Multimorbid Pregnancy: Determinants, Clusters, Consequences and Trajectories (MuM-PreDiCCT)

多重疾病是指人们患有一种以上的长期疾病。患有多种长期疾病的人很难控制自己的病情，有时他们得不到最好的护理。患有多种疾病的患者可能需要与不同的专家协调预约，他们的药物需要仔细管理。在怀孕期间，这些挑战可能会增加多病妇女。我们知道怀孕期间多病越来越普遍，但我们不明白为什么会这样，也不知道这会对母亲和婴儿造成什么后果。如果对这个问题没有更深入的了解，患有多种长期疾病的妇女在怀孕前、怀孕期间和怀孕后都不会得到最好的护理体验，因为服务不是根据她们的具体需求量身定制的。我们的合作将汇集来自英国7个学术机构的数据分析、疾病和公共卫生方面的专家。我们将与有妊娠多病经验的妇女密切合作。首先，我们的数据专家会查看电子健康记录，找出有多少女性在怀孕期间患有多种疾病，以及她们患有哪些疾病。我们将试图确定年龄、体重、文化或社会背景、教育水平和以前怀孕的次数等因素是否会影响妇女在怀孕期间是否患有多种疾病。我们还将发现哪些疾病在怀孕期间聚集在一起（群集），哪些群集最常见，以及某些群集是否对某些妇女的影响大于其他妇女。在研究的第二部分，我们将比较有和没有多病的母亲在怀孕期间的情况。我们将发现患有多种疾病的妇女是否更容易在怀孕期间（如妊娠糖尿病）、怀孕后（如产后抑郁症）以及长期（如心脏病）患上疾病。我们还将研究怀孕期间患有多种疾病的妇女的子女的健康和福祉。我们的研究的第三部分将集中在怀孕期间的药物治疗。我们将了解患有多种疾病的妇女在怀孕期间服用哪些药物，以及这些药物如何影响怀孕期间母亲和婴儿的健康。这一知识将帮助医生在怀孕期间安全开药。我们知道，怀孕期间的并发症是女性未来患病的警告信号。作为该项目的一部分，我们将能够更多地了解不同的妊娠并发症如何影响妇女的长期健康。我们可以利用这些知识在可能的地方采取预防措施。最后，我们将与妇女和保健专业人员会面，讨论为怀孕期间患有多种疾病的妇女提供的服务。我们将查明这些服务的适当程度和可及性，以及如何改进这些服务。今后，这将有助于我们与妇女及其伴侣共同设计保健服务。让公众参与我们将与有妊娠期间多种疾病经验的妇女合作。他们的见解将有助于确保我们的项目以妇女的经验为基础，并确保项目的各个阶段都致力于改善对妇女的照顾。我们的团队拥有庞大的网络，我们将通过专业组织（例如皇家妇产科学院）与医疗保健专业人员分享我们的发现；通过国民保健服务网络（如地方产妇服务）以及慈善机构和妇女网络（如产妇之声伙伴关系）。我们的影响：这项研究将使医疗保健专业人员和妇女更好地了解怀孕期间的多病。通过加深了解，我们将能够规划和设计服务，以满足妇女及其家庭在婴儿出生之前，期间和之后的需求。

The ProblemMultimorbidity is when people suffer from more than one long-term illness. It can be difficult for people with several long-term illnesses to manage their conditions and sometimes they don't receive the best quality care. Patients with multimorbidity may have to coordinate appointments with different specialists and their medications need to be managed carefully. During pregnancy, these challenges may increase for women with multimorbidity. We know that multimorbidity in pregnancy is becoming more common, but we don't understand why this is and what the consequences are for mothers and babies. Without this deeper understanding of the problem, women with several long-term illnesses won't have the best experience of care before, during and after pregnancy because services are not tailored to their specific needs. Our aims and approachOur collaboration will bring together experts in data analysis, diseases and public health from 7 academic institutions in the UK. We will work in close partnership with women with experience of multimorbidity in pregnancy. Firstly, our data specialists will look at electronic health records to find out how many women have multimorbidity in pregnancy and what illnesses they have. We will try and identify if factors such as age, weight, cultural or social background, level of education and number of previous pregnancies influences whether a woman has multimorbidity in pregnancy. We will also find out which illnesses group together(cluster) during pregnancy, which clusters are most common and whether some clusters affect some women more than others. In the second part of the study, we will compare what happens to mothers with and without multimorbidity during pregnancy. We will find out whether women with multimorbidity are more likely to develop illnesses during the pregnancy (e.g. gestational diabetes), after the pregnancy (e.g postnatal depression) and also in the longer-term (e.g. heart-disease). We will also look at the health and wellbeing of children of women with multimorbidity in pregnancy.The third part of our research will focus on medications in pregnancy. We will find out what medicines women with multimorbidity take during pregnancy and how the medications affect the health of the mother and the baby during pregnancy. This knowledge will help doctors prescribe safely during pregnancy. We know that complications in pregnancy are a warning sign of future illnesses in women. As part of this project, we will be able to find out more about how different pregnancy complications affect the longer-term health of women. We can use this knowledge to put preventative measures in place where possible. Finally, we will meet with women and healthcare professionals to discuss the services available for women with multimorbidity in pregnancy. We will find out how appropriate and accessible these services are and how services can be improved. Going forward, this will help us to jointly design health services with women and their partners. Involving the publicWe will work in partnership with women with experience of multimorbidity in pregnancy. Their insights will help ensure that our project is grounded in the experiences of women and that all stages of the project drive towards improving care for women. Sharing our findingsOur team has large networks and we will share our findings with healthcare professionals, through professional organisations (e.g. Royal Colleges of Obstetricians and Gynaecologists); through NHS networks (e.g. Local Maternity Services) and through charities and women's networks (e.g. Maternity Voice Partnerships). Our ImpactThis study will give healthcare professionals and women a much better understanding of multimorbidity in pregnancy. Through this enhanced understanding, we will be able to plan and design services that meet the needs of women and their families before, during and after the birth of their babies.