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On Tuesday, April 23, 2013, the Society for Maternal-Fetal Medicine (SMFM) sponsored a briefing for congressional officials in Washington, DC, titled "Pregnancy as a Window to Future Health." The briefing was moderated by Dr. Brian Mercer, SMFM President and featured: Dr. George R. Saade, Professor of Obstetrics and Gynecology, University of Texas Medical Branch in Galveston; Dr. M. Kathryn Menard, UpJohn Distinguished Professor of Obstetrics and Gynecology, Vice Chair for Obstetrics and Director of the Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine; and Dr. Michael Lu, Associate Administrator, Maternal and Child Health, for the federal Health Resources and Services Administration.
The purpose of the briefing was to educate congressional lawmakers and their staff about how pregnancy often provides great insight into the future health of the mother by identifying such conditions as future obesity and metabolic disorders such as diabetes, hypertension, and vascular disease.
Dr. Saade discussed the risks associated with various pregnancy conditions and the opportunity these afford for early interventions. He specifically focused on preeclampsia and preterm delivery. In regard to preeclampsia, he noted a lower rate of maternal survival over time among women who experienced the condition during pregnancy and a higher - up to four times higher - risk of hypertension later in life. In addition to the elevated risk for hypertension, studies have found that women who experienced preeclampsia are twice as likely to have heart disease or stroke. One study Dr. Saade cited found that preeclampsia presents a greater risk for cardiovascular death than other risk factors including age, weight, smoking, or fetal growth.
Dr. Saade also highlighted that pregnancy weight gain increases the risk of obesity eight to ten years later, particularly if pregnancy weight is not lost within six months. He also observed that breastfeeding decreases the obesity risk four-fold. He noted that breastfeeding has many benefits for the mother as well as the child, citing studies regarding less obesity, less hypertension, less diabetes, lower lipid levels, less myocardial infarction, and less type 2 diabetes among mothers who breastfeed. Dr. Saade then discussed how gestational diabetes is a precursor to type 2 diabetes later in life. He said that, while all women are screened for gestational diabetes and those with gestational diabetes are screened six weeks postpartum, additional follow up is needed postpartum to monitor for type 2 diabetes.
Dr. Menard explained how early screening and identification of the health conditions highlighted by Dr. Saade and early intervention may improve outcomes, and ultimately, improve a woman's health. She presented potential interventions and solutions including education, lifestyle changes (weight, smoking, etc.) and regular screening. She noted that many women do not understand - or think of - the association between pregnancy health and later health, and many providers do not ask a woman about her pregnancy experience. Dr. Menard expressed support for educating patients and providers, and implementing sustained screening measures for women that last longer than six-months postpartum.
Dr. Lu, who administers the nation's Maternal and Child Health Program, noted that maternal mortality decreased by almost 99 percent during the 20th century, to rise again in the 1990s and early 2000s. By 2009, the maternal mortality rate was 16 percent, nearly double what it was in 1990. This was accompanied by a rise in maternal morbidity and increases in obstetric complications. Dr. Lu highlighted the five areas of priority focus for the federal Advisory Committee on Infant Mortality:
All of the briefing participants called for the development of clinical guidelines for additional postpartum health screenings and a public education campaign targeting both patients and providers, in addition to an increase in health care funding support for prenatal care, testing, and interventions. The participants expressed a need for an upfront investment if we as a nation are to improve pregnancy outcomes in future pregnancies, prevent long-term consequences of chronic diseases, improve long-term health for women, and lower associated health care costs.
International Society for the study of Hypertension in Pregnancy
October 23, 2016
San Paulo, Brazil