Recent pregnancy research achievements

Miscarriage and stillbirth

We've set up the UK's first placenta clinic
The placenta is the baby's life-support machine so when it goes wrong all sorts of problems can occur, including miscarriage. In January 2009 Tommy's opened the UK's first placenta clinic at our research centre in Manchester, treating local women with placental complications. This has the dual benefit of ensuring that the women get the best standard of care and giving our scientists a chance to study placental function.

We’ve developed MRI techniques for studying the placenta
One of the main causes of stillbirth is fetal growth restriction due to problems with placental blood flow. We have developed new magnetic resonance imaging (MRI) techniques that might detect abnormalities in the placenta. We have also identified tissue fibrin as a possible marker for the condition. We hope that MRI, which is safe to use during pregnancy, could soon be used as a tool for diagnosing or predicting fetal growth restriction.

We’ve identified factors that affect placental blood flow
In pregnancy, blood vessels to the uterus get bigger to increase blood flow to the baby. If this does not occur, risks include miscarriage, pre-eclampsia or having a baby too small or too early. We have identified factors – released by placental cells called trophoblast cells – that cause this and are now looking at ways to improve blood vessel widening.

We’ve pioneered guidelines on fetal movements
Our research has shown that reduced fetal movement is a very reliable predictor of pregnancy complications. Previous practice in this area was found to be chaotic and non-evidence-based so our research has helped create a much more robust model for pregnant women to become aware of their own baby's activity levels so that if this changes – a sign that something may be wrong – it is detected quickly.

Premature birth

We’ve identified why preterm birth is increasing in Scotland
We have recently completed a major study of the Scottish population for the period 1980–2004 to investigate why rates of preterm birth have been increasing. We found that there are two main reasons: doctors are increasingly delivering women early (for the health of both the mother and the baby), and women to go into labour too early with no obvious cause. We have shown that there are fewer neonatal deaths with electively induced birth than with spontaneous preterm birth. However, stillbirth rates are increasing for elective preterm birth.

We’ve found that risk of preterm labour can be inherited
In a study of the Aberdeen maternity databank, we found that women whose mother or grandmother had a preterm birth are more likely themselves to have spontaneous preterm labour. This implies that there is a ‘genetic’ component to preterm birth, which may allow techniques for early detection and treatment to be developed.

We’ve found that progesterone does not reduce preterm birth in twins
Although progesterone reduces preterm birth in women with one baby, we found that it did not reduce preterm birth (if anything, it increased it) in women with a twin pregnancy. This study is important in preventing women with twin pregnancy getting an ineffective treatment. Accordingly, the results were published on a ‘fast track’ basis in the Lancet medical journal and were accompanied by an editorial.

We’ve moved a step closer to a predictive test
Tommy’s scientists have shown that fetal fibronectin, a special protein enabling the membranes around the baby to stick to the walls of the womb, should only appear at around 22 weeks and again at the end of pregnancy. If it appears between these dates it indicates that an early labour is imminent, which means that it is an excellent predictor for preterm birth. Our trial was recently completed and the results are now being analysed. If the test proves to be cost-effective, there will be much wider use of this predictive test for preterm labour. This will help to prevent hospital admissions and unnecessary interventions for women at low risk, thereby reassuring them and saving precious healthcare resources.

We’ve developed a simple saliva test for predicting preterm labour
We have filed a patent on a new saliva test for prediction of early preterm labour. If validated in a larger study, this simple test could be used to predict which women may go into labour very early, allowing for greater surveillance and early intervention. This may be particularly valuable in identifying women who would benefit from progesterone supplementation.

We’ve improved our understanding of inflammatory causes of preterm birth
We have investigated whether the spread of infection from the vagina to the womb plays a role in preterm labour. We also looked at how useful two commonly used treatments (progesterone or a cervical stitch) were at suppressing inflammation and preventing early delivery of the baby. Our results have given us important clues as to the mechanism of early birth and may help us develop a test to identify women at risk earlier in pregnancy. We are now looking forward to investigating whether this test also helps women in their first pregnancy. This information will help doctors determine when to treat women, and with what. Our data will be revealed in full at an international gynaecological meeting in the USA in March 2010.

Pre-eclampsia

We’ve tested and developed improved blood pressure devices
We have recently completed the testing and development of a range of automated and manual blood pressure devices. These include devices suitable for use in pregnancy and pre-eclampsia, a low-cost but accurate ‘chemist’ device that could result in major savings if rolled out across the NHS, and a solar-powered device for the World Health Organization. Tommy’s Professor Andy Shennan has also been involved in writing new international standards for validation protocols, and has advised the EU on legislation regarding replacement of mercury in these devices.

We’ve made a crucial breakthrough in the quest for a predictive test
We want to create a test that will identify women at high risk of developing pre-eclampsia long before the actual symptoms appear. Our Manchester team has developed a technique for detecting certain metabolites (metabolites are waste products produced by chemical reactions within our bodies) that predict the disease. This discovery should bring a practical test to identify high-risk women much closer.

We’ve demonstrated links between poor placental function and pre-eclampsia
Normally cells in the placenta die and replenish at an even rate. However, in women with pre-eclampsia, these cells often die at a faster rate than they can be replaced. Our research has found several reasons for this. It can be caused by an imbalance in two proteins, by low oxygen and oxidative stress, or by the overproduction of a protein called TRAIL. We have also shown that treatment with a commonly used medicine like heparin can reduce these effects.

General pregnancy health

We’ve identified pregnancy risk factors in younger women
Teenagers have a greater risk of delivering a growth-restricted baby than adult mothers. Our ‘About Teenage Eating’ (ATE) study of 500 pregnant teenagers found that insufficient weight gain, poor diet and continued smoking during pregnancy are possible causes for delivering low-birthweight babies. We confirmed that lower consumption of folic acid, an essential vitamin, was associated with a higher risk of small babies.

We’ve confirmed that obesity reduces fertility
We have found that maternal obesity can depress fertility and alter cellular metabolism in eggs and early embryos. We have also established that these very early changes persist to the later fetal and infant stages. This research is highly relevant to the increase in obesity of women of childbearing age, to assisted reproduction techniques (ART), and to potential embryonic stem cell based regenerative therapies.

We set up a clinic for obese pregnant women
Nearly half the women of childbearing age in the UK are overweight or obese. We know obesity makes a whole host of pregnancy problems more likely but we don't as yet know why. Tommy's has established a ‘Metabolic Clinic’ at our research centre in Edinburgh which will provide women with enhanced care throughout their pregnancy and also provide our scientists with valuable data to study the link between obesity and poor pregnancy outcome.