“By the end of this project, we will be able to provide an evidence-led care bundle that is specific to this group of women and that will, for the first time, ensure that their complex needs are taken care of in the best way possible.”  – Dr Mairead Black.

A team of experts led by the University of Aberdeen will, for the first time, establish the way that maternity care should be delivered to pregnant women with multiple long term health conditions.  

Made possible by an award of £1.3 million from the National Institute for Health and Care Research (NIHR), the team say their results could benefit the almost one in five women who receive maternity care whilst also managing two or more long term health conditions.  

Recent figures show that over 80 women die each year in the UK due to complications arising from their pregnancy and more than one in six pregnant women are also living with multiple long term health conditions.

Common health conditions that can affect health in pregnancy include:

• diabetes
• high blood pressure
• heart disease
• mental health disorders

The increasing occurrence of multiple long-term health conditions among pregnant women is considered an important contributor to poor maternal outcomes. 

Pregnant women with multiple long term health conditions are at double the risk of pre-term birth and 9 times more likely to die during pregnancy than those without these health complications. Despite this, there is currently no defined care requirements for pregnant women with more than one long term health condition.  

Living with multiple long term health conditions can make pregnancies more challenging due to a variety of factors.  

These include changes to medication, disjointed care received from multiple teams, conflicting advice from different care teams, lack of knowledge of red flags amongst health professionals and a lack of appropriate follow-up of health conditions after birth.

Over three years, the team, led by Dr Mairead Black, Clinical Reader in Obstetrics, at the University of Aberdeen and Honorary Consultant Obstetrician at NHS Grampian will address the challenges these women face and create a package of care that will reduce the risks they encounter in pregnancy.  

Known as a ‘care bundle’ it will be specifically designed to guide the safe maternity care for pregnant women with multiple long term health conditions.  

The care bundle will include guidance on all aspects of maternity care from medication management and team communication, to midwifery care and postnatal handovers, pulling together expertise from across the health pathway. As well as input from maternity professionals, expertise from people with lived experience of maternity care will also be sought to shape and test the care bundle.  

Dr Black will be supported by experts in implementation science including:

• Dr Kristin Konnyu, University of Aberdeen
• Dr Rosalind Adam, an academic GP ,University of Aberdeen.
• Prof Judith Dyson, Birmingham City University
• University and NHS partners
• public panel with lived experience of multiple long term health conditions.

Dr Black explained why this project is so important: 

“The chance of pregnancy related deaths in the UK is rising and we need to address the reasons for this so we can find the best ways to prevent it. 

“We know that people with multiple long term health conditions are at a greater risk of serious complications during their pregnancy and are also at a much greater risk of not surviving the pregnancy or postnatal period. 

“This, we believe is preventable. With the correct care in place and appropriate measures taken – this health inequality can be addressed.    

“We will gather all the evidence available to us, including from our previous research led by the University of Birmingham, from healthcare providers, midwives, and importantly from the people who have experience of receiving maternity care whilst also dealing with multiple health conditions.  

“By the end of this project, we will be able to provide an evidence-led care bundle that is specific to this group of women and that will, for the first time, ensure that their complex needs are taken care of in the best way possible.”

The project will be led by the University of Aberdeen and Birmingham City University alongside partners including Professor Jane Sandall and Professor Krishnarajah Nirantharakumar of King’s College London and support from the University of Birmingham, Manchester University, Barts Health NHS Trust, Newcastle-upon-Tyne NHS Foundation Trust, and Guy’s and St Thomas’ NHS Foundation Trust.