The SCOPE study - an international search for answers

Dr Dharmintra Pasupathy, Mr Paul Seed, Professor Lucilla Poston, Dr Matias Vieira, Professor Louise Kenny (collaborator and principal investigator for SCOPE)

The SCOPE study is a huge international study looking at how to predict and prevent complications in late pregnancy: pre-eclampsia, preterm birth and fetal growth restriction.

The SCOPE study is an international study looking at how to predict and prevent the major diseases of late pregnancy: pre-eclampsia, preterm birth and fetal growth restriction. Tommy’s London and Manchester research centres were both involved in the project. A total of 5,690 first-time mothers took part in New Zealand, Australia, the UK and Ireland, and more than 50 papers have been published.

The study has already led to useful ways to predict pre-eclampsia and also identify healthy pregnancies. It has also given us valuable information about many problems during pregnancy, including miscarriage and the influence of smoking on the developing baby.

The SCOPE study has established a unique, international pregnancy biobank that will serve as a platform to:

  1. identify novel molecular markers that predict in early pregnancy women who will subsequently develop late pregnancy complications.
  2. test and validate combinations of key clinical, known and novel molecular markers to predict each disease .
  3. develop predictive tests that offer first time mothers an accurate, personalised risk rating for each disease.

The SCOPE study exists because we know there are a number of potential clinical and molecular markers (certain proteins, fats and small molecules in blood) for these complications.

None of these candidate markers are useful as individual predictive tests, but combinations of markers are likely to result in clinically useful screening tests.

Further, recent advances in proteomic and metabolomic technologies and bioinformatics (advanced mathematics) allow us to discover and map differences in molecules circulating in the blood of women who later develop these conditions. This has created the opportunity to develop effective methods of predicting these diseases, with the potential to dramatically improve maternal and infant health worldwide.

Research papers

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SCOPE: identifying the risk of pre-eclampsia in obese women

An achievement of SCOPE is the development of algorithms (flow charts) that can be used to work out the risk of pre-eclampsia early in pregnancy. These use clinical factors, ultrasound measurements and 'biomarkers' found in the blood, and are based on information from all the women involved in SCOPE. However, the way that pre-eclampsia happens in obese women may be different to women of normal weight. In the women taking part in SCOPE, the number of obese women who developed pre-eclampsia (9.2%) was almost three times as high as women of a healthy weight (3.4%).

Researchers found that a protein made by the placenta – placental growth factor or PlGF – was associated with pre-eclampsia in obese women, but not in non-obese women. Meanwhile, blood pressure measurements at 15 weeks of pregnancy were more strongly associated with pre-eclampsia in women of normal weight than in obese women.

This suggests that different tests may be needed for obese and non-obese women when trying to predict the risk of pre-eclampsia.  

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Funding

This study takes place in a Tommy's centre and is funded by Tommy's and the Brazilian Ministry of Education

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