Research going Rural

GET TO KNOW YOUR PRESENTERS

A/Professor Greg Davis is an Obstetrician & Gynaecologist who specialises in caring for women with high risk pregnancy at St George Medical Hospital.

This has lead to his strong involvement in groundbreaking research regarding high risk pregnancy and exploring it’s contributing factors.

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A/Prof Greg Davis

Dr Lynne Roberts is a Clinical Midwifery Consultant (Research) at St George Medical Hospital and Conjoint Senior Lecturer at the University of New South Wales (UNSW).

Dr Lynne Roberts herself has experienced the complications that come with high risk pregnancy including hypertension, this has sparked her passion for research, to help others who have shared her struggle.

Dr Lynne Roberts READ LYNNE’S STORY

Amanda Henry is Associate Professor in Obstetrics and Gynaecology, an Obstetrician at St George Public Hospital and the Royal Hospital for Women, Sydney.

She is an active researcher and research supervisor in the areas of high-risk pregnancy, obstetric ultrasound, and clinical trials, teaches pregnancy care to both undergraduate and postgraduate students.

A/Prof Amanda Henry

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Professor El-Omar has a particular interest in the investigation and management of any aspect of luminal adult gastroenterology. He also has unique expertise in the gut microbiome, dyspepsia and Helicobacter related diseases.

He is the Editor in Chief, GUT, Professor of Medicine at UNSW, Sydney, Australia and the Director of the UNSW Microbiome Research Centre at St George Hospital.

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Prof Emad El-Omar

Naomi is the Project Manager & Executive Officer for the MothersBabies Study at the MRC. She is a dual trained Registered Nurse and Registered Midwife, with extensive experience working with children from birth to 18 years of age.

Prior to working in research Naomi has nursed in oncology/ haematology, neonatal intensive care (NICU) and adolescent health.

Ms Naomi Strout FIND OUT MORE

Madeline Tynan has been a strong advocate for medical research and continuing her father’s legacy of supporting important philanthropic ventures, leading to her founding The Michael Tynan Challenge in 2016.

Over the years she has raised over 1 million dollars for medical research, aiding various researchers to continue their essential exploration of important medical issues.

Madeline Tynan

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THE RESEARCH FIND OUT MORE ABOUT YOUR HEALTH RISKS AFTER HIGH BLOOD PRESSURE IN PREGNANCY.

A/Prof Greg Davis

Dr Lynne Roberts

A/Prof Amanda Henry

Did you have high blood pressure during pregnancy?

If you had high blood pressure or preeclampsia during pregnancy, you are at higher risk of heart disease and stroke compared to women who did not develop these conditions. Preeclampsia is a condition with increased blood pressure and the involvement of one or more of the body’s organ systems.

High blood pressure

2-4x risk

Diabetes

Heart disease

2x risk

2x risk

Stroke

2x risk

Why me?

While the exact causes are not known you’re not alone - in Australia, 30,000 women each year will develop high blood pressure in pregnancy and 10,000 of these will have preeclampsia.

What can I do?

Talk to your doctor about managing your risk at your next visit. You should then have a yearly blood pressure check and regular (5 yearly or more frequent if needed) heart health check.

Your doctor can talk to you about how often you need to be checked after that and about the many things you can do to reduce your risk of developing heart disease or stroke: • breast feed if possible • maintain a healthy weight • follow a healthy diet • exercise regularly • quit smoking

What if I want to get pregnant again?

If you’ve had preeclampsia you’re 7x more likely to have it again so: • plan any future pregnancies with your doctor • see your healthcare team early in your next pregnancy and make sure they are aware of your history • get back to your pre-pregnancy weight

Helpline 13 11 12 www.heartfoundation.org.au/conditions-women

Hypertensive Disorders of Pregnancy and Cardiovascular Disease: A Guide for GPs POST-PARTUM ASSESSMENT Did your patient experience:

¨ ¨ ¨ ¨

Gestational hypertension Pre-eclampsia/ eclampsia A pre-term delivery Birth of a baby with severe growth restriction

If you have ticked ‘yes’ to 1 more of the above then your patient would benefit from a cardiovascular check within the first 6 months post-partum.

This check should include: • • • •

Blood pressure Fasting glucose BMI Smoking assessment

Women to monitor more closely:

     

Severe or early onset (<34 weeks) pre-eclampsia Recurrent pre-eclampsia Metabolic syndrome Current smokers Concurrent gestational diabetes and pre-eclampsia Concurrent ‘traditional’ CV risk factors

For more information please visit heartfoundation.org.au

Hypertensive Disorders of Pregnancy and Cardiovascular Disease: A Guide for GPs

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Hypertensive Disorders of Pregnancy and Cardiovascular Disease: A Guide for GPs GENERAL FACTS What Is the Link?

• Hypertensive disorders of pregnancy (gestational hypertension, pre-eclampsia, eclampsia) occur in approx. 7% of pregnancies in Australia and are INDEPENDENT risk factors for the development of heart disease.

• The link involves endothelial dysfunction and inflammation.

The Risk Following Pre-eclampsia • • • • •

Hypertension: 3X increased risk Ischaemic heart disease: 2X increased risk Diabetes: 2X increased risk Stroke: 1.8X increased risk Overall morbidity: 1.5X risk

Women at Higher Risk • • • • • •

Women who also have metabolic syndrome or obesity Women who experienced early onset (<34 weeks) or severe pre-eclampsia Women who experienced a pre-term delivery Women who also experienced gestational diabetes Women with recurrent pre-eclampsia Women who delivered growth restricted/small for gestational age babies

Practical Tips for Assessing and Treating Women post HDP There is poor data regarding interventions to reduce cardiovascular risk in women following hypertensive disorders of pregnancy however we do know there is benefit in regular cardiovascular assessment and close attention to modifiable risk factors.

1. Perform a cardiovascular assessment in the first 6 months post-partum including blood pressure and fasting glucose/OGTT (for gestational diabetes).

2. Assess fasting lipids when >12 months post delivery and not breast-feeding.

3. Encourage smoking cessation, reduction in saturated fats and a healthy lifestyle.

4. Encourage women to achieve their pre-pregnancy weight.

5. If women have any ‘high risk’ features monitor them closely with yearly risk factor assessment.

6. Encourage breast-feeding where possible/appropriate.

7. Encourage women to be informed and access resources to further understand the conditions and their risk.

8. Be proactive in providing advice for optimising future pregnancies.

Hypertensive Disorders of Pregnancy and Cardiovascular Disease: A Guide for GPs

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EXAMINING LONG-TERM HEALTH OUTCOMES FOR MOTHERS POST BIRTH A/Prof Davis, Dr Roberts and the P4 Study A/Prof Davis and Dr Roberts work together on the P4 Study – a study of women and their babies after normal pregnancy and those with high blood pressure in pregnancy. Women and their babies are seen when the child is six months, two and five years of age. The women’s physical and psychological health and the development and health of their babies are assessed, to establish what is normal or otherwise in these areas. Rather than focus on high blood pressure during pregnancy, the study looks at the long-term health outcomes, especially for the mothers, which are not well understood.

The study began recruiting in 2013 and will run until the end of 2023. The Study recruited 300 women with normal blood pressure during pregnancy and 90 who experienced preeclampsia during their pregnancy.

Preeclampsia is a complication of pregnancy where the mother has high blood pressure in the second half of pregnancy and problems with other organs, most commonly the kidneys. Other body systems such as the liver, blood clotting, and nervous system or problems with blood flow through the placenta causing a slowing of the baby’s growth can occur. It is one of the leading causes of preterm birth requiring admission of the baby to the nursery. It is a common serious medical complication of pregnancy, affecting around 5 per cent of all pregnancies in Australia. The causes of this condition are not fully understood, but genetic factors and the placenta seem to play significant roles. The woman’s blood pressure usually returns to normal after the baby is born and the placenta is delivered.

Women are often unaware of having preeclampsia as they usually feel well in the early stages. This highlights the importance of attending antenatal care regularly for blood pressure checks, urine testing and general health check-ups. Management of preeclampsia aims to avoid serious complications for both the woman and her unborn baby. Rarely, does preeclampsia develop into eclampsia, where the woman has seizures, and, even more rarely, can be fatal to both the woman and her baby.

“We control their blood pressure. All you can do is control their blood pressure and keep them going as long as you think it’s safe. And then the only real treatment is to deliver the baby, so these babies will tend to be delivered earlier. We aim to get them to 37 weeks, but sometimes, they have to be delivered earlier than that if the baby is having problems or the mother is not under control as well,” answered A/ Prof Davis.

In addition to publishing seven research papers on their findings, the P4 study has “provided an important vehicle for projects for medical students coming through UNSW.” To complete their fourthyear projects, 15 UNSW medical students have done research in some aspect of P4. “Not only do we have papers, but we have 25-30 presentations at academic meetings that both students and also Lynne and [I] and others have presented at,” shared A/Prof Davis.

The collaborative approach has been hugely productive. As well as the core research team, three PhD candidates been undertaken in the project including Dr Roberts, who investigated the psychological aspects of the study for her PhD thesis.

And there is more research to come. The P4 Study has led to the BP2 Study (Blood Pressure Postpartum Study), for which Dr Roberts is also research co-ordinator. This is “a big randomised controlled trial looking at what is the best method of giving these women, after they’ve had high blood pressure, information to try and look after themselves after they’ve had a baby and educate them in that. So that’s an ongoing study which has been spawned by P4, really. It’s a baby of P4,” shared A/Prof Davis.

The P4 Study has had two big outcomes. Firstly, it has raised awareness that women who have had preeclampsia are at four to five times the risk of developing cardiovascular disease – hypertension, strokes, heart disease and kidney failure – later in life. Secondly, “we’ve redefined a new level for the blood pressure which we consider normal after pregnancy,” said A/Prof Davis. “People used to consider 140/90 the upper limit of normal, but we’ve shown that, in our normal population, the upper limit of normal is 120/80.”

“Our big problem now is actually getting that information out there to both the women and also to GPs and people that look after women postpartum.” said A/Prof Davis. This is one of the drivers for the BP2 study.

Dr Roberts’ personal experience inspired her to be involved in this project and others like it. “I experienced preeclampsia myself 28 years ago. I was a midwife at the time, and I found the whole experience quite traumatic. My son was born 10 weeks early here at St George, and he was transferred out because he needed to be on a ventilator, which we don’t do here at St George. He spent the first seven-and-a-half weeks of his life in hospital…I spent three days in the intensive care unit here at St George, and then a few more days back down in the maternity ward when I was well enough for that. I didn’t see him for a few days till I was well enough to go [to Randwick].”

“So, it can be a really traumatic experience for some women, separation from their baby, just having something that’s life-threatening to yourself, having a preterm baby. It can be pretty awful, and I took quite a long time to come to terms with what had happened,” shared Dr Roberts.

After returning to work as a midwife, one of the women in labour that Dr Roberts was caring for asked “Do you have children?” Upon answering yes, the woman replied saying “Oh, you must know what I’m going through then.” Dr Roberts thought to herself “Well, actually, no, I don’t… that was my lightbulb moment that working in the birth centre was not the place to be. I left the birth centre and moved to the RAP team, which was risk-associated pregnancy.”

“I was looking after women who had complicated pregnancies, particularly hypertension and preeclampsia. We looked after them through their pregnancy, through their labour, any admission in hospital afterwards, and I loved it. It had to be the most rewarding area of maternity I’d worked in, and I felt that I did really good work with the women because I really understood a lot of what they were going through with preeclampsia.”

Dr Roberts successfully applied for a six-month secondment on a research project examining the recurrence of high blood pressure in pregnancies. “I wanted to learn everything I could about hypertension in pregnancy. It fascinated me and wanted to know what I could do about it.”

The P4 Study evolved from the Obstetric Medicine Research Group, a multidisciplinary collaboration of obstetricians, midwives and renal physicians, as well as a psychiatrist, a dietitian, a paediatrician and an endocrinologist. Dr Roberts reflected on how the group is “such a collection of great minds and skillsets, and everybody trusts everyone else and respects everyone else, and they’re friendly, and they’re just a great group to work with.”

“I often think that the work I’m doing now may actually benefit me in the future now that we’ve moved on and we’re looking a bit more at long-term health after preeclampsia,” shared Dr Roberts. “I do love the work and the team I work with, and preeclampsia is such an interesting topic to be researching as well. And knowing that we’re doing great work with women’s health is really rewarding as well.”

A/Prof Davis believes that research plays an important role in being a doctor, and in his career. Research “improves your skills and keeps you thinking about things and keeps you up to date with the literature.

I’ve always believed that research was important, so I’ve always been involved with research all the way through my medical career.”

One of the first people A/Prof Davis met at St George Hospital was Professor Mark Brown, who has played a pivotal role in the P4 project. “He’s just such a lovely human being and a fabulous doctor and so committed to research … our collaboration started from then. At that time, we also had a very forward-thinking midwifery group… it was very collaborative right from the start. But initially, it was just really the renal physicians – or Mark Brown, really, me, and the midwives involved initially, and then as Lynne has said, it’s grown over the time.”

“Mark’s the ideas person … he’s come up with the ideas, and then we’ve sort of implemented the studies to actually answer all those ideas.”

“I’m an obstetrician. I work in high-risk pregnancy. Mark is a renal physician, works in preeclampsia and hypertension side of medical problems in pregnancy,” explained A/Prof Davis. “Most of my research has been working with Mark and then the larger team on hypertension and pregnancy.”

“A lot of the earlier work was on measuring protein in urine, [and] how you measure blood pressure. As Lynne said, does it recur in subsequent pregnancies? What’s the best way for measuring blood pressure in pregnancy?”

“When I started training, everyone said preeclampsia had disappeared by three months after the birth.

That was the standard belief, and it’s really only become apparent over the last 15 years that that is not true. And these women are at high risk, and we’re not really doing anything about it.” Over the past 10 year the group has focussed on postpartum research. “A lot of the intrapartum stuff has been sorted out, the diagnosis and management, and when you deliver people, when you make that decision, what drugs you use in pregnancy. All that stuff has been sorted out to a large extent.”

“We still don’t know how to prevent [preeclampsia], but once women actually have it, we know how to diagnose it. We know how to manage it. So that’s why we’ve moved on to trying to actually improve women’s health after they’ve had preeclampsia and do something about it – try and intervene so that they don’t have these high risks afterwards,” A/Prof Davis explained.

Achieving a balanced life When asked about his life outside of work, A/Prof Davis stated “I have a very balanced life. So we have a private practice as well. I’m an obstetrician on call, so I’m on call Monday to Friday and one weekend in four. And the rest of the time, I exercise.”

Currently, with my daughter, I’m doing a big jigsaw. I’m sort of into jigsaw puzzles. And what else am I doing? I read a lot, actually. I don’t read serious stuff. I read crime novels. And I think in our job – you deal with a lot of human pain and emotion, and I find most of what they describe as great literature is about human pain and emotion, and I think we deal with that on a daily basis. And I don’t really need to read about it any more to know that it’s not very nice, so I tend to read crime and murder – seems much less traumatic somehow.”

Dr Roberts shares A/Prof Davis’ love of jigsaws. Outside of work Ms Roberts likes to “go out walking with my dog. She’s crazy and needs to burn off energy. And like Greg, I love doing jigsaw puzzles.

I just finished a 2,000-piece puzzle on the weekend, which I was pretty chuffed about. I find them a great thing to do just for a bit of quiet downtime, but very hard to tear myself away from them. It’s very addictive… Sometimes, I set myself a timer, otherwise, I could just be there till the early hours of the morning without realising it… I also love to cook. I do like to cook sweet things. I’m a very good scone maker, so I like to host high teas at my place. I love to get out all the fine bone china and put on a show with it all with the scones with my homemade jam, as well. But yeah, I do like to cook lots of different things.”

PREECLAMPSIA. THE AUSTRALIAN EXPERIENCE OF LYNNE AND MARK ROBERTS.

As is typical of me, I had everything planned well in advanced: a nice normal birth in the Birth Centre and home a few hours later. What I did not plan on was having preeclampsia!

At 20 weeks gestation I commenced medication for my essential hypertension, a condition I was not aware that I had. This was the beginning of thorough monitoring of my baby and myself. The pregnancy progressed slowly and the underlying blood pressure problem was always of concern.

At 29 weeks, my blood pressure remained elevated and blood tests revealed that my kidney and liver functions were deteriorating. I was admitted to hospital for observation. What a shock! The first couple of days in hospital were boring and I spent the whole time convincing myself that my blood pressure would go down and the blood test results would improve so that I could go home.

I did not need to be in hospital; I felt perfectly well. Unfortunately, the blood pressure kept rising despite regular increases in medication. The blood test results kept worsening. I knew it was then time for me to take this condition seriously. My essential hypertension was now superimposed with preeclampsia.

An ultrasound revealed that my baby was smaller than it should have been and the placenta function was not ideal. I was given steroid injections to help mature the baby’s lungs and I began discussing premature birth with my doctors, family and friends.

At 30 weeks, still in hospital, I was feeling fine. A daily urinalysis showed three plusses of protein, a big increase from my usual one plus. I was examined thoroughly by my doctor and everything was unchanged. I commenced another 24 hour urine collection to test for total protein. I was not able to complete this collection.

About one hour after my doctor had seen me I began to feel unwell. I immediately blamed the hospital dinner I had just eaten! I was feeling worse by the minute and began vomiting. I developed excruciating pain in the epigastric region and then I knew that the hospital meal had nothing to do with how I was feeling. I used my call bell for the first time and the midwife found me on the bathroom floor, slumped over the toilet, vomiting. The next few hours, in fact the next few days, are a blur. The one thing I remember clearly is the intensity of the epigastric pain. My liver was bleeding, my kidneys failing, my blood pressure rising extremely high and I was very restless and agitated.

Numerous drips were connected and I was given drugs to bring down my blood pressure and prevent me from fitting. I was monitored with a cardiac monitor and my baby monitored with a CTG. I was then prepared for the operating theatre and transferred there to have a caesarean section. During all this commotion, my husband and family had been called in and had arrived.

What a shock for them to see me this way.

I was soon the proud mother of a 1280g baby boy. I was transferred to the ICU from theatre and spent the next three days there. My son, Alexander, was transferred to another hospital as he needed to be on a ventilator. We were both monitored intensely in separate hospitals. My family were able to visit him, but all I had were some photographs that they had taken.

When I was moved from ICU to the ward, I pleaded to go and see Alexander. I was permitted to go for a short visit if my blood test results for platelets had improved. The wait for the results was agony, but the second I got the good results, I was out the door. I spent about thirty minutes with Alexander and cried all that time, blaming myself for his condition. The rest of my time in hospital consisted of visiting Alexander, using the breast pump, taking medication and having my blood pressure and many more blood tests taken. I recovered quickly and left hospital a week after Alexander’s birth. Alexander came home 46 days old and weighing 2150grams.

Six weeks post-delivery, my liver and kidney function had returned to normal, but to this day I remain on medication to control my blood pressure. Alexander is now a very healthy, happy and mischievous pre-schooler.

In considering a future pregnancy, I often reflect on my experience and marvel at the strength that my husband and mother showed through such a traumatic time. I will definitely need their strength and support gain if there is another pregnancy.

Postscript When Alexander was two and a half, my husband and I sought some pre-conception advice. We were given a 25% chance of developing preeclampsia in a subsequent pregnancy. After plenty of discussion and thought, we decided to try again.

It took about five months for my blood pressure to be controlled and stabilised on a new medication. I then fell pregnant and a very busy and stressful time began.

With very frequent visits to my doctors, regular blood tests to check kidney and liver function, several ultrasounds to check the baby’s growth, and low does aspirin from 10 weeks, I managed to reach 38.5 weeks gestation. I had a very normal pregnancy!

I had an elective caesarean section of a beautiful baby boy. He weighed 3100grams and we named him Lachlan. I recovered quickly and left hospital four days later to begin my new experience of mothering a healthy term baby.

The experience was well worth the stress and worry. I am extremely proud to have had a normal pregnancy. We now have to decide if this completes our family.

A change in direction for my career When Alexander had his first birthday we celebrated with family, food and cake. It was a very happy day and a significant milestone for Alexander considering his difficult start to life. However, throughout the day I was distressed. I was constantly recalling what happened ‘this time last year’ and reliving my traumatic birth experience. I thought I just needed some more time to recover and I seemed to cope with the next birthday a little better than the previous one. A turning point for my recovery came a few years later when a psychiatrist said to me ‘you don’t need to get over it, in fact you probably won’t get over it. What you need is to find ways to cope with what happened and move on to enjoy your life’. And that is what I have done!

Since this experience and advice I have been determined to learn more about preeclampsia and to help improve the birth experience for the women who develop this complication in their pregnancy. My first step in achieving this was leaving my position as a birth centre midwife and joining the multidisciplinary team caring for women with a complicated pregnancy, particularly those with hypertension. Working as part of this team was extremely rewarding and I felt like I was making a real difference to the care women were receiving. I started teaching the topic of hypertension in pregnancy in my workplace and at university, and soon became the resource midwife for anything to do with hypertension. I wanted all midwives to be well informed on hypertension so that the best care would be given. I was already a member and committee member of a support group based in Melbourne (AAPEC) and I decided to start my own support group in Sydney. I was willing to give anything a go that meant a better experience for women and their babies following a pregnancy complicated by hypertension.

In 2003 I began working as a researcher as part of what has evolved into a well renown multidisciplinary team of midwives, nurses, doctors and allied health professionals; the St George Hospital Obstetric Medicine Research Group (OMRG). The majority of our research work is focussed on preeclampsia and other hypertensive disorders of pregnancy. I find this work very interesting and enjoyable and know that the research we do today is helping to improve women’s health now and in the future.

When I decided to undertake a PhD, there was never a question on what the topic would be.

Anyone who knew me would give you the same answer, so it is no surprise that I carried out a project about women’s mental health and improving the birth experience for women who have their pregnancy complicated by hypertension.

Monitoring my health long term Over the past decade or so, the long term consequences of preeclampsia, such as the increased risk of heart disease, diabetes and kidney disease, have become apparent and well documented.

I am very aware of my increased risks and believe that preventative health practices are very worthwhile. Being active and eating healthy is one strategy that can help to reduce the long term risks of preeclampsia. For this reason, I walk every day and try my best to stick to a healthy diet.

Since having Alex, I have remained on medication to control my blood pressure. It is also important to have my health monitored regularly. I have blood pressure checks by my GP at least twice a year, and have blood tests done every year to keep an eye on my kidney and liver function, cholesterol and sugar levels. For the past three years, I have been seeing a cardiologist annually to monitor my heart health. So far all is going well and I feel reassured that by being monitored regularly, I will know as soon as something is not quite right with my health so it can be acted upon. A message that I would like to send out into the community is that the risks of preeclampsia, and other hypertensive disorders of pregnancy, are not just confined to the pregnancy and immediate postpartum period, they are life-long risks.

Written by Lynne Roberts.

AMANDA HENRY: IMPROVING WOMEN’S HEALTH

What is your area of research and how does it help people lead healthier lives?

Complicated pregnancy generally, but now more specifically preeclampsia and other hypertensive disorders of pregnancy, and how having had a pregnancy complicated by high blood pressure increases a woman’s risk of developing cardiovascular disease. My NHMRC Early Career Fellowship that I have just commenced encompasses a longitudinal study identifying markers of increased cardiovascular risk in the first 5 years after hypertensive pregnancy, work with women and healthcare practitioners around what are the knowledge gaps about hypertensive pregnancy and long-term risk of cardiovascular disease (and how to close those gaps), and also a planned intervention study focussing on lifestyle behaviour change after hypertensive pregnancy to reduce risk. The ultimate aim is to improve women’s long-term cardiovascular health and live healthier lives through identifying the risks that their complicated pregnancy has exposed and working with women to decrease that risk.

What attracted you to working at The George Institute?

First and foremost, the George Institute’s new Global Women’s Health program. With my clinical background as an obstetrician, and my research focus in Women’s Health, it’s really exciting to be part of an evolving program in the area I’m passionate about, particularly when it’s with a leading research institute like the George. Also, I’m used to working collaboratively, and since UNSW is both my main employer and the Sydney academic partner of the George Institute, it’s great to have an opportunity to bring together George Institute and UNSW researchers to further work in Women’s Health. The enthusiasm and drive of the George Institute staff is amazing!

Another big attraction for me is the opportunity to work in an institute that has such an incredible track record in doing large-scale, impactful work that actually manages to translate from concept to clinical trial and then on into practice.

What is preeclampsia and how many people get it?

Preeclampsia is a multisystem disorder of pregnancy, that is most often recognised clinically as high blood pressure and excess protein in the urine during the second half of pregnancy, however it can have major effects on many maternal organ systems (e.g. kidneys, liver, brain, lungs) and also on the growth of the baby.

Is there a link between preeclampsia and noncommunicable diseases?

Absolutely. Although the short term consequences of preeclampsia can be devestating, from a public health perspective the long-term associations with preeclampsia and an increased risk of cardiovascular disease may be even more serious. There is now a large body of epidemiological data that shows a history of preeclampsia is associated with at least a doubling in a woman’s long-term risk of heart attacks, stroke, and vascular disease, and a 3 to 4 fold increase in chronic hypertension. Although kidney failure is overall a much rarer condition, if a woman has had preeclampsia her risk of long-term kidney disease is up to 10 times higher than a woman who did not have hypertensive pregnancy.

Also, the studies are not suggesting that these risks are “old age” risks, this is risk of premature NCD disability and death: most of the studies are looking at women only 8 to 25 years after pregnancy.

How can we prevent or treat preeclampsia?

“Ideally prevention starts before actually getting pregnant, with women being a normal weight, adopting a healthy diet, and anyone with a chronic medical problem getting it as well controlled as possible before getting pregnant. In practice of course that doesn’t necessarily happen.”

The next prevention is aspirin and calcium tablets. Although research is ongoing into how effective it is in real-world scenarios, and what is the most cost-effective way to identify “high-risk” women, aspirin given to women at high risk of getting preeclampsia (such as those who have a previous history) from about 12 weeks of pregnancy definitely decreases the risk of developing preeclampsia. Calcium supplementation, particularly in women from nutritionally deficient areas or who have low dietary calcium, also appears to lower the risk of developing preeclampsia. So identifying high-risk women and commencing aspirin and calcium from early pregnancy is a major prevention strategy.

Then unfortunately at this stage there’s not much more we can do to prevent preeclampsia, although various trials of potential medications are in place or planned. To at least make sure women are identified early, hopefully before a major complication such as an eclamptic seizure or kidney failure occurs, ensuring all women have regular pregnancy care including a blood pressure check, is vital. In fact, the current schedule of pregnancy care, with increasing visits later in pregnancy, really centres on identifying women developing preeclampsia who are unaware of it because they have no symptoms or only mild symptoms.

Once preeclampsia develops, although the high blood pressure aspect can usually be controlled (at least for a while) with medication, the only real treatment for preeclampsia is delivery. If the woman is already close to her due date when she develops preeclampsia, that’s usually not such a major issue – although both mother and baby can still get quite sick either before or after the birth – but if the baby is still quite preterm that can make for some very tough decisions.

Then after the baby is born, it’s very important to keep a close watch on mum for at least the first few days, as some women will actually have their worst complications from preeclampsia in the postpartum period. It’s also vital to think about future pregnancies, where women have a higher risk of recurrent preeclampsia, and long-term, making sure women are followed up to discuss their risks after preeclampsia and that a healthy lifestyle and minimising NCD risk factors is encouraged.

What motivates you most in your work?

I don’t think there’s any one “most”, it’s the mixture of clinical, teaching, and research work that motivates me.

Being a clinician was where it started for me, and I still am very motivated by working with women and their families, and making a difference day to day in my clinical work. The education I do with university students and postgraduate obstetrics and gynaecology trainees is another huge motivator: that work is with an eye to the next generation, ensuring our doctors and other health professionals are well equipped to deliver excellent care in Women’s Health. And then research is the long game: maybe, just maybe, I will be able to make a difference, however small, to every generation to come through my research.

How did your career in health get started?

I must ‘fess up here that I come from a medical background: both my parents are doctors! I actually spent most of high school saying I would never become a doctor though: I wanted to do something different. It was only when I really thought it through in Year 12 that I realised Medicine actually was what I was looking for – a field with huge scope, and with a great mixture of science and humanity.

Then in terms of Women’s Health, when I saw my first baby being born during medical school, it was the most magical thing I had been involved with up to that point and I was hooked!

To explain to people what I do I say…

Hmmm. That’s a tough one! It sort of depends which of my “hats” I’m wearing. To most people I would introduce myself as an obstetrician by background, with a particular focus on high-risk pregnancy, and that I work as a Clinical Academic, researching and teaching at UNSW and in hospitals, and also for the George Institute for Global Health’s new Global Women’s Health program. That usually leads to more questions (like “what is a Clinical Academic?” – nobody knows!) and detailed explanations; and quite often to someone’s birth stories also!

P4 Study Newsletter What’s been happening at P4 HQ?

Spreading the word

One of the goals of the P4 research team is to spread the word of the long term health risks for women after high blood pressure in pregnancy, and our research into reducing these risks. A/Prof Greg Davis (P4 Lead Investigator) and Dr Lynne Roberts (P4 Project Manager) will be going to Orange this month, with other researchers, to spread the word to regional NSW. They will be speaking with the community and health care providers.

Congratulations!

• Pryia, our P4 UNSW Medical student in 2021, presented her P4 work at the Perinatal Society of Australia and New Zealand (PSANZ) conference in Adelaide in May, • Heike, who graduated with a PhD (UTS). Some of you will recall talking to Heike for her PhD project.

UTS are back!

World PE Day 2022

The P4 sub-study team at UTS have been successful in securing funding to continue their research. If you are due for your 5 year followup visit this year, Lynne will be giving you information about this sub-study. Please consider taking part in it (it involves a donation of an extra 50mls of blood). If you have questions about it, please contact Lynne – she is always happy to answer P4 questions!

This year the walk around Oatley Park was a success and raised funds for AAPEC (Australian Action on Preeclampsia). The rain stopped just long enough for everyone to stay dry during the walk. Here is a video of the morning which shows the fun we had. Please join us next year!

https://drive.google.com/file/d/1wjbLismTMAuBgOr6oSve_rM g7Ey4KbQc/view?usp=sharing

ANEWSTUDY!

Based on Heike’s PhD findings, the research team has developed an educational website with information about women’s longterm health risks after experiencing high blood pressure in pregnancy. We now want to hear feedback from women on this website. This study is inviting women who have recently given birth at St George Hospital and aims to seek women’s opinion, in the first 12 months after birth, on this web-based educational package. If you are eligible to take part, you may be contacted by Heike or Susannah to discuss the finer details.

Will you be adding to your family in the next year?

Are you interested in your microbiome, and the impact it might have on the health of future generations?

If so, please consider the MothersBabies Study. Contact the researchers at mothersbabies@unsw.edu.au for more information.

Each month Lynne sends out a reminder to complete and return your consent form for using your stored (extra) blood and urine in other research. Please ensure you tick ‘yes’ or ‘no’ to indicate your decision and return the form.

When should I contact Lynne?

• • • •

If you have any questions about the P4 Study If you need to change your appointment To update your contact details If you are having trouble completing the ‘Stored Samples’ consent form • If you have not been contacted and a P4 Study appointment is due or over due.

P4 PROGRESS –assessments completed Normal BP

High BP

6 month

302

113

2 year

275

98

5 year

191

59

Pregnant

34

17

Lynne Roberts, P4 Study Project Manager. Phone: 9113 2117. Email: lynne.roberts2@health.nsw.gov.au

Study Newsletter A BP2 Study update The BP2 Study Team is very excited to announce that we have finished recruiting and enrolling women in the study. We have reached 480 completed 6 month visits! It has taken us 3 1/2 years to reach this milestone; the COVID pandemic making the journey longer than anticipated. Many thanks to all of you for taking part in this very important research project – we can’t do our work without you. With your continued support, we will now focus on your 12 month and 3 year follow-up visits.

In other exciting news, the first interview paper has been published! Many thanks to those who gave up their time to chat to Christine about your pregnancy experience, lifestyle and the BP 2 Study. Here is the link to the published paper – enjoy! https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13590-2

Will you be adding to your family in the next year?

Are you interested in your microbiome, and the impact it might have on the health of future generations?

If so, please consider the MothersBabies Study. Contact the researchers at mothersbabies@unsw.edu.au for more information.

World PE Day 2022 This year the walk around Oatley Park was a success and raised funds for AAPEC (Australian Action on Preeclampsia).

The rain stopped just long enough for everyone to stay dry during the walk. Here is a video of the morning which shows the fun we had. Please join us next year!

Spreading the word One of the goals of the BP2 research team is to spread the word of the long term health risks for women after high blood pressure in pregnancy, and our research into reducing these risks. A/Prof Amanda Henry (BP2 Lead Investigator) and Dr Lynne Roberts (BP2 Project Manager) will be going to Orange this month, with other researchers, to spread the word to regional NSW. They will be speaking with the community and health care providers.

https://drive.google.com/file/d/1wjbLismTMAuBgOr6oSve_rMg7 Ey4KbQc/view?usp=sharing

What’s the 3 year follow-up all about?

Great question! Earlier this year, we secured some funding to do your health check-up 3 years after having your baby. There are two on-line surveys to complete and a visit to your study hospital for blood pressure and body composition measurements, blood and urine tests. Please contact your site coordinator if you have not heard from them and your 3 year follow-up is due or over-due.

How to contact your site coordinator: Campbelltown Alison 0436 932 003 Liverpool Wendy 0438 925 864 RHW Judy 0409 702 263 Lynne BP20436 Project Manager RPA Roberts, Erin 915 425 St George Lynne 9113 2117 (Project Manager) Phone: 9113 2117 Westmead Lynne 9113 2117 Email: lynne.roberts2@health.nsw.gov.au

BP2 Study Progress 6M visits completed

12M visits completed

3Y visits completed

CTN

75

54

0

LIV

67

46

0

RHW

157

115

7

RPA

72

56

2

SGH

95

81

18

WMH

14

9

0

TOTAL

480

361

27

Where to Reach Us

THE RESEARCH About us.

The UNSW Microbiome Research Centre (MRC) is Australia’s first research centre solely dedicated to studying the microbiota in health and disease.

HEALTH AND PREGNANCY OUTCOMES; HOW WE CAN CHANGE OUR MICROBIOMES FOR THE BETTER?

Our research is highly collaborative and explores the role of the microbiome in several globally significant diseases.

UNSW's Microbiome Research Centre is looking at how your prepregnancy lifestyle may impact on your future health and pregnancy outcomes.

mothersbabies@unsw.edu.au 0436 410 746

Find out more here

@mothersbabiesstudy The MothersBabies Study

Prof Emad El Omar

What is the microbiome?

Ms Naomi Strout

The microbiome consists of the tiny 'bugs' such as bacteria, viruses and fungi that live in and on your body.

It is estimated that 10-100 trillion of these cells exist within each person!

SIGN UP FOR THE STUDYAll over your body, in places like your

stomach, mouth, vagina, and skin, has its own unique population of bugs.1

What is the microbiome's role in pregnancy?

Many changes happen to your body throughout pregnancy such as changes to your hormones, the immune system, and your metabolism.

In recent years it has been discovered that the microbiome also goes through these changes during pregnancy!

These changes can have an impact on pregnancy outcomes, such as gestational diabetes, weight gain in pregnancy and pre-eclampsia, as well as the health of the infant.2

What is the microbiome?

Where to Reach Us

The microbiome consists of the tiny 'bugs' such as bacteria, viruses and fungi that live in and on your body.

About us.

Are you interested in groundbreaking Find out more here pre-pregnancy research?

The UNSW Microbiome Research Centre (MRC) is Australia’s first research centre solely dedicated to studying the microbiota in health and disease.

All over your body, in places like your stomach, mouth, vagina, and skin, has its own unique population of bugs.1

Our research is highly collaborative and explores the role of the microbiome in several globally significant diseases.

What is the microbiome's role in pregnancy?

UNSW's Microbiome Research Centre is looking at how your prepregnancy lifestyle may impact on your future health and pregnancy outcomes.

Many changes happen to your body throughout pregnancy such as changes to your hormones, the immune system, and your metabolism.

mothersbabies@unsw.edu.au 0436 410 746

It is estimated that 10-100 trillion of these cells exist within each person!

@mothersbabiesstudy

The MothersBabies Study

Are you interested in groundbreaking These changes can have an impact on pre-pregnancy pregnancy outcomes, such as gestational diabetes, weight gain in research? pregnancy and pre-eclampsia, as well In recent years it has been discovered that the microbiome also goes through these changes during pregnancy!

as the health of the infant.2

SESLHD HREC Approval 2019/ETH00192 Australian Breastfeeding Association Research Approval 2020-4

What is our goal?

While we know that microbiome changes during pregnancy can affect pregnancy outcomes and infant health, no one has investigated whether the pre-pregnancy microbiome can influence these outcomes!

We want to recruit participants who would like to conceive in the near future, and test their microbiome before, during and after pregnancy.

In doing so, we may be able to discover whether changes to the microbiome prior to pregnancy, for example, by changing diet and lifestyle, can improve health, well-being and quality of life for our future generations!

Can you help us?

SESLHD HREC Approval 2019/ETH00192 Australian Breastfeeding Association Research Approval 2020-4

What do we need from you?

Where to Reach Us

Our study is completely observational which means that there is no intervention. We just ask that you send us some samples every few months and complete some surveys.

The samples we ask you to submit are: 1 x oral swab 1 x vaginal swab 1 x skin swab 2 x stool tubes This study can be completed digitally, but if you are available to visit us in person, we may also take some blood and urine samples.

mothersbabies@unsw.edu.au 0436 410 746 @mothersbabiesstudy The MothersBabies Study

References: References: 1 Ursell, Ursell, L., L., Metcalf, Metcalf, J., J., Parfrey, Parfrey, L. L. and and Knight, Knight, R., R., 2012.

2012. Defining Defining the the human human microbiome. microbiome. Nutrition Nutrition 1 Reviews, 70, 70, pp.S38-S44. pp.S38-S44.

Reviews, 2 Turjeman, Turjeman, S., S., Collado, Collado, M. M. and and Koren, Koren, O., O., 2021.

2021. The The gut gut microbiome microbiome in in pregnancy pregnancy and and pregnancy pregnancy 2 complications. Current Current Opinion Opinion in in Endocrine Endocrine and and Metabolic Metabolic Research, Research, 18, 18, pp.133-138. pp.133-138. complications.

Find out more here

GETTING PREGNANCY RIGHT – THE MOTHERSBABIES STUDY Meet Professor Emad El-Omar Professor El-Omar studied Science and Medicine at Glasgow University in Scotland and trained as a physician and specialist in gastroenterology in Scotland and the USA. “I have always wanted to be a physician and realised early on that the best way to help our patients is to seek the best knowledge and to challenge dogma through scientific research backed up by robust clinical studies. As such, research really fires me up, because it offers opportunities to help people on a global scale,” said Professor El-Omar on his passion for his chosen field.

“I have a fascination with the digestive system, hence my choice to become a gastroenterologist. One of the most exciting developments in our field over the past 20 years has been the realisation that the trillions of bugs that live in and on us (the so-called microbiome) have a major impact on our health and have a role in many diseases that afflict humans. This is not just relevant to the digestive system, but to all organs in the body.

I guess the most fundamental human activity (and all species for that matter), is to produce a fit and healthy “next generation”. This is why I am dedicating most of my time and effort to understanding how the microbiome impacts on maternal and child outcomes. If we can get pregnancy right, we will guarantee a healthy and prosperous future for humanity. To get pregnancy right, we MUST start the research before pregnancy, i.e., the pre-conception phase. This is why we designed the optimal microbiome study in the pregnancy field, starting pre-conception, and lasting till at least one year after delivery. Naturally, the babies will also be followed up into the future. This study is very difficult to conduct, but it is worth all the hard work. We owe it to humanity.”

Professor El-Omar has been published many papers in scientific journals, book chapters and news articles. The topics cover many conditions that we deal with in gastroenterology, including stomach, colon and liver cancers, peptic ulcers, dyspepsia, inflammatory bowel disease and many papers on the microbiome.

Outside of work Professor El-Omar is a keen gardener.

“I like to grow things. Like everything in life, patience, dedication and love will always be rewarded with great outcomes! I also enjoy fly fishing and hill walking.

Most of all, I love to spend quality time with my family, including my beautiful six children.”

Meet Naomi Strout Ms Strout studied nursing and midwifery at Charles Sturt University Wagga Wagga, receiving a Bachelor of Nursing and Postgraduate Diploma of Midwifery. She received a Master of Advanced Nursing from the University of Technology Sydney.

“Healthy mothers (and fathers) are the key step in making healthy babies and children for the future,” said Ms Strout, who has a strong personal connection with The MothersBabies Study she project manages. “I have recently returned to work after the birth of my first daughter and quite a difficult pregnancy. On the outside, I would have thought my microbiome was picture perfect (I eat well, exercise, don’t smoke and my BMI is in the ‘normal’ range) however during pregnancy I developed gestational diabetes (requiring insulin as it just did not respond to any changes in diet!) and pre-eclampsia which resulted in my daughter being born 4 weeks early via emergency caesarean section and spending 4 days in the NICU after birth. I also had a postpartum haemorrhage and developed postnatal depression after the trauma of the whole situation!”

“If there was a test I could have done prior to falling pregnant that would have predicted any of what happened, and then there have been a way of changing it (as your microbiome can be changed back to a positive state!) in order to prevent any of those adverse outcomes I would have jumped straight on that to avoid the complications and trauma both my husband, myself and our bub went through!

This study is super exciting as it wants to uncover how our microbiome (the DNA of all the bugs that live on us and in us) can impact on our pregnancies, in both good and bad ways.”

Outside of work Ms Strout enjoys AFL, bike polo, cycling and camping for fun and relaxation.

The MothersBabies Study A Medical Research Future Fund grant of $1,000,000 was awarded in 2019 to SSMRF which established the initial research project. In December 2021, Michael Tynan Challenge awarded $10,000 to Professor El-Omar to continue working on The MothersBabies Study.

This new funding will help Professor El-Omar with the essential tasks of recruitment and publishing interim analysis results.

The MothersBabies study aims to investigate the role of the microbiome in pregnancy and its outcomes in the mothers and their babies. It is unique in starting at the preconception stage and following women for up to a year postpartum and their babies for the first few years of life. The study outcomes will determine what constitutes a healthy preconception microbiome for women planning pregnancy, and what constitutes a microbiome that will lead to adverse pregnancy outcomes such as pre-eclampsia, gestational diabetes, excessive gestational weight and perinatal mood disorders.

To date, it is only possible to test for risk of development of adverse pregnancy outcomes, once the woman has fallen pregnant or has been pregnant previously. There are no reliable pre-emptive diagnostic tools to predict or reduce these outcomes in the preconception period, or predict how many women will be affected by them. The team hope to change this by identifying non-invasive predictive biomarkers (something in our body that could indicate disease) in the preconception period.

Early diagnosis in the preconception phase of potential adverse outcomes will ensure women can be adequately managed and treated prior to falling pregnant, therefore shifting current perinatal practice towards prevention of disease as opposed to symptom management.

Preventing disease in women also has the follow-on effect of preventing potential noncommunicable diseases in their children too, such as asthma, allergy, cardiometabolic disease and adverse neurodevelopment outcomes such as autism.

The MothersBabies Study is projected to be completed in May 2024, but it may run potentially longer with follow up required for at least two years after the last woman in the study gives birth.

WOMEN HAVE THE POTENTIAL TO CHANGE THE HEALTH OF THE WORLD, & IT’S ALL IN YOUR MICROBIOME.

How you & your baby can help change the world!

Our microbiome is the collective term for the trillions of microbes that live as a community, in us (such as our gut and mouth) and on us (such as our skin). Research has shown us that the health of our microbiome can also impact on our health as a person. Parents pass their microbiome’s onto their unborn children - but to what extent is still unknown. This is where you can help!

The MothersBabies Study aims to find out how our pre-pregnancy lifestyle impacts health outcomes for you and your baby, and how we can change our microbiomes for the better - not just for us, but for future generations too!

Meet Naomi, the Super mum & Project Manager for this world changing study.

Hi, I’m Naomi, the Project Manager for this world first study. I’m also a mum to a gorgeous and very busy one year old, Piper, who made a rather exciting entry to this world last year due to my pregnancy being complicated by gestational diabetes and pre-eclampsia! Due to this, I have a strong personal connection with the study, as I have recently returned to work after the birth of my first daughter ad quite a difficult pregnancy. On the outside, I would have thought my microbiome was picture perfect (I eat well, exercise, don’t smoke and my BMI is in the ‘normal’ range) however during pregnancy I developed gestational diabetes (requiring insulin as it just did not respond to any changes in diet!) and pre-eclampsia which resulted in my daughter being born 4 weeks early via emergency caesarean section and spending 4 days in the NICU after birth. I also had a postpartum haemorrhage and developed postnatal depression after the trauma of the whole situation!

“If there was a test I could have done prior to falling pregnant that would have predicted any of what happened, and then there have been a way of changing it (as your microbiome can be changed back to a positive state!) in order to prevent any of those adverse outcomes I would have jumped straight on that to avoid the complications and trauma both my husband, myself and our bub went through!” This study is super exciting as it wants to uncover how our microbiome (the DNA of all the bugs that live on us and in us) can impact on our pregnancies, in both good and bad ways. We’re both happy and healthy now (maybe a little sleep deprived, but what new mum isn’t?) but it would have been really interesting to know if my diabetes and blood pressure could have been predicted by a ‘marker’ in my microbiome before I became incredibly sick and needed to deliver Piper early.

What is your role in the study?

I’m the Executive Officer and Project Manager for the study, but my clinical background is as a nurse and midwife. I’m responsible for the day-to-day running of the study – making sure we get enough participants, that the information we collect is done in the easiest possible way, ensuring we have all the tools and supplies to run the study properly, and talking about the study with a variety of stakeholders to increase our reach and recruitment numbers!

What makes you most excited about this project?

Women have the power to change the health of the world – and it’s all in our microbiome! By focussing on mum’s as the framework for the future population’s health and wellbeing, we can decrease disease burden and paediatric chronic health conditions the world over. This study empowers women to take the time out for self-care and making sure they are the healthiest versions of themselves going in to pregnancy!

What is this study hoping to achieve?

The MothersBabies Study wants to find out if our pre-pregnancy health and microbiome impacts on us falling pregnant, how healthy we are during pregnancy, and the health of our baby once they are born.

The microbiome is the collective term for the trillions of microbes that live as a community in us, and on us (such as your gut, blood, mouth, skin, even a woman’s vagina). All the research is showing that the microbiome has a major impact on human health through effects on metabolism, immunity, and hormones, and is the is the focus of vastly growing research initiatives. To date, it is only possible to test for risk of development of adverse pregnancy outcomes, once the woman has fallen pregnant or has been pregnant previously. There are no reliable pre-emptive diagnostic tools that can predict or reduce these outcomes in the preconception period, or how many women will be affected by them. We hope to change that by identifying non-invasive predictive biomarkers (something in our body that could indicate disease) in the preconception period.

Can you break that down for us?

What we’ve discovered in the 10 years since this type of research began, is that there are significant links with the microbiome in pregnancy and our health and wellness, however we know surprisingly little about the consequences of this, and what this could mean for future generations. We do know that everyone inherits their microbiome from their mothers and grandmothers (known as intergenerational and matrilineal inheritance of birth microbiota) and that our microbiome’s start to develop well before we are born. Our microbiome also has the ability to exert its effects on the health of the next generation, and has been shown to be associated with specific childhood diseases such as allergies, asthma, obesity, and neurodevelopmental disorders like autism. If someone’s health is already disrupted before they start to consider a pregnancy, these can have long lasting implications on the health of the woman, and ultimately her child. It makes sense that our preconception microbiome has the ability to influences the pregnancy microbiome, given the impact our diet and lifestyles has on our reproductive success, and that appropriate management of existing medical and environmental risk factors enables us to optimise outcomes for mum and bub.

The MothersBabies Study is truly a unique opportunity to make a real difference to the health of the world. Of all the work that I have ever done, and will ever do, this is the most worthy and valuable and one that deserves all our effort and energy! We owe it to humanity to get this difficult study done because it will make a difference to millions of women and their children. No research is ever possible without the tremendous help and support of altruistic decent human beings. We need your help and together we will bring this one home!

The MothersBabies Study Quarterly Update - July 2022

TELL ME MORE ABOUT ADDITIONAL TESTING If you are can make it to a collection centre or study site and provide us with blood and urine samples, we will be conducting ‘metabolomic’ analysis on these samples. Metabolomics looks at the chemicals that are produced by our body, and the chemicals produced by the bacteria in our body.

Metabolomics is an emerging field, and as such it will only be collected participants who can attend an inperson visit, to ensure the integrity of the sample is not compromised.

We are also asking to test your blood for ‘host genetics’. This type of testing looks for common genetic variations in genetic material, and not used for screening of genetic disease.

Host genetics play an important role in microbiome studies, as they investigate the relationship race and genetics has to vaginal microbiota and adverse pregnancy outcomes, as well as their contribution to individual responses to environmental triggers. As we are not looking for genetic disease this sample cannot be used for clinical or diagnostic purposes, therefore there is no risk of incidental genetic findings so poses no risk to yourself or any future children.

If you cannot make it to a collection centre or study site due to your location, or you simply do not wish to provide us with blood samples please let us know. You are never forced to do anything you are not comfortable with as part of your involvement with this research project. We just need to know so we can make a note of it in your file.

WHERE ARE STUDY SITES OR COLLECTION CENTRES CURRENTLY LOCATED? UNSW MothersBabies Study has 3 face-to-face sites set up at: • • • •

St George Hospital (Mon - Fri 8.30am - 4.30pm) Nepean Hospital (on request) Royal Hospital for Women (Wednesday mornings on request) We also offer home visits for Sydney participants in certain areas - just email us to find out out more.

We are working on options in the near future (potentially linked to NSW Health Pathology centres) that you would be able to attend for blood and urine sampling.

We will advise you on these new locations as they are set up within the study.

Copyright (C) 2022 UNSW Microbiome Research Centre. All rights reserved.

BEHIND THE SCENES WITH LYNNE & NAOMI. Lynne Roberts, Research Midwife at St George Hospital takes us through a consult with mum, 3 years after birth and having Preeclampsia during pregnancy.

Project Manager & Executive Officer of The MothersBabies Study Naomi Strout goes through a 12 montth Postpartum visit with both Mum & Bub.

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