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Patricia Gibson (North Ayrshire and Arran) (SNP)
I beg to move,
That this House has considered pre-eclampsia.
I am delighted to have secured a debate on this important issue, and I thank my colleagues on the Backbench Business Committee for supporting it. The debate is timely because we are approaching World Pre-Eclampsia Day on 22 May. According to the House of Commons Library, the House has never had a debate about this extremely important matter, which affects every constituency, and every country in the world. Although I am surprised that there has been no previous debate, I am delighted that we are here today to put that right and to have what I hope will be a constructive, illuminating and considered debate. Before I proceed, however, I must say that I am extremely disappointed by the apparent lack of concern about this issue across the House, as we can see from the number of Members in the Chamber. Women and families who are concerned about pre-eclampsia will be equally disappointed by the poor turnout.
I want to pay particular tribute to Marcus Green, the chief executive of Action on Pre-Eclampsia, and all his team for all the support and information they have provided to me and all Members to help ensure that this debate is as well-informed as it needs to be. I applaud the work of Marcus, his team and others, including at the University of Liverpool, who expend huge personal and professional effort to combat and better understand the appalling condition of pre-eclampsia. I thank those who research this illness to help us better treat and manage it, because their work is ultimately about improving survival rates for mothers and babies when this condition occurs.
Pre-eclampsia is a very serious disease related to high blood pressure. It can strike out of the blue with no apparent warning—the word “eclampsia” is Greek for lightning. It can strike any pregnant woman, most notably in the second half of pregnancy, or up to six weeks after delivery. It is a symptom of new-onset hypertension and significant protein in the urine after the 20th week of pregnancy. There is no cure for pre-eclampsia, which is why treatment and management of the condition matter so much.
Identifying pre-eclampsia early is so important for mothers and babies; it can literally mean the difference between life and death. Globally, pre-eclampsia accounts for 14% of all maternal deaths, killing 40,000 women every year. Five women every hour die from pregnancy complications related to pre-eclampsia. Not surprisingly, poor outcomes for mother and baby are associated with poor care, which is most often found in low-income countries. Across the United Kingdom, our NHS services still face significant challenges with regards to pre-eclampsia.
The hon. Member for Banbury (Victoria Prentis), who is very sorry not to be here, suffered a stillbirth due to pre-eclampsia. My personal interest in this issue was sparked by the death of my son Kenneth, who was stillborn two days after his due date, after his birth was delayed while he was still alive and healthy. No reason was given for that delay; in fact, when I reported back to the hospital the same day in terrible pain—a few hours after being told my baby would not be delivered that day as planned—I faced obstruction and argument. I was repeatedly told to go home as there was nothing wrong. How that could have been established when I had not been examined was a question that was never answered, then or since. My husband insisted that I be admitted to hospital. I was later informed that had he not done so, I would certainly have died.
According to a leading consultant obstetrician, Professor Edward Shaxted of Northampton General Hospital, had NHS Greater Glasgow and Clyde reacted to the clear signs of my pre-eclampsia when I attended the maternity unity in pain, our otherwise healthy 8 lb 7 oz son would in all likelihood have survived. My husband and I commissioned a report from Professor Edward Shaxted after waiting for over a year in vain for NHS Greater Glasgow and Clyde to engage with us after the stillbirth.
When I reported to the hospital, I was neither examined, tested nor treated, but I was—bizarrely—injected with morphine twice. By the following morning, baby Kenneth was dead. I had developed a very severe form of pre-eclampsia called HELLP syndrome, a condition that is life-threatening to mother and baby. Not only did my baby die, but my husband was summoned to be told to say his goodbyes to me, as I was not expected to survive following a rupture of the liver. I was in a critical condition, and spent a number of weeks in a high-dependency unit.
While the mortality rate for HELLP syndrome is estimated by some to be as high as a massive 30%, Professor Shaxted’s report described the errors made in my case as “extraordinary”. He said:
“With a little thought it would have been recognised that Mrs Gibson had developed pre-eclampsia.”
My concerns were ignored despite the fact that my baby was due for delivery. The professor went on to say:
“Delivery of Mrs Gibson’s baby while still alive”—
on my due date, as planned—
“would more likely than not have led to the birth of a live child who would have survived intact.”
His conclusion was echoed by Professor Benjamin Stenson of the Royal Infirmary of Edinburgh, from whom we also commissioned a report. Anecdotally, I know that this experience is not unique to me.
We must continue to strive to do better at monitoring pregnant women and to listen to what they tell us, because being aware of, looking out for and dealing with pre-eclampsia must be on the radar of all professionals dealing with expectant mothers on the frontline. Recognition of the condition and early intervention are vital. When the signs are present, it is important they are not missed. Overall, maternal mortality across the UK has much reduced over the generations, but there must be no room for complacency, as there appeared to be in my case, and as I know there has been in others. I was labelled high risk, having undergone five years of in vitro fertilisation and being over 40.
When mistakes are made, they cannot be undone, but if we do not learn from them, that is disgraceful and completely unacceptable. Despite low levels of maternal deaths, there are still unacceptable levels of stillbirths and babies born being prematurely and/or underweight because of pre-eclampsia. Significant numbers of women suffer from pre-eclampsia in pregnancy. We know that screening and diagnosis are the cornerstones of safe management, and that deaths are preventable with good-quality routine antenatal care in pregnancy and evidence-based guidelines for antenatal care and the management of hypertension in pregnancy.
However, according to the Library, no NHS in the UK collects official statistics on the number of women who develop pre-eclampsia during pregnancy. We do know that there are around two maternal deaths due to pre-eclampsia every year in the UK, but no figures are recorded for how many babies die due to pre-eclampsia-related issues, although research by Imperial College London puts the figure at around 1,000 babies each year across the UK.
There is also no information published about how much pre-eclampsia costs the NHS across the UK. The lack of detailed information on this issue is quite staggering. I urge the Minister to ensure that such information is collected and recorded. I will lobby the Scottish Government to do the same. We need clear information to know the true scale of the challenge we are facing. One of the keys to meeting such a significant challenge is clear information.
This is a complex illness. It cannot be predicted with certainty who will develop pre-eclampsia or what causes it, although risk factors can be identified, including having a strong family history of pre-eclampsia, being over 40 years old, and being overweight or obese. Evidence appears to suggest that black and Asian women are more likely than white women to develop pre-eclampsia, which requires further investigation. It seems that black women are five times more likely than white women to develop pre-eclampsia, and that Asian women are twice as likely to develop it. We need to understand better why that is and to treat such patients accordingly.
There is also evidence that women who develop pre-eclampsia in pregnancy are at greater risk of developing cardiovascular disease and kidney disease in the longer term, shortening their life expectancy. At the moment, no part of the UK has standard care pathways to monitor the long-term health of women who have had pre-eclampsia. That needs to change. I urge the Minister to address that, and I will continue my conversations on that matter with the Cabinet Secretary for Health in Scotland, Jeane Freeman MSP.
The only cure for pre-eclampsia—if we can call it a cure—is the delivery of the baby, but that often means the baby being delivered dangerously prematurely, which throws up all kinds of moral dilemmas and is not always straightforward. Of course, pre-eclampsia is a progressive condition, which gets worse, so mother and baby need close and careful monitoring. We know that babies born underweight or prematurely are at greater risk of cardiovascular disease and diabetes in later life. We need ongoing research to find better treatments that reduce the risks to children whose mothers suffer from pre-eclampsia.
Let me say a little about the placental growth factor test. The symptoms and signs of pre-eclampsia are not always reliable or consistent, meaning that women may be admitted to hospital unnecessarily or have a severe case of pre-eclampsia that goes undiagnosed. Like too many other women, I know how tragic that can be. The PLGF test is a new blood test that indicates whether an expectant mother has the disease. When it is used on a woman with suspected pre-eclampsia, it can reliably indicate whether they will need delivery soon and whether the baby is at risk. It can also show whether the woman needs to be admitted to hospital and requires intensive monitoring to determine when delivery should take place, or whether it is safe to discharge her. Its use means that several other tests, which may not be so reliable, do not need to be done, saving our hospitals time and other resources. The PLGF test is available, and it must be provided regardless of where in the UK people live. I urge the Minister to do all she can to ensure that that is the case.
The PLGF test is an important tool that will help us make progress in combating pre-eclampsia by improving its diagnosis and treatment. NHS England will soon make the test available, and I am in negotiations with Jeane Freeman about it being made available in Scotland, too. The test is too important and too accurate, and the information it can yield too informative, for it not to be made available where necessary by health services across the UK. It will not just save lives; it will save money, and it will offer expectant parents huge reassurance about the health of their baby.
The Lancet published a study of implementation in England, which demonstrated that the test improved cost and clinical outcomes, with a 64% reduction in time to diagnosis, a 37% reduction in out-patient visits, and a 35% reduction in the use of bed nights for neonatal care. It seems that it is something of a breakthrough, and I think it has the potential to save many lives. With around 1,000 babies dying every year in the UK due to complications related to pre-eclampsia, this simple test offers real hope and gives us cause for optimism. It is a real milestone in how we treat this horrible condition, which can strike expectant mothers with no warning but with devastating, life-changing consequences for families. I hope that, one day, it offers real hope to women across the world—especially those in poorer countries—that mothers and their babies need no longer die.
World Pre-Eclampsia Day on 22 May deserves a place on our calendars. It deserves to be recognised this year and every year. More than 30 organisations recognise it, including Action on Pre-Eclampsia, Save the Children, the Preeclampsia Foundation and a whole range of others around the world. I urge the Government to ensure that more research is carried out into the condition so that better preventive work, as well as more and better treatments, can be developed. I urge the Minister to do all she can to ensure that women are educated about the condition and about how they might recognise and mitigate it.
As we approach World Pre-Eclampsia Day, this debate matters. Pre-eclampsia is killing our babies, and I believe we can and should be able to detect and treat it more effectively. I absolutely support the call from Action on Pre-Eclampsia to prioritise research into stillbirths from pre-eclampsia and to increase resources to support parents through the trauma of that. The UK has the lowest incidence of maternal mortality from pre-eclampsia in the world—that is not an accident; it is down to better care and attentive clinicians—but we have not found a cure. Until we do, and until we completely stop babies dying from this condition, we need to do more.
This is the very first debate on pre-eclampsia, and it is long overdue. I urge the Minister and the Government to commit to doing all they can to improve research, treatment and detection. We have come some way—we can see that from the number of deaths of mothers—but we must remember that 1,000 babies are stillborn as a result of this condition every year, so we certainly are not there yet. Let us work together to make as much progress as we possibly can.
Gavin Newlands (Paisley and Renfrewshire North) (SNP)
It is a pleasure to see you in the Chair, Mr Hollobone. I had not intended to make a speech, but I was ashamed by the lack of Back-Bench contributors and felt moved to do so, rather than making an intervention. I congratulate my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) on securing the debate. Despite the poor attendance, this is an extremely important issue; the figures she outlined speak for themselves and do not need repeating by me.
I am here because my wife had pre-eclampsia during both her pregnancies. It was particularly acute during her first pregnancy, with my daughter Emma. The care she received when she was eventually admitted was exemplary. I could not fault it; it was fantastic from start to finish. However, in a similar vein to my hon. Friend’s experience, when my wife was first sent to hospital by her GP, having presented feeling nauseous and light-headed and with various other symptoms, she was not taken entirely seriously when she got there. Her blood pressure was up and down, and at one point she was accused of white coat syndrome and sent home. But she knows her own body, and she did not feel right at all, so she phoned up, went back to the hospital and was eventually admitted.
My hon. Friend is right that, even now, awareness and diagnosis of pre-eclampsia is still not good enough and must be improved. Despite its prevalence, pre-eclampsia does not get the attention or research it deserves. The fact that I am the only other Back-Bench speaker is probably a testament to that. My eldest was born six and a half weeks early, at 3 lb 10 oz, in an emergency caesarean. After an extended stay in hospital, she was sent home healthy, and she is still healthy—touch wood—to this day. My wife had no repercussions from the condition thereafter. She got pre-eclampsia again, albeit a much milder version, in her second pregnancy, which almost went to full term.
Many mothers with pre-eclampsia will give birth prematurely, and premature birth is an issue we have discussed in this Chamber of late. I am sure that my hon. Friend the Member for Glasgow East (David Linden), who will speak for the SNP from the Front Bench, will talk more about that. My daughter Emma was born six and a half weeks premature, and once she was born my wife, who had had a caesarean section, sent me straight back to work, because she wanted my paternity leave to coincide with her arriving back from hospital so that I could help around the house. It does not feel natural in the slightest to go back to work with a daughter in an incubator and a wife recovering from surgery, but back to work I went, because that was her wish.
I went back to work and spoke with colleagues, receiving their congratulations and so on. About an hour and a half after getting in, I was pulled into the office by my boss, who essentially sent me straight back to the hospital—I was given additional paid leave for as long as I required it. I was extremely lucky, but that was only because my boss and another colleague had had similar experiences, so they were in a position to help me and my wife. However, it should not be down to luck. I am sure that my hon. Friend the Member for Glasgow East will go into more detail, but I fully back the calls made by him and the all-party parliamentary group on premature and sick babies for extended parental leave in such circumstances. I hope that the Department for Business, Energy and Industrial Strategy will publish the report on its review as soon as possible.
I congratulate my hon. Friend the Member for North Ayrshire and Arran once again on bringing forward the debate. I sincerely hope that this is the important first step in giving this condition the attention it deserves at parliamentary and governmental level.
David Linden (Glasgow East) (SNP)
It is, as always, an immense pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) for securing and opening the debate. Ahead of World Pre-Eclampsia Day later this month, the debate timeously highlights a hugely important issue surrounding prenatal health. She spoke with a personal understanding that sadly will resonate with many other families right across the UK. The fact that she can stand up and talk about something so deeply personal should be valued. That is not easy. She did so when many others would sit back and say, “I’m not willing to put myself in that space.” I am sure I speak on behalf of the Chamber in saying that we should be hugely appreciative of that.
This is not an easy subject to talk about, but my hon. Friend did so in a considered and sensitive manner. I very much commend her for putting pre-eclampsia on the parliamentary agenda for the first time. I heard her say earlier in the week that this was the first time it was to be debated, and I confess that I doubted that, but she confirmed today that it is the first time that it has been debated in the House of Commons. I hope that this will be not just one set-piece event to mark World Pre-Eclampsia Day, but the beginning of a conversation in this place.
I am also grateful to my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands), who stood up and contributed without notes, again referring to his personal experience and that of his wife, Lynn, with the birth of Emma and Eilidh. It is no secret that he is a genuine friend of mine and somebody I spend personal time with—not just time with here as a Member of Parliament. He is a real ally in the campaign to extend paid parental leave for parents of premature and sick babies. I am all the richer for having him at my side as together we battle the UK Government.
Pre-eclampsia has been at the forefront of my mind recently. Some in the Chamber will know that my wife Roslyn had a baby late last year and that her type 1 diabetes complicated the pregnancy. In addition to the complications we experienced during her first pregnancy with our son Isaac, we were acutely aware that diabetes increases the risk of pre-eclampsia by a factor of between two and four. I know from that experience that it is a real source of stress for expectant parents, particularly those with multiple risk factors for pre-eclampsia.
Pre-eclampsia is traditionally difficult to diagnose. Women with pre-eclampsia are often asymptomatic, and conventional diagnosis methods that look at hypertension and urinary protein levels can be subject to observer error. Therefore, the recently published findings of the Parrot trial into placental growth factor testing are a game-changer, showing that the time it takes for clinicians to diagnose the condition can be significantly reduced. Alongside clinical assessment, the testing can also be used to rule out pre-eclampsia, which would bring peace of mind to parents-to-be as well as cost-saving benefits to health services. Jane Brewin, the chief executive of Tommy’s, the charity behind the Parrot trial, said:
“For other women with raised blood pressure this ‘rule out’ test will give women peace of mind and enable doctors to treat their condition more appropriately.”
The reduction in diagnosis time brought about by placental growth factor testing is hugely important in determining the care pathway for mum and baby.
I have recently held stakeholder meetings in my role as chair of the APPG on premature and sick babies, one of which was with Professor Andrew Shennan, a professor of obstetrics at King’s College London, and Marcus Green, the chief executive of Action on Pre-Eclampsia. Professor Shennan truly is a leading expert on pre-eclampsia, with a working knowledge spanning decades of clinical practice. What really came across was the importance of individualised, tailored care pathways for patients with pre-eclampsia. A multi-disciplinary and systematic approach is required to ensure that each patient receives the appropriate care in order to reduce risk and increase the likelihood of a positive outcome.
Placental growth factor testing will play a vital role in the future, allowing for much greater management of the condition. At an estimated cost of only £70 for a simple blood test, there is clearly a massive cost-benefit in making the testing widely available. Research published by Action on Pre-Eclampsia shows that the cost reduction per patient compared to standard clinical assessment could be almost £3,000.
The recent announcement that NHS England will be rolling out this testing is a hugely welcome step forward. It would be churlish of me not to place on the record my admiration of Her Majesty’s Government for taking that step forward. I understand that the Scottish Government are looking at adopting this north of the border, and I am keen to see that. I am happy to support the lobbying efforts of my hon. Friend the Member for North Ayrshire and Arran to ensure that progress is made. Given the Scottish Government’s recent announcement of a new model for neonatal and maternity care, backed with £12 million of investment, I strongly expect that Edinburgh will be fairly receptive.
The other big takeaway from my meeting with Professor Shennan and Marcus Green was that there are training issues with some clinicians. To an extent there is a postcode lottery when it comes to the assessment and knowledge of risk factors for pre-eclampsia. Globally, the UK has the lowest level of maternal deaths caused by pre-eclampsia, but if we are ever to change the stubbornly high level of adverse outcomes for babies, educating clinicians must be prioritised.
The work being done at centres of excellence, such as the clinic at St Thomas’ Hospital just across the river, deserves to become the gold standard of care, regardless of location. It is really promising that there will be some replication of the approach taken at the unit, and in the next 12 months we will start to see more clinics set up in other places. That is welcome. That approach, building on the strong foundations of the preterm birth network, could see the UK become a true world leader in dealing with pre-eclampsia. We should all get behind that.
As my hon. Friend the Member for North Ayrshire and Arran said, we know that the greatest burden of the condition is on low-income countries, and there is a role for us to play in improving outcomes around the world as well as at home. In order to do that we need to have a best-practice model, and it needs to be in place and operational across all our health services.
Maternal deaths as a result of pre-eclampsia are now rare in the UK, with a risk of just one in a million, as my hon. Friend explained. Although that is good news, regrettably there are hundreds of stillbirths in the UK each year as a result of the condition, and we have heard personal testimony of that today. There is more research to be done and more support that can be given. It might seem like a big ask of the Minister, but one small step that the Government can take now is to recognise World Pre-Eclampsia Day, which takes place on 22 May. I sincerely hope that she will join me in doing that.
I will wrap up by noting that there is clearly a great deal of expertise and willingness within the health services to improve outcomes, but that perhaps we need to see some sharper focus on this issue from the top, including from the House of Commons. I congratulate the Government on being so quick to act on making placental growth factor testing available throughout NHS England and hope that this is followed with greater resourcing to help predict and prevent adverse outcomes in future.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is a pleasure to serve under your chairmanship again, Mr Hollobone. I am sure that happened just earlier this week or maybe it was last week; maybe it is every week.
I thank the hon. Member for North Ayrshire and Arran (Patricia Gibson) for securing this important debate, just ahead of World Pre-Eclampsia Day on 22 May, and for her heartfelt, thoughtful and passionate speech. She is so brave, as has already been said, to do this. I know, and she knows, how hard it is to speak in a debate about something as personal and hurtful as the loss of a baby; nothing can ever be harder. I have the honour of being vice-chair, along with the hon. Lady, of the all-party parliamentary group on baby loss, which we set up. All the Members who set up the group have had the awful experience of baby loss, which makes it such a powerful all-party group. We all take the work it does very seriously and have had some small achievements, thanks to the Government listening to the voices from the group.
Some changes are being made and implemented across the country because of it. I am proud that we are able to use our own tragic experiences of loss to campaign for better care, treatment and diagnosis for future parents, so that hopefully they do not ever have to go through anything like the experience that the hon. Lady has been through. Let us hope that the debate today, which, as the hon. Lady said, is the first debate of its kind, will lead to some future changes that will ensure that even fewer people will have to go through that experience. I was so very sorry to hear the details of the hon. Lady’s own personal experience of pre-eclampsia. I knew that was how she had lost her son, but not the detail. I thank her for sharing her story with us and I am sure that Kenneth would have been very proud of his mum.
I also thank the hon. Members for Paisley and Renfrewshire North (Gavin Newlands) and for Glasgow East (David Linden) for their excellent speeches, and I join everyone in saying how disappointing it is that there are not more Members attending this important debate. Perhaps the debate about acquired brain injury, taking place in the Chamber, has drawn a bigger crowd of available Members. Nevertheless, what we have lacked in quantity we have certainly made up for in quality; this has been an excellent debate so far, and we have yet to hear from the Minister.
As we have heard, pre-eclampsia affects around 6% of pregnancies; that means 1,000 babies a year are stillborn due to this awful condition. That is not good enough; it has to be and it can be reduced, as we have heard. The last triennial audit of maternal deaths in the UK reported that of the 22 deaths from pre-eclampsia, 14 were avoidable. Again, that number can be reduced. Because the symptoms of pre-eclampsia are so similar to the general symptoms of pregnancy, they are often missed and that can be fatal. That is why we are here today: to raise awareness and ensure change.
Women with diabetes, high blood pressure, kidney disease and a body mass index of over 35 are more likely to develop pre-eclampsia. Many instances of these conditions can be prevented with a healthy lifestyle. As the Shadow Minister for Public Health, I cannot miss any opportunity to mention prevention and the cuts to health services of £800 million between 2015 and 2021 under this Government. If public health budgets, which fund services such as obesity services, had not been slashed so vigorously by the Government, the number of women with these conditions would be reduced. Even so, where cases have not been prevented, these women should still be a priority for midwives and healthcare professionals, and offered the tests that exist for pre-eclampsia, and support throughout their pregnancy. The same goes for women with lupus, women over the age of 40, women expecting multiple babies and women who have had pre-eclampsia before.
If we target the women most at risk of developing pre-eclampsia, we can detect the condition early and prevent fatalities. Finding at-risk women is now much easier as tests are available, as we have heard, that can predict with nearly 100% accuracy which mothers are at risk of pre-eclampsia, but unfortunately the tests are not being used to their advantage. The test that is currently the only NICE-approved clinically available diagnostic test for pre-eclampsia in the UK has seen uptake in only a handful of trusts so far, meaning that very few women in the UK have access to those life-saving tests. Will the Minister write to NHS trusts urging them to take up those tests, and advising them of the clinical guidance to do so?
Those tests can improve patient safety through accurate diagnosis upon the suspicion of pre-eclampsia, reduce the number of unnecessary admissions of suspected pre-eclampsia and reduce the direct costs to the system from the array of in-patient monitoring tests that are undertaken on the woman and her foetus. They will also relieve the stress and anxiety felt by expectant mothers that their symptoms are pre-eclampsia. We still do not know the root cause of pre-eclampsia. Does the Minister have any plans to fund research into the causes of pre-eclampsia so that more cases can be prevented each year?
Expectant mothers must also be made aware of pre-eclampsia and the signs and symptoms to look out for. I can remember being told about this terrible condition and every time my legs swelled or I had a urine test I would worry that I would get it. Maybe I was more informed or just a worrier, but I probably did not know enough about pre-eclampsia then. I might have been worrying needlessly; information is always a good thing. The knowledge will also fuel patient-led demand for testing and will, again, help to prevent deaths.
I hope the Minister will be able to assure us that the Department will look at this important issue further in the future, so that no more families have to go through the pain and suffering of losing a child to pre-eclampsia that we have heard about today.
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
It is a pleasure to see you here again, Mr Hollobone. It is an absolute privilege to respond to the debate brought by the hon. Member for North Ayrshire and Arran (Patricia Gibson). I thank her for bringing it forward, and for her courage and honesty in the way she has approached the subject, which is clearly sensitive for her. Parliament is at its best when it hears people’s direct experience, so I am grateful for the way in which the hon. Lady has approached this.
I do not think the number of Members here reflects the importance of the subject, but, as the hon. Member for Washington and Sunderland West (Mrs Hodgson) said, the quality of the contributions we have heard, all of which have been linked to direct experience one way or another, has made it one of the most powerful debates we have had in this Chamber none the less. I thank the hon. Member for North Ayrshire and Arran again.
This is the first time that the subject has been debated by Members of Parliament; while that should be shocking, in some respects it is not, because often things that affect many women are not adequately debated in this place. Thankfully, now there are more of us here, we can start to address that, and we will do so all the more often.
The hon. Member for Paisley and Renfrewshire North (Gavin Newlands) talked about his wife’s experience, how she knew her body and presented at the hospital, but was told to go home. I am afraid that happens far too much to women. We often feel diminished or that our voices are not heard. My challenge, in which I am sure all hon. Members will join me, is to ensure that all our health services just stop doing that to women, because it is not good enough. It has left us feeling diminished and not getting the treatment that we all deserve, so I thank him for amplifying that point.
It is always a pleasure to hear from the hon. Member for Glasgow East (David Linden), who has a unique ability to bring to life a dad’s perspective on these concerns and worries. As ever, it was a pleasure to hear from the hon. Member for Washington and Sunderland West, who has also brought her own experience on these subjects in the past. I pay tribute to the work of the all-party parliamentary group that both she and the hon. Member for North Ayrshire and Arran are so passionate about and so active in.
In its short time, the all-party parliamentary group has been incredibly influential; I would struggle to find a more effective one. It is a pleasure for me to work with it and support its work, and I am expecting both hon. Ladies to come with their cap in hand for the next wave of things they want me to fund under that work. It is making a difference and giving support to families on something that has hitherto been taboo, so I am grateful to them for that.
What is important about this debate and about pre-eclampsia is that, as we have heard repeatedly, it is an avoidable illness in the sense that we know the risk factors. To be frank, there is no excuse for the incidence of pre-eclampsia in 21st-century Britain. We may have better performance than other countries—and so we should, because we are Great Britain—but we need to do better, to improve outcomes both for babies, and for mothers and fathers. I rise to the challenge here and will hope to answer some of the requests made in the course of this debate.
It is still the case that pre-eclampsia and HELLP syndrome are a leading cause of maternal mortality and pre-term births, claiming the lives of nearly 76,000 mothers and 500,000 babies internationally each year. However, we know we can monitor the health of people in pregnancy, and we know the healthiest pregnancies are those that are planned, so it is important that we ensure that our policies encourage people to properly plan their pregnancies so that they can manage their health and, in particular, tackle things such as high body mass index and any other risk factors they may have.
In the UK, mild pre-eclampsia affects about 6% of pregnancies, and severe cases develop in about 2% of pregnancies. That is still quite high—dangerously high, considering the risk. According to the statistics for England, 14,352 pregnancies were coded for pre-eclampsia in 2017-18, which is 2.29% of all deliveries. That is 39 women in England diagnosed with pre-eclampsia every day. When we look at those types of figures, they bring home the fact that this condition is more common than the parliamentary attention given to it would suggest.
The prevalence of pre-eclampsia by maternal age or ethnic group is comparable to all pregnancies, but we know there is a risk of hypertensive disorders in women over 40, and those with a gap of 10 years since their last baby are at a higher risk. It is relatively easy to identify the at-risk group. The hon. Member for North Ayrshire and Arran mentioned that there is a higher prevalence among black women, who are five times more likely to die in pregnancy than white women, while Asian women are twice as likely to die. We must ensure that we tackle that, and we will take it forward through the race disparity audit, not least because there are generally other issues that lead to black and Asian women facing higher risk factors in pregnancy across the board.
I have been asked to see that the NHS adopts a life-course focus, rather than a pregnancy disease focus, when looking at this subject. That has come up in my discussions about women’s health. The president of the Royal College of Obstetricians and Gynaecologists tells me that the factors that might lead to a woman’s mortality tend to surface during pregnancy, so it seems to me that we are not taking full advantage of pregnancy to have a look at women’s health and risk factors and help them with long-term prevention of poor health. We really need to do better at that.
For example, there are indications that someone will suffer from chronic kidney disease or cardiovascular disease in later life. We must embrace that life-course approach to women’s health. That is one of the things my women’s health taskforce will take forward, to make sure that we are really not wasting the opportunity of pregnancy to look at the health of women.
Reference has been made to placental growth factor testing, which is being made available in England through the Accelerated Access Collaborative. The hon. Member for Washington and Sunderland West challenged me, fairly, to ensure that trusts make use of that test. We need to take every opportunity to give a nudge and properly encourage all trusts to assess the risk factors in deciding whether to apply those tests.
Obviously, we will continue to have conversations with the Government in Scotland about our experiences. We would also be more than happy to support the efforts of Action on Pre-Eclampsia to raise awareness of pre-eclampsia and other hypertensive diseases in pregnancy during World Pre-Eclampsia Day.
I am pleased to report that there has been a significant decrease in maternal mortality from hypertensive disorders during pregnancy in recent years, but we cannot afford to be complacent. It is certainly true that when we look back at cases where mothers have died, too often, improvements in care could have made for a very different outcome. That reinforces the need to make sure that people are aware of this disease, which can be a killer.
I have been asked to prioritise research into stillbirths from pre-eclampsia. It was such research that supported the study that showed that placental growth factor tests can diagnose pre-eclampsia more accurately than current techniques. We are also funding the PHOENIX study at King’s College London, which aims to determine whether delivery in women with pre-eclampsia between 34 and 36 weeks of gestation reduces maternal complications without short and long-term detriment to the infant, compared with delivery at 37 weeks. That study will conclude next year. We are increasing resources to support parents through the trauma of stillbirth; we continue to fund Sands to work with other baby loss charities and the royal colleges to produce the national bereavement care pathway and to reduce the variation in quality of bereavement care provided by the NHS.
We know that 1,000 babies die every year in the UK because of pre-eclampsia. Most die as a consequence of premature delivery, rather than the disease itself, because the only cure—if, as the hon. Member for North Ayrshire and Arran says, we can call it that—is to deliver the baby. In terms of reducing those deaths, we need to ensure that we are managing that risk. Clearly, it is very important that we take full advantage of all antenatal appointments to do that, so that a pregnancy can be safely managed. We expect midwives to screen for pre-eclampsia at every appointment, by checking the woman’s blood pressure and urine. It is disappointing that MBRRACE-UK found that those routine antenatal checks were not undertaken on most women who died of pre-eclampsia. Straight away, that is something that we really need to give the system a nudge on, to make sure that risks are not taken with the health of the mother or her baby.
On some of the other things that will help to manage this, as part of the long-term plan we will continue to work with midwives, mothers and families to implement continuity of carer, so that there is a longer-term relationship between the mother and health practitioners, who can then have trust and honest, empowered conversations. Women can often feel intimidated when dealing with practitioners who perhaps treat them in a less than humane way. When we have that personal relationship, we can have honest conversations, leading to better care and trust between the mother and her midwife, nurse or doctor.
Pre-eclampsia is very unpredictable, which makes it difficult to manage if the risk factors that add to prevalence are not there. It is clearly crucial that, if a woman’s condition deteriorates, a plan must be implemented quickly, with a multi-disciplinary approach to decision-making recommended. We expect every trust with a maternity and neonatal service to be part of the national maternal and neonatal health safety collaborative, which is driving forward practical improvements to make care safer in all maternity units by the end of 2019-20. I will make sure that there is specific action on monitoring that. NHS England is also supporting the establishment of maternal medicine networks, which will ensure that women with acute and chronic medical problems, including hypertension, have timely access to specialist advice at all stages of pregnancy, which, again, will help those discussions.
Members will be aware that, in November 2017, the Department extended the national maternity safety ambition to include reducing the national rate of pre-term births from 8% to 6%. The new Saving Babies’ Lives care bundle includes a focus on preventing pre-term birth, looking in particular at prediction, prevention and better preparation where pre-term birth is unavoidable. Every maternity service in the NHS is actively implementing elements of the Saving Babies’ Lives care bundle, and we are fully committed to implementing the recently launched version 2 of the bundle by March next year. Adherence to the care bundle is included in the planning guidance and incorporated into NHS standard contracts for 2019-20.
Placental growth-based blood tests clearly provide the ability to better diagnose pre-eclampsia and to manage risks. The tests have been selected as rapid uptake products by the Accelerated Access Collaborative, which works with commercial companies and clinical experts to make such products available much more widely. We will monitor that roll-out. That is an example of how we are trying to be much more fleet of foot when we identify these tests, products or medicines that can make a difference, which involves close working between NHS England and providers to deliver them. As set out in the long-term plan, the NHS will in the future introduce a new funding mandate for health tech products assessed as cost-saving by NICE. Clearly, preventive and testing measures are crucial to that.
I hope that Members welcome the progress made so far on this important issue. I am always happy to hear representations on where we can do better. Clearly, trying to make this country the safest place to have a baby, to make sure that we are doing everything we can to tackle stillbirths and to ensure that all women have safe and healthy pregnancies that deliver safe and healthy babies are priorities of the Government. I am very grateful for the constructive contributions of all Members. I am sure that this will not be the last time that we discuss this subject, even though it might be the first.
Patricia Gibson
We clearly have a lot of work to do to raise awareness of this condition. The poor attendance in this Chamber is a clear testament to that, although I extend heartfelt thanks to my colleagues who have made the effort to come here today and speak.
As we have said—we cannot say this too often— 1,000 babies across the UK die each year from pre-eclampsia-related complications. That demands our attention and requires our action. We know and have heard today that diagnosis and treatment are not what they could be and often not what they should be. If we do not talk about difficult issues, we are extremely unlikely to tackle them or, indeed, prioritise them. With pre-eclampsia affecting about—this is an estimate —6% of pregnancies in the UK, it affects every single constituency. I say this to all constituents who are watching the debate now or who may watch it later if they catch a bit of the news on social media about it: if this is an issue about which you are concerned, I urge you to contact your MP and ask them to raise it at every opportunity, because that is how change happens.
I welcome the Minister’s constructive response to the debate, and I look forward to continuing to work with her through the all-party parliamentary group on baby loss, which deals with neonatal death. As she says, we know which women are likely to be at risk, so we need to ensure that the treatment of those women takes pre-eclampsia into account—that it is on the radar—so that we can better monitor them, and their babies’ lives can be saved as a result. It is also extremely important that women are listened to when they present to any medical professional. That cannot be stressed enough.
It is also important that the placental growth factor test is delivered, especially to those women we know are in at-risk groups. I am encouraged by the Minister’s mentioning the PHOENIX study, because I am hopeful that that will yield additional understanding that will improve treatment for pre-eclampsia.
As the Minister said at the close of her remarks, this is the first debate on pre-eclampsia, but I am pretty confident that it will not be the last.
Question put and agreed to.
Resolved,
That this House has considered pre-eclampsia.