30. Sep 2019

New guidelines recommend follow up care after complicated pregnancies

Gwendolyn Carleton
The guidelines outline what postpartum care for ‘at risk’ women should include and why it is important - providing a powerful tool for medical personnel and advocates alike.
After experiencing gestational diabetes, mothers like Nayani Nimeshika (left) should receive counselling and follow up, according to new guidelines. Photo by Jesper Westley.

Guidelines published today by the International Federation of Gynecology and Obstetrics (FIGO) recommend that ‘at risk’ women (who have suffered a complication during pregnancy) have a postpartum follow up at 6-12 weeks and periodically thereafter. 

Women who suffer from gestational diabetes, preeclampsia, hypertension or placental complications during pregnancy are at high risk of developing diabetes, obesity and cardiovascular diseases in the future. The new guidelines aim to ensure that these women are provided with appropriate follow up, not just after delivery but also over the long term.

“The new guidelines make a strong case for why postpartum care for women with pregnancy complications is important,” says WDF Chairman Anil Kapur, who helped write and review the guidelines as a member of FIGO’s Pregnancy and Non-Communicable Diseases Committee. 

“Saving women with pregnancy complications does not end with the pregnancy – postpartum follow up and preventive actions are very beneficial.”

A window of opportunity

The new guidelines recommend that follow-up include: a full medical history, physical examination, blood pressure measurements and screening for diabetes or cardiovascular risk factors, education about nutrition and physical activity, and treatment for obesity and overweight, blood pressure and smoking.

“Pregnancy is a window of opportunity. Caregivers and women need to be made aware of the risks of cardiovascular disease, and the remarkable opportunity to modulate those risks through preventive lifestyle interventions. We should strive for all women with risk factors such as gestational diabetes, obesity and pregnancy hypertension to be offered post pregnancy counselling and regular follow up at a general practitioner starting at three months postpartum,” says Prof. Moshe Hod, Chair of FIGO’s Pregnancy and Non-Communicable Diseases Committee, in a press release.

Powerful tool

WDF has supported 99 projects addressing prevention and care of GDM worldwide to date. Awareness about the dangers posed by GDM is growing, Dr Kapur says, but even in the best of settings the rate for postpartum follow up is low.

This is a shame, since a substantial benefit of identifying and treating GDM during pregnancy is the opportunity to follow up with at-risk women post-partum, he adds. 

“Preventive actions must begin when life begins and must be focussed more intensely in the early part of life where preventive actions have the greatest impact. WDF has been advocating for this through initiatives with Women Deliver and FIGO and through the many grass root projects we support in India, China, Columbia, Nigeria and other countries.” 

The new guidelines, he says, provide WDF’s partners worldwide with a powerful advocacy tool: 

“I hope this document will help WDF partners understand, communicate, advocate about the link between maternal health and NCDs, and push for policy action whereby maternal and new born child health becomes an important starting point in the fight against NCDs.”

The guidelines are published in the International Journal of Gynecology and Obstetrics, FIGO’s official journal.

See also an infographic poster prepared by FIGO, and available for download.