Maternal multimorbidity during pregnancy and after childbirth in women in low- and middle-income countries: a systematic literature review.

Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Multimorbidity*; Developing Countries/*statistics & numerical data ; Maternal Health/*statistics & numerical data ; Pregnancy Complications/*epidemiology ; Puerperal Disorders/*epidemiology; Female ; Humans ; Maternal Mortality ; Pregnancy

Background: For every maternal death, 20 to 30 women are estimated to have morbidities related to pregnancy or childbirth. Much of this burden of disease is in women in low- and middle-income countries. Maternal multimorbidity can include physical, psychological and social ill-health. Limited data exist about the associations between these morbidities. In order to address all health needs that women may have when attending for maternity care, it is important to be able to identify all types of morbidities and understand how each morbidity influences other aspects of women's health and wellbeing during pregnancy and after childbirth.
Methods: We systematically reviewed published literature in English, describing measurement of two or more types of maternal morbidity and/or associations between morbidities during pregnancy or after childbirth for women in low- and middle-income countries. CINAHL plus, Global Health, Medline and Web of Science databases were searched from 2007 to 2018. Outcomes were descriptions, occurrence of all maternal morbidities and associations between these morbidities. Narrative analysis was conducted.
Results: Included were 38 papers reporting about 36 studies (71,229 women; 60,911 during pregnancy and 10,318 after childbirth in 17 countries). Most studies (26/36) were cross-sectional surveys. Self-reported physical ill-health was documented in 26 studies, but no standardised data collection tools were used. In total, physical morbidities were included in 28 studies, psychological morbidities in 32 studies and social morbidities in 27 studies with three studies assessing associations between all three types of morbidity and 30 studies assessing associations between two types of morbidity. In four studies, clinical examination and/or basic laboratory investigations were also conducted. Associations between physical and psychological morbidities were reported in four studies and between psychological and social morbidities in six. Domestic violence increased risks of physical ill-health in two studies.
Conclusions: There is a lack of standardised, comprehensive and routine measurements and tools to assess the burden of maternal multimorbidity in women during pregnancy and after childbirth. Emerging data suggest significant associations between the different types of morbidity.
Systematic Review Registration Number: PROSPERO CRD42018079526.

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202945-1010 Department for International Development; 20168770 Global Fund to Fight AIDS, Tuberculosis and Malaria; EGA Hospital Charity Travelling Fellowship in Memory of Anne Boutwood Royal College of Obstetricians and Gynaecologists

Keywords: Burden of disease; Data collection; Low- and middle-income countries; Maternal morbidity; Measurement; Multimorbidity; Pregnancy and childbirth

Date Created: 20201021 Date Completed: 20210517 Latest Revision: 20210517

20231215

PMC7574312

10.1186/s12884-020-03303-1

33081734