Chronic Health Issues Raise the Odds of Preterm and Low Birth Weight Babies

Ruth Nimota Nukpezah, PhD

University for Development Studies

A study conducted in northern Ghana found that women with preexisting chronic conditions—such as sickle cell disease, hypertension, diabetes, asthma and heart disease—face significantly higher risks of adverse birth outcomes.

Among the cohort of postpartum women, 31.2% had chronic conditions, which increased the likelihood of preterm birth (PTB), low birth weight (LBW), and the co-occurrence of both. Results highlight a gap in prenatal care and investigators suggest preconception care could help mitigate these risks and improve outcomes for mothers and newborns.

“The incidence of chronic diseases, which are significant contributors to maternal deaths and adverse newborn outcomes, is increasing among women of reproductive age in northern Ghana,” wrote a team of investigators led by Ruth Nimota Nukpezah, PhD, associated with the School of Nursing and Midwifery at the University for Development Studies in Tamale, Ghana. “This emerging health issue raises serious concerns about the potential exacerbation of adverse birth outcomes in this setting, given that it is one of the regions in the country with a high incidence of such outcomes.”

Although healthcare continues to improve on a global level, chronic diseases, including hypertension, respiratory issues and sickle cell disease, can still pose a significant threat to maternal health and negatively impact pregnancy outcomes, including premature delivery and low birth weight. Previous research has indicated women with chronic conditions experience a substantially higher incidence of these adverse events, particularly in regions with limited resources, including Ghana.

To evaluate the risks of PTB and LBW, as well as concurrent PTB and LBW among women with preexisting chronic conditions prior to conception, investigators conducted a facility-based cross-sectional study of 420 randomly-selected postpartum women living in the Tamale Metropolis of Ghana.

Self-reported information was collected electronically and included their experience of chronic conditions prior to their most recent pregnancy, gestational age at delivery and birth weight. Additionally, as sociodemographic, obstetric and healthcare-related factors can also impact birth outcomes, investigators considered confounding influences including education, the number of pregnancies and births, antenatal care utilization, iron and folic acid supplementation, and the healthcare facility visited.

Approximately half (52.6%) of participants were aged 25 – 34 years, 33.6% received basic education, 69.3% were employed and 89.8% were in a relationship. Most (77.6%) women received iron and folic acid supplements. The most common chronic conditions were hypertension (12.4%), diabetes (7.6%) and sickle cell disease (4.8%).

Among the one-third of participants with chronic diseases, 28.6% had a single condition and 2.6% reported concurrent chronic conditions. Approximately one out of 4 mothers experienced a PTB and 27.6% of newborns were born LBW. A total of 17.4% of pregnancies resulted in both PTB and LBW. Even after accounting for confounders, the strong association between chronic diseases and PTB and/or LBW remained.

Women with chronic conditions prior to conception demonstrated an increased risk of PTB, LBW or concurrent PTB and LBW when compared with participants without chronic conditions.

“Our study highlights the burden of chronic conditions, particularly noncommunicable diseases such as hypertension and diabetes, which are increasing in prevalence, among women prior to conception,” investigators wrote. “Managing these conditions during pregnancy will pose further challenges to our already constrained healthcare system. Addressing the needs of pregnant women with preexisting medical conditions requires targeted interventions, including strengthening health systems, integrating chronic disease management into maternal health services, and improving access to medications and support.”