79 health conditions: defining 2 or more long-term health conditions in pregnancy

Definition of multimorbidity

Multimorbidity was defined by the presence of two or more pre-existing long-term physical or mental health conditions prior to the index pregnancy. Pregnancy related conditions (e.g. gestational diabetes) were not included.

An exhaustive list of long-term health conditions was first identified from existing literature, in particular based on the work commissioned by Health Data Research UK on multimorbidity conceptualisation [1], and a recent publication on prevalence of different conditions in the UK [2]. This list and phenome definitions were refined and harmonised through workshops with our research advisory group, consisting of women representatives, clinicians from general practice, obstetrics, maternal medicine, psychiatry, public health, and data scientists. Health conditions were selected on the following basis: (i) prevalence; (ii) impact on pregnancy outcomes; (iii) considered important by women; and (iv) recorded in the study datasets.

LIST OF 79 CONDITIONS:

Cancers

  1. All cancers
    • Solid cancers
    • Haematological cancers
    • Metastatic cancers
    • Exclude basal cell carcinoma

Cardiovascular disease

  1. Hypertension
  2. Ischemic heart disease & Myocardial infarction
    • Myocardial infarction (thrombosis)
    • Myocardial infarction (dissection)
  3. Heart failure
  4. Stroke
    • Transient ischemic attack
    • Ischemic stroke
    • Haemorrhagic stroke
    • Unspecified stroke
  5. Atrial fibrillation
  6. Congenital heart disease
  7. Valvular heart disease (mitral, aortic, mixed)
    • Congenital
    • Acquired (e.g Rheumatic valvular disease)
  8.  Cardiomyopathy
    • Congenital
    • Acquired

Dermatology

  1. Eczema
  2. Psoriasis
  3. Autoimmune skin disease
    • Vitiligo
    • Alopecia areata
  4. Other dermatological conditions
    • Seborrheic dermatitis
    • Rosacea
    • Hidradenitis suppurativa
    • Lichen planus

Ear, Nose, Throat

  1. Profound deafness
  2. Allergic rhinitis & allergic conjunctivitis

Eye

  1. Inflammatory eye disease
    • Scleritis & episcleritis
    • Anterior uveitis
    • Posterior uveitis
  2. Cataract
  3. Diabetic eye disease
  4. Severe blindness
  5. Retinal detachment

Gastroenterology

  1. Irritable bowel syndrome
  2. Inflammatory bowel disease
    • Ulcerative colitis
    • Crohn’s disease
  3. Coeliac disease 
  4. Chronic liver disease
    • Chronic hepatitis B & C
    • Alcoholic liver disease
    • Autoimmune liver disease
    • Cirrhosis
    • Non-alcoholic fatty liver disease
  5. Peptic ulcer
  6. Gall stones (cholelithiasis)

Gynaecology

  1. Polycystic ovarian syndrome
  2. Endometriosis
  3. Leiomyoma (fibroids)
  4. Infertility

Haematology

  1. History of venous thromboembolism (VTE)
    • Deep vein thrombosis
    • Pulmonary embolism
    • Other VTE
  2. Primary thrombocytopenia
  3. Haemophilia 
  4. Sickle cell anaemia
  5. Pernicious anaemia

Mental health

  1. Depression
  2. Anxiety
    • Anxiety
    • Panic disorder
    • Phobia disorder
    • Post traumatic stress disorder
  3. Serious mental illness 
  • bipolar affective disorder
  • schizophrenia
  • psychosis
  1. Eating disorder
  2. History of alcohol use disorder (misuse / dependence)
  3. History of substance misuse 
  4. Neurodevelopmental disorder
    • Learning disability
    • Attention deficit hyperactivity disorder
    • Autistic spectrum disorder
  5. Others
    • Obsessive compulsive disorder (OCD)
    • Self-harm
    • Personality disorder
    • Dissociative disorder 

Rheumatology

  1. Systemic lupus erythematosus
  2. Spondyloarthritis
    • Psoriatic arthritis
    • Ankylosing spondylitis
  3. Inflammatory arthritis
    • Rheumatoid arthritis
    • Sjogern’s syndrome
    • Raynaud’s syndrome
    • Systemic sclerosis
    • Primary systemic vasculitis
  4. Ehler’s Danlos Syndrome (EDS) Type 3 (Hypermobile EDS)

Orthopaedic

  1. Scoliosis
  2. Vertebral disorder
    • Intervertebral disc disorder
    • Spondylosis
    • Spondylolisthesis
    • Collapsed vertebrae
    • Spinal stenosis
  3. Chronic back pain
  4. Osteoporosis 
  5. Osteoarthritis

Neurology

  1. Migraine
  2. Other chronic headache (including cluster headache, tension headache, other chronic headache)
  3. Epilepsy
  4. Multiple sclerosis
  5. Spina bifida
  6. Idiopathic intracranial hypertension
  7. Peripheral neuropathy
  8. Somatoform disorder 
    • chronic fatigue syndrome / myalgic encephalomyelitis
    • fibromyalgia
    • chronic pain syndrome (includes chronic regional pain syndrome, myofascial pain syndrome)

Respiratory

  1. Asthma
  2. Chronic obstructive pulmonary disease
  3. Obstructive sleep apnoea
  4. Pulmonary fibrosis, interstitial lung disease
  5. Pulmonary hypertension
  6. Bronchiectasis
  7. Cystic fibrosis
  8. Sarcoidosis

Renal

  1. Chronic kidney disease 
  2. Urinary tract stones

Endocrine

  1. Diabetes mellitus
  2. Thyroid disorder
  3. Pituitary disorder
  4. Adrenal benign tumour
  5. Hyperparathyroidism

Other

  1. Human immunodeficiency viral (HIV) infection / AIDS
  2. Turner’s syndrome
  3. Marfan’s syndrome
  4. Solid organ transplant 

References

[1] Ho IS, Azcoaga-Lorenzo A, Akbari A, Black C, Davies J, Hodgins P, Khunti K, Kadam U, Lyons RA, McCowan C, Mercer S, Nirantharakumar K, Guthrie B. Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies. Lancet Public Health. 2021 Aug;6(8):e587-e597. doi: 10.1016/S2468-2667(21)00107-9. Epub 2021 Jun 22. PMID: 34166630.

[2] Kuan V, Denaxas S, Gonzalez-Izquierdo A, Direk K, Bhatti O, Husain S, et al. A chronological map of 308 physical and mental health conditions from 4 million individuals in the English National Health Service. The Lancet Digital health. 2019;1(2):e63-e77. Epub 2019/10/28. doi: 10.1016/s2589-7500(19)30012-3. PubMed PMID: 31650125; PubMed Central PMCID: PMCPMC6798263.

Phenome definitions (physical and mental health conditions, active multimorbidity)

Github: For Read codes, ICD-10 codes and phenome definitions

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