Premature birth is the main cause of brain injury and cerebral palsy in babies. Evidence shows that babies can be protected from brain injury by giving magnesium sulphate to women who are at risk of premature birth. This medicine, costing around £5 per dose, reduces the risk of cerebral palsy by a third. Despite this, many mothers in maternity units across the country were not being offered this important treatment.
To address this issue, in 2014 Bristol NHS Foundation Trust (BFT), in collaboration with Health Innovation West of England, developed a programme to increase the use of magnesium sulphate in the maternity unit at St Michael’s Hospital.
The programme, called PReCePT (Prevention of cerebral palsy in pre-term labour), was designed by both parents and staff. It provided practical tools and training to support hospital staff to give magnesium sulphate to eligible mothers.
After its success at BFT, in 2015 it was piloted in five NHS trusts across the West of England. In 2018, the Health Innovation Network scaled up and rolled out the programme across all maternity units in England, funded by NHS England. The National PReCePT Programme (NPP) aimed to increase use of magnesium sulphate to at least 85% of eligible mothers by 2020.
Researchers at the University of Bristol have now analysed NHS England maternity and neonatal data collected between 2014 and 2024. They looked at whether there were differences in magnesium sulphate uptake between groups of women from different social and demographic backgrounds.
Published in BMJ Open Quality, the study focused on mothers whose babies were born between 24 and 30 weeks' gestation who were admitted to NHS neonatal units. The findings suggest that inequalities in access to the treatment have narrowed substantially after the National PReCePT Programme was introduced.
Before the national programme, mothers in the North of England were significantly less likely to receive magnesium sulphate than mothers in the South. Women living in more deprived areas were also less likely to receive the treatment than those in more affluent areas.
However, after the rollout of the National PReCePT Programme, the researchers found no evidence of ongoing regional or deprivation-related differences in treatment rates.
The study also found some evidence that white British mothers may have been slightly less likely to receive magnesium sulphate than mothers from other ethnic groups. However, this difference was small and did not appear to change after the programme was implemented. Age did not seem to influence whether a mother received the treatment.
Hannah Edwards, Senior Research Associate in Medical Statistics at the University of Bristol, said:
“We know from recent inquiries that maternity care in the UK is not always fair, and some mums and babies seem to miss treatment they need and have worse outcomes. Our findings show progress in reducing inequalities in this aspect of maternity care.
“Since the rollout of the PReCePT programme, the North-South divide in magnesium sulphate use has reduced, helping to ensure that mothers and babies across England can benefit from this important intervention, regardless of postcode."
Karen Luyt, PReCePT national clinical lead, Professor of Neonatal Medicine at the University of Bristol and Consultant Neonatologist at Bristol NHS Foundation Trust, added:
“The success of PReCePT shows what can be achieved when evidence-based improvements are implemented consistently across the NHS. By reaching every maternity unit in England, the programme has helped deliver better and more equitable care for women at risk of very preterm birth.
“We believe this approach could be applied to other challenges in maternity and baby care, helping to ensure that improvements benefit all families, regardless of where they live or their background."
The researchers conclude that access to antenatal magnesium sulphate is now more equal across different groups in England. While the study cannot confirm a direct cause, the National PReCePT Programme may have helped to reduce those inequalities.
As a result, more very premature babies may receive this treatment, which can reduce the risk of cerebral palsy and other neurological complications.
The research is part of a study organised and funded by the Health Innovation Network (formerly the AHSN Network), National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), and the Health Foundation.
Paper
‘Antenatal magnesium sulphate for neuroprotection of preterm babies: data analysis of inequities in treatment in England 2014 to 2024’ by Hannah B Edwards, Lauren J Scott, Cheryl McQuire, Isobel L Ward, David Odd, Frank de Vocht, Karen Luyt in BMJ Open Quality