Comorbidities among women presenting for obstetric care in Uganda.

BACKGROUND

Maternal mortality rates are high in low- and middle-income countries, with Uganda’s ratio at 189 deaths per 100,000 live births. Non-communicable diseases (NCDs) account for 15% of indirect maternal deaths worldwide. We examined medical comorbidities during pregnancy at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda.

METHODS

We conducted a cross-sectional study at MRRH from January to December 2022. Each month, we randomly selected 200 women admitted to the obstetrics department and extracted data on sociodemographic characteristics and diagnoses. We summarised the prevalence and distribution of medical comorbidities using frequencies and percentages. We performed multivariable logistic regression to identify factors associated with non-pregnancy-related medical comorbidities.

RESULTS

We enrolled 2,336 women over 12 months with a mean age of 26 ± 5.9 years. Of these, 16.6% (n = 387) had ≥ 1 non-pregnancy-related comorbidity: 6.4% (n = 149) had NCDs, and 11.2% (n = 261) had an infectious comorbidity. NCDs included anaemia, 77 (3.3%); chronic hypertension, 35 (1.5%); pre-gestational diabetes, 16 (0.7%); asthma, 9 (0.4%); and cardiac disease, 6 (0.3%). Infectious comorbidities included HIV, 207 (8.9%); severe malaria, 50 (2.1%); tuberculosis, 7 (0.3%); and COVID-19, 4 (0.2%). Two hundred ninety-six (12.7%) women had ≥ 1 pregnancy-related comorbidity, 11.3% (n = 265) had pre-eclampsia/eclampsia, 10 (0.5%) had venous thromboembolic disease, and 5 (0.2%) had gestational diabetes. Factors associated with non-pregnancy-related comorbidities included maternal age over 34 years (adjusted odds ratio [aOR] = 2.56, 95%CI: 1.16, 5.62), 2–4 prior deliveries (aOR = 1.62, 95%CI: 1.08, 2.42) or grand multiparity (aOR = 2.08, 95%CI: 1.21, 3.59), being unmarried (aOR = 5.63, 95%CI: 1.93, 16.43), and alcohol use (aOR = 3.75, 95%CI: 1.45, 9.70).

CONCLUSIONS

NCDs are common among women admitted for delivery in Uganda. They are associated with advanced maternal age, increasing parity, alcohol use and unmarried status. Clinicians at all healthcare levels, should be aware of these possible underlying conditions and promptly diagnose them. This study highlights a high burden of NCDs, even among younger people, in low-resource regions and calls for further study of the impact of such conditions on pregnancy and childbirth.