A keynote address from Professor Claudia Hanson and a subsequent panel discussion explored the factors affecting maternal and neonatal survival – and the need to make pregnant women and newborns a high priority.
At a plenary session on Wednesday afternoon, Professor Claudia Hanson, Karolinska Institute Sweden, delivered the Ana Lúcia Cardoso Weinberg keynote address, commemorating the life of a much-loved member of EDCTP staff who sadly passed away in 2022 due to a rare cardiovascular condition, spontaneous coronary artery dissection (SCAD). Prof. Hanson’s lecture summarised the current status of maternal and neonatal health globally and key trends.
Pregnancy remains a hazardous time for women. Nearly 300,000 maternal deaths occur each year, as well as 1.9 million stillbirths and 2.1 million neonatal deaths. Sub-Saharan Africa is particularly badly affected, and progress in reducing mortality has stalled of late.
Maternal and neonatal deaths have multifactorial causes. Risk factors include socioeconomic status, health service capabilities and travel distance to health facilities. Medical causes include excessive bleeding, high blood pressure during pregnancy and infections; more than a quarter of maternal deaths occur in women with pre-existing conditions, including infections.
There is an important life-course aspect to maternal and neonatal health, Claudia pointed out. Risk factors for poor pregnancy outcomes can act at adolescence or earlier, while conditions affecting pregnancy can have long-term implications for a mother’s health. Low birth weight also is an important risk factor for many later life health problems in their offspring.
Some progress has been made in reducing the burden of infectious disease in pregnant women, including that due to HIV and malaria. Maternal immunization offers new opportunities for disease prevention, as illustrated by the success of maternal and neonatal tetanus prevention. Vaccination against group B streptococci (GBS), respiratory syncytial virus (RSV) and cytomegalovirus (CMV) may soon be possible.
However, Prof. Hansson argued, the quality of health services provided to pregnant women also needs to be addressed. Too often, women experience disrespectful care, or insufficiently integrated care.
In the following panel discussion moderated by Professor Marleen Temmerman, Aga Khan University, Kenya, Dr Esperança Sevene, Eduardo Mondlane University, Mozambique, Professor Philippe Van de Perre, Université de Montpellier, France and Dr Barbara Kerstiëns, European Commission, identified areas of maternal and neonatal health they saw as critical.
Dr Sevene noted that old foes such as malaria, TB and HIV are still a major challenge for women in Mozambique. Women are particularly badly affected by HIV, with infection rates hitting 30% in some communities. These infections interact with multiple other health challenges, complicating pregnancies. These challenges are compounded by health system weaknesses, and most maternal deaths occur within facilities. “This is something that we should start thinking on what we are doing, why we are not delivering the care that this woman needs,” Dr Sevene said. Additional issues such as conflict, COVID-19 and climate change are adding further complexity.
Prof. Van de Perre focused on TB, which he argued was a neglected aspect of maternal health. “Approximately 28% of full maternal mortality is caused by non-obstetric causes. And among this group of non-obstetric causes, the number one killer is tuberculosis. And that is completely neglected.”
TB infections in pregnancy are hard to diagnose but are associated with a fourfold increased risk of dying and an increased risk of other adverse pregnancy outcomes.
Dr Kerstiëns pointed out the complex interplay between infectious and non-communicable diseases during pregnancy, and called for greater collaboration across disciplines: “Both will influence the health of the woman during her pregnancy,” she pointed out. She stressed the need for more innovative diagnostics and treatments that were useable in low-resource settings. She also made the case for more implementation research, to provide evidence of impact and to address the practicalities of introduction of new interventions.
Another priority, suggested Dr Kerstiëns, was to involve pregnant women more in research: “If you leave pregnant women out of the equation, what assurance will you have that what you actually find is usable and effective?” She noted that guidelines are being developed on how to safely include pregnant women in research.
Pressed on priorities by Prof. Termmerman, Dr Sevene highlighted the need for better tools for prevention of infectious diseases, for malaria and HIV, as well as conditions such as cervical cancer, caused mainly by human papillomavirus (HPV) infections. Prof. Van de Perre noted the opportunities for innovative research at the interface between communicable and non-communicable diseases. And Dr Kerstiëns stressed the importance of prioritising research on maternal health, involving pregnant women in research, and using implementation research to spread good practice between countries.
Questions from the floor covered a wide range of issues, including the potential to leverage new technologies, the importance of breaking down disciplinary silos, and the need to engage and communicate effectively with policymakers. In conclusion, all the panellists agreed that maternal health should be a priority. Given the underlying impact of poverty, it was argued that every effort needed to be made to make best use of existing tools, so they deliver the maximum amount of benefits. This will call for collaborations to realise synergies with those working on health systems strengthening and other aspects of development.