Judith Rankin

Background and Aims: Postnatal contraception (PNC) care is an integral element of a comprehensive public health offer in the weeks and months following a pregnancy. The aim of this cross‐sectional survey study was to examine experiences of PNC care in relation to healthcare professional (HCP) engagement during and after pregnancy in an English region. Methods: Women who had completed a pregnancy in the previous 3 years in the North East and North Cumbria Integrated Care System (ICS) were invited to complete an online survey. Main outcome measures reported in this paper are uptake of medically prescribed/administered contraception and uptake of long‐acting reversible contraception (LARC) during the postnatal period, and access to preferred PNC methods, in relation to healthcare experience at various points on the pregnancy/postnatal pathway. Results: Most PNC care was accessed in primary care, but there was variation in setting of care associated with age, parity and pregnancy intention. Uptake of the most effective PNC methods and access to preferred PNC methods were positively associated with HCP engagement. PNC counselling prior to a planned Caesarean section (aOR 2.129 [1.362–3.327]), providing PNC on the postnatal ward prior to discharge (aOR 1.745 [1.408–2.164]), offering health visitor discussions about PNC (aOR 1.255 [1.046–1.507]), and attending a specialist contraception/sexual health service during the postnatal period (aOR 3.779 [2.510–5.687]) were found to be most significantly associated with these outcomes after adjusting for potential confounders. Conclusions: HCP engagement during and after pregnancy was associated with an increased likelihood of accessing PNC care for women in this sample. Expanding the availability of PNC counselling, and the availability of PNC provision in particular, may result in increased uptake of the most effective PNC methods.

Background,Food insecurity (FI) in high-income countries, including the UK, has risen significantly over the past decade, yet its impact during pregnancy remains critically underexplored. The [study name redacted for review] explored the lived experiences and support needs of pregnant or recently pregnant women experiencing FI in two deprived regions of England.,Methods,Semi-structured interviews (n=24) were conducted between July and December 2024. Interviews explored experiences of FI, coping mechanisms, and perceived barriers and enablers of support. Data were analysed using Reflexive Thematic Analysis within an intersectional framework.,Findings,Four data-driven themes were identified: 1) financial strain and instability; 2) structural and systemic barriers; 3) gendered family roles and expectations; 4) inconsistent support networks and provision. At the intersection of these themes were power and stigma, where multiple stressors culminated to create a ’perfect storm’ of challenges during pregnancy, undermining mothers’ belief in themselves as ”Good Mothers” with implications for mental health through increased anxiety, depression, and normalisation of maternal self-sacrifice.,Conclusion,This study addresses a critical gap in UK evidence. It is among the few to use an intersectional lens to explore FI during pregnancy in England, offering novel insights with implications for FI policy and practice beyond the UK. Overlapping stressors shaped maternal health and wellbeing and were impacted by gender norms and systemic barriers. Addressing these stressors requires integrated, flexible, and relational approaches, and policy-relevant communications to influence decision-making.

Objective: Low‐dose aspirin is proven to reduce the incidence of pre‐eclampsia, yet adherence remains low. This systematic review synthesises qualitative evidence on barriers and facilitators to low‐dose aspirin adherence in pregnancy and uses a co‐production approach to develop an explanatory model of this complex behaviour. The overall aim is to contribute to the development of a theory of adherence, targeting this health issue. Methods: Data sources: A search of electronic databases (Medline, Web of Science, CINAHL, PsycINFO, Embase, Scopus, Open Grey, Google Scholar, Prospero), charity and professional organisations’ archives was conducted using predefined terms. Citation searching was also performed. Searches were not time‐limited or language‐specific and completed in November 2024. Eligibility Criteria: Studies, which included qualitative data on low‐dose aspirin determinants of adherence in pregnancy were included. Study Appraisal and Synthesis Methods: Quality was assessed using the Critical Appraisal Skills Programme checklist. A meta‐ethnography approach with reciprocal translation and line‐of‐argument synthesis was used. The co‐production approach was utilised to streamline future intervention development by engaging key stakeholders in evidence synthesis, enabling them to translate evidence into action, support implementation and overcome the subjectivity inherent in meta‐ethnography. Co‐production activities followed the nominal group technique and structured discussions. Results: Out of 3757 items identified through systematic searches of published studies and grey literature, six studies were included in the review. No studies were excluded based on quality. Four 3rd‐order constructs with a total of 10 sub‐themes were identified: informational gap, verbal and non‐verbal health system communication, personal assets and autonomous control. In an explanatory model, we demonstrate that women are advised to take low‐dose aspirin in a context of lack of information and misconceptions (informational gap) with patchy and inconsistent messages from the health care system. Women ultimately control their decision about the use of low‐dose aspirin, however, the arrival at a decision depends on the utilisation of individual assets (unique personal or social characteristics inherited or acquired). Conclusions: Improving the quality and delivery of information for women and their support networks can reduce the strain on personal resources and make this essential preventive treatment more accessible and equitable. Patient or Public Contribution: A group consisting of representatives from two national charities and a service user worked alongside an academic team, contributing to all aspects of this work, including formulating the research question, participating in the selection of the search terms, conducting screening of the abstracts, data extraction, quality assessment, synthesis, drafting a graphic representation and this manuscript.

Background: Hypoxic ischaemic encephalopathy (HIE) is the most frequently occurring neonatal brain injury in term-born infants. Families affected by HIE can face significant breastfeeding and lactation challenges. Aims: This systematic review aims to improve our understanding of these challenges and identify potential solutions by answering the question: What factors influence breastfeeding and lactation outcomes after neonatal HIE? Methods: This systematic review used a convergent integrated analysis mixed methods design. Eleven databases were searched for qualitative, quantitative, and mixed methods papers meeting specified criteria (e.g., born ≥ 34 weeks gestation) in November 2022 and again in July 2023 and April 2025. Full methods are registered on PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023375506 . Of the 3393 titles and abstracts screened, 455 were identified for full-text screening and 10 were included in the review. An additional seven papers were found via reference lists and citation checking, resulting in a total of 17 included studies. Results: Five categories of potentially influencing factors were identified: infant medical factors, neuroprotective interventions, feeding during therapeutic hypothermia, support for expressing milk, and parent–infant closeness in the neonatal phase. However, significant evidence gaps were demonstrated, including the influence of environmental and social factors, interventions for lactation support and breastfeeding skills, and qualitative and mixed methods studies specifically focused on breastfeeding and lactation following neonatal HIE. Conclusion: Current research is insufficient to inform our understanding of factors influencing breastfeeding and lactation outcomes following HIE. High-quality breastfeeding and lactation-specific research is urgently needed to inform information sharing and intervention development for HIE-affected families.

Background: Parent-infant psychotherapy is a therapeutic intervention intended to address problems in the parent-infant relationship. In Newcastle Upon Tyne, a family-centred charity, Children North East, began delivering parent-infant psychotherapy in 2017, to support parents and infant relationships by addressing unconscious elements of behaviour which can create relational trauma.Objective: A formative service evaluation explored parents' experiences of the Newcastle-Upon-Tyne Parent-Infant Partnership service, alongside wider healthcare professionals' perspectives of service delivery and impact on the parents and relationship with their babies.Methods: Interviews were undertaken with parents (n = 10) who had previously engaged with the service and healthcare professionals (n = 6) who had referred parents to Newcastle-Upon-Tyne Parent-Infant Partnership.Results: The interviews highlighted a flexible and relational approach to therapy sessions, which created a positive experience for families. However, there is a need to improve public and professional awareness of infant mental health, parent-infant psychotherapeutic and relational approaches.Conclusions: The service proved effective in supporting the relationship between parent and infant identified through the parent-infant psychotherapy approach, which was fluid, open and nurturing, relative to other experiences of therapy and mental health support available in the North East. Service providers would enhance their impact on families by building and strengthening partnerships with the multiple health and social care organisations and systems involved in supporting families, and ensure their services become more inclusive. Further research is required to identify specific needs in local contexts, long-term outcomes, and to define relevant outcome measures in families with relationship concerns.

Background: Globally, Down syndrome is the most common chromosomal anomaly, often co‐occurring with cardiac or gastrointestinal anomalies. There is a lack of robust data on specific healthcare needs of children with Down syndrome compared to children with other major congenital anomalies.Objectives: To quantify the healthcare needs of children with Down syndrome in the first year of life compared to children with major congenital anomalies in a large population‐based cohort across Europe.Methods: The EUROlinkCAT study was a multicentre data linkage study between congenital anomaly registries in Europe and hospital and mortality databases. Children born between 1st January 1997 and 31st December 2014 were included. Summary statistics were used to compare differences between children (those with Down syndrome compared to all major anomalies) and regions. Random‐effects meta‐analysis was used to pool results related to survival, need for intensive care and ventilation support.Results: A total of 3554 children were born with Down syndrome out of 89,081 children with major congenital anomalies. The pooled 1‐year survival was 95.4%. In every region, > 80% of children with Down syndrome had a hospital admission excluding the birth admission. Hospital length of stay in the first year was higher for children with Down syndrome compared to those with all anomalies (median: 14 versus 7 days). Despite having similar need for ventilation support (9.7% vs. 8.4%), children with Down syndrome had higher rates of intensive care admission than all children with anomalies (24.8% vs. 13.0%).Conclusions: There is a high need for hospital care for children born with Down syndrome in the first year of life. Future work should continue to explore the long‐term prognosis for children with Down syndrome to ensure their care needs are met.

Objectives To appraise and synthesise qualitative literature identifying: (a) fathers’ concerns and challenges during the transition to fatherhood that may be impacting mental health and well-being experiences; and (b) fathers’ experiences of antenatal programmes, and psychological and social support, to understand how we can better support fathers in addressing these concerns. Design International, qualitative evidence synthesis, scoping review. Data sources Six electronic databases (Medline, Embase, PsycINFO, CINAHL, Scopus, ASSIA) alongside 'grey' and supplementary searches were conducted March 2024. Eligibility criteria Qualitative studies and qualitative data extracted from mixed methods studies focusing on fathers’ mental health within the perinatal period globally were included. Data extraction and synthesis The recommended Joanna Briggs Institute data extraction and critical appraisal tools were used, and an inductive thematic synthesis approach employed. Results 37 qualitative studies were included: UK (n=11), Europe (n=9), Australia (n=7) and Asia (n=6), USA (n=1), Canada (n=1) and the Middle East (n=2). Quality appraisal scores were moderate to high (5–10). Four analytical themes and eight subthemes were generated: (1) diminished partner relationship, (2) provider or protector? Multiplicity of fatherhood identification, (3) forgotten entity within the perinatal experience and (4) "I try to battle it myself," masculine ideals within fatherhood. The findings highlighted that fathers found the transition to be difficult, compounded by insecurity within their role as both partner and father. Fathers found a paucity of paternally focused support and antenatal programmes, not addressing fathers’ needs within the transition. Conclusions The many concerns and challenges highlighted in the review demonstrate the importance of understanding the negative impact of the transition on fathers’ mental health and well-being. There is a need for greater attention to fathers’ experiences of paternal perinatal support and programmes through research and practise to inform future interventional development. Trial registration PROSPERO: CRD4202231381.

Background: Gastroschisis is a congenital anomaly of the umbilical ring with increasing prevalence, especially amongst younger mothers. There is increasing evidence that exposure to genitourinary infections (GUTI) may play an important role in the etiology of gastroschisis. This systematic review and meta‐analysis aimed to identify, appraise, and summarize the literature on exposure to GUTI and gastroschisis.Methods: Six electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library electronic databases, and Prospero) were searched using a comprehensive search strategy. Citations and cited articles for all included studies were searched. Peer‐reviewed, quantitative studies reporting an association of urinary tract infections (UTI) and/or sexually transmitted infections (STI) with gastroschisis were included. Prospero registration CRD42022377420.Results: A total of 2392 papers were identified via the searches of which 15 met our inclusion criteria and were included after title and abstract and full text screening. The study period for included studies ranged from 1995 to 2016, most were from the USA. Four studies considering exposure to STIs and five to UTIs were eligible to progress to meta‐analysis. Meta‐analysis identified a significantly increased risk of gastroschisis in association with periconceptional exposure to UTI [OR 1.54 (95% CI 1.29, 1.8)], STI [OR 1.4 (95% CI 1.01, 1.79)].Conclusions: Periconceptional exposure to GUTI is associated with an increased risk of gastroschisis. The prevention and timely treatment of GUTI amongst women of childbearing age may help to reduce the occurrence of gastroschisis.