Background: Unexpected news in Fetal Medicine (FM) includes suspected fetal anomalies, uncertain ultrasound findings, or risks that may alter pregnancy management or outcomes. How such news is communicated can have lasting emotional and decisional consequences, particularly for women with pre-existing mental health conditions (MHCs). Objective: To explore communication practices used by FM healthcare professionals (HCPs) when delivering unexpected news to pregnant women with MHCs. Design: Qualitative co-production study Setting: Three FM services in East London, UK Population: Pregnant women with pre-existing MHC attending FM consultations, their accompanying significant others, and FM HCP. Methods: Twenty-one real-life FM consultations were audio- and/or video-recorded. Recordings were analysed collaboratively by academic researchers and public contributors with lived experience using applied conversation analysis. Main outcome measures: Observable communication practices and their interactional consequences within consultations. Results: Communication practices that supported understanding and emotional containment included clear and inclusive opening practices, explanation of ongoing activities, use of accessible language, acknowledgement of emotional cues, allowing time for processing, and involvement of significant others. Practices associated with noticeable uncertainty or distress included rushed encounters, unexplained silences or questions, technical language without clarification, vague reassurance, missed emotional cues, and exclusion of companions. Conclusions: This co-produced analysis identifies communication practices that shape how unexpected news is experienced in FM consultations. The findings can inform training and service development to support clearer, more empathetic, and more inclusive communication, particularly for women with MHCs.

Objective: This study aimed to quantify the interplay between socioeconomic and ethnic inequalities in preterm birth rates using routinely collected maternity data in England from 2018-2021. Design: A retrospective cohort study using electronic health data. Setting: English hospitals. Sample: 1,537,595 livebirths. All women aged 13-55 with a singleton livebirth (April 2018-March 2021) at 24-42 weeks were included. Methods: Multivariate Poisson regression was used to estimate rate of preterm birth in each ethnic and deprivation group. A post-hoc calculation identified the rate of preterm birth for each ethnic group at each level of deprivation. Main Outcome Measures: Preterm birth (livebirth less than 37 weeks). Results: The rate of preterm birth was 6·30% (95%CI:6·22-6·37) in women living in the most deprived areas, compared to a rate of 5·05% (95%CI:4·96-5·14) among women in the least deprived areas. White women had a preterm birth rate of 5·74% (95%CI:5·70-5·78). Whereas South Asian and Black women had higher rates of preterm birth at 6·09% (95%CI:5·98-6·21) and 5·89% (95%CI:5·70-6·09) respectively. Deprivation attenuated the rate of preterm birth across all ethnicity groups. In areas of high deprivation, preterm birth rates were similar across ethnicity groups. In the least deprived areas, South Asian and Black women had higher rates of preterm birth. Conclusion: Deprivation and ethnicity remain key drivers of inequalities in preterm birth. Prevention strategies need to address socioenvironmental and structural determinants of preterm birth in areas of high deprivation and minority ethnicity groups.