Epidemiology of pre-existing multimorbidity in pregnant women in the UK in 2018: a population-based cross-sectional study

Siang Lee, Amaya Azcoaga-Lorenzo, Utkarsh Agrawal, Jonathan Ian Kennedy, Adeniyi Francis FAGBAMIGBE, Holly F Hope, Anuradhaa Subramanian, Astha Anand, Beck Taylor, Catherine Nelson-Piercy, Christine DAMASE-MICHEL, Christopher Yau, Francesca Crowe, Gillian SANTORELLI, Kelly-Ann Eastwood, Zoe VOWLES, Maria LOANE, Ngawai Moss, Peter Brocklehurst, Rachel PlachcinskiShakila Thangaratinam, Mairead Black, Dermot O'Reilly, Kathryn Mary Abel, Sinead Brophy, Krishnarajah Nirantharakumar, Colin McCowan, on behalf of the MuM-PreDiCT Group

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Abstract

Background
Although maternal death is rare in the United Kingdom, 90% of these women had multiple health/social problems. This study aims to estimate the prevalence of pre-existing multimorbidity (two or more long-term physical or mental health conditions) in pregnant women in the United Kingdom (England, Northern Ireland, Wales and Scotland).

Study design
Pregnant women aged 15-49 years with a conception date 1/1/2018 to 31/12/2018 were included in this population-based cross-sectional study, using routine healthcare datasets from primary care: Clinical Practice Research Datalink (CPRD, United Kingdom, n=37,641) and Secure Anonymized Information Linkage databank (SAIL, Wales, n=27,782), and secondary care: Scottish Morbidity Records with linked community prescribing data (SMR, Tayside and Fife, n=6,099). Pre-existing multimorbidity preconception was defined from 79 long-term health conditions prioritised through a workshop with patient representatives and clinicians.

Results
The prevalence of multimorbidity was 44.2% (95% CI 43.7%-44.7%), 46.2% (45.6%-46.8%) and 19.8% (18.8%-20.8%) in CPRD, SAIL and SMR respectively. When limited to health conditions that were active in the year before pregnancy, the prevalence of multimorbidity was still high (24.2% [23.8%-24.6%], 23.5% [23.0%-24.0%] and 17.0% [16.0% to 17.9%] in the respective datasets). Mental health conditions were highly prevalent and involved 70% of multimorbidity CPRD: multimorbidity with ≥one mental health condition/s 31.3% [30.8%-31.8%]).
After adjusting for age, ethnicity, gravidity, index of multiple deprivation, body mass index and smoking, logistic regression showed that pregnant women with multimorbidity were more likely to be older (CPRD England, adjusted OR 1.81 [95% CI 1.04-3.17] 45-49 years vs 15-19 years), multigravid (1.68 [1.50-1.89] gravidity ≥ five vs one), have raised body mass index (1.59 [1.44-1.76], body mass index 30+ vs body mass index 18.5-24.9) and smoked preconception (1.61 [1.46-1.77) vs non-smoker).

Conclusion
Multimorbidity is prevalent in pregnant women in the United Kingdom, they are more likely to be older, multigravid, have raised body mass index and smoked preconception. Secondary care and community prescribing dataset may only capture the severe spectrum of health conditions. Research is needed urgently to quantify the consequences of maternal multimorbidity for both mothers and children.
Original languageEnglish
Article number120
Number of pages15
JournalBMC pregnancy and childbirth
Volume22
DOIs
Publication statusPublished - 11 Feb 2022

Bibliographical note

Funding Information:
This work was funded by the Strategic Priority Fund “Tackling multimorbidity at scale” programme (grant number MR/W014432/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council. BT was funded by the National Institute for Health Research (NIHR) West Midlands Applied Research Collaboration. AA and SIL were funded as NIHR Academic Clinical Fellows. The views expressed are those of the author and not necessarily those of the funders, the NIHR or the UK Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding Information:
We would like to thank our patient and public involvement representatives for their input with this study; the academic clinicians in the THINKING group for creating the Read Code lists that are not available from the literature; Professor Helen Dolk (Ulster University) for her feedback on the manuscript and Krishna Margadhamane Gokhale and Alecsandru Vitoc (University of Birmingham) for data extraction. Our patient representatives comprised of two patient and public (PPI) co-investigators and a PPI advisory group of six women with lived experience of multimorbidity and pregnancy, with various long-term conditions. They were involved with selecting the 79 long-term health conditions used to define multimorbidity. They were also involved in interpreting the results, in particular, they noted that prevalent conditions may be on the milder spectrum and do not necessarily require specialist antenatal care. This led to additional analysis on health conditions that were leading causes of maternal death in the MBRRACE report [4]. Their feedback shaped how we presented and disseminated our findings to the public, including choosing the terminology of describing multimorbidity that they were comfortable with (two or more long-term conditions). Finally, our PPI co-investigators contributed to the preparation of this manuscript.

Publisher Copyright:
© 2022, The Author(s).

Keywords

  • Epidemiology
  • Maternity
  • Multimorbidity
  • Multiple chronic conditions
  • Multiple long-term conditions
  • Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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