The Impact of Community-Based Midwife Continuity of Care Models for Women Living in Areas of Social Disadvantage and Ethnic Diversity in the United Kingdom: A Prospective Cohort Study.

Abstract

Addressing inequalities in maternal and newborn health is a UK public health priority. Evidence on effective multi-interventional strategies is urgently needed. This study evaluated the impact of community-based midwife continuity of care (CBMCOC) models for women and babies in ethnically diverse and socially disadvantaged areas of South London. We conducted a prospective cohort study using the eLIXIR, Born in South London, maternity-child data linkage. United Kingdom. Pregnant women exposed to CBMCOC and standard care between 2018 and 2020. Propensity score matching (1:4) was used to account for differences between CBMCOC and standard care cohorts and control for confounding bias. Conditional logistic regression estimated risk ratios. Subgroup analysis included women of Black, Asian and other ethnic minority groups, and those living in highly deprived areas. The primary outcome was preterm birth (< 37 weeks' gestation). Secondary outcomes included other relevant maternal, perinatal, process and clinical variables. Before matching, 12 386 women were exposed to standard care and 1338 to CBMCOC; after matching, 5352 and 1338 were included, respectively. The risk of preterm birth was lower among women exposed to CBMCOC (unmatched: 4.6% vs. 10.3%, RR = 0.50, 95% CI: 0.38-0.64; matched: 4.6% vs. 8.4%, RR = 0.54, 95% CI: 0.40-0.70). Subgroup analyses showed reduced preterm birth rates among ethnic minority women and those in deprived areas when exposed to CBMCOC. In this diverse population with a range of risk factors, locality-based interventions integrating community-based care and midwife continuity may reduce maternal and newborn health inequalities. Further trials of such models should be conducted.