Association between maternal multimorbidity and preterm birth, low birth weight and small for gestational age: a prospective birth cohort study from the Japan Environment and Children's Study

Kentaro Nakanishi; Yasuaki Saijo; Eiji Yoshioka; Yukihiro Sato; Yasuhito Kato; Ken Nagaya; Satoru Takahashi; Yoshiya Ito; Sumitaka Kobayashi; Chihiro Miyashita; Atsuko Ikeda-Araki; Reiko Kishi; Japan Environment and Children’s Study (JECS) Group

doi:10.1136/bmjopen-2022-069281

Association between maternal multimorbidity and preterm birth, low birth weight and small for gestational age: a prospective birth cohort study from the Japan Environment and Children's Study

BMJ Open. 2023 Mar 15;13(3):e069281. doi: 10.1136/bmjopen-2022-069281.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
² Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan y-saijo@asahikawa-med.ac.jp.
³ Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
⁴ Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan.
⁵ Department of Pediatrics, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
⁶ Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, Kitami, Hokkaido, Japan.
⁷ Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
⁸ Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
⁹ Hokkaido Daigaku, Sapporo, Hokkaido, Japan.
¹⁰ Hokkaido Daigaku, Sapporo, Japan.

Abstract

Objectives: Multimorbidity is defined as the coexistence of two or more chronic physical or psychological conditions within an individual. The association between maternal multimorbidity and adverse perinatal outcomes such as preterm delivery and low birth weight has not been well studied. Therefore, this study aimed to investigate this association.

Methods: We conducted a prospective cohort study using data from the Japan Environment and Children's Study of pregnant women between 2011 and 2014. Those with data on chronic maternal conditions were included in the study and categorised as having no chronic condition, one chronic condition or multimorbidities. The primary outcomes were the incidence of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). Adjusted logistic regression was performed to estimate ORs (aORs) and 95% CIs.

Results: Of the 104 062 fetal records, 86 885 singleton pregnant women were analysed. The median maternal age and body mass index were 31 years and 20.5 kg/m², respectively. The prevalence of pregnant women with one or more chronic conditions was 40.2%. The prevalence of maternal multimorbidity was 6.3%, and that of PTB, LBW, and SGA were 4.6%, 8.1%, and 7.5%, respectively. Pre-pregnancy underweight women were the most common, observed in 15.6% of multimorbidity cases, followed by domestic violence from intimate partner in 13.0%. Maternal multimorbidity was significantly associated with PTB (aOR 1.50; 95% CI 1.33-1.69), LBW (aOR 1.49; 95% CI 1.35-1.63) and SGA (aOR 1.33; 95% CI 1.20-1.46).

Conclusion: Maternal multimorbidity was associated with adverse perinatal outcomes, including PTB, LBW and SGA. The risk of adverse perinatal outcomes tends to increase with a rise in the number of chronic maternal conditions. Multimorbidity becomes more prevalent among pregnant women, making our findings important for preconception counselling.

Keywords: epidemiology; fetal medicine; maternal medicine; obstetrics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Birth Weight
Child
Cohort Studies
Female
Fetal Growth Retardation / epidemiology
Gestational Age
Humans
Infant, Low Birth Weight
Infant, Newborn
Infant, Small for Gestational Age
Japan / epidemiology
Multimorbidity
Pregnancy
Premature Birth* / epidemiology
Prospective Studies
Risk Factors