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Women who begin pregnancy with two or more pre-existing long-term physical or mental health conditions may face a 20% higher risk of miscarriage, according to new research led by King’s College London. The study also found elevated risks of several other pregnancy complications, highlighting the importance of comprehensive care before and during pregnancy.
The research, published in The Lancet Public Health, analysed more than 2.2 million pregnancies across England, Scotland, Wales and Northern Ireland between 2000 and 2022. It is described as the largest study of its kind examining the impact of multiple long-term conditions on pregnancy outcomes.
Multiple Long-Term Conditions Linked to Higher Miscarriage Risk
The study focused on women who entered pregnancy with two or more pre-existing long-term physical or mental health conditions.
Compared with women who had no recorded long-term conditions, those with multiple conditions had a 20% higher risk of miscarriage. The researchers also found that risks generally increased as the number of long-term conditions increased.
The findings do not mean that having a long-term health condition will necessarily result in miscarriage. Rather, the research identifies an association between multiple pre-existing conditions and a higher risk of adverse pregnancy outcomes.
This distinction is important because pregnancy outcomes can be influenced by numerous factors, including age, underlying disease, medication, lifestyle and access to healthcare.
Higher Risk of Other Pregnancy Complications
Miscarriage was not the only concern identified by researchers.
Women with two or more long-term conditions had a 69% higher risk of severe nausea and vomiting during pregnancy, compared with women without long-term conditions. They also had a 42% higher risk of pre-eclampsia, a pregnancy complication associated with high blood pressure.
The study additionally found that women with multiple conditions had more than twice the risk of venous thromboembolism (VTE), a condition in which a blood clot forms inside a vein. For women with three or more long-term conditions, the risk of VTE was more than three and a half times that of women without long-term conditions.
These findings suggest that women with multiple health conditions may require closer monitoring throughout pregnancy.
Mental Health Risks Also Increased
The research also highlighted the mental health burden associated with having multiple long-term conditions during pregnancy.
Women entering pregnancy with two or more pre-existing conditions were found to be around four times more likely to experience anxiety and depression than women without long-term conditions.
The finding reinforces the importance of treating pregnancy care as more than monitoring physical symptoms. Mental health screening and appropriate support can also form an important part of antenatal care, particularly for women managing several health conditions simultaneously.
Risks Rise With the Number of Conditions
One of the central findings of the research was that pregnancy risks generally increased as the number of long-term conditions increased.
This means that women with three or more conditions may face substantially greater risks than those with only one condition. The pattern was particularly evident for venous thromboembolism, with the risk increasing considerably among women with three or more conditions.
The findings underline the challenges involved in managing multimorbidity, where a person lives with several health conditions at the same time.
Why Pre-Pregnancy Care Matters
The study’s findings highlight the importance of discussing existing health conditions before conception whenever possible.
Pre-pregnancy consultations can give healthcare professionals an opportunity to review a woman’s medical history, medications and ongoing treatment and determine whether additional monitoring may be needed during pregnancy.
For women living with multiple long-term conditions, coordinated care can help healthcare professionals identify potential risks and develop an appropriate pregnancy management plan.
However, the research should not be interpreted as suggesting that women with long-term conditions should avoid pregnancy. Instead, it highlights the importance of individualised medical care and appropriate monitoring.
Study Provides Large-Scale Evidence
The scale of the research is one of its major strengths. Researchers analysed more than 2.2 million pregnancies across all four nations of the United Kingdom over a 22-year period.
Such a large dataset allows researchers to examine relatively uncommon pregnancy outcomes and identify patterns associated with multiple long-term conditions.
At the same time, observational research can identify associations but does not necessarily prove that long-term conditions directly cause miscarriage or other complications. Other factors may contribute to the observed relationships.
Implications for Pregnancy Healthcare
The findings could have implications for how healthcare systems approach women with multiple long-term conditions.
As more women enter pregnancy while managing chronic physical or mental health conditions, healthcare providers may need to consider the combined effect of several conditions rather than assessing each condition separately.
A coordinated approach involving obstetricians, primary-care doctors, specialists and mental-health professionals could help ensure that different aspects of a woman’s health are considered throughout pregnancy.
The research also highlights the importance of identifying women who may need additional support early in pregnancy.
What Women With Long-Term Conditions Should Know
A higher relative risk does not mean that an individual woman will experience a miscarriage or another complication.
Pregnancy outcomes vary considerably from person to person, and the specific conditions involved can make a substantial difference. Women who have existing health conditions and are planning a pregnancy should discuss their individual circumstances with a qualified healthcare professional.
Medication should also not be stopped or changed without medical advice, as some treatments may need to be adjusted before or during pregnancy while others may be important for maintaining the mother’s health.
A large UK study has found that women who begin pregnancy with two or more pre-existing long-term physical or mental health conditions have a 20% higher risk of miscarriage compared with women without long-term conditions. The research also identified higher risks of severe nausea and vomiting, pre-eclampsia, venous thromboembolism, anxiety and depression.
The findings highlight the importance of pre-pregnancy planning, personalised antenatal care and attention to both physical and mental health for women managing multiple long-term conditions.
Importantly, the study describes an association rather than proving that multiple long-term conditions directly cause miscarriage. Individual risk can vary depending on the underlying conditions and other factors.
