Research shows pregnancy screening algorithm could reduce inequalities in baby deaths

on 01 March 2022

Research from the Tommy’s National Centre for Maternity Improvement shows racial disparities in baby deaths could be significantly reduced using new pregnancy screening technology.

The research, published in the British Journal of Obstetrics and Gynaecology (BJOG), analysed 20,651 pregnant women – 8,080 who had the standard National Institute for Health and Care Excellence (NICE) screening and 12,571 who used the Fetal Medicine Foundation (FMF) first trimester pregnancy screening algorithm.

It was found that using the new pregnancy screening algorithm racial disparity was ‘almost eliminated’ in adverse pregnancy outcomes with improved screening and personalised care provision.

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) led the research project alongside the Tommy’s National Centre for Maternity and Improvement.

RCM CEO Gill Walton said: “No woman should lose her baby just because of her race or ethnicity. I’m really proud that the Royal College of Midwives is part of this project and that it’s already making a tangible difference. It is another example of innovation being driven by midwives and obstetricians working in partnership to make maternity care safer and better. All of this great work and effort must continue to be supported with the right levels of funding and resources to enable it to be implemented effectively."

The pregnancy screening algorithm also reduced perinatal death rates by 3-fold for Black, Asian and minority ethic women and 3 in 4 deaths linked to placental dysfunction were avoided.

Currently the NICE screening checklist of risk factors does not take maternal ethnicity into consideration and is “known to have a high screen positive rate and a low detection rate”.

Clinical Director for the Tommy’s National Centre for Maternity Improvement, who led the research team, Professor Basky Thilaganathan said: “It’s incredibly exciting to see that changing from the standard pregnancy risk factor checklists to our new approach can directly address and almost eliminate a large source of the healthcare inequality facing Black, Asian and minority ethnic pregnant women.

“We know that the causes behind health disparities are multifactorial and incredibly complex, and can include implicit racial bias, a lack of high quality research and a large gender data gap. However, we should not lose sight of the possibility that solutions for tackling these inequalities may be simple and achievable.

“The current maternal risk-factor screening programme is limited and can contribute to ongoing racial inequalities – but our algorithm can account for these deficiencies, enabling us to truly personalise care rather than treating large groups in the same way, and ultimately improve pregnancy outcomes.”

In the paper, researchers concluded: “First trimester combined screening for placental dysfunction is associated with a significant reduction in perinatal deaths for women of Black, Asian and minority ethnic background and equitable health outcomes for non-White and White women.”

The research ‘Reducing health inequality in Black, Asian and other minority ethnic pregnant women: impact of first trimester combined screening for placental dysfunction on perinatal mortality’ can be found here.