On 2 November, the Maternal Health Task Force (MHTF) hosted a panel discussion at the Harvard T.H. Chan Leadership Studio to mark the launch of the fifth MHTF-PLOS Collection, “Non-Communicable Diseases and Maternal Health Around the Globe.” The conversation was moderated by Katja Iversen, President/CEO of Women Deliver, and featured several speakers, including Lindsay Jaacks, Assistant Professor in the Department of Global Health and Population at the Harvard Chan School; Astrid Kamperman, Assistant Professor in the Department of Psychiatry at Erasmus Medical Center in Rotterdam, the Netherlands; Adya Misra, Associate Editor at PLOS One; and Otilia Perichart-Perera, researcher and Chief of the Department of Nutrition and Bioprogramming at the Instituto Nacional de Perinatología in Mexico City.
Adya Misra began by introducing the newest MHTF-PLOS collection of open access papers, which focuses on non-communicable diseases (NCDs) and maternal health. As of 2 November, PLOS One received over 35 submissions to the collection, and nine papers have been published. Additional articles will be added to the collection in the coming months.
The intersection of NCDs and maternal health
Otilia Perichart-Perera and Astrid Kamperman, contributing authors to the collection, discussed their research and its implications for global maternal health. Perichart-Perera’s paper, “Metabolic markers during pregnancy and their association with maternal and newborn weight status,” examined obesity in pregnancy among women in Mexico City. As of 2016, three-quarters of women of reproductive age in Mexico are considered to be overweight or obese. Obesity in pregnancy is associated with several poor maternal and newborn health outcomes, including gestational diabetes, pre-eclampsia, miscarriage and hemorrhage.
Kamperman’s systematic review and meta-analysis assessed interventions to treat mental disorders during pregnancy. “Approximately one out of every 10 pregnant women suffers from some kind of serious mental illness during pregnancy,” Kamperman stated. The review revealed that the majority of studies evaluating interventions for treating mental disorders during pregnancy focused solely on major depression. The evidence on other perinatal mental health issues such as anxiety, schizophrenia and bipolar disorder is extremely limited.
Iversen challenged the panelists to explore the intersection of maternal health and NCDs as well as key challenges and opportunities. Jaacks spoke about nutrition and maternal health, noting that poor dietary quality is a critical risk factor for negative maternal and child health outcomes, and women are generally the ones making food choices in the household. The farm-to-hospital model, which can improve pregnant women’s access to healthy food, is one example of an approach that can help prevent NCDs and address maternal health simultaneously. Misra highlighted the need for more open access research on NCDs and maternal health, particularly in low-resource settings, where the burden of NCDs is rising.
Another opportunity at the intersection of maternal health and NCDs is diabetes in pregnancy, which, as Iversen explained, is an example of bridging gaps between the NCD and maternal health communities. “If we do not address NCDs in the maternal health continuum of care, we will be short-changing the progress we have seen,” she remarked.
Lifestyle and social norms exemplify other issues at the intersection of maternal health and NCDs. Since women tend to be more motivated to make lifestyle changes during pregnancy compared to other stages of life, pregnancy presents a unique opportunity to encourage healthy behaviors. As such, Perichart-Perera called for preventative strategies targeting pregnant women and women planning to become pregnant to promote healthy nutrition and other behaviors.
Kamperman emphasized the persistent stigma associated with perinatal mental illness. “We’re still living in this myth of the ‘happy pregnancy,’” she said, and the lack of evidence on effective prevention and treatment strategies for women with mental health disorders during pregnancy is a missed opportunity.
NCDs on the global maternal health agenda
Finally, Iversen asked the panelists, “How can health systems leverage their existing maternity care infrastructure to address the rising burden of NCDs among women?” Kamperman commented that health providers should be aware of the burden of mental illness and trained to ask the right questions. Health providers can pose simple questions such as “How are you feeling?” during an antenatal or postpartum visit to open the dialogue.
Perichart-Perera called for more comprehensive, lifestyle-oriented antenatal assessments that include measuring gestational weight gain and reviewing diet and physical activity guidelines, which requires establishing competencies for health care providers and policies that support healthy environments and behaviors. “It takes more than the usual suspects. It’s not just an individual problem—it’s a systemic issue that needs to be addressed as such,” Iversen summarized.
Jaacks referenced Perichart-Perera’s points about gestational weight gain and added that many women do not know how much weight they should gain during pregnancy and do not meet gestational weight gain guidelines. Misra commented, “Health systems have the tools to empower women—to educate them about the risks that they face, and the risks that they can pass on to their child.”
Following questions from the in-person and online audiences, Iversen concluded the event with a plea from the NCD and maternal health communities to “integrate, collaborate and communicate” to save women’s lives around the globe.
Learn more about the MHTF-PLOS Collection on Maternal Health.
Browse open access papers from the MHTF-PLOS Collection, ““Non-Communicable Diseases and Maternal Health Around the Globe.”
Are you working on a project related to NCDs and maternal health? We want to hear from you!