New DMU research shows how racial and social inequalities are resulting in stark adverse pregnancy outcomes for Black and South Asian women

Dr Tina Harris of the CRR is one of the senior authors on a new paper published in The Lancet reporting on recent findings of the research she and others are undertaking as part of the National Maternity and Perinatal Audit Project Team. Dr Harris who is an Associate Professor of Research at DMU and the senior clinical lead for Midwifery on this project has been sharing the findings of the team’s research which has looked at topics including waterbirth, body mass index, Covid-19 and its effect on maternal and perinatal outcomes. However, their most recent paper demonstrates the extent to which known risk factors relating to socioeconomic deprivation and being from a minority ethnic background have on adverse pregnancy outcomes, and these findings have been stark, shocking and in many cases saddening.

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The NHS has set a target of halving rates of stillbirth and neonatal death and reducing levels of  preterm birth by 25% by 2025. Socioeconomic deprivation and minority ethnic background are known risk factors for adverse pregnancy outcomes. However, little has been known about the strength of these risk factors or the scale of their impact at the population level. Moreover, efforts to improve pregnancy outcomes and to lessen inequalities have been hampered by a lack of information about how differences in pregnancy outcomes are related to women’s societal circumstances and pre-existing health, and which groups are most strongly affected. To attempt to fill these gaps in knowledge, the team analysed records of births between 1st April 2015 and 31st March 2017 in NHS hospitals in England in an attempt to quantify socioeconomic and ethnic inequalities on stillbirth (the death of a fetus after 24 weeks of pregnancy), preterm birth (livebirth before 37 weeks), and fetal growth restriction (FGR) in England. In total, 1,155,981 women with a singleton birth were included in the study, of whom 77% were white, 12% South Asian, 5% Black, 2% mixed race/ethnicity, and 4% other race/ethnicity. Overall, 4,505 women had a stillbirth (0·4%). Of the 1,151,476 liveborn babies, 69,175 (6%) were preterm births and 22,679 (2%) births with FGR.

This research found that socioeconomic inequalities account for a quarter of stillbirths, a fifth of preterm births, and a third of births with fetal growth restriction—a condition in which babies at birth are smaller than expected for their gestational age. In particular, the research found that South Asian and Black women living in the most deprived areas experience the largest inequalities in pregnancy outcomes. Their estimates suggest that half of stillbirths and three quarters of births with fetal growth restriction in South Asian women living in the most deprived 20% of neighborhoods are potentially avoidable if they had the same risks as white women living in the most affluent 20% of neighborhoods. Similarly, about two thirds of stillbirths and about half of births with fetal growth restriction in Black women from the most deprived neighborhoods are potentially avoidable if they had the same risks as white women from the most affluent neighborhoods.

The findings of Dr Harris and the team has clearly indicated how pregnancy complications were found to disproportionately affect Black and minority ethnic women—with 12% of stillbirths, 1% of preterm births and 17% of births with FGR attributed to ethnic inequality. Importantly, this research found that even adjusting for socioeconomic deprivation, maternal smoking and BMI had little impact on these outcomes—indicating that other factors, including those related to discrimination based on ethnicity and culture may contribute to poor pregnancy outcomes.

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Co-lead author Professor Jan van der Meulen from the London School of Hygiene & Tropical Medicine, UK  explained: “There are many possible reasons for these disparities. Women from deprived neighbourhoods and Black and minority ethnic groups may be at a disadvantage because of their environment, for example, because of pollution, poor housing, social isolation, poor access to maternity and health care, insecure employment and poor working conditions, and more stressful life events. National targets to make pregnancy safer will only be realistically achieved if there is a concerted effort not only by midwives and obstetricians but also by public health professionals and politicians to tackle the broader socioeconomic and ethnic inequalities.”

From the findings of the research, Dr Harris and the team propose three measures to reduce inequalities in pregnancy outcomes, including targeting high-risk groups with clinical interventions during pregnancy, developing programmes to help stop smoking and promote healthy diets, as well as improving access to high-quality antenatal care (for example, by monitoring of fetal growth more precisely and frequently and offering to induce labour when stillbirth risk is increased). They also recommend public health strategies to reduce inequalities in women’s health before pregnancy, focusing on smoking and dietary habits as well as wider aspects of maternal adversity, such as mental health issues, substance abuse, and stress related to social disadvantage. Lastly, they call for wider policies to address the key causes of inequality, such as income, education, and employment, that indirectly influence pregnancy outcomes.

You can read more about this research and the work of of the National Maternity and Perinatal Audit Project Team here.

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