{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T02:52:16Z","timestamp":1789267936718,"version":"build-2803163510"},"reference-count":71,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001804","name":"Canada Research Chairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001804","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the risks of perinatal emergency department (ED) use, hospitalisation and severe maternal morbidity or mortality (SMM\u2010M) associated with preconception MCC, according to the number of chronic conditions, complex MCC and co\u2010occurring cardiometabolic conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population\u2010based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Females aged 13\u201354\u2009years, with a recognised pregnancy, 2012\u20132021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Modified Poisson regression was used to generate adjusted relative risks (aRRs) according to the number of chronic conditions, complex MCC (\u2265\u20093 chronic conditions affecting \u2265\u20093 body systems) and co\u2010occurring cardiometabolic conditions. aRRs were adjusted for age, parity, income quintile, rurality and immigrant\/refugee status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>ED use, hospitalisation and SMM\u2010M from the estimated date of conception to 42\u2009days postpartum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 894\u2009042 individuals had no pre\u2010pregnancy chronic condition; 357\u2009398 had 1; 94\u2009427 had 2; and 27\u2009326 had \u2265\u20093 chronic conditions. Relative to those without a chronic condition, the aRR for ED use increased with 1 (1.26, 95% CI 1.25\u20131.27), 2 (1.55, 1.54\u20131.56) and \u2265\u20093 (1.86, 1.85\u20131.88) conditions. For hospitalisations, the corresponding aRRs were 1.45 (1.43\u20131.47), 2.06 (2.02\u20132.10) and 3.18 (3.09\u20133.27). For SMM\u2010M, the corresponding aRRs were 1.38 (1.35\u20131.42), 1.82 (1.75\u20131.90) and 2.75 (2.59\u20132.92). SMM\u2010M risk was even more pronounced with complex MCC (aRR 2.92, 95% CI 2.72\u20133.14), and \u2265\u20093 cardiometabolic conditions (aRR 5.45, 95% CI 4.29\u20136.91).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MCC, especially complex or cardiometabolic MCC, is associated with elevated risk of maternal morbidity. Multidisciplinary patient\u2010centred care may mitigate these risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.18347","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T03:50:08Z","timestamp":1756957808000},"page":"142-153","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Multiple Chronic Conditions Before Pregnancy and Risk of Adverse Maternal Health Outcomes: Population\u2010Based Cohort Study"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8690-5841","authenticated-orcid":false,"given":"Hilary K.","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Health and Society University of Toronto Scarborough  Toronto Ontario Canada"},{"name":"ICES  Toronto Ontario 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