Background:To avoid unplanned, rapid repeat pregnancies, it is recommended that women use effective contraception from day 21 postpartum. This study presents a novel method for displaying postnatal contraception use over time, analysing data from highly health-literate women. Methods:This is a secondary analysis of a cross-sectional study which compared postnatal contraception use in women over 30 who had successful IVF to those who conceived without fertility treatment. This analysis uses a subset of data: 177 doctors who had conceived spontaneously. Their postnatal contraception use over time is presented using a Sankey plot. Chi-squared or Fisher's exact tests were used to compare contraception efficacy by socio-demographics and experience of contraception counselling. Qualitative data on quality of counselling were analysed using thematic analysis. Results:Contraception-efficacy was associated with timing of initiation (p<0.001); 92.3% of sexually-active participants initiating contraception before three weeks postpartum used effective or very effective methods. Overall, only 11.6% (17/146) of sexually-active participants used a very effective method as first contraception. Only contraception counselling at the place of birth was associated with initiation of effective or very effective contraception (p=0.041). Analysis of qualitative data on quality of counselling generated three themes: information provision, multi-disciplinary working, and need for self-advocacy. Conclusions:Use of effective postnatal contraception was low, despite a highly health-literate population. However, the high proportion of women choosing effective contraception before three weeks postpartum indicates acceptability where available. The Sankey plot is an effective visual that could be used to monitor and evaluate postnatal contraception services and interventions.

Objective: To evaluate the implementation of the London Measure of Unplanned Pregnancy (LMUP) in antenatal care. Design: Mixed methods evaluation of a pilot. Setting: Antenatal care at University College London Hospital and Homerton Hospital, England, 2019-2022. Population: Pregnant women attending antenatal care at one of the sites during the evaluation. Methods: Quantitative and psychometric analysis of anonymous data and qualitative analysis of interviews and focus groups with women and midwives, using a Framework Analysis. Main Outcome Measures: Acceptability of the inclusion of the LMUP, measured by completion rates and women’s and midwives opinions. Results: Completion of the LMUP at UCLH stabilised at around 70% and the LMUP performed as expected. Asking the LMUP at antenatal booking appointments is feasible and acceptable to women and midwives. Advantages of asking the LMUP, highlighted by participants, include providing additional support and personalising care. Midwives’ concerns about judgment were unsubstantiated; women with unplanned pregnancies valued such discussions. Conclusions: These findings support the implementation of the LMUP in routine antenatal care and show how it can provide valuable insights into the circumstances of women’s pregnancies. This can be used to help midwives personalise care, and potentially reduce adverse outcomes and subsequent unplanned pregnancy. Integration of the LMUP into the Maternity Services Data Set, will establish national data collection for a population-level measure of unplanned pregnancy, serving as a key outcome measure for sexual and reproductive health and enabling analysis of the prevalence, factors, and implications of unplanned pregnancies across subpopulations to inform implementation. Funding : NIHR PDF-2017-10-021

Background: Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have raised concerns about a causal relationship between folic acid supplementation, particularly after the first trimester, and ankyloglossia (tongue-tie) in infants. Non-evidence-based communications are potentially harmful because they could adversely affect adherence to folic acid supplementation, increasing NTD occurrence. Objectives: To review evidence on the relationships between maternal folic acid supplementation during preconception and/or pregnancy and the risk of ankyloglossia in infants. Search Strategy: We searched online bibliographic databases for studies investigating the effect of maternal folic acid supplementation during preconception or pregnancy on the occurrence of ankyloglossia in offspring. Selection Criteria: Observational, interventional studies, and systematic reviews assessing the relationships between folic acid and ankyloglossia. Data Collection and Analysis: The database searches yielded 93 articles. After removing duplicates and screening titles and abstracts, 26 remained. One article was judged relevant for inclusion in analyses; a case-control study that directly mentions the relationship between folic acid supplementation and ankyloglossia Main Results: One case-control study reported that regular intake of folic acid supplements was higher in women with infants with ankyloglossia. However, this study has limitations regarding design, selection bias, and confounding, calling the findings into question. Conclusions: Insufficient evidence exists for a relationship between folic acid supplementation and ankyloglossia. Currently, the benefits of folic acid supplementation far outweigh the risks. This must be clearly communicated to patients by their clinicians during preconception and antenatal care.