Hilary Brown, PhD, highlights maternal multimorbidity's link to neonatal morbidity and mortality

In a Contemporary Pediatrics interview, Hilary K. Brown, PhD, associate professor at University of Toronto Scarborough, discussed findings from a study examining the relationship between maternal multimorbidity and the risk of severe neonatal morbidity and mortality (SNM-M).

The research demonstrated a clear dose-response association between the number of preexisting maternal chronic conditions and adverse neonatal outcomes. With each additional chronic condition, the risk of severe neonatal complications or death increased, underscoring the cumulative impact of maternal health complexity on newborn outcomes.

Beyond simply counting chronic conditions, the study also evaluated the complexity and severity of maternal multimorbidity. Brown explained that individuals with chronic conditions affecting 3 or more body systems faced substantially greater risks of adverse neonatal outcomes compared with those whose conditions were less complex. This suggests that the breadth of physiological systems involved plays an important role in determining neonatal risk, not just the presence of multiple diagnoses.

The investigators further examined specific categories of multimorbidity, with a particular focus on cardiometabolic conditions. Given that cardiometabolic diseases are already known risk factors for adverse obstetric outcomes, the study assessed whether clustering of these conditions conferred additional neonatal risk.

The findings showed that cardiometabolic multimorbidity was associated with even greater risks of severe neonatal morbidity and mortality than other forms of multimorbidity. Indicators of severity, such as hospitalizations related to chronic conditions during pregnancy, were also linked to greater neonatal risk, reinforcing the conclusion that more severe disease burden is associated with worse outcomes for newborns.

Brown noted that these findings expand on prior research, which has generally treated maternal chronic disease as a single, binary risk factor. Previous studies often compared individuals with any chronic condition to those without, without distinguishing between those with 1 condition and those with multiple. By disaggregating multimorbidity, this study highlights that pregnant individuals with multiple chronic conditions represent a particularly high-risk group that may require more intensive monitoring, resources, and support during pregnancy.

From a clinical perspective, Brown emphasized the importance of multidisciplinary care. Pediatric and neonatology teams should be involved in birth planning for individuals with multimorbidity to ensure delivery occurs in settings equipped to manage potential neonatal complications. Anticipating longer hospital stays, increased neonatal support needs, and additional resources for families after discharge is also critical.

Finally, the findings highlight the importance of preconception counseling and coordinated care. Optimizing chronic disease management, improving communication among specialists, and ensuring person-centered, collaborative care can help reduce risks and improve outcomes for both parents and infants affected by maternal multimorbidity.

No relevant disclosures.

Reference

Brown HK, Fung K, Cohen E, et al. Multiple maternal chronic conditions and risk of severe neonatal morbidity and mortality. JAMA Netw Open. 2026;9(1):e2555558. doi:10.1001/jamanetworkopen.2025.55558