High blood pressure pushing up premature births

By Carol Natukunda

Hospitals are registering more cases of premature births than ever before. And hypertension has been cited as one of the leading causes as to why a baby might be born before 37 weeks.

Harriet Nakalembe gave birth at seven months. She had high blood pressure.

“May be I was stressed,” she says as she sits down to feed her one week old daughter at neonatal department Nsambya hospital, “I live in Kampala but the school where I teach is miles away in Wakiso district. But I didn’t think I had blood pressure until this last minute.”

Her story represents a new breed of premature cases that is worrying doctors and health experts.

“Prematures are increasing and it is mainly due to hypertension. Mothers seem to be so stressed. For some of them, the pressure is pregnancy induced,” says Sr. Immaculate Nabwami, the in charge of the neonatal department at Nsambya Hospital.

Nsambya hospital registers about 35- 40 premature children every month.   At Mulago Hospital, the numbers of premature deliveries is overwhelming. When New Vision visited the neonatal department recently, there were over 80 babies.
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Sedentary lifestyles
There is a feeling that births are becoming increasingly complex as women delay birth, along with other issues such as the sedentary lifestyles.  “As an accountant, I am always seated at my desk. I am at work by 8:00am and leave about 6:00pm. When I went into labour at six months, I was very scared,” says Patra Byenkya who went into labour at six months.

“The doctors found my pressure was up. I was stressed with work, but also I hardly exercised.”

Catherine Twesigye, the acting head of pediatrics at Nsambya hospital but states: “We don’t have a study that has looked at the psychological stress. But definitely the change in lifestyle has had an outcome. Mothers should keep active and get some physical activity each day, such as walking. Eat a healthy, balanced diet and keep your salt intake low, as this can reduce blood pressure.”

Preterm birth babies a big health problem
Each year in Uganda, over 200,000 – or 14% - of Ugandan babies are born too soon – that is before 37 weeks gestation, according to statistics from Save the Children Uganda. Preterm birthS are the leading cause of infant mortality after pneumonia and malaria. Globally, it’s estimated that of the 15.1 million born too soon, some 1 million die, according to the report “Born Too Soon,” by Save the Children.

These children have complex problems. Some premature   are not breathing at birth, mainly due to brain injury. This is caused by obstructed labor or acute hemorrhage during birth. Some suffer from meningitis while others are born with severe neonatal jaundice.

Risk of death and disability is greatest for those born at less than 28 weeks, according to Dr. Hanifah Naamala Sengendo a pediatrician and head of the Saving Newborn Lives at Save the Children Uganda.

“In the developed countries, the child might survive. But here, the chances are very slim, because we lack equipment, knowledge and technology on how to care for these babies,” Sengendo says.

Besides hypertension, other causes for premature births include infections like syphilis; other illnesses like HIV, malaria might affect the mother during pregnancy.

Dr. Twesigye also notes that multiple pregnancies (sets of twins or quadruplets) have also proved to be a big threat. “Having more than one baby in the uterus is a risk. Besides, many of them are very underweight. If a baby is 1.3kgs and above, the survival is really good, but below 1 kg it takes a lot of effort to save the baby.”

Better care needed at birth
“Essential newborn care is especially important for all babies born preterm,” says Elizabeth Mason, the Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “This means keeping them warm, clean, initiating breastfeeding, and ensuring that babies who have difficulty breathing get immediate attention. There is a golden minute after birth that counts for every newborn.”

Most newborn deaths can be prevented without intensive care. The ministry of health is encouraging low-cost interventions that are very effective. These include:

•    Antenatal steroids given to mothers in preterm labor. Sengendo explains that these are injections which help speed up the development of the baby’s lungs.

•    Kangaroo Mother Care, a technique where the infant is held skin-to-skin on the mother's chest, keeps the baby warm and facilitates breastfeeding. “Mothers are taken through counseling on how to do it, and how feed, and keep the baby clean,” says Kabami, adding that mothers should not leave hospital until they are advised to.