Pregnant women living with non-communicable diseases (NCDs) face a higher risk of complications during pregnancy and childbirth, requiring closer monitoring and access to facilities equipped to respond quickly when their conditions become more complex, the Rwanda Biomedical Centre (RBC) says.

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Globally, indirect causes of maternal deaths, many of which are linked to NCDs, account for about 23 percent of maternal deaths and are the second-leading cause after haemorrhage, or severe bleeding, according to the World Health Organization (WHO).

Data from the National Institute of Statistics of Rwanda shows that NCDs such as heart disease, diabetes and cancer are the leading causes of death in the country, accounting for 49.5 percent of deaths in health facilities and 58.8 percent of deaths in the community.

Dr Simon Pierre Niyonsenga, Director of Diabetes and Other Metabolic Diseases Programmes at RBC, said women with conditions such as hypertension, diabetes and cardiac disease are screened, monitored and treated according to the severity of their conditions. Those with complications are referred to higher levels of care.

At health centres, hypertension and diabetes are systematically screened for during antenatal care in line with national guidelines. Women diagnosed with either condition receive more frequent monitoring and treatment tailored to their individual needs, he told The New Times.

Monitoring includes blood pressure and blood glucose checks, assessments of fetal wellbeing and medication reviews to ensure treatment is safe and appropriate for each woman.

"During childbirth, women with known NCDs are supported to deliver at facilities with the capacity to manage their conditions safely. Higher-risk cases are directed to hospitals with emergency obstetric and medical care rather than lower-level facilities.

"This allows close monitoring during labour and immediate response to complications,” Niyonsenga said.

He explained that complications vary depending on the woman’s condition.

For example, women with hypertension are at risk of severe pre-eclampsia, a pregnancy complication involving high blood pressure and signs of organ damage, or eclampsia, which occurs when seizures develop in a woman with pre-eclampsia.

These conditions are managed through blood pressure control and the use of magnesium sulphate to prevent or treat seizures. When necessary, delivery is expedited.

Women with diabetes face a higher risk of prolonged or obstructed labour because they may have larger babies. Their newborns can also develop low blood sugar shortly after birth.

Niyonsenga said these risks are managed through closer monitoring during labour, readiness for caesarean delivery when necessary and routine monitoring of the newborn’s blood sugar.

"Women with cardiac conditions are monitored for signs of heart strain or failure during labour. Care teams are prepared to manage fluid balance and cardiac stress, with delivery plans adjusted according to the severity of the condition, including the mode and timing of delivery,” he said.

Care depends on severity

Niyonsenga said monitoring and management are organised according to the severity of the condition and the level of healthcare required.

Women with existing, stable hypertension or diabetes are followed at health-centre level through routine antenatal care.

Those with heart failure or other complex conditions are referred to higher levels of the health system for further care.

When a woman is newly diagnosed with an NCD during pregnancy, she is first referred to establish a long-term management plan. She then continues her antenatal care closer to home, with adjustments made based on that plan as the pregnancy progresses.

The system operates through a "funnel” structure, in which each level, from the health post to the health centre, district hospital and referral hospital is supervised and mentored by the level above it.

Niyonsenga said this approach helps maintain and improve the quality of care provided to pregnant women with NCDs across the country.

Challenges

Despite the system, pregnant women with NCDs still face barriers to care, particularly in rural areas where distance to facilities equipped to manage high-risk pregnancies remains a challenge, he said.

Workforce capacity is another challenge. At the primary-care level, for example, not all health workers currently have the skills or equipment, such as ultrasound, needed to detect warning signs early enough to arrange timely care and referral.

This is further complicated by turnover among trained staff, making it difficult to sustain capacity at facility level over time, Niyonsenga said.

He explained that the health system is addressing these gaps through three main approaches, including decentralisation, which involves expanding NCD screening and basic management capacity to lower-level facilities.

Community health workers and health posts are also being involved more directly in early detection and follow-up.

The package of services available at lower levels is being broadened so that more care can safely be provided closer to home.

"The second approach is continuous investment in training frontline health workers. There is an ongoing shift towards online training modules followed by practical, hands-on sessions to help sustain skills despite staff turnover.”

Niyonsenga said efforts are also underway to introduce basic echocardiography, a test that uses ultrasound to examine the heart, into healthcare training programmes.

The move is intended to equip health workers with these skills earlier and help build the capacity needed to provide the service over time.