Maternal Health: Time to Deliver
By: Beatrice Ballarin
Caring for a growing world means caring for women and their children, says the Financial Times.1 Preventing maternal death is about more than access to drugs, and tools. Education is necessary too. According to the World Health Organization (WHO), more than 10 million women around the world have died from pregnancy and childbirth-related causes since 2014, including hypertension, sepsis, haemorrhage, and HIV/AIDS.2 Is it possible that many of these deaths could have been avoided? Maternal health extends from the mother to her child, and steps should be taken to further understand how the health of a mother affects her unborn or newborn child.
The maternal health Millennium Development Goals (MDGs)3 were developed at the G8 Summit in 2000 by the United Nations to reduce extreme poverty and set out a series of time-bound targets to be achieved by the year 2015.4 Among those goals is a focus on improving maternal health. Unfortunately, these goals have long been considered underachieved and are among the last items on political priority lists. What is underlying the high maternal mortality rates in some countries?
In 2010, the WHO, UNICEF, and other health agencies came together to publish a report on global trends in maternal mortality.5,6 Part of this report focused on the link between HIV infection and maternal mortality. For an unknown reason, this relationship has received little attention from the media. The report estimated that 5% of pregnancy-related deaths worldwide are in some way related to HIV.7,8 Furthermore, some experts have noted a higher frequency of obstetric complications in HIV-infected women. However, the biological basis of HIV-related maternal mortality remains unclear, and more research is needed in this area.9 In addition to understanding the biological causes of HIV-related maternal mortality, stigma, and discrimination faced by HIV-positive women is often a major obstacle in seeking necessary perinatal care.
Although we have not discovered a definitive treatment for HIV, antiretroviral therapy (ART)—a combination of medications that prevents the virus from replicating—is a treatment option taken by many HIV-positive women during pregnancy.9 Care should also concern the newborn child of an HIV-positive mother to rule out the possibility of a transmitted infection. Statistics show that in the absence of ART, infected children often die before the age of two.7 To decrease the probability of HIV infecting the fetus, a caesarean delivery is usually recommended. This decreases the possibility of placental rupture during vaginal delivery, which could expose the unborn baby to any virus present in the mother’s blood.10 While little is known about the ability of HIV to cross the placenta and infect the fetus, breastfeeding is considered one of the major routes for HIV transmission from mother to child.11 Although a group of researchers from Duke University showed that only one in ten HIV-infected mothers may pass their virus to the infant, HIV-positive mothers in many countries are encouraged to use baby formula as a safe and healthy alternative to breast milk.12 Interestingly, ongoing research also suggests that the mother produces antibodies from her B-cells that are capable of neutralizing the common strain of HIV in the milk.12
The necessity to decrease pregnancy and childbirth-associated deaths among women is urgent. A well-rounded solution should improve access to treatment and encourage global healthcare workers to provide more thorough education to women. Despite advances in maternal healthcare, education that provides women with thorough knowledge about maternal health and safety is necessary to encourage the obtainment of effective perinatal care. Additionally, women should have access to treatments to combat infections that contribute to maternal mortality, and to reduce the incidence of obstetric complications. Goals to reduce HIV incidence and its link to maternal mortality are already part of the MDGs, but whether reevaluation of the approach to achieving these goals is necessary remains to be seen.
- Jack A. Maternal and child health: caring for a growing world means halting mother and child deaths. The Financial Time 2016 Nov 17.
- Moran NF, Moodley J. The effect of HIV infection on maternal health and mortality. Int J Gynaecol Obstet. 2012; 119(S26-29).
- UN Millennium Project – Commissioned by the UN secretary General and Supported by the UN Developmental Group.
- World Health Organization Millennium Development Goals (MDGs) 2012. Available from: http://www.who.int/mediacentre/factsheets/fs290/en/index.html
- World Health Organization: the world health report 2005—make every mother and child count. Available from: http://www.who.int/whr/2005/whr2005_en.pdf
- World Health Organization trends in maternal mortality: 1990 to 2008. Available from: http://whqlibdoc.who.int/publica-tions/2010/9789241500265_eng.pdf
- Gorman S. A new approach to maternal mortality: the role of HIV in pregnancy. Int J Womens Health. 2013;5:271-274.
- Calvert C, Ronsmans C. The contribution of HIV to pregnancy-related mortality: a systematic review and meta-analysis. AIDS. 2013(27(10):1631–1639.
- Abdool-Karim Q, Abouzahr C, Dehne K, et al. HIV and maternal mortality: turning the tide. Lancet. 2010(375(9730):1948–1949.
- Al-Husaini AM. Role of placenta in the vertical transmission of human immunodeficiency virus. J Perinatol. 2009;29(5):331–336.
- Labbok MH, Clark D, Goldman AS. Breastfeeding: maintaining an irreplaceable immunological resource. Nat Rev Immunol. 2004;4(7) 565–572.
- Pollara J, McGuire E, Fouda GG, et al. Association of HIV-1 envelope-specific breast milk IgA responses with reduced risk of postnatal mother-to-child transmission of HIV-1. J Virol. 2015;89(19):9952–9961.