Push for full term - WIRF · cooked at 37 weeks, but it is far from cooked at 37 weeks.” WA’s...
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HEALTH+FITNESS W A has lowered its preterm birthrate and is now pushing the rest of the nation to do the same. Babies born prematurely, particularly before 34 weeks’ gestation, are at increased risk of serious complications involving the gut, lungs, heart and brain. They often have lifelong health problems associated with vision, hearing and mental capacity. Five years ago the WA Preterm Birth Prevention Initiative began, encompassing a public health campaign called The Whole Nine Months, a dedicated preterm birth prevention clinic at King Edward Memorial Hospital and a Statewide outreach program for healthcare practitioners. The Australian Preterm Birth Prevention Alliance is now rolling out The Whole Nine Months program Australia-wide. “We are making the West Australian program national . . . it is a world’s first and everyone is watching us,” Professor John Newnham, obstetrician and chief scientific director at Women and Infants Research Foundation, says. Together with decades of medical advancements, the State is on track to make further inroads to ensure the health of women and their babies. Know your risk The most important thing a woman can know is the length of her cervix come mid pregnancy, says Professor Newnham. Of all the areas he has directed his considerable energy towards, ensuring every mid-pregnancy ultrasound in WA includes a cervix length measurement has been his priority. A short cervix at 16-24 weeks is a predictor for preterm birth. Identifying this at the standard 19-week ultrasound means the mother can immediately start progesterone, a treatment that will take half of those at risk to full term. While short cervical length is a well-known risk factor, Professor Newnham says no one had been able to implement the discovery across a population. “We made sure every person that provided health care in WA, from Kununurra in the north to Albany in the south, understood that measurement needed to be done,” Professor Newnham says. “We hammered that really hard and it was completely successful.” Combined with the prevention clinic at King Edward and education of health professionals, the initiative produced fast results. “After 18 months, the rate of preterm birth was lowered by almost 8 per cent; most of the reduction was seen in the late preterm birth group (greater than 34 weeks gestation), with a matching rise in deliveries after 39 weeks. The overall reduction equates to the prevention of almost 200 babies being born too early,” says Professor Jeffrey Keelan, head of laboratories at UWA’s division of obstetrics and gynaecology. Despite these great inroads at KEMH and some other areas, Dr Newnham says there is plenty more to be done. Every day counts In the past full term was considered “around 37 weeks”. Wrong, says Professor Newnham. “There has been a progressive increase in deliveries down to 37, 36 weeks for non-medical reasons — FIFO workers, sick of being pregnant, doctor going on holidays — various reasons,” Professor Newnham says. “Across Australia and the developed world there was this increasing trend as people thought that 37 weeks was OK, and the reason they thought it was the definition, inherited from 50-60 years ago, of term was 37 weeks. It was never right but it led us to think a baby is fully cooked at 37 weeks, but it is far from cooked at 37 weeks.” WA’s Raine Study — one of the biggest successful prospective cohorts of pregnancy, childhood, adolescence and now early adulthood to be carried out anywhere in the world — highlights the dangers of a planned early birth. “The study showed, to be born at 37 or even 38 weeks carries huge implications at school age in terms of learning ability and externalising behaviour. That Push for full term Western Australia is leading the charge in the prevention of preterm birth. ANGIE TOMLINSON reports. Risks for early delivery Professor Jeffrey Keelan, head of laboratories at UWA’s division of obstetrics and gynaecology, says some of the known modifiable and unalterable risk factors for preterm birth include: • Low socioeconomic status • Geographic isolation • Mother’s age (either young or old) • Mother’s ethnicity • Reproductive history (including a family history of preterm birth) • Prior cervical surgery or disease • Mother’s conditions (including diabetes, obesity, mental health diagnosis) • Smoking in pregnancy • Current or previous pregnancy complications • Having a boy (boys have greater risk being born preterm than girls) DID YOU KNOW? Preterm birth is the single major cause of death and disability in children aged under five in the developed world. In Australia about 25,000 babies are born preterm each year.
Transcript of Push for full term - WIRF · cooked at 37 weeks, but it is far from cooked at 37 weeks.” WA’s...
HEALTH+FITNESS today
WA has lowered itspreterm birthrateand is nowpushing the restof the nation to
do the same.Babies born prematurely,
particularly before 34 weeks’gestation, are at increased riskof serious complicationsinvolving the gut, lungs, heartand brain. They often havelifelong health problemsassociated with vision, hearingand mental capacity.
Five years ago the WAPreterm Birth PreventionInitiative began, encompassinga public health campaign calledThe Whole Nine Months, adedicated preterm birthprevention clinic at KingEdward Memorial Hospital anda Statewide outreach programfor healthcare practitioners.
The Australian PretermBirth Prevention Alliance isnow rolling out The WholeNine Months programAustralia-wide.
“We are making the WestAustralian program national. . . it is a world’s first andeveryone is watching us,”Professor John Newnham,obstetrician and chief scientificdirector at Women and InfantsResearch Foundation, says.
Together with decades ofmedical advancements, theState is on track to makefurther inroads to ensure thehealth of women and theirbabies.
Know your riskThe most important thing awoman can know is the length
of her cervix come midpregnancy, says ProfessorNewnham. Of all the areas hehas directed his considerableenergy towards, ensuring everymid-pregnancy ultrasound inWA includes a cervix lengthmeasurement has been hispriority.
A short cervix at 16-24 weeksis a predictor for preterm birth.Identifying this at the standard19-week ultrasound means themother can immediately startprogesterone, a treatment thatwill take half of those at risk tofull term.
While short cervical length isa well-known risk factor,Professor Newnham says no onehad been able to implement thediscovery across a population.
“We made sure every personthat provided health care in WA,from Kununurra in the north toAlbany in the south, understoodthat measurement needed to bedone,” Professor Newnham says.
“We hammered that reallyhard and it was completelysuccessful.”
Combined with the preventionclinic at King Edward andeducation of healthprofessionals, the initiativeproduced fast results.
“After 18 months, the rate ofpreterm birth was lowered byalmost 8 per cent; most of thereduction was seen in the latepreterm birth group (greaterthan 34 weeks gestation), with amatching rise in deliveries after39 weeks. The overall reductionequates to the prevention ofalmost 200 babies being born tooearly,” says Professor JeffreyKeelan, head of laboratories atUWA’s division of obstetrics andgynaecology.
Despite these great inroads atKEMH and some other areas, DrNewnham says there is plentymore to be done.
Every day countsIn the past full term wasconsidered “around 37 weeks”.Wrong, says ProfessorNewnham.
“There has been a progressiveincrease in deliveries down to37, 36 weeks for non-medicalreasons — FIFO workers, sick ofbeing pregnant, doctor going onholidays — various reasons,”Professor Newnham says.
“Across Australia and thedeveloped world there was thisincreasing trend as peoplethought that 37 weeks was OK,and the reason they thought it
was the definition, inherited from50-60 years ago, of term was 37weeks. It was never right but itled us to think a baby is fullycooked at 37 weeks, but it is farfrom cooked at 37 weeks.”
WA’s Raine Study — one of thebiggest successful prospectivecohorts of pregnancy, childhood,adolescence and now earlyadulthood to be carried outanywhere in the world —highlights the dangers of aplanned early birth.
“The study showed, to be bornat 37 or even 38 weeks carrieshuge implications at school agein terms of learning ability andexternalising behaviour. That
Push forfull termWestern Australia is leading the chargein the prevention of preterm birth.ANGIE TOMLINSON reports.
Risks for early deliveryProfessor Jeffrey Keelan, head of laboratories atUWA’s division of obstetrics and gynaecology, sayssome of the known modifiable and unalterable riskfactors for preterm birth include:• Low socioeconomic status• Geographic isolation• Mother’s age (either young or old)• Mother’s ethnicity • Reproductive history (including a family historyof preterm birth)• Prior cervical surgery or disease• Mother’s conditions (including diabetes, obesity,mental health diagnosis)• Smoking in pregnancy• Current or previous pregnancy complications• Having a boy (boys have greater risk being bornpreterm than girls)
DID YOU KNOW?Preterm birth is the
single major cause ofdeath and disability in
children aged underfive in the developed
world. In Australiaabout 25,000 babies
are born preterm each year.
HEALTH+FITNESS today 9Wednesday, June 19, 2019 THE WEST AUSTRALIAN
last little bit of pregnancy isterribly important for braindevelopment,” ProfessorNewnham says.
Professor Keelan explainsthat every week in the wombcounts as it allows the foetalorgans to mature and developready for life outside.
He says babies born less than28 weeks’ gestation have up to a50 per cent chance of majormorbidity but this falls to lessthan 10 per cent at 32 weeks and2 per cent at 36 weeks.
Neonatal deaths havedeclined by around a third overthe past decade in Australiathanks to neonatal intensivecare unit practices andimproved management of sicknewborns.
WA’s medical fraternity statesno pregnancy is to be endeduntil about 39 weeks without amedical reason.
Looking to the futureResearchers at UWA and KingEdward are a third of the waythrough a study to develop alow-cost test to identify womenat risk of delivering a pretermbaby.
The study will recruit morethan 6000 women from KingEdward and St John of Godhospital, Subiaco.
“We know that bacterialinfections of the womb are amajor cause of early birth butuntil now we haven’t been ableto identify women at risk withany degree of accuracy, soantibiotic treatment hasn’tbeen particularly successful orwidely adopted,” ProfessorJeffrey Keelan says.
“The new test enables us toidentify women at risk early inpregnancy, allowing timelytreatment with antibiotics andprobiotics to remove thebacteria, restore a healthyvaginal microbiome and enablethe pregnancy to continue untilfull term.”
He says the combined testand treatment program couldreduce the preterm birthrate inAustralia up to 30 per cent.
The role of fish oil inreducing rates of preterm birthsis also being investigated byresearchers, says ProfessorKeelan.
He says the dose, durationand indications for the therapyare still not clear.
Work is also being conductedby Australian and Canadianresearchers on a new drugwhich can block inflammation,prevent preterm birth andspare the foetus from theharmful effects of inflammationin utero, says Professor Keelan.The project is under way in fourcentres, including Perth.
The beginnings of whathas the potential to bea medical miracle liesin the paddockssurrounding the tiny
town of Darkan in WesternAustralia’s Wheatbelt region.
A futuristic artificial womb isbeing developed by researchersat the Women and InfantsResearch Foundation inSubiaco. Earlier this year, theteam announced a majoradvancement and world-first —the ability of an artificialplacenta-based life supportplatform to maintain extremelypreterm lamb fetuses;equivalent to a 24-week humanfetus.
While previous research haddemonstrated thetechnology’s feasibility inlate preterm fetuses, noone had done it inextremely pretermfetuses.
“For severaldecades, there hasbeen littleimprovement inoutcomes ofextremely preterminfants born at theborder of viability (21-24weeks gestation),” WIRFPerinatal ResearchLaboratories head Matt Kempsays.
But then the researcherswere able to show thetechnology was able to supportextremely preterm lambs in astable, growth-normal state forfive days, demonstrating thetechnology’s potential clinicalapplication for preterm infantsborn at the border of viability.
The research brings togetherresearchers from Perth’sWomen and Infants ResearchFoundation, The University ofWestern Australia and Japan’sTohoku University Hospital andbiomedical technologycompany Nipro Corporation,along with the buy-in of the WADepartment of Health.
“We start off down in theWheatbelt around Darkan,Collie, where we work withsome fantastic agricultural andlivestock consultants to get ouranimals for our study,”Associate Professor Kemp says.
“We then come up to the cityand do the work here, then thedata we are generating and afew other bits and pieces go upto Kyota and Osaka and then upto the US and Europe to some ofour other partners we areworking with. It is a fantasticinternational collaboration.”
While babiesborn from 25
weeks onwardsshow great improvements intheir short and long-termoutcomes, those born between21-24 weeks “haven’t seen thosesorts of improvements”, saysAssociate Professor Kemp. Theidea of the artificial womb is tobridge the three to four-weekgap to allow a baby to becomestrong enough and viable to betransitioned to existingtechnology.
“The goal is to offer a bridgebetween a natural womb andthe outside world to give babiesborn at the earliest gestationalages more time for their fragilelungs to mature,” he says.
And why lambs? “It’s not just because there
are lots of sheep kickingaround here in WesternAustralia,” laughs ProfessorKemp. “A lot of the work thathas been done in the obstetricsspace for a very long time hasbeen done on sheep.”
He says much of what weknow about fetal physiology aswell as common interventions,like antenatal steroids, was firstdeveloped in sheep.
“With additional refinement,what today might be consideredas futuristic technology mightsoon not be so futuristic andmight be standard of care.”
Artificial womb in gestation
AssociateProfessorMatt Kemp isleadingresearch onan artificialwomb.Picture: Iain Gillespie
Perth researchers’ breakthroughcould give hope to babies that are born as young as 21 weeks,writes ANGIE TOMLINSON
Pictures: Getty Images
‘The goal is to offer a bridge between a natural womb and the outside
world to give babiesmore time for their
fragile lungs tomature.’
