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Impact: Health and welfare; healthcare guidelines on elective induction of labour. The research showed that elective induction at time points from 37 weeks' gestation progressively reduces perinatal mortality. UK guidelines now recommend routine induction at 39 weeks in mothers >40 years of age.
Significance: Implementation of the guidelines for mothers >40 years of age is estimated to prevent the stillbirth of 17 babies per year in the UK.
Beneficiaries: Pregnant women, policy makers and healthcare providers.
Attribution: The work was led by Jane Norman with Sarah Stock at UoE, in collaboration with NHS Information Scotland.
Reach: UK, Europe, North America. Applies to all pregnant women, especially those over 40 years of age.
International obstetric practice has been changed by two large randomised controlled trials led from the University of Oxford's National Perinatal Epidemiology Unit, which demonstrated the efficacy of magnesium sulphate for both treatment and prevention of eclampsia during pregnancy, a condition characterised by fits in association with hypertension, and an important cause of maternal morbidity and mortality. Until the 1990s there was widespread geographical variation in the management of the condition, with magnesium sulphate used almost exclusively in North America. Following the publication of the results of these two trials magnesium sulphate is now in routine use globally, widely recommended in guidelines, and has been placed on the WHO Model List of Essential Medicines.
Impact: Health and wellbeing; commerce; studies and clinical trials of the effects of progesterone receptor modulators (PRMs) underpinned their application for the benefit of women of childbearing age.
Significance: UoE studies underpinned the application of PRMs as emergency contraception including over-the-counter availability and the treatment of heavy menstrual bleeding (HMB); changed clinical guidelines; influenced Pharma R&D.
Beneficiaries: Women of reproductive age; the NHS and healthcare delivery organisations; pharmaceutical companies.
Attribution: Studies were conducted by Critchley, Baird and colleagues (UoE).
Reach: Worldwide; annually 4M women seek emergency contraception in the USA, and in the UK 1M women seek help for HMB. Drugs targeting the PR are licenced in 67 countries. Multiple global Pharma are active in the field of PRM biology.
The ultimate goal of in-vitro fertilisation (IVF) therapy is the live birth of a single, healthy child. However, issues of treatment failure, complications and multiple births (twins or triplets) continue to persist and have a major impact on patient quality of life. Pioneering research at the University of Glasgow has driven the concept of personalised IVF therapy and outcome prediction, reforming clinical guidelines and defining criteria for access to funded IVF therapy. This research has stimulated revision of UK regulatory policy on the number of embryos transferred during IVF. These strategies underpin the recommended practice for the 48,000 women undergoing IVF in the UK each year. In addition, the Glasgow team's online, personalised `IVFpredict' calculator, which women can use to predict their success of a live birth, has been completed by more than 5 million users worldwide.
Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries with young children and pregnant women particularly at risk. Over the last 20+ years LSHTM researchers have carried out a series of definitive trials in collaboration with the Ghana Health Service to evaluate the impact of different vitamin A supplementation (VAS) strategies on maternal and/or child survival. Findings have had major impacts on national and global VAS programmes and influenced WHO guidelines on VAS in: infants and children 6-59 months of age; infants 1-5 months of age; postpartum women; and pregnant women.
Researchers at the University of Oxford instituted a rapid study of pregnant women hospitalised across the UK with 2009/H1N1 infection, which demonstrated that early antiviral treatment improved maternal outcomes of infection and led to actions by the Department of Health to ensure rapid availability of antivirals specifically for pregnant women. The poor maternal and perinatal outcomes identified by this study also led to an on-going policy change, so that all pregnant women in the UK are now recommended to receive annual immunisation against seasonal influenza.
The University of Southampton's lifecourse cohort studies have led to a paradigm shift in the medical approach to obesity and non-communicable diseases. Research linking maternal pre-conception and early years nutrition with health outcomes for later life has directly influenced public healthcare policy at international (United Nations), national (Scientific Advisory Committee on Nutrition) and local (Southampton City) levels. Dissemination through medical practice and Southampton-designed public education programmes such as LifeLab means this research has already led to health benefits for tens of thousands of people, providing them with the information and tools to help prevent themselves and their children from succumbing to a non-communicable disease.
This University of Liverpool (UoL) research programme has provided the first international guidance on pregnancy dosage regimes for the drug misoprostol. Although commonly used, its use in pregnancy is off-label. This has led to a wide variety of different dosage regimens. Professors Weeks, Alfirevic and Neilson (all UoL) have been at the forefront of research into its correct use since 1998. In 2007 they initiated a WHO expert conference to conduct dosage reviews, thus establishing an international consensus. These regimens were adopted by the International Federation of Gynecology and Obstetrics (FIGO) in 2009, and updated in 2012. Examples of resulting guidelines with social marketing are provided.
Caffeine is widely consumed in pregnancy as has the potential to harm the developing fetus. Professor Janet Cade and colleagues at the University of Leeds designed a robust study to accurately quantify caffeine intake in 2635 pregnant women throughout pregnancy. The results showed caffeine intake is associated with an increased risk of fetal growth restriction, which is linked with perinatal mortality and morbidity and adverse effects in later life. As a result of this study, and a review of previous evidence, the Food Standards Agency issued new advice to pregnant women to limit their daily caffeine intake to below 200mg/day.
Approximately 25,000 people in the UK die each year from venous thromboembolism (VTE); furthermore, VTE affects 1 in 100,000 women of childbearing age and causes one-third of all maternal deaths. Thrombophilia, pregnancy and the use of oral oestrogens can all place women at increased risk of VTE when compared with other individuals. University of Glasgow researchers quantified the probability of VTE among at-risk women and analysed the benefits and cost-effectiveness of thrombophilia screening. Their research is cited in the recommendations and evidence bases of leading national and international clinical guidelines. This work also galvanised an overhaul of VTE prevention policy within NHS Scotland by emphasising the need for regional health boards to implement and audit standardised in-house protocols and provide accessible patient information on VTE.