Research at Warwick Medical School has developed a clearer understanding of the causes of recurrent miscarriage and developed a test to identify women at risk of further miscarriages.
Recurrent miscarriage, defined as three or more consecutive miscarriages, is a widespread disorder that affects 1-2% of couples. Miscarriages cause physical and psychological stress as well as being associated with complications in subsequent pregnancies. These complications can include preterm delivery, low birth weight and physical handicap.
Researchers have discovered chromosomal errors in the implanting embryo to be a common finding, however in most cases, miscarriages remain unexplained. As a result, many affected patients receive either no treatment or are treated using a variety of drugs, with little or no evidence of clinical efficacy. Moreover, drug intervention in early pregnancy is highly restricted because of concerns regarding the effects on the developing baby.
What have we discovered?
Our recent studies have uncovered an entirely new mechanism of recurrent miscarriage.
We found that when the lining of the womb is adequately prepared for pregnancy it is capable of recognizing and responding to developmentally abnormal embryos, a process known as ‘decidualization’.
In addition, we found that the ability of the womb to decidualize is faulty in patients suffering from miscarriages, and this disrupts the response of the womb to signals from the implanting embryo.
In other words, if the lining of the womb fails to prepare adequately for pregnancy, it will not only lead to failure of a normal pregnancy but will also allow implantation of chromosomally abnormal embryos.
Importantly, we are able to examine these responses on basis of a simple womb biopsy taken before pregnancy. This work received worldwide press attention.
New tests and treatments to prevent miscarriage
We have developed a new pre-pregnancy endometrial test that identifies women at increased risk of subsequent pregnancy failure. We also conduct clinical trials aimed at testing the efficacy of novel interventions and are exploring if DPP4 inhibitors could restore endometrial function in recurrent miscarriage.
We have established a dedicated Implantation Research Clinic as part of a joint initiative between Warwick Medical School and University Hospitals Coventry and Warwickshire NHS Trust. Established in 2012, over 500 couples have been referred from across the UK to this specialist clinic over the last year.
We are working with centres across the UK and abroad to validate our test and treatments in large clinical trials.
Tommy's National Centre for Miscarriage Research
Tommy’s, the UK baby charity that funds research into miscarriage, stillbirth and premature birth, opened the country’s first national research centre dedicated to early miscarriage in April 2016, with the University of Warwick as one of its partners.
Our researchers are working with University Hospitals Coventry and Warwickshire NHS Trust to run specialist miscarriage clinics. The other partners are the University of Birmingham and Imperial College London, working with their affiliated NHS Trusts.
Nationally this will enable 24,000 women per year to access treatment and support and participate in Tommy’s research studies.