The ASPIRE study
Up to half of all miscarriages are caused by chromosome abnormalities. We want to find out if the bacteria in a woman’s vagina, known as the vaginal microbiome, is different when there are chromosomal abnormalities in the pregnancy.
Our researchers working on the ASPIRE project are investigating the microbiome and methods of detecting these differences. In 2019, 207 patients were recruited to our study and over 1,387 vaginal, blood and tissue samples have been collected for analysis. This project is the first to link the chromosomal dynamics of miscarriage to the vaginal microbiome in early pregnancy - providing new insights into the different causes of miscarriage.
Following on from this study, our researchers at Imperial College London carried out a separate study to investigate the vaginal microbiome in early pregnancy and understand its relationship with first and second trimester miscarriages. They analysed a total of 161 pregnancies: 64 resulting in first trimester miscarriages, 14 in second trimester miscarriage and 83 full-term pregnancies.
The study, published in British Journal of Obstetrics and Gynaecology (BJOG), found that first trimester miscarriage is associated with a reduced prevalence of Lactobacillus (a type of bacteria that produces lactic acid).
These findings are really exciting as this is the first paper to establish a link between the composition of the vaginal microbiome and miscarriage. This discovery will inform the development of our future research into the microbiome, helping us understand the mechanisms behind miscarriage and giving families much needed answers.
Using our research discoveries to predict miscarriages: designing an endometrial test
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).
The SIMPLANT trial, led by Professor Jan Brosens, found that a 3-month treatment of Sitagliptin, a drug to treat diabetes, significantly increased the production of stem cells in the endometrium. This incredible discovery marks a potential breakthrough for miscarriages which are associated with endometrial stem cell deficiency.
We are delighted to report that the SIMPLANT trial has now been published in EBioMedicine and has received widespread press coverage in The London Economic, The Independent and the Daily Telegraph amongst others. This data suggests that Sitagliptin taken before conception may improve outcomes for recurrent miscarriage patients.
We are now expanding our work on Sitagliptin in the endometrium. We have incorporated this research into a new, bigger project to create a pre-pregnancy endometrial test for the prediction and prevention of recurrent miscarriage. We want to investigate whether Sitagliptin, along with increasing stem cell count, improves pregnancy outcome. To do this, we need to develop a suitable test to screen recurrent miscarriage patients for stem cell deficiency.
We aim to transform current clinical practice by developing a test that identifies women at risk of miscarriage. We want to intervene before pregnancy, to enable these women to have the best possible chance of a healthy baby.
Rolling out best-practice care
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. Therefore, we have begun leading the development of a new care package for miscarriage clinical practice.
As part of the Big Give Christmas Challenge 2019, we raised an incredible £111,964 from our wonderful supporters towards the development of our miscarriage care package. Over the next two years, we will work closely with early pregnancy professionals to develop and implement our care package in test site clinics before we create clinical guidelines and aim to roll out our package across the UK.
Through rolling out our best-practice care, we can help improve pregnancy outcomes nationwide. This year, we are also funding a health economist to calculate the costs of miscarriage for the first time. This includes the social costs to the healthcare system and through taking days off work. With this information, we can influence policy to put miscarriage on the national agenda.