Maternal Multimorbidity During Pregnancy and After Childbirth in Women in Low- and Middle-Income Countries: A Systematic Literature Review

Abstract

Background For every maternal death, 20 to 30 women are estimated to have morbidity 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 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 2007-2018. Outcomes were descriptions, occurrence of all maternal morbidities, and associations between these morbidities. Narrative analysis was conducted. Results 38 papers reporting about 36 studies were included (71,229 women; 60,911 during and 10,318 after pregnancy from 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 morbidity was included in 28 studies; psychological morbidity in 32 studies and social morbidity 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 morbidity were reported in four studies and between psychological and social morbidity in six. Domestic violence increased risks of physical ill-health in two studies. Conclusions Lack of standardised, comprehensive and routine measurements and tools exist 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.