Alison Macfarlane

City, University of London · School of Health Sciences

Background Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth ra...

Objective: Robson's Ten Group Classification System (TGCS) creates clinically relevant sub-groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. Design: Observational study using routine data SETTING: 27 EU member st...

Objective To examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age. Methods The Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000–2002. Information about the child’s bi...

IntroductionWe report on service user participation in ‘Births and their Outcomes’, a population-based, retrospective, birth cohort, data linkage study to analyse the daily, weekly and yearly cycles of births and their implications for the NHS. Although Public Involvement and Engagement (PI&E), also referred to here as Patient and Public Involvemen...

In November 2018, the Euro‐Peristat collaboration published a new European Perinatal Health Report based on national‐level indicators of mothers’ and babies’ health in 2015 in current EU member states and Iceland, Norway, and Switzerland, a total of 31 countries with over five million births. Euro‐Peristat's indicator set includes 10 core and 20 re...

Background/rationale When a baby is born in England and Wales, the event is recorded in several separate systems, each of which contains different data items. Data recorded at birth registration are mainly socio-demographic, while some different data items are recorded when the birth is notified to the NHS. The data recorded in hospital systems in...

Background Clinical policies have aimed at increase the proportion of births occurring during working hours on weekdays in the belief that this facilitates staffing and is safer for mothers and babies. Our recent analyses of hospital births have shown that that planned caesareans are concentrated into weekday mornings. In contrast, spontaneous birt...

Background: Data recorded at birth and death registration in England and Wales have been routinely linked with data recorded at birth notification since 2006. These provide scope for detailed analyses on ethnic differences in preterm birth (PTB). Objectives: We aimed to investigate ethnic differences in PTB and degree of prematurity in England a...

Objective To describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth. Design National birth cohort study. Setting England and Wales 2006–2012. Subjects Singleton live births at 24–36 completed weeks’ gestation (n=256 142). Outcome measures Adjusted rate ratios for death in inf...

Background Studies of daily variations in the numbers of births in England and Wales since the 1970s have found a pronounced weekly cycle, with numbers of daily births being highest from Tuesdays to Fridays and lowest at weekends and on public holidays. Mortality appeared to be higher at weekends. As time of birth was not included in national data...

Background: International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income cou...

Background Maternity care has to be available 24 hours a day, seven days a week. It is known that obstetric intervention can influence the time of birth, but no previous analysis at a national level in England has yet investigated in detail the ways in which the day and time of birth varies by onset of labour and mode of giving birth. Method We li...

Coding of onset of labour and mode of birth. (DOCX)

Checking for linkage bias. (DOCX)

Checking for bias: Comparisons between all eligible births and study dataset. (DOCX)

The average number of births per hour on non-holiday Thursdays. (DOCX)

Objectives: We aimed to describe ethnic variations in infant mortality and explore the contribution of area deprivation, mother's country of birth, and prematurity to these variations. Methods: We analyzed routine birth and death data on singleton live births (gestational age≥22 weeks) in England and Wales, 2006-2012. Infant mortality by ethnic...

Infant mortality rates by cause of death and ethnic group (per 1,000 live births, singleton live births, England and Wales, 2006–2012). (DOCX)

The association between ethnic group and infant mortality (singleton live births, England and Wales, 2006–2012, full results for covariates in the adjusted models). (DOCX)

Ethnic group categories. (DOCX)

The association between ethnic group and infant mortality excluding congenital anomalies and stratified by gestational age (singleton live births, England and Wales, 2006–2012). (DOCX)

Introduction Maternity Hospital Episode Statistics (HES) data for 2005–2014 were linked to birth registration and birth notification data (previously known as NHS Numbers for Babies or NN4B) to bring together some key demographic and clinical data items not otherwise available at a national level. The linkage algorithm that was previously used to l...

Objective: to describe how terminations of pregnancy at gestational ages at or above the limit for stillbirth registration are recorded in routine statistics and to assess their impact on comparability of stillbirth rates in Europe. Design: analysis of aggregated data from the Euro-Peristat project. Setting: 29 European countries. Population:...

Objectives This project builds on previous work linking routinely collected data from birth registration, birth notification, death registration and hospital discharges, extending it to six million births in England and Wales from 2005 to 2014. This linkage is creating a new dataset to investigate previously unanswerable questions about variations...

Objective To use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention. Design Retrospective analysis of aggregated routine data. Setting Thirty-one European countries or regions contributing data on mode of delivery to the Euro-Peristat project. Population Birth...

Objective: to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital. Design: micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period betwe...

Objective: Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods: We...

Multiple birth rates in the participating countries. (XLSX)

Background: Previous studies have shown that socioeconomic position is inversely associated with stillbirth risk, but the impact on national rates in Europe is not known. We aimed to assess the magnitude of social inequalities in stillbirth rates in European countries using indicators generated from routine monitoring systems. Methods: Aggregate...

Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked ro...

This article discusses definitions of birthweight, including extreme values of birthweight distributions, factors associated with differences in birthweight distributions and their associations with the outcome of pregnancy and the development of statistical approaches to compare birthweight distributions and to detect outliers to inform clinical p...

Abstract Background Evidence from the Birthplace in England Research Programme supported a policy of offering ‘low risk’ women a choice of birth setting, but a number of unanswered questions remained. Aims This project aimed to provide further evidence to support the development and delivery of maternity services and inform women’s choice of birth...

The development of a United Nations sponsored Millennium Development Goal (MDG) relating to childhood survival contributed significantly to reducing mortality among children under 5 years old in many countries in the first years of the twenty-first century.1 The development of an independent authoritative mechanism, the Countdown to 2015 Collaborat...

To use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention. Retrospective analysis of aggregated routine data. Thirty-one European countries or regions contributing data on mode of delivery to the Euro-Peristat project. Births in participating countries in 2010...

Objective To explore and compare perinatal and maternal outcomes in women at ‘higher risk’ of complications planning home versus obstetric unit (OU) birth.DesignProspective cohort study.SettingOUs and planned home births in England.Population8180 ‘higher risk’ women in the Birthplace cohort.Methods We used Poisson regression to calculate relative r...

Table S1. Categorisation of potential confounders. Table S2. Categorisation of risk factors used for risk adjustment. Table S3. Medical and obstetric risk factors known prior to the onset of lavour in ‘higher risk’ women by planned place of birth. Table S4. ‘Complicating conditions’ identified at the start of care in labour in ‘higher risk’ women b...

Figure S1. Study inclusion flow chart (‘higher risk’ women). Figure S2. Study inclusion flow chart (‘low risk’ women planning a home birth).

Objective: to describe and compare women's experiences of specific aspects of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area. Design: telephone surveys undertaken in late pregnancy and about six weeks after birth. Two separate waves of interviews were conducted,...

to describe and compare women׳s choices and experiences of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area. telephone surveys undertaken in late pregnancy and about six weeks after birth in two separate time periods, Phase 1 before the birth centre opened and Phase...

Objectives To explore whether service configuration and obstetric unit (OU) characteristics explain variation in OU intervention rates in ‘low-risk’ women. Design Ecological study using funnel plots to explore unit-level variations in adjusted intervention rates and simple linear regression, stratified by parity, to investigate possible association...

AimsTo determine the diversity and stability of cultured vaginal lactobacilli in a multi-ethnic population of pregnant women.Methods and ResultsA single centre, prospective, cohort study was performed in a tertiary perinatal centre in East London, UK. Self-collected vaginal swabs at 13 and 20 weeks gestation were obtained from women attending for r...

It is unfortunate that a number of campaigning organisations are taking an anti-research, anti-national statistics line by promoting individual opt-outs for the sharing of data from patient records with researchers (Letters January 22).

In England, there is a policy of offering healthy women with straightforward pregnancies a choice of birth setting. Options may include home or a freestanding midwifery unit (FMU). Transfer rates from these settings are around 20%, and higher for nulliparous women. The duration of transfer is of interest because of the potential for delay in access...

Claims that perinatal and infant mortality rates in the UK are higher than those of all comparable countries are often made in a spirit of moral panic, to argue for policies or interventions that may or may not be effective at reducing the rates. Crude perinatal and infant mortality rates tend to be included routinely in successive national and int...

We were alarmed by the letter from Mascarenhas and colleagues entitled, “NICE promises on infertility and caesarean section are unmet.”1 We agree with the authors that current underfunding in the NHS is having grave consequences on national maternal health service provision and deserves careful scrutiny and critical comment, …

Fetal and neonatal mortality rates are essential indicators of population health, but variations in recording of births and deaths at the limits of viability compromises international comparisons. The World Health Organization recommends comparing rates after exclusion of births with a birth weight less than 1000 grams, but many analyses of perinat...

Percentage of missing birth weights (BW) and gestational ages (GA). *Denmark (fetal and neonatal mortality), Italy (fetal mortality) and Sweden (neonatal mortality) were excluded from analysis because of substantial difference in missing data by birth weight and gestational age. Proportions of 5% and over missing data are presented in bold. (DOCX)

Data sources used for data on live births, fetal and neonatal deaths in Europe in 2004. (DOCX)

An open letter to the BMA and the Academy of Medical Royal Colleges calls on them to make a joint public statement of opposition to the amended section 75 regulations On 1 April the government is due to enact enabling legislation to the Health and Social Care Act, which will in effect require clinical commissioning groups to enter into competitive...

Background: Tabulating annual national health indicators sorted by outcome may be misleading for two reasons. The implied rank order is largely a result of heterogeneous population sizes. Distinctions between geographically adjacent regions are not visible. Methods: Regional data are plotted in a geographical map shaded in terms of percentiles o...

Soljak seems not to understand how the Health and Social Care Act 2012 will limit the availability of routine data to monitor the health service and the population by abolishing area based structures and transferring most health service responsibilities to non-geographically based clinical commissioning groups.1 Neighbourhood statistics and the ind...

To compare mean birth weights, gestational ages and odds of preterm birth and low birth weight of live singleton babies of black African or Caribbean ethnicity born in 2005 or 2006 by mother's country of birth. Secondary analysis of data from linked birth registration and NHS Numbers for Babies data set. Births to women in England and Wales in 2005...

A shift away from area based populations in England will have severe implications for population health data, argue Allyson M Pollock , Alison Macfarlane , and Sylvia Godden The Health and Social Care Act 2012 will replace the administrative structure of the NHS in England, currently based on the resident populations of defined geographical areas...

Maternity Hospital Episode Statistics (HES) data for 2007 were linked to birth registration and NHS Numbers for Babies (NN4B) data to bring together some key demographic and clinical data items not otherwise available at a national level. This extended the time period 2005-06, for which data had previously been linked and reported. Birth registrati...

This work formed part of a project to link data recorded routinely at birth in England and Wales to bring together socio-demographic data and data about care at birth. Birth registration data for England and Wales had already been linked to the National Health Service (NHS) Numbers for Babies' data (NN4B) recorded when an NHS number is issued to a...

Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units...