Clusters, determinants, and short- and long-term effects of coexisting multiple high-risk factors in pregnancy on mothers and their children’s health: study protocol

Abstract Background: Existing studies have identified a wide range of preventable risk factors of adverse pregnant outcomes, including physical and mental conditions before pregnancy, complications and symptoms during pregnancy, and obesity and other risk factors. These risk factors may co-occur simultaneously, resulting in the coexistence of multiple high-risk factors in pregnancy (MHFP). There is a lack of study evaluating the characteristics, determinants, and health outcomes of MHFP. Methods: This study will be conducted by combing retrospective and prospective cohort studies. Our data will be collected from Huai’an – a prefectural region in Jiangsu province, located in the eastern part of China. In 2010, 2015, and 2022, we conducted three population-based birth surveys from 151 level I-III hospitals; and we have routinely recorded morbidity and mortality data for mothers and their children since 2008. Traditional and statistical machine learning approaches will be conducted to characterize and identify clusters of MHFP and to investigate changes in these clusters over time. Moreover, we will prospectively collect data for participants from 2022 (n=2000) to examine the short-term effects of MHFP during 2023-2025 (0-3 years); meanwhile we will retrospectively collect data for participants from Waves 2010 (n=2000) and 2015 (n=2000) to examine the long-term effects of MHFP on mothers and children during the period from 2010 to 2022 (0-12 years), and from 2015 to 2022 (0-7 years), respectively. Information on pregnant women and their children will be collected through questionnaires, physical examinations, and linkage to hospital information systems. Discussion: Our project will present a comprehensive understanding of the causes and health outcomes of MHFP on mothers and their children’s health. Examining the association between MHFP and adverse maternal and offspring outcomes can help inform comprehensive prevention strategies that move beyond targeting any single risk factor. Furthermore, these findings will inform the effective clinical interventions for MHFP before, during, and after pregnancy, and inform the necessary upstream public health and policy interventions. Study funding/competing interests: This study is funded by grant to XX from China Medical Board Open Competition Program (21-416), and XZ from Jiangsu Maternal and Child Health Program (F201932), Key Medical Program of Jiangsu Health Commission (ZD2021044), Huai’an Science and Technology Program (HAB202043). Trial registration: Not applicable.