Tuesday Talks Recap: How can we tackle the constellation of biases affecting the care of pregnant women?

This blog was written by Tarrion Baird (Research Fellow, Cellular Life) recapping our Tuesday Talks/DwD presentation on 3 Jun 2025.

Week 7’s Tuesday Talk, How can we tackle the constellation of biases affecting the care of pregnant women?, was given by Professor Marian Knight, Professor of Maternal and Child Population Health at the National Institute for Health and Care Research (NIHR).

It began with an overview of Professor Knight’s exciting career to date, emphasising that everyone experiences failure and that you can never predict where your career will end up going.

Why are Pregnant Women Still Dying?

The talk then moved onto the discussion of pregnancy, beginning with a powerful quote from Professor Mahmoud Fathalla. It was delivered to the International Federation of Obstetricians and Gynaecologists in 2006:

"Women are not dying because of diseases we cannot treat. They are dying because societies have yet to decide their lives are worth saving."

Professor Knight emphasised that this quote remains very true. Progress in reducing the deaths of pregnant women, mothers, and babies has flatlined in the last eight years due to a reduction in investment. Indeed, 4.5 million women and babies die every year during pregnancy, birth or the first week of life.

The challenges of data

The presentation then outlined the challenges of using evidence from randomised controlled trials (studies where participants are randomly assigned to different treatments to compare results) to guide clinical practice for pregnant women and babies:

• A ‘lack of equipoise’, meaning that women have perceived ideas of how they wish their pregnancy and childbirth to happen, so do not want to be randomised.

• Challenges associated with the time taken to assess the long-term impacts on babies. For example, the long-lasting effects of a treatment on academic attainment may not be observable until the child completes their final school exams.

• Some trial outcomes are also very rare, which creates problems in generating a trial cohort that’s large enough to have results that are statistically meaningful.

• There are also issues regarding interventions often taking place in emergency situations, this can also provide issues in gaining consent.

• Finally, the impacts of the treatment on both mother and baby must be assessed, and it can be difficult to work out who to prioritise between the mother and the child.

The UK Obstetric Surveillance System

In spite of these challenges, Professor Knight has set up or worked in a series of large studies for pregnant women and babies. One such study system is the UK Obstetric Surveillance System (UKOSS), which acquires and analyses observational data on pregnancy and childbirth outcomes from within the UK, and has been an enormous success. UKOSS has now completed over 70 studies and 86 publications, with the model adopted internationally.

Professor Knight described several UKOSS success stories of UKOSS. One example was a study to provide guidance on whether the birth of a second child should be by caesarean section if the first child was delivered that way. Another was a study to guide on the use of various medications within pregnancy.

Reflections over dinner

The presentation ended with a description of the various inequalities in pregnancy and childbirth outcomes both internationally and within the UK. Afterwards, guests enjoyed an excellent fish and chip dinner, and a delicious apple crumble.

The student questions and comments were very informed and insightful. Some attendees had even worked in healthcare in Kenya, or had researched into pregnancy in prison settings, so had excellent complementary perspectives on this talk.