Improving the health of pregnant women and their children

The foundations of many diseases begin in early life and timely intervention reduces long-term morbidity. The aim of the Women & Children’s Health Theme is to improve the health of pregnant women and their children in some of the most deprived boroughs of South London

(Lewisham/Southwark/Lambeth) by the introduction of early risk assessment, accessible diagnostics, and effective interventions.

By stratifying risk in the mother and neonate and understanding molecular pathways to fetal and neonatal compromise we are determining the efficacy of existing intervention strategies, developing new evidence-based targeted interventions, including those for our ethnic minorities, and importantly, avoiding overtreatment and unnecessary intervention. Similarly, we are researching effective interventions in major problems of early childhood.

Our work is set out in 3 programmes:

  • Programme 1. Pregnancy disorders and maternal Nutrition.
  • Programme 2. Developing embryo and fetus.
  • Programme 3. Neonate and child.

Example projects

  • Reducing childhood risk of food allergies Food allergy affects 8% of UK children. Following our ground-breaking LEAP Study (Du Toit G. et al. (2015) NEJM 372;803-13), which showed an 81% reduction in peanut allergy with early introduction of peanut in the infants’ diet, guidelines for the prevention of peanut allergy have changed globally and implementation has changed clinical practice (e.g., Australian infants transitioned from 30% to >90% peanut consumers) (Soriano VX. et al. (2019) J Allergy Clinical Immunol 144;1327-35). The LEAP intervention has a sustained effect after 1 year of peanut avoidance (LEAP-On) and its long-term effects are under investigation. The gold standard diagnosis, the oral food challenge (OFC), can lead to severe allergic reactions. Our researchers have pioneered safer in vitro diagnostic tests (Santos AF. et al. (2020) J Allergy Clin Immunol 146; 344-55) Basophil Activation Test and Mast Cell Activation Test, with 96-100% specificity to diagnose peanut allergy, enabling confirmation of diagnosis, and can lead to a 67% reduction in the need for OFC.  They are especially useful in identifying children at high risk.

 

  • New guidelines covering bile acids and adverse outcomes in pregnancy Intrahepatic cholestasis of pregnancy (ICP), the commonest liver disease of pregnancy, affects ~5000 UK women/year, increasing the risk of adverse outcomes. We have established that blood bile acid measurement is the only reliable way to determine the risk of stillbirth and preterm birth in ICP, with a 10-fold risk of stillbirth if the mother’s bile acid concentration is above 100 μmol/L (Ovadia C. et al. (2019) Lancet 393; 899-909). We also showed that the widely used drug ursodeoxycholic acid (UDCA) did not improve outcomes in a trial population with ICP-elevated bile acids (Chappell L. et al. (2019) Lancet 394:849-860). However, in a meta-analysis (6974 women) we found that UDCA does protects a subgroup of women (bile acids >40 μmol/L) against spontaneous preterm birth, enabling stratification of women with ICP, to identify those most likely to benefit from UDCA (Ovadia C. et al. (2021) Lancet Gastro Hep 6;547-558). This research has influenced multiple international guidelines.

 

  • An new app to predict risk of preterm birth Preterm birth (PTB) affects ~7% of UK births, with more than half resulting from spontaneous preterm labour (SPTB). The risk of early birth from SPTB cannot be accurately assessed in first time mothers, and management options for higher risk pregnancies (e.g. women with a previous mid-trimester pregnancy loss, or PTB) are limited. We have developed a risk assessment App (QUiPP App) that combines an algorithm of clinical history and other markers to provide a risk score to guide clinical management. Following validation for women in threatened preterm labour, the App was found to reduce unnecessary hospital admissions and treatment by 89% and has been widely adopted, nationally and internationally (Watson HA.et al (2021) PLoSMed 6;18(7):e1003689). Ethnic differences amongst biomarkers highlighted the importance of a precision medicine approach to improving outcomes in women at risk of PTB.