Dr Teresa MacDonald Fellowship & Grant success

The Department of Obstetrics & Gynaecology congratulates Dr Teresa MacDonald on receiving the RANZCOG Research Fellowship 2021 and Norman Beischer Medical Research Foundation Innovation Grant for 2021

RANZCOG Women’s Health Foundation - Glyn White Research Fellowship for 2021

Project Title: “Is increased fetal growth velocity during pregnancy associated with perinatal and neonatal indicators of pathological overgrowth?”

Shoulder dystocia is a serious emergency – the baby’s shoulders are too big to deliver after birth of the head. Unfortunately, most cases of shoulder dystocia are not known to be at risk, with over half of cases occurring in babies that are not big. We have discovered that rapidly increasing growth in late pregnancy predisposes to shoulder dystocia. Over 2021-2022 we will investigate whether fetal growth rates on ultrasound predict shoulder dystocia, and correlate with other measures of fetal overgrowth.

Norman Beischer Medical Research Foundation Innovation Grant for 2021

Project Title: “Assessing fetal growth to identify babies at increased risk of death of developmental disability”

Ultrasound is commonly used in pregnancy to assess babies’ size. This is often performed to try and detect placental insufficiency. In this condition, the placenta is unable to meet the oxygen and nutritional demands of the growing fetus, growth slows and this results in a small baby. Placental insufficiency is hugely important because it is associated with increased risks of death, of survival with long-term disability, and with adult diseases.

Being a small baby due to placental insufficiency is the single biggest risk factor for stillbirth – the death of the baby before it is born. This is due to the baby being starved of oxygen. Likewise, where there is placental insufficiency, the low oxygen levels can also lead to brain injury. Small babies are more likely to show signs of low oxygen during labour – which is a stress test for them – and are known to be at increased risk of developmental disability from cerebral palsy compared to those with normal placental function.

While pregnancy and birth are times of high risk for a baby with placental insufficiency, the consequences of this condition also continue into adulthood. In the face of low oxygen levels, babies in the womb preferentially send blood flow and oxygen to their brain. This reduces blood flow to the kidneys, stunting their development and increasing the risks of kidney disease and high blood pressure in adulthood. Nutritional deficits from the poorly functioning placenta also mean that small fetuses are programmed for a life of starvation. Once born and fed in the outside world, this translates to a lifelong predisposition to obesity and diabetes. Babies that suffer placental insufficiency are affected for their whole lives with higher rates of major adult diseases and earlier death.

If placental insufficiency is detected during pregnancy, intervention is possible that can vastly reduce the risk of death, and of survival with disability. However, current detection rates are poor. Only 20-30% of babies that are small at birth are detected during pregnancy. Furthermore, placental insufficiency can also affect babies considered to be a normal size – these are therefore babies at risk who are even more difficult to identify. Promisingly, our previous work has identified an important ‘missing piece of the puzzle’. The rate of a baby’s growth during pregnancy may be just as important as the size of the baby in predicting placental insufficiency. We will now confirm these findings to translate them to clinical care. We plan to build a calculator to enable clinicians to quickly and easily calculate babies’ growth rates as either normal or low. We will then use this to calculate growth rates from all of the babies who have had two ultrasound scans during the second half of their pregnancy at the Mercy over the last 9 years. We will analyse this historic information to confirm whether assessment of the babies’ growth rates would have been able to predict the most serious and devastating consequence of placental insufficiency – stillbirth.