Cholera: Expert warns Pregnant women against risk of miscarriage, stillbirth

As cholera continues to spread, causing hospitalisation and deaths, maternal health experts have raised concerns that the infection predisposes pregnant women to the risk of stillbirth and miscarriage.

The gynaecologists stated that cholera is more severe in pregnant women and could lead to catastrophic pregnancy outcomes and increase Nigeria’s already high maternal mortality rate if urgent steps are not taken to contain it.

The Centre for Disease Control and Prevention says cholera infections during pregnancy are associated with high rates of fetal death, especially when women are severely dehydrated.

The physicians said cholera could lead to sudden death in pregnant women who are malnourished are battling with early pregnancy symptoms such as vomiting due to severe levels of dehydration.

Apart from the mothers, the maternal health specialists, who spoke exclusively to PUNCH Healthwise, said unborn babies also face consequences of cholera if their mothers become infected with the acute diarrhoeal infection.

The experts’ concerns follow the recent outbreak of cholera in the country, which has affected several states, including Lagos.

Nigeria is experiencing a significant cholera outbreak, with a total of 2,102 suspected cases and 63 deaths recorded across 33 states and 122 local government areas in the country.

The outbreak has notably affected Lagos, Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, and Nasarawa.

Cholera, a highly contagious food, and waterborne disease, is caused by the ingestion of the organism, Vibrio cholerae, in contaminated water and food.

Cholera outbreak
Risky behaviours that can lead to cholera and other communicable diseases
The primary cause has been linked to the consumption of contaminated water and inadequate sanitation, exacerbated by the onset of the rainy season, which often leads to increased cholera cases due to flooding and compromised water sources.

Due to the economic hardship in the country, a lot of pregnant women are hungry, malnourished, and do not have access to safe drinking water, making them susceptible to infections.

Pregnant and breastfeeding women are especially vulnerable to malnutrition, and those weakened by the nutrition crisis are more prone to infections.

A Consultant Obstetrician and Gynaecologist, Dr Joseph Akinde, said cholera is dangerous in pregnancy because infected mothers might not be able to survive the severe dehydration associated with the disease.

Akinde, who is a past chairman, Society of Gynaecology and Obstetrics of Nigeria, Lagos State chapter, said dehydration does a lot of damage to the baby.

The gynaecologist said, “As much as possible, pregnant women should avoid getting cholera, and if by chance, they develop it, they should seek treatment on time. Otherwise, if it gets to a situation where the woman becomes dehydrated, the outcome may not be favourable.

“We might end up having maternal mortality; you may have a stillbirth on your hand or even miscarriage. So, the effects could be far and wide on the pregnant woman.

“ Unlike in the non-pregnant individuals where we are dealing with a single individual, the effect of cholera is going to be much more severe in the pregnant woman because we are dealing with two individuals.”

Akinde pointed out that the impact of cholera on pregnancy would be more on women in their first trimesters who were already battling with early pregnancy symptoms such as vomiting.

Apart from pregnant women, the gynaecologist said cholera could also have a deleterious effect on the outcomes and progression of pregnancy.

“It might result in miscarriage and stillbirth. So, any pregnant woman who develops cholera should not be treated with kids’ gloves.

“It is something that they must take seriously and treat aggressively so that they don’t have adverse maternal and foetal outcomes. The adverse effect could be on the mother or the foetus when the woman becomes dehydrated”, he said.

Akinde further noted, “Also, if a woman develops a cholera on top of early pregnancy symptoms such as vomiting, that will quicken the cholera to become very severe and that will make her go into the end of the disease spectrum with catastrophic outcomes.

“So she might not even survive it because she is vomiting everything she takes and now cholera superimposes on those early pregnancy symptoms. So it won’t be funny at all.”

He advised pregnant women to be mindful of the source of their drinking water and ensure that their foods are safe to avoid contracting the infection.

A United Nations Population Fund reproductive health specialist in Maiduguri, Dr Homsuk Swomen, in 2017, said cholera puts enormous extra stress on the body of the pregnant woman and the unborn baby.

In an article published on the UNFPA’s website, the maternal health specialist said, “Studies show that cholera infections during pregnancy can lead to sudden loss of the foetus, premature delivery, stillbirth, and an increased mortality and morbidity, both for the baby and the mother.”

In a 2023 study published by PMC journal, the researchers said cholera infection is a serious threat to pregnancy as it could lead to increased stillbirths and neonatal death.

“Foetal death was shown to occur mainly in the third trimester as most of the pregnant women infected with cholera had spontaneous abortions even after controlling for other confounding variables such as maternal age, dehydration level, and vomiting.

“Neonatal death was attributed mainly to congenital malformations and besides, cholera vaccines have shown to be safe in pregnancy and have proven to lower fetal and neonatal malformations among vaccinated compared to non-vaccinated pregnant women”, the researchers said.

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