Our aim is to make a significant reduction in the number of women in the UK who are given no reasons for their miscarriages. In order to achieve this, we will carry out a programme of research that will explore the aetiology of miscarriage and aim to develop accurate diagnostic tests.
We want to put women and couples at the heart of our research. To do this our research will focus on four themes to address the key questions asked by those who suffer miscarriages.
- Why did it happen?
- Will it happen again?
- How can we prevent it happening again?
- How can we move forward from here?
Our programme of research will be combined with clinics at all three sites, which will enable 24,000 women per year to access treatment and support and participate in Tommy’s research studies.
Why did miscarriage happen? Projects planned to investigate the reasons for miscarriage.
- Project 1A: Investigation of cell-free DNA in the evaluation of early miscarriage. The discovery of cell-free DNA in maternal plasma has already led to huge clinical advances, including the Non-invasive Prenatal Tests (NIPT), which detect disorders such as Down's Syndrome. This project will explore whether cell-free DNA can be used to identify causes of miscarriage.
- Project 1B: Testing whether specific technology (Desorption electrospray ionization mass spectrometry (DESI MS) or Nuclear Magnetic Resonance Spectroscopy (NMR)) can be used to create a cost-effective test for identifying chromosomal and genetic causes of miscarriage.
- Project 2: Problems with the lining of the uterus has been shown to be a major cause of early miscarriage. We will look to developing a test that can be used before pregnancy to identify women at risk of miscarriage for this reason.
- Project 3: Investigation of Dipeptidyl-peptidase 4 (DPP4) inhibitors for use before pregnancy as a way of preventing miscarriage.
- Project 4: Understanding of the role of bacteria in the uterus in shaping early pregnancy outcomes.
- Project 5: The heart and cardiovascular system needs to adapt to pregnancy to provide the best conditions for the body to provide for the growth of the baby. Failure of these systems to adapt sufficiently has been shown to have a role in pre-eclampsia and intrauterine growth restriction but it has not to date been explored in relation to early miscarriage. We intend to investigate whether this could be a factor and, if so, whether it could be a basis for predicting who is at risk.
- Project 6: Damage in the sperm DNA has been shown in some trials to double the risk of miscarriage but the data is incomplete. This study will investigate further and if this proves to be an issue, explore ways of helping couples by using advanced sperm selection technologies in these couples to minimise risk.
Will it happen again? Projects that will explore ways of predicting the risk of a second miscarriage
- Project 7: At the moment couples suffering miscarriage are treated according to the number of miscarriages they have had, with most only being investigated after three losses. Our aim is to change this counting of losses to an approach that uses sophisticated prediction models that incorporates demographic and clinical factors and investigations results.
- Project 8: Evaluation of the immune phenotype to improve our ability to predict pregnancy outcome in women with recurrent miscarriage.
- Project 9: The impact of any abnormalities during very early pregnancy (the period of implantation, maternal response to hormones, formation of the placenta) on short-term and long-term pregnancy outcomes (the EPOS study).
How can we prevent it happening again? Projects that investigate ways of preventing miscarriage
- Project 10: To establish a national Tommy’s miscarriage network to facilitate pilot and large scale randomised controlled trials
- Project 11: A trial to examine the role of endometrial scratch (intentionally 'scratching' the uterine wall to increase hormonal responses) in women with recurrent miscarriage.
- Project 12A: Investigating the psychological cost of early miscarriage on women and partners, and looking at opportunities for support and treatment.
How can we move forward from here? Exploring better ways of supporting couples
How to get referred to the Tommy's National Miscarriage Research Centre.
The first step is to visit your GP.
The NHS follows guidance which is set out in NICE guidelines and these say that the GP should refer you after you have has three early miscarriages. Most doctors realise that this can cause considerable distress to women and many hospitals will investigate after two miscarriages.
After one miscarriage most women go on to have a healthy pregnancy so it is unlikely you will be referred for further investigation after one miscarriage.
Talk to your GP, explain how you are feeling and ask to be referred as soon as possible.
To be referred to a Tommy’s miscarriage clinic, ask to be referred to a named Tommy’s unit when you visit your GP. The clinics will be at the following sites:
- Birmingham Women's Hospital
- University Hospital Coventry
- Queen Charlotte's & Chelsea Hospital and St Mary's Hospital, London
One of the benefits of doing this is that you will be offered entry into a research study which may trial the latest tests and/or treatments.
The Tommy's National Early Miscarriage Centre will comprise a partnership of three universities: The University of Birmingham, The University of Warwick, and Imperial College London. The three sites will run specialist clinics enabling 24,000 women per year to access treatment and support and participate in Tommy’s research studies.Hide details
We are trying to find out if a simple procedure before conception could help prevent miscarriage. If so, this could be an easy way to encourage healthy pregnancy.
Tommy’s are helping to train the carers of the future, so that we can continue giving women the best pregnancy care possible.