Pregnancy and the global disease burden

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Abstract

Pregnant women experience unique physiological changes pertinent to the effective prevention and treatment of common diseases that affect their health and the health of their developing fetuses. In this paper, the impact of major communicable (HIV/AIDS, tuberculosis, malaria, helminth infections, emerging epidemic viral infections) as well as non-communicable conditions (mental illness, substance abuse, gestational diabetes, eclampsia) on pregnancy is discussed. The current state of research involving pregnant women in these areas is also described, highlighting important knowledge gaps for the management of key illnesses that impact pregnancy globally.

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Global estimates of the prevalence of hyperglycaemia in pregnancy.

L Guariguata, U Linnenkamp, J Beagley … (2014)

We estimated the number of live births worldwide and by IDF Region who developed hyperglycaemia in pregnancy in 2013, including total diabetes in pregnancy (known and previously undiagnosed diabetes) and gestational diabetes. Studies reporting prevalence of hyperglycaemia first-detected in pregnancy (formerly termed gestational diabetes) were identified using PubMed and through a review of cited literature. A simple scoring system was developed to characterise studies on diagnostic criteria, year study was conducted, study design, and representation. The highest scoring studies by country with sufficient detail on methodology for characterisation and reporting at least three age-groups were selected for inclusion. Forty-seven studies from 34 countries were used to calculate age-specific prevalence of hyperglycaemia first-detected in pregnancy in women 20-49 years. Adjustments were then made to account for heterogeneity in screening method and blood glucose diagnostic threshold in studies and also to align with recently published diagnostic criteria as defined by the WHO for hyperglycaemia first detected in pregnancy. Prevalence rates were applied to fertility and population estimates to determine regional and global prevalence of hyperglycaemia in pregnancy for 2013. An estimate of the proportion of cases of hyperglycaemia in pregnancy due to total diabetes in pregnancy was calculated using age- and sex-specific estimates of diabetes from the IDF Diabetes Atlas and applied to age-specific fertility rates. The global prevalence of hyperglycaemia in pregnancy in women (20-49 years) is 16.9%, or 21.4 million live births in 2013. An estimated 16.0% of those cases may be due to total diabetes in pregnancy. The highest prevalence was found in the South-East Asia Region at 25.0% compared with 10.4% in the North America and Caribbean Region. More than 90% of cases of hyperglycaemia in pregnancy are estimated to occur in low- and middle-income countries. These are the first global estimates of hyperglycaemia in pregnancy and conform to the new WHO recommendations regarding diagnosis and also include estimates of live births in women with known diabetes. They indicate the importance of the disease from a public health and maternal and child health perspective, particularly in developing countries. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008.

Allen Mitchell, Suzanne M. Gilboa, Martha M. Werler … (2011)

The objective of the study was to provide information on overall medication use throughout pregnancy, with particular focus on the first trimester and specific prescription medications. The study design included the Slone Epidemiology Center Birth Defects Study, 1976-2008, and the National Birth Defects Prevention Study, 1997-2003, which together interviewed more than 30,000 women about their antenatal medication use. Over the last 3 decades, first-trimester use of prescription medication increased by more than 60%, and the use of 4 or more medications more than tripled. By 2008, approximately 50% of women reported taking at least 1 medication. Use of some specific medications markedly decreased or increased. Prescription medication use increased with maternal age and education, was highest for non-Hispanic whites, and varied by state. These data reflect the widespread and growing use of medications by pregnant women and reinforce the need to study their respective fetal risks and safety. Copyright © 2011 Mosby, Inc. All rights reserved.

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Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review.

Caitlin Jarrett, Heidi Larson, Rose Wilson … (2015)

Maternal vaccination has been evaluated and found to be extremely effective at preventing illness in pregnant women and new-borns; however, uptake of such programmes has been low in some areas. To analyse factors contributing to uptake of vaccines globally, a systematic review on vaccine hesitancy was carried out by The Vaccine Confidence Project in 2012. In order to further analyse factors contributing to uptake of maternal immunisation, a further search within the broader systematic review was conducted using the terms 'Pregnan*' or 'Matern*'. Forty-two articles were identified. Pregnancy-related articles were further screened to identify those focused on concerns, trust and access issues regarding maternal vaccination reported by pregnant women and healthcare workers. Thirty-five relevant articles were included which were then searched using the snowballing technique to identify additional relevant references cited in these articles. A search alert was also conducted from February to April 2015 in PubMed to ensure that no new relevant articles were missed. A total of 155 relevant articles were included. Most of the literature which was identified on hesitancy surrounding vaccination during pregnancy reports on determinants of influenza vaccine uptake in North America. Research conducted in low-income countries focused primarily on tetanus vaccine acceptance. The main barriers cited were related to vaccine safety, belief that vaccine not needed or effective, not recommended by healthcare worker, low knowledge about vaacines, access issues, cost, conflicting advice. From the point of view of healthcare workers, barriers included inadequate training, inadequate reimbursement and increased workload. Twenty-seven out of 46 (59%) articles mentioning ethnicity reported lower rates of coverage among ethnic minorities. Barriers to vaccination in pregnancy are complex and vary depending on context and population. There are wide gaps in knowledge regarding the attitudes of healthcare workers and how ethnicity and gender dynamics influence a pregnant woman's decision to vaccinate.

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Barbara J. Sina: sinab@mail.nih.gov

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Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 14 December 2017

Publication date PMC-release: 14 December 2017

Publication date Collection: 2017

Volume: 14

Issue : Suppl 3 Issue sponsor : Publication of this supplement has been funded by the Wellcome Trust. The articles have undergone the journal's standard peer review process for supplements. The Supplement Editors would like to acknowledge the work of Katherine Littler and Adrienne Hunt, Wellcome Trust, to make this issue possible, and we would like to thank Maureen Kelley, Ethox Centre, and Joe Millum, National Institutes of Health, for their work in supporting the development of the case studies included in this Supplement. The Supplement Editors declare no competing interests.

Electronic Location Identifier: 170

Affiliations

ISNI 0000 0004 0533 8254, GRID grid.453035.4, Fogarty International Center, National Institutes of Health, ; Bethesda, MD USA

Article

Publisher ID: 420

DOI: 10.1186/s12978-017-0420-4

PMC ID: 5751688

PubMed ID: 29297407

SO-VID: 37cdbb89-0c6d-4240-a4ab-dbaf6950b868

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Conference name: Global Forum on Bioethics in Research (GFBR)’s “Ethics of Research in Pregnancy” meeting

Conference location: Buenos Aires, Argentina

Conference date: 03-04 November 2016

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pregnancy,ethics,research,infections,non-communicable

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pregnancy, ethics, research, infections, non-communicable

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Pregnancy and the global disease burden

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Most cited references 12

Global estimates of the prevalence of hyperglycaemia in pregnancy.

Medication use during pregnancy, with particular focus on prescription drugs: 1976-2008.

Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review.

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