Groups with additional health and social care needs during pregnancy

There is no formal or universally accepted definition of a 'high risk' pregnancy. Generally, however, a high risk pregnancy incolves at these one of the following outcomes:

  • The woman or baby is more likely to become ill or die
  • Complications before or after delivery are more likely to occur
  • Longer term child and maternal health outcomes are poorer when compared to other groups.

A number of genetic and biological factors (for example, diabetes or heart disease) as well as socially determined factors affect outcomes. Socially determined influences include individual risk factors such as smoking, nutrition and alcohol, as well as wider structural influences such as gender-based violence, discrimination, income, education, housing and the environment. Complex social circumstances can in themselves create groups with additional health and social care needs; however, often, biological, genetic and social factors are inextricably linked. For example, the relationship between diabetes, obesity and poor nutrition; or gender-based violence, substance misuse and poor mental health.

The available literature suggests that in relation to inequities of access to maternity services and subsequent health inequalities the following groups are at ‘high risk’ of comparatively poorer health outcomes: 

  • Women from black and minority ethinic (BME) groups
  • Women living in poverty
  • Women with mental health problems
  • Women with learning disabilities
  • Women living with gender-based violence
  • Teenage and young women
  • Women who have substance misuse problems
  • Women who have been ‘looked after’ as children.

Clearly women do not fit neatly into these distinct groups and there may be many groups that overlap. Some women are likely to experience multiple and complex factors that influence their ability to access services and affect subsequent outcomes for themselves and their babies, for example, a teenager with learning disabilities living in poverty and experiencing gender-based violence and mental health problems.

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