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.

Our mission is to make the UK the safest place to give birth, halving the number of babies who die in pregnancy and birth by 2030. 

We want every pregnant woman to have access to the very best care and treatments available. We are committed to driving up care maternity standards across the UK so that fewer families experience the heartbreak of baby loss. One of the most effective ways that Tommy’s can achieve this vision is by supporting medical research.

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.

Miscarriage research 

Our expert researchers at our Tommy's National Centre for Miscarriage Research are at the forefront of research into miscarriage, searching for the causes and pioneering tests and treatments to find solutions.

2022 research highlights

During the menstrual cycle, the lining of the uterus goes through changes that lead to either breakdown of the lining or, following implantation of an embryo, transformation into cells that can accommodate the placenta. Our researchers have found out that this process is controlled by two different types of cells that are both important for successful implantation. If the balance of these two types of cells isn't right, it can cause the uterus lining to breakdown, leading to a miscarriage. 

Research progress this year:

  • The team have discovered specific markers for these two cell types which can tell us how likely it is that the uterus lining will break down during pregnancy
  • Our researchers have developed the digital endometrium function test, which looks at these markers and can then tell women and birthing people what role the uterus lining may have played in their past miscarriage and whether it could have an impact in the future 

Clinical impact:

  • The introduction of the digital endometrium function test has already helped provide information to parents about whether the uterus lining played a role in their miscarriage 
  • They have shown that a pregnancy with an abnormal digital endometrium function test is twice as likely to end in miscarriage, so hope that this test will help guide treatment following miscarriage and evaluation of potential interventions 
  • The team have also found that a drug called sitagliptin improves the balance of the two cell types involved, so are exploring whether this may be a treatment option for recurrent miscarriage

In a healthy vagina, there is a lot of a bacteria called lactobacillus. In miscarriages that are not caused by a genetic problem, our team previously found a link between a vagina that has a low amount of this bacteria and an increased risk of miscarriage. Our researchers are now looking at the link between miscarriage and the bacteria that usually live in the vagina and gut, and how they interact with the immune system. They have found that an unhealthy gut was linked to miscarriage, while a healthy gut was linked to substances in the vagina that helped reduce inflammation.

Research progress this year:

  • The team explored whether you could introduce more of the right bacteria into the vagina by giving a vaginal pessary containing lactobacillus
  • The data shows that this approach does increase the amount of bacteria in the vagina, so it may be a strategy to prevent miscarriage 

Clinical impact:

  • If we can better understand the relationship between the vaginal microbiome and the risk of miscarriage, we can develop bed-side tests to measure the vagina environment and help determine who would benefit from treatment 
  • The team are working on a wick test for vaginal microbiome and hope this will be a huge step forward in understanding and preventing miscarriage

Vitamin D deficiency is extremely common, and pregnant women and birthing people are at greatest risk. We know that low levels of vitamin D are linked with fertility problems and pregnancy complications such as pre-eclampsia and gestational diabetes, and research has shown that low-dose vitamin D supplements can help reduce the risk of these conditions. Our researchers are now finding out whether vitamin D levels are linked to the risk of miscarriage and recurrent miscarriage. 

Research progress this year:

  • By combining the results of 10 previous studies, our researchers found that there is a link between vitamin D levels and the risk of miscarriage or recurrent miscarriage - defined in this study as 2 or more miscarriages 
  • As a result, the team have been preparing to carry out a clinical trial in which women with a history of recurrent pregnancy loss will be tested for vitamin D deficiency prior to pregnancy so that they can receive treatment when necessary

Clinical impact:

  • If our clinical trial shows that a 'test and treat' strategy for vitamin D deficiency improves the chances of having a successful live birth, this could pave the way for vitamin D testing and treatment to be offered routinely to women and birthing people who are most a risk

Stillbirth research 

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 2022.

“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

2022 research highlights

High blood pressure in pregnancy is linked with poorer outcomes for mum and baby, as it increases the risk of pre-eclampsia, poor growth of the baby and stillbirth. Previous studies have shown that a high intake of green leafy vegetables can reduce blood pressure, so our researchers are exploring the link between diet and blood pressure during pregnancy. They are focusing on nitrate, which is found in green leafy vegetables and beetroot. Nitrate is broken down by bacteria on the tongue into a compound which plays a role in relaxing blood vessels and lowering blood pressure. 

Research progress this year:

  • Our researchers looked at the link between bacteria in the mouth, breakdown of nitrate and blood pressure during pregnancy to see if giving dietary supplements can improve blood pressure regulation
  • They found that women and pregnant people with high blood pressure had reduced amounts of the bacteria that breaks down nitrate on their tongues

Clinical impact:

  • This data suggests that the bacteria in your mouth, particularly those that break down nitrate, may play a role in regulating blood pressure during pregnancy 
  • Using this evidence, researchers plan to explore whether a daily supplementation with beetroot juice may lower high blood pressure in pregnancy by increasing the amounts of these bacteria
  • If this is effective, it could provide a new dietary approach for reducing serious complications during pregnancy associated with high blood pressure by altering the oral microbiome

Pre-eclampsia is a condition that causes high blood pressure during pregnancy. It is only partly understood, but it is strongly linked with problems with the placenta during the early stages of pregnancy. Before the embryo implants into the uterus lining, the cells in the lining go through changes (a process called decidualisation) to prepare the womb for the development of the placenta. There is also an increase in immune cells in the lining which help ensure there is a good supply of blood to the placenta. If these changes don't happen correctly, it can affect the way the placenta forms, leading to conditions like pre-eclampsia. Our researchers are looking at the interaction between the lining of the uterus and the immune system and how this may cause pre-eclampsia. 

Research progress this year:

  • By looking at blood samples and cells from the lining of the uterus from women who have had pre-eclampsia, the team found that the cells showed different changes and also released different molecules that communicate with immune cells 
  • This suggests that altered changes in these cells could lead to the development of pre-eclampsia
  • These changes were also found in samples taken from women who were not currently pregnant but had a history of pre-eclampsia 

Clinical impact:

  • This project has helped increase our understanding of why some women get recurring placental problems and indicates that the environment in the womb before pregnancy may impact the development of the placenta in the future 
  • Our team hope to uncover processes in the body that could be targeted with new treatments to help prepare the lining of the womb for pregnancy and reduce complications in the future 

Currently, babies in the womb have their heart rate checked occasionally to see if everything is okay - usually at each antenatal appointment from 18 weeks onwards. However, these tests only give us a brief snapshot of the baby's health and may not always detect when a baby is struggling. Our researchers are therefore developing a special device - called the FeHeMo vest - that can be worn by pregnant women and birthing people to track their baby's heart rate and movements over a longer period of time. 

Research progress this year:

  • Our scientists have been refining the FeHeMo vest and are now ready to ask pregnant women and birthing people to wear it as part of a clinical trial that will test whether it can accurately record the mother's heartbeat, as well as the baby's heartbeat and movements 
  • The team also asked women and healthcare professionals to share their thoughts about long-term monitoring of babies in the womb and identified several key concerns that need to be considered when developing new continuous monitoring devices like the FeHeMo vest 

Clinical impact:

  • This device should make it possible to monitor a baby's wellbeing over a long period of time, helping healthcare providers recognise when a baby is struggling in the womb
  • Ultimately, this may give doctors an earlier opportunity to intervene, which could reduce the chances of stillbirth

Improving maternity care 

Across the UK there are wide variations in maternity care as well as stillbirth and premature birth rates. This is in part due to variations in the way that guidelines are implemented locally and is leading to inefficient use of healthcare resources as well as worsening health inequalities for underserved groups. Our current method of assessing risk during pregnancy has remained unchanged since the 1970s, with midwives and doctors using a checklist to classify women and birthing people as either 'high' or 'low' risk. This does not measure how high or low the risk is and so does not allow for personalised care. 

The Tommy's National Centre for Maternity Improvement, in partnership with the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) has developed The Tommy's Pathway: a clinical decision support tool - an online medical tool that will help healthcare providers work out which pregnant women and birthing people are most at risk of giving birth prematurely or developing complications that can lead to stillbirth. It will also empower women and pregnant people to become more engaged in their own care. 

2022 research highlights

The Tommy's Pathways was launched in December 2021 and has been implemented at 4 early adopter sites across the UK. Staff at these sites have been supported to use the Pathway through extensive guidance and training, and it is expected that a final early adopter site will be up and running by the end of 2023. 

Evaluation of how the Pathway is being used across the early adopter sites is critical to inform implementation in sites across the UK. The team want to understand how the Pathway is being used by healthcare professionals and if there are any issues that need to be fixed. They will also conduct focus groups and interviews with pregnant women and birthing people to see how they feel about the use of the Pathway in their care. 

In May 2022, the centre successfully secured £1.8million in funding from the National Institute of Health and Care Research to run a 36-month trial at 26 additional maternity units. This trial will evaluate the 'real word' implementation of the Tommy's Pathway within the NHS and aim to demonstrate improved pregnancy outcomes with the use of the Pathway when compared to standard care. 

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.