{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:30:28Z","timestamp":1791462628934,"version":"4.3.4"},"reference-count":58,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Nearly 16% of pregnant individuals have multiple chronic conditions (MCC), and the risk of severe maternal morbidity and mortality increases in a dose-response manner with the number of preexisting conditions. However, little is known about newborn outcomes in this population.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association of the number of preexisting maternal chronic conditions, as well as the presence of MCC complexity, cardiometabolic MCC, and MCC severity, with the risk of severe neonatal morbidity or mortality (SNM-M).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based cohort study was conducted in Ontario, Canada, among all live births from 2012 to 2021. Data were analyzed from September 2024 to November 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Maternal MCC measured in the 2 years before conception.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Modified Poisson regression was performed to generate adjusted relative risks (aRRs) for SNM-M by the number of chronic conditions, MCC complexity (\u22653 chronic conditions in \u22653 body systems), co-occurring cardiometabolic conditions, and MCC severity marked by a prenatal hospitalization for a chronic illness. Multivariable models were adjusted for age, parity, immigration status, income quintile, and rurality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The cohort comprised 1\u202f018\u202f968 newborns, including 20\u202f934 to mothers with 3 or more chronic conditions (mean [SD] maternal age, 30.0 [6.3] years), 73\u202f768 to mothers with 2 chronic conditions (mean [SD] maternal age, 30.3 [5.8] years), 276\u202f765 to mothers with 1 chronic condition (mean [SD] maternal age, 30.7 [5.4] years), and 647\u202f501 to mothers with 0 chronic conditions (mean [SD] maternal age, 31.0 [5.1] years). Compared with newborns of mothers with 0 chronic conditions, the aRR for SNM-M increased in a dose-response fashion in newborns of mothers with 1 (1.26; 95% CI, 1.24-1.28), 2 (1.58; 95% CI, 1.54-1.62), and 3 or more (2.01; 95% CI, 1.94-2.09) chronic conditions. The aRRs were also increased with complex MCC (1.97; 95% CI, 1.88-2.06), cardiometabolic MCC (2.67; 95% CI, 2.24-3.19), and severe MCC (3.11; 95% CI, 2.55-3.79).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and relevance<\/jats:title>\n In this study, risks of SNM-M increased with an increasing number of preexisting maternal chronic conditions. These findings suggest that women and adolescents with MCC may benefit from preconception counseling to optimize chronic disease management, monitoring in pregnancy for earlier identification of complications, and enhanced newborn supports.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.55558","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T16:30:40Z","timestamp":1769185840000},"page":"e2555558","source":"Crossref","is-referenced-by-count":4,"title":["Multiple Maternal Chronic Conditions and Risk of Severe Neonatal Morbidity and Mortality"],"prefix":"10.1001","volume":"9","author":[{"given":"Hilary K.","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Women\u2019s College Research Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinwah","family":"Fung","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Cohen","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Edwin S.H. 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Leong Centre for Healthy Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C.","family":"Rosella","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Varner","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Mount Sinai Hospital, Toronto, Ontario, 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