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Article History

Received: 11 December 2023

Accepted: 27 November 2024

First Online: 29 January 2025

Declarations

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: Ethical approvals were sought from and granted by the King’s College London Health Faculties Research Ethics Sub-committee (ref:- HR/DP-21/22-28808). All participants provided informed consent to participate.

: N/A.

: This work was formed as a sub-study of The PUDDLES Study, which has looked at the experiences of late-miscarriage, stillbirth, neonatal death, and associated care during the SARS-CoV-2 Pandemic. PUDDLES is one of many UK-based studies which feeds directly into PIVOT-AL. At a meeting of PIVOT-AL in November 2021, two areas of research were identified as being unaddressed by current or ongoing pandemic-related portfolios of research: early pregnancy loss and early elective abortion care. This study was therefore devised in response to a call from PIVOT-AL for researchers to plug this lacuna. The PUDDLES programme of work has been discussed with members of the NIHR ARC South London Patient and Public Involvement and Engagement [PPIE] meeting for Maternity and Perinatal Mental Health Research (July 2020; June 2021), which has a focus on co-morbidities, inequalities, and maternal ethnicity; a meeting with the Chief Midwifery Officer and the Maternity Transformation Team of NHS England and NHS Improvement (July 2020), at a meeting focused on multi-morbidities and maternity safety; and an NIHR ARC South London Work in Progress Meeting (October 2020), focusing on maternity and perinatal mental health research. This work has also been discussed at PIVOT-AL national collaborative meetings (November 2021; April 2022; September 2022), a research collaborative which is leading on the national response for policy makers during the pandemic; and to NHS England and Improvement’s Chief Midwifery Office (December 2021), which focused on early insights from new research on maternity services to inform service COVID-19 recovery. Further input was received PPIE members at King’s College London’s Department of Women & Children’s Health Maternal and Perinatal Mental Health Systems & Policy Research Group Meeting (October 2021) and the Department’s PPIE Group for Perinatal Bereavement, Trauma, & Loss (March, June, & October 2022). To ensure sensitivity and appropriateness of recruitment materials and interview schedules, and to aid recruitment, The PUDDLES Study team originally worked with the International Stillbirth Alliance, Tommy’s Charity, and Sands. Subsequently, PUDDLES – Early Pregnancy Loss has worked in conjunction with Petals: The Baby Loss Counselling Charity, The Ectopic Pregnancy Trust, and The British Pregnancy Advisory Service. Through all these engagements, we received feedback on recruitment, study design, and interpretation on findings from both lay and expert stakeholders, including members of the public, those with lived experience, health and social care professionals, researchers, and policy makers.

: This manuscript was derived from the Master’s Thesis of Ms. Flora E. Kent-Nye, who was awarded Mary Seacole Prize at King’s College London for being the cohort’s Highest Achieving Student, and the thesis itself won the 43rd Annual Conference Master’s Prize from The Society of Reproductive and Infant Psychology. None of the authors have any other competing interests to declare in relation to this manuscript.