Non-communicable diseases and maternal health: a scoping review

Abstract

Background Non-communicable diseases [NCDs] are leading causes of ill health among women of reproductive age and an increasingly important cause of maternal morbidity and mortality worldwide. Reliable data on NCDs is necessary for accurate measurement and response. However, inconsistent definitions of NCDs make reliable data collection challenging. We aimed to map the current global literature to understand how NCDs are defined, operationalized and discussed during pregnancy, childbirth and the postnatal period. Methods For this scoping review, we conducted a comprehensive global literature search for NCDs and maternal health covering the years 2000 to 2020 in eleven electronic databases, five regional WHO databases and an exhaustive grey literature search without language restrictions. We used a charting approach to synthesize and interpret the data. Results Only seven of the 172 included sources defined NCDs. NCDs are often defined as chronic but with varying temporality. There is a broad spectrum of conditions that is included under NCDs including pregnancy-specific conditions and infectious diseases. The most commonly included conditions are hypertension, diabetes, epilepsy, asthma, mental health conditions and malignancy. Most publications are from academic institutions in high-income countries [HICs] and focus on the pre-conception period and pregnancy. Publications from HICs discuss NCDs in the context of pre-conception care, medications, contraception, health disparities and quality of care. In contrast, publications focused on low- and middle-income countries discuss NCDs in the context of NCD prevention. They take a life cycle approach and advocate for integration of NCD and maternal health services. Conclusion Standardising the definition and improving the articulation of care for NCDs in the maternal health setting would help to improve data collection and facilitate monitoring. It would inform the development of improved care for NCDs at the intersection with maternal health as well as through a woman's life course. Such an approach could lead to significant policy and programmatic changes with the potential corresponding impact on resource allocation.

Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era

“…Pregnancy is an opportune time in the lives of women to diagnose and manage underlying conditions, including NCD risk factors and existing NCDs which can lead to adverse MNCH outcomes, thereby improving the health of women and their children across the life course ( 12 , 56 ). This integrated approach is well articulated in the 2016–2030 Global Strategy for Women’s, Children’s, and Adolescents’ Health that provides the framework for continued investment in evidence-based actions, including addressing NCDs to end preventable maternal, newborn, and child mortality and morbidity ( 57 ).…”

“…However, increasingly non-direct causes, including NCDs, are becoming the major burden in this population in a process deemed the “obstetric transition,” occurring in both LMICs and HICs ( 11 ). Despite significant overlap, NCDs and MNCH are often treated as completely separate entities in global health financing, planning, and programming ( 12 ). Integrated action across these domains can enable women and children to live long, healthy lives ( 13 ).…”

Adapting group care to the postpartum period using a human-centered design approach in Malawi

“…The postpartum period, defined for this study as the period from the delivery of the infant up to 12 months after delivery allows for the variation in women’s physical and psychological changes [ 10 ] and is an important window for prevention and response across the maternal and child health continuum setting the stage for long-term health, but is often neglected [ 11 ]. The first year of life for children is equally crucial for their long-term health and development and maternal morbidities have long-term health consequences for children [ 12 – 14 ]. When responsive caregiving, attachment, cognitive stimulation, and social support are missing, children are more likely to experience negative behavioral, cognitive, social, and emotional outcomes [ 13 – 16 ].…”