Multimorbidity and Pregnancy: Determinants, Clusters, Consequences and Trajectories (MuM-PreDiCT)

Lead Research Organisation: University of Birmingham
Department Name: Institute of Applied Health Research

Abstract

What is the problem?
One in five pregnant women have two or more active long-term health conditions. These can be both physical conditions (like diabetes or raised blood pressure), and mental health conditions (such as depression or anxiety). Often women also have to take several medications to manage their different health needs. Having two or more health conditions is also becoming increasingly common in pregnant women as women are increasingly older when they start having a family and as obesity and mental health conditions are on the rise in general.

We don't really understand what the consequences are of multiple health conditions or medications for mothers and babies. This can make pregnancy, healthcare and managing medications more complicated. Without deeper understanding of the problem, women with several long-term health conditions may not have the best and safest experience of care before, during and after pregnancy because services have not been designed with their health needs in mind.

What will we do?
Our research is divided into five work packages. The first work package will examine how health conditions accumulate over time and identify what makes a woman more at risk of developing two or more long-term health conditions before pregnancy.

The second work package will explore women's experiences of care during pregnancy, birth and after birth. We will work together with families and health professionals to establish how care could be improved.

The third work package will look further at how having two or more long-term health conditions may affect pregnant women and their children. We will do this in three ways: we will identify outcomes that women, health professionals and researchers feel should be reported in research; we will examine how often women experience pregnancy complications; and we will explore how frequently women and their children develop additional long-term ill health.

In the fourth work package we will describe how medications are prescribed. We will investigate how taking combinations of medication may affect pregnant women and their babies.

In our fifth work package, we will build a prediction model to help identify how likely a previously healthy pregnant woman will develop multiple long-term conditions after pregnancy. We can do this by using health information collected during or just after pregnancy. This is because we know that some complications in pregnancy may be a warning sign of future illnesses.

What will our research achieve?
We will help women and their healthcare professionals make informed decisions about their care and medication use by providing accessible information on risk. For example, the risks associated with pregnancy; the risks associated with combinations of medications during pregnancy; and the future risk of developing long-term health conditions after a pregnancy complication.

Our work will also identify important time points to intervene and ways to prevent pregnancy complications or developing future long-term health conditions. This will reduce the health burden for women, partners, carers and reduce avoidable healthcare and economic cost in the long run for society. Working together with women and healthcare professionals, we will produce recommendations on how to plan and design services that meet the needs of women and their families before, during and after pregnancy.

Technical Summary

Our vision is to characterise and understand the determinants and consequences of pre-existing multimorbidity (MM) in pregnant women; and to predict and prevent MM and its adverse consequences in women and their offspring.

We will use electronic health records and birth cohort data from across the four UK nations and European registries of congenital anomaly. We have already harmonised most of the definitions of variables and linkage algorithms to ensure comparable methods across the datasets.

We have described the epidemiology of pre-existing MM in pregnant women. We will characterise MM clusters and trajectories. We will investigate if MM clusters and trajectories differ by parity, age, ethnicity, social-deprivation and lifestyle factors. Identifying the determinants of MM clusters and trajectories will enable development of preventive interventions and strategies to reduce inequalities.

To improve maternity services, we will interview pregnant women with MM, their carers and health professionals to understand current service provision and their limitations. We will then hold workshops to co-design care pathways for pregnant women with MM.

We will then study how maternal MM affects the outcomes of pregnancy, mothers and offspring. Initially we will use established consensus methods to develop a core outcome set for research of pregnant women with MM. Then we will determine the rates of these outcomes based on maternal MM status and then based on prescription combinations received. Findings will help women make informed decisions about their pregnancy, inform maternity care planning and improve safe prescribing during pregnancy.

Our previous work has demonstrated that pregnancy complications are associated with development of future morbidities after pregnancy. Using this information and other covariates we will develop and validate prediction models to inform prevention and early detection of multiple long-term conditions postpartum.
 
Title DextER Updated version 
Description DExtER is a software that was created before the fellowship. This forms the basis on which the whole new Automated Clinical Epidemiology Studies (ACES) platform will work. 
Type Of Material Improvements to research infrastructure 
Year Produced 2019 
Provided To Others? No  
Impact Needless to say the tool enable data extraction according to study designs within a couple of hours compared to weeks and months previously 
URL https://www.birmingham.ac.uk/research/activity/applied-health/research/health-informatics/Automated-...
 
Description IAHR seminar 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact presentation of the various programmes
Year(s) Of Engagement Activity 2020,2021
 
Description Newcastle-Birmingham joint seminar 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Discussion and presentations on Epidemiology of multimorbidity in pregnant women and birthing people and medications in pregnancy
Year(s) Of Engagement Activity 2021
 
Description SPF Multimorbidity Wave 2 Launch and Networking Event/Steering Group Meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Presentations and discussions on other programmes on multimorbidities. Followed by Group work and discussions
Year(s) Of Engagement Activity 2021
 
Description MuM-Pre-DiCT website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact The website is the platform for disseminating information about the programme through,publishing resources, videolinks,blogs and meeting minutes(of the operational monthly meetings of mumpredict)
Year(s) Of Engagement Activity 2021
 
Description MuMPreDiCT: Dissemination and engagement 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The event was organised to share findings from the work we carried out during the grant period.

All videos can be found in:
https://mumpredict.org/video-recordings-from-the-18th-feb-2021-dissemination-webinar/
Year(s) Of Engagement Activity 2021
URL https://mumpredict.org/video-recordings-from-the-18th-feb-2021-dissemination-webinar/