Any pregnancy that involves increased health risk or complications for the mother, foetus, or both during pregnancy or childbirth is referred to as high-risk pregnancy.
Having a pregnancy that is considered high risk does not necessarily mean that the pregnant person or foetus will have problems.(Creative COmmons)
According to the World Health Organisation (WHO), an estimated 13 lakh maternal deaths have occurred among Indian women over the past two decades.
They constitute around 12 percent of global maternal deaths over the same period, according to the WHO.
The majority of these deaths were attributed to medical causes directly linked to pregnancy-related morbidities and mortality caused by high-risk pregnancies.
Now, a study by the ICMR-National Institute for Research in Reproductive and Child Health has found that women from the Telugu states of Andhra Pradesh and Telangana have some of the highest numbers of high-risk pregnancies in the country.
Telangana has a prevalence of 60.3 percent of high-risk pregnancies, while Andhra Pradesh has 54.5 percent.
Any pregnancy that involves increased health risks or complications for the mother, foetus, or both during pregnancy or childbirth is referred to as high-risk pregnancy.
Nearly 15 percent of women develop life-threatening complications during pregnancy, and 50-60 percent with maternal complications undergo Caesarean delivery.
“High-risk pregnancies place women and their offspring at the highest risk for morbidity and mortality,” Hyderabad’s Yashoda Hospitals’ Gynaecologist, Obstetrician, and Laparoscopic Surgeon Dr Sarada M told South First.
“Factors that can make a pregnancy high-risk include pre-existing medical conditions such as diabetes and hypertension, as well as events that occur during pregnancy such as preterm labour, multiple pregnancies, and pre-eclampsia (a blood-pressure disorder that happens during pregnancy),” she added.
Sarada also said that women who become pregnant under 17 or over 35 years old are also at a higher risk.
High-risk pregnancies require close monitoring to reduce the chance of complications, and people with high-risk pregnancies may need extra care before, during, and after they give birth.
A study found that breech presentation (1.7 percent), heavy bleeding (7.2 percent), obstructed labour (7.7 percent), and prolonged labour (8.2 percent) were the primary obstetric complications in Indian women.
Moreover, high-risk pregnancies are responsible for 75 percent of perinatal deaths — deaths occurring immediately after birth — in India.
However, having a pregnancy that is considered high-risk does not necessarily mean that the pregnant person or foetus will always have problems.
The cross-sectional ICMR study utilised secondary data from India’s National Family Health Survey-5 (NFHS-5), focusing on 23,853 women who were pregnant over its duration.
The subjects were selected based on some inclusion and exclusion criteria.
HRP in India. (ICMR_NIRRCH)
The study found that within the southern states, Tamil Nadu exhibited a high prevalence of 46.5 percent for high-risk pregnancies, while Kerala and Karnataka recorded rates of 46.8 percent and 46.5 percent, respectively.
Interestingly, Telangana and Andhra Pradesh showed some of the highest occurrences of “multiple” high-risk pregnancies.
Specifically, Andhra Pradesh reported a prevalence of 26.6 percent for multiple high-risk pregnancies, while Telangana followed close with a rate of 26.2 percent.
“Women in southern states were more likely to experience high-risk and multiple-high-risk pregnancies than those in northern states, and it could be due to the higher frequency of women with obesity, comorbidities, short birth spacing, and more Caesarean-section delivery,” said the study.
One of the reasons for this was said to be the development of southern states, which led to inadequate physical activity, causing obesity.
“When individuals consume more calories than they burn, especially coupled with a lack of physical activity, it can lead to an increase in fat, and obesity is not at all good for the pregnancies,” said Sarada.
The study also found that high-risk factors among pregnant women were more prevalent in northeastern states, such as Meghalaya, Manipur, and Mizoram.
“In those states, risk factors such as advanced maternal age, smoking and tobacco use, alcohol consumption, higher birth orders and short birth spaces were found to be more common,” said the author of the study.
On the other hand, the lowest prevalence was observed in Sikkim, Odisha, and Chhattisgarh. However, these findings revealed that states with higher Infant Mortality Rates (IMR) or Maternal Moratlity Rate (MMR) had a lower prevalence of high-risk factors.
“Hence, this study emphasises that greater attention is required to provide quality maternal and obstetric care during pregnancy and delivery,” read the study.
The study identified short birth spacing as the primary factor contributing to the elevated prevalence of high-risk pregnancies across the country.
A significant concern associated with short birth spacing was the fact that half of Indian women did not use contraception to delay their next pregnancy.
According to the NFHS-5, infant and child mortality rates were higher in high-risk births by Indian mothers with multiple risk factors, such as being too young or very old, having higher birth orders, and experiencing excessively short birth intervals.
The under-five mortality rate for shorter birth intervals was reported to be twice as high as the rate for birth intervals of three or more years.
A shorter inter-pregnancy interval was closely linked to complications such as premature rupture of membranes, abruptio placenta (when the placenta separates from the inner wall of the uterus before birth), placenta previa (when the placenta attaches low in the uterus), and uterine rupture — particularly in women with previous Cesarean deliveries.
Caesarean deliveries, preterm deliveries, and adverse birth outcomes such as miscarriage, abortion, and stillbirth were other key contributing factors to high-risk pregnancies.
The study also pointed out that bad obstetric history, pregnancy-induced hypertension, anaemia, and poor maternal nutrition were all linked to low birth weight and infant malnutrition.
The study revealed that over 4 percent of women had a higher BMI, and more than 6 percent reported comorbidities during their pregnancies, highlighting associations with gestational diabetes, cardiovascular disease, venous thromboembolism, and infections, particularly in older women, who face a higher risk of perinatal fatalities.
Increased BMI and excessive gestational weight gain were linked to the infant’s birth weight, the development of preeclampsia in women, and a greater likelihood of requiring interventions like Caesarean delivery.
Additionally, women from the Christian community exhibited a higher prevalence of high-risk pregnancies compared to those of other religions, while women from Scheduled Tribes (STs) had a lower likelihood of high-risk and multiple-high-risk situations than women from other castes.
The study suggested that effective primary care referral systems would aid in the early detection of high-risk conditions, which would help provide early management and quality obstetric care for complicated pregnancies.
A multidisciplinary team of obstetricians, maternal-foetal medicine specialists, cardiologists, nephrologists, diabetologists, and psychologists were necessary for providing care to high-risk pregnant women, particularly those with illnesses like diabetes, hypertension, heart disease, and mental health disorders.
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