Multiple long-term health conditions (multimorbidity) are commonly found in older populations. However, there is growing evidence to suggest that multimorbidity is increasingly occurring in younger people. Recent research estimated that one in five women of childbearing age becomes pregnant with multimorbidity. We do not fully understand the reasons for the change in trends, how multimorbidity accumulate over time in women of childbearing age, and the diseases that are commonly found together. Additionally, women with multimorbidity often use multiple medications, however, the effect on the baby is not known. In addition, we are uncertain whether based on race and ethnicity, some women with multimorbidity have better outcomes than others.
To fill the knowledge gaps, we will link and analyse the CPRD Mother-Baby link, HES Admitted Patient Care, ONS Death Registration, and the Patient Level Index of Multiple Deprivation datasets between January 1, 2003, and December 31, 2022. We will examine the accumulation and trend of multiple long-term health conditions among them. We will explore whether there are differences in pregnancy outcomes (e.g., risk of stillbirth, preterm birth) because of the mother’s race, and the effect of multiple medications on infant health, growth, early childhood development, and school performance. Furthermore, we will investigate the impact of multimorbidity during pregnancy on subsequent maternal health and the risk of maternal death. Our findings will inform the design of interventions to lower multimorbidity, promote equality in health outcomes, and improve the health of mothers and newborns.
This research sets out to investigate the trend and impacts of multimorbidity during pregnancy on maternal and child health outcomes, and the associated use of multiple medications (polypharmacy) on infant health. This will be a population-based cohort study using linked datasets – the CPRD primary care data, Hospital Episode Statistics [HES] admission, Patient Level Index of Multiple Deprivation, and the ONS Death Registration datasets, of all women with antenatal and childbirth records in the England between 1 January 2003 and 31 December 2022.
The main exposures are multimorbidity and polypharmacy during pregnancy. The primary outcomes of interest include adverse pregnancy outcomes (such as the risk of miscarriage, congenital anomaly, stillbirth, preterm birth, birth asphyxia, and neonatal admission), maternal health and wellbeing (such as the risk of hospitalisations, and maternal death) and early infant health, including the risk of infant death. Other outcomes of interest are clustering of morbidities, and incident child multimorbidity.
We will explore the extent to which the prevalence of multimorbidity reflects co-occurrence (i.e., discordant) or clustering (i.e., concordant, likely with a shared aetiology) of any two of long-term medical conditions by exploratory factor analysis with promax rotation and examine associated determinants using multivariable logistic regression. We will use modified Poisson regression to explore the impact of multimorbidity on adverse pregnancy outcomes. Cox proportional hazards regression will be used to determine the risk of incident child multimorbidity and the impact of multimorbidity on maternal health wellbeing in later life.
The research results will foster guideline development and integrated care pathways for multimorbid pregnant women and contribute to improving child health.
a. Trend and clustering of multimorbidity in childbearing women.
b. Adverse pregnancy outcomes i.e., the risk of miscarriage, stillbirth, preterm birth, operative delivery, congenital abnormality, APGAR score less than 7 at 5 minutes, and neonatal unit admission (up to 48 hours),
c. Maternal outcomes i.e., severe maternal morbidity, postpartum haemorrhage, puerperal sepsis, postnatal depression (up to one year after childbirth), risks of maternal hospital admissions, maternal death.
d. Infant outcomes i.e., congenital anomaly, infant death, incident child multimorbidity.
Abiodun Adanikin - Chief Investigator - Coventry University
Abiodun Adanikin - Corresponding Applicant - Coventry University
Jennifer Gamble - Collaborator - Coventry University
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;CPRD Aurum Mother-Baby Link;CPRD Aurum Pregnancy Register;CPRD GOLD Mother-Baby Link;CPRD GOLD Pregnancy Register