Pre-eclampsia

Jackie Doyle-Price Excerpts

Thursday 9th May 2019 Westminster Hall

[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.