OAA Large Project Grants

Background
Ensuring the safe birth of every child is a global health goal. During the process of labour and birth, over half of women will receive some form of anaesthetic. Anaesthetics include spinal anaesthetics, epidural anaesthetics and general anaesthetics. General anaesthetics involve the patient being put into a state of controlled unconsciousness using various drugs. Spinal and epidural anaesthetics use local anaesthetic drugs to make the patient numb so that surgery may proceed. The patient generally remains awake during this type of anaesthetic. The type of anaesthetic given depends on each woman's individual circumstances taking into account factors such as maternal wellbeing and urgency of delivery. Whilst there are reassuring data to support the safety of anaesthesia in the immediate period after birth (survival, need for newborn resuscitation etc), the question of whether these different types of anaesthetic have any effect on the long-term development of the child is difficult to investigate and has not yet been satisfactorily answered. The effect of anaesthesia on the developing brain has been highlighted as an area of research priority by the patient-centred organisation, The James Lind Alliance.

Aims
We will use National data including over half a million patients to investigate any associations of anaesthetics used in labour and birth on short and long term childhood outcomes.

Methodology
This is a Scotland-wide study using routinely collected data from Scottish mothers and their offspring during labour, delivery and subsequent childhood development. Approval for the linkage of ten national databases has been received from the Information Services Division of National Services Scotland. Using this large resource, we will determine whether the types of anaesthetic used during pregnancy and delivery have an impact on the short and long-term health and educational outcomes of the offspring. All patient information will be anonymised and will be accessed only by trained staff members using secure servers. All data protection procedures will be followed.

Expected outcomes
We will investigate short and long term childhood outcomes including need for resuscitation at birth, need for admission to intensive care, survival, developmental milestones, special educational needs and educational attainment. We expect that this work will provide new and important information to health care professionals and patients.

Implications
The outcomes being investigated in this study are of importance to all future parents and their children. Further information is vital if we are to be able to give accurate information to parents when asked the common and fundamental question "Will this anaesthetic harm my baby?" If no adverse effects are found, this will allow us to reassure patients with a much greater degree of certainty. If associations with adverse effects are found, this will stimulate ongoing research to refine anaesthetic techniques to minimise this as far as possible. In doing this work, we will use "big data" to its best effect to advance the health and care of patients and the public.

Background
About 1 in 100 women experience life-threatening illness ('critical illness') during pregnancy or childbirth. Recent reports suggest that the care that critically ill pregnant women receive could be improved by developing ways to identify women at risk of critical illness earlier during pregnancy or childbirth, improving how doctors and nurses provide care and having specialised pregnancy specific support for survivors. However, we have little research to guide these improvements in care. Our project aims to provide high quality data to inform development and implementation of these recommendations.

Aims
We aim to measure the number of pregnant women who need critical care, identify those women at highest risk of needing critical care, and report the short and long-term health consequences of surviving critical care for pregnant women and their babies.

Methodology
We will use routinely recorded and linked clinical datasets to answer our research questions.

In Scotland, every pregnant woman has clinical information recorded about her pregnancy and its outcome recorded in national databases. This pregnancy information will be linked to a critical care database, which contains additional information about those admitted to critical care. This combined dataset will then be linked to other sources of information, including mental-health admissions and pharmacy prescriptions. This final dataset will be anonymised so that researchers cannot identify individual women. The data will be analysed in a secure environment, which only the research team can to access.

We will calculate how frequently women need critical care across Scotland. We will compare women who need critical care with those who do not in order to identify factors that could predict which women are at highest risk of needing critical care. We will take account of important factors such as the mother's socioeconomic status, weight, age and previous health problems. We will then compare a range of short and long-term outcomes that affect mothers and their babies including death, hospital length of stay, pregnancy-related complications, and hospital readmission.

Expected outcomes
Our project will help us i) find out how often pregnant women need critical care; ii) identify risk factors for critical illness, leading to better recognition of women who may need critical care; iii) identify the major problems that women and their babies experience after surviving critical care which will enable researchers/health workers to develop targeted interventions/services to improve care; and iv) provide important data to improve maternal critical-care audits.

Implications
We have a strong team and expert advisory panel in order to make sure our findings influence care in the NHS. We have worked with a woman who has survived critical illness after pregnancy to develop this project. Our findings will be used by obstetricians, obstetric anaesthetists and midwives to better recognise critically ill women and ensure adequate numbers of staff are trained to meet this demand; by critical care doctors and nurses to guide improvements in multidisciplinary working, the national maternal critical care audit and follow-up for women who survive critical care; and community healthcare staff and critical illness survivors and families.