The development of a core outcome set for studies of pregnant women with multimorbidity.

Siang Ing LEE, Stephanie Hanley, Zoe Vowles, Rachel Plachcinski, Ngawai Moss, Megha Singh, Chris Gale, Adeniyi Francis Fagbamigbe, Amaya Azcoaga-Lorenzo, Anuradhaa Subramanian, Beck Taylor, Catherine Nelson-Piercy, Christine Damase-Michel, Christopher Yau, Colin McCowan, Dermot O’Reilly, Gillian Santorelli, Helen Dolk, Holly Hope, Katherine PhillipsKathryn M Abel, Kelly-Ann Eastwood, Lisa Kent, Louise Locock, Maria Loane, Mohamed Mhereeg, Peter Brocklehurst, Sharon McCann, Sinead Brophy, Steven Wambua, Sudasing Pathirannehelage Buddhika Hemali Sudasinghe, Shakila Thangaratinam, Krishnarajah Nirantharakumar, Mairead Black

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BACKGROUND: 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.

Original languageEnglish
Article number314
Pages (from-to)1-15
Number of pages15
JournalBMC Medicine
Issue number1
Early online date21 Aug 2023
Publication statusPublished (in print/issue) - 21 Aug 2023

Bibliographical note

© 2023. BioMed Central Ltd., part of Springer Nature.


  • multimorbidity
  • multiple chronic conditions
  • multiple long-term conditions
  • pregnancy
  • maternity
  • outcome
  • core outcome set
  • Maternity
  • Core outcome set
  • Multimorbidity
  • Multiple chronic conditions
  • Pregnancy
  • Multiple long-term conditions
  • Outcome


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