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A group of UCL-led scientists has unveiled innovative methods for foreseeing outcomes in pregnancies where the fetus is experiencing abnormal development within the womb. The study, known as the EVERREST Prospective Study, encompassed 142 women facing severe early-onset fetal growth restriction (FGR), indicating significantly reduced size on ultrasound scans between 20 and 27 weeks of pregnancy. FGR affects approximately 60,000 infants annually in Europe and the USA. While some infants with FGR manage to grow and are born close to their due dates, many either necessitate extremely premature delivery (prior to 28 weeks of pregnancy) or do not survive, resulting in stillbirth. In England alone, the estimated annual cost for neonatal care is £262 million.
Dr. Rebecca Spencer (from UCL’s EGA Institute for Women’s Health and the University of Leeds), the lead author, stated, “There is currently a lot of uncertainty for the families of unborn babies with early-onset fetal growth restriction and for their health-carers. We want to give them a better idea of what to expect if they are affected – as many people find uncertainty harder to cope with than definite bad news. Predicting pregnancy outcomes may also help doctors decide how often to do ultrasound scans and when to give antenatal steroids to prepare the baby for preterm delivery.”
The results were analyzed for 123 women who provided blood samples and underwent regular ultrasound examinations to assess their baby’s size and well-being. Initially, the researchers assessed the levels of 102 proteins in the blood samples from 63 women, and combined this data with the ultrasound measurements to construct statistical models capable of predicting pregnancy outcomes. The team consulted both the women and their doctors to determine which pregnancy outcomes they considered significant. Subsequently, measurements from the remaining 60 women in the study were utilized to validate the models predicting these outcomes.
Dr. Spencer explained, “We found that by assessing ultrasound and protein measurements – both alone and combined – we were able to predict which pregnancies would end in stillbirth or neonatal death, and which may require extreme preterm delivery before 28 weeks of pregnancy.”
The researchers anticipate that employing these techniques will aid in identifying which women should be included in trials for potential treatments. Professor Anna David (from UCL’s EGA Institute for Women’s Health), the senior author, leads the multinational EVERREST consortium, which is focused on developing a novel treatment to enhance the growth and outcomes of very small babies in the womb. She stated, “Currently we have no therapy to improve fetal growth inside the womb but a novel drug is being developed by our team. This will need to be tested in clinical trials. These results will help researchers to identify those women who might be most suitable to participate in the clinical trial, where the possible benefits outweigh the risks. Better prediction of which pregnancies will end in stillbirth, neonatal death or extreme preterm delivery will help to identify who should be included in these trials.”
