The Unseen Side of Pregnancy: Non-Communicable Diseases and Maternal Health

“The ongoing incidence of preventable global maternal morbidity reflects a clear failure to achieve the global public health goal of ensuring equitable access to high quality healthcare for women during and after pregnancy.” - The Unseen Side of Pregnancy: Non-Communicable Diseases and Maternal Health

Around the world, approximately 18 million women of reproductive age die each year because of non-communicable diseases (NCDs), and two in every three deaths among women are due to an NCD. In fact, NCDs have been the leading cause of death among women globally for at least the past 30 years. And yet, women’s specific needs are often excluded from conversations about NCDs. They are underrepresented in clinical research and the effect of NCDs on women in particular is rarely considered. NCD-related symptoms during pregnancy are commonly misinterpreted or dismissed by clinicians.

NCDs, often referred to as chronic illnesses, are non-transmissible diseases that may be caused by genetic or behavioral factors, and generally have a slow progression and long duration. Those that most significantly affect pregnancy are cardiovascular disease, hypertension, diabetes, cancer, mental health disorders, thyroid disease, and multiple sclerosis.

In The Unseen Side of Pregnancy: Non-Communicable Diseases and Maternal Health, we explore factors contributing to the rising prevalence of NCDs, their effect on women of reproductive age, and potential solutions to address this growing problem.

The world is experiencing an obstetric transition—a shift from maternal deaths due to direct causes, like hemorrhage and infection, to patterns of maternal deaths due to indirect causes, like NCDs. In addition to global trends like urbanization and women having children later in life, behavioral risk factors like chronic stress and tobacco and alcohol use can accelerate the occurrence and consequences of NCDs.

Social determinants, like gender and race, greatly influence maternal health and the impact of chronic illness on pregnancy outcomes. Globally, 90 percent of men and women hold biases against women—biases which contribute to the underrepresentation of women in medical research, poor quality of reproductive and maternal healthcare, and overall gender inequity. These manifest in gender-based violenceanddisrespect and abuse in maternity care. Furthermore, racial and ethnic disparities impede women’s access to quality care in both high- and low-income countries. Systemic factors like lack of health care coverage, an insufficient health workforce, and the misuse of cesarean deliveries increase the under-diagnosis and under-treatment of NCDs during pregnancy and postpartum.

In our report, we outline nine strategies intended to address the impact of NCDs on women. One significant constraint in this report is the limited data available, especially outside of the United States. In publishing this report and these recommendations, we hope this report can be used as a reference to highlight the urgency of the impact of NCDs on maternal health and prompt more investment and research from stakeholders in these areas of health. Addressing this, as well as the strategies below, is crucial to addressing the gaps in research, prevention, and treatment of NCDs and maternal health.

Strategies to address the impact of NCDs on women:

• Integration of primary care, chronic disease, and maternal health providers.
• Increase access to and quality of care at all levels, with a focus on respectful and equitable care for women.
• Invest in and support maternal health workforce – specifically midwives, nurses, and doulas.
• Emphasize the importance of prevention and preconception care.
• Enhanced routine screenings for NCDs before, during, and up to a year after pregnancy.
• Implement global policies to promote healthy behaviors and control marketing of unhealthy products, like tobacco and alcohol.
• Create, pass, and implement protective policies for pregnant women and new mothers.
• Improve research and investment in Strategies 1-7 to better integrate NCD prevention and treatment and maternal, newborn, and child health.
• Increase and improve data collection and analysis.

Non-communicable diseases are too often unseen, undiagnosed, and untreated in women around the world. The consequences of this are catastrophic. It’s time we invest in a more holistic, systemic approach to improving maternal health—one that addresses the global burden of NCDs on maternal mortality and morbidity.