Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data

Background: Multimorbidity in pregnancy increases health risks to women and babies, and creates challenges for services. The aim of this study was to explore the prevalence and patterns of maternal multimorbidity in a UK population.

Methods: This population-based, retrospective study used individual-level, linked, routinely collected health data accessed via The Health and Social Care Northern Ireland Business Service Organisation Honest Broker Service within a Trusted Research Environment following the Five Safes Framework. Pregnancy episodes were ascertained from the Northern Ireland Regional Maternity Service Database and linked via unique Health and Care Number to secondary care diagnoses and primary care medications. Yearly prevalence (2012-2020) of multimorbidity (≥ 2 physical or mental health conditions) and complex multimorbidity (involvement of ≥ 3 organ systems) were calculated for the full cohort and stratified by age, deprivation, body mass index (BMI) and gravida. Cross-sectional analyses of prevalence and exploration of unique combinations of conditions and organ system involvement across strata were performed during a period of stability in detection rates (2014-2019).

Results: The annual number of pregnancies ranged from n = 24,403 (2012) to n = 19,504 (2020). Prevalence of maternal multimorbidity ranged from 18.2% (95%CI: 17.7-18.7%) (2012) to 22.8% (95% CI: 22.3-23.4%) (2016) and mostly involved coexistence of physical and mental health conditions (range: 13.0-17.4%). Complex multimorbidity ranged from 4.0% (2012) to 6.1% (2017). The mental health system demonstrated the highest prevalence compared to all other organ systems (range: 18.6-26.2%). Multimorbidity was higher at extremes of maternal age (< 25y: 24.15%; 25-34y: 21.20%; ≥ 35y: 23.39%), and increased with deprivation (least deprived:19.61%; most deprived:25.78%), BMI (healthy: 18.37%; obesity III: 39.18%), and gravida (first pregnancy: 19.18%; ≥ 5 pregnancies: 30.69%). Mental health multimorbidity most impacted the youngest group (< 25y: 4.60%; 25-34y: 1.36%; ≥ 35y: 0.85%) and those who were underweight (3.73% vs 1-2% in other categories). Mental health represented the most common organ system involved in multimorbidity (18.6% of the total study population), followed by respiratory (7.3%) and dermatology (7.2%).

Conclusions: Multimorbidity impacts over 1 in 5 pregnant women in NI, with complex multimorbidity affecting over 1 in 20. This may present challenges across public health, primary and community care and maternity services which offer support to women with multimorbidity throughout their reproductive journeys, from preconception through to long-term postnatal follow-up.