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Multimorbidity and Risk of Adverse Pregnancy Outcomes in a Safety-Net Hospital Cohort
Michelle Huezo Garcia1, Samantha E Parker1, Collette N Ncube1
1Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
Summary
Multimorbidity, or having multiple chronic conditions, affects over a third of pregnancies and significantly increases risks for adverse outcomes like preterm birth and hypertensive disorders. Collaborative preconception and pregnancy care is crucial for improving perinatal health in these high-risk pregnancies.
Area of Science:
- Reproductive Health
- Maternal-Fetal Medicine
- Public Health
Background:
- Single chronic conditions are known risk factors for adverse pregnancy outcomes.
- The impact of multiple chronic conditions (multimorbidity) during pregnancy is less understood.
- This study investigates the association between multimorbidity and a range of adverse pregnancy outcomes.
Purpose of the Study:
- To assess the association between multimorbidity and adverse pregnancy outcomes.
- To examine how body mass index (BMI) modifies these associations.
- To explore disparities in adverse pregnancy outcomes among racial and ethnic subgroups with multimorbidity.
Main Methods:
- Retrospective cohort study of 6,455 births (2015-2019) at a safety-net hospital.
- Multimorbidity defined as ≥2 diagnosis codes before or during pregnancy.
- Log-binomial regression models used to analyze associations between multimorbidity and outcomes, stratified by BMI and race/ethnicity.
Main Results:
- Multimorbidity (35.2% of births) significantly increased risks for hypertensive disorders, preterm birth, low birthweight, stillbirth, placental abruption, and prolonged hospital stays.
- Individuals with multimorbidity and BMI ≥30 kg/m² had higher risks of hypertensive disorders and gestational diabetes compared to those with multimorbidity and BMI <30 kg/m².
- Adverse outcomes were more frequent in non-Hispanic Black and Hispanic/Latine patients with multimorbidity compared to white patients.
Conclusions:
- The high prevalence of multimorbidity underscores its significant impact on pregnancy.
- Findings highlight the need for integrated, collaborative preconception and pregnancy care models.
- Optimizing perinatal health requires addressing multimorbidity and associated risk factors, including obesity and racial disparities.
