Non-communicable diseases during pregnancy in low and middle income countries

Abstract

Apart from the risks of obstetric complications like haemorrhage and eclampsia, a large number of medical conditions affect pregnancy and result in adverse outcomes for both the mother and offspring. Non-communicable diseases in pregnancy are becoming increasingly important in contributing to death and poor health. Changes in the patterns and distribution of these conditions mean that we need new perspectives and ways of dealing with these challenges for the future. This article reviews the burden of ill-health due to non-communicable diseases during pregnancy in low and middle income countries and presents some paradigms relevant to public health and health system needs of the future. KeywordsMaternal mortality, complications, diabetes, general medicine, obesity Maternal mortality in low and middle income countriesMaternal mortality in many countries is unacceptably high. In 2015, it was estimated that 303,000 maternal deaths occurred across the world, with 99% in low and middle income countries (LMIC). The maternal mortality ratio globally is 216 deaths per 100,000 live births. The world's highest maternal mortality ratio is seen in sub-Saharan Africa at 546 deaths per 100,000 live births, where two-thirds of the maternal deaths in the world occur. This is in contrast to industrialised countries, where the maternal mortality ratio is 12 per 100,000 live births. Other developing regions of the world, e.g. Southern Asia, have a ratio of 176 deaths per 100,000 live births. Worldwide, maternal mortality has decreased by 44% since the 1990s. Between 1990 and 2015, rates of decrease were over 4% annually in South and East Asia but only 2.4% in sub-Saharan Africa. 1The determinants of maternal mortality were elegantly laid out many years ago.2 Distal and intermediate determinants are described. The distal determinants comprise factors like women's education and income, as well as wider cultural and economic factors. Intermediate determinants comprise biomedical factors, including women's general and reproductive health, and health care system factors, like access to care and use of services. The commonest causes of maternal death are the so-called direct causes, due to obstetric complications like haemorrhage during childbirth, eclampsia, abortion, obstructed labour and sepsis.3 For these reasons, efforts to reduce global maternal mortality have focused on obstetric interventions and maternity services. Less attention has been paid to the general health of women and medical conditions during pregnancy that result in maternal mortality and morbidity. This article focuses attention on the relatively neglected problem of non-communicable diseases (NCDs) during pregnancy in LMIC, and investigates the public health implications of changing patterns of health in pregnancy.

A framework for healthcare interventions to address maternal morbidity

“…10 Pregnancy can reveal underlying or undiagnosed diseases that might have been dormant or unrecognized, as well as the risk of future chronic conditions. 11 As an example, hypertensive disorders were among the most common diagnoses in both ANC and PPC women (2.9% and 4.1%, respectively) participating in the pilot study. 6 It is well established that hypertensive disorders of pregnancy, particularly pre-eclampsia, increase the future risk of hypertension, stroke, cardiovascular disease, and premature death.…”

“…The uniqueness of pregnancy as an event in the life course of a woman is that the physiologic demands of pregnancy act as a “stress test” . Pregnancy can reveal underlying or undiagnosed diseases that might have been dormant or unrecognized, as well as the risk of future chronic conditions . As an example, hypertensive disorders were among the most common diagnoses in both ANC and PPC women (2.9% and 4.1%, respectively) participating in the pilot study .…”

A new conceptual framework for maternal morbidity

“…In addition, early detection of noncommunicable diseases and interventions targeting lifestyle factors before conception, during pregnancy, and after pregnancy can prevent other adverse events for women and infants. Diabetes and chronic hypertension, for instance, can both lead to adverse outcomes during pregnancy and delivery, and are risk factors for increased cardiovascular diseases later in life for women . This is why a life‐cycle approach to women's health care is necessary.…”

“…Diabetes and chronic hypertension, for instance, can both lead to adverse outcomes during pregnancy and delivery, and are risk factors for increased cardiovascular diseases later in life for women. 37 This is why a life-cycle approach to women's health care is necessary.…”

Women’s knowledge on common non-communicable diseases and nutritional need during pregnancy in three townships of Ayeyarwaddy region, Myanmar: a cross-sectional study

“…Important NCDs during pregnancy include a large number of different medical conditions. They are cardiovascular diseases such as hypertension, endocrine, or metabolic diseases such as diabetes, hematological diseases such as anemia, mental illness such as depression, and neoplasm [4]. NCDs during pregnancy have a significant adverse effect on maternal health and pregnancy outcomes.…”