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Core outcomes for studies of pregnant women with multimorbidity : clinician focus group
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Lee, Siang Ing, Plachcinski, Rachel, Moss, Ngawai, Vowles, Zoe, Singh, Megha, Azcoaga- Lorenzo, Amaya and Taylor, Beck (2022) Core outcomes for studies of pregnant women with multimorbidity : clinician focus group. BJOG: An International Journal of Obstetrics & Gynaecology, 129 (Supplement 1). EP.0730. doi:10.1111/1471-0528.15_17178
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Official URL: https://doi.org/10.1111/1471-0528.15_17178
Abstract
Objective: A key aim of MuM-PreDiCT is to develop a core outcome set for studies of pregnant women and birthing people with pre-existing multimorbidity. This involves four stages: systematic literature search, focus groups, Delphi surveys and a consensus meeting. We present the findings from a focus group, exploring outcomes that clinicians feel should be measured.
Method: One focus group was conducted online (2021, UK), with eight clinicians who care for pregnant women with multimorbidity. Participants were purposively sampled, with representation from obstetric/maternal medicine (n = 2), midwifery (2), obstetrics (1), neonatology (1), perinatal psychiatry (1), and general practice (1); England (7) and Scotland (1); ethnic minorities (6) and white ethnicity (2). Inductive thematic analysis was conducted.
Results: Outcomes were categorised by maternal (22 themes) and children’s outcomes (10 themes), and health care utilisation (6 themes). Selected themes are presented here.
Maternal outcomes in the pre-pregnancy period included fertility and the quality of preconception counselling. Pregnancy may influence women’s long-term health conditions and perinatal mental health. They may have limited options in birth, such as mode of birth and birth with no intervention.
Care-related outcomes included whether there was shared decision making, multidisciplinary coordination and continuity of care throughout pregnancy; whether postnatal and long-term support was offered and its quality. Outcomes after birth included women’s capability as a mother, such as mother-infant bonding and establishing feeding.
Clinicians wanted information on the effects of medication on child outcomes and women’s compliance with medications during and after pregnancy. It is important to measure the impact of stopping medication as suboptimal control of existing health conditions may affect the pregnancy and child.
Child outcomes pertinent to patient counselling included the risk of congenital anomalies, neurodevelopmental outcomes, neonatal mortality and morbidity. Health care utilisation outcomes included the need for additional appointments, admission to hospital/intensive care and length of separation from baby after birth.
Core outcomes specific to multimorbidity in pregnancy may need to focus more on patient reported experiential outcomes, for example women’s satisfaction with care. Other considerations included framing outcomes positively and measuring the differential association of maternal ethnicity with outcomes.
Conclusions: Clinicians reported a range of outcomes important for studies of pregnant women with multimorbidity. After we have completed focus groups with women with multimorbidity and experience of, or are planning a pregnancy, we shall conduct a Delphi survey using the focus group outcomes to inform its design.
Item Type: | Journal Item | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||
Journal or Publication Title: | BJOG: An International Journal of Obstetrics & Gynaecology | ||||
Publisher: | Wiley-Blackwell Publishing, Inc | ||||
ISSN: | 1470-0328 | ||||
Official Date: | 10 June 2022 | ||||
Dates: |
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Volume: | 129 | ||||
Number: | Supplement 1 | ||||
Article Number: | EP.0730 | ||||
DOI: | 10.1111/1471-0528.15_17178 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Free Access (unspecified licence, 'bronze OA') | ||||
Description: | Full author list available from publisher |
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