Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study
Objective In the UK and worldwide, there are substantial ethnic inequalities in maternal and perinatal care and outcomes. We aim to assess the impact of the unprecedented change in care provision during the COVID-19 pandemic on inequalities in adverse maternity outcomes.Design Retrospective cohort s...
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BMJ Publishing Group
2025-01-01
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| Online Access: | https://bmjopen.bmj.com/content/15/1/e090359.full |
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| author | Andrew Judge Erik Lenguerrand Tim Draycott Stamatina Iliodromiti Asma Khalil Buthaina Ibrahim Jennifer Elizabeth Jardine |
| author_facet | Andrew Judge Erik Lenguerrand Tim Draycott Stamatina Iliodromiti Asma Khalil Buthaina Ibrahim Jennifer Elizabeth Jardine |
| author_sort | Andrew Judge |
| collection | DOAJ |
| description | Objective In the UK and worldwide, there are substantial ethnic inequalities in maternal and perinatal care and outcomes. We aim to assess the impact of the unprecedented change in care provision during the COVID-19 pandemic on inequalities in adverse maternity outcomes.Design Retrospective cohort study using structured electronic health record data.Setting English hospital trusts providing maternity care.Participants Women giving birth and babies born in the National Health Service (NHS) in England between 1 April 2018 and 31 March 2021, in three time groups: prepandemic, the first pandemic wave (26 March 2020 to 30 June 2020) and second pandemic wave (1 July 2020 to 31 March 2021). Self-reported ethnicity was grouped into White, South-Asian, Black, Mixed and Other.Main outcome measures Composite and component measures of maternal (emergency caesarean section, obstetric anal sphincter injury, hysterectomy, sepsis, anaesthetic complications and prolonged hospital stay) and perinatal (stillbirth, neonatal death, preterm birth, brain injury, small for gestational age and prolonged hospital stay). Poisson regression was used to compare relative risks between different ethnic groups.Findings 1.54 million maternal and 1.43 million neonatal records were included. The overall incidence of adverse outcomes per 1000 births initially decreased maternal: from 308.0 (95% CI 307.0 to 309.0) to 291.0 (95% CI 311.4 to 314.9) (p<0.001); perinatal: from 133.0 (95% CI 132.3 to 133.7) to 111.9 (95% CI 110.1 to 113.7) (p<0.001)), but then increased in the second pandemic period (maternal: 313.2 (95% CI 311.4 to 314.9) (p<0.001); perinatal 118.9 (95% CI 117.7 to 120.0) (p<0.001)). The risk of adverse outcomes was higher in women and babies from all ethnic minority groups compared with White women in both pandemic periods. Black and South-Asian women and babies were approximately 25% more likely to sustain adverse outcomes. While similar overall changes in adverse outcomes were seen in all groups, existing inequalities were sustained throughout the pandemic periods.Interpretation Existing inequalities in adverse maternal and perinatal/neonatal outcomes were maintained, not tempered, during the pandemic, despite substantial changes to maternity services and care. Further research on possible interventions to reduce inequality is needed. |
| format | Article |
| id | doaj-art-229a646c41bf490a944e5d21ed745018 |
| institution | Kabale University |
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| language | English |
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| series | BMJ Open |
| spelling | doaj-art-229a646c41bf490a944e5d21ed7450182025-01-10T07:10:13ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-090359Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based studyAndrew Judge0Erik Lenguerrand1Tim Draycott2Stamatina Iliodromiti3Asma Khalil4Buthaina Ibrahim5Jennifer Elizabeth Jardine64 Musculoskeletal Research Unit, University of Bristol, Bristol, UK3 Translational Health Sciences, University of Bristol, Bristol, UK6 Department of Women`s Health, North Bristol NHS Trust, Westbury on Trym, UK8 Centre for Primary Care and Public Health, Queen Mary University of London Wolfson Institute of Preventive Medicine, London, UK3 Royal College of Obstetricians and Gynaecologists, London, UK1 Royal College of Obstetricians and Gynaecologists, London, UK2 Queen Mary University of London Centre for Public Health and Policy, London, UKObjective In the UK and worldwide, there are substantial ethnic inequalities in maternal and perinatal care and outcomes. We aim to assess the impact of the unprecedented change in care provision during the COVID-19 pandemic on inequalities in adverse maternity outcomes.Design Retrospective cohort study using structured electronic health record data.Setting English hospital trusts providing maternity care.Participants Women giving birth and babies born in the National Health Service (NHS) in England between 1 April 2018 and 31 March 2021, in three time groups: prepandemic, the first pandemic wave (26 March 2020 to 30 June 2020) and second pandemic wave (1 July 2020 to 31 March 2021). Self-reported ethnicity was grouped into White, South-Asian, Black, Mixed and Other.Main outcome measures Composite and component measures of maternal (emergency caesarean section, obstetric anal sphincter injury, hysterectomy, sepsis, anaesthetic complications and prolonged hospital stay) and perinatal (stillbirth, neonatal death, preterm birth, brain injury, small for gestational age and prolonged hospital stay). Poisson regression was used to compare relative risks between different ethnic groups.Findings 1.54 million maternal and 1.43 million neonatal records were included. The overall incidence of adverse outcomes per 1000 births initially decreased maternal: from 308.0 (95% CI 307.0 to 309.0) to 291.0 (95% CI 311.4 to 314.9) (p<0.001); perinatal: from 133.0 (95% CI 132.3 to 133.7) to 111.9 (95% CI 110.1 to 113.7) (p<0.001)), but then increased in the second pandemic period (maternal: 313.2 (95% CI 311.4 to 314.9) (p<0.001); perinatal 118.9 (95% CI 117.7 to 120.0) (p<0.001)). The risk of adverse outcomes was higher in women and babies from all ethnic minority groups compared with White women in both pandemic periods. Black and South-Asian women and babies were approximately 25% more likely to sustain adverse outcomes. While similar overall changes in adverse outcomes were seen in all groups, existing inequalities were sustained throughout the pandemic periods.Interpretation Existing inequalities in adverse maternal and perinatal/neonatal outcomes were maintained, not tempered, during the pandemic, despite substantial changes to maternity services and care. Further research on possible interventions to reduce inequality is needed.https://bmjopen.bmj.com/content/15/1/e090359.full |
| spellingShingle | Andrew Judge Erik Lenguerrand Tim Draycott Stamatina Iliodromiti Asma Khalil Buthaina Ibrahim Jennifer Elizabeth Jardine Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study BMJ Open |
| title | Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study |
| title_full | Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study |
| title_fullStr | Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study |
| title_full_unstemmed | Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study |
| title_short | Impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in England: a population-based study |
| title_sort | impact of pandemic service changes on ethnic inequalities in maternal and perinatal outcomes in england a population based study |
| url | https://bmjopen.bmj.com/content/15/1/e090359.full |
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