Women With Pre-Pregnancy Chronic Conditions Face Greater Risk of Severe Maternal Complications: Study Shows
Canada: Women entering pregnancy with multiple chronic conditions (MCC) face significantly higher risks of severe maternal complications, including morbidity and mortality, according to a large population-based study from Ontario, Canada. The study also found that emergency department visits and hospitalizations were more frequent among these women, highlighting the need for tailored, multidisciplinary care.
The research, led by Hilary K. Brown from the Department of Health and Society, University of Toronto Scarborough, along with colleagues, was published in BJOG: An International Journal of Obstetrics & Gynaecology. The study analyzed data from females aged 13–54 years with recognized pregnancies between 2012 and 2021, examining how the presence and type of chronic conditions before conception influenced maternal health outcomes up to 42 days postpartum.
Using modified Poisson regression models adjusted for age, parity, income, rurality, and immigrant or refugee status, the team assessed the impact of the number of chronic conditions, complex MCC (defined as three or more conditions affecting at least three body systems), and co-occurring cardiometabolic conditions. The outcomes measured included perinatal emergency department (ED) use, hospitalizations, and severe maternal morbidity or mortality (SMM-M).
Based on the study, the researchers reported the following findings:
- The study analyzed 1,373,193 pregnancies.
- Among these, 894,042 women had no pre-pregnancy chronic conditions, 357,398 had one condition, 94,427 had two conditions, and 27,326 had three or more conditions.
- Maternal risk increased stepwise with the number of chronic conditions.
- Adjusted relative risks (aRR) for severe maternal morbidity or mortality (SMM-M) within 42 days postpartum were:
- 1.38 for women with one chronic condition
- 1.82 for women with two chronic conditions
- 2.75 for women with three or more chronic conditions
- Women with complex MCC (three or more conditions affecting at least three body systems) had an aRR of 2.92.
- Women with three or more cardiometabolic conditions had an aRR of 5.45.
- Emergency department visits increased with the number of chronic conditions, with women having three or more conditions showing a 1.86-fold higher risk.
- Hospitalizations were also higher, with a threefold increased likelihood for women with three or more chronic conditions compared with those without chronic conditions.
These findings emphasize that MCC, particularly when complex or cardiometabolic in nature, is strongly associated with adverse maternal health outcomes. The authors suggest that multidisciplinary, patient-centered care could help mitigate these risks and improve postpartum recovery.
The study also notes that MCC is socially patterned, disproportionately affecting individuals with lower socioeconomic status, which may amplify healthcare costs and mortality risks. Future research is needed to identify which socioeconomic factors influence these associations, as well as to evaluate a broader range of perinatal and extended postpartum outcomes to better support mothers with MCC and their infants.
"Overall, this study provides important evidence for healthcare providers, underscoring the necessity of preconception risk assessment and comprehensive care planning for women with multiple chronic conditions to reduce maternal complications and improve pregnancy outcomes.
Reference:
Brown, H. K., Fung, K., Cohen, E., Dennis, L., Grandi, S. M., Rosella, L. C., Varner, C., Vigod, S. N., Wodchis, W. P., & Ray, J. G. Multiple Chronic Conditions Before Pregnancy and Risk of Adverse Maternal Health Outcomes: Population-Based Cohort Study. BJOG: An International Journal of Obstetrics & Gynaecology. https://doi.org/10.1111/1471-0528.18347
