Acceptability of data linkage to identify women at risk of postnatal complication

Why it matters

Pregnancy acts as a stress test on the maternal body, where most organ systems need to work harder to support the developing foetus. As a result, some women experience health issues like high blood pressure, gestational diabetes, and the risk of their babies being born too early, very small or very large. In some cases, they may also experience baby loss.

Although many complications resolve once the baby is born, a growing body of evidence suggests that women with hypertensive disorders of pregnancy (a group of medical conditions characterised by high blood pressure during pregnancy) have an increased risk of developing cardiovascular disease (CVD) long-term. Monitoring postnatal health can reduce this risk but better methods are needed to identity women at high risk of developing CVD to ensure they receive the relevant healthcare to help prevent any potential problems.

In England, mothers and babies are assessed at regular intervals postnatally to prevent short-term complications, and these assessments are recommended in three stages:

1. Between 24 and 36 hours after birth, a midwife assesses any immediate health issues in both the mother and baby
2. Around days five and 10, a health visitor assesses the recovery of the mother and baby’s health and development
3. Six to eight weeks after birth, a GP conducts a postnatal assessment of mothers mental and physical health.

Unfortunately, though, while taking action to modify risk factors early can prevent 75% of premature cardiovascular disease, the warning signs are often neglected or mistaken for pregnancy associated adaptations. Postnatal blood pressure is often poorly monitored and not properly treated.

Although linking health and care data can help with analytics and healthcare improvement, to date there’s been limited understanding of how digital tools can improve postnatal care for women. The study, which includes input from healthcare professionals and members of the public, explores the potential of linked maternity data, and developing dashboards and digital tools for risk management to enhance postnatal healthcare delivery.

What we found

Results from focus groups showed that the reality of postnatal examinations was not the same as most women’s expectations, with some people describing them as a ‘tick-box’ exercise.

Healthcare professionals also thought that some postnatal care processes were not effective, and that system limitations could prevent detailed examinations. For example, GP practices relied on hospital discharge summaries to identify women who needed a postnatal check, but these were not always complete or accurate. Electronic hospital discharge summaries that did contain short-term treatment plans were often delivered too late or lost completely.

Although there were concerns about data – both its security and how it was used – during discussions about linking maternity data between healthcare providers, everyone who took part supported the idea of better education for women and their families about the benefits of sharing health data in a secure data environment for improving research and supporting clinical guidance and decision making.

Stakeholders recommended creating customised educational campaigns on postnatal care for specific communities to promote inclusivity, and both public and clinical contributors saw the advantages of digital risk prediction tools. These tools could streamline processes, make it easier to spot women at higher risk earlier, and facilitate personalised care plans and lifestyle recommendations.

The limitations of the current health system in England prevent comprehensive and personalised postnatal care for women. Digital tools may allow for more tailored care plans, filling the gaps in current postnatal practices but it is vital their design is inclusive and address challenges of system integration. By connecting health data and providing education about digital tools, monitoring and overall future health of women could be improved in the future.