KHPeople: Prof Laura Magee

Following International Women’s Day, Samara Ruberg sits down with Prof Laura Magee to learn more about her research on pregnancy, hypertension, and the impact of COVID-19.

Please describe your role(s) within King’s Health Partners.

I joined King’s College London in 2015 as a Professor of Women’s Health. My clinical background is obstetric medicine, and my research has focused on the hypertensive disorders of pregnancy and antihypertensive therapy specifically.

For reference, hypertension––high blood pressure––is a condition where the force of the blood in the arteries is too high. In south east London, about 10% of women experience hypertensive disorders of pregnancy. Additionally, I am an active member of the KHP’s Women and Children’s Health Clinical Academic Partnership (CAP).

Please describe your work and research into maternity care and the RESILIENT project.

As did so many of us, I pivoted to work on COVID-19 during the pandemic. It was clear that while COVID-19 infection affected many pregnant women, maternity care service reconfigurations affected all women in pregnancy and postpartum. With my clinical training in high-risk pregnancy, it seemed logical to work on COVID-19, which was more severe in pregnant women as well as those with more medical problems specifically.

Can you introduce us to how RESILIENT works. What are you measuring? How are you collecting data? Who are you researching?

RESILIENT is a National Institute of Health and Care Research (NIHR) funded project on post-pandemic planning in maternity care, involving co-investigators from King’s College London, St. George’s, University of London, and the University of Warwick. 

During the pandemic, pregnant and postpartum women often had ‘virtual’ care (by phone or online), rather than in clinic. Some women monitored their blood pressure or blood sugar at home and transmitted readings to care-providers via apps.

Also, women had to decide whether to accept COVID-19 vaccination when offered. The effects of maternity care changes on pregnant and postpartum women may have been greater for those with complex needs or already affected by inequalities.

RESILIENT is a two-year project (from November 2021) in which we aim to:

1. Study among all pregnant women, the consequences for maternity care quality, health, and costs, of rapidly-changed models of maternity care that incorporated virtual care, self-monitoring (such as of blood pressure), and decisions about COVID-19 vaccination (including reasons and side effects);
2. Study whether the consequences for all women were magnified or diminished for minority ethnic group women, and those living with social or medical complexity (including subfertility and mental health problems); and
3. Engaging with stakeholders to develop policy interventions for local, regional, and national health systems across the four nations.

The work is being delivered in three types of work ‘packages’. The first package is using routinely-collected maternity and mental health information from currently-linked South London records in the early-LIfe data cross-LInkage in Research (eLIXIR) platform. This is a unique King’s Health Partners resource.

The second package involves interviews with women (and specifically those living with social or medical complexity), partners, health care workers, and policy-makers, to gather views on care changes undertaken and their effects. UK-wide, we have surveyed women who are planning pregnancy, pregnant, or postnatal and using the King’s College London COVID-19 Symptom Study (CSS)/ZOE Global Ltd. App, to share their views on COVID-19 vaccination and pregnancy outcomes. 

Finally, we are planning to hold ‘listening events’ in each of the four nations, and a national ‘Policy Lab’, where we will ‘imagine our best future’ and co-produce actionable recommendations for policy-makers.

Importantly, all facets of our work involve patient and public involvement and engagement (PPIE), through a team member and a broader advisory group that meets quarterly.

What is the anticipated impact of RESILIENT? 

Our impact will be on women, NHS maternity staff, NHS Long Term Plan, and wider society. We aim to learn how to ‘build back fairer’, by asking whether there were any changes to maternity care that were useful, unwelcome or damaging, or more costly?

We will identify whether there were different groups of women affected, and articulate lessons learned to reduce inequalities in maternity care. We will share our findings locally, regionally, and nationally, across the four nations, through peer-reviewed publications, webinars, social media, online, and a plain-language report. In fact, we just published our first article––“National surveillance data analysis of COVID-19 vaccine uptake in England by women of reproductive age”––in Nature Communications in February 2023 and it can be accessed here.

How has being a part of King’s Health Partners supported your work?

First, I was fortunate to receive a King’s Together Fund grant for COVID-19 work at the very beginning of the pandemic; this opportunity catalysed all subsequent pandemic-related work, by bringing together a team of individuals who were keen to work together on this topic. That funding made all the difference to me. 

Second, my membership of the Women and Children’s Health CAP has been hugely helpful to me, particularly by providing networking opportunities. More specifically, the CAP connected me with the ZOE app and COVID-19 Symptom Study Biobank and the Policy Institute at King’s College London.

Today, both are key aspects of work in RESILIENT and, I hope, in future work. Finally, I was again fortunate to receive another King’s Together Fund to catalyse further work on postnatal care, an area of maternity care that is very much in need of our focussed attention.