India is facing a serious challenge of high risk pregnancy, which can lead to adverse outcomes for both the mother and the child. A recent study by researchers at the ICMR’s National Institute for Research in Reproductive and Child Health (NIRRCH) in Mumbai analysed the data from the National Family Health Survey-5 (2019-2021) and found that the prevalence of high-risk pregnancies among Indian women was 49.4% .
What is a high risk pregnancy?
A high-risk pregnancy is one that poses a threat to the health or life of the mother or the fetus, or both. It may require special care and monitoring by a medical team. Some of the factors that can contribute to a high-risk pregnancy are:
- Maternal age: Women who are younger than 18 or older than 35 are at a higher risk of complications during pregnancy and delivery.
- Maternal health conditions: Women who have pre-existing conditions such as diabetes, hypertension, heart disease, kidney disease, thyroid disorders, obesity, anaemia, or infections are more likely to have a high-risk pregnancy.
- Lifestyle factors: Women who smoke, drink alcohol, use drugs, or have poor nutrition are more likely to have a high-risk pregnancy.
- Pregnancy complications: Women who develop gestational diabetes, preeclampsia, eclampsia, placenta previa, placental abruption, preterm labour, or multiple gestation are more likely to have a high-risk pregnancy.
- Previous pregnancy outcomes: Women who have had a history of miscarriage, stillbirth, abortion, caesarean delivery, or low birth weight babies are more likely to have a high-risk pregnancy.
What are the findings of the study?
The study encompassed data from nearly 24,000 pregnant women across India and identified short birth spacing, adverse birth outcomes, and caesarean deliveries as primary contributors to the incidence of high-risk pregnancies . The study also revealed regional disparities and temporal patterns in the prevalence of high-risk pregnancies. Some of the key findings are:
- Northeastern states, including Meghalaya (67.8%), Manipur (66.7%), and Mizoram (62.5%), alongside Telangana (60.3%), exhibited the highest prevalence rates of high-risk pregnancies .
- Meghalaya recorded the highest frequency of multiple high-risk factors at 33% .
- High-risk factors tended to escalate during the third trimester, emphasizing the critical need for vigilant monitoring and timely interventions .
- Pregnant women with limited formal education were disproportionately affected, exhibiting heightened prevalence rates of multiple high-risk factors compared to their educated counterparts .
- Livebirth decreased by 1.3 points (90.2% vs. 88.9%), and nearly half of the Indian states/UTs (n=17/36) had lower than the national average of livebirth (88.9%) reported during 2019-21 .
- A higher proportion of pregnancy loss was noted, particularly miscarriages increased in both urban (6.4% vs. 8.5%) and rural areas (5.3% vs. 6.9%), and stillbirth increased by 28.6% (0.7% vs. 0.9%) .
- The number of abortions decreased (3.4% vs. 2.9%) among Indian women . Nearly half of the abortions were due to unplanned pregnancies (47.6%) and more than one-fourth (26.9%) of abortions were performed by self . Abortions among adolescent women in Telangana was eleven times higher during 2019-21 as compared to 2015-16 (8.0% vs. 0.7%) .
What are the implications and recommendations?
The study highlights the urgent need for improving maternal health and pregnancy outcomes in India, especially in the regions with higher prevalence rates of high-risk pregnancies. The study suggests that there is a need for regional-specific, comprehensive and quality maternal healthcare programs that can address the local challenges effectively . The study also recommends that:
- Pregnant women should be screened for high-risk factors at regular intervals and provided with appropriate care and counselling.
- Pregnant women should be encouraged to adopt healthy lifestyle habits and avoid tobacco, alcohol, and drugs.
- Pregnant women should be educated about the importance of birth spacing, family planning, and safe abortion methods.
- Pregnant women should be made aware of the signs and symptoms of pregnancy complications and seek immediate medical attention if needed.
- Pregnant women should be provided with adequate nutrition, iron and folic acid supplementation, and immunization.
- Pregnant women should be ensured access to quality antenatal care, skilled birth attendance, and emergency obstetric care.
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