Risk of pregnancy complications increases for women with multiple long-term health conditions

Women who have two or more existing conditions face a higher risk of developing pregnancy-related complications according to a new study that demonstrates the clear need for a holistic approach to managing perinatal health of mothers and babies.

In the first UK study of its kind, published today in The Lancet Public Health and co-led by researchers at the University of Birmingham, anonymised records from more than 2.2 million pregnancies were analysed to see how common pregnancy complications are among women with two or more existing health conditions, which affects around one in five pregnant women in the UK.

Researchers compared women who had multiple long-term physical or mental health conditions, such as asthma, diabetes, high blood pressure, depression or anxiety, which were present prior to conception. The team compared these patients with those who had none, to understand the impact of these conditions on pregnancy risks.

The study found that women with multiple conditions were more likely to experience a range of pregnancy complications, including severe pregnancy sickness, gestational diabetes, raised blood pressure and pre-eclampsia, liver conditions, placental abruption, blood clots and miscarriage.

These women were also several times more likely to experience anxiety and depression during pregnancy, with the study finding that the risk of pregnancy complications continued to increase with each condition.

Around one in five pregnant women in the UK currently live with two or more long-term health conditions. However, maternity care is still largely organised around one condition at a time, meaning women with multiple long-term conditions are often looked after by several teams working separately, with no monitoring of the combined risk of these conditions.

Megha Singh, Research Fellow, University of Birmingham

Birmingham researchers, of which some have been supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre: Birmingham, carried out the study in collaboration with members of the MuM-PreDiCT Consortium, a UK-wide research program studying pregnant women who have two or more long-term physical or mental health conditions. Funded by the Medical Research Council, it spans eight universities across all four nations of the UK to improve maternity care.

Researchers hope that the study’s findings will change the standard care, with women identified at their first appointment that would trigger a single joined-up plan across obstetric, medical and perinatal mental health teams, rather than parallel clinics. This would include closer monitoring for the complications that were raised the most in findings, blood clots, pre-eclampsia, gestational diabetes, anxiety and depression.

The study is funded by the UKRI Strategic Priorities Fund and the Department of Health and Social Care via the NIHR, and delivered by the Medical Research Council (MRC).

The MuM-PReDiCT consortium was established with the aim of improving care for pregnant women with multiple long-term health conditions. Further work within MuM-PreDiCT will examine birth and child outcomes and identify which combinations of conditions carry the greatest risk.