THE HEALTH | JULY , 2023

BY KHIRTINI K KUMARAN

Obstetrical and Gynaecological Society of Malaysia ( OGSM ) President-elect for 2022 / 2023 Prof Dr Nazimah Idris said : “ There were worrying trends in the massive rise in diabetes in pregnancy and mental health issues among young mothers .

“ Among the children , there was a high prevalence of anaemia , obesity and at the same time malnutrition among children 0-5 years old , developmental delay and a considerable rise in incompletely vaccinated and unvaccinated children .

“ These will pose serious national health concerns in the not-too-distant future if we do not take appropriate action to stop the worrying trends .”

TACKLING DIABETES AND HIGH BLOOD PRESSURE

For diabetes and hypertension , Dr Nazimah explained there are modifiable and nonmodifiable risk factors . Non-modifiable includes age and family history of these two medical conditions .

“ To reduce prevalence , we must modify the modifiable risk factors , which means women must maintain an ideal body weight before pregnancy , do regular pre-pregnancy physical activity , and eat healthy .

“ Having diabetes increases the risk of hypertension in pregnancy , so modifying risk factors for diabetes has the added benefit of reducing the risk of hypertension in pregnancy too .

“ For the more severe form of hypertension in pregnancy , which is pre-eclampsia , a risk assessment should be done in the first trimester and if a woman is found to be high risk , preventive measures will be advised for risk reduction .”

MCH reported that 9.3 per cent of women had medical disorders before pregnancy , and 64 per cent received advice to delay the pregnancy .

“ This is mostly to ensure the medical illnesses are well-controlled and will not adversely affect the mother ’ s health during pregnancy ,” said Dr Nazimah .

“ As an example , uncontrolled diabetes can cause hypertension and frequent infection in the mother and abnormalities in the fetus . In other circumstances , a woman will even be advised against pregnancy altogether .”

SCREENING AND SUPPORT FOR POSTNATAL DEPRESSION

The prevalence of postnatal depression among mothers remained high at 11.2 per cent , showing a slight decrease from the previous survey in 2016 , where it was 12.7 per cent .

“ Unfortunately , 90 per cent of them were unaware of their condition ,” stated Dr Nazimah .

“ To increase awareness , mothers and their family must be educated about this condition to detect the problem and seek help as appropriate .

“ Screening for mental health issues during pregnancy is a good starting point , and if a pregnant woman is identified to be at risk , interventive measures can be taken . Risk factors include previous depressive illness , family history of depression , firsttime or very young mothers and financial problems .”

According to Director-General of Health Datuk Dr Radzi Abu Hassan , one of the ongoing measures by MoH in preventing postnatal depression is early recognition of mental health problems during antenatal or postnatal check-ups . This is to ensure early treatment can be given .

Health personnel , he said , need to be alert and recognise any changes in the mother ’ s mental state during their encounters and refer her for further assessment .

Using the integrated mental health care approach into MCH services , MoH continues strengthening the existing service provision and plans to introduce mental health screening among pregnant and postnatal mothers . Dr Nazimah continued : “ Preventive measures include providing social support during pregnancy and postpartum so mothers will not feel isolated and suffer emotional stress , which can lead to depression .

“ As shown in NHMS 2022 , young mothers in urban areas who lacked social support were especially at risk , and this is the group we want to pay special attention to .”

ANAEMIA IN CHILDREN

It was found that 45.6 per cent of children aged between 6-59 months were anaemic . Of these , 24.3 per cent suffered from mild anaemia , 21.9 per cent from moderate anaemia and 0.3 per cent from severe anaemia .

“ The cause of anaemia in children is mostly nutritional and closely related to feeding / eating habits , which can be corrected . Analysis of nutritional status showed that stunting was present in 21.2 per cent of children , wasting was seen in 11.0 per cent and underweight children 15.3 per cent ,” Dr Nazimah shared .

“ Parents must be educated and supported in making good decisions for their children ’ s nutritional requirements and healthy eating habits .

“ Another important cause of anaemia in children is a genetic condition such as Thalassemia . Children at risk are those for whom either one or both parents carry the thalassemia genes .

“ Thalassemia , which includes α- and β-thalassemia , is one of Malaysia ’ s most common genetic diseases . Between 4.5 and five per cent of the Malaysian population were reported to be carriers of this disease .”

National Institutes of Health ( NIH ), Institute of Public Health ( IKU ) Director , Dr Noor Ani Ahmad , said informed efforts will be made to improve the quality and accessibility of nutrition services .

“ These initiatives are based on the ‘ National Strategic Plan to Combat the Problem of Double Burden of Malnutrition ( BBM ) among Malaysian Children , 2023 - 2030 ,’ chaired by the Deputy Prime Minister Datuk Seri Ahmad Zahid Hamidi .”

FAMILY PLANNING AND UNPLANNED PREGNANCY

While 42.8 per cent of women use some form of contraception , only 34.5 per cent currently use modern and more effective contraceptive methods . This resulted in unplanned pregnancies in 33 per cent of women .

Dr Nazimah said women of reproductive age and their spouses need to be educated on various aspects of family planning to meet the family planning needs .