Tommys third research centre, at the Royal Infirmary of Edinburgh.
The Edinburgh Tommy’s Centre for Maternal and Fetal Health opened in April 2008.
The Tommy’s Centre sits within the MRC for Centre for Reproductive Health and in the wider Queen’s Medical Research Institute in Edinburgh. In addition to those MRC CRH Principal Investigators whose activity is almost entirely focused on pregnancy research, (JEN, FD, and SS), those whose focus is gynaecology and early pregnancy (AH), and those who work on the molecular basis of reproduction and reproductive failure (NG) the Tommy’s Centre also includes those with primary appointments at the British Heart Foundation Centre for Cardiovascular Science in Edinburgh (BHF CCVS). These individuals (RR) bring a background in endocrinology and diabetes to bear on our primary foci of obesity in pregnancy and prematurity.
Research and clinical interests.
We work on the major clinical challenges of preterm birth, stillbirth, and the impacts of each of maternal obesity and maternal depression and stress. These are huge global issues - annually, preterm birth affects nearly 15 billion babies globally and 50,000 in the UK. Stillbirth rates in the UK are currently at around 1 per 200, rates which are commoner than most other European countries. Maternal obesity rates are now around 20%. The adverse impacts on pregnancy outcome include increased risk of caesarean section and stillbirth, together with an increase in minor pregnancy complications, all of which have a significant economic impact. Maternal stress and anxiety increases the risk of short term adverse outcomes including preterm birth and low birthweight and adverse long term outcomes for the offspring including abnormalities in glucose tolerance and cardiovascular response to stress.
Review of activity 2015 - 2016
The Tommy’s Centre continues to publish widely, with over 60 peer reviewed publications during this period.
Our ongoing grant funding in the field of pregnancy research is around £16 million. Funding from Tommy’s is key to almost everything we do, and certainly allows us to successfully apply for additional grants, such as those to conduct clinical trials including EMPOWaR, OPPTIMUM, GOT-IT, STOPPIT -2 QUIDs and AFFIRM.
Recruitment is well underway to STOPPIT 2 and GOT-IT, and we will complete recruitment to AFFIRM, our flagship stepped wedge cluster randomized trial funded jointly by Tommy’s, the Chief Scientists Office, and SANDS in 2017.
Tommy’s staff also make major contributions to knowledge transfer. Jane Norman was Chair of the group developing the NICE Guideline Preterm Labour and Birth, which was published in November 201
Major research achievements in 2015 included:
- Shalini Rajagopal and Jane Norman showed 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. (Rajagopal S et al 2015 doi 10.1093/molehr/gav027).
- The Tommy’s team, with Carolyn Chiswick completed, analysed and published our randomised trial testing whether metformin prevents high birthweight in obese women. We found, contrary to our original hypothesis, 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 (Chiswick C et al 2015 doi: 10.1016/S2213-8587(15)00219-3).
- Rebecca Reynolds and Fiona Denison 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 8 x higher in women who did not attend the clinic compared with those who attended the clinic.
- Laura Stirrat and Rebecca Reynolds 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 (Stirrat et al 2015 doi: 10.1016/j.psyneuen.2015.09.019).
- Theresia Mina and Rebecca Reynolds showed that obese pregnant women have increased symptoms of anxiety and depression during pregnancy compared with normal weight women (Mina et al 2015 doi: 10.1017/S0033291715001087). 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.
- Nor Mohd Shukri and Rebecca Reynolds showed that obese pregnant women eat an energy rich diet that is low in key micronutrients important for fetal growth and development (Shukri et al 2015 doi: 10.3390/nu7105403). We are working with the dietician in our specialist antenatal metabolic clinic to optimize nutrition for obese pregnant women.
- Ken Lee and Rebecca Reynolds 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 (Lee et al 2015 doi: 10.1161/HYPERTENSIONAHA.115.05920).
- Fiona Denison showed that it is possible to assess placental glutamine and glutamate in the placenta as it supports the developing fetus (Macnaught et al 2015)
- Fiona Denison and Laura Stirrat reported a new surgical approach to caesarean section in very severely obese pregnant women with a larger dependent pannus (Stirrat et al 2015)
- Sara Rinaldi, Jane Norman and Sarah Stock developed a new less invasive mouse model of inflammatory preterm birth (Rinaldi et al, 2015 doi: 10.1016/j.ajpath.2015.01.009). We are now using this to investigate anti-inflammatory treatments for preterm birth.
View the Tommy's Lothian Preterm Birth Clinic website