June 11, 2025 • 32 mins
Mr Nigel Simpson shares how Leeds became one of the first hospitals to open a clinic dedicated to preventing preterm births. Discover how genetic testing at birth and anonymous health data is giving researchers new tools to support babies—and their families—from day one.
Views and experiences shared in this podcast belong to the individuals and do not constitute medical advice. For medical advice please contact your pharmacist, GP or dial 111. In an emergency please dial 999.
This podcast was recorded and produced by Under the Mast– creative audio productions and was presented by Caroline Verdon
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Episode Transcript
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(00:07):
Medical breakthroughs,the research journey.
Hello and welcome.
I'm your host, Caroline Burden,and you are about to join me on
a journey into the fascinatingworld of medical breakthroughs,
but not just any breakthroughs.
We are diving into thepersonal stories, the setbacks.
(00:30):
That you will not believe.
This moment behind the cutting edgeresearch happening right here at
Leeds Teaching Hospitals NHS Trust.
Coming up in this episode,
we have become increasinglyaware that babies health doesn't
start at the time of birth.
It's been going on for several monthsbefore that, in their mum's womb.
(00:53):
And the things that can happen duringpregnancy have a profound impact
on the baby, not just at birth, butthroughout their early and later lives.
That's Mr. Nigel Simpson.
In this episode, we're gonna findout about how Leeds became one of
the first hospitals to open a clinicdedicated to preventing preterm births.
We'll discover how genetic testingat birth and anonymous health data is
(01:17):
giving researchers new tools to supportbabies and their families from day one.
We all think of research as sometimessort of mad scientists in the labs
up odd treatments or discoveries.
Bit mind blowing.
Um, actually research is just part ofnormal clinical care and it's really
(01:40):
important to understand what that meansbecause many of our, uh, moms under our
care, we approach to take part in studiesand, uh, research is very much part of
the fabric of the care that we provide.
So much of research isactually just observing.
Um, just finding out what, what happensin a particular context because in, in
(02:05):
doing that, in a measured way, we havea much better way of understanding a
particular condition or response totreatment in a way that we wouldn't
normally have the time or the precisionto do when delivering regular care.
So much research is simply observing.
There is a, a, the next tier ofresearch, which is starting to say,
(02:29):
okay, we have several treatments,which we know, uh, we offer moms.
Um, now is there a, is there one of thesethat is better in a particular context
or with a particular group of moms?
Uh, and so we do research in thatway to sort of, to, to try and work
out what types of treatment are moreappropriate in certain circumstances.
(02:54):
And then there's a sort of thirdlayer of, uh, uh, of research where
we are assessing, uh, new tests ornew new therapies to see whether
these are, are better at picking upconditions at an earlier stage where
we're more able to intervene and, uh,make a difference or whether, uh, new
(03:15):
therapies are an improvement upon.
Able, uh, offer the moment.
So there whole range of different typesof research and certainly this has uplift.
The ways in which we're ableto care for moms across the uk.
(03:35):
Uh, we know that in our, what we callthe NIHR, the National Institute for
Health and Care Research, uh, we have amom joining a research study every three
minutes of every hour of every day of.
(03:58):
A research study, research studyin this past year alone, it shows
the altruism that women have.
They recognize that, uh, the,there is a pressing need that, uh,
they want their care to improve.
They want their peers care to improve.
They want it the same fortheir children as well.
Uh, and there is a, a, a deepinterest in that, uh, in, in our nuns.
(04:23):
So this is something that'shappening all around the uk.
Uh, and it's particularlyimportant to the women, uh, here
in our communities in Leeds.
Um, we know that simply by takingpart in clinical research, it's not
only perfectly safe, but you arelikely to have better health outcomes.
And if you do not take part in research.
(04:45):
Uh, and hospitals that are active inresearch are much safer places to be
cared for than hospitals who do not.
So that's why the c qc, for example,um, part of their remit is to, uh, is
to ask when they come around, well,what's going on in terms of research?
Are you active?
Do you offer the opportunity for women?
(05:13):
Our care culture, if youlike, that research is there.
And so when mums come to our antenatalclinics, they will see lots of research
studies, uh, literature about that.
They will have research midwives anddoctors approaching them and saying,
look, you could be, um, suitable totake part in this, this vital research.
(05:36):
Do you, um.
It's, it's part and parcel of the fabricwe have here in our care and needs.
And these research projects makeactive differences, real life,
real world differences, don't they?
Well, I think the, one of the mostdramatic examples was when COVID came.
(05:57):
And we had no idea about what thismeant, uh, for, well, not just, uh,
everybody, but for expectant mums inparticular, no idea and kind of approach.
To be able to say, uh, yes, this iswhat happens to moms in pregnancy
(06:18):
if they, uh, if they catch COVID,but also allowed us to, uh, work out
whether the treatments we're offeringother, uh, populations are, you know,
non-pregnant populations, whether theywould be equally affected in pregnancy.
(06:39):
Uh, at pace, uh, and at scale, we wouldn'thave been able to respond and care for
our moms in the way that we're able to do.
So that was really important.
Another good example would be the careof moms who, uh, require, um, help with
the birth of their baby at the end of ahm, neighbor, for example, with forceps.
(07:02):
Um, one of the studies.
Giving antibiotics on a routine basis.
In that situation, halved thenumber of, uh, delayed, uh, wound
healings, uh, that occurred.
If antibiotics weren't used now, we,we, we wouldn't be able to appreciate
(07:24):
that if we hadn't been able to carry outa study ands, hadn't been willing to.
Kind of care is far safer.
The recovery from the birth is farquicker for moms as a consequence.
These are just two examples ofwhere, uh, research, uh, was
(07:47):
able to, uh, make a differencein the lives of thes we we serve.
And when it comes to, um, researchthat is based on sort of medication is.
There's an of testing on my baby.
(08:07):
Is it harder companies?
What's important to remember that in theUK we have a very high regulatory bar.
You can't just sort of say, oh,I just wanna see what impact this
drug is gonna have in pregnancy.
And that goes all the way fromvitamins to antibiotics to
anything else you care to, to set.
(08:28):
They're all carefullystudied by the regulators.
Uh, an assessment of whetherthere could be potential.
And that is, well, well beforeanything comes, uh, near, uh, anybody
within a maternity care setting.
So mums can rely on that process,uh, to to know that if they're
(08:54):
invited to participate in a studythat could involve medication.
It's undergone the highest standardsof investigation to make sure not
just the medication, but the processby which the study is taking part
will be to the highest standards.
Um, and that is, as I say, tighterin the UK than, uh, most other.
(09:19):
Countries in the world.
But that's really important becausewhen the results of these studies
are published, we can have faiththat they are true, uh, and that they
apply to our ours here in the uk.
Um.
You know, because clearly when you carryout a study, it has to have scalability
(09:40):
for, uh, your particular group of moms.
Um, so yes, I think moms, uh, ofcourse, are going to be apprehensive
about taking part in the study,which might involve, uh, aspects
of their and their baby's health.
Uh, but they can beassured that these, uh.
A thought through and examinedindependently before they,
(10:04):
they, they come to you.
And that's one of the great thingsabout the NIHR, is that it is able
to, uh, to provide that what we callgovernance, that assurance of quality,
uh, and of safety, uh, that we feelconfident that, uh, safely take
(10:28):
right.
Is the pharma industry interestedin in mums and pregnancy?
I think generally speaking, they're,they're not that interested.
There's far more money to be made,uh, in, uh, looking at chest pain in
many of my age than there are in mums
(10:50):
with say, blood pressureproblems in pregnancy because.
Young women are, are, are very resilient.
Their, their systems cancope with quite a bit.
And generally speaking, um, deathis not an outcome, whereas it
would be for somebody of my age.
So, so, uh, drug companies, you know,aren't that excited about investing a
(11:14):
lot of money, uh, in the care of women,especially younger women in pregnancy
because they're not, the, the returnsare not gonna be great for them.
Um, however, that does notdeter many from doing so.
Uh, and obviously the, these kindsof innovative research, uh, we,
(11:35):
uh, are very keen to, to run out.
One, for example, was the use ofa test in the detection of, uh,
condition involving high blood pressurein pregnancy called preeclampsia.
A dangerous conditionfor both mother and baby.
Uh, and, uh, can commonly result in, uh,a premature birth, an early birth of a
(12:00):
small baby, and con, you know, issuesfor for mother as well as her baby.
Um, what.
Our evaluation was able to do,and this manys was conducted
nationally, uh, um, showed thatthis was a very effective test at.
(12:23):
Uh, ahead of, uh, the sort of moreclinical signs, it was able to pick
this up ahead of that time and meantthat mums could be more carefully
monitored as a consequence of that andthe birth more accurately predicted.
Um, also importantly, it meantthat mums who had these sort
of non-specific symptoms.
(12:45):
Reassuring could be told, it's okay,you don't this condition perfectly.
Okay.
Uh, so the flip side, the ruling inand the ruling out of a condition, uh.
As a consequence of that test.
And that was, I say thisis, this is a novel test.
(13:05):
It's now progressed to being a standard ofcare in all our maternity units in the uk.
Uh, but it wouldn't have happenedif mums hadn't been invited to
participate and hadn't willinglygiven their permission to do so.
Now, one of the studies, um,that I found really fascinating
is the generation study.
(13:27):
Can you tell us a little bit about that?
I think again, this, this,this is the best of British is.
We have a relatively, uh,tightly regulated and well
networked health service.
Uh, we're able to do these studies,which, uh, in another context would
(13:52):
be very, very difficult to carry out.
Um, what the Generation Studyis essentially is doing is, uh,
it involves approaching a, a mumduring pregnancy and asking her if
we can collect a sample of blood.
From either the placenta or from her baby.
Obviously the blood from the placentais the babies, um, which would be
(14:15):
sent off for a genetic screening.
This screening, uh, this reliablescreening is able to pick
up more than 200 conditions.
Which we know, uh, are notcommon, but they have a huge
impact on the baby's future life.
Um, many of the conditions are,uh, slowly progressing and can only
(14:41):
pick, be picked up when it's toolate to, to really effectively help
the baby in any significant way.
Um.
And so if we are able to, to pick upthe, the condition from a genetic test
that allows that ab to be identifiedand to receive the, uh, support and
intervention, which is likely to leadto a better and more timely outcome, uh,
(15:07):
for them and of course for their family.
So it's a very easy study.
Um, the samples, uh, are, aresent to an independent laboratory
run by Genomics England.
Uh, and, uh, a result comes backas to whether any of these 200 or
so conditions are present or not.
(15:28):
Uh, if they are, then theparents are contacted.
The NHS uh, referrals are made andthat baby and their parents are seen
and counseled in, as I say, a moretimely fashion, uh, knowing that that
a, a particular condition is presentand can receive the sort of support
(15:50):
and intervention that's going vital.
In that waiting period.
Um, but the security thatbrings, uh, may be outweighed.
Um, and to a some extent we do it already.
You know, people have babies have, andyour baby probably had a he prick test
(16:13):
done a few days after birth to pick up.
Uh, it was just one of severalconditions to do with thyroid
function and what have you.
Um.
This is like that test, whichwas introduced in the eighties.
Okay, well this is the sametest, uh, for the 21st century.
This is something that's going tobe the face of the future because we
(16:35):
now have the technology to be ableto effectively screen, as I say, for
these over 200 conditions, uh, in the.
So, uh, the Generation Study is wantingto, to ascertain is this possible,
can we do this in a selected, uh,number of centers around the uk?
(16:57):
One of which I'm pleased to say is inleads, because if it's possible to.
To do so in these settings, and we'reprobably gonna be approaching up to a
hundred thousand parents on this matter.
Then it's something that the countrycan adopt fully for all babies.
(17:17):
Um, but we have to understandwhat are the, what are the
potential teething problems.
For example, are, are we going to beoverwhelmed in terms of our services,
our pediatric services, uh, fromfinding out more cases than we thought?
Well, I think that's unlikely, but wehave to, we have to demonstrate it.
(17:37):
And then these days where moneyis tight in the public sector.
It's important to demonstrate, uh, thata program like this is effective and
is in the interest of, uh, our moms andtheir babies simply because we pick up a
condition well before it becomes too lateto retrieve, uh, health for that baby.
(18:01):
And that's, that's so significant andso incredible to have the ability to be
able to do that, to be able to make thatchange just from a simple blood test.
And it couldn't be donewithout, as I say, the NIHR.
And this is again, a, a publicbody which nobody knows much about.
Uh, but, uh, for example, whatit means that in Elite we have,
(18:24):
uh, 10 research midwives who.
Are the ways in which we offerthese studies to our mothers.
They are particularly skilled in research.
They understand all about the studiesthat they're, they're offering.
Um, they know how to conduct the studyin the right way, in an ethical way
(18:48):
and in a way that is scientificallyrigorous and can be trusted.
Uh, and that's all, as I say, down this.
Maternity units, every hospital inthe country, um, and which is able
to offer these studies, uh, in a waythat, uh, moms can understand and
(19:10):
take part in, uh, and in the resultsof which can shape public policy in
the ways that I've already described.
Um.
We can trust the results.
That's the really important thing.
If it was just mad, Dr. Simpson doinga study in leads and he came up and
said, well, I've just discovered this,uh, people would say, well, okay, you.
(19:35):
Possibly, but, you know, weknow much about Dr. Simpson.
Uh, if it's done as a networkwithin an organization like the
NIHR, we can trust those results.
And more importantly, the civilservants and politicians who determine
where our moneys spent, uh, can take,uh, can take heed of that as well.
(19:55):
And that's so importantthat trustworthiness is.
So how many trials and researchprojects happen within the department
at one time or over a over a year?
You know how many different sort.
Well, that's a really good question.
I mean, at the moment we have over 20studies running, uh, at the moment.
(20:16):
These range from these sort of verybig studies like generation or baby,
which we may discuss at the moment downto very small studies, which may only
involve perhaps one or two months a yearbecause the conditions are that uncommon.
Um.
So it, it, it, it involves, as I say,the, the, the range of conditions,
(20:38):
uh, that affect the moms within needs.
Um, we've chosen those from over180 studies that are currently on
what's called the portfolio, the NIHR's portfolio within reproductive.
We feel these are, are, are singularlyimportant to the health of our, our
(21:02):
moms and their babies here in needs.
They incorporate, you know,things like high blood pressure in
pregnancy, diabetes in pregnancy, um.
Uh, after and during labor, they lookat anesthetics that are used, uh,
during birth, uh, and they includemany other studies, uh, within
(21:25):
women's health such as endometriosis.
We have, uh, a center of excellenceof endometriosis here in in Leeds,
and so many women will come to for.
This study, uh, sorry.
In this area, there are manyunresolved questions about how we
can improve the health of moms,uh, of women with endometriosis.
(21:48):
And so we have several studiesthat are, are looking at different
treatments according to the, theproblems that women, uh, describe,
uh, when they have endometriosis.
So looking at the.
Can you talk us throughjust the headline of that?
(22:09):
Yeah, so this is, again, is a very easystudy to take part in because when a
man is approached, usually early inpregnancy, but not always at that stage,
what we're asking her is whether wecan have access to her healthcare data,
uh, through the pregnancy and throughthe early years of that baby's life.
(22:32):
We, uh, have become increasinglyaware, uh, that baby's health
doesn't start at the time of birth.
It's been going on for several monthsbefore that in their mom's womb.
And the things that can happenduring pregnancy have a profound
impact on the baby, not.
(22:59):
The, the best way to examine that more,most closely is to be able to approach
moms early in pregnancy and say,look, can we, can we keep, can we have
permission to, in anonymized fashion?
Uh, in other words.
Not using data that can be directed orfollowed back to you as an individual.
(23:21):
Um, can we follow what happens duringyour pregnancy and in the life of
your baby in their early years?
Because what that will do isit will help us understand, uh.
Why, for example, um, you know, somebabies will develop asthma or why some
(23:42):
children find it difficult to succeedat school or perhaps in later life.
Some of these so-called birth cohorts,that's the sort of technical name for
them, uh, have been able to follow,uh, babies well through adolescence.
(24:02):
Things that have happened duringpregnancy have been a, a signal for
what is likely to happen in later life.
For example, uh, heart disease, um, forexample, mental health, for example.
Uh, the tendency to develop diabetes, andthat's tremendously important because.
Uh, it can then put the focus onhow we can care for our moms most
(24:26):
effectively at the time when theirbaby's health is being shaped.
Uh, and for those individuals,how, uh, during their lives, their
lifestyle can be adjusted, um,to reduce the charts of them, uh,
developing problems and makes of life.
So, uh, again, it all starts withthese, uh, observational studies.
(24:55):
Correlations andassociations are examined.
I think many, uh, peoplelistening will be aware of the
Born in Bradford, um, uh, study.
Uh, this was a very large study thatwas done in the early naughties,
uh, and it examined over 12,000,uh, babies borns in that has been
(25:20):
immensely helpful in in understanding.
Uh, predictors there are of laterhealth and happiness, um, and has
shaped policy within Bradford.
So for example, um, the clean airzone that is in Bradford at the
moment is as a direct consequenceof work that was carried out.
(25:46):
What the researchers were able to identifywas that moms who were exposed to higher
levels of environmental pollutions, theirbabies tended to suffer as a consequence.
We wouldn't, we might have suspectedthat, um, but we wouldn't have been able
to prove it, uh, in a way that would'veaffected public policy in the way that it.
(26:15):
We, we want the same benefits of thatkind of observational study being applied
here in Leeds, or at least we wanna offerit to our, our, our mothers and their
families here in Leeds to take part inthat because we feel the same benefits
will accrue for us specifically in leed.
(26:36):
Uh, that's, we understand how our.
Our children can grow up in anenvironment which is supportive and
gives them the best chance of success.
This study, which starts withthat consultation at your
booking visit in pregnancy, isthe beginning of that journey.
(26:58):
Um.
The other power of that is that, um,so our, our, our site is the born
and bred in leads site, baby leads.
Uh, we have, uh, a large networkof other sites who are conducting
exactly the same type of.
(27:22):
We have sites, uh, for example, inWakefield, in Doncaster, uh, uh,
they're starting in Hull and in York.
So there's a very strongYorkshire interest in all of this.
So again, what's important for usin Yorkshire that really affects,
for example, how we deliver healthservices within, uh, this part of
(27:44):
the country, but nationally as well.
We have, uh, sites in Nottinghamand in Bury and in East London.
Uh, if you like, working together, uh,with these larger numbers gives us much
greater ideas to whether the issuesthat we've identified here in LEED are
the same, that they're facing those in.
(28:07):
Um, so again.
It shows the benefit of what we canascertain here within our locality,
but also what, how that can influence,uh, national policy, uh, as well.
Um, it allows, uh, the ability forother investigators to say, okay, you've
(28:27):
got that sort of conduit in there.
We have a particular interest in thisgroup, ofs cans in your, in your, in your.
Uh, and offer them the chancesto take part in studies.
So, uh, we've recently been awarded alarge grant, uh, to, to look at the impact
(28:49):
of, um, uh, plant-based diets, um, inthe health of mothers and their babies.
Uh, but we can only do that because we a.
Uh, both here and around the country.
And within that there will be mumswho are, who have a plant-based
(29:11):
diet who will say, yes, let'ssee how this, how this works out.
Um, and that will again, allow usto care for and advise those mums
and their families, uh, in terms ofthe benefits of what they're doing.
But also to, to say, well, look,there, there may be a chance, you
may be low on this supplement orthat this and that, or whatever, and
(29:32):
that can be easily addressed so thatthat lifestyle can be, uh, preserved
I imagine as well.
Much like, uh, you know, the generationstudy, it gives you the chance to get
one step ahead, um, in that if youare, if you, if the results are showing
that actually, uh, if a mother has had.
(29:53):
Preeclampsia, then the chances arein later life the baby is gonna be
more susceptible to X, Y, and Z. Wellthen those are those things that can
then be, you know, looked out forand, you know, treated or, you know,
lifestyle can be changed to do thebest that you can to either prevent
that happening or to catch it early.
It gives us knowledge, it givesus greater certainty that, um, uh.
(30:20):
As not only as a group, butwhat more importantly as an
individual, these are the issuesI need to be aware of in my life.
Um, uh, whether I choose to doanything about it is another matter.
Uh, there's obviously that issue betweenpublic policy and individual choice,
but what we can't have is a, a situationwhere there, there is no freedom for
(30:44):
the individual to exert a choice.
Uh, and uh, certainlya classic is smoking.
For example, you know, we say weknow that when we study groups of,
uh, people who smoked, that they'reat a higher chance of developing a
whole range of health conditions.
Now that's been well established.
I mean, we just take it as granted now.
(31:04):
It wasn't in the fifties until theseobservational cohorts were done actually
in doctors, strangely enough where.
The who smoked were more likelyto have, uh, major health issues.
We just take that as accepted.
Now we're doing it in a similarway, uh, in these birth cohorts.
And you quite right.
(31:24):
It allows people to be more aware of.
The consequences of a particular conditionthat they've encountered or a lifestyle
that they adopt and also allows theopportunity to say, well, look, we can
restore or retrieve or mitigate theseissues in these other particular ways.
It's giving information that's appsan appropriate for that individual.
(31:49):
Which is what we'd want for ourselves,
and you can find out more in the shownotes coming up on our next episode.
The main thing is the mammogram hasto be diagnostic, so that means we
can read it to make a diagnosis.
And in cases where things have gonenot the way that it was planned and the
images aren't really of great quality,the AI algorithm can flag in real time.
(32:13):
You may want to considerrepeating an image.
Yes.
Using.
AI to check your breasts.
We are going to hear from Dr.Nisha Sharma in our next episode.
She's an expert in breastscreening in radiology and in ai.
She's a consultant radiologist and thedirector of the breast screening program
for leads and Wakefield, and she willgive us the lowdown of the use of this
(32:35):
latest technology, medical breakthroughs.
The research journey is anunder the mask audio production.
Medical breakthroughs,the research journey.
Hello and welcome.
I'm your host, Caroline Burden,and you are about to join me on
a journey into the fascinatingworld of medical breakthroughs,
but not just any breakthroughs.
We are diving into thepersonal stories, the setbacks.
(00:30):
That you will not believe.
This moment behind the cutting edgeresearch happening right here at
Leeds Teaching Hospitals NHS Trust.
Coming up in this episode,
we have become increasinglyaware that babies health doesn't
start at the time of birth.
It's been going on for several monthsbefore that, in their mum's womb.
(00:53):
And the things that can happen duringpregnancy have a profound impact
on the baby, not just at birth, butthroughout their early and later lives.
That's Mr. Nigel Simpson.
In this episode, we're gonna findout about how Leeds became one of
the first hospitals to open a clinicdedicated to preventing preterm births.
We'll discover how genetic testingat birth and anonymous health data is
(01:17):
giving researchers new tools to supportbabies and their families from day one.
We all think of research as sometimessort of mad scientists in the labs
up odd treatments or discoveries.
Bit mind blowing.
Um, actually research is just part ofnormal clinical care and it's really
(01:40):
important to understand what that meansbecause many of our, uh, moms under our
care, we approach to take part in studiesand, uh, research is very much part of
the fabric of the care that we provide.
So much of research isactually just observing.
Um, just finding out what, what happensin a particular context because in, in
(02:05):
doing that, in a measured way, we havea much better way of understanding a
particular condition or response totreatment in a way that we wouldn't
normally have the time or the precisionto do when delivering regular care.
So much research is simply observing.
There is a, a, the next tier ofresearch, which is starting to say,
(02:29):
okay, we have several treatments,which we know, uh, we offer moms.
Um, now is there a, is there one of thesethat is better in a particular context
or with a particular group of moms?
Uh, and so we do research in thatway to sort of, to, to try and work
out what types of treatment are moreappropriate in certain circumstances.
(02:54):
And then there's a sort of thirdlayer of, uh, uh, of research where
we are assessing, uh, new tests ornew new therapies to see whether
these are, are better at picking upconditions at an earlier stage where
we're more able to intervene and, uh,make a difference or whether, uh, new
(03:15):
therapies are an improvement upon.
Able, uh, offer the moment.
So there whole range of different typesof research and certainly this has uplift.
The ways in which we're ableto care for moms across the uk.
(03:35):
Uh, we know that in our, what we callthe NIHR, the National Institute for
Health and Care Research, uh, we have amom joining a research study every three
minutes of every hour of every day of.
(03:58):
A research study, research studyin this past year alone, it shows
the altruism that women have.
They recognize that, uh, the,there is a pressing need that, uh,
they want their care to improve.
They want their peers care to improve.
They want it the same fortheir children as well.
Uh, and there is a, a, a deepinterest in that, uh, in, in our nuns.
(04:23):
So this is something that'shappening all around the uk.
Uh, and it's particularlyimportant to the women, uh, here
in our communities in Leeds.
Um, we know that simply by takingpart in clinical research, it's not
only perfectly safe, but you arelikely to have better health outcomes.
And if you do not take part in research.
(04:45):
Uh, and hospitals that are active inresearch are much safer places to be
cared for than hospitals who do not.
So that's why the c qc, for example,um, part of their remit is to, uh, is
to ask when they come around, well,what's going on in terms of research?
Are you active?
Do you offer the opportunity for women?
(05:13):
Our care culture, if youlike, that research is there.
And so when mums come to our antenatalclinics, they will see lots of research
studies, uh, literature about that.
They will have research midwives anddoctors approaching them and saying,
look, you could be, um, suitable totake part in this, this vital research.
(05:36):
Do you, um.
It's, it's part and parcel of the fabricwe have here in our care and needs.
And these research projects makeactive differences, real life,
real world differences, don't they?
Well, I think the, one of the mostdramatic examples was when COVID came.
(05:57):
And we had no idea about what thismeant, uh, for, well, not just, uh,
everybody, but for expectant mums inparticular, no idea and kind of approach.
To be able to say, uh, yes, this iswhat happens to moms in pregnancy
(06:18):
if they, uh, if they catch COVID,but also allowed us to, uh, work out
whether the treatments we're offeringother, uh, populations are, you know,
non-pregnant populations, whether theywould be equally affected in pregnancy.
(06:39):
Uh, at pace, uh, and at scale, we wouldn'thave been able to respond and care for
our moms in the way that we're able to do.
So that was really important.
Another good example would be the careof moms who, uh, require, um, help with
the birth of their baby at the end of ahm, neighbor, for example, with forceps.
(07:02):
Um, one of the studies.
Giving antibiotics on a routine basis.
In that situation, halved thenumber of, uh, delayed, uh, wound
healings, uh, that occurred.
If antibiotics weren't used now, we,we, we wouldn't be able to appreciate
(07:24):
that if we hadn't been able to carry outa study ands, hadn't been willing to.
Kind of care is far safer.
The recovery from the birth is farquicker for moms as a consequence.
These are just two examples ofwhere, uh, research, uh, was
(07:47):
able to, uh, make a differencein the lives of thes we we serve.
And when it comes to, um, researchthat is based on sort of medication is.
There's an of testing on my baby.
(08:07):
Is it harder companies?
What's important to remember that in theUK we have a very high regulatory bar.
You can't just sort of say, oh,I just wanna see what impact this
drug is gonna have in pregnancy.
And that goes all the way fromvitamins to antibiotics to
anything else you care to, to set.
(08:28):
They're all carefullystudied by the regulators.
Uh, an assessment of whetherthere could be potential.
And that is, well, well beforeanything comes, uh, near, uh, anybody
within a maternity care setting.
So mums can rely on that process,uh, to to know that if they're
(08:54):
invited to participate in a studythat could involve medication.
It's undergone the highest standardsof investigation to make sure not
just the medication, but the processby which the study is taking part
will be to the highest standards.
Um, and that is, as I say, tighterin the UK than, uh, most other.
(09:19):
Countries in the world.
But that's really important becausewhen the results of these studies
are published, we can have faiththat they are true, uh, and that they
apply to our ours here in the uk.
Um.
You know, because clearly when you carryout a study, it has to have scalability
(09:40):
for, uh, your particular group of moms.
Um, so yes, I think moms, uh, ofcourse, are going to be apprehensive
about taking part in the study,which might involve, uh, aspects
of their and their baby's health.
Uh, but they can beassured that these, uh.
A thought through and examinedindependently before they,
(10:04):
they, they come to you.
And that's one of the great thingsabout the NIHR, is that it is able
to, uh, to provide that what we callgovernance, that assurance of quality,
uh, and of safety, uh, that we feelconfident that, uh, safely take
(10:28):
right.
Is the pharma industry interestedin in mums and pregnancy?
I think generally speaking, they're,they're not that interested.
There's far more money to be made,uh, in, uh, looking at chest pain in
many of my age than there are in mums
(10:50):
with say, blood pressureproblems in pregnancy because.
Young women are, are, are very resilient.
Their, their systems cancope with quite a bit.
And generally speaking, um, deathis not an outcome, whereas it
would be for somebody of my age.
So, so, uh, drug companies, you know,aren't that excited about investing a
(11:14):
lot of money, uh, in the care of women,especially younger women in pregnancy
because they're not, the, the returnsare not gonna be great for them.
Um, however, that does notdeter many from doing so.
Uh, and obviously the, these kindsof innovative research, uh, we,
(11:35):
uh, are very keen to, to run out.
One, for example, was the use ofa test in the detection of, uh,
condition involving high blood pressurein pregnancy called preeclampsia.
A dangerous conditionfor both mother and baby.
Uh, and, uh, can commonly result in, uh,a premature birth, an early birth of a
(12:00):
small baby, and con, you know, issuesfor for mother as well as her baby.
Um, what.
Our evaluation was able to do,and this manys was conducted
nationally, uh, um, showed thatthis was a very effective test at.
(12:23):
Uh, ahead of, uh, the sort of moreclinical signs, it was able to pick
this up ahead of that time and meantthat mums could be more carefully
monitored as a consequence of that andthe birth more accurately predicted.
Um, also importantly, it meantthat mums who had these sort
of non-specific symptoms.
(12:45):
Reassuring could be told, it's okay,you don't this condition perfectly.
Okay.
Uh, so the flip side, the ruling inand the ruling out of a condition, uh.
As a consequence of that test.
And that was, I say thisis, this is a novel test.
(13:05):
It's now progressed to being a standard ofcare in all our maternity units in the uk.
Uh, but it wouldn't have happenedif mums hadn't been invited to
participate and hadn't willinglygiven their permission to do so.
Now, one of the studies, um,that I found really fascinating
is the generation study.
(13:27):
Can you tell us a little bit about that?
I think again, this, this,this is the best of British is.
We have a relatively, uh,tightly regulated and well
networked health service.
Uh, we're able to do these studies,which, uh, in another context would
(13:52):
be very, very difficult to carry out.
Um, what the Generation Studyis essentially is doing is, uh,
it involves approaching a, a mumduring pregnancy and asking her if
we can collect a sample of blood.
From either the placenta or from her baby.
Obviously the blood from the placentais the babies, um, which would be
(14:15):
sent off for a genetic screening.
This screening, uh, this reliablescreening is able to pick
up more than 200 conditions.
Which we know, uh, are notcommon, but they have a huge
impact on the baby's future life.
Um, many of the conditions are,uh, slowly progressing and can only
(14:41):
pick, be picked up when it's toolate to, to really effectively help
the baby in any significant way.
Um.
And so if we are able to, to pick upthe, the condition from a genetic test
that allows that ab to be identifiedand to receive the, uh, support and
intervention, which is likely to leadto a better and more timely outcome, uh,
(15:07):
for them and of course for their family.
So it's a very easy study.
Um, the samples, uh, are, aresent to an independent laboratory
run by Genomics England.
Uh, and, uh, a result comes backas to whether any of these 200 or
so conditions are present or not.
(15:28):
Uh, if they are, then theparents are contacted.
The NHS uh, referrals are made andthat baby and their parents are seen
and counseled in, as I say, a moretimely fashion, uh, knowing that that
a, a particular condition is presentand can receive the sort of support
(15:50):
and intervention that's going vital.
In that waiting period.
Um, but the security thatbrings, uh, may be outweighed.
Um, and to a some extent we do it already.
You know, people have babies have, andyour baby probably had a he prick test
(16:13):
done a few days after birth to pick up.
Uh, it was just one of severalconditions to do with thyroid
function and what have you.
Um.
This is like that test, whichwas introduced in the eighties.
Okay, well this is the sametest, uh, for the 21st century.
This is something that's going tobe the face of the future because we
(16:35):
now have the technology to be ableto effectively screen, as I say, for
these over 200 conditions, uh, in the.
So, uh, the Generation Study is wantingto, to ascertain is this possible,
can we do this in a selected, uh,number of centers around the uk?
(16:57):
One of which I'm pleased to say is inleads, because if it's possible to.
To do so in these settings, and we'reprobably gonna be approaching up to a
hundred thousand parents on this matter.
Then it's something that the countrycan adopt fully for all babies.
(17:17):
Um, but we have to understandwhat are the, what are the
potential teething problems.
For example, are, are we going to beoverwhelmed in terms of our services,
our pediatric services, uh, fromfinding out more cases than we thought?
Well, I think that's unlikely, but wehave to, we have to demonstrate it.
(17:37):
And then these days where moneyis tight in the public sector.
It's important to demonstrate, uh, thata program like this is effective and
is in the interest of, uh, our moms andtheir babies simply because we pick up a
condition well before it becomes too lateto retrieve, uh, health for that baby.
(18:01):
And that's, that's so significant andso incredible to have the ability to be
able to do that, to be able to make thatchange just from a simple blood test.
And it couldn't be donewithout, as I say, the NIHR.
And this is again, a, a publicbody which nobody knows much about.
Uh, but, uh, for example, whatit means that in Elite we have,
(18:24):
uh, 10 research midwives who.
Are the ways in which we offerthese studies to our mothers.
They are particularly skilled in research.
They understand all about the studiesthat they're, they're offering.
Um, they know how to conduct the studyin the right way, in an ethical way
(18:48):
and in a way that is scientificallyrigorous and can be trusted.
Uh, and that's all, as I say, down this.
Maternity units, every hospital inthe country, um, and which is able
to offer these studies, uh, in a waythat, uh, moms can understand and
(19:10):
take part in, uh, and in the resultsof which can shape public policy in
the ways that I've already described.
Um.
We can trust the results.
That's the really important thing.
If it was just mad, Dr. Simpson doinga study in leads and he came up and
said, well, I've just discovered this,uh, people would say, well, okay, you.
(19:35):
Possibly, but, you know, weknow much about Dr. Simpson.
Uh, if it's done as a networkwithin an organization like the
NIHR, we can trust those results.
And more importantly, the civilservants and politicians who determine
where our moneys spent, uh, can take,uh, can take heed of that as well.
(19:55):
And that's so importantthat trustworthiness is.
So how many trials and researchprojects happen within the department
at one time or over a over a year?
You know how many different sort.
Well, that's a really good question.
I mean, at the moment we have over 20studies running, uh, at the moment.
(20:16):
These range from these sort of verybig studies like generation or baby,
which we may discuss at the moment downto very small studies, which may only
involve perhaps one or two months a yearbecause the conditions are that uncommon.
Um.
So it, it, it, it involves, as I say,the, the, the range of conditions,
(20:38):
uh, that affect the moms within needs.
Um, we've chosen those from over180 studies that are currently on
what's called the portfolio, the NIHR's portfolio within reproductive.
We feel these are, are, are singularlyimportant to the health of our, our
(21:02):
moms and their babies here in needs.
They incorporate, you know,things like high blood pressure in
pregnancy, diabetes in pregnancy, um.
Uh, after and during labor, they lookat anesthetics that are used, uh,
during birth, uh, and they includemany other studies, uh, within
(21:25):
women's health such as endometriosis.
We have, uh, a center of excellenceof endometriosis here in in Leeds,
and so many women will come to for.
This study, uh, sorry.
In this area, there are manyunresolved questions about how we
can improve the health of moms,uh, of women with endometriosis.
(21:48):
And so we have several studiesthat are, are looking at different
treatments according to the, theproblems that women, uh, describe,
uh, when they have endometriosis.
So looking at the.
Can you talk us throughjust the headline of that?
(22:09):
Yeah, so this is, again, is a very easystudy to take part in because when a
man is approached, usually early inpregnancy, but not always at that stage,
what we're asking her is whether wecan have access to her healthcare data,
uh, through the pregnancy and throughthe early years of that baby's life.
(22:32):
We, uh, have become increasinglyaware, uh, that baby's health
doesn't start at the time of birth.
It's been going on for several monthsbefore that in their mom's womb.
And the things that can happenduring pregnancy have a profound
impact on the baby, not.
(22:59):
The, the best way to examine that more,most closely is to be able to approach
moms early in pregnancy and say,look, can we, can we keep, can we have
permission to, in anonymized fashion?
Uh, in other words.
Not using data that can be directed orfollowed back to you as an individual.
(23:21):
Um, can we follow what happens duringyour pregnancy and in the life of
your baby in their early years?
Because what that will do isit will help us understand, uh.
Why, for example, um, you know, somebabies will develop asthma or why some
(23:42):
children find it difficult to succeedat school or perhaps in later life.
Some of these so-called birth cohorts,that's the sort of technical name for
them, uh, have been able to follow,uh, babies well through adolescence.
(24:02):
Things that have happened duringpregnancy have been a, a signal for
what is likely to happen in later life.
For example, uh, heart disease, um, forexample, mental health, for example.
Uh, the tendency to develop diabetes, andthat's tremendously important because.
Uh, it can then put the focus onhow we can care for our moms most
(24:26):
effectively at the time when theirbaby's health is being shaped.
Uh, and for those individuals,how, uh, during their lives, their
lifestyle can be adjusted, um,to reduce the charts of them, uh,
developing problems and makes of life.
So, uh, again, it all starts withthese, uh, observational studies.
(24:55):
Correlations andassociations are examined.
I think many, uh, peoplelistening will be aware of the
Born in Bradford, um, uh, study.
Uh, this was a very large study thatwas done in the early naughties,
uh, and it examined over 12,000,uh, babies borns in that has been
(25:20):
immensely helpful in in understanding.
Uh, predictors there are of laterhealth and happiness, um, and has
shaped policy within Bradford.
So for example, um, the clean airzone that is in Bradford at the
moment is as a direct consequenceof work that was carried out.
(25:46):
What the researchers were able to identifywas that moms who were exposed to higher
levels of environmental pollutions, theirbabies tended to suffer as a consequence.
We wouldn't, we might have suspectedthat, um, but we wouldn't have been able
to prove it, uh, in a way that would'veaffected public policy in the way that it.
(26:15):
We, we want the same benefits of thatkind of observational study being applied
here in Leeds, or at least we wanna offerit to our, our, our mothers and their
families here in Leeds to take part inthat because we feel the same benefits
will accrue for us specifically in leed.
(26:36):
Uh, that's, we understand how our.
Our children can grow up in anenvironment which is supportive and
gives them the best chance of success.
This study, which starts withthat consultation at your
booking visit in pregnancy, isthe beginning of that journey.
(26:58):
Um.
The other power of that is that, um,so our, our, our site is the born
and bred in leads site, baby leads.
Uh, we have, uh, a large networkof other sites who are conducting
exactly the same type of.
(27:22):
We have sites, uh, for example, inWakefield, in Doncaster, uh, uh,
they're starting in Hull and in York.
So there's a very strongYorkshire interest in all of this.
So again, what's important for usin Yorkshire that really affects,
for example, how we deliver healthservices within, uh, this part of
(27:44):
the country, but nationally as well.
We have, uh, sites in Nottinghamand in Bury and in East London.
Uh, if you like, working together, uh,with these larger numbers gives us much
greater ideas to whether the issuesthat we've identified here in LEED are
the same, that they're facing those in.
(28:07):
Um, so again.
It shows the benefit of what we canascertain here within our locality,
but also what, how that can influence,uh, national policy, uh, as well.
Um, it allows, uh, the ability forother investigators to say, okay, you've
(28:27):
got that sort of conduit in there.
We have a particular interest in thisgroup, ofs cans in your, in your, in your.
Uh, and offer them the chancesto take part in studies.
So, uh, we've recently been awarded alarge grant, uh, to, to look at the impact
(28:49):
of, um, uh, plant-based diets, um, inthe health of mothers and their babies.
Uh, but we can only do that because we a.
Uh, both here and around the country.
And within that there will be mumswho are, who have a plant-based
(29:11):
diet who will say, yes, let'ssee how this, how this works out.
Um, and that will again, allow usto care for and advise those mums
and their families, uh, in terms ofthe benefits of what they're doing.
But also to, to say, well, look,there, there may be a chance, you
may be low on this supplement orthat this and that, or whatever, and
(29:32):
that can be easily addressed so thatthat lifestyle can be, uh, preserved
I imagine as well.
Much like, uh, you know, the generationstudy, it gives you the chance to get
one step ahead, um, in that if youare, if you, if the results are showing
that actually, uh, if a mother has had.
(29:53):
Preeclampsia, then the chances arein later life the baby is gonna be
more susceptible to X, Y, and Z. Wellthen those are those things that can
then be, you know, looked out forand, you know, treated or, you know,
lifestyle can be changed to do thebest that you can to either prevent
that happening or to catch it early.
It gives us knowledge, it givesus greater certainty that, um, uh.
(30:20):
As not only as a group, butwhat more importantly as an
individual, these are the issuesI need to be aware of in my life.
Um, uh, whether I choose to doanything about it is another matter.
Uh, there's obviously that issue betweenpublic policy and individual choice,
but what we can't have is a, a situationwhere there, there is no freedom for
(30:44):
the individual to exert a choice.
Uh, and uh, certainlya classic is smoking.
For example, you know, we say weknow that when we study groups of,
uh, people who smoked, that they'reat a higher chance of developing a
whole range of health conditions.
Now that's been well established.
I mean, we just take it as granted now.
(31:04):
It wasn't in the fifties until theseobservational cohorts were done actually
in doctors, strangely enough where.
The who smoked were more likelyto have, uh, major health issues.
We just take that as accepted.
Now we're doing it in a similarway, uh, in these birth cohorts.
And you quite right.
(31:24):
It allows people to be more aware of.
The consequences of a particular conditionthat they've encountered or a lifestyle
that they adopt and also allows theopportunity to say, well, look, we can
restore or retrieve or mitigate theseissues in these other particular ways.
It's giving information that's appsan appropriate for that individual.
(31:49):
Which is what we'd want for ourselves,
and you can find out more in the shownotes coming up on our next episode.
The main thing is the mammogram hasto be diagnostic, so that means we
can read it to make a diagnosis.
And in cases where things have gonenot the way that it was planned and the
images aren't really of great quality,the AI algorithm can flag in real time.
(32:13):
You may want to considerrepeating an image.
Yes.
Using.
AI to check your breasts.
We are going to hear from Dr.Nisha Sharma in our next episode.
She's an expert in breastscreening in radiology and in ai.
She's a consultant radiologist and thedirector of the breast screening program
for leads and Wakefield, and she willgive us the lowdown of the use of this
(32:35):
latest technology, medical breakthroughs.
The research journey is anunder the mask audio production.
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