The AFFIRM trial for prevention of stillbirth

Researchers supported by Tommy’s are looking at whether a package of care and resources for pregnant women can help stop stillbirths.

  • Author's list

    Dr Elizabeth Camacho, Professor Jane Norman, Dr Sarah Stock, Professor Alexander Heazell

Start: January 2014

End: June 2020

Why do we need this research?

The rate of stillbirth in the UK are among the highest in the developed world. A 2016 study in The Lancet ranks it as 26th out of 49 high-income countries. Tommy's believes that this is unacceptable.

Most of the time, stillborn babies appear to have grown completely normally. Often, it is only discovered after birth that there was something wrong with the placenta: the organ that provides babies with the oxygen and nutrients that they need in the womb. An early sign that something might have gone wrong is if a mother notices that her baby is moving less than usual – this is known as reduced fetal movement.

Tommy’s have been supporting a trial to try and prevent stillbirth from happening, by focusing on women who report their babies are moving less than normal.  

The AFFIRM trial

The AFFIRM trial, which ran from 2014 to 2016, aimed to see whether a simple ‘care bundle’ can reduce stillbirths by raising awareness of, and acting on, reduced fetal movement.

The AFFIRM care package was made up of:

-          information for pregnant women raising awareness of monitoring reduced fetal movements

-          more tests and clinical help when babies are moving less than normal.

The study generated huge interest, involving around 450,000 pregnant women across the UK. The results of the AFFIRM trial showed a small drop in the rate of stillbirth among women receiving the care package. However, this drop wasn’t large enough to be completely certain that it was caused by the care package, rather than being caused by chance.

Watch this video to learn more about the results of the AFFIRM trial.

What’s next for the AFFIRM trial?

Our researchers are now carrying out an analysis to show whether the AFFIRM care package is cost-effective to implement, compared to standard care. The team will be assessing the cost of extra resources needed to provide the care package, including additional scans. Along with the results of the trial, the cost-effectiveness analysis will provide policymakers with the information they need to decide whether to implement the care package across the NHS.

What difference will this project make?

If the care package studied in the AFFIRM trial is found to be cost-effective, it could be implemented it across the NHS. This could provide women whose babies are moving less than normal with additional support when they need it, and potentially help to reduce stillbirth rates in the UK.

More research projects

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  • Preventing stillbirth: the role of the immune system in rejecting the placenta

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    To help diagnose pre-eclampsia after it has developed, doctors can now use a blood test which measures the amount of a hormone called placental growth factor (PlGF). Our scientists are looking into PlGF and what it can tell us about the health of the placenta.
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  • Can low levels of taurine make stillbirth more likely?

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

    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.
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  • Understanding the causes of stillbirth by studying the placenta

    We still don’t know enough about the changes in the placenta which lead to stillbirth. In this project, our researchers are using cutting-edge techniques to study the placenta. This will help doctors in the future to give parents whose baby has died the answers they need.
    Understanding the causes of stillbirth by studying the placenta

  • Analysing multiple studies to find ways to prevent stillbirth

    Tommy’s researchers are drawing upon multiple studies to address questions about stillbirth that have not yet been answered.
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