Care of pregnant women with pre-existing medical conditions in German perinatal centers

Archives of Gynecology and Obstetrics https://doi.org/10.1007/s00404-025-08016-4 RESEARCH Care of pregnant women with pre‑existing medical conditions in German perinatal centers P. Kosian1 · B. Strizek1 · S. Kehl2 · M. Abou‑Dakn3 · E. Jost1 · W. M. Merz1 Received: 24 February 2025 / Accepted: 19 March 2025 © The Author(s) 2025 Abstract Introduction Pregnancies in women with chronic medical conditions are characterized by a higher maternal and perinatal complication rate during pregnancy, childbirth, and the postpartum period. The German Maternity Guideline does not provide specific recommendations for the care of these women. The aim of this study was to evaluate the care of pregnant women with pre-existing medical conditions in German perinatal centers (Level 1 and 2) and perinatal care level 3 hospitals. Materials and methods Based on guidelines and literature, seven topics were identified: preconception counseling, timing of consultation, care for pregnant women with rare diseases, participation in continuing education, multidisciplinary case conferences, resources for patient counseling, and transfer of the patient to another center. Representatives of all perinatal centers were contacted by email and invited to participate. The anonymous online survey was conducted using the SoSci Survey platform. Results Of 310 centers, 103 (33.2%) representatives responded. 62.2% (n = 64) reported managing 11–30 pregnant women with pre-existing conditions per month. 22.1% (n = 23) of all centers regularly care for pregnant women with rare diseases, and 46.6% offer preconception counseling. University hospitals offer these services more frequently. Regular case conferences are held in 34.0% of centers, and 80.6% of medical staff regularly participate in continuing education on the topic. Conclusion According to the results of our survey, 76.7% (n = 79) of perinatal centers regularly care for patients with preexisting conditions, while only 22.1% care for patients with rare diseases. The findings highlight the need to implement standardized recommendations and targeted resource allocation to ensure optimal care for this patient group. Keywords Pre-existing medical condition · Pregnancy · Perinatal care · Germany · Surveys and questionnaires What does this study add to the clinical work * P. Kosian 1 Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany 2 Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany 3 Department of Obstetrics and Gynecology, St Joseph Hospital, Berlin, Germany This study is the first to investigate current practices of management for pregnant women with preexisting medical conditions across perinatal centers in Germany. Implementation of standardized training in"Obstetric Medicine"as already established in anglophone countries [17] and structured preconception counseling and co-care according to the pre-existing medical condition could be important next steps in further improving care for this group of patients. Vol.:(0123456789) Archives of Gynecology and Obstetrics Introduction The proportion of pregnant women with pre-existing medical conditions has tripled since the beginning of the millennium and varies depending on the region investigated. A population-based study by Lundborg et al. calculated the prevalence of at least one pre-existing medical condition 5 years prior to childbirth in Sweden with 8.7%, a threefold increase between 2002 and 2019 [1]. Data from British Columbia, Canada, show a prevalence of 26.2% within 5 years before childbirth [2]. Pregnancy, childbirth, and the postpartum period in these women are characterized by an increased rate of maternal and perinatal complications [3]. In recent years, the proportion of multimorbid pregnant women (defined as ≥ 2 chronic pre-existing medical conditions) has increased and a dose-dependent association between the number of co-existing chronic medical conditions and the likelihood of adverse maternal outcomes, such as severe maternal morbidity or mortality [3–5], has been revealed. Relevant maternal complications (e.g., acute kidney failure, sickle cell crisis, heart failure) during pregnancy, childbirth, and the postpartum period are categorized as severe maternal morbidity (SMM) [6] and can lead to significant short- or long-term consequences for the mother [7]. Moreover, the occurrence of SMM negatively impacts perinatal outcome, increasing the risk of a 5-min Apgar score < 7, admission to neonatal intensive care unit (NICU), and perinatal and neonatal mortality [8]. SMM result in substantial costs for healthcare systems and society due to associated maternal and perinatal complications [9, 10]. Care of high-risk pregnancies in Germany is provided by office-based gynecologists, other medical specialists for pre-existing medical conditions, and perinatal centers. A risk catalog including obstetric risk factors and maternal preexisting medical conditions exists, but specific guidelines for the antenatal care of pregnant women with pre-existing medical conditions cannot be derived from the German Maternity Guideline [11]. Multidisciplinary co-management is not regulated or mandatory [11]. To date, the management of care for this patient group at German perinatal centers has not been investigated. Therefore, the aim of this survey was to assess antenatal care of pregnant women with pre-existing medical conditions at German perinatal centers (Level 1 and 2) and perinatal care level 3 hospitals (Level 3). Methods Based on the literature, the following topics were included in the survey: preconception counseling and timing of referral for co-management [12, 13], care for pregnant women with rare diseases (defines as prevalence ≤ 5/10,000 individuals), resources for patient counseling (clinical decision support systems (CDS systems) such as online databases, interdisciplinary consultations, guidelines, PubMed, online teratology information services (Embryotox) [14] and textbooks), the necessity of transferring patients to another center in cases of maternal complications related to underlying conditions, continuing education, and the organization of multidisciplinary case conferences [5]. A total of 11 questions were developed (Supplemental File). Representatives of all 310 perinatal centers (Level 1, Level 2) and perinatal care level 3 hospitals were invited to participate in the survey via email in January 2024. Contact details were obtained from the list of perinatal centers available at www.perinatalzentren.org. Care levels are categorized as follows: Level 1: estimated birth weight of less than 1250 g or gestational age of less than 29 + 0 weeks. Level 2: estimated birth weight between 1250 and 1499 g and at least 32 + 0 weeks of gestational age. Level 3: estimated birth weight of at least 1500 g. Two reminders were sent at 4-week intervals, and the survey was concluded in March 2024. The anonymous online (...truncated)