Exploring chronic and comorbid maternal conditions and pregnancy and birth outcomes: a case study at a joint maternity cardiac clinic and statistical analysis using the Northern Ireland Maternity System (NIMATS)

Abstract

Background: UK Confidential Enquires have recognised the influence of pre-existing conditions on maternal morbidity and mortality (Knight et al., 2014-2018). Cardiovascular disease was reported as the leading cause of death by Knight et al. (2016) and recommendations called for joint maternity/cardiac services. Knight et al. (2018) recommended appropriate training for all staff in order to improve care for women with pre-existing conditions.

Aim: To explore chronic and comorbid maternal conditions and pregnancy and birth outcomes in Northern Ireland.

Method: A mixed methods study of exploratory and analytic design, with three interrelated phases was undertaken. Ethical approval was given by ORECNI (Rec number: 16/NI/0012), for Phases Two and Three and Governance Approval by Belfast Health and Social Care Trust for Phase Three (Ref: 15189MS-SW). Phase One, a scoping literature review, identified online educational resources designed for health professionals caring for women with heart disease. Phase Two was a nested clinical observation study of 17 pregnant women. Phase Three involved descriptive and inferential statistical analyses of regional maternity data (n= 45754 women) to ascertain the comorbidity burden and relationships with pregnancy, labour, birth and infant outcomes for women who had cardiovascular disease, diabetes, mental health conditions, epilepsy or asthma. BMI groups were also included.

Results: In Phase One, two online resources were retrieved, StratOG: the RCOG online training programme (Vause, 2007, updates in 2010, 2013, 2017) and Rheumatic Heart Disease Australia e-learning module, (Clinician Module 14, Pregnancy in Rheumatic Heart Disease, Martin and Walters, 2012). Key components were early multidisciplinary and preconception care, continuity of care and effective communication. Phase Two demonstrated the importance of risk assessment at every consultation, the vital role of effective communication among members of the Pregnancy Heart Team and with women and the potential role for midwives to further enhance exemplary care in this setting.

Descriptive and inferential statistical analyses in Phase Three provided strong evidence of comorbidity between pre-existing conditions and increased likelihood of pregnancy, birth and infant complications, for example gestational hypertensive disorders, gestational diabetes, babies born outside the normal birthweight range or the normal weight for gestational age in women with all included pre-existing conditions.

Conclusion and implications: Evidence from each phase of this study demonstrates the burden of chronic conditions and the need to target resources.

Date of Award	Jun 2019
Original language	English
Sponsors	DEL
Supervisor	Marlene Sinclair (Supervisor), Brendan Bunting (Supervisor) & Joan Condell (Supervisor)