The DESiGN trial: does the growth assessment protocol (GAP) find which small babies are at risk?

Dr Dharmintra Pasupathy, Professor Jane Sandall, Mr Paul Seed, Dr Annette Briley, Dr Asma Khalil; Dr Matias Vieira; on behalf of the DESiGN consortium

We want to find out if changing the way we assess fetal growth can tell us which small babies are really at risk, and help us to reduce the chances of stillbirth.

Why do we need this research?

Most babies that die before birth seem to have developed normally, but many weigh less than expected. A baby that is smaller than normal for its age is known as small for gestational age, or SGA. A small baby may mean that the placenta hasn’t been working properly, and could be at a higher risk of stillbirth. However, some small babies are completely healthy, and are growing normally.

We need to find better ways to tell when a small baby is really at risk, so that we can give them the best chance of a healthy birth.

Growth Assessment Protocol (GAP)

Telling when a baby is too small and might be in danger can depend on things like the size and ethnicity of its mother. Researchers have developed a new way to customise growth charts, so that they into account these other factors that might affect a baby’s growth. A 2013 study showed that using these new personalised growth charts to find out which babies really are too small can halve the risk of stillbirth.

The Growth Assessment Protocol (GAP) is a training programme designed to help maternity units implement these customised growth charts, along with other measures to improve the way they measure fetal growth. Recent early studies suggest that units which adopt GAP are better at finding which babies are at risk, and areas with a high uptake of GAP had 22% fewer stillbirths.

However, it’s possible that other factors may have influenced these results. Therefore, our researchers are now conducting a clinical trial to prove whether GAP has any effect on stillbirth rates.

What’s happening in this project?

DESiGN is a randomised control trial that aims to find out whether the GAP programme really is better for finding out which small babies are at risk. Hospitals which are taking part in the DESiGN trial will either carry on using their normal methods to track fetal growth during pregnancy, or will switch to implement GAP. Our researchers will assess the impact that GAP has had on stillbirth rates at these hospitals, as well as the costs involved in implementing the programme. The team will also interview maternity staff and women to gather their opinions of the new methods.

What difference will this project make?

This project will find out whether changing the way we assess fetal growth will help to identify which small babies are at risk. If the results of earlier studies are confirmed, this could significantly reduce stillbirth rates in the UK.

Get our research updates

Tommy’s funds research across the UK investigating the reasons for pregnancy complications and loss. We can keep you updated on our research news. If you're interested in being kept updated about our research and news from Tommy's, click here.

More research projects

Read Tommy's new and views

  • A nurse taking a patients blood pressure in a hospital room

    News

    Pregnancy is a unique chance to predict health risks to mums

    A recently published article, co-authored by Professor Catherine Williamson from Tommy’s Research Centre at King’s College London, suggests that certain pregnancy complications can indicate future health issues for women.

  • Rising demand for Tommy's midwives in coronavirus lockdown

    News

    Tommy’s awarded grant to help meet rising demand for support during coronavirus lockdown

    Tommy’s has received a grant from the UK Government’s Department for Health and Social Care to support the costs of its PregnancyHub information and support services throughout the summer, due to rising demand in the wake of coronavirus.

  • Tommy's researchers latest findings

    News

    Tommy’s Research Centres continue vital work on pregnancy complications

    Although recruitment to some clinical trials had to be paused when coronavirus hit the UK, scientists at Tommy’s Research Centres across the UK are still hard at work, supporting women and families in our specialist clinics and sharing their latest studies with academic journals.

  • Blog

    Miscarriage during lockdown

    The day before Mother’s Day, and two days before the UK officially went into coronavirus lockdown, Zara Dawson found out she was having a miscarriage. Her third consecutive miscarriage in less than a year, and fourth consecutive loss, after losing her second son Jesse in 2018 to termination for medical reasons.