Pregnancy screening algorithm can reduce racial disparities in baby deaths, research shows
By RCM on 28 February 2022 NHS Midwives RCM Maternity Services Government Safety Maternity Safety Women Antenatal / Prenatal BAME Race matters
- Study ‘almost eliminated’ racial disparity in adverse pregnancy outcomes with improved early screening and personalised care provision
- Reduced perinatal death rate by 3-fold for Black, Asian and minority ethnic mums
- 3 in 4 deaths linked to placental dysfunction were avoided
Racial disparities in baby death rates could be significantly reduced with new pregnancy screening technology, according to research from the Tommy’s National Centre for Maternity Improvement – led by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives – published today in BJOG*.
Pregnancy risks are significantly higher for women from ethnic minority backgrounds in the UK, with 2-3 times higher rates of stillbirth and perinatal death compared to their white counterparts, and these disparities are shown to persist even when socioeconomic factors and other demographic variables are taken into account.
The study followed 20,651 pregnant women - 8,080 who had standard NICE screening and 12,571 who used the new algorithm - from July 2016 to December 2020. Of these women, 71 (1.4%) experienced perinatal loss, when babies die after 24 weeks of pregnancy or within a month of birth. Almost half (45%) of these deaths were linked to placenta problems, and three out of four of these losses were prevented with timely specialist care.
Gill Walton, Chief Executive of the Royal College of Midwives, said:
“No woman should lose her baby just because of her race or ethnicity. I’m really proud that the Royal College of Midwives is part of this project and that it’s already making a tangible difference. It is another example of innovation being driven by midwives and obstetricians working in partnership to make maternity care safer and better. All of this great work and effort must continue to be supported with the right levels of funding and resources to enable it to be implemented effectively."
Researchers found significant racial disparities in pregnancy outcomes when standard screening was used, with perinatal death rates 3 times higher among mothers from ethnic minority backgrounds (7.95 deaths per 1,000 births compared with 2.63 per 1,000 births among white mothers) – but when the new screening algorithm was used in conjunction with targeted care, mortality rates were equivalent between ethnic groups.
Professor Basky Thilaganathan, clinical director of the Tommy’s National Centre for Maternity Improvement, who led the research team at St George’s, said:
“It’s incredibly exciting to see that changing from the standard pregnancy risk factor checklists to our new approach can directly address and almost eliminate a large source of the healthcare inequality facing Black, Asian and minority ethnic pregnant women.
“We know that the causes behind health disparities are multifactorial and incredibly complex, and can include implicit racial bias, a lack of high quality research and a large gender data gap. However, we should not lose sight of the possibility that solutions for tackling these inequalities may be simple and achievable.
“The current maternal risk-factor screening programme is limited and can contribute to ongoing racial inequalities – but our algorithm can account for these deficiencies, enabling us to truly personalise care rather than treating large groups in the same way, and ultimately improve pregnancy outcomes.
“We have already started piloting this new digital tool with pregnant women across three sites in the UK. Given this new evidence, we would urge the government to support and invest in this new system which will allow us to roll this out more widely across the UK.”
The current method for antenatal risk assessment remains the same as it was in the 1970s and involves a checklist that asks for the presence of certain risk factors. This checklist does not weigh or assess the interaction between risk factors, and it does not allow for risk reduction in the absence of these factors.
Researchers at St George’s University Hospital NHS Trust in London replaced the standard NICE maternal risk factors checklist with a pregnancy screening algorithm linked to a personalised care pathway, which they developed as part of the Tommy’s National Centre for Maternity Improvement's efforts to make the UK the safest place in the world to give birth.
The Tommy’s National Centre for Maternity Improvement has since used this algorithm to form the basis of a new clinical decision tool developed for women and maternity staff. The tool uses validated AI algorithms to process the data routinely gathered during antenatal appointments to assess individual risk of potential complications developing during pregnancy.
In addition to St George’s who use this algorithm, the clinical decision tool is currently being introduced in three early adopter maternity units across England (Sheffield, Chertsey and Bolton) where the team will further evaluate its implementation.
Previous research found that St George’s changing from standard NICE screening to the new algorithm led to rates of the dangerous pregnancy complication pre-eclampsia to fall by a quarter (25%), and this latest study shows the lifesaving impact of preventing such problems. Researchers believe the reduction in perinatal deaths was driven by a significant reduction in placenta problems, thanks to the change in screening.
Overall, the new screening algorithm reduced baby deaths among mothers from ethnic minority backgrounds by 60% – and for mothers with hypertensive issues or babies born small for their gestational age, the perinatal mortality rate fell 73%. Researchers argue that mothers found to be at high-risk by the algorithm need extra monitoring during pregnancy, so that care teams can act early to prevent problems and save babies’ lives.
Jane Brewin, CEO of Tommy’s charity which funded the research, said:
“We sadly know all too well that mothers from minority ethnic backgrounds in the UK face higher pregnancy risks – but our new study makes it painfully clear these inequalities are not only unacceptable but avoidable. This issue demands urgent attention from both clinicians and policymakers. Meanwhile, our researchers are working to share their findings across the wider NHS, as part of our National Centre for Maternity Improvement’s ongoing efforts to make pregnancy safer for all.”
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:
“It is unacceptable that Black, Asian and minority ethnic women face huge inequalities when it comes to maternity outcomes and at the RCOG we are committed to addressing these. This research is vital in understanding the benefits of first trimester screening for women from Black, Asian and minority ethnic women and tackling health disparities. The digital tool created by the Tommy’s National Centre for Maternity Improvement provides a practical way to support women with personalised care during pregnancy and make informed decisions about birth. What’s clear is the current way of risk assessing women isn’t providing the safest approach and it’s vital both clinicians and health policymakers work to update it.”
The Tommy’s National Centre for Maternity Improvement is a unique collaboration, led jointly by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM). The team at St George's collaborate with other research experts from the University of Bristol, University of Sheffield and King’s College London together with charitable partners Mothers for Mothers and PROMPT Maternity Foundation and crucially, a diverse group of women with lived experience. The multi-disciplinary team works collaboratively to develop new ways of making maternity care more effective and efficient for both patients and professionals.
To find out more about Tommy’s National Centre for Maternity Improvement and efforts to make the UK the safest place in the world to have a baby, visit tommys.org/research.
ENDS
For media enquiries or to arrange an interview, please contact the RCOG press office: pressoffice@rcog.org.uk / +44 (0)7986 183167.
Notes to editor
About Tommy’s
1 in 4 women will lose a baby during pregnancy or birth. Tommy’s believes that every baby lost is one too many.
Tommy’s is a national charity that works tirelessly to reduce the UK’s unacceptable rates of miscarriage, stillbirth and premature birth. Tommy’s funds pioneering medical research to discover the causes of baby loss and helps women at every stage of their pregnancy journeys, supporting them and their partners with expert information and care. Tommy’s wants to make pregnancy safer for all and ensure that excellent maternity care is available for every family, every baby, everywhere.
About Tommy’s National Centre for Maternity Improvement
It shouldn’t matter who you are or where you live, every parent should be entitled to the best care for themselves and their baby – but we know that families’ experiences across the UK vary significantly, so our newest research centre is working to address this inequality and make pregnancy safer for everyone.
Launched in partnership with the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) in 2019, the Tommy’s Centre for Maternity Improvement brings together research experts from Bristol, Sheffield and London (King’s College and St George's) to develop pioneering tools and techniques for maternity care staff so they can easily tailor support to mothers’ unique risks and needs throughout pregnancy while making the best use of precious NHS resources. Maria Viner, CEO of Mothers for Mothers, a Bristol-based charity that has supported women and their families through maternal mental illness for 40 years, leads the Women’s Voices Group for the Tommy’s National Centre for Maternity Improvement.
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.
About the RCM
The Royal College of Midwives (RCM) is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance, and information, and learning opportunities with our broad range of events, conferences, and online resources. For more information visit the RCM website.