King's College London

Perinatal mortality rates for Black and Asian women in the UK are higher than those for white women. Black and Asian women are also generally underrepresented in clinical research. Here, Holly Lovell and colleagues explore the extent to which representation and inclusion are considered in UK maternity trials. They identify UK-based trial protocols that recruited pregnant people or people within 6 months of giving birth between 2004-2024, as well as any resulting publications. They then explore whether the study design considers representation of participants, and whether the studies aimed to recruit from ethnic minority groups. The authors also ask whether representation and recruitment strategies were discussed in the results papers. Of 96 published protocols, only 8 mention specific recruitment strategies, with 5 mentioning retention strategies. Meanwhile, 57 of the 67 results papers analysed report on participant ethnicity, but only 32 papers discuss whether the study participants are representative. Overall, this study shows that few UK maternity trials report strategies for ethnically representative participant recruitment, suggesting a need for inclusive research guidance in this field.

Holly is a Senior Research Midwife at Guy’s and St Thomas’ NHS Foundation Trust (GSTT), and this is the first publication to result from her PhD research. “I knew undertaking a PhD would be a labour of love and therefore it had to be something I was passionate about,” Holly said. “In 2019, MBRRACE published their report showing that Black women were five times more likely to die in pregnancy compared to White woman, and FIVEXMORE started their hugely influential campaign to address these inequalities. I was involved in some other initiatives around inclusion, but I knew there was a lot of work going on in the field, and I didn’t see how I could add value from a research perspective. Then the pandemic happened, and there was a lot of discussion around under-representation of ethnic minority groups within research. Working as a research midwife I felt this was a really important element I could explore. If we were not including the women impacted by the worst outcomes in our research, how would we ever improve care? This was the spark that started my application to undertake a PhD.”

Reflecting on the potential impact of her work, Holly said: “I hope the results of my scoping review demonstrate a need for inclusion and diversity to be more thoroughly considered throughout all stages of perinatal clinical trials, and that authors should be more explicit in discussions around generalisability and who were represented within their participants. This will better illustrate where our gaps still exist in terms of who we are including in our research.”

Holly hopes her future work in this area will help drive these changes and embed inclusion and diversity in maternity research – a major part of her PhD research is around the development of recommendations for those involved in all parts of the research cycle on how they can ensure they are offering genuine choice to woman from ethnic minority groups to participate in research.

Holly is also Head of Nursing and Midwifery for ACORN (A Centre of Research for Nurses and Midwives) at GSTT. “I am really passionate about the impact of nurse and midwife led research, and so being able to support others to develop feels like such a privilege,” Holly said. “Working with colleagues across the organisation has opened my eyes to the huge range of research activities that staff are doing, and these conversations and collaborations are really important in growing as a researcher. Part of my role is to explore how nurses and midwives can be supported to embed research in their careers, which is a challenge nationally as we do not have the same pathways compared to our medic colleagues who pursue clinical academic careers. Being able to be part of this conversation and to explore how we can better facilitate this is important for our profession, and it also helps me consider my next steps post-PhD. I hope I will be able to combine research and clinical roles, and it would be great to see our work in ACORN contribute to making this a reality.”

‘Recruitment, retention and reporting of ethnic representativeness in maternity trials: a scoping review’ (Lovell et al.) (DOI: 10.1136/bmjopen-2025-098926) was published in BMJ Open).