Pregnancy with multiple high-risk factors: a systematic review and meta-analysis

Yue Zhang; Weijie Ding; Tingting Wu; Songtao Wu; Hui Wang; Muhammad Fawad; Akilew Awoke Adane; Xiaochen Dai; Xiaoqin Zhu; Xiaolin Xu

doi:10.7189/jogh.15.04027

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Pregnancy with multiple high-risk factors: a systematic review and meta-analysis

Journal article

Open access

Peer reviewed

Pregnancy with multiple high-risk factors: a systematic review and meta-analysis

Yue Zhang, Weijie Ding, Tingting Wu, Songtao Wu, Hui Wang, Muhammad Fawad, Akilew Awoke Adane, Xiaochen Dai, Xiaoqin Zhu and Xiaolin Xu

Journal of global health, Vol.15, 04027

2025

DOI: https://doi.org/10.7189/jogh.15.04027

PMID: 39913559

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Abstract

Female

Humans

Pregnancy

Pregnancy Complications - epidemiology

Pregnancy Outcome - epidemiology

Risk Factors

Background: A wide spectrum of high-risk factors in pregnancy can lead to adverse pregnancy outcomes or short- or long-term health effects. Despite this, there has been no synthesis of findings on the measurement, potential causes, and health outcomes of multiple high-risk factors in pregnancy (MHFP). We aimed to address this gap by summarising the existing research on this topic. Methods: We retrieved studies published up to 3 June 2024 through systematic database searches and used a narrative synthesis approach to summarise the measurement, patterns, causes, and outcomes of MHFP. We also estimated the pooled MHFP prevalence through meta-analysis with a random effects model and performed subgroup analyses and meta-regression to examine potential sources of between-study heterogeneity. Results: We included 83 observational studies published between 2010 and 2024, of which 72% were from high-income countries. These studied factors can be grouped into four categories: physical conditions, mental conditions, sociobehavioural problems, and pregnancy history. We identified 16 MHFP patterns, among which co-existing multiple physical conditions were the most common pattern. The overall pooled prevalence of MHFP was 12% (95% confidence interval (CI) = 12–13), with an increasing trend and relatively higher levels in low- and middle-income countries (LMICs). We observed heterogeneity in the measurement of MHFP across the studies, possibly due to the number of risk factors in the definition of MHFP. About 78% of included studies investigated MHFP-associated health outcomes for women and offspring, with only two studies examining long-term maternal or offspring outcomes later in life. Conclusions: Research into MHFP has been emerging over the past decade, but is far from complete. The burden of MHFP is increasing worldwide, particularly LMICs. Maternal healthcare systems must shift to a multidisciplinary and integrated framework so as to better design and implement prevention and intervention programmes and sustain the healthy development of the next generation. Registration: PROSPERO: CRD42022358889.

Details

Title: Pregnancy with multiple high-risk factors: a systematic review and meta-analysis
Authors/Creators: Yue Zhang - Second Affiliated Hospital of Zhejiang University
Weijie Ding - Yangzhou University
Tingting Wu - Second Affiliated Hospital of Zhejiang University
Songtao Wu - Zhejiang University
Hui Wang - Yangzhou University
Muhammad Fawad - Second Affiliated Hospital of Zhejiang University
Akilew Awoke Adane - Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
Xiaochen Dai - University of Washington, Seattle
Xiaoqin Zhu - Yangzhou University
Xiaolin Xu - School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
Publication Details: Journal of global health, Vol.15, 04027
Publisher: International Society of Global Health
Number of pages: 24
Grant note: China Medical Board Open Competition Program: 21-416 Key Medical Program of Jiangsu Health Commission: ZD2021044 Huai'an Science and Technology Program: HAB2024039
Funding: This study was funded by grant to XX from China Medical Board Open Competition Program (21-416) , grant to XZ from Key Medical Program of Jiangsu Health Commission (ZD2021044) , and grant to WD from Huai'an Science and Technology Program (HAB2024039) .
Identifiers: 991005742064307891
Murdoch Affiliation: Ngangk Yira Institute for Change
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.72 Obstetrics & Gynecology; 1.72.1072 Perinatal Mental Health
Web Of Science research areas: Public, Environmental & Occupational Health
ESI research areas: Social Sciences, general