{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:15:43Z","timestamp":1787163343307,"version":"build-2736575974"},"reference-count":32,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Strategic Priority Fund","award":["MR\/W014432\/1"],"award-info":[{"award-number":["MR\/W014432\/1"]}]},{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,9]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study is to co-produce a care bundle for women with multiple long-term health conditions (MLTC) that could be pilot tested and implemented in UK maternity services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Online co-production workshops each attended by 20\u201330 key interest holders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>United Kingdom, October 2023-February 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Women with experience of pregnancy with MLTC, healthcare professionals and other interest holders involved in commissioning, planning and delivering care for pregnant women with MLTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study followed a three-step process: (1) a consolidated list of key components of care for pregnant women with MLTC was created through secondary analysis of prior collected qualitative data; (2) the list of care components was explored during four co-production workshops; and (3) findings from (1) and (2) were synthesised to develop a maternity care bundle of 4\u20135 key care components for pregnant women with MLTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>A maternity care bundle of five key care components for pregnant women with MLTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A list of 25 care components was refined to develop a proposed care bundle of five components. These were provisions of early and reliable medication advice and decision support; creation of a \u2018goals of care summary\u2019 accessible to women and the care team; provision of continuity of midwifery care throughout pregnancy and postnatal care; provision of a named care coordinator; and a formal postnatal handover of care from the multidisciplinary care team to the General Practitioner (GP) and secondary care team involving the woman.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study coproduced an evidence-based care bundle for pregnant women with MLTC to enhance communication and ensure individualised care and support. Further collaborative work with women and professionals is required to refine, implement and evaluate its impact on outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103366","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T14:55:17Z","timestamp":1770389717000},"page":"e103366","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Maternity care bundle for UK women with multiple long-term health conditions: coproduction workshops"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5260-4450","authenticated-orcid":false,"given":"Stephanie","family":"Hanley","sequence":"first","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"McCann","sequence":"additional","affiliation":[{"name":"Aberdeen Centre for Evaluation, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3680-7124","authenticated-orcid":false,"given":"Megha","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Vowles","sequence":"additional","affiliation":[{"name":"Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2332-5452","authenticated-orcid":false,"given":"Siang Ing","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Plachcinski","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6816-1279","authenticated-orcid":false,"given":"Krishnarajah","family":"Nirantharakumar","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mairead","family":"Black","sequence":"additional","affiliation":[{"name":"Aberdeen Centre for Women\u2019s Health Research, Aberdeen Maternity Hospital, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Locock","sequence":"additional","affiliation":[{"name":"Aberdeen Centre for Evaluation, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beck","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"2026062610411018000_16.2.e103366.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-04442-3","article-title":"Epidemiology of pre-existing multimorbidity in pregnant women in the UK in 2018: a population-based cross-sectional study","volume":"22","author":"Lee","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026062610411018000_16.2.e103366.2","doi-asserted-by":"crossref","DOI":"10.1016\/j.preghy.2018.08.430","article-title":"401. A retrospective audit of the socio-demographic characteristics and pregnancy outcomes for all women with multiple medical problems giving birth at a tertiary hospital in the UK in 2016","volume":"13","author":"D\u2019Arcy","year":"2018","journal-title":"Pregnancy Hypertens"},{"key":"2026062610411018000_16.2.e103366.3","doi-asserted-by":"crossref","DOI":"10.5888\/pcd15.170397","article-title":"Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions","volume":"15","author":"Admon","year":"2018","journal-title":"Prev Chronic Dis"},{"key":"2026062610411018000_16.2.e103366.4","unstructured":"Knight MB . Saving Lives, Improving Mothers\u2019 Care Core Report - Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. 2022: Oxford,"},{"key":"2026062610411018000_16.2.e103366.5","unstructured":"Knight MB , Kotnis R . Saving Lives, Improving Mothers\u2019 Care Core Report - Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21. 2023: Oxford,"},{"key":"2026062610411018000_16.2.e103366.6","unstructured":"Frise CRS , Kelly T , Shakespeare J , et al . Messages on caring for women with multiple morbidities. In: Knight M , Bunch K , Patel R , et al ., eds. Saving Lives, Improving Mothers\u2019 Care Core Report - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. 2022: 34\u201344."},{"key":"2026062610411018000_16.2.e103366.7","doi-asserted-by":"crossref","DOI":"10.1111\/hex.14104","article-title":"Lost in the System: Responsibilisation and Burden for Women With Multiple Long-Term Health Conditions During Pregnancy","volume":"27","author":"Hanley","year":"2024","journal-title":"Health Expect"},{"key":"2026062610411018000_16.2.e103366.8","unstructured":"Excellence, N.I.f.H.a.C . Intrapartum care: existing medical conditions and obstetric complications. Quality standard [QS192], 2020. Available: https:\/\/www.nice.org.uk\/guidance\/qs192 [Accessed 22 Nov 2024]."},{"key":"2026062610411018000_16.2.e103366.9","unstructured":"Gynaecologists R . Providing Quality Care for Women. a Framework for Maternity Service Standards. London, 2016."},{"key":"2026062610411018000_16.2.e103366.10","unstructured":"Service NH . Maternal medicine network service specification. 2021."},{"key":"2026062610411018000_16.2.e103366.11","unstructured":"Resar RG , Haraden C , Nolan TW . Using Care Bundles to Improve Health Care Quality. Cambridge, MA: Institute for Healthcare Improvement, 2012."},{"key":"2026062610411018000_16.2.e103366.12","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s00192-021-04786-y","article-title":"The OASI care bundle quality improvement project: lessons learned and future direction","volume":"32","author":"Jurczuk","year":"2021","journal-title":"Int Urogynecol J"},{"key":"2026062610411018000_16.2.e103366.13","unstructured":"England, N.H.S . Saving Babies Lives Version Three. 2023."},{"key":"2026062610411018000_16.2.e103366.14","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2026062610411018000_16.2.e103366.15","doi-asserted-by":"crossref","unstructured":"Boone A , Braeckman L , Michels N , et al . Accessibility, Retention and Interactivity of Online Co-Creation Workshops: A Qualitative Post-Hoc Analysis. Int J Qual Methods 2023;22. doi:10.1177\/16094069231180169","DOI":"10.1177\/16094069231180169"},{"key":"2026062610411018000_16.2.e103366.16","doi-asserted-by":"crossref","DOI":"10.12688\/hrbopenres.13905.1","article-title":"Care bundles for women during pregnancy, labour\/birth, and postpartum: a scoping review","volume":"7","author":"Ryan","year":"2024","journal-title":"HRB Open Res"},{"key":"2026062610411018000_16.2.e103366.17","unstructured":"Gynecologists, T.A.C.o.O.a . Safe Motherhood Initiative, 2024. Available: https:\/\/www.acog.org\/community\/districts-and-sections\/district-ii\/programs-and-resources\/safe-motherhood-initiative [Accessed 25 Nov 2024]."},{"key":"2026062610411018000_16.2.e103366.18","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2015.11.019"},{"key":"2026062610411018000_16.2.e103366.19","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s10995-017-2358-0","article-title":"Making Decisions About Medication Use During Pregnancy: Implications for Communication Strategies","volume":"22","author":"Lynch","year":"2018","journal-title":"Matern Child Health J"},{"key":"2026062610411018000_16.2.e103366.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-022-05218-5","article-title":"Interventions to enhance medication adherence in pregnancy- a systematic review","volume":"23","author":"Davies","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026062610411018000_16.2.e103366.21","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-015-0378-5"},{"key":"2026062610411018000_16.2.e103366.22","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp18X700193"},{"key":"2026062610411018000_16.2.e103366.23","article-title":"Midwife continuity of care models versus other models of care for childbearing women","volume":"4","author":"Sandall","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062610411018000_16.2.e103366.24","unstructured":"Alderdice FMR , McLeish J , Roberts N , et al . What Evidence Is Available about the Use and Effectiveness of Collaborative Midwife Continuity of Care Models to Improve Pregnancy Outcomes for Women with Medical and Obstetric Complexity? A Scoping Review. Oxford, 2022."},{"key":"2026062610411018000_16.2.e103366.25","unstructured":"Health, G.B.P.H.o.C, S.C. Committee . The Health and Social Care Committee\u2019s Expert Panel: Evaluation of the Government\u2019s Progress Against Its Policy Commitments in the Area of Maternity Services in England: First Special Report of Session 2021-22. Rep Group Adv Psychiatry 2021."},{"key":"2026062610411018000_16.2.e103366.26","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.whi.2015.10.003","article-title":"Improving Pregnancy Outcomes through Maternity Care Coordination: A Systematic Review","volume":"26","author":"Kroll-Desrosiers","year":"2016","journal-title":"Womens Health Issues"},{"key":"2026062610411018000_16.2.e103366.27","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s10995-016-2144-4","article-title":"Postnatal Care Experiences and Barriers to Care Utilization for Home- and Facility-Delivered Newborns in Uganda and Zambia","volume":"21","author":"Sacks","year":"2017","journal-title":"Matern Child Health J"},{"key":"2026062610411018000_16.2.e103366.28","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71016-3"},{"key":"2026062610411018000_16.2.e103366.29","doi-asserted-by":"crossref","DOI":"10.3399\/BJGPO.2024.0229","article-title":"Content and timing of the 6-8 week maternal postnatal check: a mixed-methods study","volume":"9","author":"Macdonald","year":"2025","journal-title":"BJGP Open"},{"key":"2026062610411018000_16.2.e103366.30","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.13.04176","article-title":"Facilitators and barriers of implementation of routine postnatal care guidelines for women: A systematic scoping review using critical interpretive synthesis","volume":"13","author":"Be\u0148ov\u00e1","year":"2023","journal-title":"J Glob Health"},{"key":"2026062610411018000_16.2.e103366.31","unstructured":"Knight M , Bunch KTD , Jayakody H , et al . Saving Lives, Improving Mothers\u2019 Care - Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. 2018: Oxford,"},{"key":"2026062610411018000_16.2.e103366.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0250150","article-title":"Stillbirth rates, service outcomes and costs of implementing NHS England\u2019s Saving Babies\u2019 Lives care bundle in maternity units in England: A cohort study","volume":"16","author":"Widdows","year":"2021","journal-title":"PLoS ONE"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-103366","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:43:28Z","timestamp":1782495808000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-103366"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,6]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-103366"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-103366","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}