Noncommunicable Diseases and Maternal Health

• Resources
• The Role of the MHTF

Noncommunicable diseases (NCDs) account for approximately two of every three deaths among women globally, and the majority of these deaths occur in low- and middle-income countries. Occurrence of NCDs and treatment for them may increase the risk of developing childbirth-related complications for both women and their babies. Furthermore, children born to mothers with NCDs are more likely to experience adverse health outcomes later in life. The potential impact of several NCDs that are particularly relevant to maternal health are explained in detail below.

• Diabetes during pregnancy, both pregestational and gestational, increases rates of pre-eclampsia, pre-term labor, and operative delivery; diabetes-related complications including hypoglycemia and ketoacidosis may also arise.
• Anemia is among the leading causes of maternal deaths; women with anemia during the first or second trimesters are at heightened risk for low birth weight, preterm birth, and neonatal mortality.
• Maternal cancer diagnosed during or slightly after pregnancy may hinder fetal growth, thereby increasing risk of neonatal mortality, stillbirth, and infants being born small-for-gestational-age (SGA).
• Hypertensive pregnancy disorders, namely pre-eclampsia and eclampsia, are a major cause of maternal and paternal deaths, preterm births, and low birthweight births. These conditions are also associated with higher risks of chronic NCDs later in life.
• Overweight and obese pregnant women face an increased risk of pre-eclampsia, rate of caesarean section delivery, and length of hospital stay at the time of birth. Infants born to overweight and obese mothers are also more likely to be born preterm, be born large-for-gestational-age (LGA), and require intensive hospital care at birth. As the global prevalence of overweight and obesity is increasing, the burden of these NCDs continues to grow.
• Perinatal mental health issues can persist through all stages of pregnancy and delivery and adversely affect maternal relationships with their infants and partners. In extreme cases, they may also lead to self-harm, a significant contributor to women’s deaths globally. Maternal depression is associated with increased risk of preterm labor and birth, intrauterine growth restriction, and preeclampsia.

As the world continues to undergo the “obstetric transition” from mostly direct causes of maternal mortality to more indirect causes, addressing the effects of NCDs on maternal health is becoming increasingly urgent. Interventions designed to reduce maternal mortality and morbidity, particularly in low-resource settings, have traditionally focused heavily on obstetric complications and intrapartum care, while less attention has been given to the complex “indirect causes” of maternal deaths and their underlying risk factors. More holistic approaches to improve maternal health involving community-based primary care interventions have been effective; however, additional work addressing the global burden of NCDs contributing to maternal mortality and morbidity is needed.