Research into health and wellbeing in pregnancy

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.

During pregnancy there are some behaviours, such as smoking, over-eating and being sedentary, that can have an adverse effect on the baby. These effects cannot be underestimated - they go beyond the immediate effect on the baby in the womb and at birth to DNA programming that can effect the future health of a generation. What the mother eats during pregnancy, for example, can effect on their child's risk of obesity in later life. 

We fund projects that further the body of evidence available to the bodies, such as NICE, who make recommendations on the information that should be given to pregnant women.

We also research the best ways to deliver information and interventions to hard-to-reach groups, such as young women, who are more at risk of pregnancy complications due to lifestyle issues.

Some recent health and well-being research projects 

Running is safe in pregnancy

Many women who are keen runners are not sure whether running during pregnancy will harm their baby, and to date there’s been no conclusive evidence either way. Our scientists in London have now proved through a trial called Recreational running in pregnancy that running is safe in pregnancy. It can, in fact, be recommended as a form of healthy exercise. This will be reassuring news for many women.

Read more about Recreational running in pregnancy (SPORT)

Reaching young women with smoking cessation messages

Smoking in pregnancy greatly increases the risk of stillbirth - it is the single most important modifiable risk factor in pregnancy. With funding from the Department of Health, we are developing a stop smoking intervention that is:

  • targeted specifically at young pregnant women
  • non-judgemental
  • convenient and cost-effective
  • sustainable.

The current pathway for quitting smoking (eg stop smoking services) is not meeting the needs of this group evidenced by the low referral rates and the high rate of young women who smoke in their pregnancies (2012 IFS). Yet babies born to mothers aged under 20 are 60% more likely to die than children born to older mothers and have a 25% greater likelihood of being born too early or too small.

Read more about Reaching young women with smoking cessation messages

Improving the nutritional status of pregnant teenagers

We are partners in this study, funded by MRC, that is looking at ways to improve the diet and nutrition of pregnant teenagers.

Teenage girls have the poorest quality diets of any population group in the UK. Coupled with the demands of a growing baby and their own rising nutritional needs, this increases their risk of adverse pregnancy outcomes. Previous research shows that pregnant teenagers want to improve their diets and trust advice from their midwives. Midwives however struggle to find opportunities to discuss diet and nutrition and often lack the confidence and knowledge to do so.

In partnership with pregnant teenagers and midwives, this project is looking to develop a theoretically-driven, evidence-based intervention to provide pregnant teenagers with tailored support for sustaining improvements to their diets between appointments with a midwife trained in skills to support behaviour change. 

Read more about Improving the nutritional status of pregnant teenagers

Pregnancy and maternal weight

Our centre in Edinburgh is dedicated to analysing the relationship between pregnancy outcome and obesity. This is extremely important if we’re to improve pregnancy outcomes in the UK as almost half the women of childbearing age are now obese or overweight.

We are investigating why some babies don't grow properly in the womb and how conditions experienced during pregnancy might `programme' the offspring to have greater risk of heart disease, obesity and diabetes later in life.

The Edinburgh Antenatal Metabolic Clinic was established by Tommy's in 2008 to address such questions. The clinic provides multidisciplinary antenatal care to severely obese pregnant women, including advice about diet and lifestyle. We are also carrying out a detailed study of the women who attend our clinic to look at their weight gain and change in body composition during pregnancy, and how this affects their babies.

Read more about the Edinburgh antenatal metabolic clinic

The effect of early nutrition on later life

The Tommy’s London centre is involved in several parts of the large multinational EU study known as EarlyNutrition, which is addressing the long-term effects of early nutrition on later life.

As part of this Professor Poston is leading a number of intervention studies in pregnant women or in infants. 

We are investigating why some babies don't grow properly in the womb and how conditions experienced during pregnancy might `programme' the offspring to have greater risk of heart disease, obesity and diabetes later in life.

It is known that genetic changes can cause certain diseases but in recent years it has become clear that environmental factors might also increase the risk of disease in the offspring by changing the way that genes work (‘epigenetic’ changes), without actually causing mutations. 

The effects of stress in pregnancy

Mental wellbeing has been shown to have an effect on pregnancy, the postnatal period and the baby in later life. We funded the first study of antenatal yoga in the UK and the first worldwide to investigate how both single and multiple sessions of yoga can effect mood and stress hormone levels among healthy pregnant women.

This study, funded by Tommy’s and carried out in Manchester and Stockport by myself and colleagues, showed that antenatal yoga can reduce stress hormone levels and reduce maternal anxiety through a combination of breathing exercises, mindfulness techniques and physical postures, all within a supportive group setting. A single session of yoga was found to reduce self-reported anxiety by one third and stress hormone levels by 14%. Encouragingly, similar findings were made at both the first and final session of the eight-week intervention. 

Read more about how Yoga can help make pregnancy stress-free

The Birthplace in England research programme

The ‘Birthplace In England’ project looked at birth outcomes in different settings provided by the NHS. Expansion of care to maternity units and home births has the potential to reduce intervention rates in low-risk women. Our findings also support greater provision of services to women who wish to have a second or subsequent birth at home. However, for women having a first baby, home birth increases the risk of poor outcomes and of needing to transfer to an obstetric unit during labour or immediately after delivery. Major changes such as centralisation of services in larger obstetric units and affiliated maternity units, and changes to admission criteria, need to be monitored and evaluated. Our findings will be useful to managers organising maternity services and will enable women to make informed choices on where to give birth.

We’ve improved our understanding of which women are most at risk of excessive bleeding during childbirth

Our recent ‘STOP’ study found the highest rates of postpartum haemorrhage (blood loss after delivery) ever recorded in the UK, indicating that is a growing problem. We have identified new risk factors, including previous IVF (in vitro fertilisation) treatment and being of black ethnicity. The STOP study also showed that health professionals make many errors when transferring records of blood loss to hospital electronic databases. The study has therefore set the scene for developing new and more accurate methods for monitoring blood loss, for assessing risk and for developing better ways to manage postpartum haemorrhage.

We’ve shown that maternal diabetes has lifelong effects in the offspring

Our analysis of data from Generation Scotland (a large group of families in Scotland who have agreed to take part in medical research) has shown that maternal diabetes is associated with higher percent body fat in the offspring, high blood pressure and an increased risk of developing ‘metabolic syndrome’, which increases the risk of heart disease. These results show that being exposed to diabetes during development has significant effects on lifelong health, which has clear implications for public health. We hope that this will help pregnant women to understand the importance of keeping blood sugar levels within normal limits during pregnancy.

We’ve shown that maternal obesity can affect subsequent generations

We have used a mouse model to explore the effects of maternal diet-induced obesity on the offspring. Surprisingly, maternal obesity had few effects on the first-generation offspring. However, we found clear evidence of fetal growth restriction and persistent metabolic changes in the second-generation offspring. Effects on birthweight, insulin levels and gene expression in the liver were passed on through both maternal and paternal lines. This suggests that the current obesity epidemic may affect the descendants of obese individuals, even when the first generation appears to be unaffected.

We’ve confirmed that obesity reduces fertility

We have found that maternal obesity can depress fertility and alter the activity of mitochondria in eggs and early embryos. Mitchondria are important organelles in cells that generate energy. We have also shown that these early changes continue through to later fetal and infant stages. This research is highly relevant given the increase in obesity in women of childbearing age. It is also important in assisted reproduction techniques (ART), and the development of potential regenerative therapies based on embryonic stem cells.

We’ve established a clinic to help obese pregnant women

Nearly half the women of childbearing age in the UK are overweight or obese. We know that many pregnancy problems are more likely in obese women, but we don't know why. Tommy's established the Edinburgh Antenatal Metabolic Clinic at our research centre in 2009. The clinic provides enhanced care throughout pregnancy to about 200 women every year and provides our scientists with valuable data to help understand the link between obesity and poor pregnancy outcomes. A recent audit showed that severely obese women cared for by this clinic had a significantly lower rate of stillbirth.

We’ve shown that obese pregnant women have lower levels of stress hormones

Our recent SCOOP project (Study of Cortisol and Overweight in Pregnancy) showed that obese pregnant women have lower levels of stress hormones in their blood in pregnancy than women of normal weight. We also found that this could contribute to macrosomia (increased size at birth) and longer gestation (post-term birth) in obese pregnancy. Macrosomia can complicate vaginal delivery and puts the baby at risk of injury during birth. It also increases the newborn baby’s risk of health problems after birth.

We’ve identified barriers to physical activity in obese pregnant women

Exercise in pregnancy is safe and has considerable benefits for both mother and baby. However, studies encouraging exercise in obese pregnant women have largely been unsuccessful. In this project we explored the knowledge, attitudes and behaviours of severely obese women, including the perceived benefits of and barriers to physical activity during pregnancy and the postnatal period. We identified several personal, societal and support barriers to physical activity. Walking was the most popular activity. Most women (71%) reported that their levels of physical activity decreased as their pregnancy progressed, and half reported that they were less confident about maintaining/increasing activity. Three-quarters of women used the physical activity information leaflet provided, and three-quarters of those who trialled the pedometer found it useful. Our study showed that lifestyle interventions designed for severely obese pregnant women should take into account individual, societal and professional barriers to physical activity during pregnancy.

We’ve studied how to optimise nutrition in obese pregnant women

By studying dietary patterns in women attending our specialised Edinburgh Antenatal Metabolic Clinic, we have found that obese pregnant women tend to eat an energy-rich diet that is low in key micronutrients important for the baby’s growth and development. We are now working with our dietician to optimise nutrition for these women.

We’ve shown that metformin does not reduce excess birthweight in babies of obese women (the EMPOWaR study)

A total of 449 obese women took part at centres in Coventry, Sheffield and Nottingham, in addition to the Tommy’s funded centres in Edinburgh and Liverpool, following a huge amount of interest from academic centres and the UK and overseas press (including an interview with Professor Jane Norman on Radio 4’s ‘Today’ programme). The women took either metformin or placebo from 12–16 weeks until delivery. We found that that, in fact, metformin did not reduce the birthweight of the babies. This means that there may be no benefit in giving metformin to severely obese women during pregnancy. It is important to show this, so that these women are not given metformin in the belief that it may be beneficial. This study also emphasises the importance of being of normal weight before pregnancy, as it is difficult to prevent the risks that maternal obesity presents to the baby in later life once pregnancy has started.

We’ve shown that home blood pressure monitoring using telemetry is acceptable to pregnant women (the BLOSSOM study)

Women with high blood pressure require frequent monitoring during pregnancy. This involves appointments with the community midwife or attendance at hospital day units or triage departments. In this study we explored home monitoring of blood pressure using telemetry. Most of the women found the blood pressure monitor easy to use and preferred monitoring blood pressure at home rather than attending hospital.

We’ve demonstrated that measuring the stiffness of arteries in obese pregnant women can identify those at risk of blood pressure complications

We have recently demonstrated that the Vicorder device provides a valid and reliable method for routine measurement of arterial stiffness in obese pregnant women. Given that arterial stiffness increases before blood pressure does, this technique could be a useful screening tool to identify women who have an increased risk of developing blood pressure complications during pregnancy.

We’ve confirmed that a mother’s diet during pregnancy can affect her child’s long-term health

This study involved men and women born in the late 1960s in Motherwell, for whom we have records of their mothers’ food intake in pregnancy. Our study is the first to show that an ‘Atkins-type’ high-protein, low-carbohydrate diet during pregnancy affects the regulation of several genes that may be important in increasing the risk of diseases such as adult obesity and high blood pressure, which are also affected by the baby’s birthweight. This work highlights the importance of the early life environment for future health.

We’ve found that domestic violence and maternal depression may be associated with behavioural problems in the child

We have followed up 13,617 mother and child pairs until the child was 42 months old. We found that most women who experience violence during pregnancy continue to experience violence afterwards. Domestic violence during pregnancy is associated with depression both during and after pregnancy. Furthermore, domestic violence and maternal depression may be associated with future behavioural problems in the child. A review of the literature also identified a strong association between domestic violence and mental health, but domestic violence is rarely identifed by clinicians in mental health settings.

Desai M, Jellyman JK, Ross MG (2015) Epigenomics, gestational programming and risk of metabolic syndrome. Int J Obes (Lond). 2015 Apr;39(4):633-41. doi: 10.1038/ijo.2015.13. Epub 2015 Feb 2.