Table 2.
Characteristics and summary of studies of multimorbidity among pregnant women
| Reference | Country | Study Period | Data source | Number of participants (women or births) | Number of conditions defining multi-morbidity | Type/included conditions | Number of adverse outcomes reported | Type/included adverse outcomes |
|---|---|---|---|---|---|---|---|---|
| Allen, 2016 [18] | USA | 1996–2010 | Registry | 21,857 | 2 |
- Preeclampsia - liver dysfunction |
6 |
- Preterm birth, - infant death, miscarriage, - stillbirth, - overall foetal mortality rate, - NICU admission |
| Aubry, 2019 [19] | Switzerland | 2005–2016 | Registry | 2,170 | 3 |
- Obesity - diabetes, - preeclampsia, or hypertension |
8 |
- Apgar score ≤ 7 at 5 min, - early neonatal death, - fracture of the clavicle, - NICU admission, - macrosomia, - neonatal hypoglycaemia, - preterm birth, - respiratory distress of newborn |
|
Azcoaga- Lorenzo, 2023 [21] |
Scotland | 2014–2018 | Registry | 30,557 | ≥ 2 | - Preexisting long-term physical or mental health conditions | 1 | - Preterm birth |
| Bapayeva, 2022 [23] | Kazakhstan | 2012–2017 | Medical records | 323 | 2 |
- Diabetes mellitus - obesity |
1 | - Preterm birth |
| Bartáková, 2017 [69] | Czechia | 2011–2013 | Registry | 432 | 2 |
- Gestational diabetes mellitus - hypertension |
3 |
- Apgar score, - abnormal base excess (BE) or umbilical cord blood pH, - foetal death |
| Belsti, 2024 [24] | Australia | 2016–2021 | Registry | 48,502 | 2 |
- Pre-existing and/or - pregnancy-related medical conditions |
4 |
- Preterm birth, - foetal death, - congenital defects, - newborn admission to a neonatal special care nursery and/or NICU |
| Brakewood 2024 [25] | USA | 2002–2013 | Medical records | 5,416,171 | ≥ 2 |
- Chronic hypertension, - renal disease, - autoimmune disease, - asthma, - cardiac disease, - bleeding disorder, and/or clotting disorder |
7 |
- Neonatal morbidity, - foetal growth restriction, - macrosomia, - shoulder dystocia, - gestational age at delivery (average), - NICU admission, - neonatal death |
| Bröms, 2016 [66] | Sweden | 2006–2010 | Registry | 246 | ≥ 2 |
- Inflammatory bowel disease, - hypertension, - diabetes or systemic disease |
1 | - Preterm birth |
| Chaalan, 2024 [27] | Qatar | 2021–2021 | Medical records | 1,892 | ≥ 2 | - Obstetric Comorbidity Index [74] | 6 |
- Foetal morbidity, - Apgar score, - low umbilical artery pH (< 7,2), - hypoxic ischemic - encephalopathy, - NICU admission |
| Chen, 2022 [28] | Finland | 1996–2014 | Registry | 1,097,753 | 2 |
- PCOS - diabetes mellitus |
3 |
- Preterm birth, - LGA, - SGA |
| Chen, 2023 [29] | Finland | 2004–2014 | Registry | 652,732 | ≥ 2 |
- Hypertensive disorders (gestational hypertension, - chronic hypertension, or - pre-eclampsia) and PCOS |
4 |
- Preterm birth (< 37 weeks), - very preterm birth (28–31 weeks), - SGA, - LGA |
|
Conti- Ramsden, 2019 [30] |
South Africa | 2015–2016 | Registry | 1,547 | 2 |
- Preeclampsia - acute kidney injury |
2 |
- Stillbirth, - neonatal death |
| Cozzi, 2024 [56] | USA | 2016–2018 | Medical records | 337 | ≥ 2 |
- Chronic hypertension, - pre-gestational diabetes mellitus, - systemic lupus erythematosus, - chronic kidney disease |
11 |
- Birth weight, - NICU admission, - mechanical ventilation, - cardiopulmonary resuscitation, - necrotizing enterocolitis, - intraventricular haemorrhage, - respiratory distress syndrome, - arterial cord pH < 7.1, - Apgar score at 5 min, - hypoxic-ischemic encephalopathy, - neonatal death |
| Dudley, 2017 [32] | USA | 2011–2014 | Medical records | 1,257 | 2 |
- Obesity or morbid obesity - diabetes mellitus |
7 |
- Composite neonatal morbidity, - RDS, - NICU admission, - stillbirth, - neonatal death, - macrosomia, birthweight |
| Eissa, 2023 [62] | Saudi Arabia | 2023–2023 | Online survey | 245 | ≥ 2 |
- Sleeve gastrectomy - diabetes mellitus, anaemia, - preeclampsia, or hypertension |
6 |
- Preterm birth, - SGA, - LGA, - NICU admission, - jaundice, - birthweight |
| Feig, 2022 [59] | Canada | 2011–2018 | Medical records | 460 | 2 |
- Nephropathy - hypertension |
7 |
- SGA, - birth weight, - gestational age, - preterm birth, - NICU admission within 24 h of birth, - neonatal hypoglycaemia requiring IV dextrose infusion, - head and abdominal circumferences |
| Huet, 2018 [33] | France | 2012–2014 | Medical records | 1,484 | 2 |
- Gestational diabetes mellitus - obesity |
15 |
- Preterm birth (32–37 weeks), - extreme preterm birth (< 32 weeks), - LGA, - macrosomia, - intrauterine growth restriction, - shoulder dystocia, - foetal traumatism, - stillbirth, - early neonatal mortality, - need for ventilation, - admission in neonatology, - Apgar score < 10 at 5 min, - umbilical pH < 7.20, - hypoglycaemia, - hypocalcaemia |
| Lin, 2024 [38] | China | 2015–2022 | Medical records | 13,645 | 2 |
- Gestational diabetes mellitus - hypertensive disorders of pregnancy |
5 |
- Gestational week of delivery, - birthweight, - composite pregnancy outcomes (at least one of: preterm -- birth, placenta previa, or neonatal jaundice), - SGA, - LGA |
| Liu, 2020 [39] | China | 2014–2018 | Medical records | 2,146 | 2 |
- Gestational diabetes mellitus - echocardiographic epicardial adipose tissue |
5 |
- LGA, - neonatal hypoglycaemia, - NICU admission, - preterm delivery, - hyperbilirubinemia |
| Liu, 2021 [40] | China | 2010–2019 | Registry | 19,424 | 2 |
- Coronary heart disease - pulmonary hypertension |
4 |
- Foetal distress, - foetal growth restriction, - foetal malformation, - LBW |
| Manoharan, 2020 [42] | Australia | 2015–2019 | Medical records | 1,545 | 2 |
- Polycystic ovary syndrome (PCOS) - gestational diabetes mellitus |
9 |
- Prematurity, - Apgar score < 7 at 1 min, - Apgar score < 7 at 5 min, - neonatal birth weight, - NICU admission, - neonatal hypoglycaemia, - NICU admission with neonatal hypoglycaemia, - neonatal death, - congenital abnormality |
| Peyvandi, 2020 [43] | USA | 2007–2012 | Registry | 2,419,651 | ≥ 2 |
- BMI > 25 kg/m2, - hypertensive disorder, - diabetes mellitus |
3 |
- CHD, - CHD without chromosomal anomalies, - CHD without single ventricle |
| Schlichting, 2019 [47] | USA | 2008–2013 | Registry | 22,881,691 | 2 |
- Coronary heart disease - pulmonary hypertension |
4 |
- Foetal distress, - foetal growth restriction, - foetal malformation, - foetal death or stillbirth |
| Sweeney, 2024 [49] | USA | 2013–2021 | Medical records | 40,840 | 2 |
- Chronic hypertension - hypertensive disorders of pregnancy |
4 |
- Preterm birth, - SGA, - NICU admission, - perinatal morbidity |
| Tanner, 2022 [50] | Australia | 2009–2017 | Registry | 17,824 | ≥ 2 |
- Preeclampsia - chronic hypertension, - diabetes or obesity |
5 |
- Gestational age at delivery (28–32 weeks, 33 − 26 weeks, >37 weeks), - RDS, - neonatal sepsis, - NICU admission, - Apgar score < 5 at 5 min |
| Tsur, 2017 [51] | USA | 2007–2011 | Medical records | 2,049,196 | ≥ 2 |
- Overweight or obesity - diabetes mellitus, - chronic hypertension, or pregnancy-related hypertensive disorder |
1 | - Preterm birth |
| Venkatesh, 2020 [53] | USA | 2002–2008 | Registry | 2,217 | 2 |
- Preeclampsia with severe features - chronic hypertension or diabetes mellitus |
6 |
- NICU admission, - gestational age < 28 weeks, 28–32 weeks, 32–34 weeks, - mean gestational age, - mean neonatal length of stay |
| Wu, 2024 [55] | China | 2021–2022 | Interviews and medical records | 149 | 2 |
- PCOS - gestational diabetes mellitus |
3 |
- Apgar score at 1-minute, - neonatal birth weight, - hypoglycaemia |
| Deutsch, 2022 [57] | USA + South Africa | Not reported | Survey | 3,042 | 2 |
- Anxiety - depression |
2 |
- Infant neurological maturation, - preterm birth |
| Männistö, 2016 [41] | USA | 2002–2008 | Medical records | 228,668 | ≥ 2 |
- Depression - anxiety or bipolar disorder with depression and/or anxiety |
1 | - Preterm birth |
| Miller, 2021 [60] | USA | 2017–2021 | Interviews | 1,274 | ≥ 3 | - Adverse childhood experience score > 3 | 1 | - Preterm birth |
|
Popovic, 2018 [64] |
Italy | 2005–2016 | Survey | 5,150 | ≥ 2 | - Eating disorders with depression and/or anxiety | 1 | - Infant wheezing |
| Uguz, 2019 [52] | Turkey | Not reported | Interviews and medical records | 1,119 | 2 |
- Major depression - anxiety disorder |
4 |
- Gestational age at birth, - birthweight, - preterm birth, - LBW |
| Clements 2016 [61] | USA | 2006–2009 | Registry | 221,860 | ≥ 2 | - Diseases of the circulatory system, musculoskeletal system and connective tissues, nervous system and senses, hypertension, or diabetes, and mental illness | 3 |
- Preterm birth, - SGA, - Apgar score > 7 at 5 min |
| Flynn 2015 [63] | USA | 2010–2012 | Registry | 419 | ≥ 3 |
- Kidney problems, - high blood pressure, or diabetes - mental health status |
2 |
- Birth weight, - Apgar score at 5 min |
| Jiao 2020 [35] | China | 2015–2018 | Survey and medical records | 4,380 | 2 |
- Gestational diabetes mellitus - depression |
6 |
- Gestational age (weeks), - birthweight (g), - body length (cm), - head circumference (cm), - chest circumference (cm), - LGA |
| Kolstad 2015 [65] | Norway | 1999–2018 | Registry | 107,214 | 2 |
- Epilepsy - an eating disorder |
6 |
- Small Ponderal Index (PI), - large PI, - SGA, - LGA, - small head for gestational age, - Apgar score < 7 at 5 min |
| Wang 2023 [54] | China | 2021–2022 | Interviews and medical records | 5,734 | 2 |
- Gestational diabetes mellitus - depression |
5 |
- Gestational age at birth, - preterm birth, - birthweight, - SGA, - LGA |
|
Karasek 2021 [36] |
USA | 2020–2021 | Medical records | 240,157 | ≥ 2 |
- Covid-19 - hypertension, - diabetes mellitus, or obesity |
2 |
- Very preterm (< 32 weeks), - preterm (< 37 weeks) |
| Baguiya 2021 [22] | 43 countries (LICs + LMICs) | Dec 2017 | Medical records | 1,219 | ≥ 2 |
- Infection of any kind - anaemia, - diabetes, HIV or any disease that required corticotherapy, - chemotherapy, immunotherapy, or transfusion during the pregnancy |
4 |
- Neonatal near miss (birthweight < 1750 g, - gestational age at birth between 28 and 33 weeks, - perinatal death |
|
DeWaard 2021 [58] |
South Africa | 2020–2020 | Registry | 100 | 2 |
- Covid-19 infection - HIV |
2 |
- Stillbirth, - preterm birth |
|
Guida 2022 [70] |
Brazil | 2020–2021 | Medical records | 729 | 2 |
- Covid-19 infection - preeclampsia |
7 |
- Preterm birth, - LBW, - Apgar < 7 at 5 min, - neonatal respiratory distress, - NICU admission, - neonatal morbidity, - neonatal death |
| Nakanishi 2023 [34] | Japan | 2011–2014 | Registry | 86,885 | ≥ 2 |
- Allergic diseases, - asthma, - anaemia, - diabetes mellitus, - dyslipidaemia, - epilepsy, - gastric or duodenal ulcer, - heart disease, - hepatitis, - HIV infection, - hypertension, - inflammatory bowel disease, - kidney disease, - malignancy, migraine, - neurological disease, - sexually transmitted diseases, - psychiatric disorders, - rheumatic or collagen diseases, - thyroid disease, - underweight and obesity, - physical or verbal domestic violence, - substance abuse |
6 |
- Extremely low birth weight (< 1000 g), - low birth weight (< 2500 g), - preterm birth (34–37 weeks), - SGA, - very low birth weight (< 1500 g), - preterm birth (before 34 weeks) |
| Lopez 2019 [67] | USA | 2008–2010 | Registry | 178,737 | ≥ 2 | - Reports scores from the Charlson-Deyo Index for comorbidities [74] | 2 |
- Poor foetal growth, - preterm birth |
| Priyadharshini 2021 [44] | India | 2020–2020 | Medical records | 381 | ≥ 2 |
- Covid-19 - pregnancy induced hypertension, - hypothyroidism, - gestational diabetes mellitus, - anaemia, - cardiovascular disease, - immunocompromised, - kidney disease, or central nervous system disease |
1 | - Foetal death |
| Sania 2017 [45] | South Africa | 2013–2014 | Registry | 571 | ≥ 2 |
- HIV - depression, - intimate partner violence, - moderate psychological distress, - hazardous alcohol use |
2 |
- SGA, - preterm birth |
| Sardinha 2024 [46] | Brazil | 2020–2021 | Medical records | 729 | 2 |
- Covid-19 infection - overweight or obese |
4 |
- Gestational age at birth, - NICU admission, - neonatal death, - Apgar score at 5 min |
| Schapkaitz 2021 [68] | South Africa | 2017–2020 | Medical records | 768 | 2 |
- HIV - venous thromboembolism |
1 | - Preterm birth |
| Sobieray 2024 [48] | Brazil | 2020–2021 | Medical records | 100 | 2 |
- Covid-19 infection - preeclampsia |
7 |
- Foetal growth restriction, - foetal death, - prematurity, - birth weight, - LBW, - Apgar score < 7 at 5 min, - NICU admission |
| Buteau 2023 [26] | Canada | 2000–2016 | Registry | 1,342,198 | ≥ 2 |
- Exposure to PM2.5 or NO2 - preexisting diabetes mellitus, - obesity, - preeclampsia, - preexisting hypertension, epilepsy, mood disorders, anaemia, or substance use disorders |
1 | - CHD (tetralogy of Fallot, coarctation of the aorta, transposition of great vessels, truncus arteriosus, hypoplastic left heart, common ventricle, atrial septal defect, ventricular septal defect, endocardial cushion defect, pulmonary artery defects, or heterotaxy) |
| Lavigne 2016 [37] | Cananda | 2005–2012 | Registry | 818,400 | ≥ 2 |
- Exposure to ambient air pollution - asthma, - hypertension, - heart disease, - diabetes, - gestational diabetes mellitus, or preeclampsia |
3 |
- Preterm birth, - SGA, - LBW |
| Zhao 2020 [71] | Mongolia | 2013–2016 | Medical records | 69,945 | ≥ 2 |
- Exposure to SO2, CO, PM10, O3, NO2, or PM2.5 - gestational diabetes mellitus, - gestational hypertension, - preeclampsia, - polyhydramnios, - oligohydramnios, - hyperthyroidism, - hypothyroidism, or anaemia |
2 |
- Preterm birth, - LBW |
| Avalos 2024 [20] | USA | 2011–2020 | Registry | 364,924 | 3 |
- Cannabis use during pregnancy - anaemia, diabetes, - abnormal BMI, - asthma, nausea, or mental health conditions |
6 |
- LBW, - SGA, - preterm birth < 34 weeks, - preterm birth < 37 weeks, - NICU admission, - neonatal respiratory support |
| deAndrade 2025 [31] | USA | 2000–2004 | Registry | 150,775 | 2 |
- Tobacco use during pregnancy - diabetes, anaemia, or eclampsia |
1 | - Congenital malformations |