Log in
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.
UCL researchers and overseas partners have developed a successful community intervention to improve maternal and newborn health, which is now saving lives in India's poorest communities and is being taken up in other low- and middle-income countries. The intervention involves village women's groups working together to identify, prioritise and address common problems during and after pregnancy using local resources. The process was tested successfully in Nepal, led to a 45% reduction in newborn mortality in an award-winning trial in rural India, demonstrated an impact on maternal mortality in a meta-analysis of seven trials across four countries, and has already been scaled up to a population of over 1.5 million in rural India's poorest communities.
Impact: Health and welfare; a UK clinical trial of uterine artery embolisation (UAE), with five-year follow-up, defined the risk- and cost-benefit of UAE versus surgery.
Significance: The trial informed guidelines/recommendations internationally and changed clinical practice. Women worldwide can now make an informed choice about their treatment; economic factors have been quantitated.
Beneficiaries: Uterine fibroid patients, the NHS, healthcare providers.
Attribution: G. Murray, UoE, developed and delivered innovative trial methodology; clinical aspects led by University of Glasgow.
Reach: UK guidelines; worldwide (Australia, USA, Europe) effect on clinical practice that will impact up to 25% of women.
Pre-pregnancy care (PPC) significantly reduces the risk of poor pregnancy outcomes among women with diabetes. Yet, lack of awareness has resulted in poor participation, with two thirds of women receiving suboptimal PPC (CEMACH, 2007).
An innovative preconception counselling resource (DVD/website) to inform women about PPC and improve pregnancy outcomes is embedded in routine care in Northern Ireland and beyond since 2010. The UK's first widely distributed multimedia preconception counselling resource for women with diabetes is already having a significant impact on pregnancy planning. In early evaluation results 76% of all pregnant women with diabetes in Northern Ireland reported receiving PPC.
Pre-eclampsia is a major contributor to death and disability in pregnancy. Diagnosis, based on accurate blood pressure (BP)/proteinuria determination, is limited by measurement errors and being late features of the disease. In collaboration with industry, King's College London (KCL) researchers have developed an inexpensive, accurate, simple BP device suitable for rural clinics. This device allows intervention to reduce mortality/morbidity and is currently being rolled out in a Gates Foundation project in Africa and Asia. KCL researchers have also helped the company Alere Inc. with the development of a diagnostically accurate test of placental growth factor (PlGF) in women with suspected pre-eclampsia: Alere Triage®PlGF. This demonstrates high sensitivity, superior to current tests, and following commercialisation is being adopted internationally. Their work is additionally reflected in guidelines of international standards for BP device accuracy.
Clinical trials designed and led by Professor Chris Twelves (University of Leeds) showed eribulin to be the first single agent cytotoxic to prolong survival in women with heavily pre-treated metastatic breast cancer (MBC).
Eribulin has been approved by European, U.S. and other regulatory authorities since 2010. Cancer treatment guidelines in the U.S., Europe and elsewhere now recommend eribulin. Sales of eribulin generated many millions of pounds in the first full year following approval. Already tens of thousands of women have been treated with eribulin, who collectively have gained up to ten thousand added life years. The U.S. regulatory authorities have advocated the EMBRACE trial design for future trials.
Approximately 80% of all breast cancer is hormone receptor positive localised cancer in postmenopausal women. For 30 years the universal standard adjuvant endocrine treatment for these women was five years of tamoxifen, but side effects and recurrences limited its usefulness. Results from the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial led to a major worldwide change in the standard recommended treatment, from tamoxifen to anastrozole (an aromatase inhibitor). From 2009 this treatment became UK national policy (recommended by NICE), and guidance in other countries (eg Australia, USA) has also been revised. Anastrozole is now routinely offered to women with hormone receptor positive breast cancer in UK and (extrapolating from trial data) we estimate over a thousand are spared a recurrence in UK annually.
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.
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.