Looking at the effects of ICP and gestational diabetes on the fetal heartbeat

Dr Sian Chivers, Mr Paul Seed, Prof Catherine Williamson, Ms Tharni Vasavan, Dr Peter Dixon, CLN research midwives, Dr Caroline Ovadia, Professor William Fifer, Professor Hanns-Ulrich Marschall, Dr Manasi Nandi

We don’t know enough how some pregnancy complications can lead to stillbirth. Our researchers are developing new ways to assess the fetal heartbeat to spot babies in distress. This could enable doctors to intervene early and prevent stillbirth.

Why do we need this research?

In the UK, around 4,000 babies every year are stillborn. For half of these, there is no obvious cause, meaning parents are left without answers for why it happened. We need to better understand the causes of stillbirth, so that we can give parents the answers they need at a difficult time, and find ways to prevent stillbirth from happening in the future.

What’s happening in this project?

We know that some health conditions during pregnancy, such as intrahepatic cholestasis of pregnancy (ICP) or gestational diabetes, can sometimes increase the chances of stillbirth. However, we haven’t fully understood why this is the case. Our researchers are looking for clues in the heartbeats of unborn babies.

Fetal heartbeats can be measured using electrocardiography, or ECG. This test produces a waveform on a computer screen or on paper, which doctors can use to spot problems. Our researchers are looking at the ECG results of babies of mothers with ICP and gestation diabetes, as well as substances in the blood.

So far, the team have found that in severe ICP, the heartbeat of the unborn baby is different to a normal heartbeat. Looking in umbilical cord blood of these babies, they also found that a substance linked to heart problems, called NT‑proBNP, is also present at higher than normal levels. These results confirm earlier work which showed that ICP can cause irregular heartbeats in babies’ hearts.

The team are now studying the heartbeats of babies of mothers with extreme ICP, who are most at risk of stillbirth. They are also carrying out the same studies in mothers with gestational diabetes, to see if the condition has any effect on the baby’s heartbeat.

What difference will this project make?

By finding new ways to detect problems with the baby’s heartbeat, this project could help doctors spot babies who are at risk of stillbirth as a result of pregnancy complications. This could mean that they can intervene as early as possible to increase the chances that a mother will give birth to a healthy baby.

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