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Implementing a national database to improve clinical care and reduce the risk of miscarriages for women

Implementing a national database to improve clinical care and reduce the risk of miscarriages for women

Professor Theo Arvanitis, Chair in Digital Health Innovation and Director of the Institute of Digital Healthcare – WMG

Clinician on a tablet with digital healthcare icons surrounding it.

In celebration of International Women’s Day, Professor Theo Arvanitis, Chair in Digital Health Innovation and Director of the Institute of Digital Healthcare – WMG, University of Warwick discusses how an innovative programme of research is aiming to transform lives.

Aiming to increase live births through research

A quarter of a million miscarriages occur every single year, affecting a third of women more than once. Subfertility and repeated miscarriage are significant and consistent factors that contribute to failure to achieve live birth.

There are several biological factors that influence the risk of a miscarriage. These can include elements such as age, body mass index and lifestyle factors such as smoking.

However, whilst we know these factors contribute to the challenge, there are no established validated models available to predict the risk of such traumas for specific individuals. For those unfortunate enough to go through this, the risk of preterm birth also increases with every miscarriage.

It’s vital that we develop targeted solutions to this challenge, and data is the foundation that we need to build from in order to do this accurately and meaningfully.

Early identification, referral to fertility services and counselling are all tools that can be used to encourage conception and increase live births, but we need to know why the risk patterns mentioned above are present in order to reduce the chances of a failure to achieve live births for women experiencing recurrent miscarriages.

Implementing the National Clinical Database

To delve deeper into this problem, our researchers at the Institute of Digital Healthcare (IDH) at WMG, University of Warwick joined forces with Warwick Medical School (WMS), Warwick Computer Science, University of Birmingham, Imperial College London and 4 hospitals, including Birmingham Women’s Hospital, University Hospitals Coventry and Warwickshire, Queen Charlotte's & Chelsea Hospital, and St Mary's Hospital. All partners established the Tommy's National Centre for Miscarriage Research (NCMR), in 2016.

The NCMR is the largest miscarriage research centre in Europe. Funded by leading baby and pregnancy charity Tommy’s, the Centre focuses on all aspects of miscarriage and early pregnancy complications.

We needed to uncover whether an individual’s attendance at a recurring miscarriage clinic affected long term live birth rates, which would allow us to draw correlations between the trauma rates when there is intervention and clinical treatment options provided early in the pregnancy.

Implementing an information-driven approach, IDH developed the National Clinical Data Platform, Tommy’s Net, with the support of all partners in the NCMR, in order to help relieve the misery of miscarriages for thousands of women.

This secure clinical database is designed to collect data, such as medical history and pregnancy outcomes from participants across multiple recurring miscarriage clinics, consented to Tommy’s miscarriage studies. This database has been established with a view to aiding the delivery of new care pathways, identifying where extra research is needed and accelerating the development of models and tests to predict risk levels for individuals.

Supporting 24,000 women every year

The NCMR’s specialist research clinics provide the opportunity to 24,000 women a year to have access to treatment, support, and the opportunity to participate in pioneering research trials in miscarriage and reproductive health.

The development of Tommy’s Net as part of the Centre, enhances these opportunities. The clinical database work on Tommy’s Net, from the IDH team at WMG, University of Warwick builds on the pedigree of IDH’s internationally recognised research, which is pioneering in the development of novel health informatics solutions and clinical information systems. IDH has already delivered digital health innovations that revolutionise the way we conduct data-driven clinical trials.

Building on our progress over the last five years, and together with our partners at NCMR, IDH is now planning a follow-on research project that revolves around the dataset we have established in order to expand our knowledge, provide clinical solutions and recommendations for the treatment of miscarriages, and develop prediction models to map the risk for patients.

As part of this follow-on programme of work, we also aim to integrate the database with established hospital and GP records systems to streamline the inputting and sharing of data to enable optimum visibility, tailored care for individuals potentially across multiple clinical locations and help participants contribute their own data around future pregnancy outcomes, which will improve the tracking of progress and clinical correlations.

Find out more about research at the Institute of Digital Healthcare, WMG at the University of Warwick here.