliveries were taken in an unregistered maternity home. She began to convulse within 18 hours of delivery of her third child which could not be controlled by the attendant in the maternity home. Upon referral to a hospital, her blood pressure was found to be highly elevated at 220/140 mmHg. Her urine contained 3+ protein. With appropriate care, she was stabilized and discharged home. She narrowly survived death from ECLAMPSIA.
Pregnancy is a period of numerous changes in the body of a woman. The organs and systems adjust to the demands of the growing baby. In some cases, some pregnant women develop medical problems which go unnoticed if they do not attend antenatal care clinics. The following must be kept in check to prevent unfavorable developments in pregnancy, delivery, and motherhood.
- Blood pressure: Typically, during certain periods in pregnancy, the blood pressure drops slightly but the values remain within normal. In some women, they may develop pregnancy associated hypertension. Some women may not have any complaint to suggest that blood pressure has risen. Highly elevated blood pressure may restrict the growth of the baby. In some instances, the baby dies because the blood supply to the placenta has been reduced due to the events that follow elevation of the maternal blood pressure. The woman also risks damage to her organs if the elevated blood pressure is left unchecked.
- Blood sugar: Pregnancy, due to the hormonal changes, may affect blood sugar control. Highly elevated blood sugar can impair the blood circulation to the placenta. This may restrict the growth of the unborn baby (fetus), and in extreme cases, cause fetal death. In some cases, the fetus may actually be larger than normal. Elevated blood sugar in the mother’s circulation often times increases the blood sugar level in the fetus. The elevated blood sugar in the fetuses stimulates insulin production which is responsible for a growth more than expected. Large babies can make vaginal delivery difficult.
- Weight: The weight is a measure of maternal nutrition, growth of the baby, and other products of pregnancy. During antenatal clinics, the weight is monitored to ensure that it is appropriate. Small sized women, and women who weigh less than 50kg, may have small pelvis(es). In such women, vaginal delivery may be difficult. Such persons are advised prior to delivery that Caesarean Section may be the appropriate route of delivery. Overweight or obese women are advised on lifestyle modifications as well.
- Nutrition: In some communities, there are myths about what to eat and what not to eat in pregnancy. These false beliefs claim that certain staple meals excessively increase the weight of the baby. As a result, some women avoid food items which they had eaten prior to pregnancy. In antenatal clinics, lectures are given which address the fact that all staple foods are appropriate in pregnancy. Any food that didn’t harm the woman in the non-pregnant state will definitely not harm her or her baby when pregnant. A few women develop iron-deficiency anemia from their dietary restrictions. The growing baby takes its nutrient from the blood supply through the placenta. Therefore, the woman needs to eat more than usual to accommodate her needs and those of the baby.
- Blood type: Some women have no idea of their blood group. Pregnancy is an opportunity to have the blood group checked. Women who have blood group O may have their babies develop jaundice if the babies have any of the other blood groups such as A, B, and AB. The other blood group system, Rhesus blood group, is also tested for in pregnancy. Women with rhesus negative blood group who are married to rhesus positive partners have 85% chance of having rhesus positive babies. During labour, miscarriages, and less often, during pregnancy; the rhesus positive blood of the fetus may get into the rhesus negative blood circulation of the mother. This stimulates her to produce antibodies (‘soldiers’) against rhesus positive blood group. These antibodies may get transferred through the placenta into the blood circulation of the developing babies in future pregnancies to destroy their red blood cells. The outcome is jaundice. This can be prevented by administering Rhogam injection to the rhesus negative woman within 72 hours of her first delivery or miscarriage, and subsequent ones.
- Immunity: Some women may have some infections- human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, syphilis, etc. Most of these women would have no symptoms, therefore checking for these infections during the early stages of their pregnancy helps in counseling the woman on mode of delivery ( vaginal or caesarean section), need to use medications, and feeding options for the baby. Some babies have been infected as a result of neglect of this precaution by their mothers during pregnancy.
- Mental Health: Apart from physical health, the need for the pregnant woman to be in stable mental health cannot be over-emphasized. During pregnancy, cues of vulnerability to mental health disorders, can be detected. If addressed by the appropriate medical personnel, this will prevent development of the various mental health disorders during pregnancy and after delivery.
Key Recommendation: Regular antenatal care services help ensure healthy mothers and babies. Myths are corrected while safe nursing habits are promoted.
Dr Ademola Orolu is a Consultant Family Physician. He holds the Fellowship of The West African College of Physicians. He is also an Associate Fellow of The National Postgraduate Medical College of Nigeria. He is in active clinical practice. He is a writer, a patient advocate, and has a passion for health education. He is the chief editor of The Family Doctors. He can be contacted via firstname.lastname@example.org