Natasha Spencer, MD, highlights advances in obstetric management – Contemporary OB/GYN

Report on Advances in Obstetric Care and Alignment with Sustainable Development Goals

Introduction: Maternal Health in the Context of Global Development

A review of current obstetric practices, as detailed by Dr. Natasha Spencer of Orlando Health, indicates significant progress in the care of women of advanced maternal age (35 years and older). These advancements and the societal trends driving them align closely with several United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). This report analyzes these developments through the lens of the SDG framework.

Clinical Advancements Supporting SDG 3: Good Health and Well-being

Modern obstetric protocols for women of advanced maternal age have incorporated evidence-based interventions that directly contribute to SDG Target 3.1 (reduce global maternal mortality) and Target 3.2 (end preventable deaths of newborns). Key advancements include:

• Pharmacological Prophylaxis: The routine prescription of low-dose aspirin until 36-37 weeks’ gestation is a critical measure to reduce the incidence of preeclampsia, a major contributor to maternal and infant morbidity and mortality. This practice directly supports the goal of ensuring healthy lives.
• Advanced Prenatal Screening: Noninvasive prenatal screening has become a standard of care, analyzing fetal DNA from the maternal bloodstream. This technology contributes to SDG 3 by enabling early detection of chromosomal abnormalities, allowing for better parental counseling, preparation, and specialized neonatal care planning.
• Specialized Fetal Monitoring: Co-management of patients with maternal-fetal medicine specialists for detailed level 2 anatomy ultrasounds ensures meticulous monitoring of fetal development. This targeted approach helps identify potential anomalies, improving outcomes and aligning with the objective to reduce neonatal mortality.

Societal Trends and Implications for SDG 5: Gender Equality

The report highlights a significant demographic shift where more women are choosing to have children later in life. This trend is indicative of progress toward SDG 5, which aims to achieve gender equality and empower all women and girls.

Factors influencing this trend include:

1. Career and Educational Prioritization: Women are increasingly pursuing higher education and establishing careers before starting families, reflecting greater autonomy and economic empowerment.
2. Reproductive Choice: The emergence of “second-stage families” and decisions to delay childbearing underscore women’s enhanced control over their reproductive lives, a key component of SDG Target 5.6 (ensure universal access to sexual and reproductive health and reproductive rights).
3. Demographic Milestones: Recent data showing higher birth rates among women in their 40s compared to teenagers signifies a profound change in reproductive patterns, linked to the expanded life choices available to women.

Addressing Health Disparities and Promoting SDG 10: Reduced Inequalities

Despite clinical progress, misconceptions about the risks of later-life pregnancies persist, creating anxiety and potential barriers to care. Addressing these challenges is essential for promoting health equity, in line with SDG 10.

• Combating Misinformation: Dr. Spencer emphasizes that age alone does not preclude a healthy pregnancy. By promoting accurate, evidence-based information, clinicians can combat health-related misinformation and reduce the inequality of outcomes that stems from fear or lack of knowledge.
• Proactive Patient Education: Encouraging open conversations about reproductive planning during routine visits supports SDG Target 3.7 (ensure universal access to sexual and reproductive health-care services, including information and education). This empowers women to make informed decisions, irrespective of age.
• Importance of Preconception Care: Highlighting the role of managing chronic conditions and maintaining a healthy lifestyle before conception ensures that women receive equitable opportunities for a healthy pregnancy, reducing disparities linked to pre-existing health status.

Conclusion: Integrating Advanced Care with Global Health Goals

The evolution of obstetric care for women of advanced maternal age demonstrates a successful alignment of clinical innovation with global development objectives. By implementing standardized, evidence-based protocols and fostering patient-centered communication, the healthcare community can effectively support the health and well-being of this growing demographic. This integrated approach not only improves individual patient outcomes but also makes a tangible contribution to achieving the targets set forth in SDGs 3, 5, and 10, fostering a healthier and more equitable society.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article is fundamentally about health, specifically focusing on improving obstetric care and maternal health outcomes for women of advanced maternal age (35 years and older). It discusses clinical practices, prenatal screenings, and preconception care aimed at ensuring healthy pregnancies and reducing complications, which directly aligns with the goal of promoting well-being for all at all ages.

• SDG 5: Gender Equality

  The article touches upon gender equality by highlighting the societal shift of women choosing to have children later in life due to “career prioritization” and other life choices. This relates to women’s empowerment, autonomy, and their right to make informed decisions about their reproductive health and family planning. The emphasis on proactive conversations about reproductive planning supports women’s reproductive rights, a key component of SDG 5.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3: Good Health and Well-being
   • Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

     The article directly relates to this target by discussing specific medical interventions designed to reduce maternal health risks. The routine use of “low-dose aspirin…to help reduce the risk of preeclampsia and other complications” is a clear example of a practice aimed at preventing a leading cause of maternal mortality and morbidity.

   • Target 3.8: Achieve universal health coverage, including…access to quality essential health-care services.

     The article highlights advancements that represent quality essential healthcare services. These include “noninvasive prenatal screening” to detect chromosomal abnormalities and co-management with “maternal-fetal medicine specialists who perform detailed level 2 anatomy ultrasounds.” These services ensure higher quality and more comprehensive care for pregnant women in this demographic.

2. Under SDG 5: Gender Equality
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.

     This target is addressed through the article’s emphasis on patient education and informed decision-making. Dr. Spencer encourages clinicians to “foster open, proactive conversations about reproductive planning during routine visits” to “help women make informed decisions and dispel myths about age-related fertility and pregnancy risks.” This promotes access to information and counseling, which are crucial for exercising reproductive rights.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.1 (Reduce maternal mortality):
  • Implied Indicator: Incidence rate of preeclampsia in women of advanced maternal age. The article states that low-dose aspirin is used to “reduce the risk of preeclampsia,” implying that tracking the incidence of this condition is a measure of the success of such preventive care.
  • Implied Indicator: Rate of utilization of advanced prenatal care services. The article mentions “noninvasive prenatal screening” and “detailed level 2 anatomy ultrasounds” as cornerstones of care. The percentage of eligible women receiving these services could serve as an indicator of improved obstetric care quality.
• For Target 5.6 (Universal access to reproductive health):
  • Explicit Indicator: Age-specific fertility rates. The article explicitly states that “women in their 40s are now giving birth at higher rates than teenagers.” This demographic data serves as a direct indicator of changing reproductive trends and the societal and medical support enabling these choices.
  • Implied Indicator: Proportion of women receiving reproductive planning counseling. The recommendation to “foster open, proactive conversations about reproductive planning” suggests that measuring the frequency and quality of such counseling during routine visits would be a relevant indicator of progress in providing comprehensive reproductive healthcare.

4. Summary Table of SDGs, Targets, and Indicators

Source: contemporaryobgyn.net