Legacies and Futures: Measuring the roles of resilience and vulnerability in pregnancy and birth outcomes

Plain English summary of protocol

Background and study aims
Patients using reproductive health services, like care during pregnancy (called antenatal care), are most often assumed to be heterosexual married women whose gender matched their sex assigned at birth (i.e., cisgender). Due to these assumptions, pregnancy care procedures are based on a sweeping assumption of who becomes pregnant and gives birth. This assumption is based on the pregnant person’s gender and/or sexual orientation. As a result of this assumption, parents who are lesbian, gay, bisexual, queer, intersex, asexual, and/or transgender (LGBTQIA+) can experience stress in the form of stigma, prejudice, and discrimination (i.e. “minority stress”). In the United Kingdom, there are 525,000 LGBTQIA+ potential gestational parents who may face this type of stress while receiving pregnancy care. That means that there is a preventable higher risk for pregnancy and birth complications caused by increased stress during pregnancy and daily life. These complications include macrosomia, pre-term birth, and low-birth weight. Preventable stress, also called minority stress, links to this increase in health problems outside of pregnancy as well. Since minority stress influences patient/parents’ health, it is also called a risk or vulnerability. Resilience, or the ability to overcome stress and discrimination, can sometimes help improve health outcomes. However, little is known about which types of resilience can be helpful for LGBTQIA+ parents given their unique experiences of minority stress.

The planned observational study will investigate the ways in which experiences of minority stress and resilience in pregnancy care are associated with parent health and birth outcomes.

Who can participate?
A sample of pregnant parents from maternity wards in and around London. Participant recruitment will focus on LGBTQIA+ pregnant parents. A matched comparison sample of cisgender, heterosexual pregnant parents will also be recruited to take part from the same maternity.

What does the study involve?
Participants will take part in an online panel survey (completed twice) that will be linked to each patient/participant’s electronic health records to create a quantitative dataset. From the full sample, a smaller group of patient/parents from University College London Hospital will be invited to complete an at-home journal activity which will provide qualitative data on their experiences of minority stress and resilience. Results from this study can be used to inform LGBTQIA+ guidelines, training, and help make reproductive healthcare more inclusive.

What are the possible benefits and risks of participating?
There are no direct personal health benefits to participating in this study. You may find that thinking through the questions is interesting and provides new perspectives on your lived experiences, but this will vary for each participant. By taking part in the study, you will be helping to improve what is known about pregnancy and childbirth among diverse communities in a way that should help to improve guidelines and policies.

There are no known risks for participating study, since there are no changes to your pregnancy care. The topics that will be covered in the survey questions are similar to topics discussed in everyday conversations that you might have with family and friends. These may also include topics covered by the news and social media as well. There will be a brief description of the questions you will be answering at the start of each section.

When answering questions in the surveys about your daily life you may experience uncomfortable emotions or discontent. We suggest taking your time with the survey, taking it in a safe and comfortable space. There are recommended points to take a break within the survey in case you do need to step away and come back at a later time.

For privacy purposes, we recommend using an individual email address for communication and survey reminders. Additionally, while completing the surveys you may also wish to position yourself where no-one is able to see your screen. After completing each survey, you may wish to clear your browser history if you are concerned about it being on the computer you used.

Where is the study run from?
University College London Hospital (UK)

When is the study starting and how long is it expected to run for?
September 2019 to March 2024

Who is funding the study?
Economic and Social Research Council (UK)

Who is the main contact?
Kate Luxion, stnvkll@ucl.ac.uk

Study website

Contact information

Ms Kate Luxion
Scientific

Thomas Coram Research Unit
27-28 Woburn Square
London
WC1H 0AA
United Kingdom

ORCID ID	0000-0002-3093-3683
Phone	+44 20 3108 4358
Email	stnvkll@ucl.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centres

Sponsor information

University College London
University/education

UCLH/UCL Joint Research Office, part of the Research Directorate
4th Floor
West 250 Euston Road
London
NW1 2PG
England
United Kingdom

Phone	No telephone contact available
Email	uclh.randd@nhs.net
Website	http://www.ucl.ac.uk/
"ROR"	https://ror.org/02jx3x895

Funders

Funder type

Research council

Results and Publications

Study outputs

Additional files

39872_Protocol_v3.3_22Feb22.pdf

Editorial Notes

27/03/2023: The recruitment end date was changed from 30/03/2023 to 30/09/2023.
11/05/2021: Trial's existence confirmed by the National Institute for Health Research (NIHR) (UK).