Title: Post-pandemic planning for maternity care for local, regional, and national maternity systems across the four nations
Funder: Department of Health and Social Care

Abstract: We aim to find out how pregnant women and babies have been affected by maternity care changes due to COVID-19. Questions include:_x000D_ _x000D_ -Were any changes useful? Were any unwelcome or damaging?_x000D_ -How were different groups affected?_x000D_ -Can lessons be learned to reduce inequalities in maternity care in the future?_x000D_ _x000D_ We ask whether the overall consequences of the pandemic for pregnant women were magnified or diminished for minority ethnic groups, and those women living with social or medical problems._x000D_ _x000D_ BACKGROUND_x000D_ _x000D_ During the pandemic, pregnant and post-birth women often had ‘virtual’ care (by phone or online), rather than in clinic. Some monitored their blood pressure or blood sugar at home and sent readings to care-providers via apps. Now women must decide whether to accept COVID vaccination when offered. Yet, there is little information about how well COVID vaccines in pregnancy or post-birth work, their safety, and whether women will accept them when offered. This is important, as pregnant women who contract COVID-19 are more likely to develop severe illness, particularly women from minority ethnic groups, who may also more often decline vaccination._x000D_ _x000D_ WHAT CAN WE LEARN?_x000D_ _x000D_ The effects of maternity care changes on some women may have been greater, such as those experiencing racial discrimination, lone parenthood or domestic abuse, or affected by deprivation or ill-health. We will investigate this possibility for women and babies known to have poorer health and pregnancy outcomes before COVID – those: from minority ethnic groups, with prior health conditions, current pregnancy complications, or living with social difficulties. We will explore associated care costs. _x000D_ _x000D_ In more detail, the 2-year project will have 3 work packages (WPs):_x000D_ _x000D_ WP1 will use existing maternity and mental health records, collected as part of care in south London. These are accessible via a secure database, the early-LIfe data cross-LInkage in Research (eLIXIR) platform. They include some details of how maternity care changed in the pandemic, such as virtual care, self-monitoring (eg, blood pressure), and acceptance of COVID-19 vaccination. This WP will compare care and the consequences for different groups. _x000D_ _x000D_ WP2 will collect information across the UK in two ways. First, interviews with minority ethnic group women, those living with complex social or medical needs, and health service leaders and policymakers, will gather views on care changes that have occurred and their effects. Second, women who are planning pregnancy, pregnant, or post-birth and using the King’s College London COVID Symptom Study app (ZOE Global Ltd.) will be invited to join the COVID Symptom Study Biobank and share their views on COVID-19 vaccination, pregnancy outcomes, mental health, and early-life parenting._x000D_ _x000D_ In WP3, we will hold ‘listening events’ in the four UK nations, and a national ‘Policy Lab’ workshop, to engage maternity service users, health care staff, and health policymakers. We will present the study results and ‘imagine our best future’, then work together to agree recommendations for future policy and action._x000D_ _x000D_ A patient and public involvement and engagement advisory group will work with us throughout. We will share our findings locally, regionally, and nationally across the four nations, through webinars, social media, online, and plain-language reports. Our impact will be on women, NHS maternity staff, the NHS Long Term Plan, and wider society.

Lay abstract: BACKGROUND_x000D_ _x000D_ One in 10 pregnant women contract COVID, but all are affected by pandemic-associated maternity service reconfiguration._x000D_ _x000D_ AIMS_x000D_ _x000D_ To study the pandemic impact on maternal and offspring outcomes, focussing on virtual care, out-of-office monitoring, and the evolving vaccination strategy, to strengthen maternity services post-pandemic._x000D_ _x000D_ OBJECTIVES_x000D_ _x000D_ 1) For all pregnancies, to study the impact on maternity care quality (effectiveness, safety, and acceptability), pregnancy outcomes, and costs within the context of maternity service configurations, particularly virtual consultations, out-of-office monitoring (eg, self-monitored BP), and COVID-19 vaccination (ie, provision, uptake, and adverse events):_x000D_ _x000D_ 2) Explore and describe the perceptions and experiences of pregnant and postpartum women during the pandemic, with a focus on those who:_x000D_ - identify with an ethnic minority group;_x000D_ - have medical or mental health co-morbidities; and/or_x000D_ - live with social complexity, including socioeconomic deprivation._x000D_ _x000D_ 3) Across the four nations, engage with stakeholders to develop policy interventions for local, regional, and national health systems._x000D_ _x000D_ METHODS_x000D_ _x000D_ Work Package (WP)1: QUANTITATIVE - describe, quantify, and explain_x000D_ We will use routinely-collected, linked maternity, mental health, and offspring data from the MRC-funded early-LIfe data cross-LInkage in Research platform (˜35,000 records currently) from a diverse area, South London. We will describe and quantify temporal trends in relevant health outcomes and costs, by service reconfiguration and inequalities (as above), using segmented and individual-level multivariate regression. We seek a coherent pattern of results to be interpreted in light of WP2 findings._x000D_ _x000D_ WP2: SOCIAL SCIENCE - enrich understanding_x000D_ In-depth interviews with a maximum diversity sample of 105 pregnant/postpartum women, partners, care-providers, and policy-makers, with lived experience of maternity services during the pandemic. Interview schedules will explore what changed in care, its personal meaning, and confidence about care, analysed qualitatively (eg, thematic framework analysis)._x000D_ Questionnaires administered to maternity service users nationally (˜43,000) via the COVID Symptom Study (CSS) Biobank, recruiting participants from the King’s College London-CSS/ZOE app, to understand vaccine uptake, hesitancy, and side effects._x000D_ _x000D_ WP3: STAKEHOLDER ENGAGEMENT_x000D_ Regional listening events (‘imagining our best future’) in each UK nation will assess WP1 and WP2 findings; brainstorm, shortlist, and prioritise high-impact future actions; and understand relevant facilitators and barriers to implementation._x000D_ National Policy Lab (‘co-production for action’) to explore listening event findings and produce an ‘imagine our best future’ report for dissemination._x000D_ _x000D_ TIMELINES_x000D_ _x000D_ 24 months_x000D_ _x000D_ DISSEMINATION_x000D_ _x000D_ Will be through established networks of local, regional, and national stakeholders, through engagement events across the four nations, virtual engagement (webinars, social media), academic publications, website, and report._x000D_ _x000D_ IMPACT will be on:_x000D_ _x000D_ - Patients: improve care quality;_x000D_ - NHS maternity providers: evidence-informed service reconfiguration and vaccine role-out;_x000D_ - NHS Long Term Plan: address maternal and fetal/newborn death and morbidity and support digitally-enabled care implementation;_x000D_ - Society: innovation to commercialise and decrease costs.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH