Women's Health

Professor Gordon Smith

Gordon SmithIn recent years, technological developments in ultrasound, biochemical screening and molecular genetics have made a significant contribution to certain aspects of care, in particular, population-based screening for foetal abnormality. However, the methods for screening the low risk population for other complications of pregnancy such as intra-uterine growth restriction, pre-eclampsia and stillbirth have remained largely unchanged for the past 20-30 years.

Complications in pregnancy represent a persistent and major problem with the first three months after conception known to be the most critical, when as many as 20% of pregnancies lost during this time. For pregnancies that develop beyond 24 weeks, between 0.5 and 1% result in death of the baby, either in the womb or in the first four weeks of life.

Premature birth can incur major complications associated with delivery, immediate care of the infant, childhood diseases, and educational and social problems in later life. The emotional cost to families, coupled with the associated healthcare and social costs, mean that research into the prevention of these conditions is more crucial than ever.

The Cambridge BRC Women's Health theme focuses on tackling the origins, treatment and prevention of many of the health issues that affect women during their reproductive years. We do this by translating excellence in scientific and clinical research into measurable improvements and treatments that have a positive effect on the health of women and their newborn babies.

We are building on basic science studies in oxidative stress, placental transport, genomic imprinting, maternal-fetal immune reactions and application of genomic technology in order to develop an integrated method of screening pregnant women. This will both determine their risk of adverse perinatal outcomes and identify novel genetic and molecular markers for adverse perinatal outcomes.

The bulk of our Cambridge BRC funding supports a prospective cohort study of unselected women in their first pregnancy attending for antenatal care in the first trimester of pregnancy. It is called the Pregnancy Outcome Prediction study (POP study). Women are serially scanned through the pregnancy and have blood obtained at recruitment, 20, 28 and 36 weeks gestational age. Paternal DNA is also obtained and, at the time of delivery, samples of placenta, fetal membranes and umbilical cord (including blood) are collected.

The study is designed to create an optimally phenotyped biobank of complicated pregnancies and controls. By the end of March 2011, we had recruited and involved more than 3000 women in the POP study. Read more about how they contributed to our research in our case study section. The study protocol has been published in an open access journal and is freely available at www.biomedcentral.com/1471-2393/8/51

Professor Gordon Smith gcss2@cam.ac.uk
May 2011

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Figure: Three-colour perfused human placental villi. Dr Steve Charnock-Jones, Professor Graham Burton, Dr Jeremy Skepper