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  • 1
    In: BMC Pregnancy and Childbirth, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: Although maternal death is rare in the United Kingdom, 90% of these women had multiple health/social problems. This study aims to estimate the prevalence of pre-existing multimorbidity (two or more long-term physical or mental health conditions) in pregnant women in the United Kingdom (England, Northern Ireland, Wales and Scotland). Study design Pregnant women aged 15–49 years with a conception date 1/1/2018 to 31/12/2018 were included in this population-based cross-sectional study, using routine healthcare datasets from primary care: Clinical Practice Research Datalink (CPRD, United Kingdom, n  = 37,641) and Secure Anonymized Information Linkage databank (SAIL, Wales, n  = 27,782), and secondary care: Scottish Morbidity Records with linked community prescribing data (SMR, Tayside and Fife, n  = 6099). Pre-existing multimorbidity preconception was defined from 79 long-term health conditions prioritised through a workshop with patient representatives and clinicians. Results The prevalence of multimorbidity was 44.2% (95% CI 43.7–44.7%), 46.2% (45.6–46.8%) and 19.8% (18.8–20.8%) in CPRD, SAIL and SMR respectively. When limited to health conditions that were active in the year before pregnancy, the prevalence of multimorbidity was still high (24.2% [23.8–24.6%], 23.5% [23.0–24.0%] and 17.0% [16.0 to 17.9%] in the respective datasets). Mental health conditions were highly prevalent and involved 70% of multimorbidity CPRD: multimorbidity with ≥one mental health condition/s 31.3% [30.8–31.8%] ). After adjusting for age, ethnicity, gravidity, index of multiple deprivation, body mass index and smoking, logistic regression showed that pregnant women with multimorbidity were more likely to be older (CPRD England, adjusted OR 1.81 [95% CI 1.04–3.17] 45–49 years vs 15–19 years), multigravid (1.68 [1.50–1.89] gravidity ≥ five vs one), have raised body mass index (1.59 [1.44–1.76], body mass index 30+ vs body mass index 18.5–24.9) and smoked preconception (1.61 [1.46–1.77) vs non-smoker). Conclusion Multimorbidity is prevalent in pregnant women in the United Kingdom, they are more likely to be older, multigravid, have raised body mass index and smoked preconception. Secondary care and community prescribing dataset may only capture the severe spectrum of health conditions. Research is needed urgently to quantify the consequences of maternal multimorbidity for both mothers and children.
    Type of Medium: Online Resource
    ISSN: 1471-2393
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2059869-5
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  • 2
    In: BMC Medicine, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2023-08-21)
    Abstract: Heterogeneity in reported outcomes can limit the synthesis of research evidence. A core outcome set informs what outcomes are important and should be measured as a minimum in all future studies. We report the development of a core outcome set applicable to observational and interventional studies of pregnant women with multimorbidity. Methods We developed the core outcome set in four stages: (i) a systematic literature search, (ii) three focus groups with UK stakeholders, (iii) two rounds of Delphi surveys with international stakeholders and (iv) two international virtual consensus meetings. Stakeholders included women with multimorbidity and experience of pregnancy in the last 5 years, or are planning a pregnancy, their partners, health or social care professionals and researchers. Study adverts were shared through stakeholder charities and organisations. Results Twenty-six studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Thematic analysis of the focus groups added a further 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important ). Thirteen stakeholders reviewed 15 Borderline outcomes in the first consensus meeting and included seven additional outcomes. Seventeen stakeholders reviewed these 52 outcomes in a second consensus meeting, the threshold was ≥80% of all participants voting for inclusion. The final core outcome set included 11 outcomes. The five maternal outcomes were as follows: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care and development of new mental health conditions. The six child outcomes were as follows: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight and separation of baby from mother for health care needs. Conclusions Multimorbidity in pregnancy is a new and complex clinical research area. Following a rigorous process, this complexity was meaningfully reduced to a core outcome set that balances the views of a diverse stakeholder group.
    Type of Medium: Online Resource
    ISSN: 1741-7015
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2131669-7
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  • 3
    In: BMJ Open, BMJ, Vol. 13, No. 2 ( 2023-02), p. e068718-
    Abstract: One in five pregnant women has multiple pre-existing long-term conditions in the UK. Studies have shown that maternal multiple long-term conditions are associated with adverse outcomes. This observational study aims to compare maternal and child outcomes for pregnant women with multiple long-term conditions to those without multiple long-term conditions (0 or 1 long-term conditions). Methods and analysis Pregnant women aged 15–49 years old with a conception date between 2000 and 2019 in the UK will be included with follow-up till 2019. The data source will be routine health records from all four UK nations (Clinical Practice Research Datalink (England), Secure Anonymised Information Linkage (Wales), Scotland routine health records and Northern Ireland Maternity System) and the Born in Bradford birth cohort. The exposure of two or more pre-existing, long-term physical or mental health conditions will be defined from a list of health conditions predetermined by women and clinicians. The association of maternal multiple long-term conditions with (a) antenatal, (b) peripartum, (c) postnatal and long-term and (d) mental health outcomes, for both women and their children will be examined. Outcomes of interest will be guided by a core outcome set. Comparisons will be made between pregnant women with and without multiple long-term conditions using modified Poisson and Cox regression. Generalised estimating equation will account for the clustering effect of women who had more than one pregnancy episode. Where appropriate, multiple imputation with chained equation will be used for missing data. Federated analysis will be conducted for each dataset and results will be pooled using random-effects meta-analyses. Ethics and dissemination Approval has been obtained from the respective data sources in each UK nation. Study findings will be submitted for publications in peer-reviewed journals and presented at key conferences.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2599832-8
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  • 4
    In: The Lancet, Elsevier BV, Vol. 398 ( 2021-11), p. S7-
    Type of Medium: Online Resource
    ISSN: 0140-6736
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2067452-1
    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
    SSG: 5,21
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  • 5
    Online Resource
    Online Resource
    Wiley ; 2023
    In:  The Obstetrician & Gynaecologist Vol. 25, No. 3 ( 2023-07), p. 186-195
    In: The Obstetrician & Gynaecologist, Wiley, Vol. 25, No. 3 ( 2023-07), p. 186-195
    Abstract: Congenital anomalies affect more than 2% of fetuses in the UK, with 70% noncardiac in origin. Around 10% are gastrointestinal anomalies such as abdominal wall defects and intestinal atresias. Most gastrointestinal anomalies require postnatal surgical management. Obstetricians must understand the key features of diagnosis and management of common gastrointestinal anomalies. Clinically relevant and evidence‐based information helps facilitate parental reproductive autonomy through timely and informed counselling, planning for delivery and optimising perinatal outcomes. Management of pregnancies complicated by congenital gastrointestinal anomalies requires a multidisciplinary approach with specialist input. Learning objectives To be familiar with the antenatal diagnosis of gastrointestinal anomalies, associated conditions and potential obstetric complications To understand the antenatal and postnatal management of gastrointestinal anomalies including the approach to surgery To appreciate the role of multidisciplinary counselling in fetal medicine Ethical issues Antenatal counselling in the context of diagnostic and outcome uncertainties Consideration of termination of pregnancy for fetal anomaly, including grounds for, and timing of, decision‐making
    Type of Medium: Online Resource
    ISSN: 1467-2561 , 1744-4667
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2180587-8
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  • 6
    In: Prenatal Diagnosis, Wiley, Vol. 43, No. 5 ( 2023-05), p. 647-660
    Abstract: What's already known about this topic? Congenital heart disease (CHD) is the most common congenital anomaly. Antenatal detection rates remain low, with limited understanding of aetiology. Metabolomics provides a global physiological overview to derive potential novel biomarkers in screening and causation. What does this review add? Several metabolites in lipid, amino acid and homocysteine/methionine metabolic pathways significantly differ in mothers with offspring affected by CHD. We identify metabolic pathways for further investigation in establishing causality and screening biomarkers for foetal CHD.
    Type of Medium: Online Resource
    ISSN: 0197-3851 , 1097-0223
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 1491217-X
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  • 7
    In: Placenta, Elsevier BV, Vol. 70 ( 2018-10), p. 53-59
    Type of Medium: Online Resource
    ISSN: 0143-4004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2002489-7
    SSG: 12
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  • 8
    In: BMC Pregnancy and Childbirth, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-08-01)
    Abstract: Maternal multiple long-term conditions are associated with adverse outcomes for mother and child. We conducted a qualitative study to inform a core outcome set for studies of pregnant women with multiple long-term conditions. Methods Women with two or more pre-existing long-term physical or mental health conditions, who had been pregnant in the last five years or planning a pregnancy, their partners and health care professionals were eligible. Recruitment was through social media, patients and health care professionals’ organisations and personal contacts. Participants who contacted the study team were purposively sampled for maximum variation. Three virtual focus groups were conducted from December 2021 to March 2022 in the United Kingdom: (i) health care professionals (n = 8), (ii) women with multiple long-term conditions (n = 6), and (iii) women with multiple long-term conditions (n = 6) and partners (n = 2). There was representation from women with 20 different physical health conditions and four mental health conditions; health care professionals from obstetrics, obstetric/maternal medicine, midwifery, neonatology, perinatal psychiatry, and general practice. Participants were asked what outcomes should be reported in all studies of pregnant women with multiple long-term conditions. Inductive thematic analysis was conducted. Outcomes identified in the focus groups were mapped to those identified in a systematic literature search in the core outcome set development. Results The focus groups identified 63 outcomes, including maternal (n = 43), children’s (n = 16) and health care utilisation (n = 4) outcomes. Twenty-eight outcomes were new when mapped to the systematic literature search. Outcomes considered important were generally similar across stakeholder groups. Women emphasised outcomes related to care processes, such as information sharing when transitioning between health care teams and stages of pregnancy (continuity of care). Both women and partners wanted to be involved in care decisions and to feel informed of the risks to the pregnancy and baby. Health care professionals additionally prioritised non-clinical outcomes, including quality of life and financial implications for the women; and longer-term outcomes, such as children’s developmental outcomes. Conclusions The findings will inform the design of a core outcome set. Participants’ experiences provided useful insights of how maternity care for pregnant women with multiple long-term conditions can be improved.
    Type of Medium: Online Resource
    ISSN: 1471-2393
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2059869-5
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  • 9
    In: International Journal of Population Data Science, Swansea University, Vol. 7, No. 3 ( 2022-08-25)
    Abstract: ObjectivesThis feasibility and hypothesis generating study aimed to compare maternal characteristics between pregnancies in which at least one infant received a diagnosis of CP (case pregnancies) and pregnancies in which all infants did not receive a diagnosis (control pregnancies). ApproachData for individuals with cerebral palsy (CP) born between 1990 (commencement of Northern Ireland Maternity System (NIMATS)) and 2012 (latest fully validated birth year in Northern Ireland Cerebral Palsy Register (NICPR)) were transferred to the Honest Broker Service, who performed linkage to NIMATS.  Offspring were primarily matched between NICPR and NIMATS using the unique Health and Care Number. Where this was unavailable in NIMATS, matching from offspring to mother-infant pairs was performed using surname, gender, date of birth and/or postcode.  Chi-square tests were used to test for differences in maternal characteristics between case and control pregnancies. ResultsCohorts consisted of 486 case and 266,260 control pregnancies.  After missing values were removed, case pregnancies had a greater proportion of mothers under 25 years (case: 28.0% vs control: 23.1%, p 〈 0.05), multiple births (7.8% vs 1.5%, p 〈 0.001), nulliparous mothers (47.5% vs 41.1%, p 〈 0.05), unplanned pregnancies (42.8% vs 34.4%, p 〈 0.001), late booking appointments (14.0% vs 9.7%, p 〈 0.01), hypertension during pregnancy (11.9% vs 8.5%, p 〈 0.05), no recorded folic acid intake (46.7% vs 34.8% p 〈 0.001), family history of congenital abnormality (33.3% vs 24.4%, p 〈 0.001), medical problems with potential to affect labour (respiratory, cardiac, diabetes, other) (6.6% vs 3.9%, p=0.004).  A non-significant trend was observed suggesting that case pregnancies had a higher proportion of mothers with BMI≥30kg/m2 (21.4% vs 13.2%, p=0.086). ConclusionThis feasibility study has highlighted a range of potential maternal characteristics that may be associated with a diagnosis of cerebral palsy in offspring and mirrors findings from other studies.  A future data extraction update and predictive model development is planned.
    Type of Medium: Online Resource
    ISSN: 2399-4908
    Language: Unknown
    Publisher: Swansea University
    Publication Date: 2022
    detail.hit.zdb_id: 2892786-2
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  • 10
    In: International Journal of Population Data Science, Swansea University, Vol. 7, No. 3 ( 2022-08-25)
    Abstract: ObjectivesThis study aimed to 1) establish the success rate of matching offspring in the Northern Ireland Cerebral Palsy Register (NICPR) to mother-infant pairs within the Northern Ireland Maternity System (NIMATS); and explore changes in 2) quality of maternal data (NIMATS) and 3) maternal characteristics over the study period. ApproachData for individuals with cerebral palsy (CP) born between 1990 (commencement of NIMATS) and 2012 (latest fully validated birth year in NICPR) were transferred to the Honest Broker Service, who performed data linkage.  Offspring were primarily matched between NICPR and NIMATS using the unique Health and Care Number (HCN).  Where this was unavailable in NIMATS, matching from offspring to mothers/pregnancies was performed using surname, gender, date of birth +/- postcode.  Changes in completeness and quality of data and maternal characteristics were explored per year and visualised using histograms.  All pre-processing and analyses were performed using R. ResultsFrom 1263 included CP cases, 377(30%) were matched using HCN.  A further 121(9%) were matched by secondary strategies.  Substantial improvements in completeness of maternal data were observed over time (body mass index (46.2% to 97.7%); BP (44.8% to 95.3%); age 100% complete throughout).  An apparent tendency to round systolic and diastolic blood pressure to the nearest ten was observed.  This tendency decreased over time which potentially led to an overestimation of hypertension detected in earlier years.  Characteristics of mothers also changed over the study duration, seen in increasing proportions with BMI≥30 kg/m2 (9.97% to 18.9%). Age of mothers also increased with decreasing proportions aged 〈 25y (33.7% to 19.6%) and increasing proportions aged≥35y (9.7% to 20.4%).  No change over time was observed in maternal blood pressure variables. ConclusionMatching success was affected by incomplete NIMATS coverage in earlier years and lag time in CP diagnosis being confirmed by NICPR (typically beyond the age of 4 years).  Over time, completeness and quality of maternal variables in NIMATS has improved meaning future studies using these linkages will be more reliable.
    Type of Medium: Online Resource
    ISSN: 2399-4908
    Language: Unknown
    Publisher: Swansea University
    Publication Date: 2022
    detail.hit.zdb_id: 2892786-2
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