Multimorbidity in Pregnancy: An Exploratory Study Among Women Attending Antenatal Clinics in Odisha, India

Abstract Background: In recent years, the interplay of non-communicable diseases (NCDs) in pregnancy has gained global prominence, with documented risk for maternal and newborn wellbeing; especially, multimorbidity, the coexistence of two or more chronic conditions, is being recognized as a maternal health challenge. At the same time, pregnancy has remained as an exclusion criterion in most of the multimorbidity estimation studies resulting in deficient understanding of the problem in this vulnerable population. We aimed to estimate the prevalence of multimorbidity and identify its correlates among females presenting to antenatal care clinics, and assessed the outcomes in terms of health care utilization and expenditure.Method: An exploratory cross-sectional study was conducted among 127 pregnant women attending three antenatal clinics of Bhubaneswar, Odisha from January – June 2016. Data was collected using “multimorbidity assessment questionnaire for antenatal care” (MAQ ANC) specifically developed and validated for the purpose. Multimorbidity was defined as two or more of the enlisted morbidities. Descriptive analysis was performed to determine prevalence and correlates. Outcomes were measured by number of healthcare visit, medications and healthcare expenditure. Result: Multimorbidity was present in 15% of antenatal women. Anemia (58.62%), hypertension (21%), acid peptic diseases (21%) and thyroid (17.24%) were leading chronic conditions. A statistically significant association was found (p-value <0.05, Pearson’s chi-square test) between multimorbidity and medical consultation, medicines consumed, and functional limitation. Health care expenditure was significantly higher among multimorbidity group, of which nearly half was incurred on diagnostics. Conclusion: Multimorbidity is an emerging issue in pregnancy. Our findings suggest inclusion of comprehensive multimorbidity assessment in routine antenatal screening. The preconception care needs to establish linkages between maternal and reproductive health with NCD prevention, and identify ways to reduce health care utilization and expenditure Longitudinal studies to assess the trajectory and impact of multimorbidity on maternal and infant health are warranted.