Department of Medicine, Brown University, Providence, RI, USA.
Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica.
Int J Gynaecol Obstet. 2018 May;141 Suppl 1(Suppl Suppl 1):61-68. doi: 10.1002/ijgo.12469.
The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to promoting women's health and wellness. A critical focus of this trajectory includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable diseases (NCD) among pregnant women. The WHO convened the Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining, measuring, and monitoring maternal morbidity. Based on the MMWG's work, we propose paradigms for conceptualizing maternal health and related interventions, and call for greater integration between maternal health and NCD programs. This integration can be synergistic, given the links between chronic conditions, morbidity in pregnancy, and long-term health. Pregnancy should be viewed as a window of opportunity into the current and future health of women, and offers critical entry points for women who may otherwise not seek or have access to care for chronic conditions. Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions, and integration with existing services. Health systems need to respond by prioritizing funding for developing integrated health programs, and workforce strengthening. The MMWG's efforts have highlighted the changing landscape of maternal health, and the need to expand the narrow focus of maternal health, moving beyond surviving to thriving.
孕产妇健康议程正在经历从预防孕产妇死亡到促进妇女健康和健康的范式转变。这一转变的一个关键焦点包括解决孕产妇发病率问题,以及孕妇中慢性和非传染性疾病(NCD)负担的增加。世卫组织召集了孕产妇发病率工作组(MMWG),以改善定义、衡量和监测孕产妇发病率的科学基础。基于 MMWG 的工作,我们提出了概念化孕产妇健康和相关干预措施的范例,并呼吁在孕产妇健康和非传染性疾病方案之间加强整合。鉴于慢性病、妊娠期间的发病率和长期健康之间的联系,这种整合可以产生协同作用。怀孕应该被视为了解当前和未来妇女健康的机会之窗,并为那些可能不会寻求或获得慢性病护理的妇女提供关键的切入点。孕产妇保健服务应超越对紧急产科护理的关注,采取更广泛的方法,包括预防和早期干预,并与现有服务相结合。卫生系统需要通过优先为制定综合卫生方案和加强劳动力提供资金来做出回应。MMWG 的努力突显了孕产妇健康状况的变化,需要扩大孕产妇健康的狭义关注,从生存转向繁荣。