Maternal and Child Health

The programme of work of our research group aims to improve the health and care of women and infants during and after pregnancy and birth and of children and young people. It includes cohort studies to establish risk factors, randomised controlled trials to test potentially effective interventions, systematic reviews and qualitative research. These studies are within a variety of topic areas, including childbirth related health problems, antenatal and postnatal care, maternity care in deprived populations, use of lay workers, postnatal depression, urinary and faecal incontinence, perineal trauma, swaddling, vitamin D supplementation, weaning food, breastfeeding, maternity care, health in the low and middle income countries (LMIC), care of children with life-limiting conditions and support of their families.

We aim to:

• Undertake high quality research generated by the team through identifying gaps in the evidence.
• Assist in the evaluation of service delivery through consultations with health commissioners and providers – in this capacity we are involved in NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands 2014-2019, WHO and Ministries of Health in LMIC.
• Facilitate the incorporation of research based evidence (and where evidence is lacking, examples of good practice) into commissioning, delivery and monitoring of maternity, and child services.

• Professor Christine MacArthur
• Professor Kate Jolly
• Professor Sara Kenyon
• Dr Carole Cummins
• Dr Semira Manaseki-Holland
• Dr Laura Jones
• Professor Tracy Roberts
• Professor Peter Brocklehurst
• Dr Katie Morris
• Lee Middleton
• Pollyanna Hardy

Maternity Theme of Applied Research Collaboration (ARC):

• Explore the neonatal jaundice pathway in the community
• Facilitate the implementation of Birmingham Symptom specific Obstetric Triage System (BSOTS)
• Induction of labour:

- Explore women’s views across two maternity Trusts. 

- Explore the extent of any logistical problems the increasing number of women being induced is resulting in, by undertaking a survey in a sample of maternity units thorough the UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG)

• Explore postnatal care during the Covid-19 period
• Explore the number and reason of pregnant women’s attendance at the emergency department of University Hospital Birmingham

Professor Sara Kenyon is Chief Investigator for the HOLDS trial which is a multicentre (around 30 UK obstetric units) randomised, double blind controlled trial which will recruit 1500 nulliparous women at term, with confirmed delay in labour - using National Institute for Health and Care Excellence (NICE) definitions -  and ruptured membranes. The trial is funded by the Health Technology Assessment programme (HTA) at the National Institute of Health Research (NIHR) and will compare the standard dose regimen of syntocinon (2mU/min increasing every 30 minutes to a maximum of 32mU/min) with a high dose regimen (4mU/min increasing every 30 minutes to a maximum of 64mU/min). The primary outcome is Caesarean section and secondary outcomes include key safety, maternal and neonatal outcomes.

The trial is currently suspended due to COVID 19 and a re-start is planned for autumn 2021.

Professor Sara Kenyon is also the Chief Investigator on a study funded by the HTA called iHOLDS.  Numbers of women whose labour are being induced is increasing with up to 36% of first time mothers being induced. This is a comparison of the standard dose regimens of syntocinon (2mU/min increasing every 30 minutes to a maximum of 32mU/min) with a high dose regimen (4mU/min increasing every 30 minutes to a maximum of 64mU/min) for nulliparous women for whom it is described as part of the induction of labour process.  The trial will recruit 2400 women from the same 30 maternity units as are recruiting to HOLDS over 36 months, began in autumn 2021.

The Maternal, Newborn and Infant Clinical Outcome Review Programme (previously the Confidential Enquiries in Maternal, Newborn and Infant death)

This is a collaboration appointed by the Healthcare Quality Improvement Partnership (HQIP) in 2012 to continue the national programme of work investigating maternal deaths, stillbirths and infant deaths, including the Confidential Enquiry into Maternal Deaths (CEMD).  Professor Sara Kenyon is involved in both the maternal confidential enquiry and co-chairs the perinatal confidential enquiries.

This was funded by HQIP in 2017 on behalf of DH (England), NHS Wales and Scottish Government to develop and establish a national standardised Perinatal Mortality Review Tool (PMRT).  The PMRT is used by all UK Trusts and has been designed with user and parent involvement to support high quality standardised perinatal reviews on the principle of 'review once, review well'.

Weaning food is a potential source of infection for the vulnerable young child. There is a great deal of research into the content of weaning food, but little into interventions that can improve its hygienic preparation in low resource settings. We are conducting formative research and a cluster randomised controlled trial in 30 villages of rural Gambia to test community level interventions to reduce contamination of weaning food and water drank by young children. This is a collaborative piece of work with London School of Hygiene and Tropical Medicine (LSHTM) using critical control point methodology and motivational theories of behaviour change.

• Effects on childhood infections of promoting safe and hygienic complementary-food handling practices through a community-based programme: A cluster randomised controlled trial in a rural area of The Gambia

The first ever randomized controlled trial (RCT) in Mongolia was conducted by our members in 2002-6, investigating the effects of health swaddling in Mongolia in infants:

• Thermoregulatory effects of swaddling in Mongolia: a randomised controlled study

Extended data on 1300 families, mothers and infants enable on-going research. We intend to follow-up these children, now adolescents for risk factors and health outcome measures.  Further studies, such as first ever studies of PND in Mongolia: 

• Depression in Mongolian women over the first 2 months after childbirth: Prevalence and risk factors

and other maternal and child health research continue in Mongolia. More recent studies investigate the state of inequalities in service provisions for maternal-child health services and child and adolescent health services.

A low intensity NHS delivered peer support worker service to increase breastfeeding initiation and continuation in Heart of Birmingham PCT was evaluated in a cluster  randomized clinical trial (RCT), HoBBIT.  The findings showed no benefit of the service in increasing initiation (BMJ) or continuation to 6 months postpartum.  Two systematic reviews by the team (BMJ and CMAJ) further examine evidence on breastfeeding peer support.  Building on this work we developed a new intervention to increase breastfeeding and explored its feasibility in the ABA feasibility study and are now evaluating its effectiveness in the ABA-feed trial (funded by NIHR PHR). 

This work, over the last 20+ years, is based around a cohort study (Prolong) of 7879 women who gave birth in 1993/4. The study (with colleagues in Aberdeen and New Zealand) has followed women at 6 and 12 years to investigate persistence and risk factors of incontinence and prolapse.  It is currently the largest long-term postpartum recruited cohort study on the topic. Examples of recent findings (BJOG) are that Caesarean section, relative to vaginal birth is not associated with a reduction in stress incontinence unless all a woman’s deliveries are by Caesarean.  And even exclusive Caesarean delivery is not associated with less faecal incontinence: whilst just one forceps delivery will increase the risk. A linked randomized clinical trial (RCT), PINT of pelvic floor muscle exercise for women with symptoms at 3 months postpartum showed improvement at 1 year but not at 6 years (both BMJ).  A current linked RCT (PREVPROL) is on exercise to prevent prolapse, funded in UK centres by RCOG charity Wellbeing, about to report.  Follow-up at 22 years is planned.

Other work in this area includes collaborations on a pregnancy recruited cohort study followed to 4 years with colleagues at University of Melbourne; and a population based study of pelvic floor disorders in Pakistan. The latter has also investigated obstetric fistula. A 5 year NIHR funded programme of work (APPEAL) is investigating antenatal prophylactic pelvic floor exercise in the prevention of postnatal incontinence including qualitative developmental work, systematic reviews leading to a pilot RCT.

Background: Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidity worldwide. Raised blood pressure (BP) affects 10% of pregnancies worldwide, of which almost half develop pre-eclampsia. The proportion of pregnant women who have risk factors for pre-eclampsia (such as pre-existing hypertension, obesity and advanced maternal age) is increasing. Pre-eclampsia can manifest itself before women experience symptoms and can develop between antenatal visits. Incentives to improve early detection of gestational hypertensive disorders are therefore strong and self-monitoring of blood pressure (SMBP) in pregnancy might be one means to achieve this, whilst improving women's involvement in antenatal care. The Blood Pressure Self-Monitoring in Pregnancy (BuMP) study aimed to evaluate the feasibility and acceptability of SMBP in pregnancy.

• Blood pressure self-monitoring in pregnancy (BuMP) feasibility study; a qualitative analysis of women's experiences of self-monitoring
• BUMP Evaluation Report

The Female Genital Mutilation (FGM) Sister Study is a qualitative study exploring the views of FGM survivors, male partners and healthcare professionals on the timing of deinfibulation surgery. 

Principal Investigator: Dr Laura Jones 

 

 

***Recruitment to this study is currently suspended***

Secondhand tobacco smoke (SHS) harms children in many ways and we don’t know how best to help smoking families to change their behaviour to protect them. A child living with smokers being brought to hospital may provide a good opportunity to support families to change their home smoking behaviours.

The aim of the Precedent study is to develop an intervention suitable for use in relation to a child’s hospital attendance to support families to change their smoking behaviours to reduce children’s SHS exposure.

SUPPORT (SUpporting health Professionals to help Parents address OveRweighT in children) Study

The SUPPORT study is now complete and we have reported our findings.  Our study identified how local health systems can support healthcare professionals to have healthier weight conversations with parents of primary school-age children.

The PROSPER study: suPporting Role Of SPecialist sERvices

A mixed methods, co-research study of the role, funding and commissioning of specialist services provided by the voluntary sector in England.

Our research is about understanding, informing and supporting families to plan care, so that every child with a life-limiting or life-threatening condition has the best possible quality of life and care. Download the ACP web page

 

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Our study will explore how to help pregnant women with moderate to severe mental illness to stop smoking. This research could help to reduce the number of stillbirths, miscarriages, sudden infant deaths and health problems linked to mothers who smoke.

A joint research collaboration, led by Dr Laura Jones, aims to explore the feasibility and acceptability of conducting a study comparing the effectiveness of colpocleisis with sacrospinous fixation in women with pelvic organ prolapse (the C-POP study). 

Download the study pages