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

Siang Ing Lee, Amaya Azcoaga-Lorenzo, Utkarsh Agrawal, Jonathan I. Kennedy, Adeniyi Fagbamigbe, Holly 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 M. Abel, Sinead Brophy, Krishnarajah Nirantharakumar*, Colin McCowan, MuM-PreDiCT Group

*Corresponding author for this work

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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 = 6099). 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

Keywords

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

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