Abstract
IntroductionA large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women.MethodsA systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.ResultsMaternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33).ConclusionWhile prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women’s psychological health problems are urgently needed to combat this leading cause of morbidity.
Highlights
A large proportion of women around the world suffer from chronic diseases including mental health diseases
This paper systematically reviewed all the literature published up to 2011 to identify studies describing the effectiveness of preconception interventions and risks for preventing and managing chronic diseases and promoting psychological health for improved maternal, newborn and child health (MNCH) outcomes
The prevalence of Type 2 diabetes continues to increase worldwide [15,16], especially in the low and middle income countries (LMICs) [17,18]. This in turn means more women of reproductive age in LMICs have diabetes, a greater number of pregnancies are complicated by the condition [19,20] putting both the mother and the fetus at an increased risk of morbidity and mortality [21]
Summary
A large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women. 60 million women of reproductive age have type-2 diabetes [1]. While diabetes has known macro- and micro-vascular complications, this increasing prevalence in women of reproductive age makes it a serious health concern for those to-be mothers and their newborns. Diabetes during pregnancy is associated with increased risk for miscarriages, stillbirth, macrosomia and obstetric complications, intrauterine. Thyroid disease is another prominent chronic illness in women of child-bearing age, second only to diabetes. The most favorable period to achieve control is before conception
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