Evaluating the relationship between maternal psychosocial risk and resource and newborn outcomes: a whole nation birth cohort using linked administrative data for England

“Understanding which combinations of psychosocial risks and protective factors are linked to poorer outcomes could help identify women who may benefit most from additional support and inform more equitable maternity care.”
— Dr Nicola Vousden

This study is being led by Dr Nicola Vousden (University of Oxford) and was funded by the Academy of Medical Sciences Starter Grant for Clinical Lecturers. The study started in May 2025 and aims to finish in June 2027.

‍This project was reviewed and approved through ECHILD's data access process. Learn how ECHILD data is kept safe.‍

    • Which psychosocial risks and resources experienced by women before and during pregnancy are associated with maternal and neonatal adverse outcomes?

    • What is the role of type and model of antenatal care in mitigating these outcomes for women with psychosocial disadvantage?

  • Women living in the most deprived areas face a greater risk of adverse pregnancy outcomes, but measures of area-level deprivation tell us relatively little about an individual woman’s circumstances. Psychosocial risks often occur together and interact, while factors such as social support and education may be protective. Understanding how these risks and resources cluster, and how they relate to outcomes, could help maternity services identify women who may benefit most from additional support.

    Reducing inequalities in maternal health is a national priority. NHS policy has recommended approaches such as continuity of midwifery care for women living in deprived areas, but implementation is challenging. By improving understanding of who is at risk and how antenatal care may influence outcomes, this project could inform policy and help services plan and target care more equitably.

  • We will use linked ECHILD administrative data to study a national cohort of mothers and babies in England, bringing together information on women’s health, social circumstances, education, antenatal care and birth outcomes. We will use statistical methods to identify patterns of psychosocial risks and protective factors and examine how these relate to maternal and newborn outcomes, as well as whether antenatal care modifies these relationships.

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  • Why does this matter?

    There is growing evidence that deprivation and social complexity are associated with poor health outcomes in pregnancy and childhood, but we do not know which combinations of psychosocial risks and protective factors confer the greatest risk of maternal and infant morbidity.

    What do we want to find out?

    We want to identify which combinations of psychosocial risks and protective factors are associated with severe maternal morbidity and adverse infant outcomes, including preterm birth, small for gestational age, low birth weight and stillbirth.

    What we will do

    We will use linked administrative data to identify a range of psychosocial risks and protective factors experienced by women before and during pregnancy. We will use latent class analysis to identify groups of women with different combinations of these factors, and regression methods to examine their association with maternal and infant outcomes.  We will also investigate whether the type and model of antenatal care women receive can reduce the risk of adverse outcomes. The findings could help inform maternity care, policy and future research, supporting better targeting of services and efforts to reduce health inequalities.

  • Background and aims

    Psychosocial disadvantage before and during pregnancy is associated with maternal morbidity and adverse perinatal outcomes, but risks rarely occur in isolation and there is limited evidence about how combinations of psychosocial risks and protective factors influence outcomes. This study aims to describe associations between multiple psychosocial exposures and protective factors and maternal morbidity and adverse perinatal outcomes, and to examine whether the type and model of antenatal care may mitigate adverse outcomes among disadvantaged women.

    Methods and analysis

    We will undertake a retrospective cohort study of women aged 15–45 with a singleton pregnancy who gave birth in an NHS hospital in England after 20 weeks’ gestation. Psychosocial exposures and protective factors will be identified from routinely collected health, maternity, social care and education data. We will use descriptive statistics and regression analyses to examine associations between individual exposures and outcomes, and latent class analysis to identify clinically relevant subgroups characterised by different combinations of exposures. Poisson, multinomial and multilevel regression methods will be used as appropriate, accounting for clustering within hospitals. We will also examine antenatal care—including gestation at booking, attendance at expected appointments, and model and type of care—as a potential effect modifier.

    ECHILD data used

    The study will use linked ECHILD data including Hospital Episode Statistics Admitted Patient Care (HES APC), the Maternity Services Data Set (MSDS), Children Looked After data and the National Pupil Database Key Stage 4 educational outcomes data, with ONS Birth Registration data used to assess MSDS data quality. Pre-defined ECHILD mother–baby links will be used.