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 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
2019 research highlights
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.
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
2019 research highlights
Preventing stillbirth by combatting placental rejection
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.
The team have compared the blood samples of women with CHI to other pregnant women and the initial results suggest that placental rejection does have similarities to organ transplant rejection.
These findings could lead to the development of “cross-matching” between the placenta and mother, to define the placental antibodies to be used in screening. Ultimately, this project is bringing us closer to ensuring that these at-risk women have safer pregnancies.
Advancing our research: developing new technologies - the FeHeMo vest
Our researchers are developing a fetal health monitoring vest to record maternal heart rate, fetal heart rate and fetal movements at different stages of pregnancy to ensure the baby is continuously monitored.
This vest has the potential to improve pregnancy outcomes through continuous monitoring, enabling doctors to intervene early to prevent stillbirth in at risk patients.
Rainbow Clinic roll-out
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 to report that there are now six operational Rainbow Clinics including Norwich, Leicester, Reading, East Lancashire and Leeds. To ensure that the Rainbow Clinics retain key elements of care established at our Manchester centre, we have developed a programme to support these new units, including collecting data to measure consistency. In 2019, our evaluation of women’s experience within the service demonstrated a reduction in anxiety, stress and depressive symptoms over time from the first contact through to the postnatal period.
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
2019 research highlights
Our researchers have published a new study showing that for a group of high-risk women who have had a previous failed vaginal stitch, an abdominal stitch is proven to be effective in reducing the risk of late miscarriage and preterm birth.
The MAVRIC study was a UK-wide randomised controlled trial that took ten years to complete, focusing on very high-risk women with recurrent pregnancy losses and failed treatment.
The study found that women receiving an abdominal stitch were more likely to have a baby that survives and are less likely to give birth before 32 weeks of pregnancy. The study was published in the American Journal of Obstetrics and Gynaecology, the highest impact speciality journal.
“We are delighted to show that women who lose multiple babies, even after failed vaginal stitches will usually have successful pregnancies with an abdominal stitch. We have proven this is a life saver in the first randomised trial of the procedure. There are not many treatments in pregnancy that can make that claim. We are so glad to be able to help these women in their desperate situation.”
Professor Andrew Shennan, Clinical Director at Tommy’s Preterm Surveillance Clinic
Pioneering treatment for patients with gestational diabetes
We are currently developing a method to predict which women are at high risk of gestational diabetes through a prediction tool.
We are determined to find a more effective way of diagnosing women with diabetes, so that we can manage their care to ensure they have the safest pregnancy possible. We are funding a PhD studentship for Cyrus Fan, to investigate the effectiveness of progesterone sulphates as indicators of diabetes in early pregnancy.
We have also recently set up the GUARD trial, led by Professor Catherine Williamson, that will study the impact of the drug ursodeoxycholic acid (UDCA) on severity of gestational diabetes. UDCA is already used to treat cholestasis, so it has good safety data for use in pregnancy. We hope UDCA will result in fewer women needing insulin and will improve outcomes for the babies of women with gestational diabetes.
After several years the BEATS Study, investigating the link between cholestasis and stillbirth, has come to an end. The study investigated whether cholestasis, characterised by higher levels of bile acid in the liver, causes babies to have irregular heartbeats. Our researchers have made significant breakthroughs over the last year which have the potential to have a significant impact on practice. Data analysis from the BEATS study shows that high serum bile acids are associated with fetal ECG abnormalities – and this may be an explanation for the increased risk of stillbirth.
Our researchers are now drafting the manuscript to be submitted to a peer reviewed journal and our final findings will be shared in Spring 2020.Hide details
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
2019 research highlights
Enjoy Your Bump
The growing prevalence of issues, such as mental health problems and obesity, bring higher risk to pregnancies. It is vital that we learn more about what puts pregnancies at risk, and what we can do to prevent stillbirth and preterm birth if we are to meet our aim of making pregnancy safer for everyone.
Mental health disorders are amongst the most common illnesses during pregnancy, affecting a quarter of pregnant women in the UK. If depression is untreated during pregnancy, women have a seven-fold increased risk of postpartum depression. Despite this shocking statistic, there is an extreme lack of treatment options available specifically for pregnant women that do not require drugs.
Our aim is for all women to be able to benefit from expert mental health care, to enable them to feel
supported and empowered during pregnancy. Our Edinburgh team have developed Enjoy Your Bump, an online package that teaches CBT-based life skills on a modular basis, in a fun, interactive and accessible way. We have received extremely positive feedback from pregnant women who have tested the package and are now making further improvements.
Breathing problems during sleep in pregnancy
Our researchers are now pioneering research into the effects of breathing problems during sleep in pregnancy. There is evidence that women suffering from sleep disordered breathing have a higher risk of developing pregnancy complications such as pre-eclampsia, gestational diabetes, stillbirth and preterm birth, and this is particularly the case for women with obesity.
The team will be developing their work in this area and are recruiting more than 80 women to a study which investigate this link.Hide details
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.
Our NHS supported specialist clinics deliver high-quality care, enabling improved recruitment to clinical trials and faster implementation of research findings.
Tommy's PregnancyHub informs and empowers families to make healthy behaviour and lifestyle choices, through evidence-based, high-quality information, ultimately leading to a reduction in the number of babies who die during pregnancy or birth.
All of Tommy's work has the same goal. To reduce the number of babies who die during pregnancy or birth. These are the rates of stillbirth, miscarriage and preterm births in the UK.