Multimorbidity and Pregnancy: Determinants, Clusters, Consequences and Trajectories (MuM-PreDiCT)

有什么问题吗？五分之一的孕妇有两种或两种以上的长期健康状况。这些可以是身体状况（如糖尿病或血压升高）和心理健康状况（如抑郁或焦虑）。妇女通常还必须服用几种药物来管理其不同的健康需求。同时患有两种或两种以上的健康状况在孕妇中也变得越来越普遍，这是因为孕妇开始组建家庭的年龄越来越大，肥胖和心理健康状况也在普遍上升。我们并不真正了解多种健康状况或药物对母亲和婴儿的影响。这可能会使怀孕，医疗保健和管理药物变得更加复杂。如果不对这一问题有更深入的了解，患有几种长期健康状况的妇女在怀孕前、怀孕期间和怀孕后可能得不到最好和最安全的护理，因为在设计服务时没有考虑到她们的健康需要。我们该怎么办？我们的研究分为五个工作包。第一个工作包将研究健康状况如何随着时间的推移而积累，并确定是什么使妇女在怀孕前更容易患上两种或两种以上的长期健康状况。第二个工作包将探讨妇女在怀孕、分娩和产后的护理经验。我们将与家庭和卫生专业人员共同努力，以确定如何改善护理。第三个工作包将进一步研究两种或两种以上长期健康状况如何影响孕妇及其子女。我们将从三个方面来做这件事：我们将确定妇女、卫生专业人员和研究人员认为应该在研究中报告的结果;我们将检查妇女发生妊娠并发症的频率;我们将探索妇女及其子女患上其他长期疾病的频率。我们将研究药物组合如何影响孕妇及其婴儿。在我们的第五个工作包中，我们将建立一个预测模型，以帮助确定以前健康的孕妇在怀孕后患上多种长期疾病的可能性。我们可以通过使用在怀孕期间或怀孕后收集的健康信息来做到这一点。这是因为我们知道怀孕期间的一些并发症可能是未来疾病的警告信号。我们的研究将取得什么成果？我们将通过提供可获得的风险信息，帮助妇女及其医疗保健专业人员就其护理和药物使用做出明智的决定。例如，与怀孕相关的风险;与怀孕期间药物组合相关的风险;以及怀孕并发症后发展长期健康状况的未来风险。我们的工作还将确定干预的重要时间点，以及预防妊娠并发症或发展未来长期健康状况的方法。这将减轻妇女、伴侣和护理人员的健康负担，并从长远来看减少社会可避免的医疗保健和经济成本。我们将与妇女和医疗保健专业人员合作，就如何规划和设计服务提出建议，以满足妇女及其家庭在怀孕前、怀孕期间和怀孕后的需求。

What is the problem?One in five pregnant women have two or more active long-term health conditions. These can be both physical conditions (like diabetes or raised blood pressure), and mental health conditions (such as depression or anxiety). Often women also have to take several medications to manage their different health needs. Having two or more health conditions is also becoming increasingly common in pregnant women as women are increasingly older when they start having a family and as obesity and mental health conditions are on the rise in general.We don't really understand what the consequences are of multiple health conditions or medications for mothers and babies. This can make pregnancy, healthcare and managing medications more complicated. Without deeper understanding of the problem, women with several long-term health conditions may not have the best and safest experience of care before, during and after pregnancy because services have not been designed with their health needs in mind. What will we do?Our research is divided into five work packages. The first work package will examine how health conditions accumulate over time and identify what makes a woman more at risk of developing two or more long-term health conditions before pregnancy. The second work package will explore women's experiences of care during pregnancy, birth and after birth. We will work together with families and health professionals to establish how care could be improved. The third work package will look further at how having two or more long-term health conditions may affect pregnant women and their children. We will do this in three ways: we will identify outcomes that women, health professionals and researchers feel should be reported in research; we will examine how often women experience pregnancy complications; and we will explore how frequently women and their children develop additional long-term ill health.In the fourth work package we will describe how medications are prescribed. We will investigate how taking combinations of medication may affect pregnant women and their babies. In our fifth work package, we will build a prediction model to help identify how likely a previously healthy pregnant woman will develop multiple long-term conditions after pregnancy. We can do this by using health information collected during or just after pregnancy. This is because we know that some complications in pregnancy may be a warning sign of future illnesses.What will our research achieve?We will help women and their healthcare professionals make informed decisions about their care and medication use by providing accessible information on risk. For example, the risks associated with pregnancy; the risks associated with combinations of medications during pregnancy; and the future risk of developing long-term health conditions after a pregnancy complication. Our work will also identify important time points to intervene and ways to prevent pregnancy complications or developing future long-term health conditions. This will reduce the health burden for women, partners, carers and reduce avoidable healthcare and economic cost in the long run for society. Working together with women and healthcare professionals, we will produce recommendations on how to plan and design services that meet the needs of women and their families before, during and after pregnancy.