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The current study aimed to describe the impact of the COVID-19 pandemic on the rate of maternal postnatal examinations in England over time and its predictors, including socioeconomic deprivation and ethnicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>With the approval of NHS England, the OpenSAFELY platform was used to access the TPP SystmOne electronic health record (EHR) system for primary care. All records for registered female patients aged 14 to 49\u00a0years with a recorded birth coded between January 2019 and August 2023. Monthly rates of postnatal examinations were estimated based on the number of patients with a postnatal-related code within 6, 8 or 12\u00a0weeks of birth. Interrupted time-series analysis modelled the impact of the COVID-19 pandemic on the rate of examinations. Characteristics that may influence the likelihood of not having a postnatal examination were estimated using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For 626,180 patients with births coded, the rate of postnatal examinations increased with length of time after birth. Rates within 8\u00a0weeks fell from 368 to 279 per 1000 (\u219324.1%) between January and March 2020, recovering to 402 per 1000 by January 2023. The incident rate ratio for the first national lockdown was 0.87 (95%CI 0.81\u20130.91) for 6\u00a0weeks, 0.84 (0.81\u20130.87) for 8 and 1.06 (1.04\u20131.08) for 12\u00a0weeks. The odds of no examination were affected by ethnicity (Asian or Asian British (OR 1.11, 1.09\u20131.14)), region (North East (1.39, 1.28\u20131.37) and West Midlands (1.33, 1.27\u20131.39)) and deprivation (most deprived (1.43, 1.31\u20131.37)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maternal postnatal examinations within the recommended time were negatively affected by the onset of the pandemic. Despite rates improving over time, most failed to occur within the recommended 6\u20138\u00a0weeks. Significant variation in rates exists across NHS regions: rates were lower in ethnic minority groups and in more deprived populations. Addressing these disparities will require a combination of policy changes, financial incentives and targeted, culturally appropriate interventions to ensure equitable access to care for all mothers and infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-025-04436-w","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T11:48:57Z","timestamp":1762775337000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The impact of the COVID-19 pandemic on the rate of maternal postnatal healthcare examinations in England: an OpenSAFELY interrupted time series analysis providing evidence of disparity in care access"],"prefix":"10.1186","volume":"23","author":[{"given":"Dexter J. 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This implementation of OpenSAFELY is hosted within the TPP environment, which is accredited to the ISO 27001 information security standard and is NHS IG Toolkit compliant; [\n                      \n                      ].Patient data has been pseudonymised for analysis and linkage using industry-standard cryptographic hashing techniques; all pseudonymised datasets transmitted for linkage onto OpenSAFELY are encrypted; access to the NHS England OpenSAFELY COVID-19 service is via a virtual private network (VPN) connection; the researchers hold contracts with NHS England and only access the platform to initiate database queries and statistical models; all database activity is logged; only aggregate statistical outputs leave the platform environment following best practice for the anonymisation of results such as statistical disclosure control for low cell counts [\n                      \n                      ].The service adheres to the obligations of the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018. The service previously operated under notices initially issued in February 2020 by the Secretary of State under Regulation 3(4) of the Health Service (Control of Patient Information) Regulations 2002 (COPI Regulations), which required organisations to process confidential patient information for COVID-19 purposes; this set aside the requirement for patient consent [\n                      \n                      ]. As of 1 July 2023, the Secretary of State has requested that NHS England continue to operate the Service under the COVID-19 Directions 2020 [\n                      \n                      ]. In some cases of data sharing, the common law duty of confidence is met using, for example, patient consent or support from the Health Research Authority Confidentiality Advisory Group [\n                      \n                      ].Taken together, these provide the legal bases to link patient datasets using the service. GP practices, which provide access to the primary care data, are required to share relevant health information to support the public health response to the pandemic, and have been informed of how the service operates.This study was approved by the Health Research Authority REC reference 21\/SC\/0287 and by the Ethics Board IRAS 303631.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"BG has received research funding from the Bennett Foundation, the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he has previously been a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. BMK is also employed by NHS England working on medicines policy and clinical lead for primary care medicines data.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"626"}}