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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.
Our theoretical and empirical work in the area of normal childbirth and associated cultural and contextual issues has been cited in two NICE guidelines, in professional body standards, and national consumer group websites (AIMS, NCT, BirthChoiceUK). One study provided the catalyst for the UK's Normal Birth Campaign (http://www.rcmnormalbirth.org.uk/ and international successors, and influenced the definition of normal birth in UK National Statistics. The programme has generated: significant media coverage; an EU funded network including 26 countries that is influencing the international normal birth debate; recognition as international change agents in this area (http://econpapers.repec.org/paper/emnwpaper/023.htm, leading to the award of an OBE.
Impact: Health and welfare; public policy; the work led to UK and international guidelines advising against progesterone use to prevent preterm birth in twin pregnancy.
Significance: Thousands of women now avoid this unpleasant procedure annually, with a saving to the NHS of £25M.
Beneficiaries: Pregnant women, policy-makers, the NHS and healthcare-providers.
Attribution: The work was initiated by a five-centre UK collaborative group including UoE. Data analysis, interpretation and translation into practice were led by Jane Norman, UoE.
Reach: The data are cited in guidelines and have changed clinical practice on three continents: Europe (NICE), North America and Australasia. Applies to 11,000 women annually in UK alone.
Globally, there are around 290,000 maternal deaths per year, 83,000 of them in South Asia. Post-partum haemorrhage [PPH] is a major contributor to maternal mortality. Currently, oxytocin is advocated as a key life-saving drug for arresting/preventing PPH when administered immediately after birth. Edinburgh University research on home deliveries in India exposed one important but largely unacknowledged and unquantified risk-factor for maternal mortality: widespread misuse of oxytocin during labour to speed up the process. These and other findings in relation to the supply and unregulated use of pharmaceuticals in South Asia have been brought to the attention of advocacy groups and international donors, thus helping frame pharmaceuticals policy debate, e.g. by highlighting the need to reduce the diversion of oxytocin for dangerous use during labour. The research has also increased recognition of the importance of ethnographic research in facilitating evidence-based public-health policy-making and enhanced the capacity of advocacy groups to provide evidence-led input on crucial policy questions.
Maternal health and mortality remains a major concern in the developing world. Research led by Prof Arri Coomarasamy and colleagues at the University of Birmingham has demonstrated the effectiveness of non-typical support for maternal health in low- and middle-income countries worldwide, focused on the benefits of bringing in traditional birth attendants and non-physician clinicians to support the slow process of developing more capacity amongst skilled birth attendants in these regions. Prior to this work, these individuals were considered unsafe and inappropriate to support births, even though they were conducting millions of deliveries in the developing world. Prof Coomarasamy's team's research clearly demonstrated that this is not the case. This has had a major impact on international thinking about the valuable role of non-physician support for maternal health and mortality, reflected in the latest World Health Organisation task-shifting recommendations. In these and other related issues, policy and public awareness has been further supported by Prof Coomarasamy's crucial role in Ammalife, an international maternal health charity focused on the developing world.
Instrumental births can cause problems and are needed more often with epidurals. The Comparative Obstetric Mobile Epidural Trial (COMET) was the definitive trial that led to the NICE Intrapartum Care guideline recommendation to discontinue traditional epidurals using high concentration local anaesthetic solutions in favour of low dose epidural techniques which allow women to be mobile during labour. It is estimated that these changes have resulted in about 10,000 fewer instrumental deliveries annually in the UK. Correspondingly, numbers of women experiencing effects of instrumental births such as faecal incontinence will have been substantially reduced. This research has also influenced clinical guidelines and led to changes in practice on the type of epidurals used during labour elsewhere, including Australia and Canada.
The IOE's Evidence for Policy and Practice Information and Co-ordinating (EPPI) Centre has helped UK and overseas governments to make better-informed decisions on education, public health and health education, social welfare and international development, through the use of systematic reviews. The internationally-respected research team has done this by developing and improving methods and tools that produce a broader range of high quality, reliable studies better able to answer policy-makers' questions. EPPI trains civil servants to formulate effective research questions, supports NICE and WHO in ensuring the validity of their guidelines, and works with governments across the EU to build capacity in evidence-informed policy and practice in education.
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.
(1) Enhancing the awareness of (i) women of childbearing age suffering from epilepsy and prescribed new and/or older generation AEDs, and (ii) their healthcare professionals. Empowering both to make informed decisions through evidence-based practice that will reduce/prevent the risk of harm to unborn children potentially exposed to AEDs in early pregnancy.
(2) A change in the process by which GlaxoSmithKline (GSK) practices post-marketing epidemiological surveillance of the new generation AED `lamotrigine' in pregnancy.
(3) Benefit to the methodological practice of other researchers in Europe involved with AEDs and epidemiological surveillance
(4) Contribution to building European system for reproductive safety evaluation