Impact of non-communicable diseases on maternal and perinatal outcomes in a low resource setting

Abstract

Background: Non-communicable diseases (NCDs) are increasingly prevalent among women of reproductive age and may pose significant risks to maternal and perinatal health. Despite their growing burden, data on their impact in low-resource settings remains limited. This study aimed to investigate the impact of pre-pregnancy NCDs on severe maternal and adverse perinatal outcomes among pregnant women admitted at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods: We prospectively enrolled pregnant women admitted to the maternity ward of MRRH from July 2022 to October 2023. We consecutively included all women with one or more NCDs and next two admissions without NCDs. Baseline sociodemographic and clinical documentation of pre-pregnancy NCDs including chronic hypertension, pre-gestational diabetes, cardiac disease, chronic kidney disease, sickle cell disease, asthma, and epilepsy. Participants were followed from admission through delivery, puerperium, and post-discharge with phone calls at 2, 4, and 6 weeks, and severe maternal and adverse perinatal outcomes were documented. We compared outcomes between women with and without NCDs and performed multivariable logistic regression analyses to determine the association between NCDs and these outcomes, adjusting for potential confounders, including maternal age, gravidity, employment status, HIV serostatus and delivery mode. Results: We enrolled a cohort of 300 pregnant women (100 with NCDs and 200 without NCDs) with a mean age of 27.8 ± 5.9 years. Severe maternal outcomes occurred in 80/300 participants (26.7%), with a significantly higher incidence among those with NCDs (36.0%, n = 36/100) compared to those without (22.0%, n = 44/200), including maternal death (4.0%, n = 4 vs. 0.5%, n = 1), acute heart failure (7.0%, n = 7 vs. 0%), ICU admission (9.0%, n = 9 vs. 2.0%, n = 4), pulmonary embolism (4.0%, n = 4 vs. 0%) and sepsis (7.0%, n = 7 vs. 1.0%, n = 2). At least one adverse perinatal outcome occurred in most participants (52.7%, n = 158/300). Women with NCDs also experienced significantly higher rates of adverse perinatal outcomes (69.0%, n = 69/100) than those without NCDs (44.5%, n = 89/200), including miscarriage (11.0%, n = 11 vs. 1.0%, n = 2), neonatal death (11.5%, n = 9 vs. 4.5%, n = 8), and NICU admission (48.7%, n = 38 vs. 20.3%, n = 36). In multivariable analysis, having one or more pre-pregnancy NCD (adjusted odds ratio [aOR]: 2.02, 95% CI [1.10, 3.68]) and attending fewer than four antenatal care (ANC) visits (aOR: 2.25, 95% CI [1.26, 4.04]) were significantly associated with increased risk of both severe maternal and adverse perinatal outcomes (NCDs: aOR: 2.39, 95% CI [1.34, 4.26];< 4 ANC visits: aOR: 1.95, 95% CI [1.12, 3.38]). Conclusions Pre-pregnancy NCDs and inadequate antenatal care are linked to severe maternal and adverse perinatal outcomes. Strengthening early identification, integrating NCD management into routine maternal care, and ensuring adequate antenatal visit coverage are critical to mitigating these risks. These findings underscore the need for targeted, multidisciplinary interventions to improve outcomes in resource-limited settings.