Maternal health, pregnancy and birth outcomes for women involved in care proceedings in Wales:a linked data study

Griffiths, L.J. and Johnson, R.D. and Broadhurst, K. and Bedston, S. and Cusworth, L. and Alrouh, B. and Ford, D.V. and John, A. (2020) Maternal health, pregnancy and birth outcomes for women involved in care proceedings in Wales:a linked data study. BMC Pregnancy and Childbirth, 20 (1). ISSN 1471-2393

Full text not available from this repository.


Background: Under the Children Act 1989, local authorities in Wales, UK, can issue care proceedings if they are concerned about the welfare of a child, which can lead to removal of a child from parents. For mothers at risk of child removal, timely intervention during pregnancy may avert the need for this and improve maternal/fetal health; however, little is known about this specific population during the antenatal period. The study examined maternity characteristics of mothers whose infants were subject to care proceedings, with the aim of informing preventative interventions targeted at high risk mothers. Methods: Anonymised administrative data from Cafcass Cymru, who provide child-focused advice and support for family court proceedings in Wales, were linked to population-based maternity and health records held within the Secure Anonymised Information Linkage Databank. Linked data were available for 1111 birth mothers of infants involved in care proceedings between 2015 and 2018. Findings were benchmarked with reference to an age-deprivation-matched comparison group (n = 23,414), not subject to care proceedings but accessing maternity services during this period. Demographic characteristics, maternal health, reproductive history, interaction with midwifery services, and pregnancy and birth outcomes were examined. Descriptive and statistical tests of independence were used. Results: Half of the women in the cohort (49.4%) resided in the most deprived areas. They were more likely to be younger at entry to motherhood (63.5% <21 years-of-age compared to 42.7% in the comparison group), to have mental health (28.6% compared to 8.2%) and substance use issues (10.4% compared to 0.6%) and to smoke (62.7% compared to 24.8%) during pregnancy. The majority first engaged with maternity services within their first trimester of pregnancy (63.5% compared to 84.4%). Babies were more likely to be born preterm (14.2% compared to 6.7%) and, for full-term babies, to have low birthweights (8.0% compared to 2.8%). Conclusion: This novel linkage study highlights multiple vulnerabilities experienced by pregnant mothers who have experienced care proceedings concerning an infant. Policy and practice colleagues require a clearer picture of women’s needs if child protection and health services are to offer effective services which prevent the need for family court proceedings and infant removal.

Item Type:
Journal Article
Journal or Publication Title:
BMC Pregnancy and Childbirth
Additional Information:
Funding text 1: All authors are part of the Family Justice Data Partnership (FJDP) - a collaboration between Lancaster University and Swansea University. The authors would like to thank other team members involved in the Family Justice Data Partnership including K Jones, A Akbari, A Lee, J Smart and S Thompson (Swansea University), and B Alrouh, S Doebler and J Harwin (Lancaster University). We would also like to thank the following for their support with this study: L Harker, Director, Nuffield Family Justice Observatory; Cafcass Cymru; Administrative Data Research Centre Wales; and Welsh government. The authors would like to acknowledge all the data providers who make data available for research, and the Adolescent Mental Health Data Platform for providing the substance use and mental health clinical codes used within this study. References: Alrouh, B., Broadhurst, K., Cusworth, L., Griffiths, L., Johnson, R.D., Akbari, A., (2019) Born into care Wales: newborns and infants in care proceedings in Wales, , Nuffield Foundation, London; Mason, C., Robertson, L., Broadhurst, K., (2019) Pre-birth Assessment and Infant Removal at Birth: Experiences and Challenges - A literature review, , Nuffield Foundation, London; Grant, T., Graham, J.C., Ernst, C.C., Peavy, K.M., Brown, N.N., Improving pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: factors associated with subsequent exposed births (2014) Child Youth Serv Rev, 46, pp. 11-18; Grant, T., Huggins, J., Graham, J.C., Ernst, C., Whitney, N., Wilson, D., Maternal substance abuse and disrupted parenting: distinguishing mothers who keep their children from those who do not (2011) Child Youth Serv Rev, 33 (11), pp. 2176-2185; Taplin, S., Prenatal reporting to child protection: characteristics and service responses in one Australian jurisdiction (2017) Child Abuse Negl, 65, pp. 68-76. , PID: 28113086; (2018) Care Crisis Review Options for Change, ,, (Accessed 22 Sept 2020); Wall-Wieler, E., Kenny, K., Lee, J., Thiessen, K., Morris, M., Roos, L.L., Prenatal care among mothers involved with child protection services in Manitoba: a retrospective cohort study (2019) CMAJ., 191 (8), pp. E209-E215. , PID: 30803951; McKetta, S., Keyes, K.M., Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: an analysis of nationally representative cross-sectional surveys (2019) PLoS Med, 16 (11). , PID: 31770389; Vesga-López, O., Blanco, C., Keyes, K., Olfson, M., Grant, B.F., Hasin, D.S., Psychiatric disorders in pregnant and postpartum women in the United States (2008) Arch Gen Psychiatry, 65 (7), pp. 805-815. , PID: 18606953; Jordan, S., Davies, G.I., Thayer, D.S., Tucker, D., Humphreys, I., Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: a population cohort analysis (2019) PLoS One, 14 (11), pp. 1-21; Broadhurst, K., Budd, T., Williams, T., (2018) The Nuffield Family Justice Observatory for England and Wales: Making It Happen, , London; Lyons, R.A., Jones, K.H., John, G., Brooks, C.J., Verplancke, J.-P., Ford, D.V., The SAIL databank: linking multiple health and social care datasets (2009) BMC Med Inform Decis Mak, 9 (1), p. 3. , PID: 19149883; Ford, D.V., Jones, K.H., Verplancke, J.-P., Lyons, R.A., John, G., Brown, G., The SAIL databank: building a national architecture for e-health research and evaluation (2009) BMC Health Serv Res, 9 (1), p. 157. , PID: 19732426; Jones, K.H., Laurie, G., Stevens, L., Dobbs, C., Ford, D.V., Lea, N., The other side of the coin: harm due to the non-use of health-related data (2017) Int J Med Inform, 97, pp. 43-51. , PID: 27919394; Jones, K.H., Ford, D.V., Thompson, S., Lyons, R., A Profile of the SAIL Databank on the UK Secure Research Platform (2019) Int J Popul Data Sci, 4 (2), p. 1134; Bedston, S., Pearson, R.A., Jay, M.A., Broadhurst, K., Gilbert, R., Wijlaars, L., Data Resource: Children and Family Court Advisory and Support Service (Cafcass) public family law administrative records in England (2020) Int J Popul Data Sci, 5 (1), p. 1159; Broadhurst, K., Shaw, M., Kershaw, S., Harwin, J., Alrouh, B., Mason, C., Vulnerable birth mothers and repeat losses of infants to public care: is targeted reproductive health care ethically defensible? (2015) J Soc Welf Fam Law, 37 (1), pp. 84-98; Johnson, R.D., Ford, D.V., Broadhurst, K., Cusworth, L., Jones, K.H., Akbari, A., Data resource: population level family justice administrative data with opportunities for data linkage (2020) Int J Popul Data Sci, 9, p. 1339; Maternity Indicators Data Set, ,!WordDocuments/maternityindicatorsdatasetmids.htm, Accessed 04 Nov 2020; (2020) Patient Episode Database for Wales (PEDW), ,, Available from, (Accessed 14 May; (2016),, Accessed 14 May 2020; (2011) 2011 Census: Population and Household Estimates for Small Areas in England and Wales, ,, . Available from:, (Accessed 24 Mar 2020); The Platform - Adolescent Mental Health Data Platform, ,, Accessed 28 Feb 2020; John, A., Marchant, A.L., Fone, D.L., McGregor, J.I., Dennis, M.S., Tan, J.O.A., Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study (2016) Psychol Med, 46 (16), pp. 3315-3327. , COI: 1:STN:280:DC%2BC2snps1WjtA%3D%3D, PID: 27879187; John, A., McGregor, J., Fone, D., Dunstan, F., Cornish, R., Lyons, R.A., Case-finding for common mental disorders of anxiety and depression in primary care: an external validation of routinely collected data (2016) BMC Med Inform Decis Mak., 16, p. 35. , PID: 26979325; John, A., McGregor, J., Jones, I., Lee, S.C., Walters, J.T.R., Owen, M.J., Premature mortality among people with severe mental illness - new evidence from linked primary care data (2018) Schizophr Res, 199, pp. 154-162. , PID: 29728293; Demmler, J.C., Brophy, S.T., Marchant, A., John, A., Tan, J.O.A., Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: national data linkage study (2020) Br J Psychiatry, 216 (2), pp. 105-112. , PID: 31256764; R: The R Project for Statistical Computing, ,, Accessed 5 June 2020; (2019) Quality Report: Maternity and Birth Statistics, , Welsh Government, Cardiff; Bohensky, M., Bias in data linkage studies (2016) Harron K, Goldstein H, Dibben C. Methodological Developments in Data Linkage, pp. 63-82; Bywaters, P., Brady, G., Sparks, T., Bos, E., Child welfare inequalities: new evidence, further questions (2016) Child Fam Soc Work, 21 (3), pp. 369-380; Harwin, J., Alrouh, B., (2017) New Entrants and Repeat Children: Continuity and Change in Care Demand over Time, pp. 404-411. , Fam Law; Elliott, M., Child welfare inequalities in a time of rising numbers of children entering out-of-home care (2019) Br J Soc Work, 50 (2), pp. 581-597; Fone, D., Dunstan, F., Lloyd, K., Williams, G., Watkins, J., Palmer, S., Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis (2007) Int J Epidemiol, 36 (2), pp. 338-345. , PID: 17329315; Goodwin, R.D., Cheslack-Postava, K., Nelson, D.B., Smith, P.H., Hasin, D.S., Janevic, T., Serious psychological distress and smoking during pregnancy in the United States: 2008-2014 (2017) Nicotine Tob Res, 19 (5), pp. 605-614. , PID: 28403468; Peregrino, A.B., Watt, R.G., Heilmann, A., Jivraj, S., Breastfeeding practices in the United Kingdom: is the neighbourhood context important? (2018) Matern Child Nutr, 14 (4). , PID: 29888866; Riaz, M., Lewis, S., Naughton, F., Ussher, M., Predictors of smoking cessation during pregnancy: a systematic review and meta-analysis (2018) Addiction, 113, pp. 610-622. , PID: 29235189; Canfield, M., Radcliffe, P., Marlow, S., Boreham, M., Gilchrist, G., Maternal substance use and child protection: a rapid evidence assessment of factors associated with loss of child care (2017) Child Abus Negl, 70 (May), pp. 11-27; Roscoe, J.N., Lery, B., Chambers, J.E., Understanding child protection decisions involving parents with mental illness and substance abuse (2018) Child Abus Negl., 81, pp. 235-248; Baldwin, H., Biehal, N., Allgar, V., Cusworth, L., Pickett, K., Antenatal risk factors for child maltreatment: linkage of data from a birth cohort study to child welfare records (2020) Child Abuse Negl, 107, p. 104605. , PID: 32590228; Simmat-Durand, L., Lejeune, C., Polydrug use during pregnancy and neonatal outcome: data from a ten-year retrospective French study (2012) J Neonatal Nurs, 18 (6), pp. 232-240; Tsantefski, M., Humphreys, C., Jackson, A.C., Infant risk and safety in the context of maternal substance use (2014) Child Youth Serv Rev, 47, pp. 10-17; Sarkola, T., Kahila, H., Gissler, M., Halmesmäki, E., Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems (2007) Acta Paediatr, 96 (11), pp. 1571-1576. , PID: 17850394; Fair Society, Healthy Lives (2010) The Marmot Review: Strategic Review of Health Inequalities in England Post-2010; Zhao, L., McCauley, K., Sheeran, L., The interaction of pregnancy, substance use and mental illness on birthing outcomes in Australia (2017) Midwifery., 54, pp. 81-88. , PID: 28886465; Mamluk, L., Edwards, H.B., Savović, J., Leach, V., Jones, T., Moore, T.H.M., Low alcohol consumption and pregnancy and childhood outcomes: Time to change guidelines indicating apparently “safe” levels of alcohol during pregnancy? A systematic review and meta-analyses (2017) BMJ Open, 7. , PID: 28775124; Minnes, S., Singer, L.T., Humphrey-Wall, R., Satayathum, S., Psychosocial and behavioral factors related to the post-partum placements of infants born to cocaine-using women (2008) Child Abuse Negl, 32 (3), pp. 353-366. , PID: 18374413; Taylor, L., Hutchinson, D., Rapee, R., Burns, L., Stephens, C., Haber, P.S., Clinical features and correlates of outcomes for high-risk, marginalized mothers and newborn infants engaged with a specialist perinatal and family drug health service (2012) Obstet Gynecol Int, ,; Taplin, S., Mattick, R.P., Supervised contact visits: results from a study of women in drug treatment with children in care (2014) Child Youth Serv Rev, 39, pp. 65-72; (2019) Maternity Care in Wales-a 5 year vision for the future, , Welsh Government, Cardiff; (2019) A healthier Wales: our plan for health and social care, , Welsh Government, Cardiff; Cymru Well Wales: The First 1000 Days (F1000D), ,, (Accessed 29 Sept 2020); (2019) Together for mental health delivery plan: 2019-22, , Welsh Government., Cardiff; Witcombe-Hayes, S., Cymru, N., Jones, I., Jones, S., (2018) From Bumps to Babies: Perinatal Mental Health Care in Wales - Full Report (English), , Wales /, Professor W, Cardiff: NSPCC, National Centre for Mental Health, Mind Cymru, Mental Health Foundation, Maternal Mental Health Everyone’s Business; Alrouh, B., Broadhurst, K., Cusworth, L., (2020) Women in recurrent care proceedings in Wales: a first benchmarking report, , Nuffield Foundation, London; Griffiths, L.J., Johnson, R.D., Broadhurst, K., Cusworth, L., Bedston, S., Jones, K.H., (2020) Born into care: one thousand mothers in care proceedings in Wales, , Nuffield Foundation, London; Barnardo’s Reflect, ,, (Accessed 04 Nov 2020); Believe in Children | Children’s Charity | Barnardo’s, ,, (Accessed 22 Sept 2020)
Uncontrolled Keywords:
ID Code:
Deposited By:
Deposited On:
30 Nov 2020 15:40
Last Modified:
19 Sep 2023 02:32