Impact of Tommy's research centres

Our research centres produce ground-breaking studies that build the evidence needed to deepen understanding, find treatments, improve care and ultimately save babies’ lives.
Image

Jump to: Tommy's National Centre for Miscarriage Research | Tommy's Manchester Research Centre | Tommy's London Research Centre | Tommy's Edinburgh Research Centre

Why we invest in research

Tommy's research centres produce relevant, high quality research improving the lack of evidence in the field.

"We are passionate about investing in world-leading research into the causes and treatments of baby loss. To improve pregnancy care we need to better understand what goes wrong and where to direct treatment. We can only improve care by investing in scientific research to give us answers."

Jane Brewin, CEO Tommy's

Every paper published by Tommy’s researchers helps to increase understanding and can lead to new treatments and updated guidelines which have the potential to reduce the number of babies who die during pregnancy or birth.

Tommy's National Centre for Miscarriage Research

Tommy’s believes that every baby lost is one too many. We refuse to dismiss the loss of a baby as just ‘not meant to be’. The heart-breaking disappointment of a miscarriage causes untold emotional and physical pain to couples across the UK. Our research has found that 1 in 6 women who miscarry experience long term symptoms of post-traumatic stress disorder.

Our expert researchers at our centre are at the forefront of research into miscarriage, searching for the causes and pioneering tests and treatments to find solutions.

“Miscarriage is the most common complication of pregnancy: 1 in 4 women experience at least 1 miscarriage during their reproductive lifetime. The work of Tommy’s National Centre for Miscarriage Research is therefore important and personally relevant to millions of families across the United Kingdom and beyond. We are proud of our efforts to answer the questions of couples experiencing miscarriage, and to improve their lives.”

Professor Arri Coomarasamy, Director of Tommy’s National Centre for Miscarriage Research

2020 research highlights

There are currently no tests that can identify women at risk of recurrent miscarriage. Our research team at the University of Warwick, led by Tommy’s Senior Researcher Professor Jan Brosens, has found that some miscarriages are associated with a lack of stem cells in the endometrium (the lining of the womb). This led to our pioneering SIMPLANT trial, which found that a 3-month treatment of Sitagliptin significantly increased the production of stem cells in the endometrium, marking a potential breakthrough for miscarriages associated with endometrial stem cell deficiency.

We have now expanded our work on Sitagliptin in the endometrium and have incorporated this research into a new, bigger project to create pre-pregnancy endometrial tests for the prediction and prevention of recurrent miscarriage. 

Our progress this year:

  • In early 2020 the team published a paper in Communication Biology detailing the discovery of biomarkers in the endometrium that may predict if the womb can successfully accommodate a pregnancy or not. The patent for these biomarkers has now been submitted and is pending review.
  • We know that the lining of the uterus sheds and regenerates every cycle. This process can vary between ‘normal’ and ‘abnormal’ from cycle to cycle and may have an effect on the risk of miscarriage. Our researchers have developed a theoretical model to calculate the expected risk of these “abnormal” cycles to patients.
  • Our molecular studies of the endometrium have allowed us to develop a model to identify whether the endometrium is in the physiological state (can healthily accommodate the developing placenta) or the pathological state (prone to breakdown in early pregnancy) at implantation. This model offers the potential for a test to be developed that can predict the likelihood of miscarriage in future pregnancies.

Developing the first ever endometrial test to identify women at risk of miscarriage has the potential to lead to a new, targeted treatment that will help to help save more babies’ lives.
 

Tommy’s Net was created to collect data from our three miscarriage sites to increase our knowledge of the risk factors associated with miscarriages. We want to understand how these factors contribute to miscarriage as there are currently no robustly developed and widely validated risk prediction models in clinical use.

We now have information on over 7,563 pregnancies stored in our Tommy’s Net database. In the past year, we have pulled together data on maternal age, BMI and other factors to predict the likely outcome of a pregnancy. For example, we have found that a quarter of women had modifiable risk factors for miscarriage, including obesity and smoking. 

We are developing our important platform improve our data collection to predict risk. Next year, we aim to:

  • Build an online risk calculator that can be used to aid implementation of the new Tommy’s Miscarriage Care Package and reduce modifiable risk factors.
  • Investigate the association of high BMI, smoking, anxiety and depression and reduced ovarian reserve with failure to conceive after first visit at a recurrent miscarriage clinic.
  • Use the system to assess whether early pregnancy scanning can identify chromosomally normal or abnormal pregnancy losses.

These developments will bring us closer to identifying and adopting the most effective tests and treatments across all our miscarriage sites, helping us better care for women and their families.

At our clinics, we ensure that women receive the best possible care. However, we know that there is currently a large variation across the UK in the standard of care that women who cannot attend our clinics will receive. Thanks to our wonderful supporters who helped us raise an incredible £111,964 in our Big Give Christmas Challenge last year, we have been developing a new care package for miscarriage clinical practice.

Over the past year the team have been meeting with clinicians, doctors and other key stakeholders to discuss core issues surrounding miscarriage care and treatment to inform the care package. There was a strong consensus on test and treatment recommendations and models of care. The group agreed that health services should standardise and structure care using a ‘graded model’ where women are offered online healthcare advice and support after one miscarriage, care in a nurse or midwife-led clinic after two miscarriages, and care in a medical consultant-led clinic after three miscarriages. At the moment, no care at all is offered to women who experience one miscarriage; they are simply left to deal with the devastation of losing their baby on their own. Across the UK, the majority of recurrent miscarriage clinics only see women who have experienced at least three miscarriages, however Tommy’s clinics see women who have experienced two.

Our team have also created SMART guidelines for recurrent miscarriage clinics across the UK to help them implement best practice care for every woman. In 2021, we will be developing a patient’s charter to inform and empower women to know what service they should be able to expect.

Tommy's Manchester Research Centre

In the UK, approximately 1 in 250 pregnancies end in stillbirth, which equates to around 2,900 babies dying each year.

Often, parents are given no reason for their loss, and are left to cope with little support. Our research centre in Manchester was created to find answers for these families through pioneering research into stillbirth and its associated pregnancy complications. We are delighted to share with you the activities and achievements of our centre from 2019.

“Our vision is to find solutions to pregnancy problems through research excellence. We deliver world-class advances in pregnancy research to inform better clinical care, policy and practice that will improve outcomes for mothers and families.”

Professor Alex Heazell, Clinical director of Tommy’s Manchester Research Centre

2020 research highlights

A poorly functioning placenta prevents babies from growing to their full potential in the womb, and is the most common cause of stillbirth. There is currently not a way to deliver therapies to placentas of pregnant women with placental disease, so our researchers aim to find safe treatments that increase the baby’s growth, reduce the risk of stillbirth and improve lifelong health. 

To create safer medicines that do not harm the baby, we have developed ways of selectively delivering drugs to the placenta. This year, to further our research, we have also began investigating the function of small molecules inside placental cells, called microRNAs. The actions of some microRNAs are linked to placental disease, and there is evidence that altering microRNA levels can improve placental growth and/or function. We want to know which microRNA levels can be altered, to treat placental disease in women at high risk of stillbirth.

Our researchers screened 12 placentas with severe placental dysfunction and 12 healthy placentas for comparison. The analysis found that 37 microRNAs were increased and 29 microRNAs were decreased in the placental dysfunction samples. Our analysis also revealed that several of these microRNAs whose levels were altered in the samples were responsible for important processes in the placenta including removing cells that are carrying viruses. Our team are now assessing which microRNAs we could alter to help improve the function of the placenta. This will enable the development of targeted treatments of these molecules to help women have safer pregnancies.

Although the causes of the majority of stillbirths are still unknown, one recognised cause is a condition called Chronic Histiocytic Intervillositis (CHI). CHI occurs when the mother’s immune system fails to accept the placenta in the womb. This is a serious condition which reoccurs in subsequent pregnancies, meaning that affected women are at high risk of multiple stillbirths and miscarriages.

We are pioneering a research project to understand the causes of CHI and develop treatments for this devastating condition. Our researchers believe that the rejection of the placenta may be similar to organ transplant rejection and therefore have used a test to check antibodies in the blood to validate this.

This year, to confirm that placental rejection occurs in CHI, our researchers chose to adopt the Banff Criteria, the gold standard classification criteria used in organ transplants in order to improve clinical diagnosis of CHI. 

They have discovered unusual antibodies in the majority of women with CHI and are using Human Leukocyte Antigen (HLA) screening to validate this. HLA markers are found in most cells in the body that the immune system uses to recognise which cells belong in your body and which do not. Our researchers have discovered higher levels of anti-HLA titres in 43% of women with confirmed CHI, compared to a control group of women with no confirmed CHI, likely indicating antibody-mediated rejection of the placenta.

The team have also been undertaking computerised analysis of placentas with suspected CHI to confirm the disease, as tests demonstrated that some CHI placentas did not have antibodies present, therefore questioning whether the diagnosis of CHI was correct. Computerised analysis of features in the placental tissue could be useful in confirming CHI diagnosis. The team are continuing this work to help assess how severe the case is to inform clinical management.

Our Rainbow Clinic provides support in pregnancy following a stillbirth or neonatal death. The majority of women who have a history of stillbirth will become pregnant again and 70% will become pregnant within a year of the loss of their baby.

Our research has found that a previous stillbirth or neonatal death increases parents’ anxiety and emotional vulnerability, highlighting the need for specialist support.

Since opening our Rainbow Clinic in 2013, we have cared for over 850 families. We rolled out our Rainbow Clinic model of care to a second site in 2016 and a third site in 2018. We are delighted that the Rainbow Clinic model has now been adopted by all maternity care providers in the Greater Manchester Strategic Clinical Network. Across the UK, there are 13 active Rainbow Clinics with another three ready to launch. 21 maternity units have Rainbow Clinics in development. 

Our researchers have also begun a national ‘Rainbow Clinic Study’ to evaluate the physical outcomes for mothers and babies after being cared for in the clinic, as well as the psychological impact of the service. We have developed a tool to allow us to compare information by different participating sites so we can identify how units are performing. 

We have also been obtaining information from women attending our Manchester Rainbow Clinic about their initial stillbirth and subsequent pregnancy. Our study has found that mothers who had medical problems were twice as likely to have a poor outcome in subsequent pregnancy and those with placental problems were 9 to 11 times more likely to have a poor outcome in another pregnancy. This gives valuable information about which mothers attending Rainbow Clinic are at the highest risk of complications.

Tommy's London Research Centre

At our London Research Centre at Kings College London and St Thomas' Hospital, our internationally renowned clinicians focus on understanding and preventing premature birth. The team also carry out cutting-edge research into pregnancy complications such as gestational diabetes and hypertension.

“I am committed to helping women have healthier pregnancies; I lead a team which employs rigorous standards in research to improve our understanding and treatment of problems faced all too often by women when they are pregnant. These include pre-eclampsia, premature birth and gestational diabetes. I was drawn to this area as obstetrics is a field which has often been neglected but one which is critically important, not only for the health of women but for the future health of the next generation.”

Professor Lucilla Poston, Director of Tommy’s London Research Centre

2020 research highlights

We know that infection within the womb is the leading cause of spontaneous preterm birth, and may be responsible for up to as much as 40% of premature births. Rates are also significantly higher in very premature babies (those born before 28 weeks).

Our INSIGHT study is investigating exactly how infection leads to premature birth. Studies have shown that infection results in a shortening of the cervix. The cervix connects the opening of the vagina to the uterus. During pregnancy it lengthens and hardens to protect the baby. The cervix can become infected by microbes such as bacteria, and when this happens, the cervix shortens. This normally happens when a woman’s body is getting ready to give birth and the cervix becomes shorter and softer – eventually becoming too short to hold onto the baby and the woman will then go into labour.

We have been recruiting women from our prematurity clinic to take part in the INSIGHT study so that we can take sample analyses and measure their concentrations of elafin - the antimicrobial peptide that the body releases to fight off infections. We have made exciting progress so far and have discovered a composition of vaginal metabolites with potential for predicting spontaneous preterm birth before 37 weeks, and a combined metabolite/bacteria model for prediction of spontaneous preterm birth before 34 weeks. 

This will help us to understand the mechanisms behind what happens when infection occurs, and how we can create interventions to prevent premature birth.

Our researchers developed safe techniques for taking pictures of the baby and placenta using MRI scans. This year, we completed our PUFFIN project which investigated the placenta through advanced imaging to find out if this could improve our ability to detect abnormalities in the pregnancy, to help us better care for high-risk women.

The results of our MRI scans demonstrated large variations in the placentas of the women in the control group and those in the pre-eclampsia group. The T2 weighted images showed that the placentas in both groups organise themselves into lobules (small circular lobes), increasing in number as the pregnancy develops. However, in the pre-eclampsia group, the T2 images show that there are significantly increased lobules.

The scans were also examined for evidence of maternal vascular malperfusion (MVM). MVM refers to abnormalities in the oxygenation and blood flow of the vessels that supply and make up the placenta, indicating a placenta that is not properly functioning. Our researchers found no evidence of MVM in any of the placentas of the women in the control group, however, 10 out of the 12 placentas examined in the pre-eclampsia group did have features of MVM. The two women that did not show any features went on to deliver after 37 weeks and their babies had normal birthweights.

Our PUFFIN study has shown clear, visual differences in the placentas of women affected by preeclampsia compared to those with non-complicated pregnancies.

Not only does MRI scanning produce clear images to examine the condition of the woman’s placenta, but it also does so very quickly. T2 images can be available in less than one minute, which means that there is a high potential for this method to be applied in clinics, as it produces fast and reliable results.

This study has proven the effectiveness of MRI in pregnancy, and future work with these established techniques could involve monitoring high-risk pregnancies to help inform clinical management decisions.

Tommy's Edinburgh Research Centre

Tommy’s wants to ensure that every mother and baby has the best possible chances in life. We refuse to accept that a baby’s death is ’just one of those things’. We fund high impact research projects in Scotland at the Royal Infirmary of Edinburgh which have the potential to increase our understanding of pregnancy complications, improve care and reduce the risk to babies. The ground-breaking research at our Edinburgh centre is translated through our clinics and is influencing national policies and guidelines.

"The pioneering research at our Edinburgh centre is translated to benefits for pregnant women through multidisciplinary clinics with embedded research. This approach has succeeded in influencing national policies and guidelines, including establishing a Scottish target for the reduction of preterm birth and a national guideline for management of obese pregnancy."

Professor Fiona Denison, Centre Director

2020 research highlights

It is currently difficult to predict which women are at real risk of preterm birth. Up to 80% of women who have signs and symptoms of preterm labour remain pregnant after 7 days. This means that many women unnecessarily receive treatments aimed at preventing complications in preterm babies, to ensure that the babies that are actually born preterm will be healthy. If preterm delivery doesn’t occur, these treatments are costly and potentially harmful to babies and women.

Researchers at our Edinburgh centre are developing a test to measure the amount of fetal fibronectin to help improve diagnosis of preterm labour. Fetal fibronectin is protein produced by fetal cells, which acts as a ‘glue’ between the amniotic sac and the lining of the uterus.

A test to identify whether fetal fibronectin is present (which provides a positive or negative result) has been available for some time. However, the ability to measure the absolute amount of fetal fibronectin is new. This new test has the potential to more accurately rule out preterm labour.

In order to ensure that the test works in UK populations, the team trialled it in women attending 26 UK maternity units with symptoms of preterm labour. We found that a prognostic model including quantitative fetal fibronectin and clinical risk factors showed excellent performance in the prediction of spontaneous preterm birth within seven days of test, was cost-effective and can be used to inform a decision support to help guide management decisions for women with threatened preterm labour.

In the UK, most babies are monitored during labour using cardiotocography, which detects changes in the baby’s heartbeat. Changes in the fetal heart rate pattern may reflect hypoxia. Hypoxia is extremely dangerous because it means that the baby’s body is not receiving enough oxygen.

Fetal blood sampling, where a drop of blood is taken from the baby’s scalp during labour, is often used in addition to cardiotocography to identify babies at risk of harm. However, these methods have proved unreliable and insufficient.

Our researchers are investigating if it is possible to extract and simultaneously detect changes in the amount of lactate to monitor the baby’s wellbeing. Lactate is lactic acid in the blood and is produced when there is insufficient oxygen supply to the tissues, meaning that the baby is at risk of suffering from hypoxia which can lead to a range of adverse outcomes, including irreversible brain damage.

Currently, lactate is measured using fetal blood sampling, however these results are only accurate at the time of sampling, meaning that changes can be missed. 

Our researchers are using a technique called microdialysis which can measure lactate from the fluid surrounding the baby’s scalp throughout labour. Lactate moves freely from surrounding blood vessels into this fluid. 

The team have started to develop a microdialysis probe with sensors to allow for reliable insertion and removal from the fetal scalp during labour. This will help to continuously monitor the baby’s wellbeing without the need for repeated fetal blood sampling.

Our research centres are independently reviewed every year by leading professors from around the world. In addition, each centre must report its annual progress on key performance measures.