More and more people are living with two or more long-term health conditions. Some people may experience difficulties managing several long-term health conditions. They may have to coordinate appointments with different specialists and their medications need to be managed carefully.
During pregnancy, these challenges may increase. We know that it is becoming more common for women to have two or more long-term health conditions before pregnancy, but we don’t understand why this is and what the consequences are for mothers and babies. Without this deeper understanding of the problem, women with several long-term health conditions may not have the best experience of care before, during and after pregnancy because services are not tailored to their specific needs.
We are developing a project to study and improve maternity care for women who are also managing two or more long-term health conditions. These can be both physical conditions, such as diabetes and raised blood pressure, and mental health conditions such as depression and anxiety.
Our research team will include experts in data science, obstetrics, psychological medicine, primary care and public health from eight academic institutions and various NHS trust partners across all four countries in the UK. Our initial work is supported by the Medical Research Council (MRC) and Health Data Research UK (HDRUK). We will work in close partnership with women with experience of two or more health conditions that presented before pregnancy.
The research will consist of five projects:
Our data scientists will look at electronic health records to find out how many women have two or more long-term health conditions that presented before pregnancy and what health conditions they have. We will try and identify if factors such as age, weight, cultural or social background, level of education and number of previous pregnancies influences this. We will also find out which health conditions group together (cluster) during pregnancy, which clusters are most common and whether some clusters affect some women more than others.
We will meet with women and healthcare professionals to discuss the services available for pregnant women who live with two or more long-term health conditions that presented before pregnancy. We will find out how appropriate and accessible these services are and how services can be improved. Going forward, this will help us to jointly design health services with women and their partners.
We will compare what happens to women with and without two or more long-term health conditions during pregnancy. We will find out whether these women are more likely to develop illnesses during the pregnancy (e.g. gestational diabetes), after the pregnancy (e.g. postnatal depression) and also in the longer-term (e.g. heart disease). We will also look at the health and wellbeing of children of these women.
We will focus on medications in pregnancy. We will find out what medicines women living with two or more long-term health conditions take during pregnancy and how the medications affect the health of the woman and the baby during pregnancy. This knowledge will help doctors prescribe safely during pregnancy.
Finally, we know that complications in pregnancy are a warning sign of future illnesses in women. As part of this project, we will be able to find out more about how different pregnancy complications affect the longer-term health of women. We can use this knowledge to put preventative measures in place where possible.
Involving the public
We will work in partnership with women with experience of managing two or more long-term health conditions in pregnancy. Their insights will help ensure that our project is grounded in the experiences of women and that all stages of the project drive towards improving care for women.
Sharing our findings
Our team has large networks and we will share our findings with healthcare professionals, through professional organisations (e.g. Royal Colleges of Obstetricians and Gynaecologists); through NHS networks (e.g. Local Maternity Services) and through charities and women’s networks (e.g. Maternity Voice Partnerships).
This study will give healthcare professionals and women a much better understanding of having two or more health conditions in pregnancy. Through this enhanced understanding, we will be able to plan and design services that meet the needs of women and their families before, during and after the birth of their babies.
Where the terms ‘woman’ or ‘mother’ are used, these should be taken to include people who do not identify as woman but are pregnant or have given birth.
We would love to hear what you think about this research project. Please feel free to leave your comments below!