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Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data

Lisa Kent, Siang Ing Lee, Megha Singh, Steven Wambua, Katherine Phillips, Utkarsh Agrawal, Amaya Azcoaga-Lorenzo, Colin McCowan, Jonathan Kennedy, Holly Hope, Ngawai Moss, Rachel Plachcinski, Catherine Nelson-Piercy, Mairead Black, Sinead Brophy Orcid Logo, Aideen Maguire, Dermot O’Reilly, Krishnarajah Nirantharakumar, Kelly-Ann Eastwood

BMC Pregnancy and Childbirth, Volume: 25, Start page: 666

Swansea University Authors: Jonathan Kennedy, Sinead Brophy Orcid Logo

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DOI (Published version): 10.1186/s12884-025-07771-1

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Background: Multimorbidity in pregnancy increases health risks to women and babies, and creates challenges for services. The aim of this study was to explore the prevalence and patterns of maternal multimorbidity in a UK population. Methods: This population-based, retrospective study used individual...

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Published in: BMC Pregnancy and Childbirth
ISSN: 1471-2393
Published: Springer Nature 2025
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The aim of this study was to explore the prevalence and patterns of maternal multimorbidity in a UK population. Methods: This population-based, retrospective study used individual-level, linked, routinely collected health data accessed via The Health and Social Care Northern Ireland Business Service Organisation Honest Broker Service within a Trusted Research Environment following the Five Safes Framework. Pregnancy episodes were ascertained from the Northern Ireland Regional Maternity Service Database and linked via unique Health and Care Number to secondary care diagnoses and primary care medications. Yearly prevalence (2012&#x2013;2020) of multimorbidity (&#x2265; 2 physical or mental health conditions) and complex multimorbidity (involvement of &#x2265; 3 organ systems) were calculated for the full cohort and stratified by age, deprivation, body mass index (BMI) and gravida. Cross-sectional analyses of prevalence and exploration of unique combinations of conditions and organ system involvement across strata were performed during a period of stability in detection rates (2014&#x2013;2019). Results: The annual number of pregnancies ranged from n = 24,403 (2012) to n = 19,504 (2020). Prevalence of maternal multimorbidity ranged from 18.2% (95%CI: 17.7&#x2013;18.7%) (2012) to 22.8% (95% CI: 22.3&#x2013;23.4%) (2016) and mostly involved coexistence of physical and mental health conditions (range: 13.0&#x2013;17.4%). Complex multimorbidity ranged from 4.0% (2012) to 6.1% (2017). The mental health system demonstrated the highest prevalence compared to all other organ systems (range: 18.6&#x2013;26.2%). Multimorbidity was higher at extremes of maternal age (&lt; 25y:24.15%; 25-34y:21.20%; &#x2265; 35y:23.39%), and increased with deprivation (least deprived:19.61%; most deprived:25.78%), BMI (healthy:18.37%; obesity III:39.18%), and gravida (first pregnancy:19.18%; &#x2265; 5 pregnancies:30.69%). Mental health multimorbidity most impacted the youngest group (&lt; 25y:4.60%; 25-34y:1.36%; &#x2265; 35y:0.85%) and those who were underweight (3.73% vs 1&#x2013;2% in other categories). Mental health represented the most common organ system involved in multimorbidity (18.6% of the total study population), followed by respiratory (7.3%) and dermatology (7.2%). Conclusions: Multimorbidity impacts over 1 in 5 pregnant women in NI, with complex multimorbidity affecting over 1 in 20. 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spelling 2025-06-09T11:17:44.5191977 v2 69649 2025-06-09 Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data 08163d1f58d7fefcb1c695bcc2e0ef68 Jonathan Kennedy Jonathan Kennedy true false 84f5661b35a729f55047f9e793d8798b 0000-0001-7417-2858 Sinead Brophy Sinead Brophy true false 2025-06-09 MEDS Background: Multimorbidity in pregnancy increases health risks to women and babies, and creates challenges for services. The aim of this study was to explore the prevalence and patterns of maternal multimorbidity in a UK population. Methods: This population-based, retrospective study used individual-level, linked, routinely collected health data accessed via The Health and Social Care Northern Ireland Business Service Organisation Honest Broker Service within a Trusted Research Environment following the Five Safes Framework. Pregnancy episodes were ascertained from the Northern Ireland Regional Maternity Service Database and linked via unique Health and Care Number to secondary care diagnoses and primary care medications. Yearly prevalence (2012–2020) of multimorbidity (≥ 2 physical or mental health conditions) and complex multimorbidity (involvement of ≥ 3 organ systems) were calculated for the full cohort and stratified by age, deprivation, body mass index (BMI) and gravida. Cross-sectional analyses of prevalence and exploration of unique combinations of conditions and organ system involvement across strata were performed during a period of stability in detection rates (2014–2019). Results: The annual number of pregnancies ranged from n = 24,403 (2012) to n = 19,504 (2020). Prevalence of maternal multimorbidity ranged from 18.2% (95%CI: 17.7–18.7%) (2012) to 22.8% (95% CI: 22.3–23.4%) (2016) and mostly involved coexistence of physical and mental health conditions (range: 13.0–17.4%). Complex multimorbidity ranged from 4.0% (2012) to 6.1% (2017). The mental health system demonstrated the highest prevalence compared to all other organ systems (range: 18.6–26.2%). Multimorbidity was higher at extremes of maternal age (< 25y:24.15%; 25-34y:21.20%; ≥ 35y:23.39%), and increased with deprivation (least deprived:19.61%; most deprived:25.78%), BMI (healthy:18.37%; obesity III:39.18%), and gravida (first pregnancy:19.18%; ≥ 5 pregnancies:30.69%). Mental health multimorbidity most impacted the youngest group (< 25y:4.60%; 25-34y:1.36%; ≥ 35y:0.85%) and those who were underweight (3.73% vs 1–2% in other categories). Mental health represented the most common organ system involved in multimorbidity (18.6% of the total study population), followed by respiratory (7.3%) and dermatology (7.2%). Conclusions: Multimorbidity impacts over 1 in 5 pregnant women in NI, with complex multimorbidity affecting over 1 in 20. This may present challenges across public health, primary and community care and maternity services which offer support to women with multimorbidity throughout their reproductive journeys, from preconception through to long-term postnatal follow-up. Journal Article BMC Pregnancy and Childbirth 25 666 Springer Nature 1471-2393 Maternal, Pregnancy, Multimorbidity, Long-term condition, Mental health, Obesity, Preconception health, Population health, Routinely collected data, Administrative data, Northern Ireland, United Kingdom 7 6 2025 2025-06-07 10.1186/s12884-025-07771-1 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This work was funded by (1) the Strategic Priority Fund “Tackling multimorbidity at scale” programme (grant number MR/W014432/1) delivered by the Medical Research Council and the National Institute for Health Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council; and (2) UKRI's ADRC-NI (ES/W010240/1). 2025-06-09T11:17:44.5191977 2025-06-09T11:05:44.9373041 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Lisa Kent 1 Siang Ing Lee 2 Megha Singh 3 Steven Wambua 4 Katherine Phillips 5 Utkarsh Agrawal 6 Amaya Azcoaga-Lorenzo 7 Colin McCowan 8 Jonathan Kennedy 9 Holly Hope 10 Ngawai Moss 11 Rachel Plachcinski 12 Catherine Nelson-Piercy 13 Mairead Black 14 Sinead Brophy 0000-0001-7417-2858 15 Aideen Maguire 16 Dermot O’Reilly 17 Krishnarajah Nirantharakumar 18 Kelly-Ann Eastwood 19 69649__34420__899eea270edf44448b948ec3e7bed744.pdf 12884_2025_Article_7771.pdf 2025-06-09T11:05:44.9368880 Output 2746238 application/pdf Version of Record true © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). true eng http://creativecommons.org/licenses/by/4.0/
title Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data
spellingShingle Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data
Jonathan Kennedy
Sinead Brophy
title_short Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data
title_full Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data
title_fullStr Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data
title_full_unstemmed Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data
title_sort Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data
author_id_str_mv 08163d1f58d7fefcb1c695bcc2e0ef68
84f5661b35a729f55047f9e793d8798b
author_id_fullname_str_mv 08163d1f58d7fefcb1c695bcc2e0ef68_***_Jonathan Kennedy
84f5661b35a729f55047f9e793d8798b_***_Sinead Brophy
author Jonathan Kennedy
Sinead Brophy
author2 Lisa Kent
Siang Ing Lee
Megha Singh
Steven Wambua
Katherine Phillips
Utkarsh Agrawal
Amaya Azcoaga-Lorenzo
Colin McCowan
Jonathan Kennedy
Holly Hope
Ngawai Moss
Rachel Plachcinski
Catherine Nelson-Piercy
Mairead Black
Sinead Brophy
Aideen Maguire
Dermot O’Reilly
Krishnarajah Nirantharakumar
Kelly-Ann Eastwood
format Journal article
container_title BMC Pregnancy and Childbirth
container_volume 25
container_start_page 666
publishDate 2025
institution Swansea University
issn 1471-2393
doi_str_mv 10.1186/s12884-025-07771-1
publisher Springer Nature
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description Background: Multimorbidity in pregnancy increases health risks to women and babies, and creates challenges for services. The aim of this study was to explore the prevalence and patterns of maternal multimorbidity in a UK population. Methods: This population-based, retrospective study used individual-level, linked, routinely collected health data accessed via The Health and Social Care Northern Ireland Business Service Organisation Honest Broker Service within a Trusted Research Environment following the Five Safes Framework. Pregnancy episodes were ascertained from the Northern Ireland Regional Maternity Service Database and linked via unique Health and Care Number to secondary care diagnoses and primary care medications. Yearly prevalence (2012–2020) of multimorbidity (≥ 2 physical or mental health conditions) and complex multimorbidity (involvement of ≥ 3 organ systems) were calculated for the full cohort and stratified by age, deprivation, body mass index (BMI) and gravida. Cross-sectional analyses of prevalence and exploration of unique combinations of conditions and organ system involvement across strata were performed during a period of stability in detection rates (2014–2019). Results: The annual number of pregnancies ranged from n = 24,403 (2012) to n = 19,504 (2020). Prevalence of maternal multimorbidity ranged from 18.2% (95%CI: 17.7–18.7%) (2012) to 22.8% (95% CI: 22.3–23.4%) (2016) and mostly involved coexistence of physical and mental health conditions (range: 13.0–17.4%). Complex multimorbidity ranged from 4.0% (2012) to 6.1% (2017). The mental health system demonstrated the highest prevalence compared to all other organ systems (range: 18.6–26.2%). Multimorbidity was higher at extremes of maternal age (< 25y:24.15%; 25-34y:21.20%; ≥ 35y:23.39%), and increased with deprivation (least deprived:19.61%; most deprived:25.78%), BMI (healthy:18.37%; obesity III:39.18%), and gravida (first pregnancy:19.18%; ≥ 5 pregnancies:30.69%). Mental health multimorbidity most impacted the youngest group (< 25y:4.60%; 25-34y:1.36%; ≥ 35y:0.85%) and those who were underweight (3.73% vs 1–2% in other categories). Mental health represented the most common organ system involved in multimorbidity (18.6% of the total study population), followed by respiratory (7.3%) and dermatology (7.2%). Conclusions: Multimorbidity impacts over 1 in 5 pregnant women in NI, with complex multimorbidity affecting over 1 in 20. This may present challenges across public health, primary and community care and maternity services which offer support to women with multimorbidity throughout their reproductive journeys, from preconception through to long-term postnatal follow-up.
published_date 2025-06-07T05:28:45Z
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