Understanding the impact of covid-19 on pregnant women and new parents: The Born in Bradford 2020 Families Study
Lead Research Organisation:
Bradford Teaching Hospitals NHS Foundation Trust
Department Name: Bradford Institute for Health Research
Abstract
The COVID19 pandemic has dramatically changed how health care is delivered. Pregnant women have been identified as a vulnerable group to COVID19 and as a consequence, women have received much of their essential health care over the phone, and partners have not been able to attend maternity appointments including baby scans. After birth the usual social support offered by friends and family has been restricted due to social distancing. For women and their partners who are having a baby during this time there is concern that this could have an impact on their physical and mental wellbeing and the health and development of their babies.
The recovery from the COVID19 pandemic needs research information on the health, social and economic impacts on vulnerable populations to be made available quickly to key policy and decision makers so that they can develop and implement policies and interventions to reduce potential longer term impacts of the COVID19 pandemic.
The Born in Bradford (BiB) research programme (www.borninbradford.nhs.uk) is in a unique position to be able to provide such information on a key vulnerable population: pregnant women living in a highly deprived and ethnically diverse city. BiB have two ongoing birth cohort studies: Born in Bradford's Better Start (BiBBS) focussed on women living in ethnically diverse and deprived communities and BiB4All - a routine data linkage birth cohort study aiming to recruit all pregnant women booked to give birth at Bradford Teaching Hospitals NHS Foundation Trust. Participants give permission for follow-up via routine data from multiple agencies (e.g. GPs, maternity, health visiting, social care) and agree to be contacted for additional research projects with bespoke data collection.
The aim of our study is to understand the experiences of being pregnant, giving birth and caring for a baby during the COVID19 pandemic. We will adapt the data collection within our birth cohorts to collect additional quantitative survey data and qualitative interview data at 4 time points during pregnancy and during the first year after birth. This will allow us to:
a) understand how COVID19 has affected pregnant women (e.g., being identified as high risk by government, having changes to care or birth plans), and the short- and long-term impact these changes have had, for example on their expectations and experiences of care, their mental wellbeing, worries and concerns, birth outcomes;
(b) understand how the crisis is affecting wider aspects of pregnancy and the transition to
parenthood, for example peer-to-peer social support, support for breastfeeding and
parenting, family relationships and livelihoods;
(c) explore how these changes affect the partners of pregnant women during pregnancy
and in the postnatal period;
(d) inform practitioners, service providers and policy makers where intervention is needed
to reduce the adverse effects of the health and well being of women and their babies in the
short term and as part of recovery.
We will combine the findings of our surveys and qualitative work and use expert groups of key stakeholders and local parents to co-produce recommendations for practice. This research will significantly contribute to understanding the impact of COVID19 on
pregnant women and their partner's current and future health and the health and development of their children. It will also inform interventions to reduce the impacts of the pandemic. Bradford, like many other large UK cities, has high levels of deprivation and ethnic diversity, the findings from our study will therefore be scientifically valid and relevant to services and policy makers nationally. Our research team have connections to many other COVID19 research teams nationally and internationally as well as direct links into key national health organisations and policy makers. We will use these connections to ensure wide dissemination of our findings and ensure they are integrated in policy.
The recovery from the COVID19 pandemic needs research information on the health, social and economic impacts on vulnerable populations to be made available quickly to key policy and decision makers so that they can develop and implement policies and interventions to reduce potential longer term impacts of the COVID19 pandemic.
The Born in Bradford (BiB) research programme (www.borninbradford.nhs.uk) is in a unique position to be able to provide such information on a key vulnerable population: pregnant women living in a highly deprived and ethnically diverse city. BiB have two ongoing birth cohort studies: Born in Bradford's Better Start (BiBBS) focussed on women living in ethnically diverse and deprived communities and BiB4All - a routine data linkage birth cohort study aiming to recruit all pregnant women booked to give birth at Bradford Teaching Hospitals NHS Foundation Trust. Participants give permission for follow-up via routine data from multiple agencies (e.g. GPs, maternity, health visiting, social care) and agree to be contacted for additional research projects with bespoke data collection.
The aim of our study is to understand the experiences of being pregnant, giving birth and caring for a baby during the COVID19 pandemic. We will adapt the data collection within our birth cohorts to collect additional quantitative survey data and qualitative interview data at 4 time points during pregnancy and during the first year after birth. This will allow us to:
a) understand how COVID19 has affected pregnant women (e.g., being identified as high risk by government, having changes to care or birth plans), and the short- and long-term impact these changes have had, for example on their expectations and experiences of care, their mental wellbeing, worries and concerns, birth outcomes;
(b) understand how the crisis is affecting wider aspects of pregnancy and the transition to
parenthood, for example peer-to-peer social support, support for breastfeeding and
parenting, family relationships and livelihoods;
(c) explore how these changes affect the partners of pregnant women during pregnancy
and in the postnatal period;
(d) inform practitioners, service providers and policy makers where intervention is needed
to reduce the adverse effects of the health and well being of women and their babies in the
short term and as part of recovery.
We will combine the findings of our surveys and qualitative work and use expert groups of key stakeholders and local parents to co-produce recommendations for practice. This research will significantly contribute to understanding the impact of COVID19 on
pregnant women and their partner's current and future health and the health and development of their children. It will also inform interventions to reduce the impacts of the pandemic. Bradford, like many other large UK cities, has high levels of deprivation and ethnic diversity, the findings from our study will therefore be scientifically valid and relevant to services and policy makers nationally. Our research team have connections to many other COVID19 research teams nationally and internationally as well as direct links into key national health organisations and policy makers. We will use these connections to ensure wide dissemination of our findings and ensure they are integrated in policy.
Technical Summary
We will produce robust evidence on the significant impact of the pandemic, and response
to it, on the health of pregnant women and their babies. This will inform immediate practice
and policy for the recovery period.
We will conduct a mixed methods study of pregnant women, postpartum mothers and
fathers. The core will be a quantitative telephone/online longitudinal survey of around 1800
pregnant women at four times points during pregnancy and postpartum. They will be
recruited from two large population-based studies with ongoing recruitment, supported by
the Born in Bradford infrastructure in Bradford. Data during pregnancy will be collected on
a range of demographic and socioeconomic factors as well as food, housing and income
security, self-reported physical and mental health and wellbeing, COVID-19 related
behaviours, access to maternity services, family relationships and social support, and
concerns related to COVID19 as well as infant feeding plans. Parallel diary and
exploratory qualitative studies will provide deeper understanding. Cortisol levels in hair
samples taken in the days after birth will be compared with historical control samples.
Rapid-cycle analysis of our survey and hair sample data linked with routine primary care,
maternity, health visiting social care and education data will provide timely information on
areas where action is needed. Longer-term follow up will be of major scientific and policy
significance.
Expert groups convened with the support from professional bodies and relevant agencies
will distill our findings and produce timely recommendations for practice, service
improvement and policy for immediate and also longer term implementation.
to it, on the health of pregnant women and their babies. This will inform immediate practice
and policy for the recovery period.
We will conduct a mixed methods study of pregnant women, postpartum mothers and
fathers. The core will be a quantitative telephone/online longitudinal survey of around 1800
pregnant women at four times points during pregnancy and postpartum. They will be
recruited from two large population-based studies with ongoing recruitment, supported by
the Born in Bradford infrastructure in Bradford. Data during pregnancy will be collected on
a range of demographic and socioeconomic factors as well as food, housing and income
security, self-reported physical and mental health and wellbeing, COVID-19 related
behaviours, access to maternity services, family relationships and social support, and
concerns related to COVID19 as well as infant feeding plans. Parallel diary and
exploratory qualitative studies will provide deeper understanding. Cortisol levels in hair
samples taken in the days after birth will be compared with historical control samples.
Rapid-cycle analysis of our survey and hair sample data linked with routine primary care,
maternity, health visiting social care and education data will provide timely information on
areas where action is needed. Longer-term follow up will be of major scientific and policy
significance.
Expert groups convened with the support from professional bodies and relevant agencies
will distill our findings and produce timely recommendations for practice, service
improvement and policy for immediate and also longer term implementation.
Publications
Gibson LY
(2021)
Comparison of Experiences in Two Birth Cohorts Comprising Young Families with Children under Four Years during the Initial COVID-19 Lockdown in Australia and the UK: A Qualitative Study.
in International journal of environmental research and public health
Jackson C
(2023)
Being pregnant and becoming a parent during the COVID-19 pandemic: a longitudinal qualitative study with women in the Born in Bradford COVID-19 research study.
in BMC pregnancy and childbirth
McIvor C
(2022)
The Impact of the Pandemic on Mental Health in Ethnically Diverse Mothers: Findings from the Born in Bradford, Tower Hamlets and Newham COVID-19 Research Programmes.
in International journal of environmental research and public health
Rosemary R C McEachan
(2020)
The Born in Bradford COVID-19 Research Study: Protocol for an adaptive mixed methods research study to gather actionable intelligence on the impact of COVID-19 on health inequalities amongst families living in Bradford
in Wellcome Open Research
Description | In the early stages of the COVID-19 pandemic pregnant women were categorized as high risk, with stringent restriction placed on their care and lifestyle. In addition the lockdowns impacted the support for new parents after birth. Poor and fragmented care and support, coupled with psychological stress, could have profound effects on women's health and children's early development. The aim of this study was to follow a cohort of pregnant women to identify the short- and long-term impact of the pandemic restrictions on their and their child's wellbeing. We sent quantitative surveys to over 1,000 women and undertook qualitative interviews with 15 women at three critical time points : pregnancy; 3-6 and 12-14 months postpartum. During pregnancy / early post-partum, women reported high levels of mental ill health, with 32% of mothers reporting mild symptoms and 12% reporting moderate-to-severe symptoms of depression. Women's biggest fears included being separated from their birth partner during labour, seeing friends and family at home after having their baby, and passing the virus to their baby. In the qualitative interviews at 6-12 months, women reported high levels of concern about their babies social development, with many reporting that their children were showing socio-emotional difficulties. The study suggests a need for a balance between measures to prevent potential health issues protecting women's mental well-being and children's early socio-emotional development. There is a clear need to explore in more detail the longer-term consequences of the pandemic restrictions on women and children born during hte pandemic to prevent longer-term problems in mental health and child development. |
Exploitation Route | A number of policy implications have been identified from this work: There is a need for a balance between preventative measures and the mental wellbeing of women. Having a partner at scans, during labour and birth, and on the postnatal wards is very important to women. Face to face appointments, not phone calls are very important to women. There is a risk that phone calls result in a lack of needed support and a failure to identify and address issues of concern. Create a single source of consistent, accurate, up to date and understandable information on Covid-19 risks for midwives, health visitors and women. This is essential to avoid confusion and misinformation Create a resource women can use to find information on managing after birth, and where to seek additional help for breastfeeding, perinatal mental health, parenting. This is essential whilst there are less face-to-face visits Actively encourage services to creatively adapt as they did in the pandemic to allow for optimum results for each service. We believe there are long-term implications for children born during the pandemic and we are putting in funding bids to follow-up these children longer-term to identify the problems and develop appropriate interventions to prevent further negative outcomes. |
Sectors | Education Healthcare |
URL | https://www.bradfordresearch.nhs.uk/family-and-community-impacts-of-covid-19/ |
Description | Bradford maternity unit has listened to these findings with keen interest, and have updated their plans for any future lockdowns on the basis of these findings. Findings have also fed into national policy meetings and been drawn into key learning from the pandemic for pregnancy. |
Sector | Healthcare,Government, Democracy and Justice |
Impact Types | Policy & public services |
Description | Local dissemination to CCG/ICS |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Contribution to a national consultation/review |
Description | Pivotal |
Geographic Reach | National |
Policy Influence Type | Contribution to a national consultation/review |
Description | local dissemination midwives and hvs |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Contribution to new or Improved professional practice |
Impact | The impact was increased knowledge and awareness of the work and findings and influence on midwives practice. |
Description | COVID-19: Families, children aged 0-4 and pregnant women: vulnerabilities, resources and recovery in Tower Hamlets |
Amount | £322,568 (GBP) |
Funding ID | ES/V004891/1 |
Organisation | Economic and Social Research Council |
Sector | Public |
Country | United Kingdom |
Start | 05/2020 |
End | 12/2022 |
Description | NIHR Population Health Career Progression Fellowship Award |
Amount | £522,819 (GBP) |
Funding ID | NIHR302938 |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 08/2023 |
End | 08/2027 |
Description | The Born in Bradford COVID-19 Research Study: An adaptive mixed methods longitudinal study of the impact of COVID-19 on health inequalities in families living in Bradford |
Amount | £198,680 (GBP) |
Funding ID | 2301201 |
Organisation | Health Foundation |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 02/2021 |
End | 03/2022 |
Description | Vaccine hesitancy in women of reproductive age through the lens of race and ethnicity |
Amount | £4,840 (GBP) |
Funding ID | NIHR303110 |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 05/2023 |
End | 02/2024 |
Title | Born in Bradford Covid-19 dataset |
Description | Data collected from pregnancies, parents and children during Covid-19 pandemic across the BiB cohorts. |
Type Of Material | Database/Collection of data |
Year Produced | 2023 |
Provided To Others? | Yes |
Impact | none to date |
URL | https://borninbradford.github.io/datadict/crosscohort/ |
Description | COVID-19: Families, children aged 0-4 and pregnant women: vulnerabilities, resources and recovery in Tower Hamlets (£ 322568; 2020 - 2021) |
Organisation | University College London |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Co-Investigator on complementary UKRI grant at UCL: Economic and Social Research Council: ES/V004891/1 - |
Collaborator Contribution | Mutual sharing and development of surveys, data, findings and interpretation of results |
Impact | n/a |
Start Year | 2020 |
Description | Parent-Infant Covid organizational academic learning collaborative |
Organisation | University of Central Lancashire |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Born in Bradford have been part of this group since it was set up during the height of COVID. We have disseminated our findings to this collaborative. We have helped fund a meeting for us to work in person to help bring together our findings as a group. We are also helping to organise a policy meeting in April by being on the organising committee and as one of it's funders. We are helping to contribute to knowledge across the perinatal period and in turn, helping to produce outputs. |
Collaborator Contribution | Soo Downe, the lead of this group, set up the group and chairs most of the meetings. Everyone in this group contributes by sharing ideas and helping to plan and organise events to help facilitate change. Some members of the group are also on the organising committee and will help to synthesize, develop and share our findings to policy makers and key organisations. |
Impact | Group dissemination event chaired online by Jane Sandall. Purpose was to share the early insights from new research on maternity services to inform service COVID-19 recovery. Useful meeting to get our findings out there to key members ahead of the policy meeting in April. |
Start Year | 2020 |
Description | 0-19 research network in Yorkshire and Humber presentation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | Presented the summary findings and circulated links to the published qual reports. The impact was increased knowledge and awareness of the work and findings. |
Year(s) Of Engagement Activity | 2021 |
Description | 3 workshops for the BaBi network, in Bradford, Wakefield and Doncaster |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | Presented the summary findings and circulated links to the published qual reports at the workshops. There were more than 140 delegates across the three workshops, representing midwives, health visitors, public health leads, service commissioners, voluntary sector organisations and members of the public. The impact was increased knowledge and awareness of the work and findings and influence on the identification of local research priorities. |
Year(s) Of Engagement Activity | 2021 |
Description | Born in Bradford Radio Broadcast to let people know about what Covid-19 research BIB is currently undertaking |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | To notify members of the public, other organizations and study participants what BIB are up to and our plans to research the impact of the pandemic on families across Bradford. |
Year(s) Of Engagement Activity | 2020 |
Description | Born in Bradford to study the effects of COVID-19 on families |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | To notify members of the public, other organizations and study participants what BIB are up to and our plans to research the impact of the pandemic on families across Bradford. |
Year(s) Of Engagement Activity | 2020 |
Description | Community Soft Intelligence |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Dialogue with local communities and key stakeholders to develop priority research quesitons for this study |
Year(s) Of Engagement Activity | 2020 |
Description | Community research advisory group |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | We are aware of Covid research fatigue and used the workshop to discuss how to ensure good retention of our participants |
Year(s) Of Engagement Activity | 2021 |
Description | Conference presentation at the Society of reproductive infant psychology |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | The COVID-19 work was presented to increase awareness of the study internationally and the impact of the cohort in Bradford and the impacts it has discovered. This presentation has helped to build links between other institutions to collaborate or understand our findings in other contexts. |
Year(s) Of Engagement Activity | 2023 |
Description | Covid-19 impact communications |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | The URKI picked our project to feature in the UKRI communications about the impact of their research and innovation funding. They issued 12 regional emails to MPs, marking the 2nd anniversary of the first UK lockdown. Our summary was based on the practical steps Yorkshire took to support pregnant women during the pandemic. For example, that we found that the changes to the city' midwifery care, including pre, postnatal and breastfeeding support to improve birth outcomes and mental health. |
Year(s) Of Engagement Activity | 2022 |
Description | Engagement of study participants |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Social media post on Facebook announcing we have over 500 women in our Covid pregnancy and new parent study. |
Year(s) Of Engagement Activity | 2020 |
Description | Engagement of study participants via social media |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Social media post on Facebook announcing we have over 500 women in our Covid pregnancy and new parent study. |
Year(s) Of Engagement Activity | 2020 |
Description | Engagement of study participants via social media |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Social media post announcing some of our findings to our BiB participants |
Year(s) Of Engagement Activity | 2021 |
Description | Policy engagement event |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | Presentation on the Bradford COVID pregnancy work. This was a quick snapshot of the findings, impacts and recommendations to be taken forward for future policy decisions. |
Year(s) Of Engagement Activity | 2022 |
Description | Poster Presentation on recruitment strategies used for the postpartum 9-14 month wave |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Other audiences |
Results and Impact | Submitted a poster presentation for the CLOSER conference to discuss novel ways of recruitment and ways in which to retain a sample. I spoke about the use of token's of appreciation for retaining participants and the current results for whether it's best to donate on behalf of your participant or provide them with a £5 voucher, unconditional to them participating in the study. |
Year(s) Of Engagement Activity | 2022 |
Description | Poster presentation at a research event celebrating research activity |
Form Of Engagement Activity | Participation in an open day or visit at my research institution |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Schools |
Results and Impact | Poster presentation to communicate the different pieces of work that BIB has been involved in over the last few years. This was an event that invited schools, local and national research partners, charities, or other organizations to join us in a day of talks, debates and conversations about how to improve the lives of children. The COVID-19 work was presented as a poster prize competition to highlight a key piece of work that has taken place at BIB. |
Year(s) Of Engagement Activity | 2023 |
Description | Poster presentation of the qualitative COVID pregnancy work |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Postgraduate students |
Results and Impact | I presented a poster at a qualitive launch for Bradford. In this, I was able to showcase the qualitative arm of work for the pregnancy COVID work and therefore talk about the findings and get it out there more for people to see/understand. |
Year(s) Of Engagement Activity | 2023 |
Description | Radio interview about Covid studies |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | Radio interview on BBC radio Leeds about our Covid studies to spread information of what we are up to and what different studies are running at BiB at the moment. |
Year(s) Of Engagement Activity | 2020 |
Description | Radio interview about Covid studies |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | Radio interview on BBC radio Leeds about our Covid studies to spread information of what we are up to and what different studies are running at BiB at the moment, including the pregnancy and new mums study. |
Year(s) Of Engagement Activity | 2020 |
Description | UKRI communications about the impact of our research and innovation funding. |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | UKRI issude 12 regional emails to MPs, marking the 2nd anniversary of the first UK lockdown (on 23 March), to highlight the fantastic, publicly-funded projects making a real difference locally, nationally and globally. Our study was selected as one of the case studies entitled "Yorkshire takes practical steps to support pregnant women during pandemic" |
Year(s) Of Engagement Activity | 2022 |