Tommy's was founded in 1992 when two obstetricians at St. Thomas' Hospital, Dr Ian Fergusson and Dr Anthony Kenney, couldn't and wouldn't accept the lack of answers surrounding premature birth any longer. Together with one of their patients, Lucy Nelson, they decided to start raising money to fund investigations of why some babies are born early and how it can be prevented. The campaign grew into Tommy's, which is now the UK's biggest funder of pregnancy research.
Since opening the country's first-ever pregnancy research centre in 1997, focused on understanding and preventing premature birth, the charity has expanded to include centres dedicated to stillbirth and miscarriage. Tommy's researchers also work to reduce the risks that mothers and babies face from complications such as pre-eclampsia and gestational diabetes, as well as studying how pregnancy is affected by long-term health issues like obesity and autoimmune disorders.
However, science alone can't save babies' lives; translating study findings into the best possible care and advice for parents is crucial, so in 2002, Tommy's set up its midwife-run PregnancyLine and online PregnancyHub which currently supports millions of families at all stages of their journey. By offering expert information and impartial advice on everything from pre-conception health to baby movements and nutrition, the charity empowers mothers to have healthier and safer pregnancies.
Tommy's also puts research into practice through its network of specialist clinics which provide preconception and antenatal care for mothers with high-risk pregnancies or a history of baby loss. But every family should be entitled to the best possible care, so the charity's newest centre is an alliance with the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists to share their scientific breakthroughs more widely. Working with and within the NHS, Tommy's National Centre for Maternity Improvement aims to support midwives and other professionals to deliver the best possible care and make the UK the safest place in the world to give birth.
Translating study findings into the best possible care and advice for parents is crucial
Rates of stillbirth and premature birth vary significantly from place to place, with mothers in the most deprived parts of the UK facing 80% higher risk of their baby dying. This difference is not for lack of current research recommendations but due to local variation in the implementation of such guidelines affecting clinical practice, complicated by differences in the availability and organisation of resources. While national rates are slowly falling thanks to safety initiatives like the Saving Babies' Lives Care Bundle, these efforts don't always reach the families most in need, and maternity services won't be able to reduce these risks without the capacity to provide consistent best practice care.
Tommy's National Centre for Maternity Improvement aims to prevent up to 600 stillbirths and 12 000 premature births every year by creating a model of patient-centred care that can be scaled up nationally, with a focus on bringing pregnancy outcomes across the UK up to the level of the top performing 20% of maternity services. Researchers at the centre are also developing a digital tool that uses information already routinely gathered by midwives to provide personalised care and treatment recommendations, while also empowering expectant mothers to become more engaged in their own care.
Currently, risk is not accurately assessed in pregnancy which means that many problems develop unnoticed and are harder to treat by the time they are identified—and future risk is often assessed based on previous obstetric history, meaning that many parents must experience loss before being referred to a doctor. The tool being developed by the Tommy's team will enable maternity services to make far more accurate risk assessments and tailor care accordingly, benefitting professionals and patients alike by avoiding unnecessary medical intervention and focusing precious NHS resources on those most in need.
Early findings published in the British Journal of Obstetrics and Gynaecology (Guy et al, 2019) last year showed the digital tool performed far better than the standard screening process for pre-eclampsia in early pregnancy, doubling success rates in detection of the condition (82% versus 41%) and improving uptake of treatment six-fold (99% versus 28.9%). Aspirin is recommended to prevent pre-eclampsia but the study found clinicians were unlikely to prescribe this when they weren't using the Tommy's tool—maybe because they were aware of the limitations of the standard screening, or perhaps the high number of patients with potential risk factors made the workload unmanageable.
The National Institute for Health and Care Excellence deems patients vulnerable to pre-eclampsia if they display one major risk factor or two moderate risk factors but the research evidence suggests this approach is too simplistic for such a complex condition. Using the Tommy's tool halved the number of women deemed high-risk (8.2% versus 16.1%) and by following this with a special care pathway, giving aspirin and extra growth scans until planned induction at 40 weeks, the Tommy's team achieved a 23% reduction in overall rates of the condition and an 80% reduction in the more clinically severe form of preterm pre-eclampsia.
Study author and Tommy's National Centre for Maternity Improvement director Professor Basky Thilaganathan, said: ‘This screening programme is feasible in an NHS setting and has resulted in a significant reduction of the earliest and most severe form of pre-eclampsia—so this study clearly demonstrates that the continued use of the current maternal risk-factor based pre-eclampsia screening programme in routine healthcare settings must be re-evaluated.’
Tommy's Chief Executive Jane Brewin added: ‘These findings are just the beginning; our National Centre for Maternity Improvement will continue working to develop this pioneering tool, and other lifesaving interventions, which we aim to equip the NHS with so that everyone can get the right care in the right place at the right time.’
After the research programme completes in 2022, the tool will be freely available to every maternity care provider and patient in the UK. Expectant mothers who input personal data will be signposted to advice related to their care, or lifestyle choices that can improve their chance of a healthy baby. When medical professionals contribute their clinical data to patients' records, the tool will combine this information to make highly personalised risk assessments and potential management strategies.