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Objectives There exists a body of research regarding ethnic differences in perinatal health whereas this is not the case concerning the role of migration status and acculturation in attenuating these differences. This study aims to investigate determinants of health during pregnancy up to one-year postpartum by migration status. Methods The study utilises data collected by the Born in Bradford cohort. The focus of analysis was migration status groupings, based on self-reported country of birth of participants and their parents and grandparents. Chi-Square, one-way ANOVA and correlation coefficients examined relationships between variables. Results Migrant women were less likely to smoke (native: 34.4%, 1st generation: 2.8%, 2nd generation: 8.6%) or to be obese (native: 25.5%, 1st generation: 17.4%, 2nd generation: 21.3%) compared to native women. Migrants were less physically active at 6 months (Mean (SD) minutes/week: native 265 (245), 1st generation 113 (162), 2nd generation 147 (182)) with larger increases in BMI over time compared to native women. Migrant women were more likely to be suffering psychological distress at baseline and 6 months postpartum and migrant families were more likely to live in areas of high socio-economic deprivation, despite higher levels of educational attainment. Conclusions for Practice This study ethnicity and migration identifies some important differences between ethnic groups with different migration histories, therefore indicating that healthcare professionals should consider eliciting full migration histories to improve care. The impact of these differences on perinatal outcomes is a priority for future research.

Objective: To investigate differences in infant feeding practices and styles by maternal migration status Design: Prospective cohort study Setting: Maternity unit of a large hospital in Northern England Participants: Women recruited to the Born in Bradford longitudinal cohort study Measurements: Breastfeeding initiation; breastfeeding at six months; breastfeeding at twelve months; timing of introduction of complementary feeding; maternal feeding style at twelve months. Findings: Migrant women were more likely to initiate breastfeeding and continue breastfeeding for longer compared to native women. Native women also introduced complementary feeding earlier than migrant women. There was evidence of feeding practices among second= generation migrants becoming increasingly more aligned with those of native women, with lower breastfeeding rates and earlier introduction of complementary feeding compared to first-generation migrants. Migrant women were more likely to adopt a ‘Demanding’ feeding style, with the strongest associations seen in first-generation migrants. Key conclusions: Migration status is an important factor to consider in reference to infant feeding practices. This is particularly important in considering intergenerational changes in families with migration backgrounds and the potential of culture to impact on family practices. Implications for practice: Interventions to maintain cultural norms around infant feeding in families with migration backgrounds would be beneficial, due to the observed higher rates of breastfeeding in first-generation migrants. Targeted interventions to improve breastfeeding in white British native women should consider the role that culture can play in encouraging positive health behaviours.

Objective: To investigate the relationship between maternal ethnicity and migration status on perinatal outcomes. Design: Population-based cohort Setting: Maternity department of a large hospital in Northern England Population: Women delivering at Bradford Royal Infirmary between March 2007 and December 2010 Methods: Impact of maternal migration status and ethnicity were assessed using multiple logistic regression for categorical outcomes and multiple linear regression for continuous outcomes. Main outcome measures: Maternal and neonatal outcomes Results: First-and-second-generation Pakistani migrants had higher odds of low birthweight (aOR 1.63, CI 1.35-1.97 and aOR 2.01, CI 1.66-2.42 respectively) and gestational diabetes (aOR 2.68, CI 2.20-3.27 and aOR1.79, CI 1.43-2.23) and lower odds of macrosomia (aOR 0.30, CI 0.24-0.37 and aOR 0.30, CI 0.24-0.39) compared to white British natives. First-generation Pakistani migrants also had higher odds of stillbirth (aOR 2.01, CI 1.00-4.01) and lower odds of preterm birth (aOR 0.80, CI 0.64-0.98) and APGAR score

Introduction Approximately 20.1% of Indonesian pregnant women are underweight (BMI Methods This is a two armed feasibility RCT (1:1) in which 200 women with body mass index Results A total of 107 women were recruited to the trial in the first wave from Dec 2018-March 2019 (recruitment rate of ∼25/month). Of these 81 have been followed up to delivery and will be followed up to 6 months postpartum. Local Dadih production reached its full capacity in one region and recruitment had to be extended to other regions. Comparative trends on study outcomes including GWG, mode of birth, postpartum depression, postpartum haemorrhage, maternal nutritional status, anaemia, birthweight, gestational age, admission to neonatal care unit, breastfeeding, neonatal health status will be reported. Conclusions Early results show that the supplementation is acceptable to women and protocol implementation is feasible. In order for this feasibility project to be developed to a full scale RCT, improvements to the infrastructure of supply are required. Such projects may have positive economic impact and provide sustainable solutions to local maternal and neonatal health challenges. Reference 1. Soltani H, Lipoeto NI, Fair FJ, Kilner K, Yusrawati Y. (2017) Pre-pregnancy body mass index and gestational weight gain and their effects on pregnancy and birth outcomes: a cohort study in West Sumatra, Indonesia. BMC Women's Health. Key messages Nutritional supplementation using a traditional Indonesian yogurt (Dadih) made from buffalo milk during pregnancy has been received positively by women. Depending on the observed comparative trends from the study outcomes, infrastructure investment is required to enable the feasibility study to be expanded to a full scale randomised controlled trial.

Background Maternal overweight and obesity are associated with numerous adverse outcomes including higher rates of maternal and infant mortality and morbidity. Overweight and obesity before, during and after pregnancy are therefore a significant public health priority in England. This project explored and mapped healthy weight service availability at different stages of the childbearing cycle. Methods A mixed methods approach included a questionnaire-based survey disseminated through Local Maternity Systems and semi-structured interviews or focus groups with providers and commissioners. Current maternal weight service provision was explored along with some of the barriers and facilitators for providing, delivering and accessing healthy weight services. Descriptive statistics were reported for quantitative data and content analysis was used for thematic reporting of qualitative data. Results A total of 88 participants responded to the survey. All services were offered most frequently during pregnancy; with healthy eating and/or weight management services offered more often than physical activity services. Few services were targeted specifically at women with a raised body mass index. There was a high degree of inconsistency of service provision in different geographical areas. Several themes were identified from qualitative data including “equity and variation in service provision”, “need for rigorous evaluation”, “facilitators” to encourage better access or more effective service provision, including prioritisation, a change in focus and co-design of services, “barriers” encountered including financial and time obstacles, poor communication and insufficiently clear strategic national guidance and “the need for additional support”. Conclusions There is a need to reduce geographical variation in services and the potential health inequalities that this may cause. Improving services for women with a raised body mass index as well as services which encourage physical activity require additional emphasis. There is a need for more robust evaluation of services to ensure they are fit for purpose. An urgent need for clear national guidance so that healthcare providers can more effectively assist mothers achieve a healthy weight gain was identified. Commissioners should consider implementing strategies to reduce the barriers of access identified such as childcare, transport, location and making services free at the point of use.

There is significant evidence to suggest that pregnancy outcomes among\ud adolescent pregnant women may be less favourable compared to those of adult\ud women. Incidence of preterm delivery, low birthweight and babies who are small\ud for their gestational age have been identified as outcomes of particular concern\ud for this population. One school of thought regarding this issue suggests that\ud nutrition in adolescent pregnancies may have a role to play in reducing these\ud differences and improving outcomes for adolescent mothers and their babies,\ud however this area is in need of further research. The primary aim of this thesis\ud therefore is to address the research question "Is there a need for additional\ud nutritional support in adolescent pregnancies?"\ud This is a mixed methods study following a sequential explanatory design in\ud which priority is given to the quantitative research phase. Following a\ud systematic review of the academic literature, the program of research is carried\ud out in two distinct phases and the findings from each integrated.\ud The quantitative research phase utilises secondary data from the Born in\ud Bradford cohort study to investigate differences in maternal and neonatal\ud outcomes and dietary patterns between adolescents (age ≤19 years) and an\ud adult control group (age 20-34 years). Differences in outcomes were assessed\ud using logistic regression models and differences in dietary pattern assessed\ud using a combination of principle component analysis and regression models.\ud The qualitative research phase was informed by the results of the quantitative\ud phase and sought the perspectives of youth support professionals on\ud supporting healthy eating in adolescent pregnancies through semi-structured\ud interviews. Interviews were transcribed and analysed thematically. Findings\ud from the program of research as a whole were then integrated narratively.\ud The results of the systematic literature review confirmed that the nutritional\ud status of pregnant adolescents is likely to be poor. The quantitative analyses\ud identified significant differences in outcomes between adolescent and adult\ud women, particularly a higher odds of delivering babies who were very (

ObjectivesExplore associations between maternal and neonatal outcomes and maternal age, with particular reference to adolescent women.DesignPopulation-based cohort study.SettingMaternity department of a large hospital in Northern England.ParticipantsPrimiparous women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 aged ≤19 years (n=640) or 20–34 years (n=3951). Subgroup analysis was performed using women aged ≤16 years (n=68). Women aged 20–34 years were used as the reference group.Primary outcome measuresMaternal and neonatal outcomes.ResultsThe odds of extremely low birth weight (Women in the adolescent group had lower odds of gestational diabetes (aOR 0.35, 95% CI 0.20 to 0.62), caesarean delivery (aOR 0.53, 95% CI 0.42 to 0.67 and instrumental delivery (aOR 0.53, 95% CI 0.41 to 0.67).ConclusionsThis study identifies important differences in maternal and neonatal outcomes between women by age group. These findings could help in identifying at-risk groups for additional support and tailored interventions to minimise the risk of adverse outcomes for these vulnerable groups. Further work is needed to identify the causal mechanisms linking age with outcomes in adolescent women where significant gaps in the literature exist.

Background Babies born to adolescent mothers have been shown to have poorer outcomes compared to those born to adults. Nutritional status may have an important role to play in improving the health of pregnant adolescents; however there is a lack of evidence regarding the adequacy of adolescent diets during pregnancy. This systematic review aims to examine what is known about the nutritional status of adolescent pregnant women. Methods A systematic search of the literature identified 21 studies which met the inclusion criteria for the review. Primary research papers using any methods were included where they were published in English between January 1995 and May 2015 and included measurements of nutrient intakes or biological markers of nutritional status in pregnant women aged 11–19 years. Individual study data was first summarised narratively before study means were pooled to give an estimate of nutritional status in the population. Results The results show that individual studies reported intakes of energy, fibre and a number of key micronutrients which were below recommended levels. Biological markers of iron and selenium status also showed cause for concern. Pooled analysis of individual means as a percentage of UK Dietary Reference Intakes showed intakes of vitamin D (34.8 % CI 0–83.1) to be significantly below recommendations (p = 0.05). Serum selenium levels were also found to be low (61.8 μg/L, CI 39–84). Conclusions This review has identified a number of areas where the nutritional status of pregnant adolescents is sub-optimal, which may have implications for the health of adolescent mothers and their babies. It was not however possible to examine the impact of supplement use or socio-demographic characteristics which limits the interpretation these results. Further work is needed to establish the characteristics of those most at risk within this population, how this differs from adult pregnant women and the role of supplementation in achieving adequate nutrition. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1059-9) contains supplementary material, which is available to authorized users.

BACKGROUND: Nutrition is a modifiable factor affecting birth outcomes, particularly in adolescent pregnancies. This study explores diet and supplementation practices, information and advice before, during and after pregnancy from the perspectives of pregnant or new young mothers and healthcare professionals. METHODS: Two cross-sectional surveys used online questionnaires for young women who were currently pregnant or who had recently given birth, and health care professionals providing antenatal care. The surveys utilised a combination of question types including free text and multiple choice. Recruitment was conducted via the Tommy's website, online forums for young mothers and professional networks. RESULTS: A total of 205 young women and 146 health care professionals were included in the study. Most young women reported taking supplements at some stage of pregnancy (93.2%), with 54.6% taking it on a daily basis. Those who reported taking supplements less than 7 days a week stated it was mainly due to forgetting. Health care professionals however reported that some young women had difficulties accessing healthy start supplements. Young women reported positive dietary changes; however a significant proportion of participants indicated that they avoided some foods unnecessarily. Avoiding or reducing foods such as red meat (22.7%), eggs (40.6%), oily fish (60.4%) and soft cheese (36.2%) is of concern. Midwife/family nurse (38.0%) was young women's current favourite information source; smartphone applications (apps) and recipe booklets were suggested by over 50% of participants as a new addition to existing services. Health care professionals reported they included nutritional information and support as part of their role; however they felt there were some gaps in knowledge and confidence. Midwives in particular suggested a lack of sufficient time and resources as a main challenge in providing adequate support. CONCLUSIONS: Avoiding or reducing major food groups was reported which can indicate a poor dietary pattern. A positive change in dietary intake reported by the majority of young women in this survey indicates willingness to adopt a healthy lifestyle. This, in addition to their trust in health professionals particularly midwives, provides an opportunity for health interventions which support behaviour change to improve birth outcomes. Identified gaps in knowledge and confidence by health professionals in providing dietary advice highlight the need for some additional training for health professionals in delivering dietary and lifestyle behaviour change interventions. Independent and trustworthy online resources for women and their health professionals which can be accessed at any time to provide up to date information in between appointments are also required.