A National Cohort Study and Confidential Enquiry to Investigate Ethnic Disparities in Maternal Mortality

Knight, Marian; Bunch, Kathryn; Vousden, Nicola; Banerjee, Anita; Cox, Philippa; Cross-Sudworth, Fiona; Dhanjal, Mandish; Douglas, Jenny; Girling, Joanna; Kenyon, Sara; Kotnis, Rohit; Patel, Roshni; Shakespeare, Judy; Tuffnell, Derek; Wilkinson, Michelle; Kurinczuk, J J

doi:10.2139/ssrn.3933640

Cited by 10 publications

(12 citation statements)

References 4 publications

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“…18 Previous confidential enquires into maternal mortality in the UK have emphasised that lack of preconception care is a contributory factor to maternal deaths as well as highlighting a need for better management of women with multiple health conditions. 15,19 Suicide remains one of the leading causes of direct maternal mortality and successive reports have stressed the need for better mental healthcare and coordination between primary care, maternal and mental health services. Mental disorders are increasingly common in young women 1 and mental disorders before pregnancy are associated with increased risk of disorders during the perinatal period as well as having an impact on maternal-infant bonding.…”

Section: Discussionmentioning

confidence: 99%

The physical‐mental health interface in the preconception period: analysis of 131 182 women planning pregnancy in the UK

Tosh

Kavanagh

Flynn

et al. 2023

BJOG

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Around one in five women present with the common mental disorders (CMDs) of anxiety and depression in the UK, with younger aged women particularly at risk. 1 There is evidence that individuals with mental disorders have high rates of physical comorbidities such as obesity and Type 2 diabetes, which contribute to premature mortality and health inequalities throughout life. 2 Associations between mental and physical health have been found to be more common in women. [3][4][5] However, most studies do not disaggregate findings by gender or age, therefore the physical-mental health interface in women of reproductive age remains poorly understood.It is increasingly recognised that women's health around the time of conception is a key determinant of pregnancy outcome and impacts the health of the next generation. Indeed the preconception period represents an opportunity to intervene to optimise the health of women and their children, 6 although the impact of physical and mental multimorbidity prior to pregnancy on maternal and child outcomes is not well documented. 7 Relatively few studies report obstetric and neonatal outcomes for women with mental disorders

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Section: Discussionmentioning

confidence: 99%

The physical‐mental health interface in the preconception period: analysis of 131 182 women planning pregnancy in the UK

Tosh

Kavanagh

Flynn

et al. 2023

BJOG

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“…Reflecting the setting, 40% of study participants described their ethnicity as Asian or Black. Asian and Black women and those living in deprived areas are significantly more likely to experience perinatal death [ 30 ] and are often under-represented in research, particularly surrounding maternity experiences [ 31 ]. Nevertheless, a number of potential participants were excluded by language barriers, as it was not possible to provide translation within the scope of this feasibility study.…”

Section: Discussionmentioning

confidence: 99%

Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study

Mills

Roberts

Camacho

et al. 2022

BMC Pregnancy Childbirth

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Background Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS). Methods A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8). Results Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited. Conclusions Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities. Trial registration ISRCTN17447733 first registration 13/02/2018.

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“…Perinatal mental health problems can lead to an increased risk of adverse outcomes including preterm birth, low birth weight, attachment difficulties, and longer term developmental difficulties for the child [ 7 – 10 ]. At the extreme, mental health problems contribute to maternal deaths, with suicide being one of the leading causes of maternal mortality in England [ 11 , 12 ]. It is therefore essential that mental health is discussed with all women during their pregnancy and soon after childbirth.…”

Section: Introductionmentioning

confidence: 99%

Disparities in who is asked about their perinatal mental health: an analysis of cross-sectional data from consecutive national maternity surveys

Harrison

Pilkington

Quigley

et al. 2023

BMC Pregnancy Childbirth

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Background The perinatal period is a vulnerable time, with one in five women experiencing mental health problems. Antenatal and postnatal appointments are key contact points for identifying women in need of support. Since 2014, the UK National Institute for Health and Care Excellence (NICE) has recommended that all women be asked about their mental health at their antenatal booking appointment and early in the postnatal period. The aim of this study was to assess the proportions of women who reported being asked about their mental health during the perinatal period across consecutive national maternity surveys (NMS) in England and to evaluate sociodemographic disparities in who was asked. Methods Secondary analysis was performed on cross-sectional data from the NMS in 2014–2020. In each survey, women reported whether they had been asked about their mental health antenatally (during their booking appointment) and postnatally (up to six months after giving birth). The proportions of women in each survey who reported being asked about their mental health were calculated and compared according to key sociodemographic characteristics and across survey years. Logistic regression was conducted to identify disparities in who was asked. Results The proportion of women who reported being asked about their mental health antenatally increased from 80.3% (95%CI:79.0–81.5) in 2014 to 83.4% (95%CI:82.1–84.7) in 2020, yet the proportion of women who reported being asked postnatally fell from 88.2% (95%CI:87.1–89.3) in 2014 to 73.7% (95%CI:72.2–75.2) in 2020. Ethnic minority women (aOR range:0.20 ~ 0.67) were less likely to report being asked about their mental health antenatally and postnatally across all surveys compared to White women. Women living in less socioeconomically advantaged areas (aOR range:0.65 ~ 0.75) and women living without or separately from a partner (aOR range:0.61 ~ 0.73) were also less likely to report being asked about their mental health, although there was less consistency in these disparities across the antenatal and postnatal periods and across surveys. Conclusions Despite NICE recommendations, many women are still not asked about their mental health during the perinatal period, particularly after giving birth. Women from ethnic minority backgrounds are less likely to be asked and these disparities have persisted over time.

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A National Cohort Study and Confidential Enquiry to Investigate Ethnic Disparities in Maternal Mortality

Cited by 10 publications

References 4 publications

The physical‐mental health interface in the preconception period: analysis of 131 182 women planning pregnancy in the UK

The physical‐mental health interface in the preconception period: analysis of 131 182 women planning pregnancy in the UK

Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study

Disparities in who is asked about their perinatal mental health: an analysis of cross-sectional data from consecutive national maternity surveys

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