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Building on work which has contributed, via NICE guidance, to £1 billion in annual savings to the NHS in its healthcare provision for osteoporotic fractures in older adults, research at the £14.4 million MRC Lifecourse Epidemiology Unit (LEU), University of Southampton, has inspired the world's first randomised controlled trial of vitamin D supplementation versus placebo in pregnancy. This work was designed to provide a definitive answer to the question of whether supplementing pregnant women with vitamin D leads to increased bone mineral accrual in the offspring. This work has also shaped national and international guidance on vitamin D supplementation both during pregnancy and in older age; Southampton's programme of osteoporosis research has attracted £10 million in research funding from health organisations and the EU.
Research at the University of Nottingham (UoN) has had influence on development of health policy in the UK and internationally. It is recognised that the risk of diseases related to obesity and insulin resistance, is partly determined by the nutritional environment experienced during early life. Against a background of scepticism researchers at the UoN have generated data that has been critical in demonstrating the biological plausibility of such associations. This has influenced expert panels and non-governmental organisations in framing their current recommendations for nutrition in pregnancy and infancy, which benefit women and children worldwide.
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.
(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
Clinical research conducted at the UCL Institute of Child Health between 1998 and 2011 under the direction of Professors Alan Lucas and Atul Singhal showed that a slower rate of infant weight gain had long-term benefits to reduce the risk of obesity and cardiovascular disease. This contradicted the accepted view, which favoured the promotion of rapid weight gain in infancy. This work has had a significant influence on public health policies and initiatives in the UK and elsewhere. It has changed the way infant formulas are made and used. Two new interventions for overweight children have been developed and are helping families around the world.
Research undertaken at the University of Ulster has had a global impact on public health advice about fish consumption during pregnancy. Ulster's international collaborative research has been used by the Food and Agriculture Organisation (FAO) of the United Nations and the World Health Organization (WHO), and also by industry, to promote greater fish consumption during pregnancy. The work has also been evaluated by the European Food Safety Authority (EFSA) in its assessment of the public health risk of methyl-mercury in food.
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.
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.
Obesity is a global epidemic. Currently, more than half a billion adults worldwide are estimated to be overweight or obese yet this problem is entirely preventable. Excess weight costs the NHS over £5 billion each year and is associated with an increased risk of obesity-related disease (e.g. type 2 diabetes and heart disease). University of Glasgow researchers defined two `Action Levels' for waist circumference to indicate the point when an individual needs to initiate weight loss to reduce their risk of disease. These Action Levels have been incorporated into national and international clinical guidelines for the diagnoses and management of obesity-related disease, and have provided the foundation for public-health campaigns and policies worldwide, designed to reduce the burdens of chronic ill-health that follow obesity.
New criteria for the diagnosis of diabetes in pregnancy have been developed by the International Association of Diabetes in Pregnancy Study Groups and adopted by the American Diabetes Association on the basis of the Hyperglycaemia and Pregnancy Outcomes (HAPO) study. These new criteria double the percentage of women diagnosed with diabetes in pregnancy from approximately 8.5% to 17%. Appropriate management improves outcomes for them and their new born children. The results, which proved valid for all ethnic groups and countries, have led to a worldwide re-appraisal of glycaemic risk in pregnancy and the introduction of new guidelines to manage this.