Here in Birmingham, we are taking a holistic and collaborative approach to Maternal Health research.
Through Birmingham Health Partners we have a strong network of consultants, academics and students, all working to tackle key issues regarding Maternal Health. This research has real impact: informing policy, driving updated guidelines and making a tangible difference to women and their babies.
In 2019, the University of Birmingham was designated as World Health Organization (WHO) Collaborating Centre for Global Women’s Health – recognising its research supporting WHO’s maternal and perinatal health programmes.
The Centre’s goal is to prevent mothers and babies around the world from dying from preventable causes, by undertaking research shaped by the views of women, communities, and local stakeholders.
Our research includes evidence syntheses, clinical trials, prognostic models, multi-country surveys, qualitative and implementation studies, supported by capacity building activities.
Birmingham’s maternal health research has also been supported through funding from NIHR and the Medical Research Council. Explore our work in the sections below.
Professor Shakila Thangaratinam is Birmingham Health Partners’ Academic Lead for Maternal Health.
She is Professor of Maternal and Perinatal Health at the University of Birmingham and as Consultant Obstetrician she is involved in the care of high-risk mothers at Birmingham Women’s and Children’s NHS Foundation Trust.
A living systematic review on COVID-19 in pregnancy is being conducted by students, researchers and clinicians across BHP. The findings are continuously updated in the BMJ informing public, researchers and policy makers of appropriate new evidence as it becomes available.
For further information, please visit the PregCOV-19 LSR page.
In the UK, 4 in 1,000 women who give birth have epilepsy. But, one in 10 women who die during pregnancy or after childbirth are those with epilepsy. Uncontrolled seizures are the main cause of death. The 2020 Confidential enquiries (MBRRACE-UK) raised concerns about the significant increase in epilepsy-related maternal deaths from eight to 18 in consecutive reports. Neurological conditions are now the second highest cause of all maternal deaths.
Through partnerships with women, their families, and relevant charities, we plan to improve seizure-related maternal outcomes, and provide robust evidence on the long-term effects of AEDs on children through a comprehensive research programme.
The i-WIP Collaborative Group was established in 2013 and gathered researchers who conducted trials on the effect of diet and physical activity based interventions in pregnancy. The main aim of establishing the i-WIP Collaborative Group was to conduct an Individual Participant Data (IPD) meta-analysis of randomised controlled trials on the effect of diet and physical activity in pregnancy which has been published in the British Medical Journal in 2017.
Progesterone for Miscarriage Prevention
Work conducted through BHP has provided evidence to show that progesterone supplementation of women with a history of miscarriage who experience early pregnancy bleeding can prevent pregnancy loss.
Following publication of this work the percentage of healthcare practitioners offering progesterone supplementation for miscarriage prevention rose from 13% to 75%, based on 150 staff surveyed. This work has also led to an update of the NICE Guidelines: Birmingham research shapes new miscarriage guidelines.
MifeMiso for Miscarriage
Missed miscarriages can be devasting for women and their families, they occur when the foetus is no longer alive but the body has not recognised the pregnancy loss.
The MifeMiso trial is a great example of BHP working together to understand if there is a more effective treatment strategy for women experiencing a missed miscarriage. BHP worked to help the trial fit in with routine hospital practice as far as possible to maximise the clinical relevance of the findings and aid recruitment. Based on the results of the work, there could be evidence for an alternative treatment method for the timely resolution of miscarriage.
E-MOTIVE: Carbetocin for Post-Partum Haemorrhage
Every six minutes, a mother dies from losing too much blood while giving birth. Most of these deaths occur in Low- and Middle-Income Countries and therefore it is important to try and identify an effective treatment that can be used globally.
The E-MOTIVE trial showcases BHP affiliates working together to develop a detailed approach of how to tackle this global maternal health problem. The trial is operational in Kenya, Tanzania, Nigeria, South Africa and Sri Lanka and involves 300,000 women. It is through collaboration and strong partner relationships that the team believe these interventions can be effective at preventing women from dying of post-partum haemorrhage.
Caesarean section is considered a life-saving procedure for pregnant women and their babies. Yet, in low- and middle-income countries (LMICs), mothers who give birth by caesarean section are 100 times more likely to die than those having the procedure in high-income countries. In these settings, caesarean sections also contribute to lifelong health problems that affect the women’s quality of life and their ability to safely have more children. Their babies are also at high risk of dying during or soon after caesarean section.
We propose a five-year programme that aims to improve mother and baby outcomes following caesarean sections in low-and middle-income countries. The programme (C-Safe) plans to (ii) ensure caesarean sections are done for the right reasons (C-Why), (ii) improve their safety (C-Op), and (iii) promote safe and respectful care in labour resulting in vaginal births, including safe delivery with instruments (C-Non).
The C-Safe intervention will be implemented using a comprehensive training programme, empowerment of local opinion leaders (C-Safe Champions) and mothers, team-based working, and learning through audit and feedback, in four hospitals each in India and Tanzania (30,000 births).
Pre-eclampsia, a condition in pregnancy associated with high blood pressure and protein in the urine, is a major cause of avoidable deaths in mothers and babies, particularly in LMICs. Calcium supplements in pregnancy could prevent pre-eclampsia and potentially save 21,500 mothers every year from dying in these countries.
Although calcium is on the national essential medicines list of these countries, and the World Health Organization (WHO) recommends high-dose calcium (>1.5g/day) to prevent pre-eclampsia, calcium deficiency in pregnancy continues to be a major preventable public health challenge.
We plan to combine the data from individuals who participated in studies on calcium supplementation by a technique called ‘IPD meta-analysis’ to determine if the effects of calcium differed between different groups of women, and if it varied according to the dose and duration of calcium use. We will obtain the views of mothers and healthcare professionals through surveys and interviews on what they consider may hinder the uptake and use of the calcium supplementation strategy that we find to be most effective. We will study the costs of calcium supplementation against the costs saved in LMICs by avoiding pre-eclampsia and its complications. This economic model will be provided in a format that can be used by experts in other countries to determine the relevant economic impact.
Research capacity strengthening of our partners is the key to the long-term sustainability of the project.
Maternal health researchers and clinicians within BHP have called for lifesaving research into pharmaceuticals for use during pregnancy. The Call for Action is the first step towards driving research in this area with aims to engage key stakeholders to help with this important agenda.
‘Safe and Effective Medicines for Use in Pregnancy: A Call to Action’ can be downloaded from https://www.birminghamhealthpartners.co.uk/wp-content/uploads/2021/01/21560-Policy-Commission-Maternal-Health-Report-AW-accessible.pdf. Its signatories – BHP Professors Katie Morris, Peter Brocklehurst, Arri Coomarasamy and Shakila Thangaratinam – have established a major policy commission to review evidence, opportunities and options for policy which will be integral to the formation of clear, multi-stakeholder recommendations to the UK Government. The policy commission is expected to report on its findings in Spring 2022.
PPI Participation – The Hildas
Professor Shakila Thangaratinam’s research group is passionate about working with the public and patients to help shape their research. They are actively recruiting to The Hildas, an advisory group made up of women with lived experience of maternal health issues. For further information or to join the group, visit The Hildas’ website.
We aim to bring together researchers, clinicians and medical students to work towards improving the health of women and children through multi-disciplinary research embedded within excellent clinical care. The objectives of the network include: providing opportunities to develop new research collaborations; embedding Patient and Public Involvement in current and planned research; and promoting Women’s Health via outreach and public engagement activities. The network also offers peer-to-peer and junior-senior mentoring in research methodology and careers.
A selection of recent publications are included below – for more, visit the WHO Collaborating Centre for Women’s Health site.
- Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. J Allotey, et al., 2 Feb 2021, In: BMJ. 370, m3320
- Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Chmielewska, et al., Jun 2021, In: Lancet Global Health. 9, 6, p. e759-e772 14 p
- Lancet Miscarriage Series
- Miscarriage matters: the epidemiological, physical, psychological and economic burden of early pregnancy loss. I Gallos, et al., 1 May 2021, In: The Lancet. 397, p. 1658–1667
- Sporadic miscarriage: evidence to provide effective care. A Coomarasamy, et al., May 2021, In: The Lancet. 397, 10285, p. 1668-1674
- Recurrent miscarriage: evidence to accelerate action. A Coomarasamy, et al., 1 May 2021, In: The Lancet. 397, 10285, p. 1675-1682 8 p.
- Progestogens for preventing miscarriage: a network meta-analysis (Review). A Devall, et al., 9 Apr 2021, In: Cochrane Database of Systematic Reviews. 2021, 4, CD013792.
- Uterotonic agents for first-line treatment of postpartum haemorrhage: a network meta-analysis. AT Garces, et al., 24 Nov 2020, In: Cochrane Database of Systematic Reviews. 2020, 11, 76 p., CD012754.
- The FAST-M complex intervention for the detection and management of maternal sepsis in low-resource settings: a multi-site evaluation. L Jones, et al., 4 Feb 2021, (E-pub ahead of print) In: BJOG: An International Journal of Obstetrics & Gynaecology.
- Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis. S Sobhy, et al., 7 May 2019, In: The Lancet. 393, 10184, p. 1973-1982 10 p.
- Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. J Daru, et al., May 2018, In: Lancet Global Health. 6, 5, p. e548-e554 7 p.
Professor Arri Coomarasamy is Director of the Tommy’s National Centre for Miscarriage Research. He leads two research teams, one focusing on treatments to prevent miscarriages and the other targeting on ways to stop mothers dying during childbirth. In his role as Joint Director of the WHO Collaborating Centre for Global Women’s Health, Professor Coomarasamy leads an international team of researchers focused on finding ways to prevent women dying from excessive bleeding at childbirth.
Professor Katie Morris is Director of Birmingham Clinical Trials Unit and Honorary Consultant in Maternal Fetal Medicine at Birmingham Women’s and Children’s Hospital. Katie’s research aims to improve the care for women with multiple pregnancies, fetal anomalies, growth restriction, reducing infection in maternity and prevention of preterm birth, employing both prognostic and diagnostic research, modelling, systematic reviews and trials.
Shakila Thangaratinam is Professor of Maternal and Perinatal Health at University of Birmingham, leads the Maternal and Reproductive Health Theme (Jan 2020-), and is the co-Director of WHO Collaborating Centre for Global Women’s Health. Professor Thangaratinam’s work focuses on prediction, prevention and treatment of complications in mothers with pre-eclampsia, epilepsy, diabetes, and obesity.
Ioannis D Gallos is Professor of Obstetrics and Gynaecology and Joint Director of the WHO Collaborating Centre for Global Women’s Health. Ioannis’ research work focusses on health issues affecting women and families living in resource-constrained settings, particularly targeting on ways to stop mothers dying from excessive bleeding during childbirth. He is also a consultant for the Tommy’s National Centre for Miscarriage Research based at Birmingham Women’s Hospital.
Dr Adam Devall is a Lecturer in Maternal Health Clinical Trials and a Senior Clinical Trials Fellow at the Tommy’s National Centre for Miscarriage Research. Adam’s primary research focus is clinical trials in early pregnancy care, with a particular focus on miscarriage, infertility and global women’s health. As a lecturer, he collaborates with the Birmingham Clinical Trials Unit to manage a portfolio of national and international clinical trials.
Dr John Allotey is a lecturer in epidemiology and women’s health at the WHO Collaborating Centre for Global Women’s Health within the Institute of Metabolism and Systems Research. He has almost a decade of experience in academic clinical research, primarily in the field of maternal health. His research interests lie in the development, evaluation and implementation of prognostic models and evidence synthesis using aggregate data and individual participant data meta-analysis.