Understanding ethnic disparities in adverse pregnancy outcomes in the UK using our future health

Ethnic disparities in adverse pregnancy outcomes remain a persistent public health concern in the UK. Women from minority ethnic backgrounds—particularly Black and some Asian groups—experience substantially higher rates of stillbirth, preterm birth, and maternal mortality compared with White British women. Although these inequalities are well documented, their underlying drivers remain poorly understood. Known risk factors, including socioeconomic disadvantage, health behaviours, and pre-existing medical conditions, only partially explain observed differences. Moreover, the relationship between deprivation and risk appears to vary across ethnic groups. National surveillance data and surveys frequently include only high-level information about ethnicity which groups together heterogenous ethnic and cultural groupings, which may mask multiple cultural, ethnic and religious differences. There is a need for large-scale, integrated data that combines social, behavioural, and biological information to better understand pathways underlying these disparities.

This research examines ethnic disparities in adverse pregnancy outcomes using data from Our Future Health (OFH), the UK’s largest biomedical research programme to date, comprising over 2.1 million participants. What is unique about OFH is its absolute size, broad representativeness by age range and ethnicity, and the breadth of information collected. To date OFH has successfully recruited approximately 10% of participants from UK non-White ethnic-minority groups, with larger samples of ethnic minorities and younger female participants compared to comparable biomedical studies such as UK Biobank.

Our study includes women of reproductive age with recorded pregnancy outcomes and ethnicity data. Outcome variables are stillbirth, preterm birth (<37 weeks gestation), foetal growth restriction and maternal mortality. We combine self-reported demographic and lifestyle characteristics, physical measurements (e.g., BMI and blood pressure), biomarkers from blood samples, and linked NHS health records. We conduct mediation analysis to quantify the extent to which socioeconomic status, health behaviours, cardiometabolic conditions, biological markers, and differences in area-level deprivation or health services, explain disparities.