Lee, Siang Ing 
ORCID: 0000-0002-2332-5452
(2024).
Multimorbidity in pregnancy: Epidemiology and core outcome set.
University of Birmingham.
Ph.D.
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Lee2024PhD_Redacted.pdf
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Abstract
Background: Women are increasingly entering pregnancy with two or more long-term physical or mental health conditions. This can impact on the outcomes for the pregnant women and her offspring. This thesis aims to (i) describe the epidemiology of multimorbidity in pregnancy in the United Kingdom (UK) and (ii) develop a core outcome set for studies of pregnant women with multimorbidity.
Methods: The epidemiological study used an observational study design utilising routine health records in the UK. This included primary care records (Clinical Practice Research Datalink [CPRD, UK] and Secure Anonymised Information Linkage [SAIL, Wales]); and secondary care records with linked community prescriptions (Scottish Morbidity Records [SMR]).The study population was pregnant women and the exposure was pre-existing multimorbidity (2 or more long-term conditions). Multimorbidity was operationalised by 79 long-term conditions selected by a multidisciplinary team. Logistic regression was performed to examine the association of maternal multimorbidity with sociodemographic factors.
The core outcome set development consisted of four stages: (i) systematic literature search, (ii) focus groups with stakeholders in the UK, (iii) international Delphi surveys, and (iv) virtual consensus meetings.
Results: Amongst women pregnant in 2018 in the UK, 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). 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).
For the core outcome set development study, 26 studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Three virtual focus groups (n=22) were conducted from December 2021 to March 2022 in the United Kingdom. Thematic analysis of the focus groups added 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important). After two rounds of consensus meetings (first meeting n=13, second meeting n=17), the final core outcome set included 11 outcomes: The five maternal outcomes were: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care, and development of new mental health conditions. The six child outcomes were: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight, and separation of baby from mother for health care needs.
Conclusion: Multimorbidity is highly prevalent in pregnant women in the United Kingdom. We developed a core outcome set to guide future studies for pregnant women with multimorbidity. The next step would be to quantify the association between maternal multimorbidity and outcomes for the women, the pregnancy, and their offspring.
| Type of Work: | Thesis (Doctorates > Ph.D.) | ||||||||||||
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| Award Type: | Doctorates > Ph.D. | ||||||||||||
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| Licence: | Creative Commons: Attribution 4.0 | ||||||||||||
| College/Faculty: | Colleges (2008 onwards) > College of Medical & Dental Sciences | ||||||||||||
| School or Department: | Institute of Applied Health Research | ||||||||||||
| Funders: | Engineering and Physical Sciences Research Council, Economic and Social Research Council, Medical Research Council, National Institute for Health Research | ||||||||||||
| Other Funders: | National Institute for Health and Care Research (NIHR) Academic Clinical Fellowship, Strategic Priority Fund “Tackling multimorbidity at scale” programme delivered by Medical Research Council and National Institute for Health Research in partnership with the Economic & Social Research and Engineering & Physical Sciences Research Council | ||||||||||||
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine R Medicine > RG Gynecology and obstetrics |
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| URI: | http://etheses.bham.ac.uk/id/eprint/14002 |
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