Multiple long-term health conditions linked to pregnancy complications

Approximately one in five pregnant women in the UK manage multiple pre-existing health conditions, yet standard maternity care remains rigidly organized around single ailments managed by separate teams with no systematic monitoring of combined risk. This structural disconnect leaves vulnerable patients exposed to compounding physical and mental health hazards throughout their pregnancies, according to a comprehensive new study published in The Lancet Public Health.

The first UK investigation of its kind analyzed anonymized health records from more than 2.2 million pregnancies across England, Scotland, Wales, and Northern Ireland between the years 2000 and 2022. Led by researchers at the University of Birmingham and King's College London in collaboration with the MuM-PreDiCT Consortium, the research demonstrates that women entering pregnancy with two or more pre-existing physical or mental conditions face substantially elevated risks that scale upward with every additional diagnosis.

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The statistical findings reveal sharp increases across multiple specific pregnancy complications. Women with pre-existing multimorbidity face a 20 percent higher risk of miscarriage and a 69 percent higher risk of severe nausea and vomiting, according to findings covered by DT Next and Awaz the Voice. Furthermore, the data show a 42 percent higher risk of pre-eclampsia and more than double the risk of venous thromboembolism compared to pregnant women without pre-existing conditions. These hazards escalate sharply as complexity grows; the risk of venous thromboembolism more than tripled to over three and a half times among women managing three or more pre-existing conditions.

Most striking among the psychological findings is a nearly four-fold increase in the risk of antenatal anxiety and depression for women who begin pregnancy with multiple conditions. Lead authors emphasize that these stacked physical and mental vulnerabilities necessitate an urgent overhaul of perinatal health services. Currently, maternity systems rely on parallel clinics where specialists operate in isolation, failing to track how conditions like asthma, diabetes, high blood pressure, depression, or anxiety interact.

"Around one in five pregnant women in the UK currently live with two or more long-term health conditions. However, maternity care is still largely organised around one condition at a time, meaning women with multiple long-term conditions are often looked after by several teams working separately, with no monitoring of the combined risk of these conditions"

Megha Singh, Research Fellow at the University of Birmingham, via Healthcare in Europe

The study's authors argue that multimorbidity should be formally recognized as an independent marker of antenatal risk from day one. Senior author Krishnarajah Nirantharakumar, clinical professor of public health and health data science at King's College London, stressed the practical implications for patient management.

"These findings make a strong case for recognising multiple long-term conditions as a marker of antenatal risk in its own right. That means identifying these women at maternity booking, assessing physical and mental health needs together, and joining up obstetric, primary care and mental health services around them. The near four-fold risk of antenatal anxiety and depression is particularly striking, and points to perinatal mental health support as an urgent priority"

Krishnarajah Nirantharakumar, clinical professor of public health and health data science at King's College London, via DT Next

To address these compounding vulnerabilities, researchers are urging healthcare providers to restructure standard maternity pathways. Under the proposed model, high-risk patients would be identified at their initial booking appointment, instantly triggering a single, integrated care plan that connects obstetric, primary care, and perinatal mental health teams. Such a coordinated approach aims to establish rigorous monitoring for high-incidence complications, including gestational diabetes, severe hypertension, blood clots, and acute mental health distress.

While the study provides robust population-level evidence across five major datasets, the research team noted that as an observational investigation utilizing routinely collected electronic health records, certain individual conditions and outcomes may be under-recorded or inconsistently documented.

Building on these foundational insights, further investigations within the UK-wide MuM-PreDiCT Consortium—funded by the Medical Research Council, the UKRI Strategic Priorities Fund, and the Department of Health and Social Care via the National Institute for Health and Care Research (NIHR)—will examine subsequent birth and child outcomes. This upcoming work aims to pinpoint which exact combinations of pre-existing physical and mental health conditions carry the absolute greatest cumulative risk for mothers and infants.

Evaluating Combined Risk Across UK Nations

The landmark investigation conducted by researchers at the University of Birmingham and King's College London draws upon an extensive repository of anonymized health records spanning more than two decades, specifically capturing data between the years 2000 and 2022. According to findings detailed by DT Next and Awaz the Voice, this comprehensive dataset aggregates patient outcomes across five distinct information streams covering England, Scotland, Wales, and Northern Ireland. By evaluating these population-level records, the research team was able to map how pre-existing conditions compound vulnerabilities across diverse regional healthcare settings in the UK.

• Analysis of over 2.2 million pregnancies and birth events recorded between 2000 and 2022.
• Data aggregated from five major datasets spanning England, Scotland, Wales, and Northern Ireland.
• Identification of specific physical and mental health conditions present before conception, including asthma, diabetes, high blood pressure, depression, and anxiety.
• Evaluation of escalating complication risks tied directly to the accumulation of two or more pre-existing diagnoses.

These empirical observations underscore that current maternity pathways, which typically isolate individual ailments into separate clinical silos, are ill-equipped to handle the compounding nature of multimorbidity during pregnancy. As investigators within the MuM-PreDiCT Consortium continue their work to identify which exact pairings of physical and mental health issues generate the absolute highest cumulative hazards for mothers and infants, the next step relies on translating these population-level insights into immediate, cross-disciplinary clinical reforms at the initial maternity booking appointment.