Chronic diseases in pregnant women: prevalence and birth outcomes based on the SNiP-study

Abstract

Background: The subject of "pregnancy and disease" is of particular importance for maternal well-being and neonatal outcomes. The international literature has focused on acute diseases during pregnancy; however, there are only a few studies investigating chronic diseases in pregnant women. The focus of this study is on diseases of women in childbearing age that are not related to the pregnancy. The objective of the paper is to deliver population based prevalences of chronic dieases in childbearing women and compare the two groups of chronically ill women and healthy women in detail regarding sociodemography, peri- and prenatal parameters and birth outcomes.

Methods: Data of n = 5320 childbearing women were evaluated in the context of the population-based Survey of Neonates in Pomerania (SNiP). Data were obtained via face-to-face interviews, self-applied questionnaires, and abstraction from medical records at the time of giving birth. Sociodemographic and health status data were assessed, including chronic diseases that were taken out of medical records. A comprehensive set of pre- and perinatal varaiables were assessed.

Results: In the SNiP, every fifth pregnant woman suffers from at least one chronic disease, and higher prevalence rates have been reported in the literature. There was a significant difference between chronically ill women and healthy women in age, education and income. Prenatal complications were more frequent in the healthy group than in the chronic disease group. Women with chronic diseases delivered by Cesarean section more frequently than women in the healthy group. Every tenth woman with at least one chronic disease gave birth to a premature infant, while only one in every 13 woman in the healthy control group gave birth to a premature infant.

Conclusions: This analysis is the first population-based study in which all chronic diseases could be taken into consideration. The population-based prevalences rates in the SNiP data are consistently lower than those found in the literature. There are differences between chronically ill women and healthy women in peri- and prenatal variables as well as birth outcome on the population level. However, they are less frequent than expected and further analyses are need focusing on specific diseases.

Figure 1

Study region of “Ostvorpommern” (dark grey) with location of major Pediatric Hospitals (HGW: Hansestadt Greifswald, WLG: Wolgast, ANK: Anklam), based on [7].

Figure 2

Data and reasons of loss of potential participants in Survey of Neonates in Pommerania (SNiP), based on [7], n: number of births.

Figure 3

Prevalences of major chronic diseases in SNiP.

Figure 4

Complications during pregnancy course plot against chronic diseases as well as pariety and gravidity. A: primigravidae, primiparae, B: multigravidae, primiparae (women who had have at least one abruption, extrauterine pregnancy, abortion or stillbirth and who participated in SNiP with their first child), C: multigravidae, multiparae (the number of pregnancies correlates with the number of life births), D: multigravidae, multiparae (women who had have at least one of the pregnancy outputs already mentioned in category B), 1: chronically ill mothers, 2: mothers without chronic diseases.

Figure 5

Birth mode of women who participated in SNiP plot against chronic diseases as well as pariety and gravidity. A: primigravidae, primiparae, B: multigravidae, primiparae (women who had have at least one abruption, extrauterine pregnancy, abortion or stillbirth and who participated in SNiP with their first child), C: multigravidae, multiparae (the number of pregnancies correlates with the number of life births), D: multigravidae, multiparae (women who had have at least one of the pregnancy outputs already mentioned in category B), 1: chronically ill mothers, 2: mothers without chronic diseases.

Figure 6

Gestational age (GW: gestational week) plot against chronic diseases as well as pariety and gravidity. A: primigravidae, primiparae, B: multigravidae, primiparae (women who had have at least one abruption, extrauterine pregnancy, abortion or stillbirth and who participated in SNiP with their first child), C: multigravidae, multiparae (the number of pregnancies correlates with the number of life births), D: multigravidae, multiparae (women who had have at least one of the pregnancy outputs already mentioned in category B), 1: chronically ill mothers, 2: mothers without chronic diseases.

Figure 7

Pathologic pH of the umbilical cord artery and of Base Excess plot against chronic diseases as well as pariety and gravidity. A: primigravidae, primiparae, B: multigravidae, primiparae (women who had have at least one abruption, extrauterine pregnancy, abortion or stillbirth and who participated in SNiP with their first child), C: multigravidae, multiparae (the number of pregnancies correlates with the number of life births), D: multigravidae, multiparae (women who had have at least one of the pregnancy outputs already mentioned in category B), 1: chronically ill mothers, 2: mothers without chronic diseases.

Figure 8

Frequency of extended primary care and of hospitalisation plot against chronic diseases as well as parity and gravidity. A: primigravidae, primiparae. B: multigravidae, primiparae (women who had have at least one abruption, extrauterine pregnancy, abortion or stillbirth and who participated in SNiP with their first child), C: multigravidae, multiparae (the number of pregnancies correlates with the number of life births), D: multigravidae, multiparae (women who had have at least one of the pregnancy outcomes already mentioned in category B), 1: chronically ill mothers, 2: mothers without chronic diseases.