InternationalFederationofGynecologyandObstetrics

FIGOMission

• The International Federation of Gynecology and Obstetrics (FIGO) is a unique organization, being the only international professional body that brings together 130 obstetrical and gynecological associations from all over the world.

• FIGO is dedicated to the improvement of women’s health and rights and to the reduction of disparities in health care available to women and newborns as well as to advancing the science and practice of obstetrics and gynecology. The organization pursues its mission through advocacy, programmatic activities, capacity strengthening of member associations and education and training.

INEQUITIES

10/100.000

1000/100.000

InternationalFederationofGynecologyandObstetricsWorkingGrouponGoodClinicalPracticeinMaternal-FetalMedicine

Chair: G C Di Renzo

Expert members:E Fonseca, BrasilE Gratacos, SpainS Hassan, USAM Kurtser, RussiaF Malone, IrelandS Nambiar, MalaysiaM Sierra, MexicoK Nicolaides, UKH Yang, China

Expert members ex officio:C Fuchtner, FIGOM Hod, EAPMGH Visser, SM CommitteeE Castelazo , CBET CommitteeL Cabero, WG GDMV Berghella, SMFMY Ville, ISUOGM Hanson, DOHaD, WG NutritionPP Mastroiacovo, ClearinghouseJL Simpson, March of DimesD Bloomer, GLOWM

InternationalFederationofGynecologyandObstetricsWorkingGroupontheChallengesofLabour andDelivery

Chair: R Romero

Expert members:D Farine, CanadaMT Gervasi, ItalyJ M. Robson, IrelandT Duan, ChinaS Rosales, MexicoT Kimura, JapanL Yeo, Korea-USA

Expert members ex officio:C N Purandare, FIGOG C Di Renzo, FIGOM Stark, NESAGH Visser, SM CommitteeE Castelazo , CBET CommitteeC Lees, RCOGA Conde’ Agudelo, NIH NICHDD Bloomer, GLOWM

International Federation of Gynecology and ObstetricsMarch of DimesWorking Group on Preterm Birth Prevention

Chairs: J L SimpsonG C Di Renzo

Expert members:Ernesto CastelazoMary D’AltonEduardo FonsecaChris HowsonBo JacobssonJames MartinJane NormanT Y Leung

Expert members ex officio:CN Purandare, FIGOJ Howse, March of DimesG Visser, SM CommitteeD Bloomer, GLOWMJim Larson BCGDavid Ferrero, BCG

International Federation of Gynecology and ObstetricsGDM initiative

Chair: M Hod

Expert members:Mukesh AgarwalBlami DaoGian Carlo Di RenzoHema DivakarEran HadarAnil Kapur

Expert members ex officio:CN Purandare, FIGOGH Visser, SM CommitteeD Ayres do Campo, SM CommL Cabero, CBET CommitteeD Bloomer, GLOWMR Fabienke, Novo Nordisk

Good practice advice

• Folicacidsupplementation•Predictionandpreventionofpretermbirth•Noninvasiveprenataldiagnosisandtesting

Good practice advice

• Thyroiddiseasesinpregnancy•MgSO4useinobstetrics•Appropriateuseofultrasoundinpregnancy•Hyperglycemiaandpregnancy

GoodpracticeadvicefinalisedinJune2016

•AspirinUseinPregnancy• Irondeficiencyanaemia•ManagementofTwinPregnancy•MicronutrientsinPregnancy

GoodpracticeadvicetobediscussedonDecember2016

• Intrauterinegrowthrestriction•RecurrentMiscarriage•Predictionofpreeclampsia

Preconceptional folic acid for the prevention of NTD

FIGO Recommendation StatementMethods: a systematic review of the evidence on folic acid supplementationin women of childbearing age published, including review and peer-reviewedpapers, government publications, and statements from others societies wasused to develop a new clinical practice guideline for the InternationalFederation of Gynecology and Obstetrics.

Objective: to provide information regarding the use of folic acid for the prevention of NTD, and also standardize strategies in the primary prevention of NTD providing an adequate orientation according to scientific bases for all childbearing women.

GOOD PRACTICE ADVICE

• Folic acid supplementation has been proven to be effective in the reduction of NTD.

• However, take into account that nearly 50% of pregnancies are unplanned, and about 5-20% of all pregnant women start folic acid before pregnancy.

• the recommendation for preconceptional folic acid supplementation has to achieve both health workers and childbearing women.

Results

GOOD PRACTICE ADVICE

ThisreviewoffiveRCT,involving6105women(1949withaHxofapregnancyaffectedbyaNTDand4156withnoHxofNTDs),confirmsthatfolicacidpreventsthefirstandsecondtimeoccurrenceofNTDs.

Reductionof72%

Supplementationwithfolicacidversusnotreatment/othermicronutrients/placeboforNTD

GOOD PRACTICE ADVICE

16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 462 4 6 8 10 12 14 48

Gestational age,weeks

Days

3° 4° 5° 6° 7°

16 18 20 22 24 26 28 30 32 342 4 6 8 10 12 14

Firstheartbeat 4-chamber

EmbryonalageDays

Neuraltubecloses

FirstdayofLMP

Conception(mean)

Pregnancymaybesuspected(mean)

Firstantenatalvisit

• Upto50%ofpregnanciesareunplanned,• About5-20%ofallpregnantwomen

startfolicacidbeforepregnancy.

Before conception,since a fertility control method is stoppedup to the end of the first trimester

When

GOOD PRACTICE ADVICE

§ Nutritional guidance and food fortification

§ Periconceptional supplementation

§ Folic acid in association with pills

Folic Acid in the strategy for NTD

GOOD PRACTICE ADVICE

All women who plans to become pregnant or all women atchildbearing age without contraceptive method and who doesnot present risk factors for NTD utilize 400 micrograms (0.4mg)of synthetic folic acid, beginning at least 30 days before theconception and to continue daily supplements throughout thefirst trimester of pregnancy.

RECOMMENDATIONFORLOWRISKPOPULATION

Expertpanelssuggestthatsupplementalintakeinthispopulationshouldrangefrom400µgto800µg,nomore.

First:

GOOD PRACTICE ADVICE

All women in the reproductive age group should be advised aboutthe benefits of folic acid supplementation during wellness visits(birth control renewal, Pap testing, yearly examination), especially ifpregnancy is contemplated.

RECOMMENDATIONFORINCREASINGTHEINTAKEOFFASecond:

GOOD PRACTICE ADVICE

WomenwhohaveNTD-affectedpreviouspregnancyshouldbeadvisedthatsyntheticfolicacidsupplementationatadoseof4,000mcgperday(4.0mg)isrecommended.Itshouldstartatleast30daysbeforetheconceptionandtocontinuedailysupplementsthroughoutthefirsttrimesterofpregnancy.

RECOMMENDATIONFORHIGHRISKPOPULATIONThird:

Inthisgroup,itwouldbeimportant;ifpossible,preconceptiongeneticcounselingwithaphysicianspecializedinmedicalgenetics.

GOOD PRACTICE ADVICE

Additionalguidance

Consideringthehighfrequencyofunplannedpregnanciesworldwide,theinternationalFederationofGynecologyandObstetricsencouragesalleffortsofpublicagenciesworldwidetowardsthedevelopmentofmorecomprehensiveprogramstofortifyfoodwithsyntheticfolicacidandmorevigilanceinmonitoringtheseprograms.

Pregnant women taking a multivitamin with folic acid supplementshould be advised not to take more than 1 daily dose of vitaminsupplement, as indicated on the product label.

GOOD PRACTICE ADVICE

CONCLUSIONS

FOCUSONGLOBALSTRATEGIES

AMELIORATEOURPROFESSIONOVERCOMINGTHELIMITSOFNATIONALSOCIETIESGUIDELINES:THEBESTPRACTICEADVICEGLOBALSTRATEGIESFOR:PRETERMBIRTHPREVENTIONNONCOMMUNICABLEDISEASESPREVENTINGEXPOSURETOTOXICCHEMICALS

FIGHTINGTHEINEQUITY

Gatheringdataonmaternalmortalityandmaternalhealthisnotoriouslydifficult.However,onethingisclearfromallthestatistics:althoughmaternalandperinatalmortalityandmorbidityisfallinggloballytheperspectivesforwomen-infantsinpoorresourcescountriesaremuchworstthanforthoseinindustrialisedcountries.

Accesstocare

HealthcareSystems/InsuranceCoverage

Education/Counseling

PreventivetoolsBest

Practice

Riskfactors/MarkersImplementation

Window of Opportunity

Pregnancyoffersawindowofopportunitytoprovidematernalcareservicestomotherandoffspring

Reducetraditionalmaternalandperinatalmorbidityandmortality

indicators

AddressintergenerationalpreventionofpretermbirthandNCDs,suchas

diabetes,hypertension,cardiovasculardisease,andstroke.

OnSept2015theUNGeneralAssemblyadoptedthe“Agenda2030:TransformingourWorld”,withaconsensusoftheWorldGovernmentCommunity- introduced17sustainabledevelopmentgoalsSDGs.ManyofthesuggestedSDG’shaveEnvironmentalandReproductivehealthembeddedintheirgoals

Itisasheerco-incidencethatSeptember2015witnessedthe20th anniversaryoftheBeijingWorldConferenceonWomenundertheslogan-“Planet50-50by2030:SetitupforGenderEquality”.

‘TheAgenda2030;Transformingourworld’ orPlanet50-50by2030’ i.e.SDGswillnotmaterialisewithoutthecontributionof50%ofitspopulationi.e.women- Thiscanbeachievedonlywithgenderequality,equaleducationandemploymentopportunities+providingsexualreproductivehealthandrights.

ReproductiveHealthandRightswillnotbecompleteunlessweimproveenvironmentalHealth

FIGOwasnotandwillnotbeapassiveobservertobringaboutthisrequiredchangeandwillacttomakethesedreamsrealforwomen.