Understanding pregnancy research needs and priorities in the UK

Pregnant woman visiting doctor for checkup, photo by Halfpoint/Adobe Stock

Photo by Halfpoint/Adobe Stock

A review of the research needs and expenditure on pregnancy in the UK found that £51 million is invested in pregnancy research each year. By contrast, the NHS spends £5.8 billion on pregnancy-related care each year and in 2018/19 spent £2.5 billion on litigation.

The study shows that there is a case for further investment in pregnancy research and offers some guidance on where to target that investment.

Background

There is mounting evidence that more pregnancy-related research is needed to improve outcomes for women and babies. Recent UK policies have emphasised the need to improve pregnancy care and noted a lack of research in key areas, including pre-conception interventions, screening tests, pregnancy treatments and models for perinatal care (e.g. NIHR’s Better Beginnings (2017).

A 2009 review concluded that UK maternal and perinatal health research is underfunded compared to other disease areas, with the UK devoting a lower proportion of funding than other English-speaking countries. However, the review did not provide a comprehensive picture of where and how existing funding was invested, and how this aligned with research needs and priorities in the area.

In an annual report focused on women’s health, England’s Chief Medical Officer recommended a review of research needs and expenditure in pregnancy in the UK.

Goals

This study, commissioned by the UK Clinical Research Collaboration, aimed to deliver that review and generate a sound evidence base on UK pregnancy research needs and priorities and how these compare to the current funding landscape. The main research questions of the study were:

  1. What is the current level of spend on pregnancy research in the UK?
  2. What is this spent on, in terms of type of research and topic?
  3. How does the current pregnancy research spend in the UK compare to other health research areas?
  4. What are the main priorities for future pregnancy research in the UK?

Methodology

Researchers approached the study from three aspects. First, the study team analysed the current level of spending on pregnancy research in the UK. For this analysis, the team gathered and analysed data from a wide range of funders – including public funders and charities – on pregnancy-related research they have funded in the past several years.

To put the research funding data in context, the team reviewed data on the healthcare costs associated with pregnancy, and the levels of research spend on other aspects of health.

Through a literature review, an online crowdsourcing exercise, survey and workshops, the researchers then identified and explored what key stakeholders understand the key research priorities in this area to be.

The results of these three strands of work were then brought together for the report, to be published along with an open dataset of the funding data gathered.

Findings

  • £51m per year is invested in pregnancy research in the UK, about 2.4 per cent of all direct, non-industry health research.
  • Pregnancy-related care costs the NHS £5.8 billion per year. This means that for every £1 spent on pregnancy care in the NHS, less than 1p is spent on pregnancy research, significantly less than other conditions.
  • Litigation costs related to pregnancy are around 50 times current pregnancy research spend, estimated at £2.5bn in 2018/19.
  • Investment in mental health research is the top priority for all stakeholders surveyed for the study, and is likely underfunded – despite being one of the most common complications of pregnancy, affecting up to 20 per cent of women, perinatal mental health receives only 4 per cent of all research investment in pregnancy.
  • Other priority topics include stillbirth, preterm birth, inequalities in outcomes, postnatal support, and safety of medications during pregnancy.
  • Some areas of pregnancy research should be considered for future investment given their priority level and current research spend.
  • Funding decisions also need to take into account wider considerations, such as research capacity, the costs and consequences of different pregnancy issues and the feasibility of conducting research to address these issues.

Conclusions

Funding decisions also need to take into account wider considerations, such as research capacity, the costs and consequences of different pregnancy issues and the feasibility of conducting research to address these issues.

The study shows that there is a case for further investment in pregnancy research, and the survey offers some guidance on where to target that investment. However, the identification of key areas should also take into account wider considerations beyond the scope of the survey, such as the potential for return on investment. For example, if effective antenatal interventions could reduce risk levels across a range of conditions, this could potentially be cost effective both in terms of research investment and healthcare delivery.

Additionally, a reduction of 2 per cent in the NHS litigation bill in relation to pregnancy would be sufficient in itself to financially compensate for a doubling of investment in pregnancy research. This suggests there is also a sound economic case for investment in pregnancy research.

The evidence provided here highlights the need for action and can also act as a starting point to promote discussion and help funders and policymakers coordinate increased, targeted investment in pregnancy research in the UK.