Imperial College London

Academic Institute

Edward Mullins

Unknown

No

NIBDAPC_2023_0021

This project aims to explore which and how many long-term conditions women have when they become pregnant. This will allow us to investigate whether women with different long-term conditions have an increased risk of complications during pregnancy, such as diabetes, and at the time of birth, such as stillbirth. It will also allow us to understand whether any of those long-term conditions alone or in combination may increase the risk of babies being born prematurely or with low birthweight. We want to understand how a woman’s environment before and during pregnancy may have additional or linked impact on pregnancy alongside any long-term conditions. Specifically, whether exposure to air and noise pollution and/or extreme temperatures during pregnancy can increase the risk of complications for both mother and baby. We will explore whether women from different groups in NW London with long-term conditions have a higher risk of complications due to e.g. air pollution compared with women who do not have long-term conditions. Finally, we want to investigate how we might address the factors we find are contributing to poorpregnancy outcomes. These could include improving engagement of maternity services with local communities, providing more personalised information for women planning or in pregnancy and developing plans to improve the environment women live in to improve pregnancy outcomes.

Reduction of stillbirth and pre-term birth are national UK priorities, with targets for reduction by 50% and 25% respectively by 2025 set by Department for Health and Social Care. This study will explore the factors in women’s demogrpahics, medical histories and envirmental exposures which are associated with poor pregnancy outcomes. EM and ACPG have conducted several focus group discussions with London maternity community engagement groups, with representation from population groups who experience particularly high rates of pregnancy complications, including those of Black and Asian ethnicity and those living in socioeconomic deprivation. These workshops demonstrated that the impact of environmental factors, including air pollution, is a growing concern for communities, particularly mothers. For instance, they said that they had not considered how exposure to air pollution in utero could influence pregnancy outcomes and the health of the babies. The women we engaged with felt that communities in the most deprived areas were exposed to greater levels of air pollution than those in affluent neighbourhoods, whilst not being responsible for much of this pollution. These findings informed our choice of outcomes for this study, which include both maternal and children’s health outcomes. In addition, they demonstrated that women were particularly worried about air pollution, even more than underlying health conditions, which emphasised the need to have a detailed geographical data to link with air pollution data. This is essential to address the questions that women see as priorities for research. When asked about dissemination of the findings, the mothers considered that it was important to raise awareness “even if the messages were scary”. They said that information is key for empowering communities to advocate for good air quality. They proposed reaching out to disadvantaged groups as those tend to be the worst impacted by air pollution, and this made us strengthen our collaboration with the Global Black Maternal Health group as they also advocate for addressing inequalities in exposure to air pollution. EM and ACPG met with Agnes Agyepong, the founder & CEO of this group, who is an engagement lead with vast experience working with Black mothers in London and globally. We discussed the findings of their survey of over 400 black women during or just after pregnancy, which identified air pollution and its impact on pregnancy as a priority area for women living in London. As a result, EM was invited to speak at the first Black Child Clean air conference at the Royal College of Obstetricians and Gynaecologists on the 15th of June 2013, the Clean Air Day, when a report of this survey was presented. The women in our focus groups also recommended that we should engage with policy makers in local government in London as they are not aware of the detrimental impact of air pollution on pregnant women and their children. Understanding this impact could lead to policies that reduce exposure, such as reduction in traffic in residential areas or free public transport passes for pregnant women during off peak times to avoid the highest levels of air pollution. Women also emphasised the need to raise awareness among healthcare professionals, as they are trusted sources of information for pregnant women. If they are not aware of the impact of air pollution, they cannot give informed advice on how to reduce exposure. Although many interventions are in the remit of policy makers (e.g., traffic restrictions), reducing exposure may also be achieved by avoiding travelling during peak times or preferring parks to busy roads for walking or using masks to reduce inhalation of particulate matter when air pollution levels are high. We will continue engaging with the public, patients and policy-makers. ACPG has important contacts in the London Greater Authority and local councils in London, which will be paramount to ensure the findings of this study reach policy makers. This builds on our engagement workshops in which women acknowledged that some of the actions were of local/central government responsibility. EM has important contacts in maternity services in NW London, which will help disseminating the findings to healthcare professionals looking after pregnant women. We will work with our lay research team members to disseminate information to women in a sensitive manner. This is based on our discussions with focus groups, in which women considered that we needed to strike the right balance between giving information and “over-burdening” people during pregnancy about topics which may seem “too big”, overwhelming, or about which, they may feel powerless to affect. In response to these concerns, we will endeavour to combine raising awareness on the harms of exposure to air pollution with advice on how individuals and communities can take to reduce their exposure, for instance by increasing exposure to natural environments, which have additional mental health benefits. To widen our audience, we will aim to present our findings at the Imperial College Great Exhibition Road Festival in 2024 as this will allow us to showcase our research in a creative way and friendly environment. We will work with our PPIE ambassadors to design our stand at the Festival. We hope that our findings will contribute to: -improving design and integration of preconception healthcare services e.g. preconception services for women with multi-morbidity, with women’s everday lives -increasing women’s awareness and engagement with pregnancy health through identification of modifiable local factors affecting pregnancy outcomes -designing e.g. road traffic reduction schemes to reduce pollution in areas where women have high exposures to pollution and poor pregnancy outcomes -informing public health campaigns to reduce damaging environmental exposures during pregnancy -measures to adapt women’s environment, e.g. workplaces, during extreme heat, as seen this summer, to support better pregnancy outcomes

Public Health Research

12/10/2023

De-Personalised

Not applicable

Not applicable

One-off

TRE