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Pre-birth to antenatal

Leicester Children's Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with the pre-birth to antenatal period.

The pre-birth to antenatal period is paramount to providing each child a ‘best start in life’. Investments targeted to the pre-birth and antenatal period influence a child’s readiness for school, educational attainment, economic participation and long term health. The right support at this stage is therefore key to children’s long-term health and well-being.

Issues on which this section focuses are preconception, pregnancy, the perinatal period (around childbirth), the neonatal period (until the infant is 28 days old), infant mortality (up to a year) and breastfeeding.

Who’s at risk and why?

The main factors which can adversely affect health outcomes at this stage are:

  • Deprivation
  • Ethnicity
  • Low birth weight (LBW)
  • Maternal age
  • Maternal obesity
  • Maternal mental health
  • Lifestyle
  • Poor parenting
  • Consanguinity
  • Access to quality services

The level of need in the population

Demographics

  • In 2015, about 46% (n=79,566) of all females in Leicester were of child bearing age, that is aged 15 to 44 years. This was a significantly higher proportion than the England average, which was 38%.
  • Between 2009 and 2015 there was a decrease of 1% in the proportion of women of child bearing age in Leicester. This was similar to the regional and national trends (2%).
  • The GFR is the total number of live births per 1,000 females of child bearing age. There were 5,156 babies born to women in Leicester in 2015, giving a GFR of 64.8 per 1,000 women aged 15 to 44 years.
  • Approximately 50% of births in Leicester in 2015 were to women born outside the UK. This is significantly higher than the England and the East Midlands averages.

Outcomes

Maternal Mortality

The overall maternal mortality rate for England for 2012-14 was 0.39 per 100,000 women aged 15 to 44 years. There were no maternal deaths in Leicester in the same period.

Infant Mortality

  • Stillbirth and perinatal deaths - The perinatal mortality rate is the number of deaths per 1,000 births. The current rate (9.3 per 1,000 births) is significantly higher than the England (6.8 per 1,000 births) and East Midlands (6.9 per 1,000 births) rates.
  • Infant deaths - The Infant Mortality Rate (IMR) for Leicester has not changed significantly over the past 10 years. The IMR for specific areas of Leicester vary, with 13 middle super output areas having significantly higher IMRs compared to England.

Low Birth Weight (LBW)

The areas of the city with a significantly higher proportion of births that are less than 2,500g are the Eastern and Central areas of Leicester.

Teenage Pregnancy

Historically, Leicester has a higher than average rate of teenage pregnancy. By 2010 the rate in Leicester had reduced by 40%. The conception rate for females aged 15-17 years in Leicester in 2012/14 was 29.3 per 1,000 females. The rate for England was 24.9 per 1,000, and the rate for the East Midlands was 24.8 per 1,000. In 2012/14, 8 wards, primarily located in the West and South of the city, had teenage conception rates significantly higher than the England average.

Determinants of health

Smoking during pregnancy

In 2011 the Department of Health (DH) set the national goal to reduce rates of smoking in pregnancy to 11% or less by the end of 2015. The relevant data is called Smoking at Time Of Delivery (SATOD). Between 2010/11 and 2015/16 SATOD did not significantly decrease in Leicester, but the 2015/16 SATOD (11.8%) was close to the National Ambition.

Perinatal Mental Health

Data on perinatal maternal mental illness are not routinely collected, so it is not possible to report the actual local prevalence of various types of perinatal poor mental health in Leicester.

Overweight or Obesity in Pregnancy

The most recently available UHL maternity data shows that 25% of pregnant women in Leicester who booked with University Hospitals of Leicester were recorded as being overweight with 19% being obese. This is significantly higher than the England average.

Diabetes in Pregnancy (Pre-existing and Gestational)

UHL data indicates that 4.8% of pregnant women in Leicester developed gestational diabetes in 2014/15.

Domestic Violence (DV) in pregnancy

In Leicester, the SAFE Project supported 1609 victims between April 2013 and November 2015. 67% of the victim-survivors had children, and approximately 7% were pregnant at the time of entry to the service.

Antenatal screening and immunisation

All pregnant women in Leicester are routinely offered antenatal screening for HIV, Hepatitis B and Syphilis, and susceptibility to Rubella.

The uptake of the seasonal influenza vaccine by Leicester’s pregnant women was significantly lower than the England and East Midlands averages and should be kept under review by the local Health Protection Board.

Projected Service Use

The fertile population (15 to 44 year female population) in Leicester is predicted to decrease by 2.15% by 2021 and therefore there will be a slightly reduced burden on maternity services.

Recommendations

Recommendations based on the findings of this JSNA.