Policy and practice change at local, regional and international levels: impacts from Born in Bradford

YesBorn in Bradford is a prospective pregnancy and birth cohort in the UKs 6th largest city. Between 2007 and 2011 12,453 women (13,776 pregnancies), 3,448 of their partners and 13,818 babies were recruited. Half of families are in the poorest fifth of deprivation for England and Wales, and 45% are of Pakistani origin. Recruitment was in one Metropolitan District. This allows consideration of the impact of local circumstances, including service provision and policy choices, and engagement with the local community to implement evidence based responses to study findings. The introduction of a large study into a local health economy contributed to organizational changes including the development of a paperless maternity data system and better links between primary, secondary, and child health services. Embedding research in practice can lead to improved quality of routine data collected, for example on infant growth, and make routine data available for research, enhancing its cost effectiveness. Early adoption of research findings locally includes the introduction of routine vitamin D supplementation and an oral glucose tolerance test for all pregnant women. Findings that consanguinity was associated with a doubling of risk for congenital anomaly and that 30% of all anomalies in children of Pakistani origin could be attributed to consanguinity reinforced local commitment to community education about genetics and targeted genetic counselling. These findings also led to the establishment of a regional congenital anomalies register. In partnership with the European ESCAPE consortium (14 cohorts in 12 countries) a significant association was found between fetal growth and air pollution. The European Environmental Agency Director stated that this evidence is sufficient to trigger changes in EU regulations. Some findings can be quickly embedded in local provision, some have a resonance that prompts regional changes, some are generated with collaborators and can lead to policy change at international level