Contact with child protection services during pregnancy: a cross-sectional study using the eLIXIR Born in South London, UK maternity-child data linkage

In the last decade, rates of children with child protection agency involvement have increased in many high-income countries, including the UK. Disparities in both maternal and child health outcomes as well as child welfare referrals have been widely evidenced, yet no previous research has investigated contact with child protection agencies in the UK (Children's Social Care, CSC) during pregnancy using linked maternity and mental health records. The aim of this study was to investigate characteristics of pregnant women when child protection agencies are involved and investigate what risk factors are associated with child protection agency contact during pregnancy. We conducted a retrospective cross-sectional study using linked electronic health records from maternity, neonatal, and mental health services in South London (eLIXIR-BiSL cohort). A cohort of singleton pregnancy records was created (October 2018 – April 2023). We used descriptive statistics to investigate sociodemographic and clinical characteristics, and binomial regression to explore risk factors and characteristics associated with CSC contact during pregnancy. A cohort of 36,322 singleton pregnancy records was studied, with CSC contact identified in 2,206 records (6%). CSC contact was most frequently observed among Black and multiparous women, and those living in poorer socio-economic circumstances. Those with CSC contact more often had recorded medical, obstetric and psychiatric comorbidities compared to those without CSC contact. When investigating referral indications associated with CSC contact, we found 1,733 pregnancy records with risk factors indicating referral concordant with local guidance yet without any CSC contact. In contrast, in 913 pregnancies CSC contact occurred without any prescribed referral indication being identified. In this group, CSC contact was more frequently associated with Black or mixed ethnicity, social deprivation, maternal unemployment, single motherhood, maternal age under 25 years, previous domestic abuse disclosures, and previous mental health or CSC contact. In this UK population cohort, socio-economic and ethnic disparities were observed between those in contact with child protection agencies during pregnancy and those without. This continued to be observed when excluding those with referral indications associated with CSC involvement. Consistent guidance and a strengths-based family approach is needed to address referral disparities for this group of women and birthing people.