New Delhi: Beginning pregnancy with multiple long-term physical or mental health conditions may be associated with a significantly higher risk of several pregnancy complications, including miscarriage, severe nausea and vomiting, blood clots, pre-eclampsia, anxiety and depression, according to a new study.
The research, published in The Lancet Public Health, found that women who entered pregnancy with two or more pre-existing long-term conditions faced a 20 per cent higher risk of miscarriage and a 69 per cent higher risk of hyperemesis, a condition involving severe nausea and vomiting.
The study, led by researchers at King’s College London, also highlighted a substantial increase in mental health risks among women with multiple long-term conditions. Those with two or more conditions had nearly four times the risk of experiencing anxiety or depression during pregnancy compared with women without long-term conditions.
Higher risk of pregnancy complications
Researchers analysed more than 2.2 million pregnancies and birth events recorded between 2000 and 2022. The data came from five datasets covering England, Scotland, Wales and Northern Ireland.
The study found that women with multiple long-term conditions had higher risks of a range of complications during pregnancy.
These included hyperemesis, gestational diabetes, gestational hypertension, pre-eclampsia, obstetric cholestasis, placental abruption, venous thromboembolism and miscarriage.
The findings suggest that the presence of several long-term conditions before pregnancy may be an important factor when assessing maternal health risks.
Women with multiple conditions had more than double the risk of venous thromboembolism, a potentially serious condition in which a blood clot forms in a vein. They also had a 42 per cent higher risk of pre-eclampsia, a pregnancy complication characterised by high blood pressure and other signs of organ involvement.
Risks increase with additional conditions
The research indicated that the risk did not remain constant as the number of pre-existing conditions increased.
Each additional long-term condition was associated with a further increase in the likelihood of pregnancy complications.
For instance, women with three or more long-term conditions had more than three-and-a-half times the risk of venous thromboembolism compared with women who had no long-term conditions.
This pattern suggests that multimorbidity — the presence of multiple long-term health conditions in the same person — may need to be considered separately from individual medical conditions when assessing pregnancy risks.
The researchers said recognising this cumulative risk could help healthcare professionals identify women who may require closer monitoring and coordinated care.
Mental health concerns highlighted
One of the most notable findings was the increased risk of antenatal anxiety and depression.
Women entering pregnancy with two or more long-term conditions had almost four times the risk of these mental health problems compared with women without long-term conditions.
Senior author Krishnarajah Nirantharakumar, clinical professor of public health and health data science at King’s College London, said the findings support recognising multiple long-term conditions as an independent marker of antenatal risk.
He stressed the importance of identifying women with multiple conditions when they first access maternity services, assessing their physical and mental health needs together and coordinating care between obstetric, primary care and mental health services.
Nirantharakumar described the near four-fold increase in antenatal anxiety and depression as particularly significant, pointing to the need for stronger perinatal mental health support.
Need for integrated pregnancy care
The findings support a more integrated approach to pregnancy care for women living with multiple long-term conditions.
Rather than addressing each condition separately, researchers suggested that healthcare providers should consider the combined effect of multiple conditions when developing care plans.
Early identification could allow doctors and maternity teams to assess potential risks and plan appropriate monitoring throughout pregnancy.
The researchers also highlighted the importance of linking maternity services with primary care and mental health services. Such coordination could help ensure that both physical and psychological needs are addressed during pregnancy.
The approach may be particularly important because pregnancy can affect existing health conditions, while the presence of multiple conditions can, in turn, complicate pregnancy management.
Study limitations
The researchers cautioned that the study has limitations because it was observational and relied on routinely collected health records.
Some medical conditions and pregnancy outcomes may have been under-recorded or recorded inconsistently across the datasets. As a result, the findings demonstrate associations between multiple long-term conditions and pregnancy outcomes but do not establish that the conditions directly caused the complications.
Nevertheless, the researchers said the scale of the analysis provides important evidence for improving risk assessment and care planning.
The study’s findings support earlier identification of women with multiple long-term conditions, closer integration of physical and mental healthcare throughout pregnancy, and the inclusion of multimorbidity in antenatal risk assessment.
For women with existing health conditions who are planning a pregnancy, the findings underline the importance of discussing individual health needs with healthcare professionals before and during pregnancy. Personal risk can vary considerably depending on the specific conditions, medications and other factors involved.