DEFINING PRECONCEPTION MATERNAL MULTIMORBIDITY : A SYSTEMATIC REVIEW AND META-ANALYSIS

Sarjit Singh¹, Shang Wang¹, Chiara Viviani², Aizhan Kyzayeva¹, Martin F Shaw¹, Rachel J Kearns^1,2

1University of Glasgow, 2Glasgow Royal Infirmary

BACKGROUND

• Multimorbidity (MM) is defined as two or more chronic conditions in a person¹

• MM affects 1 in 4 pregnant women and is increasing in prevalence¹

• MM is associated with adverse maternal and neonatal outcomes²

• The conditions used to capture MM are not standardised and vary between studies²

• We aimed to evaluate definitions, prevalence, and patterns of preconception multimorbidity

 

METHODS

• Review registered a-priori with PROSPERO

• Databases: Medline, Embase and CINHAL (inception to 1 Sep 2024)

• Inclusion criteria:

   • Population: pregnant women

   • Exposure: preconception MM

   • Comparison: no preconception MM

   • Outcome: all maternal/neonatal outcomes

• At least 2 independent reviewers screened titles/abstracts and full texts using the Covidence review management package

• Study characteristics and conditions studied extracted by one reviewer and synthesised

• Conditions were grouped using ICD-10 categories

 

RESULTS

• 16,134 articles screened, 643 underwent full text review. 99 articles met inclusion criteria.

• Most studies were retrospective (n = 78, 78.8%) and cohort (n = 76, 76.8%) in design

• 108 total country instances studied (Figure 1)

   • Mostly high-income countries (n = 93, 85.3%)

   • Mostly North American (n = 54, 49.5%)

• Studies included between 2 and 79 conditions

• A shift was observed from infectious to non-infectious diseases over time (Figure 2)

• Infectious diseases comprised 100% of studied conditions in 1990-1994, falling to 7.83% in 2020-2024

• Most studied conditions were diabetes mellitus (n = 60, 60.6%) and HIV (n = 56, 55.6%)

• Pooled prevalence of preconception multimorbidity 15% (95% CI: 11 - 19%)

• Significant heterogeneity: I2 = 100%

 

CONCLUSIONS

• We observed variation in the conditions co-studied

• In turn, significant variation in MM prevalences

• There is a need for a more inclusive, globally-representative core condition set to harmonise research, inform targeted interventions, and aid resource allocation

 

REFERENCES

1 – Lee SI,, et al. Epidemiology of pre-existing multimorbidity in pregnant women in the UK in 2018: a population-based cross-sectional study. BMC Pregnancy Childbirth 2022

2 – Brown HK, McKnight A, Aker A. Association between pre-pregnancy multimorbidity and adverse maternal outcomes. Journal of Multimorbidity & Comorbidity 2022; 12: 1