There is an urgent need to raise awareness among rural women and healthcare workers at all levels of the postpartum period and the long-term health of women with a history of hypertension and gestational diabetes mellitus (GDM). Early identiﬁcation and counseling of women at high risk of cardiometabolic disorders through innovative community-level interventions may offer opportunities to address the escalating burden of these conditions.
These major findings from a qualitative study “Women’s and healthcare providers’ perceptions of long-term complications associated with hypertension and diabetes in pregnancy” undertaken in Andhra Pradesh and Haryana by researchers from The George Institute for Global Health, India and UK. This is the ﬁrst qualitative study exploring the views and knowledge of women and key healthcare providers around the long-term cardiometabolic consequences of high-risk conditions in pregnancy in rural India.
“Anaemia was identiﬁed as the most common and important high-risk condition affecting pregnant women at both study sites,” says lead researcher Dr. Shobana Nagraj, who conducted focus group discussions with pregnant women in the two states to understand their knowledge and perception of cardiovascular risk.
Their qualitative findings on the significance of anemia among this population are corroborated by other studies that have highlighted that over half of pregnant women in India are anemic. The Government of India has recognized the importance of the early recognition and treatment of the condition throughout a woman’s life-course and has recently launched the Anemia Free India campaign. This includes comprehensive guidelines for the diagnosis and management of anemia in pregnancy, including free medication such as iron folate tablets and intravenous iron sucrose and resources to improve diet and adherence to medication.
“We also observed a mismatch between behavior change interventions provided by healthcare workers around anemia prevention and the constraints of pregnant women within their socio-cultural environments,” said Dr. Nagraj.
GDM has been the key priority area for funding and research within many regions across the globe including India. Most studies of GDM in India have focused on the growing semi-urban and urban populations, where there are signiﬁcant differences in rural settings, in terms of physical characteristics (body mass index), the nature of daily labor, and socioeconomic status.
Significant barriers exist to the widespread implementation of GDM guidelines including successful integration into the existing healthcare system in rural areas. Strengthening of health systems, provision of adequate training, education, equipment, supply chains of medications and diagnostics, is required before high-quality implementation of these guidelines is possible. Additionally, postpartum management and long-term follow up of high-risk pregnant women were found to be lacking.