Objective To identify outcomes that are important to families, to inform the development of a core outcome set for stillbirth care research. Design Qualitative interview study. Setting A national study in the United Kingdom. Population A diverse sample of parents with a personal history of stillbirth were interviewed. Methods Data collection, coding and analysis were influenced by a modified Grounded Theory approach. Parents’ lived experiences of stillbirth were translated into outcomes for the purpose of developing a core outcome set. Results Forty parents and family members were interviewed. Analysis identified 343 potential care outcomes, 298 (87%) of which have not been previously reported by stillbirth care studies. Outcomes were organised into four major care outcome themes: 1) Clinical 2) Mental health and wellbeing 3) Social and family 4) Future pregnancy and children. Short- and long-term outcomes related to the labour, birth, investigations to understand why a baby had died, stillbirth in a multiple pregnancy, postpartum, psychological and subsequent pregnancy care were reported. Outcomes infrequently measured in previous stillbirth care research yet discussed by most participants were social isolation, impact on occupation and need for mental health support. Parents spoke of the importance of counselling to help them understand their grief, however, the provision of this service was reported to be varied throughout the UK. Conclusion A comprehensive outcome inventory has now been constructed, from which the final core outcome set will be determined. Future care should be developed and evaluated using outcomes that directly relate to the lived experiences of parents and families exposed to stillbirth.

Objective To estimate the shape and magnitude of associations between maternal Hb levels in the first and third trimesters of pregnancy, and pregnancy outcomes in a high-income setting. Design Prospective cohort studies Setting Two population based pregnancy cohorts from the UK Population The Avon Longitudinal Study of Parents and Children(ALSPAC) and Pregnancy Outcome Prediction Study(POPS). Methods We used multivariable logistic regression models to examine the relationship between Hb and pregnancy outcomes, adjusting for maternal age, ethnicity, BMI, smoking status and parity. Main Outcome Measures Preterm labour, low birth weight, small for gestational age(SGA), pre-eclampsia(PET), and gestational diabetes mellitus(GDM). Results There was no strong evidence of associations between a higher Hb (1g/dL) in the first trimester and preterm birth (1.07: 95% CI 0.96,1.21), low birth weight(1.09: 0.96, 1.24) and SGA (1.05; 0.96, 1.14). Higher Hb in the third trimester was associated with preterm birth (1.43:1.28,1.61), low birth weight(1.68: 1.48,1.90) and SGA (1.41:1.30, 1.53). Higher Hb in the first and third trimesters were associated with PET in ALSPAC(1st trimester- 1.38:1.07,1.76, 3rd trimester- 1.57: 1.28,1.94) but not in POPS(1st trimester- 1.10: 0.92, 1.30, 3rd trimester- 1.10: 0.92, 1.31). In ALSPAC(1st trimester- 1.37:0.96,1.95, 3rd trimester- 1.35:0.97,1.78) and POPS(1st trimester- 0.94:0.77, 1.17, 3rd trimester- 0.85: 0.69, 1.01), there were no associations with GDM. Conclusion Higher maternal Hb, in late pregnancy, may indicate a suboptimal increase in blood volume and therefore, women at risk of adverse pregnancy outcomes. Further research is required to investigate if this association is causal, and to identify underlying mechanisms.

Objective To explore and characterise maternity healthcare professionals’ (MHCPs) experience and practice of informed decision-making (IDM), to inform policy, research and practice development. Design Qualitative focus group study. Setting Online with MHCPs from a single maternity unit in the Southwest of England. Population MHCPs who give information relating to clinical procedures and pregnancy care and are directly involved in decision-making conversations purposively sampled from a single National Health Service (NHS) Trust. Data collection: A semi-structured topic guide was used. Data Analysis: Reflexive thematic analysis . Results Twenty-four participants attended seven focus groups. Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time, and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve IDM. There were communication challenges with women/birthing people who do not speak English. Three controversies were explored in the controversies theme: the role of prior clinical experience, the validity of informed consent when women/birthing people were in pain and during emergencies, and instances where women/birthing people declined medical advice. Conclusions We found that MHCPs are committed to IDM but need better support to deliver it consistently. Structured processes including core information sets, communication skills training and the decision support aids may help to standardise the information and better support IDM.

Background: Micro- and nanoplastics are novel pollutants which have been detected in human tissues including placenta and fetal meconium. However, their association with adverse fertility or pregnancy outcomes in humans is not known. Objectives: To synthesise evidence for the presence of micro- and nanoplastics in human reproductive tissue and their associations with environmental exposures and reproductive outcomes. Search Strategy: Medline, Embase, Emcare, CINAHL, ClinicalTrials.gov and ICTRP were searched from inception to 03/02/2023. Selection Criteria: Studies of human participants, assessing presence of micro- and nanoplastics in reproductive tissues, environmental exposures to micro- and nanoplastics, and fertility or pregnancy-related outcomes. Data Collection and Analysis: Two independent reviewers selected studies and extracted data on study characteristics, microplastics detected, environmental exposures, reproductive outcomes, and risk of bias. Narrative synthesis was performed due to methodological heterogeneity. Main Results: Of 1094 citations, seven studies were included, covering 96 participants. Microplastics were detected in 68 out of 96 placentas examined across all studies, and in all 14 meconium samples. Two studies reported associations between lifestyle factors (daily water intake, use of scrub cleanser or toothpaste, bottled water and takeaway food) and placental microplastics. One study reported associations between meconium microplastics and microbiota diversity and composition. One reported placental microplastics levels correlated with reduced birth weights and 1-minute Apgar scores. All studies had a very high risk of bias. Conclusions: There is a need for high-quality observational studies to assess the effects of microplastics on human reproductive health. Funding: None received Keywords: microplastics, nanoplastics, pregnancy, fertility, environmental pollution

Background A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which has been identified as an important research priority. Objectives To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. Search strategy Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. Selection criteria Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. Data collection and analysis Interventions, outcomes reported, definitions and outcome measurement tools were extracted. Main results 40 randomised and 200 non-randomised studies were included. 58 different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. 242 outcome measurement instruments were used, with 0-22 tools per outcome. Conclusions Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.