Non-communicable diseases are quietly reshaping maternal health and pregnancy outcomes worldwide

Non-communicable diseases have become one of the most underestimated forces in modern obstetrics. According to an editorial published in Frontiers in Global Women’s Health by Karin Windsperger, Johanna Alexopoulos, Nadja Taumberger and Christian Göbl of the Medical University of Vienna and Barmherzige Brüder Hospital Graz, chronic conditions that were once considered peripheral to maternal care now account for a substantial share of pregnancy-related illness and death. The figures are sobering: non-communicable diseases are responsible for approximately 18 million deaths among women of reproductive age and an estimated 30.3 million disability-adjusted life years. As infectious causes of maternal mortality recede in many regions, chronic diseases are stepping into the vacuum, and the World Health Organization now lists hemorrhage as the leading cause of maternal death, followed closely by indirect causes, a category that increasingly includes non-communicable diseases.

The scope of the problem is broader than most clinical definitions allow. The editorial points out that no standardized definition of non-communicable diseases in pregnancy has ever been established, which leaves the term covering an unruly spectrum of conditions: cardiovascular disease, obesity, diabetes, thyroid disease, malignancies, multiple sclerosis and mental health disorders, among others. Each of these interacts with pregnancy in its own way. The physiological demands of gestation, with its dramatic increases in cardiac output, insulin resistance and inflammatory load, can modify the course of a pre-existing chronic condition, while the underlying disease can, in turn, raise the risk of adverse pregnancy outcomes. The implications do not end at delivery. The editorial emphasizes that the effects of maternal chronic disease may extend across the maternal life course and shape the development and long-term health of the child, making pregnancy a critical window for interventions that could benefit two generations.

One of the most striking contributions to the Research Topic comes from Yan and colleagues, who examined the impact of fine particulate matter, known as PM2.5, on maternal health in a large cohort study. Air pollution is rarely discussed in the context of pregnancy complications, yet the findings add to growing evidence that PM2.5 exposure may affect multiple organ systems, including the cardiovascular, respiratory, nervous, immune and renal systems. In particular, the authors demonstrated an association between PM2.5 exposure and alterations in serum creatinine, a key marker of renal function, suggesting that polluted air may quietly impair the kidneys of pregnant women. This work reinforces a concept that the editorial argues is essential for the field: the burden of non-communicable diseases cannot be understood solely through individual-level risk factors such as diet or exercise, but must be considered within the broader context of environmental and global determinants of health.

Metabolic dysfunction before and during pregnancy is another area where the science is advancing rapidly. Pre-pregnancy obesity and metabolic dysfunction are closely associated with an increased risk of gestational diabetes mellitus, a condition that complicates a significant proportion of pregnancies and carries risks for both mother and fetus. Zhao and colleagues provide further insight into early metabolic risk stratification in their large prospective cohort study, demonstrating that the triglyceride-glucose index, a simple calculated marker of insulin resistance, measured in the first trimester was independently associated with the subsequent development of gestational diabetes. The beauty of this finding lies in its practicality: the triglyceride-glucose index can be derived from routine blood tests, meaning that clinicians could identify women at increased risk months before symptoms appear and intervene with lifestyle modifications or closer monitoring. Such findings highlight how non-communicable diseases can complicate pregnancy, making the early identification of women at increased risk a clinical priority.

The bidirectional relationship between pregnancy and chronic disease remains one of the most poorly understood areas in maternal health. The editorial notes that pregnancy itself may exacerbate underlying chronic conditions, but evidence on this dynamic is limited and appears to vary across different disease entities. In some cases, the immune and hormonal shifts of gestation may ameliorate a condition, while in others they may accelerate it. This uncertainty has real consequences for clinical care, because women with chronic conditions are often left without clear guidance on how their disease might evolve during pregnancy or how their pregnancy might evolve because of their disease. The editorial calls for an integrated approach to prevention, recognition and management across the reproductive life course, arguing that the current fragmented model, in which obstetricians and medical specialists operate in parallel rather than together, is no longer adequate for the scale of the problem.

The impact of maternal chronic disease may extend beyond maternal health and pregnancy complications to the developing fetus. In their narrative review, Sui and colleagues examine the relationship between maternal circulatory, endocrine and metabolic, infectious, and autoimmune diseases and the development of cleft lip and palate in newborns. Cleft lip and palate are among the more common congenital anomalies, although their prevalence varies considerably across populations. By bringing together evidence on diverse maternal disease pathways, the review illustrates the complex interplay between maternal health and fetal development. Importantly, the effects of non-communicable diseases such as obesity may extend beyond fetal development, with potential long-term health consequences for the offspring, a phenomenon researchers describe as intergenerational transmission of risk. Pregnancy therefore represents an important window during which maternal health may shape health outcomes across generations, a concept that reframes maternal care as an investment in the health of the next generation.

Chronic conditions can also influence the course and outcome of delivery itself. In a retrospective cohort study, Zhuang and colleagues investigated hypothyroidism and severe postpartum hemorrhage, finding that overt hypothyroidism was significantly associated with an increased risk of severe postpartum hemorrhage, whereas no significant association was observed for subclinical hypothyroidism. Age and a history of radiation exposure appeared to modify this relationship, with a stronger association observed among women younger than 35 years. These findings underscore the importance of considering chronic maternal conditions not only in antenatal risk assessment but also in the planning and management of childbirth and the postpartum period. They also reveal how the severity of a chronic condition, rather than its mere presence, may determine the risk it poses during delivery, a distinction that could refine how clinicians stratify patients in the delivery room.

While common non-communicable diseases account for a substantial proportion of the disease burden in pregnancy, less prevalent chronic conditions should not be overlooked. Deng and colleagues draw attention to a particularly rare and challenging group of disorders, pheochromocytomas and paragangliomas, through a bibliometric analysis of the existing literature. These tumors of the adrenal and sympathetic nervous system can release surges of catecholamines that threaten both mother and fetus, and their rarity makes them exceptionally difficult to diagnose during pregnancy, where symptoms may be mistaken for preeclampsia or other common complications. The analysis highlights the diagnostic and therapeutic challenges associated with these tumors during pregnancy, as well as the continued focus on pregnancy-related complications and clinical management. The rarity and complexity of these conditions make multidisciplinary collaboration particularly important and emphasize the need for clear clinical management pathways to ensure timely diagnosis and coordinated care for affected women.

Taken together, the contributions to this Research Topic illustrate the remarkable breadth of the intersection between non-communicable diseases and pregnancy, from the prevention and identification of risk factors to their effects on pregnancy and delivery and their potential consequences for maternal and fetal health. Moving the field forward will require not only improved understanding of these complex interactions but also the development of multidisciplinary clinical pathways and evidence-based guidelines that integrate obstetric care with expertise from relevant medical specialties. Such approaches are essential to ensure that women with chronic conditions receive timely, coordinated and individualized care before conception, throughout pregnancy and beyond. As the global burden of chronic disease continues to rise, the editorial makes clear that the future of maternal health will depend on how well the medical community learns to see pregnancy not as an isolated event but as a chapter in the longer story of a woman’s health, and as a decisive influence on the health of her child.

Subject of Research: Editorial: The impact of non-communicable diseases on maternal health and pregnancy outcomes

Article Title: Editorial: The impact of non-communicable diseases on maternal health and pregnancy outcomes

Article References: Windsperger, K., Alexopoulos, J., Taumberger, N., & Göbl, C. (2026). Editorial: The impact of non-communicable diseases on maternal health and pregnancy outcomes. Frontiers in Global Women's Health, 7, Article 1975383. https://doi.org/10.3389/fgwh.2026.1975383

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1975383

Keywords: Editorial, impact, non-communicable, diseases, maternal, health, pregnancy, outcomes, scientific research