Pregnancy research - 2019 highlights

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Dr Tom Cade with patient Gemma Cooper
Researcher Dr Tom Cade with patient Gemma Cooper

International trial to help unborn babies’ racing hearts  

Lead researcher: Dr Darren Hutchinson and Associate Professor Ricardo Palma-Dias 

The Women’s has joined an international trial investigating the best way to slow the dangerously racing hearts of sick unborn babies without compromising the care of their mothers. 

The FAST Therapy Trial will assess the benefits and side-effects of three drugs – Sotalol, Flecainide and Digoxin – commonly used to treat fetal atrial flutter and supraventricular tachycardia (fast heart rhythm). 

About 20 Victorian fetuses will be treated each year for racing hearts up to 250 beats per minute, which can be fatal within days if not treated. 

One of the Lead Researchers, Dr Darren Hutchinson said he hoped the five-year trial would provide definitive evidence of what treatment was best. 

“The treatments on offer are ones that we use all the time. It’s a matter of which drug is given first and which combination,” he said. 

Associate Professor Ricardo Palma-Dias explained that the drugs for the fetus are given to the mother, which comes with a level of risk, complications, and side-effects. 

“In fetal medicine, we treat the fetus as our primary patient, but this is a conundrum where, to treat the fetus, we have to treat the mother. It’s a fine balance between fixing the baby, while also inflicting the least possible range of complications on the mother,” he said. 

“This trial will give families confidence that the treatment we’re providing is based on strong internationally recognised data.”

Thesis puts gestational diabetes criteria in the spotlight

Lead researcher: Dr Tom Cade

In 2014, Australia became one of the only major Western countries to introduce universal screening for gestational diabetes using new criteria from the International Association of Diabetes in Pregnancy Study Group. 

A thesis on the implications of the criteria change at the Women’s was published in the British Medical Journal and became one of the top research outputs globally in 2019, according to research impact tracker Altmetric. 

To identify effects on health outcomes and analyse costs of care associated with the new criteria, Lead Researcher Dr Tom Cade compared data before and after the change was implemented at the Women’s. 

“We saw an increase in annual incidence of gestational diabetes of 74 per cent – without overall improvements in primary health outcomes,” Dr Cade said. 

The change also incurred a net cost increase of more than $500,000, due to more women meeting the lower threshold for diagnosis. 

“While the overall costs are seemingly not redeemed in the short term, there needs to be further research into longer term health outcomes of women and babies affected by gestational diabetes,” said Dr Cade. 

“It’s also important to investigate more economic ways of managing women with gestational diabetes, particularly in the lower risk group.” 

Dr Cade’s thesis was also awarded the Arthur Nyulasy Prize – awarded annually by the University of Melbourne to research that has made the most significant contribution to obstetrics and gynaecology. 

Director of the Pregnancy Research Centre, Professor Shaun Brennecke AO said the thesis had generated worldwide interest as other countries grappled with whether to adopt the new diagnosis criteria. 

“Greater uniformity of diagnosis that lead to better outcomes for women with gestational diabetes is highly desirable. Many countries have been cautious about adopting the new criteria so Dr Cade’s findings may assist in decision-making regarding public health policy,” he said.

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