Obstetric and Neonatal Outcomes of Pregnant Indian Pilgrims: A three-year experience at the Indian Hajj Medical Mission

Abstract

Objectives:The Hajj, an annual mass gathering of Muslim pilgrims, is known for its high morbidity and mortality rates. However, pregnant women sometimes participate in this pilgrimage, despite guidelines that discourage such an undertaking due to potential fetomaternal complications. This study aimed to evaluate fetomaternal outcomes among pregnant Indian Hajj pilgrims. Methods: This prospective cross-sectional study was conducted at two Indian Hajj Medical Mission (IHMM)-affiliated secondary care hospitals in Saudi Arabia during the Hajj periods of August-October 2015 and 2016 and July-September 2017. All female Indian pilgrims of reproductive age who underwent pregnancy screening at secondary care IHMM hospitals during this period were included in the study. Definitive obstetric care was provided at the Makkah Maternity & Child Hospital. Data regarding the pilgrims' obstetric characteristics, antenatal complications, management and fetomaternal outcomes were evaluated. Results: A total of 114 pregnant Indian pilgrims were identified during the study period. The most common antenatal complications were respiratory tract infections (51.75%), followed by iron deficiency anaemia (17.54%), hyperemesis gravidarum (14.04%), hypothyroidism (9.65%) and gestational diabetes mellitus (5.26%). There were 20 vaginal deliveries (17.54%), two Caesarean sections (1.75%) and 32 abortions (28.07%). The cumulative three-year birth rate was 24.60 per 1,000 females. Conclusion: During Hajj, pregnant pilgrims have a high risk of abortion, respiratory tract infections and various antenatal, perinatal and neonatal complications which may go unreported or untreated. Women should therefore be educated regarding the risk of adverse fetomaternal outcomes which may occur while undertaking a Hajj pilgrimage during pregnancy. Advances in Knowledge-This prospective study is the first of its kind to evaluate fetomaternal outcomes among pregnant Indian Hajj pilgrims.-The cumulative three-year birth rate was 24.60 per 1,000 women.-The most common antenatal complications were respiratory infections, followed by iron deficiency anaemia. There was also a high incidence of abortions and other adverse pregnancy and neonatal outcomes. Application to Patient Care -Mass gatherings increase the transmissibility of respiratory pathogens. In addition, local healthcare systems may not be able to detect antenatal complications during Hajj or may experience transport difficulties due to crowded conditions, potentially leading to neonatal morbidity and mortality. Pregnant women considering undertaking Hajj pilgrimage should be educated regarding such risks.

A scoping review of Islamic pilgrimage to Mecca: Mapping the health concerns and proposed solutions

“…Health‐risk assessment and management, including technology‐based disease monitoring were included in the current trends regarding protecting their health status (Pane et al., 2019). For high‐risk pregnant women, postponing the Hajj was suggested to avoid the unwanted obstetric outcomes that have occurred (Khan & Khan, 2018).…”