Risks factors and causes of postnatal General Practitioner consultations and hospital admissions following perinatal mortality: a cohort study

Study type
Date of Approval
Study reference ID
Lay Summary

The loss of a baby is one of the most devastating life events that parents can face. There is, however, limited evidence of the impact of perinatal mortality (stillbirth and death of the baby within 28 days of being born) on the health of parents. We aim to use data from general practice records within CPRD Aurum and the linked hospital admission records to find out how often women go and see their doctor and are admitted to hospital within 12 months of perinatal deaths, and the reasons for these consultations and admissions (for example, whether they are related to their pregnancy or mental health). We will determine whether the number of consultations and admissions vary by factors like the geographical region where the woman lives or the extent of deprivation in their local area. We will find out what the key factors are which increase the risk of having more consultations and admissions, investigating factors such as age, deprivation, geographical region, existing other illnesses such as diabetes and depression, and previous pregnancies. The new knowledge from this research will be used to understand gaps in care following perinatal deaths and inform the development and design of new interventions and health policy. These, in turn, should improve the physical and mental health of women and families following perinatal deaths across the nation.

Technical Summary

There is limited evidence of the impact on a mother’s health and care of perinatal mortality, defined as stillbirths and neonatal deaths (death within 28 days of life). The proposed research aims to determine the frequency and reasons for consultations to primary care, and of hospital admissions within 12 months of perinatal mortality using CPRD Aurum linked to HES Admitted Patient Care records. The study population will be women aged 11-49 with perinatal mortality recorded in their records between 1997 and 2020. We will include all consultations and admissions as outcomes but also focus specifically on pregnancy-related, hypertension, and mental health reasons for consultation and admission. We will determine geographical variation and factors which increase the risk of consultation and admission including socio-demographics (such as age, deprivation), index year, comorbidities (including anaemia, diabetes, hypertension, asthma, anxiety, depression) and prior pregnancy history. Cox proportional hazards models will be used to identify associations between the baseline potential risk factors and time to event (GP consultation and hospital admission), and negative binomial regression will be used to determine associations with number of consultations. The outputs from the proposed research will extend the current evidence-base and inform new interventions and service provision strategies, and ultimately help to improve the physical and mental health of women and families following perinatal mortality across the nation.

Health Outcomes to be Measured

1. GP consultations within 12 months of perinatal mortality; Number of consultations; Causes for consultation e.g., hypertension, mental health (including depression, anxiety, and post-traumatic stress disorder),
including prescriptions for these conditions

2. Hospital admissions within 12 months of perinatal mortality; Number of admissions; Causes of admissions e.g., puerperal infection, bleeding, hypertension, depression


Pensee Wu - Chief Investigator - Keele University
Pensee Wu - Corresponding Applicant - Keele University
Carolyn Chew-Graham - Collaborator - Keele University
James Bailey - Collaborator - Keele University
Kelvin Jordan - Collaborator - Keele University
Muhammad Usman - Collaborator - Keele University


HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;CPRD Aurum Mother-Baby Link;CPRD Aurum Pregnancy Register