In addition to its focus on maternal obesity in pregnancy, other areas of research interest include blood vessel and tissue remodelling, fetal ‘programming’, inflammation, hypoxia and the process of labour and childbirth and maternal depression/stress.
Situated in the state-of-the-art buildings of the Queen’s Medical Research Institute, the centre is helping to make Tommy’s maternal and fetal research network a truly major force worldwide. It has 35 core staff and in 2013/2014 published 59 scientific papers in the pregnancy field in peer-reviewed medical journals. The centre has developed excellent collaborative links with the sister Tommy’s centres in London and Manchester, as well as with other relevant groups within Edinburgh and beyond.
A major achievement has been the award of Centre status from the Medical Research Council (MRC), with the MRC Centre for Reproductive Health opening in April 2011. The Tommy’s centre is an integral part of the MRC Centre and is key to one of its main themes: ‘Developmental programming and reproductive resilience’.
The centre opened the Tommy’s Antenatal Metabolic Clinic in August 2008 and it is now providing specialised care to around 200 obese pregnant women per year. This clinic provides the infrastructure for most of the centre’s work on obesity in human pregnancy, and it has become a template for similar clinics around the UK.
Core funding from Tommy’s has allowed the Edinburgh centre to develop new research threads that are crucial for better understanding and treatment of complications associated with pregnancy.
Some recent research achievements from the Edinburgh centre
We have shown that myocytes (the muscle of the womb) and monocytes (circulating white blood cells) co-operate when placed together to enhance inflammation over and above inflammation caused by either separately. These effects increase contraction of the myometrium (womb) but can be reduced by progesterone.
We found that metformin had no effect on reducing birthweight. We hope to follow the babies up to see if there are any longer term beneficial effects on baby health.
We audited key clinical outcomes among women attending the Tommy’s antenatal metabolic clinic compared with outcomes among women of comparable BMI who delivered in Lothian and received routine antenatal care. We showed that the risk of having a stillbirth was eight times higher in women who did not attend the clinic compared with those who attended the clinic.
We showed that obese pregnant women have lower levels of stress hormones in their blood in pregnancy than women of normal weight. They also demonstrated that this may be a novel mechanism contributing to macrosomia (increased size at birth) and longer gestation in obese pregnancy.
We showed that obese pregnant women have increased symptoms of anxiety and depression during pregnancy compared with normal weight women. This is important as anxiety and depression can have a major impact on the health of the mother and her family. We are now testing ways to identify and manage these women better.
We showed that obese pregnant women eat an energy rich diet that is low in key micronutrients important for fetal growth and development. We are working with the dietician in our specialist antenatal metabolic clinic to optimize nutrition for obese pregnant women.
We showed that obesity in pregnancy leads to a 35% increased risk in premature mortality in later life compared with being normal weight in pregnancy. Obesity in pregnancy also increases a woman’s risk of having heart disease in later life.
Lecture from Professor Jane Norman on pregnancy research in Edinburgh
Professor Jane Norman is to be congratulated for developing an outstanding and cohesive team that tracks the biological and clinical consequences of maternal-placental-fetal ‘stressors’ as they present as pregnancy complications. The team is multidisciplinary, linking more classical areas of pregnancy research to less-investigated areas such as maternal mental health. The local and global impact is significant and important.
Recent research achievements in miscarriage and stillbirth, premature birth, pre-eclampsia and general pregnancy health.
In addition to our core work on miscarriage, stillbirth, preterm birth and pre-eclampsia, Tommy’s also funds projects that research the effects of lifestyle and well-being on pregnancy and on the later life of the child.
When a baby dies after 24 weeks of gestation it is called a stillbirth. Incredibly, over 3,500 babies are stillborn every year in the UK and many of these deaths remain unexplained. Tommy’s research is dedicated to improving these shocking statistics.