Understanding the impact of covid-19 on pregnant women and new parents: The Born in Bradford 2020 Families Study

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.

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.