Maternal Multimorbidity and preterm birth in Scotland: An Observational Record-Linkage Study

Amaya Azcoaga-Lorenzo; Adeniyi Fagbamigbe; Utkarsh Agrawal; Mairead Black; Muhammad  Usman; Siang Ing Lee; Kelly Ann Eastwood; Ngawai Moss; Rachel Plachcinski; Catherine Nelson-Piercy; Sinead Brophy; Dermot  O´Reilly; Krishnarajah Nirantharakumar; Colin McCowan; MuM-PreDiCT Group

doi:10.1186/s12916-023-03058-4

Maternal Multimorbidity and preterm birth in Scotland: An Observational Record-Linkage Study

Amaya Azcoaga-Lorenzo^* (Corresponding Author), Adeniyi Fagbamigbe, Utkarsh Agrawal, Mairead Black, Muhammad Usman, Siang Ing Lee, Kelly Ann Eastwood, Ngawai Moss, Rachel Plachcinski, Catherine Nelson-Piercy, Sinead Brophy, Dermot O´Reilly, Krishnarajah Nirantharakumar, Colin McCowan, MuM-PreDiCT Group

^*Corresponding author for this work

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Abstract

Background
Multimorbidity is common in women across the life course. Preterm birth is the single biggest cause of neonatal mortality and morbidity. We aim to estimate the prevalence of multimorbidity in pregnant women and to examine the association between maternal multimorbidity and PTB.
Methods
This is a retrospective cohort study using electronic health records from the Scottish Morbidity Records. All pregnancies among women aged 15 to 49 with a conception date between 1 January 2014 and 31 December 2018 were included. Multimorbidity was defined as the presence of two or more pre-existing long-term physical or mental health conditions, and complex multimorbidity as the presence of four or more. It was calculated at the time of conception using a predefined list of 79 conditions published by the MuM-PreDiCT consortium. PTB was defined as babies born alive between 24 and less than 37 completed weeks of gestation. We used Generalised Estimating Equations adjusted for maternal age, socioeconomic status, number of previous pregnancies, BMI, and smoking history to estimate the effect of maternal pre-existing multimorbidity. Absolut rates are reported in the results and tables, whilst Odds Ratios (ORs) are adjusted (aOR).
Results
30, 557 singleton births from 27,711 pregnant women were included in the analysis. The prevalence of pre-existing multimorbidity and complex multimorbidity was 16.8% (95% CI: 16.4-17.2) and 3.6% (95% CI: 3.3-3.8), respectively. The prevalence of multimorbidity in the youngest age group was 10.2%(95% CI: 8.8-11.6), while in those 40 to 44, it was 21.4% (95% CI: 18.4-24.4), and in the 45 to 49 age group, it was 20% (95% CI: 8.9-31.1). In women without multimorbidity, the prevalence of PTB was 6.7%; it was 11.6% in women with multimorbidity and 15.6% in women with complex multimorbidity. After adjusting for maternal age, socioeconomic status, number of previous pregnancies, Body Mass Index (BMI), and smoking, multimorbidity was associated with higher odds of PTB ( aOR= 1.64, 95% CI: 1.48-1.82)
Conclusions
Multimorbidity at the time of conception was present in one in six women and was associated with an increased risk of preterm birth. Multimorbidity presents a significant health burden to women and their offspring. Routine and comprehensive evaluation of women with multimorbidity before and during
pregnancy is urgently needed.

Original language	English
Article number	352
Journal	BMC medicine
Volume	21
DOIs	https://doi.org/10.1186/s12916-023-03058-4
Publication status	Published - 12 Sept 2023

Bibliographical note

Acknowledgements
We acknowledge the support of the Health Informatics Centre, University of Dundee for managing and supplying the anonymised data and NHS Tayside and Fife for the original data source.
Funding
This work was funded by Northwood Charitable Trust and by 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. The views expressed are those of the author and not necessarily those of the funders, the NIHR, or the UK Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.

Data Availability Statement

The data that support the findings of this study are available from the HIC at the University of Dundee, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. All code used in this study is publicly available at https://github.com/mumpredict.

Keywords

Multimorbidity
pregnancy
Premature birth
Electronic health records
Generalised Estimating Equation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Azcoaga_etal_BMCM_Maternal_Multimorbidity_And_VOR
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Data from: Maternal multimorbidity and preterm birth in Scotland: an observational record-linkage study
Azcoaga-Lorenzo, A. (Creator), Fagbamigbe, A. F. (Creator), Agrawal, U. (Creator), Black, M. (Creator), Usman, M. (Creator), Lee, S. I. (Creator), Eastwood, K. (Creator), Moss, N. (Creator), Plachcinski, R. (Creator), Nelson-Piercy, C. (Creator), Brophy, S. (Creator), O’Reilly, D. (Creator), Nirantharakumar, K. (Creator) & McCowan, C. (Creator), Figshare, 2023
DOI: 10.6084/m9.figshare.c.6830243, https://springernature.figshare.com/collections/Maternal_multimorbidity_and_preterm_birth_in_Scotland_an_observational_record-linkage_study/6830243
Dataset

Cite this

Azcoaga-Lorenzo, A., Fagbamigbe, A., Agrawal, U., Black, M., Usman, M., Lee, S. I., Eastwood, K. A., Moss, N., Plachcinski, R., Nelson-Piercy, C., Brophy, S., O´Reilly, D., Nirantharakumar, K., McCowan, C., & MuM-PreDiCT Group (2023). Maternal Multimorbidity and preterm birth in Scotland: An Observational Record-Linkage Study . BMC medicine , 21, Article 352. https://doi.org/10.1186/s12916-023-03058-4

Azcoaga-Lorenzo, A, Fagbamigbe, A, Agrawal, U, Black, M, Usman, M, Lee, SI, Eastwood, KA, Moss, N, Plachcinski, R, Nelson-Piercy, C, Brophy, S, O´Reilly, D, Nirantharakumar, K, McCowan, C & MuM-PreDiCT Group 2023, 'Maternal Multimorbidity and preterm birth in Scotland: An Observational Record-Linkage Study ', BMC medicine , vol. 21, 352. https://doi.org/10.1186/s12916-023-03058-4

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title = "Maternal Multimorbidity and preterm birth in Scotland: An Observational Record-Linkage Study ",

abstract = "BackgroundMultimorbidity is common in women across the life course. Preterm birth is the single biggest cause of neonatal mortality and morbidity. We aim to estimate the prevalence of multimorbidity in pregnant women and to examine the association between maternal multimorbidity and PTB.MethodsThis is a retrospective cohort study using electronic health records from the Scottish Morbidity Records. All pregnancies among women aged 15 to 49 with a conception date between 1 January 2014 and 31 December 2018 were included. Multimorbidity was defined as the presence of two or more pre-existing long-term physical or mental health conditions, and complex multimorbidity as the presence of four or more. It was calculated at the time of conception using a predefined list of 79 conditions published by the MuM-PreDiCT consortium. PTB was defined as babies born alive between 24 and less than 37 completed weeks of gestation. We used Generalised Estimating Equations adjusted for maternal age, socioeconomic status, number of previous pregnancies, BMI, and smoking history to estimate the effect of maternal pre-existing multimorbidity. Absolut rates are reported in the results and tables, whilst Odds Ratios (ORs) are adjusted (aOR).Results30, 557 singleton births from 27,711 pregnant women were included in the analysis. The prevalence of pre-existing multimorbidity and complex multimorbidity was 16.8% (95% CI: 16.4-17.2) and 3.6% (95% CI: 3.3-3.8), respectively. The prevalence of multimorbidity in the youngest age group was 10.2%(95% CI: 8.8-11.6), while in those 40 to 44, it was 21.4% (95% CI: 18.4-24.4), and in the 45 to 49 age group, it was 20% (95% CI: 8.9-31.1). In women without multimorbidity, the prevalence of PTB was 6.7%; it was 11.6% in women with multimorbidity and 15.6% in women with complex multimorbidity. After adjusting for maternal age, socioeconomic status, number of previous pregnancies, Body Mass Index (BMI), and smoking, multimorbidity was associated with higher odds of PTB ( aOR= 1.64, 95% CI: 1.48-1.82)ConclusionsMultimorbidity at the time of conception was present in one in six women and was associated with an increased risk of preterm birth. Multimorbidity presents a significant health burden to women and their offspring. Routine and comprehensive evaluation of women with multimorbidity before and duringpregnancy is urgently needed. ",

keywords = "Multimorbidity, pregnancy, Premature birth, Electronic health records, Generalised Estimating Equation",

author = "Amaya Azcoaga-Lorenzo and Adeniyi Fagbamigbe and Utkarsh Agrawal and Mairead Black and Muhammad Usman and Lee, {Siang Ing} and Eastwood, {Kelly Ann} and Ngawai Moss and Rachel Plachcinski and Catherine Nelson-Piercy and Sinead Brophy and Dermot O´Reilly and Krishnarajah Nirantharakumar and Colin McCowan and {MuM-PreDiCT Group}",

note = "Acknowledgements We acknowledge the support of the Health Informatics Centre, University of Dundee for managing and supplying the anonymised data and NHS Tayside and Fife for the original data source. Funding This work was funded by Northwood Charitable Trust and by 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. The views expressed are those of the author and not necessarily those of the funders, the NIHR, or the UK Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.",

year = "2023",

month = sep,

day = "12",

doi = "10.1186/s12916-023-03058-4",

language = "English",

volume = "21",

journal = "BMC medicine ",

issn = "1741-7015",

publisher = "BioMed Central",

}

TY - JOUR

T1 - Maternal Multimorbidity and preterm birth in Scotland

T2 - An Observational Record-Linkage Study

AU - Azcoaga-Lorenzo, Amaya

AU - Fagbamigbe, Adeniyi

AU - Agrawal, Utkarsh

AU - Black, Mairead

AU - Usman, Muhammad

AU - Lee, Siang Ing

AU - Eastwood, Kelly Ann

AU - Moss, Ngawai

AU - Plachcinski, Rachel

AU - Nelson-Piercy, Catherine

AU - Brophy, Sinead

AU - O´Reilly, Dermot

AU - Nirantharakumar, Krishnarajah

AU - McCowan, Colin

AU - MuM-PreDiCT Group

N1 - Acknowledgements We acknowledge the support of the Health Informatics Centre, University of Dundee for managing and supplying the anonymised data and NHS Tayside and Fife for the original data source. Funding This work was funded by Northwood Charitable Trust and by 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. The views expressed are those of the author and not necessarily those of the funders, the NIHR, or the UK Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.

PY - 2023/9/12

Y1 - 2023/9/12

N2 - BackgroundMultimorbidity is common in women across the life course. Preterm birth is the single biggest cause of neonatal mortality and morbidity. We aim to estimate the prevalence of multimorbidity in pregnant women and to examine the association between maternal multimorbidity and PTB.MethodsThis is a retrospective cohort study using electronic health records from the Scottish Morbidity Records. All pregnancies among women aged 15 to 49 with a conception date between 1 January 2014 and 31 December 2018 were included. Multimorbidity was defined as the presence of two or more pre-existing long-term physical or mental health conditions, and complex multimorbidity as the presence of four or more. It was calculated at the time of conception using a predefined list of 79 conditions published by the MuM-PreDiCT consortium. PTB was defined as babies born alive between 24 and less than 37 completed weeks of gestation. We used Generalised Estimating Equations adjusted for maternal age, socioeconomic status, number of previous pregnancies, BMI, and smoking history to estimate the effect of maternal pre-existing multimorbidity. Absolut rates are reported in the results and tables, whilst Odds Ratios (ORs) are adjusted (aOR).Results30, 557 singleton births from 27,711 pregnant women were included in the analysis. The prevalence of pre-existing multimorbidity and complex multimorbidity was 16.8% (95% CI: 16.4-17.2) and 3.6% (95% CI: 3.3-3.8), respectively. The prevalence of multimorbidity in the youngest age group was 10.2%(95% CI: 8.8-11.6), while in those 40 to 44, it was 21.4% (95% CI: 18.4-24.4), and in the 45 to 49 age group, it was 20% (95% CI: 8.9-31.1). In women without multimorbidity, the prevalence of PTB was 6.7%; it was 11.6% in women with multimorbidity and 15.6% in women with complex multimorbidity. After adjusting for maternal age, socioeconomic status, number of previous pregnancies, Body Mass Index (BMI), and smoking, multimorbidity was associated with higher odds of PTB ( aOR= 1.64, 95% CI: 1.48-1.82)ConclusionsMultimorbidity at the time of conception was present in one in six women and was associated with an increased risk of preterm birth. Multimorbidity presents a significant health burden to women and their offspring. Routine and comprehensive evaluation of women with multimorbidity before and duringpregnancy is urgently needed.

AB - BackgroundMultimorbidity is common in women across the life course. Preterm birth is the single biggest cause of neonatal mortality and morbidity. We aim to estimate the prevalence of multimorbidity in pregnant women and to examine the association between maternal multimorbidity and PTB.MethodsThis is a retrospective cohort study using electronic health records from the Scottish Morbidity Records. All pregnancies among women aged 15 to 49 with a conception date between 1 January 2014 and 31 December 2018 were included. Multimorbidity was defined as the presence of two or more pre-existing long-term physical or mental health conditions, and complex multimorbidity as the presence of four or more. It was calculated at the time of conception using a predefined list of 79 conditions published by the MuM-PreDiCT consortium. PTB was defined as babies born alive between 24 and less than 37 completed weeks of gestation. We used Generalised Estimating Equations adjusted for maternal age, socioeconomic status, number of previous pregnancies, BMI, and smoking history to estimate the effect of maternal pre-existing multimorbidity. Absolut rates are reported in the results and tables, whilst Odds Ratios (ORs) are adjusted (aOR).Results30, 557 singleton births from 27,711 pregnant women were included in the analysis. The prevalence of pre-existing multimorbidity and complex multimorbidity was 16.8% (95% CI: 16.4-17.2) and 3.6% (95% CI: 3.3-3.8), respectively. The prevalence of multimorbidity in the youngest age group was 10.2%(95% CI: 8.8-11.6), while in those 40 to 44, it was 21.4% (95% CI: 18.4-24.4), and in the 45 to 49 age group, it was 20% (95% CI: 8.9-31.1). In women without multimorbidity, the prevalence of PTB was 6.7%; it was 11.6% in women with multimorbidity and 15.6% in women with complex multimorbidity. After adjusting for maternal age, socioeconomic status, number of previous pregnancies, Body Mass Index (BMI), and smoking, multimorbidity was associated with higher odds of PTB ( aOR= 1.64, 95% CI: 1.48-1.82)ConclusionsMultimorbidity at the time of conception was present in one in six women and was associated with an increased risk of preterm birth. Multimorbidity presents a significant health burden to women and their offspring. Routine and comprehensive evaluation of women with multimorbidity before and duringpregnancy is urgently needed.

KW - Multimorbidity

KW - pregnancy

KW - Premature birth

KW - Electronic health records

KW - Generalised Estimating Equation

U2 - 10.1186/s12916-023-03058-4

DO - 10.1186/s12916-023-03058-4

M3 - Article

C2 - 37697325

SN - 1741-7015

VL - 21

JO - BMC medicine

JF - BMC medicine

M1 - 352

ER -

Maternal Multimorbidity and preterm birth in Scotland: An Observational Record-Linkage Study

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

Access to Document

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Datasets

Data from: Maternal multimorbidity and preterm birth in Scotland: an observational record-linkage study

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