Maternal morbidity and mortality associated with complicated pregnancy in this part of the continent is totally unacceptable and all encompassing efforts should be put together to stem the tide. While most results from system failure, all stakeholders should play their roles. Worrisome is the fact that some of these pregnancies  result in preventable birth defects especially congenital heart defects like hole in the heart .

I don’t know how many of us are concerned when you see ,read or hear in media  about those little ‘angels’ whose parents are soliciting for financial assistance for their babies to have corrective surgery done especially outside the country. The burden is endless and this is why for some weeks now, the column will tell us how to prevent some of these maternal complications, especially birth defects.

There are many risk factors associated with this rising phenomenon but for this week I will dwell on maternal hypertension and its association with birth defects.

Maternal hypertension
Pregnant women with treated or untreated hypertension are at higher risk of carrying fetuses with congenital anomalies than women free of hypertension. In pregnancy we talk of chronic and gestational hypertension. Pregnant women are considered to have chronic hypertension if hypertension was present before the pregnancy or if it develops before 20 weeks of pregnancy.  Chronic hypertension is differentiated from gestational hypertension, which develops after 20 week of pregnancy. In either case, hypertension is defined as systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg on 2 occasions > 24 h apart. On each side of the coin, hypertension can harm both the mother and the babies either jointly or separately.

Hypertension increases risk of fetal growth restriction by decreasing uteroplacental blood flow and risk of adverse fetal and maternal outcomes. The finding in some researches from California points to elevated blood pressure as the teratogen, rather than the drugs used to treat it. The researchers compared 4 groups of pregnant women: those with hypertension who took ACE inhibitors (a drug for hypertension for long associated with birth defects) during the first trimester, those with hypertension who took other antihypertensives during the first trimester, those with hypertension who took no antihypertensives during the first trimester, and pregnant women who did not have hypertension and did not receive antihypertensives for other indications

The offspring of women taking antihypertensives had elevated rates of cardiac anomalies and birth defects overall, but not of neural tube defects, compared with women not taking the drugs. However, the elevation was not seen when rates were compared with the cohort of women with untreated hypertension, implicating the underlying hypertension.  What this means is that taking hypertension drugs during pregnancy increase the risk of fetal defects but not treating hypertensions during pregnancy give a higher risk of fetal abnormalities.  The way out really is prevention of hypertension in the reproductive age group as well as general population.

I want to encourage all women in the reproductive age to please monitor their blood-Pressure and if you have high blood pressure get it well controlled before becoming pregnant. As soon as you get pregnant please register early for antenatal care in proper and well-established hospital or clinics for the purpose.

Prenatal care begins as early as possible and includes measurements of baseline kidney function (eg, serum creatinine, BUN).  Cardiovascular evaluation (auscultation and sometimes ECG, echocardiography, or both) to assess the state of the heart and to treat if there is any abnormality before the mother and baby develops complication.  At the end of each trimester (3 month), 24-h urine protein, serum uric acid, and serum creatinine are measured.

In certain centres in the country ultrasonography can be done to monitor fetal growth at 28 wk and every 4 wk thereafter. Any fetal defect can be detected on time and adequate measures are taken to manage that child without much stress to parents. You will agree with me that all these are possible if you book early for antenatal.

I want to encourage you not to joke with that high blood pressure. Get it well managed before that pregnancy; this may be the only step in keeping stress out of your home, which care of congenital fetal defects brings.