push for full term - wirf · cooked at 37 weeks, but it is far from cooked at 37 weeks.” wa’s...

HEALTH+FITNESS today

WA has lowered itspreterm birthrateand is nowpushing the restof the nation to

do the same.Babies born prematurely,

particularly before 34 weeks’gestation, are at increased riskof serious complicationsinvolving the gut, lungs, heartand brain. They often havelifelong health problemsassociated with vision, hearingand mental capacity.

Five years ago the WAPreterm Birth PreventionInitiative began, encompassinga public health campaign calledThe Whole Nine Months, adedicated preterm birthprevention clinic at KingEdward Memorial Hospital anda Statewide outreach programfor healthcare practitioners.

The Australian PretermBirth Prevention Alliance isnow rolling out The WholeNine Months programAustralia-wide.

“We are making the WestAustralian program national. . . it is a world’s first andeveryone is watching us,”Professor John Newnham,obstetrician and chief scientificdirector at Women and InfantsResearch Foundation, says.

Together with decades ofmedical advancements, theState is on track to makefurther inroads to ensure thehealth of women and theirbabies.

Know your riskThe most important thing awoman can know is the length

of her cervix come midpregnancy, says ProfessorNewnham. Of all the areas hehas directed his considerableenergy towards, ensuring everymid-pregnancy ultrasound inWA includes a cervix lengthmeasurement has been hispriority.

A short cervix at 16-24 weeksis a predictor for preterm birth.Identifying this at the standard19-week ultrasound means themother can immediately startprogesterone, a treatment thatwill take half of those at risk tofull term.

While short cervical length isa well-known risk factor,Professor Newnham says no onehad been able to implement thediscovery across a population.

“We made sure every personthat provided health care in WA,from Kununurra in the north toAlbany in the south, understoodthat measurement needed to bedone,” Professor Newnham says.

“We hammered that reallyhard and it was completelysuccessful.”

Combined with the preventionclinic at King Edward andeducation of healthprofessionals, the initiativeproduced fast results.

“After 18 months, the rate ofpreterm birth was lowered byalmost 8 per cent; most of thereduction was seen in the latepreterm birth group (greaterthan 34 weeks gestation), with amatching rise in deliveries after39 weeks. The overall reductionequates to the prevention ofalmost 200 babies being born tooearly,” says Professor JeffreyKeelan, head of laboratories atUWA’s division of obstetrics andgynaecology.

Despite these great inroads atKEMH and some other areas, DrNewnham says there is plentymore to be done.

Every day countsIn the past full term wasconsidered “around 37 weeks”.Wrong, says ProfessorNewnham.

“There has been a progressiveincrease in deliveries down to37, 36 weeks for non-medicalreasons — FIFO workers, sick ofbeing pregnant, doctor going onholidays — various reasons,”Professor Newnham says.

“Across Australia and thedeveloped world there was thisincreasing trend as peoplethought that 37 weeks was OK,and the reason they thought it

was the definition, inherited from50-60 years ago, of term was 37weeks. It was never right but itled us to think a baby is fullycooked at 37 weeks, but it is farfrom cooked at 37 weeks.”

WA’s Raine Study — one of thebiggest successful prospectivecohorts of pregnancy, childhood,adolescence and now earlyadulthood to be carried outanywhere in the world —highlights the dangers of aplanned early birth.

“The study showed, to be bornat 37 or even 38 weeks carrieshuge implications at school agein terms of learning ability andexternalising behaviour. That

Push forfull termWestern Australia is leading the chargein the prevention of preterm birth.ANGIE TOMLINSON reports.

Risks for early deliveryProfessor Jeffrey Keelan, head of laboratories atUWA’s division of obstetrics and gynaecology, sayssome of the known modifiable and unalterable riskfactors for preterm birth include:• Low socioeconomic status• Geographic isolation• Mother’s age (either young or old)• Mother’s ethnicity • Reproductive history (including a family historyof preterm birth)• Prior cervical surgery or disease• Mother’s conditions (including diabetes, obesity,mental health diagnosis)• Smoking in pregnancy• Current or previous pregnancy complications• Having a boy (boys have greater risk being bornpreterm than girls)

DID YOU KNOW?Preterm birth is the

single major cause ofdeath and disability in

children aged underfive in the developed

world. In Australiaabout 25,000 babies

are born preterm each year.

HEALTH+FITNESS today 9Wednesday, June 19, 2019 THE WEST AUSTRALIAN

last little bit of pregnancy isterribly important for braindevelopment,” ProfessorNewnham says.

Professor Keelan explainsthat every week in the wombcounts as it allows the foetalorgans to mature and developready for life outside.

He says babies born less than28 weeks’ gestation have up to a50 per cent chance of majormorbidity but this falls to lessthan 10 per cent at 32 weeks and2 per cent at 36 weeks.

Neonatal deaths havedeclined by around a third overthe past decade in Australiathanks to neonatal intensivecare unit practices andimproved management of sicknewborns.

WA’s medical fraternity statesno pregnancy is to be endeduntil about 39 weeks without amedical reason.

Looking to the futureResearchers at UWA and KingEdward are a third of the waythrough a study to develop alow-cost test to identify womenat risk of delivering a pretermbaby.

The study will recruit morethan 6000 women from KingEdward and St John of Godhospital, Subiaco.

“We know that bacterialinfections of the womb are amajor cause of early birth butuntil now we haven’t been ableto identify women at risk withany degree of accuracy, soantibiotic treatment hasn’tbeen particularly successful orwidely adopted,” ProfessorJeffrey Keelan says.

“The new test enables us toidentify women at risk early inpregnancy, allowing timelytreatment with antibiotics andprobiotics to remove thebacteria, restore a healthyvaginal microbiome and enablethe pregnancy to continue untilfull term.”

He says the combined testand treatment program couldreduce the preterm birthrate inAustralia up to 30 per cent.

The role of fish oil inreducing rates of preterm birthsis also being investigated byresearchers, says ProfessorKeelan.

He says the dose, durationand indications for the therapyare still not clear.

Work is also being conductedby Australian and Canadianresearchers on a new drugwhich can block inflammation,prevent preterm birth andspare the foetus from theharmful effects of inflammationin utero, says Professor Keelan.The project is under way in fourcentres, including Perth.

The beginnings of whathas the potential to bea medical miracle liesin the paddockssurrounding the tiny

town of Darkan in WesternAustralia’s Wheatbelt region.

A futuristic artificial womb isbeing developed by researchersat the Women and InfantsResearch Foundation inSubiaco. Earlier this year, theteam announced a majoradvancement and world-first —the ability of an artificialplacenta-based life supportplatform to maintain extremelypreterm lamb fetuses;equivalent to a 24-week humanfetus.

While previous research haddemonstrated thetechnology’s feasibility inlate preterm fetuses, noone had done it inextremely pretermfetuses.

“For severaldecades, there hasbeen littleimprovement inoutcomes ofextremely preterminfants born at theborder of viability (21-24weeks gestation),” WIRFPerinatal ResearchLaboratories head Matt Kempsays.

But then the researcherswere able to show thetechnology was able to supportextremely preterm lambs in astable, growth-normal state forfive days, demonstrating thetechnology’s potential clinicalapplication for preterm infantsborn at the border of viability.

The research brings togetherresearchers from Perth’sWomen and Infants ResearchFoundation, The University ofWestern Australia and Japan’sTohoku University Hospital andbiomedical technologycompany Nipro Corporation,along with the buy-in of the WADepartment of Health.

“We start off down in theWheatbelt around Darkan,Collie, where we work withsome fantastic agricultural andlivestock consultants to get ouranimals for our study,”Associate Professor Kemp says.

“We then come up to the cityand do the work here, then thedata we are generating and afew other bits and pieces go upto Kyota and Osaka and then upto the US and Europe to some ofour other partners we areworking with. It is a fantasticinternational collaboration.”

While babiesborn from 25

weeks onwardsshow great improvements intheir short and long-termoutcomes, those born between21-24 weeks “haven’t seen thosesorts of improvements”, saysAssociate Professor Kemp. Theidea of the artificial womb is tobridge the three to four-weekgap to allow a baby to becomestrong enough and viable to betransitioned to existingtechnology.

“The goal is to offer a bridgebetween a natural womb andthe outside world to give babiesborn at the earliest gestationalages more time for their fragilelungs to mature,” he says.

And why lambs? “It’s not just because there

are lots of sheep kickingaround here in WesternAustralia,” laughs ProfessorKemp. “A lot of the work thathas been done in the obstetricsspace for a very long time hasbeen done on sheep.”

He says much of what weknow about fetal physiology aswell as common interventions,like antenatal steroids, was firstdeveloped in sheep.

“With additional refinement,what today might be consideredas futuristic technology mightsoon not be so futuristic andmight be standard of care.”

Artificial womb in gestation

AssociateProfessorMatt Kemp isleadingresearch onan artificialwomb.Picture: Iain Gillespie

Perth researchers’ breakthroughcould give hope to babies that are born as young as 21 weeks,writes ANGIE TOMLINSON

Pictures: Getty Images

‘The goal is to offer a bridge between a natural womb and the outside

world to give babiesmore time for their

fragile lungs tomature.’