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Table 2 Associations between types of maternal morbidity

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

Type of morbidity Author, date Associations between different types of maternal morbidity
Physical morbidity Shamu
2014 [18]
Positive HIV status was associated with intimate partner violence for pregnant women: partially adjusted OR 1.43: (95%CI: 1.00–2.05).
2017 [26]
In models adjusted for sociodemographic factors and co-morbidities, all postpartum illnesses were associated with an increased relative risk of depressive symptoms in women by 6 months postpartum. These morbidities included uterine prolapse (RR 1.20, 95% CI 1.04–1.39), urinary tract infection (RR 1.24, 95% CI 1.11–1.38), stress related incontinence (RR 1.49, 95% 1.33–1.67), simultaneous stress related incontinence and continuously dripping urine (RR 1.60–2.96), headache [RR 1.20 (95% CI 1.12–1.28)], convulsions (RR 1.67, 95%CI 1.36–2.06), night blindness (RR 1.33, 95% CI 1.19–1.49), anaemia (RR 1.38, 95% CI 1.31–1.46), pneumonia (RR 1.24, 95% CI 1.12–1.37), gastroenteritis (RR 1.24, 95% CI 1.17–1.31) and hepatobiliary disease (RR 2.10, 96% CI 1.69–2.60).
2015 [6]
Multivariate logistic regression showed that for pregnant women in Malawi, after controlling for parity and pregnancy stage, antepartum bleeding increased the odds of psychological morbidity 5-fold (OR: 5.01; 95% CI 1.60, 15.70; p = 0.006). Infective morbidity (i.e. for each additional infective morbidity) showed more than 2.5-fold increase in the odds of having psychological morbidity (OR: 2.58; 95% CI 1.92, 3.47; p = 0.000). For Pakistan, there was a 56% increase in odds of psychological morbidity due to increasing burden of infective morbidity (OR: 1.56; 95% CI 1.36, 1.79; p = 0.000), and 78% increased odds due to increasing burden of non-infective morbidity (OR: 1.78; 95% CI 1.51, 2.11; p = 0.000), when controlling for the effect of complications during previous pregnancy. Complications during previous pregnancy, infective morbidity (p < 0.001), intra or postpartum haemorrhage (p < 0.02) were associated with psychological morbidity in both settings.
Psychological morbidity Faisal-Cury 2009 [16] Obstetric complications were independently associated with common mental disorders in pregnant women.
Faisal-Cury 2010 [15] Common mental disorders during pregnancy were not associated with risk of preterm birth (adjusted OR: 1.03, 95% CI: 0.57–1.88) or low birth weight (adjusted OR: 1.09, 95% CI: 0.62–1.91).
Karmaliana 2009 [19] Psychological distress in pregnant women was associated with husband unemployment (p = 0.032), lower household wealth (p = 0.027), having 10 or more years of formal education (p = 0.002), first (p = 0.002) and unwanted pregnancies (p < 0.001).
Hanlon 2009 [45] Significant associations exist between pregnant women who report intimate partner violence and preterm labour, need for caesarean section, antenatal hospitalization and vaginal bleeding.
Nasreen 2011 [37] Increasing levels of common mental disorder symptoms in pregnant women were associated with prolonged labour (> 24 h) (SRQ 1–5: RR 1.4; 95% CI 1.0–1.9, SRQ > or = 6: RR 1.6; 95% CI 1.0–2.6).
Natasha 2015 [38] There was no association between women with depression and gestational diabetes mellitus or other obstetric factors. However, pregnant women’s level of literacy, poor household economy, poor relationship with husbands, and partner violence showed strong associations with depression and anxiety.
2012 [50]
Unwanted pregnancy, small perceived infant size and stillbirth or neonatal deaths were all independently associated with increased risk of psychological distress in postnatal women. Loss of infants or unwanted pregnancies increased the risk of distress considerably (aORs: 7.06 95% CI: 5.51–9.04 and 1.49, 95% CI: 1.12–1.97).
2016 [47]
For pregnant women with any mental distress, adjusted odds ratios for four or more traumatic events and severe psychological abuse was 3.60 (95% CI 2.08–6.23); for four or more traumatic events and physical abuse 7.03 (95% CI 3.23–15.29); and for four or more traumatic events and severe psychological and physical abuse the adjusted OR was 10.45 (95% CI 6.06–18.01). For pregnant women who reported four or more traumatic events, and either physical abuse alone or in combination with severe psychological abuse, there was a 10-fold increase in depressive and other mental health symptoms.
Ukacukw 2009 [28] After multivariable adjustment, intimate partner violence intensity had a strong and statistically significant association with depression symptom severity for pregnant women.
2015 [41]
Results of unadjusted log-binomial regression showed that unwanted pregnancy, prenatal depression and social support were associated with low birth weight.
2017 [42]
Inferential analysis revealed that higher HADS scores were significantly associated with lower social support scores, rural background, history of harassment, abortion, caesarean birth and unplanned pregnancies (P < .05).
Social morbidity Hassan 2014 [44] A significant association was found between pregnant women reporting intimate partner violence and preterm labour [adjusted odds ratio (adjOR) 1.54, 95% confidence interval (CI) 1.16–2.03], caesarean section (adjOR 11.84, 95% CI 6.37–22.02), antenatal hospitalization (adjOR 6.34, 95% CI 3.82–10.52) and vaginal bleeding (adjOR 1.51, 95% CI 0.9–2.3).
2011 [46]
Maternal complications were higher in pregnant women who experienced violence (30.2% vs 23.6%, p = 0.004). Pregnant women who experienced sexual violence had more maternal complications (43.2%), and pregnant women who experienced psychological violence had more neonatal complications (54.2%).
Stöckl 2010 [48] Women’s odds of drinking alcohol during pregnancy were significantly increased if they had experienced violence during pregnancy. Violence during pregnancy was also associated with having had a child or infant that died.