NIHRDataInsights/HRCSData huggingface dataset:
Title: Tocolytics for delaying preterm birth: a network meta-analysis
Funder: Department of Health and Social Care

Abstract: In 2019, five million children under the age of five died, and one third of these deaths was attributed to complications of prematurity.1,2 Although tocolytic drugs are often used to prevent preterm birth, the World Health Organization (WHO) does not currently recommend their administration for antenatal optimisation, based on outdated systematic reviews.3 WHO has acknowledged the need to prioritise evidence synthesis and promote the implementation of antenatal packages to support women in preterm labour.4 Tocolysis is the first key element of any such bundled intervention, including steroids for lung maturation, magnesium sulphate for neuroprotection, and antibiotics for prevention of chorioamnionitis. In view of emerging evidence, WHO has prioritised the PICO question on tocolytics for delaying preterm birth. We propose to conduct a network meta-analysis (NMA) to generate a ranking of all available tocolytic drugs according to their effectiveness and side-effects profile. We plan to synthesize data from 150 studies, involving more than 18,000 women at risk of preterm labour, into a single coherent analysis. We will use Cochrane’s tools to unsure that the derived evidence is of high certainty. We will then summarise findings using the GRADE approach and escalate results to policy makers to review and update corresponding recommendations.5 References/Other: 1. WHO and Maternal and Child Epidemiology Estimation Group (MCEE) interim estimates produced in September 2019, applying cause fractions for the year 2017 to UN IGME estimates for the year 2018 >>> but retrieved from Levels-and-Trends-in-Child-Mortality-Report-2019 (figure 8b) 2. United Nations Inter-agency Group for Child Mortality Estimation (UNIGME). Levels & Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. United Nations Children’s Fund 2020. 3. WHO recommendations on interventions to improve preterm birth outcomes. World Health Organization 2015. 4. March of Dimes, PMNCH, Save the children, WHO. Born Too Soon: The Global action report on preterm Birth. Eds CP Howson, MV Kinney, JE Lawn. World Health Organization 2012. 5. Andrews JC, Schünemann HJ, Oxman AD, Pottie K, Meerpohl JJ, Coello PA, Rind D, Montori VM, Brito JP, Norris S, Elbarbary M, Post P, Nasser M, Shukla V, Jaeschke R, Brozek J, Djulbegovic B, Guyatt G. GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength. J lin Epidemiol. 2013 Jul;66(7):726-35.

Lay abstract: See Plain English Summary

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Using digital phenotyping to explore the association between environment and pregnancy health: a novel Scottish Digital Birth Cohort.
Funder: Chief Scientist Office, Scotland

Abstract: What happens to us in the womb affects us and our families for the rest of our lives. Recently, we have seen that stillbirth rates are starting to increase and that babies from more disadvantaged backgrounds are more likely to be born early or born small. This is a particular problem in Scotland, and the Government has said that addressing health inequality and improving outcomes for the whole population are a key priority. We know that the environment a pregnant person lives and moves in affects their health and their babies health but we don’t have a good understanding of how things like pollution, sunlight and temperature affect different individuals and how exposure to these things varies with a person’s social background or personal economic circumstances. The fact that most of us carry smartphones with us wherever we go offers a unique opportunity to collect the information those phones already hold about where we have been and how active we are and link it to what we know about local levels of pollution, temperature and sunlight. This has never been done before in this way, but technology that has previously been used to measure activity, sleep and speech in people living with brain disorders could be adapted to help answer important questions about environment and pregnancy health. I am going to work with members of the public and experts to design and test a new app that will securely collect this information. I will link our findings to the information collected in the new Born in Scotland birth cohort study in order to try and understand how the environment affects health in pregnancy. This might lead to new treatments to keep babies healthy in the womb or help the government to set new priorities in environmental and health policy


Research activity codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Delivering a Planning card to reduce drop-off in breastfeeding: A feasibility study
Funder: Chief Scientist Office, Scotland

Abstract: Breastfeeding at six to eight weeks after birth is associated with improved health outcomes for both mothers and babies. Yet many women report that they stopped breastfeeding sooner than they had intended. In 2018, the Scottish Government launched its Diet and Healthy Weight Delivery Plan, which states a commitment to reduce drop-off in breastfeeding rates at 6-8 weeks by 10% by 2025. We have recently published peer-reviewed research in the British Journal of Midwifery that looks to make a contribution towards this goal. In our study we delivered a breastfeeding planning card to women who were at least 36 weeks pregnant. The planning card reduced drop-off from breastfeeding four-fold. In a quasi-randomised trial, women who received the card were also found to engage in exclusive breastfeeding at significantly higher rates than the control group. Our pilot study suggests that if midwives in Scotland were to deliver this planning card then rates of breastfeeding at 6-8 weeks would increase and health outcomes would improve. This funding application seeks to test whether it is feasible to deliver the card as part of standard antenatal care. This study will form a co-production, action-research approach drawing on the expertise of key stakeholders: midwives, infant feeding practitioners, expectant mothers, breastfeeding mothers and the wider research team. If it finds that delivery of the card is feasible, we will develop this study into a large-scale randomized controlled trial for which we will seek funding from National Institute for Health Research


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Precision Treatment and Drug Repurposing to Reduce Endometriosis-Associated Pain in Women.
Funder: Chief Scientist Office, Scotland

Abstract: Endometriosis is associated with debilitating pelvic pain and affects ~176 million women worldwide. It is a complex, heterogeneous disorder of unknown aetiology defined by the presence of endometrial-like tissue (‘lesions’) outside the uterus. Management options for endometriosis-associated pain include surgical removal of lesions and medical treatment with ovarian suppressive drugs. However, the recurrence of endometriosis-associated pain is up to 50% within five years following surgery, and drug treatments are contraceptive and/or have menopausal-like side-effects. There is an unmet need to have clarity around the effectiveness of surgery for women with endometriosis and to assess the effectiveness of non-hormonal medical treatments. During the lectureship, I will lead a feasibility trial to inform a future large definitive trial to determine if surgical treatment of the commonest subtype of endometriosis, superficial peritoneal disease, is effective. I will also lead two multicentre clinical trials to determine the effectiveness of re-purposed non-hormonal treatments (dichloroacetate and Omega-3 polyunsaturated fatty acids) for endometriosis-associated pain. This lectureship will allow me to: (a) Address clinically relevant research questions in endometriosis. (b) Gain leadership skills and methodological expertise in clinical trial design/delivery so that I can develop as an independent Chief Investigator leading a portfolio of Women’s Health studies.


Research activity codes: 6.1 PHARMACEUTICALS;6.4 SURGERY
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Preventing Unintended Pregnancy in the Post-COVID-19 Era.
Funder: Chief Scientist Office, Scotland

Abstract: Unintended pregnancy is common. About 200000 abortions are performed each year in the UK and there is evidence that among the 640000 live births each year, nearly a third of these were not planned when they were conceived. General Practitioners provide most of the contraceptive care in the UK, however due to the COVID-19 pandemic, their ability to do so has been limited, both by the need to prioritise other kinds of care and because of short-staffing. Sexual and Reproductive Health (SRH) Services can provide simple short-acting forms of contraception like pills, patches, and rings, but they also need to provide long-acting reversible methods, such as the implant (‘the rod’), the injection (‘the jag’) and intrauterine methods (‘the coil’). SRH services have experienced funding cuts across the UK (particularly in England) and so they are less able to help patients who would also usually access their GP for contraception. An important development in 2021 was the approval for the progestogen-only pill to be provided by community pharmacies without the need to see a doctor or nurse prescriber. However, the impact of this innovation has not be assessed. Male contraception methods have been long in development but there are not yet any reversible hormonal contraceptive options. There are ongoing studies looking at possible new methods that are testing efficacy in couples and new drugs are being developed ready for clinical testing in humans. During this lectureship, I will: 1) carry out a study examining new ways of accessing contraception for patients at high risk of unintended pregnancy 2) assess the impact of the progestogen-only pill being provided at pharmacies 3) work on further clinical trials of new reversible male contraception methods. I will also gain skills that will allow me to develop into a research leader in the field of SRH.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: 2020 Doctoral Fellowship: Strategies to improve iodine status in early pregnancy
Funder: Public Health Agency, NI

Abstract: Iodine is an essential component of thyroid hormones. Requirements increase during pregnancy and iodine deficiency in-utero and early life is accepted as the leading cause of preventable mental impairment worldwide. Two billion people are thought be iodine deficient worldwide. While the effects of severe iodine deficiency are well described (cretinism and goitre), the effects of mild iodine deficiency are not well understood, particularly in pregnancy. However, an important recent observational study in the United Kingdom (UK) has reported a dose-dependent relationship between the degree of mild iodine deficiency of the mother in first trimester and subsequent offspring cognition scores. In the UK, mild-moderate iodine deficiency was endemic in the past but from the 1930s onwards, “an accidental public health triumph” occurred with the use of iodine-containing cattle feed and cleaning agents in milking parlours. The richest source of iodine in the UK is cow’s milk and other dairy products. Salt fortification programmes exist in many parts of the world, endorsed as the optimal protection by the World Health Organisation (WHO). However, historically food fortification in general has been a politically challenging issue in the UK and iodised salt availability is very low. Surveys have now demonstrated the re-emergence of mild deficiency in the British Isles. Our group in Northern Ireland (NI) has recently reported low levels of iodine awareness among pregnant women and documented iodine deficiency in a large cohort, which persisted across the trimesters, despite 50% of women taking a supplement containing iodine. This fellowship will explore the effect of increasing iodine intake via the major food source, cow’s milk, in early pregnancy. Women in early pregnancy will be enrolled, recording their supplement intake and randomly assigning them to receive an iodine factsheet plus a free supply of milk (1pint/day or 4L/week) for 12 weeks or an iodine factsheet alone. All women will be assessed across pregnancy for changes to biochemical indices of iodine status of the mothers and, post-delivery, the offspring. We will also assess attitudes towards increased milk consumption among participants and more broadly explore barriers to iodine optimisation among women and midwives, who have been shown to be important and trusted sources of nutritional advice for women. The Scientific Advisory Committee for Nutrition UK has called for further research on improving iodine nutrition. To our knowledge, this milk-based intervention study is the first of its kind and may offer an urgently required evidence base for options outside of fortification in the UK.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Motherhood in Carceral Space: Pregnancy, Childbirth, and Maternity in Prisons and Immigration Removal Centres in England
Funder: Wellcome Trust

Abstract: This project seeks to shed light on experiences of pregnancy, childbirth, and maternity in carceral space in England – namely, within the women’s prison estate and the immigration removal estate. The extent, albeit limited, scholarship surrounding this area has focused almost exclusively on maternal incarceration and detention as it relates to child separation. This project would examine how motherhood itself – spanning pregnancy, childbirth, and maternity – is experienced and endured within these two types of custodial institutions. Empirically grounded, this project will consist of fieldwork in two women’s prisons, and two immigration removal centres. It will investigate how perinatal healthcare is administered within these spaces, and how custody is experienced and endured by pregnant and maternal subjects. Ethnographically oriented, it seeks to lend visibility and centrality to the women confined within these low-visibility spaces. Ultimately, this project seeks to develop answers to the following questions: how is perinatal healthcare experienced by women within the women’s prison estate and the immigration removal estate in England? What are the conceptual and practical implications for our understanding of dignity, agency, autonomy, and privacy? How do the experiences of pregnancy, childbirth, and maternity further our understanding of the gendered harms of custodial space?

Lay abstract: Through this project, I hope to shed light on experiences of pregnancy, childbirth, and maternity within the women’s prison estate and the immigration removal estate in England. Existing scholarship in this area has focused almost exclusively on the impact of maternal incarceration and detention on separated children. Instead, I will focus on how incarcerated and detained women experience and endure motherhood within these custodial institutions. I hope, in turn, to conduct fieldwork in two women’s prisons, and two immigration removal centres. In doing so, I hope to develop answers to the following questions: how is perinatal healthcare experienced by women within the women’s prison estate and the immigration removal estate in England? What are the conceptual and practical implications for our understanding of dignity, agency, autonomy, and privacy? How do the experiences of pregnancy, childbirth, and maternity within these institutions further our understanding of the gendered harms of custodial space?

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Valuing fetal health outcomes in cost-effectiveness analysis
Funder: Wellcome Trust

Abstract: Medical interventions used in pregnancy can affect the length and quality of life of both the woman and fetus. In cost-effectiveness analysis these effects are measured using quality-adjusted life years (QALYs), but fetal outcomes are rarely measured in QALYs, despite being an important clinical outcome. This exclusion will inevitably alter the perceived cost-effectiveness of interventions. I propose QALYs should be used in this setting to support consistent decision making across healthcare, but that how fetal QALYs are valued may differ from the value used for other patients. The aim of this doctoral studentship is to investigate whether QALYs could be applied to fetal outcomes when evaluating the cost-effectiveness of interventions in pregnancy, and how those QALYs should be valued. The project will take the preferences of pregnant women as its starting point, using secondary analysis of interviews with women experiencing high-risk pregnancies, qualitative focus groups, and a discrete choice experiment to first conceptualise and then quantify possible values that could be used in cost-effectiveness analysis. The outcomes of the project will be a valuation based on maternal preferences, which could be used to make resource allocation decisions in pregnancy, while also opening the door to further research in this setting.

Lay abstract: How much should the NHS pay for a treatment that prevents miscarriage or stillbirth? The answer depends on how much society values these health outcomes. Values that help the NHS decide which treatments to pay for have been widely researched for children and adults, but there is no such evidence for unborn babies. As a result, studies have often attached no value to their outcomes. I aim to find a value that the NHS could use to decide whether a treatment is cost-effective based on what pregnant women think is important. I will run focus groups to find out about women’s experiences, and then develop a value by surveying women using a method called a discrete choice experiment. If NHS decision makers used such a value, this could lead to fairer decisions, potentially resulting in better treatments being available on the NHS, with better outcomes for women and their babies.

Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Assisted Reproductive Technologies in the Islamic Republic: Infertility, Inequality and Masculinities in Iran
Funder: Wellcome Trust

Abstract: This research examines how (in)fertile couples, men in particular, can access and utilize assisted reproductive technologies (ARTs) in the socio-cultural, legal, religious and medical context of contemporary Iran. Iran is the only Muslim country in which ARTs, including the use of donor gametes and embryos, have been regulated by the state. Although the state partly subsidizes ARTs, they are not equally accessible to all. In Iran, infertility—a stigmatized condition—is considered a ‘woman’s problem’; male infertility is hardly recognized in families, society or in social science. This ethnographic study will yield insights into male infertility and the use of ARTs in Iran and how this relates to dominant notions of masculinity. It will build on four core theoretical notions—‘reproductive navigation’, ‘(Islamic) biopolitics’, ‘stratified reproduction’ and ‘emerging masculinities’—and take an intersectional perspective considering gender, class and religion. Conducted in Tehran and Yazd, the research methods will include: observation in hospitals and in the mundane lives of (in)fertile couples; interviews with couples and religious authorities, medical professionals and policymakers. This research will further our understanding of how gender, class and religion inform disparities in the use of and access to ARTs, and speak to reproduction policies in Iran and countries with similar conditions.

Lay abstract: Through an ethnographic study, I aim to explore how infertile couples, especially men, access and use assisted reproductive technologies (ARTs), in the socio-cultural, religious and medical context of contemporary Iran. Exploration of male experiences of infertility and the use of and access to ARTs within the Iranian context will yield new insights by taking an intersectional perspective considering gender, class and religion and inform policy and practice in Iran and other countries with similar considerations.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Defining repressive mechanisms at the alpha globin locus
Funder: Wellcome Trust

Abstract: Zeta globin, an embryonic alpha-like globin, is expressed in early fetal life but strongly repressed from 8 weeks gestation. Clinically, zeta globin could substitute for alpha globin in patients with Barts hydrops fetalis syndrome, the severest form of alpha thalassemia where all 4 alpha globin genes are deleted. Reactivation of zeta globin may rescue this phenotype if the mechanisms underlying its repression and the switch to alpha globin are understood. My research aims to establish the factors underlying this switch using a variety of techniques, including whole genome sequencing of patients who naturally express zeta globin and chromatin capture techniques on both mouse and human samples. I also plan to use genome editing techniques, including base editing and chromatin modification, to develop a safe strategy for derepressing zeta globin.


Research activity codes: 1.1 NORMAL BIOLOGICAL DEVELOPMENT AND FUNCTIONING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH
Title: Measuring unmet need in sexual and reproductive health among women under the age of 25
Funder: Wellcome Trust

Abstract: When designing and evaluating health policies, there is a particular challenge that often arises - how do we work out the number of people who need healthcare but haven’t received it? This is often referred to as ‘unmet need’. Although a lot of data are collected regarding the use of healthcare services, by definition, the people who aren’t receiving the services that they require do not contribute to these datasets. My thesis will look at the concept of unmet need through the lens of sexual and reproductive health, attempting to ascertain whether we can calculate levels of unmet need across England using the data that we already have available. Through this project I will attempt to calculate the number of women in England under the age of 25 who did not receive the sexual and reproductive healthcare that they needed between 2010 and 2020. I will then use financial data to work out whether this unmet need was greater in areas that had smaller budgets for sexual and reproductive health during this period.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH