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.
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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.

2021 research highlights

Across the UK, there is large variation in the quality and type of care that is given following miscarriage, with women often having to suffer three losses before the cause of miscarriage is investigated. Our researchers believe that an overhaul is needed of the medical care and advice offered to women who have experienced miscarriage, and are working to make sure that miscarriage care is improved for all.

Research progress this year:

  • In April 2021, our scientists published a series of three articles in The Lancet that summarised the latest evidence about the epidemiology, causes and treatment of both sporadic and recurrent miscarriage; the series laid bare the devastating impact of miscarriage and set out recommendations to improve treatment and care.
  • Using findings from the Lancet series, our researchers are developing a National Miscarriage Care Package that that will provide guidelines to health professionals across the UK, helping to standardise care; use of the care package will be assessed in a small number of NHS trusts before being rolled out nationwide.

Clinical impact:

  • The Lancet miscarriage series has been discussed with key policy makers in government. As a result, the government has committed to implementing our recommendations for miscarriage care as part of their Women’s Health Strategy, with 24/7 access to emergency miscarriage services being made a priority. 
  • The Royal College of Obstetricians and Gynaecologists (RCOG) clinical guideline for the investigation and treatment of recurrent miscarriage is currently being updated and the proposals put forward in the Lancet miscarriage series will be considered as part of this review.

There has been a lot of debate around whether progesterone supplementation in early pregnancy can help to prevent miscarriage. In the PRISM study – published in 2019 – our researchers found that progesterone is an effective treatment for women with early pregnancy bleeding and a history of previous miscarriage. Since then, our team have been generating more evidence that has been used to update national treatment guidelines, ensuring that more women will be able to access this important treatment.

Research progress this year:

  • Our researchers worked with scientists from other centres to conduct a network meta-analysis into the effect of progesterone treatment in early pregnancy. This analysis – which combines the results of all relevant trials into a single, clear result – confirmed that progesterone increases the chances of a live birth in women with early pregnancy bleeding who have already experienced at least one previous miscarriage.

Clinical impact:

  • NICE treatment guidelines were updated in November 2021 to recommend that progesterone should be given to women with early pregnancy bleeding who have previously had a miscarriage.
  • Our research will therefore have a direct impact on clinical practice, enabling more parents to get the treatment they need and potentially preventing up to 8,450 miscarriages a year in the UK.

We still don’t know enough about miscarriage, which means that many women do not get an explanation as to why it happened to them or a prediction of the chances of it happening again in the future. To find out more, Tommy’s are supporting The Early Pregnancy Observational Study (EPOS), which has followed more than 1,500 women from five weeks pregnant through to birth; 230 of these pregnancies sadly ended in miscarriage. By working with so many women, our researchers have collected a huge amount of data that can be used to learn more about miscarriage.

Research progress this year:

  • By analysing samples from 95 women who had a miscarriage and 265 women who had a healthy pregnancy, our researchers found that a hormone called kisspeptin – which potentially has an important role in many aspects of pregnancy – is present in lower levels in women who eventually miscarry.

Clinical impact:

  • Our researchers are using the kisspeptin data, along with other findings from the EPOS study, to build models that can be used to predict how likely it is that a woman will have a miscarriage in the first trimester; they hope that their models can be validated and eventually introduced into clinical practice.
  • This could lead to problems being detected earlier, enabling healthcare providers to give the best possible care while also giving women and their families an opportunity to prepare emotionally for the possibility of having a miscarriage.

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 2021.

“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

2021 research highlights

Chronic histiocytic intervillositis – or CHI – is a rare and serious condition in which the mother’s immune system fails to accept the placenta in the womb, increasing the risk of miscarriage, stillbirth and neonatal death. We think CHI happens when certain antibodies mistake the placenta for an alien object, causing it to be rejected by the mother’s immune system in a similar way to the rejection of an organ transplant. CHI can recur in subsequent pregnancies, putting affected women at risk of multiple pregnancy losses. It has no symptoms and can only be diagnosed by looking at the placenta after pregnancy; no treatment has been proven to cure it. Consequently, our team have been carrying out a pioneering research project to find out more about the causes of CHI so that we can better identify, manage and prevent the condition.

Research progress this year:

  • Our scientists found that women who had CHI in a previous pregnancy were actually less likely than healthy pregnant women to have antibodies in their blood that are usually linked to rejection of an organ transplant, although the placentas from pregnancies affected by CHI looked similar under a microscope to a rejected organ. The team are now looking to see whether there are any other unusual antibodies that may be causing CHI.
  • Our researchers treated 39 pregnant women who had been affected by CHI in a previous pregnancy with drugs that alter how the immune system works. The team found that treatment with hydroxychloroquine and/or prednisolone reduced the severity of CHI in the placenta and increased the chances of having a live birth.

Clinical impact:

  • 45 women with CHI have now been treated at the Tommy’s Rainbow Clinic in Manchester, where they have received bespoke, high-quality care.
  • CHI clinical care guidelines have now been developed, known as the ‘Manchester Protocol’. This standardised treatment protocol describes the way in which immunomodulatory medication should be used in women with a history of CHI and will help clinicians at other centres provide the best possible care to reduce the chances of pregnancy loss.

Parents who have experienced stillbirth or neonatal death often need extra care and emotional support throughout their next pregnancy. The Tommy’s Rainbow Clinic is a specialist service for parents who have suffered a stillbirth or neonatal death that provides the best possible care and support throughout a subsequent pregnancy. The clinic was opened in 2013 at St Mary’s Hospital in Manchester and has since looked after more than 900 families. The Rainbow Clinic model is now being rolled out to other maternity units in the UK.

Research progress this year:

  • Our researchers are carrying out the National Rainbow Clinic Study to monitor pregnancy outcomes and to assess the psychological impact of these clinics on parents who are going through pregnancy after loss. 
  • Our scientists have also been looking at data from women treated at the original Rainbow Clinic in Manchester to help them understand more about the risks associated with pregnancy after stillbirth. In one study, the team found that complications in a subsequent pregnancy were twice as likely in women with a pre-existing medical condition and around ten times as likely in women whose stillbirth was linked to placenta problems. In another study, our researchers found that women with a smaller, thicker placenta or with abnormal blood flow to the uterus were more likely to experience complications.

Clinical impact:

  • There are now 17 active Rainbow Clinics around the country, with 11 more ready to launch and a further 14 in development. The National Rainbow Clinic Study is expected to provide more evidence of the positive impact of these clinics, which should encourage other maternity units around the country to set up their own clinics.
  • The Rainbow Clinics are also providing us with a vast amount of information about the causes of stillbirth that can be used to improve and personalise the care that women receive when they are pregnant again after a stillbirth or neonatal death.

It is difficult for researchers to carry out clinical trials into stillbirth because they need hundreds of thousands of pregnant women to take part. Instead of setting up brand new trials, Tommy’s researchers are bringing together data from lots of previous studies in the hope that they will reveal brand new findings that couldn’t be seen in smaller, individual studies.

Research progress this year:

  • Our researchers combined data from 19 previous studies that investigated whether stillbirth rates could be reduced by either raising awareness of the importance of a baby’s movements or by improving treatment for reduced movements. The team found that the risk of stillbirth was not reduced when women were given more education about the importance of their babies’ movements or asked to count kicks. There were not enough studies that looked at how women presenting with reduced fetal movements should be treated, and so the benefit of interventions such as ultrasound scanning and fetal heart rate monitoring remain unclear.

Clinical impact:

  • By combining the data from lots of older studies into one analysis, our researchers hope to reveal brand new findings that can influence national treatment guidelines.
  • In particular, the Royal College of Obstetricians and Gynaecologists (RCOG) clinical guideline for the management of reduced fetal movements is currently being updated and will reflect the recent work carried out in the Tommy’s Manchester Research Centre. Professor Alex Heazell is the lead author of this guideline.

Premature birth and gestational diabetes research 

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.

2021 research highlights

The cervix is a small canal that connects the vagina to the womb; it plays an important role in stopping a baby from being born too soon. If it becomes too short early in pregnancy, there is a high risk that the baby will be born prematurely. At the moment, there are three treatments that can be used if this happens. The first is a small surgical procedure called cervical cerclage, where a stitch is put around the cervix to try and help it stay closed. The second is treatment with progesterone suppositories. The third is the use of a cervical pessary: a silicone device put in by a doctor that sits around the cervix to help it stay closed. To date, these three ways of stopping premature birth haven’t been compared.

Research progress this year:

  • Our researchers are carrying out the SuPPoRT study – a randomised controlled trial that aims to find out which of these three methods is best at preventing premature birth, or if they are as effective as each other.
  • SuPPoRT is being carried out at 14 hospitals around the country and includes nearly 400 women who developed a short cervix between 14 and 24 weeks of pregnancy. The team are waiting for the last few women to deliver their babies, and then will look at the results.

Clinical impact:

  • The SuPPoRT trial is the first study to compare the three main treatments that are given to pregnant women with short cervixes. This important study will provide doctors with crucial information that can be used to decide which of the three treatments should be offered to these high-risk women to give them the best chance of having a healthy baby.

Women with gestational diabetes are more likely to experience pregnancy complications such as pre-eclampsia, premature birth and stillbirth, and there is also an increased risk of their children having obesity, cardiovascular disease or type 2 diabetes in later life. Metformin is often used to treat gestational diabetes, but it isn’t always effective. Our researchers have recently carried out some work that has suggested that another drug called UDCA – which is usually used to treat a pregnancy complication called intrahepatic cholestasis of pregnancy – might also be a useful treatment for gestational diabetes, and they are now looking into this further.

Research progress this year:

  • Our scientists have been planning the GUARD trial, which will find out whether UDCA is more effective than metformin at treating women with gestational diabetes; the team will compare how well the two drugs are able to control blood glucose levels and will also find out whether treatment with UDCA improves outcomes for babies. 
  • The team hope that 158 women will take part in the study.

Clinical impact:

  • The GUARD study should give us more information about whether UDCA really is a potential new treatment for women with gestational diabetes. It is hoped that UDCA could be used in the future to reduce the risks of the condition for both mother and baby.

Some health conditions that occur during pregnancy, such as intrahepatic cholestasis of pregnancy (ICP) or gestational diabetes, can sometimes increase the chances of stillbirth or other pregnancy complications. By using electrocardiography – or ECG – to measure babies’ heartbeats, our researchers have found that babies of mothers with ICP have abnormal heart rhythms, compared with babies from healthy pregnancies. These babies also have higher levels of a protein called NT-proBNP in their cord blood, which is indicative of heart failure. Importantly, when women with ICP were treated with a drug called ursodeoxycholic acid (UDCA), their babies did not have such severe problems with their hearts.

Research progress this year:

  • Our researchers combined data from women with severe ICP who were treated in previous randomised controlled trials and found that treatment with UDCA reduced the risk of these women suffering either stillbirth or premature birth.

Clinical impact:

  • Our research has shown that treatment with UDCA is beneficial for pregnant women with severe ICP and is therefore expected to change clinical practice.
  • Our team are now finding out more about the heart problems that can affect unborn babies of women with either gestational diabetes or existing type 1 or 2 diabetes, and hope to identify therapies that can be used to reduce stillbirth in these high-risk pregnancies.

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.