Table 1.

Literature included in the scoping review

Article and Year	Methodology	Aim	Findings
National Institute for Health and Clinical Excellence (NICE)9 2010	Clinical guideline	This guideline sets out recommendations for healthcare professionals to address vulnerable women’s needs and to improve pregnancy outcomes in this population.	The NICE guideline identified four groups of vulnerable women: pregnant women who misuse alcohol or drugs, pregnant women who are recent migrants, asylum seekers or who have difficulty reading or speaking English, young pregnant women aged <20 years and pregnant women who experienced domestic abuse. This guideline gives recommendations in order to improve access to care and to offer proper additional care to pregnant women with complex social factors.
Scupholme et al.18 1992	Quantitative survey	To describe the extent to which certified nursemidwives (CNMs) provide care to vulnerable populations in the United States and the source of reimbursement for this care.	Ninety-nine per cent of CNMs in all types of practices report providing care at least to one group of vulnerable women, and CNMs in the inner city and rural practices serve several groups. The vast majority of CNMs are salaried; 11% receive their primary income from fee-for-service, 50% from Medicaid and government-subsidised sources, less than 20% from private insurance. CNMs make a major contribution to the care of vulnerable populations.
Menke et al.19 2014	Qualitative, descriptive phenomenology	To examine midwives’ perceptions of organisational structures and processes of care when working in a caseload model for socially disadvantaged and vulnerable childbearing women.	The study demonstrated that midwives were adept at responding to the diverse needs of women with a wide range of risk profiles. The research found that midwives perceived they could make a difference in women’s lives after birth. Receiving caseload care was viewed as a potentially transformative journey for many women and impacted on the women’s lives in positive ways. Midwives felt that relationships with other members of the healthcare team were typified by lack of respect, minimal collaboration, and the imposition of clinical practices that were perceived by participating midwives to be ‘outdated’ rather than based on best available evidence.
Glasgow Child Protection Committee20 2008	Procedural guidance	To assist vulnerable parents to acquire the necessary parenting skills.	This guidance identified categories of women who require interagency support. The guidance recommends the identification of vulnerable mothers, to assess their needs and the potential risks of the unborn child, in order to put in place appropriate services.
de Groot et al.21 2016	Quantitative and qualitative, mixed method design	To investigate whether the subjective caregiver’s perception of workload and the objective registry-based caseload of vulnerable clients are in agreement, and whether a structure organisation of antenatal risk management reduces the burden associated with perceived workload, in particular if the objective caseload is high.	This study addressed the effect of a specific antenatal practice setting on the subjective workload and associated burden of vulnerable clients, in a region with multiple deprivation areas. Subjective workload and objective caseload were only weakly related, the relation being modified by the organisation of antenatal risk management. If the organisational structure of antenatal risk management was low, the experienced burden was high, even if the objective caseload was low. Highly structured antenatal risk management was associated with medium to low burden. Study suggests that changing antenatal risk management practice policies towards more structured care provision not only may benefit vulnerable clients and their offspring, but also may benefit the healthcare providers in work satisfaction. Increased prevalence of vulnerable clients induces an increased strain on midwives, obstetricians and other healthcare professionals involved in antenatal care.
Briscoe et al.22 2016	Concept analysis	To develop a concept analysis to identify how the term vulnerability is currently understood and used in relation to pregnancy, birth and the postnatal period.	Vulnerability should be viewed as a complex phenomenon. It can be defined by three main attributes, which are: Threat, Barrier and Repair. These attributes could have an impact on maternal outcomes. Subattributes as attachment between mother and baby, woman’s free will and choice added complexity to the concept.
MacMullen et al.23 1992	Literature review	To describes stress factors related to vulnerability in pregnancy and the implementation of a support group as one intervention able to reduce the vulnerability in a group of women during the antenatal period	Women with high risk pregnancies could be hospitalised during the antenatal period. Women could be exposed to vulnerability due to the psychological and physiological disruptions that accompany hospitalisation, leading to increase anxiety and stress. Authors identified twelve stressor themes that contribute to antenatal vulnerability. They described the implementation of a support group, that lasted for over a year, with the aim to reduce the vulnerability in a group of pregnant women.
Tezcan et al.24 2011	Quantitative survey	To assess the feasibility of using a mobile text to reach vulnerable pregnant or postnatal women.	The mobile technology is readily available for 97% of the population considered. Of 94 women who responded, 28% (n=26) admitted to having forgotten at least one antenatal or scan appointment, while 21% (n=20) missed an appointment because they had not received a letter. The majority (61%) of women who were from vulnerable groups or from deprived areas, possessed third generation mobile technology. The survey showed that a significant majority of women would like to have reminders via mobile about appointments and medication taking. These requests for mobile information are even higher in the more vulnerable proportion of the study population.
White et al.25 2015	Quantitative non-randomized controlled study	To assess the efficacy of a primarily antenatal intervention with a traditional hard-to-reach population.	Intervening in the antenatal period may improve outcomes for pregnant women with additional health and social-care needs and their infants, and be more cost-effective than intervening later. Results suggested that psycho-educational antenatal interventions may benefit pregnant women with significant psychosocial needs. Further research with a larger sample size is required.
Malebranche et al.26 2017	Discussion paper, editorial	To discuss the importance of addressing specific mental, physical and reproductive health needs of refugee women, especially during pregnancy	Studies that have explored health outcomes among resettled refugee women demonstrated significant disparities in maternal and perinatal outcomes. Adverse outcomes included higher rates of preterm birth, low birthweight infants, stillbirths and maternal mortality. These could have long-lasting impact on the health and development of the newborn, well into adulthood. High income countries should take action, offering equal opportunity and interventions especially during pregnancy, that minimise the difference between the local population and the refugee one.
Birtwell et al.28 2015	Qualitative, interpretive phenomenology	To understand the experiences of pregnancy for a group of vulnerable women and to understand their experiences following an intervention (called Mellow Bumps) designed to address some of their vulnerabilities.	Authors identified 5 superordinate and 14 master themes; each master theme was divided into multiple subthemes. The study demonstrated a significant overlap between vulnerable women and ‘ordinary’ women’s experiences of pregnancy. Furthermore, authors endorsed the notion that the period of pregnancy may provide a unique and optimal opportunity to intervene to effect change at the level of prenatal attachment, with possible subsequent benefits for longer term postnatal attachment.