Researching a wide range of long-term health conditions and how these interact with pregnancy

This blog post was written by our parent and public representatives Rachel Plachcinski, Ngawai Moss and our PPI Advisory Group. The infographic was designed by Ngawai Moss.

MuM-PreDiCT’s chief investigator, Professor Krish Nirantharakumar, outlines why it is important to include a wide range of long-term health conditions when studying how these interact with pregnancy. The research will also explore how multiple health conditions develop over time, from hay fever to heart disease.

In consultation with our parent representatives and the senior clinicians on our research team, we have developed a list of conditions to include in our research.1  These vary in how widespread they are within the population but also from seemingly mild to more serious conditions.

Why include both mild and serious conditions?

By analysing all the long-term health conditions affecting anyone who has been pregnant, regardless of their impact on day-to-day life, we can get an idea of how different conditions cluster together. We can then watch how the clusters develop over time and whether they are likely to lead to more serious conditions later in life.

For example, does having a few seemingly minor allergies predispose someone to developing a more severe autoimmune condition, such as lupus, later in life?2

Does the order in which the allergies develop, plus pregnancy, influence this?

Is a particular cluster, which includes both serious and relatively mild conditions, in the mother likely to result in health problems for her baby?

And does a particular combination of prescription medication play a part in any of this?

The MuM-PreDiCT research aims to answer some of these questions.

Serious conditions – common and uncommon

It’s also important to study serious health conditions as many of them are under-researched. Often there is little or no guidance for health professionals on how to care for women with these conditions during pregnancy.

Some serious conditions are relatively common, for example diabetes affects about 5% of pregnant women in the UK. These more common serious conditions are easier to study because researchers have enough cases to work out what was likely to have caused them (and potential issues for an individual’s future health). There is also likely to be a care pathway in place, such as the NICE guidance for caring for women with diabetes in pregnancy.3 All these things give us a great starting point for working out what further research is needed and how we can improve maternity care for the women affected.

Other serious conditions are much less common, especially in women who are of an age to fall pregnant, such as stroke, congenital heart disease, cancer and kidney disease. Uncommon serious conditions are much harder to study as the small number of people affected means it is harder to draw general conclusions about that condition and make predictions. Add in the pregnancy requirement and the numbers get even smaller.

Many midwives and doctors will never encounter a pregnant woman with uncommon health conditions, so producing research and guidance about how to care for women with each separate condition would be a very expensive way to improve care.

MuM-PreDiCT is going to look in more detail at one or two uncommon conditions as part of our cluster analysis. We want to identify what clusters these women form and then study their pregnancy outcomes. We don’t have the funding to look at more of the uncommon serious conditions in this way, but we hope the way we run the project will become established as a framework to help other researchers in the future. 

A care pathway for all women with two or more long-term health conditions

Women and birthing people experiencing pregnancy along with two or more long-term health conditions face particular challenges in navigating day-to-day life and health care. The MuM-PreDiCT team believes it is important to improve maternity knowledge and care for all of them.

Part of our project is to interview these women, and the doctors and midwives caring for them. We will then combine these findings with our research looking at health records, so we can make recommendations about general care pathways for more complex pregnancies.

It is important to include a wide range of long-term health conditions within our research, so we have a holistic understanding of how long-term health conditions interact with pregnancy. We hope that the learning from our 3-year research project will lead to measurable and long-lasting changes in maternity care which will benefit women and their families.

References

1.           MuM-PreDiCT. 79 health conditions defining 2 or more long-term health conditions inpregnancy. 2021. https://mumpredict.org/79-health-conditions-defining-2-or-more-long-term-health-conditions-in-pregnancy/.

2.           Krishna MT, Subramanian A, Adderley NJ, Zemedikun DT, Gkoutos GV, Nirantharakumar K. Allergic diseases and long-term risk of autoimmune disorders: longitudinal cohort study and cluster analysis. European Respiratory Journal 2019; 54(5): 1900476.

3.           National Institute for Health and Care Excellence. NICE guideline [NG3]: Diabetes in pregnancy: management from preconception to the postnatal period. 16 December 2020. https://www.nice.org.uk/guidance/ng3.

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