An investigation into the effect of quality of antenatal care on the risk of stillbirths in the UK

Date of ISAC Approval: 
Lay Summary: 
Stillbirth rates in the UK are higher than many other European countries, and reductions in rates have slowed. Determining the risk factors for stillbirth is vital to understand how to reduce rates further. Most current research has focused on understanding biological and lifestyle factors, such as smoking during pregnancy. Much less attention has focussed on social factors, such as quality of care for pregnant women. It is recommended that women attend between 7 and 10 check-ups during pregnancy. These may be essential to prevent stillbirth, because the majority of stillbirths in the UK occur during pregnancy rather than during labour. Therefore, the purpose of this study is to look at the association between the quality of care that pregnant women receive and their rates of stillbirth. In addition to this, patterns in the ethnicity and deprivation level of people who do and do not receive good quality care will be studied to determine whether high-risk groups that are vulnerable to receiving poor care are also at greater risk of stillbirth. This work will guide further research and development of interventions that better target the people who are in most need of appropriate, timely, good quality care.
Technical Summary: 
NHS England have the aim to half the rates of stillbirths by 2030, but reductions in the rates have slowed. Current interventions have been based on care that raises awareness of biological factors that increase the risk of stillbirth. Yet, there is little research into who is actually receiving this care and the social risk factors of stillbirth. Therefore, this study will use the Pregnancy Register at the Clinical Practice Research Datalink, to investigate the association between quality of antenatal care and the risk of stillbirth. Descriptive analysis will identify the characteristics of the study population and the proportion who have experienced a stillbirth. Multivariable logistic regression will then be used to determine the odds of stillbirth in those who do and do not receive good quality antenatal care (according to NICE guidelines). This analysis will also control for numerous potential confounders. Subgroup analyses will then be conducted to determine the characteristics of those who do and do not receive good quality care to identify high-risk groups. The identification of these factors and their effects on stillbirth and high-risk groups will guide further research into designing the most appropriate interventions to resume the decline in the UKs stillbirth rates.
Health Outcomes to be Measured: 
- Stillbirth - Livebirth - Quality of antenatal care

Amanda Clery - Chief Investigator - London School Of Hygiene & Tropical Medicine (LSHTM)
Amanda Clery - Corresponding Applicant - London School Of Hygiene & Tropical Medicine (LSHTM)
Miss Caroline Minassian - Collaborator - London School Of Hygiene & Tropical Medicine (LSHTM)
Professor Liam Smeeth - Collaborator - London School Of Hygiene & Tropical Medicine (LSHTM)
Rohini Mathur - Collaborator - London School Of Hygiene & Tropical Medicine (LSHTM)

Patient IMD;Practice IMD (Standard);Pregnancy Register