Perceptions of risk in pregnancy with chronic disease: A systematic review and thematic synthesis

Elizabeth Ralston*, Priscilla Smith, Joseph Chilcot, Sergio A. Silverio, Kate Bramham

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)
86 Downloads (Pure)


Background: Women with chronic disease are at increased risk of adverse pregnancyoutcomes. Pregnancies which pose higher risk, often require increased medicalsupervision and intervention. How women perceive their pregnancy risk and its impacton health behaviour is poorly understood. The aim of this systematic review ofqualitative literature is to evaluate risk perceptions of pregnancy in women with chronicdisease. 

Methods: Eleven electronic databases including grey literature were systematicallysearched for qualitative studies published in English which reported on pregnancy, riskperception and chronic disease. Full texts were reviewed by two researchers,independently. Quality was assessed using the Critical Appraisal Skills ProgrammeQualitative checklist and data were synthesised using a thematic synthesis approach.The analysis used all text under the findings or results section from each includedpaper as data. The protocol was registered with PROSPERO. 

Results: Eight studies were included in the review. Three themes with sub-themeswere constructed from the analysis including: Information Synthesis (Sub-themes: Riskto Self and Risk to Baby), Psychosocial Factors (Sub-themes: Emotional Response,Self-efficacy, Healthcare Relationship), and Impact on Behaviour (Sub-themes:Perceived Risk and Objective Risk). Themes fitted within an overarching concept ofBalancing Act. The themes together inter-relate to understand how women with chronicdisease perceive their risk in pregnancy. 

Conclusions: Women’s pregnancy-related behaviour and engagement with healthcareservices appear to be influenced by their perception of pregnancy risk.  Women withchronic disease have risk perceptions which are highly individualised. Assessment andcommunication of women’s pregnancy risk should consider their own understandingand perception of risk. Different chronic diseases introduce diverse pregnancy risksand further research is needed to understand women’s risk perceptions in specificchronic diseases.
Original languageEnglish
Article numbere0254956
Pages (from-to)1-15
JournalPLoS One
Issue number7
Publication statusPublished - 19 Jul 2021


  • Pregnancy
  • Chronic Disease
  • Risk perception


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