Multiple Chronic Conditions Before Pregnancy and Risk of Adverse Maternal Health Outcomes: Population-Based Cohort...

Area of Science:

• Reproductive Health
• Maternal Health
• Chronic Disease Management

Background:

• Preconception multiple chronic conditions (MCC) represent a growing concern in maternal health.
• Understanding the spectrum of risks associated with varying degrees of MCC is crucial for effective perinatal care.

Purpose of the Study:

• To evaluate the association between preconception MCC and adverse perinatal outcomes.
• To quantify risks for emergency department (ED) use, hospitalisation, and severe maternal morbidity or mortality (SMM-M) based on the number and complexity of MCC.

Main Methods:

• A population-based cohort study was conducted in Ontario, Canada, including females aged 13-54 years with a recognised pregnancy between 2012-2021.
• Modified Poisson regression was used to calculate adjusted relative risks (aRRs) for ED use, hospitalisation, and SMM-M.
• Adjustments were made for age, parity, income quintile, rurality, and immigrant/refugee status.

Main Results:

• Individuals with ≥3 chronic conditions had significantly increased risks: aRR for ED use was 1.86, for hospitalisation was 3.18, and for SMM-M was 2.75, compared to those without chronic conditions.
• Complex MCC (≥3 conditions affecting ≥3 systems) further elevated SMM-M risk (aRR 2.92).
• The presence of ≥3 cardiometabolic conditions showed a substantially higher risk for SMM-M (aRR 5.45).

Conclusions:

• Multiple chronic conditions, particularly complex or cardiometabolic types, are strongly associated with increased maternal morbidity and mortality risks.
• Implementing multidisciplinary, patient-centred care strategies is recommended to mitigate these elevated risks during pregnancy and postpartum.