Trends in cardiometabolic conditions and pregnancy outcomes: a retrospective cohort study in South-Eastern Melbourne

To examine trends in preconception and pregnancy cardiometabolic risk factors and conditions, pregnancy and birth complications, obstetric interventions, and the impact of COVID-19, and to forecast future disease burden.

A multi-centre retrospective cohort study.

A large hospital network with three maternity hospitals serving ethnically diverse populations in Melbourne, Australia.

Pregnant women who gave birth between 2016 and 2022.

Trends in cardiometabolic conditions, birth complications and obstetric interventions.

Over 7 years, 63 232 women were included, of whom 40% were nulliparous, and 60.9% were born overseas from 167 countries. From 2016-2022, maternal age (30.2-31.3 years), obesity (21.0%-26.2%), gestational diabetes mellitus (GDM) (15.9%-28.1%) and caesarean delivery (28.5%-37.6%) increased, while average gestational weight gain, premature births and special care admissions declined from 12.6-11.6 kg, 6.3%-4.9% and 24.2%-14.1%, respectively; and was statistically significant (p<0.05). Hypertensive disorders of pregnancy remained stable, fluctuating slightly (6.5% in 2016, 7.6% in 2020, 6.9% in 2022). During the COVID-19 lockdown period, the odds of GDM and induced birth increased by 8.0%, whereas the odds of caesarean section decreased by 5.0%. GDM is forecast to reach 43.0% by 2028.

Prepregnancy and pregnancy cardiometabolic risk factors and conditions, pregnancy and birth complications, and obstetric interventions increased markedly over 7 years. Despite this, offspring complications, including special care admissions, stillbirths and prematurity, decreased, while pregnancy complications peaked during COVID-19. GDM is forecasted to increase to 43.0% by 2028, posing an unsustainable health and economic burden that necessitates urgent public health initiatives.