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Healthy Mum, Healthy Baby, Healthy Future: Report Sets out Vision to Deliver Safe, Effective and Accessible Medicines for use in Pregnancy

Written by Louise Stanley on . Posted in Birmingham Health Partners, Maternal health.

In a UK-first report launched today, in the House of Commons, leading figures from charity, healthcare, industry, law and academia have outlined a collaborative vision for UK leadership to improve maternal health. The Healthy Mum, Healthy Baby, Healthy Future: The Case for UK Leadership in the Development of Safe, Effective and Accessible Medicines for Use in Pregnancy report proposes a clear roadmap to improve the lives of millions of people, not just for women while they are pregnant, but for future generations.

Download the report Healthy Mum, Healthy Baby, Healthy Future: The Case for UK Leadership in the Development of Safe Medicines for Use in Pregnancy  [PDF, 2mb]

Globally, over 800 women and 12,000 newborns die every day from preventable pregnancy-related complications – that is one woman and 17 babies every 2 minutes. Pregnancy complications affect two lives in one short period of time, yet only two medicines have ever been developed specifically for pregnancy-related conditions, and not a single new medicine for some of the most serious pregnancy-specific conditions has reached women in decades.

Over the past year, a Birmingham Health Partners led Policy Commission – co-chaired by Baroness Manningham-Buller, Co-president of Chatham House and Professor Peter Brocklehurst, University of Birmingham – has heard from key stakeholders on how best to develop safe, effective and accessible medicines for use in pregnancy. Compelling evidence gathered throughout the process has informed eight critical recommendations which, if implemented by government, will successfully prevent needless deaths and find new therapeutics to treat life-threatening conditions affecting mothers and their babies.

Key proposals include strengthening the UK’s research capabilities to address gaps in our biological knowledge; more effective clinical trials support; and harnessing collaborative partnerships between government, universities and the pharmaceutical industry. Importantly, the report advocates for women who have been historically excluded from clinical trials to be a vital part of future research, ensuring they are not left behind and can benefit from modern medical advances. The UK, with its existing track record of pregnancy research, and lifelong NHS health records, is uniquely placed to lead this overdue and vital reform, working alongside global partners to deliver real change.

Commenting on the report, Co-chair, Baroness Manningham-Buller LG, DCB, FMedSci said: “When I was asked to become joint chair of the Commission that has produced this report, I am ashamed to say that I wasn’t aware that there was an acute problem. Despite being at Wellcome for twelve years and Imperial College for six, I had no idea that research into conception and pregnancy was largely neglected and that virtually no drugs had been developed and trialled for pregnant women in the many decades since thalidomide. This leaves women at the mercy both of general diseases, the diseases of pregnancy and drugs which are usually unlicensed. The evidence taken by the Commission in its inquiry convinces us that this urgently needs to change. We suggest how.”

Co-chair, Professor Peter Brocklehurst said: “This report represents a clear and timely platform to improve the care we provide to pregnant and breastfeeding women, by increasing the availability of safe, effective and accessible medicines for their use. The Commission’s role was to provide a blueprint for action and will provide ongoing support in implementing the recommendations set out in this report, as there is an urgent need for action to address this underserved area of medical need. Without it, women and babies will continue to die when they could be saved. They will continue to experience long-term health effects, disability and distress, which might be avoided.

“We strongly urge the scientific, clinical, industry, regulatory, governmental and public sectors to come together to address the recommendations of this Commission. The UK has the opportunity to transform maternal health across the world, improving the lives of mothers, their babies and future generations – let’s not waste it.”

Yasmin Golding, campaigner from the Epilepsy Society, who continues to be affected by the lack of safe and effective medicines said: “As a mixed race woman with epilepsy there are pregnancy risks I cannot avoid, but many I should be able to in the age of modern medicine. This report gives me and other women hope that in the future they will be able to spend more time enjoying pregnancy and less worrying about avoidable risks that threaten them and their baby.”

Sandra Igwe, founder of The Motherhood Group and Co-chair of the National Inquiry into Racial Injustice in Maternity Care welcomed the report by saying: “Giving a voice back to those who are ultimately the most affected is crucial, and an imperative step for us mothers advocating for ourselves. All women, regardless of race, age, and socioeconomic background should be allowed to have safe and effective medicine during their pregnancy. It’s key in building trust, offers more choice, and lowers potential health risks – a springboard in the right direction. These recommendations will specifically further help women like me, who due to the colour of our skin, face health inequalities within maternity care.”

Find out more about Birmingham’s holistic and collaborative approach to maternal health research on our new research spotlight page

Birmingham research shapes new miscarriage guidelines

Written by Louise Stanley on . Posted in Clinical trials, Maternal health.

Research led by BHP founder-member the University of Birmingham has helped to shape guidelines which could mean thousands of women with prior miscarriage, and bleeding in early pregnancy, could be eligible for treatment with progesterone each year.

The updated guidance, announced today by the National Institute for Health and Care Excellence (NICE), follows a review of evidence by NICE’s independent guideline committee. The key evidence came from two trials – PRISM and PROMISE – led by the University of Birmingham in collaboration with Tommy’s National Centre for Miscarriage Research.

The results of the clinical trials, published in January 2020, evidenced both the clinical and economic advantages of giving a course of self-administered twice daily progesterone pessaries to women with prior miscarriage from when they first present with early pregnancy bleeding up until 16 weeks of pregnancy. In such women, the treatment reduces miscarriage risk and increases livebirth chances.

NICE’s updated guidance – ‘Ectopic pregnancy and miscarriage: diagnosis and initial management’ – recommends offering progesterone to women who have early pregnancy bleeding and who have previously had a miscarriage.  An ultrasound scan should be performed in these women, and if a fetal heartbeat is confirmed, NICE’s new guidelines recommend treatment with progesterone should continue until 16 weeks of pregnancy have been completed.  NICE’s independent guideline committee found that there was no evidence of benefit in women with early pregnancy bleeding but no previous miscarriage, nor in women with previous miscarriage but no early pregnancy bleeding in the current pregnancy.

Progesterone is a hormone that is naturally secreted by the ovaries and placenta in early pregnancy and is vital to the attainment and maintenance of healthy pregnancies.

PROMISE studied 836 women with unexplained recurrent miscarriages at 45 hospitals in the UK and the Netherlands, and found a 3% higher live birth rate with progesterone, but with substantial statistical uncertainty.

PRISM studied 4,153 women with early pregnancy bleeding at 48 hospitals in the UK and found there was a 5% increase in the number of babies born to those who were given progesterone who had previously had one or more miscarriages compared to those given a placebo. The benefit was even greater for the women who had previous ‘recurrent miscarriages’ (i.e., three or more miscarriages) – with a 15% increase in the live birth rate in the progesterone group compared to the placebo group.

Of the newly updated NICE guidance, Arri Coomarasamy, Professor of Gynaecology & Reproductive Medicine at the University of Birmingham and Director of Tommy’s National Centre for Miscarriage Research who led the PRISM and PROMISE trials, said: “After many years researching the use of progesterone and working to make treatment more accessible, today’s new miscarriage care guidelines from NICE include a very welcome change. Our research has shown that progesterone is an effective and safe treatment option, which could prevent 8,450 miscarriages a year in the UK – but we know it’s not yet reaching everyone who might benefit. This recommendation from NICE is an important step in tackling the current variation in miscarriage services across the country and preventing these losses wherever possible.”

Tommy’s CEO Jane Brewin said: “It’s great to see NICE taking our progesterone research on board in their new miscarriage care guidelines, which will help save babies’ lives and spare parents’ heartache. Miscarriage is often dismissed as ‘one of those things’ we can’t do anything about – even by some healthcare professionals, who may not specialise in this area to know the latest evidence. We hear from women who were denied progesterone treatment when they should have been eligible, simply because their doctor wasn’t familiar with it, so we hope NICE’s recommendation will help end some of these inequalities in miscarriage care that add more pain to an already unbearable experience.”

Meanwhile, Professor Coomarasamy was among the leading authors to lay bare the devastating impact of miscarriage and set out a raft of recommendations to improve treatment and care in a series of three research papers published in The Lancet in April 2021.

Amongst the calls to action by the research team was for urgent changes to NHS policy, which currently provides exploratory testing for underlying causes of miscarriage for women only after they have experienced three consecutive miscarriages.  The team says many of the risks related to a miscarriage are present even after one or two miscarriages, and appropriate care should be provided to all women who have experienced one or more miscarriages.

The Lancet ‘Miscarriage Matters’ series of papers formed part of a campaign by charity Tommy’s, including a petition to improve miscarriage care which has been signed by almost 230,000 supporters.

Tommy’s National Centre for Miscarriage Research has also been working with the Royal College of Obstetricians and Gynaecologists (RCOG) to share the knowledge and recommendations from The Lancet research.  Now, RCOG has updated its miscarriage care guidelines taking The Lancet papers on board and encourages the NHS to adopt a graded model of care so that parents can get support after every loss and earlier access to specialist tests and treatments.

In the revised guidelines, RCOG suggest that ‘recurrent miscarriage’ should be redefined so that losses don’t have to happen in a row for parents to receive support. Instead, they encourage doctors to use their discretion after two miscarriages if they suspect an issue might be causing the losses, and state that non-consecutive losses or those with different partners should still be treated as recurrent miscarriage.

Meanwhile, in June this year Olivia Blake MP delivered Tommy’s petition to an Adjournment Debate in Parliament in support of the campaign, which led to the then Minister for Mental Health, Suicide Prevention and Patient Safety, Nadine Dorries MP, announcing that the Government would incorporate a number of the recommendations into the Women’s Health Strategy which will aim to improve the health and wellbeing of women across the country.

Since then, Tommy’s CEO Jane Brewin has written a joint letter with Olivia Blake to new Health Minister Gillian Keegan MP, asking her to uphold Nadine Dorries’ promises in Parliament and meet with Tommy’s to discuss what happens next to make good miscarriage care widely and fairly available for everyone.

Professor Coomarasamy said: “As we work to open the ‘black box’ of miscarriage in the hope of unpicking its causes and finding new therapies, the UK must change its approach to miscarriage care, not only to reduce the risk wherever possible but also to better support those who do tragically lose their babies.”

Tommy’s CEO Jane Brewin said: “The right care can reduce the risk of miscarriage, and the right support can help parents if they experience loss – but that help isn’t reaching everyone across the UK after every miscarriage; this can and must change.

“It’s great to see the Royal College taking forward Tommy’s recommendations from our Lancet research in their new care guidelines, so we can prevent more losses wherever possible but also better support those who do sadly lose their babies. We know what to do and how to do it, so now we need a commitment across the NHS to develop these care pathways and improve support for everyone.”

In addition to the recommendations on tests and treatments for miscarriage, RCOG has also highlighted where research and evidence is lacking. This includes the health disparities facing women from Black, Asian or minority ethnic backgrounds, who were found to be at higher risk of having a miscarriage than White women in The Lancet research series. Researchers at the University of Birmingham have already begun work in this area, in partnership with Tommy’s National Centre for Miscarriage Research.

An estimated 23 million miscarriages occur every year worldwide – equating to 44 pregnancy losses each minute.  Miscarriage (defined as the loss of a pregnancy before 24 weeks) costs the UK at least £471 million a year due to direct impact on health services and lost productivity. However, scientists expect costs surpass £1 billion per year when factoring in longer-term physical, reproductive and mental health impacts.

New study aims to improve healthcare for pregnant women with multiple health conditions

Written by Louise Stanley on . Posted in Health inequalities, Inflammation and chronic disease, Maternal health, Mental health.

BHP founder-member the University of Birmingham is leading a new three-year UK-wide study aimed at improving healthcare and outcomes for pregnant women who have two or more active long-term health conditions.

Currently, one in five pregnant women in the UK have two or more active long-term health conditions. These can be both physical conditions (like diabetes or raised blood pressure), and mental health conditions (such as depression or anxiety). Often women also have to take several medications to manage their different health needs.

The new study, called Multimorbidity and Pregnancy: Determinants, Clusters, Consequences and Trajectories (MuM-PreDiCT), aims to use data-driven research to characterise and understand what makes having two or more long-term conditions more likely for pregnant women and the consequences for mother and child; and to predict and prevent adverse outcomes.

MuM-PreDiCT will be divided into five research work packages:

      1. Examining how health conditions accumulate over time and identifying what makes a woman more at risk of developing two or more long-term health conditions before pregnancy.
      2. Exploring women’s experiences of care during pregnancy, birth and after birth, working together with families and health professionals to establish how care could be improved.
      3. Deeper delve into how having two or more long-term health conditions may affect pregnant women and their children by identifying outcomes that women, health professionals and researchers feel should be reported in research; examining how often women experience pregnancy complications; and exploring how frequently women and their children develop additional long-term ill health
      4. Investigating how taking combinations of medication may affect pregnant women with two or more long-term health conditions and their babies.
      5. Building a prediction model to help identify how likely a previously healthy pregnant woman will develop multiple long-term conditions after pregnancy.

Professor Krish Nirantharakumar, of the University of Birmingham’s Institute of Applied Health Research and Principal Investigator of MuM-PreDiCT, said: “Having two or more health conditions is becoming more common in pregnant women as women are increasingly older when they start having a family and as obesity and mental health conditions are on the rise in general.

“However, we don’t really understand what the consequences are of multiple health conditions or medications for mothers and babies.

“This can make pregnancy, healthcare and managing medications more complicated. Without deeper understanding of the problem, women with several long-term health conditions may not have the best and safest experience of care before, during and after pregnancy because services have not been designed with their health needs in mind.”

Dr Beck Taylor, Clinical Senior Lecturer at the University of Birmingham and Co-Investigator of MuM-PreDiCT, said: “Our research will provide valuable information to help women and clinicians make informed decisions and identify points for prevention and intervention. We will also explore the experiences of maternity care for women with two or more long-term conditions and work with families and health and social care professionals to produce recommendations on how to plan and design services that meet the needs of women and their families before, during and after pregnancy.”

MuM-PreDiCT is being funded via the £20M UK Research and Innovation’s (UKRI) Strategic Priorities Fund (SPF) initiative ‘Tackling multi-morbidity at scale: Understanding disease clusters, determinants & biological pathways’. SPF is delivered by the Medical Research Council and National Institute for Health Research in partnership with the Economic and Social Research Council, and in collaboration with the Engineering and Physical Sciences Research Council. It is jointly funded by UKRI and the Department of Health and Social Care, through the NIHR.

MuM-PreDiCT is being led by the University of Birmingham in collaboration with the University of Aberdeen, University of St Andrews, Swansea University, Queen’s University of Belfast, University of Ulster, The University of Manchester, Keele University, University Hospitals Bristol & Weston NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, and Guy’s & St Thomas’ NHS Foundation Trust.

Siang Ing Lee, Academic Clinical Fellow at the University of Birmingham and MuM-PreDiCT, added: “We would like to extend our heartfelt gratitude to our amazing patient and public involvement (PPI) advisory group and PPI co-investigators who will play an integral part in MuM-PreDiCT.”

Better treatment for miscarriage patients is also more cost effective

Written by Louise Stanley on . Posted in Clinical trials, Maternal health.

A new drug combination that is better at treating miscarriage is also more cost effective than current standard NHS treatment, finds a new study led by BHP founder-member the University of Birmingham and Tommy’s National Centre for Miscarriage Research.

A previous study by the same team and published in The Lancet in August last year, found that a combined drug treatment is more effective than the standard medication for women having miscarriages without symptoms – also known as missed, delayed or silent miscarriage.

Missed miscarriage occurs when a baby has died in the womb but the mother hasn’t had symptoms, such as bleeding or pain. Current hospital restrictions on surgery mean that many women face waiting for the miscarriage to happen by itself, which can take weeks and still might not happen, or being offered medication to speed the process along.

National guidelines recommend a treatment called misoprostol, which is successful in most cases – but some women wait anxiously for weeks, repeating the medication and eventually needing surgery.

The research published in The Lancet in August 2020 showed that misoprostol is more effective when combined with mifepristone, an anti-progesterone drug used to induce labour. The trial found that the combined drug treatment worked in 83% of cases, compared to 76% in the misoprostol and placebo group – and crucially, it reduced the need for surgery. One in four women (25%) given the placebo later needed an operation to complete the miscarriage, compared with less than one in five (18%) of those who had the new medication.

Now the team has carried out a further study to assess the cost-effectiveness of mifepristone and misoprostol combined compared with misoprostol alone for the medical management of a missed miscarriage.

The National Institute for Health Research (NIHR) funded study involved 711 women across 28 UK hospitals with a diagnosis of missed miscarriage in the first 14 weeks of pregnancy, who were randomly assigned to receive either mifepristone or a placebo drug followed by misoprostol two days later.

Published in the British Journal of Obstetrics and Gynaecology, the study found the new combined drug treatment was on average £182 cheaper for each successfully managed miscarriage than the current standard NHS medication.

As this is the largest ever study into the most effective medical treatment for missed miscarriage, and the results are so clear, researchers and campaigners are calling for guidance from the National Institute for Health and Care Excellence (NICE) to be updated in light of the newly published findings. In the meantime, Tommy’s experts encourage anyone diagnosed with missed miscarriage to ask their doctor about the combined drug treatment.

Senior author Tracy Roberts, Professor of Health Economics at the University of Birmingham, said: “Pregnancy loss causes heartbreak for millions of families, and it is crucial that we find better ways to care for everyone going through miscarriage. Our findings could have huge benefits if they’re translated into clinical practice, with better outcomes for patients and lower costs for care services.”

First author Dr Duby Okeke Ogwulu, of the University of Birmingham’s Institute of Applied Health Research, added: “We hope the NICE guidance will be updated in light of this new evidence, so that everyone who needs it has access to the most effective treatment.”

Tommy’s CEO Jane Brewin commented: “Besides the physical harm, miscarriage can have serious psychological consequences, which can be made worse by the trauma of a failed treatment forcing mothers to endure weeks of carrying a baby they know has died.

“One in four pregnancies ends in loss, and while our researchers work to understand how we can prevent this, it’s vital their latest findings are put into practice so that everyone going through miscarriage has the best possible care. Particularly given Covid-19 pressures on the NHS, our new study could be applied to make better use of precious resources, as well as reducing the toll miscarriage can take on parents.”

An estimated 23 million miscarriages occur every year worldwide – equating to 44 pregnancy losses each minute. Miscarriage (defined as the loss of a pregnancy before 24 weeks) costs the UK at least £471 million a year, through direct impact on health services and lost productivity, but scientists expect the costs surpass £1 billion a year when factoring in longer-term physical and mental health impacts.

Claire Bromley, aged 32, from Sittingbourne in Kent, chose surgery when she had a miscarriage last year, as her previous experience when medication failed was so distressing.

Claire said: “The whole process took around 3 months and was extremely traumatic, so I hope this new drug will mean others don’t have to suffer like I did. I was told medication would take a few hours to work, but started bleeding and cramping in minutes, while stuck in hospital waiting for other prescriptions. Despite taking effect so fast, the medication didn’t work, so I was sent for surgery – and when that failed too, I had to take the pills again. With my second miscarriage, I chose surgery right away to avoid the risk of repeating such a long and painful treatment.”

Katy Allan, aged 43, from South Yorkshire has experienced multiple miscarriages and a range of treatment, initially having surgery that caused internal scarring and later choosing medication in the hope it would cause less damage.

Katy said: “The treatment for my third miscarriage was a four-month long nightmare, with several rounds of medication and hospital staff trying to physically remove the pregnancy while I was awake, ending in painful surgery; it was one of the most horrendous experiences of my life and I remain completely traumatised. I couldn’t move on physically or mentally because I was pregnant and not pregnant for months, with tests remaining positive and hormones still racing long after we heard those spine-shivering words of ‘I am so sorry but there is no heartbeat’. The long ordeal of treatment made miscarriage even harder so I hope this new research can help to prevent others from going through what I did.”

Revolutionising diagnosis and treatment of life-threatening post-partum haemorrhage

Written by Louise Stanley on . Posted in Early diagnosis and detection, Maternal health.

Post-partum haemorrhage (PPH) accounts for 27% of all maternal deaths worldwide, according to the World Health Organization (WHO). The burden of PPH disproportionately affects mothers from low- and middle-income countries, which account for 86% of all maternal deaths.

PPH is defined as blood loss from the genital tract of 500 ml or more within 24 hours of birth. PPH usually happens within a day of giving birth, but it can occur up to six weeks after a birth.

To find possible solutions to the terrible problem of PPH, researchers at BHP founder-member the University of Birmingham are conducting the E-MOTIVE trial based on the WHO ‘first response bundle’ in five countries: Kenya, Sri Lanka, South Africa, Tanzania and Nigeria.

Kristie-Marie Mammoliti, one of the lead researchers for the University of Birmingham explained the thinking behind the trial: “Surviving childbirth shouldn’t be a privilege; it should be the norm. Tragically this is not the case for so many women around the world. As PPH is the leading cause of maternal mortality globally, we are working together with our low– and middle-income country partners to find solutions to stop women from bleeding to death after childbirth.”

Professor Hadiza Galadanci, from one of the University’s partners in Nigeria, commented: “One of the most frightening sights in Obstetrics is to see blood pouring from a woman after birth and to try all you can to stop it and you are not able to. If E-MOTIVE strategy is implemented in low- and middle-income countries, the light at the end of the tunnel to reducing maternal deaths due to PPH will be bright.”

The E-MOTIVE trial has the potential to revolutionise how medical institutions diagnose and treat PPH, and remove it from the list of life-threatening conditions facing pregnant women.

As we approach International Mother’s Day on Sunday 9 May, it is important for everyone to care and be aware of the risks that women across the world face when bringing life into the world, and how these risks can be reduced.

a pregnant woman in a patterned dress sits on the edge of a hospital bed. a female doctor is speaking to her, with hands clasped.

End the postcode lottery in miscarriage care and treatment, say researchers

Written by Louise Stanley on . Posted in Health inequalities, Maternal health.

Leading experts at BHP founder-member the University of Birmingham and Tommy’s National Centre for Miscarriage Research are calling on the UK government to invest in early pregnancy units and recurrent miscarriage clinics to end the current care and treatment postcode lottery.

The calls come as the team has laid bare the devastating impact of miscarriage and sets out recommendations to improve treatment and care in a series of three articles published today in The Lancet.

Urgent changes should be made to NHS policy, which currently provides exploratory testing for underlying causes of miscarriage for women only after they have experienced three consecutive miscarriages.

The team says many of the risks related to a miscarriage are present even after one or two miscarriages, and appropriate care should be provided to all women who have experienced one or more miscarriages.

Miscarriage care must also go beyond current best practice to include long-term mental health support to those who need it, while high-risk groups should also be offered specialist help from pre-conception and throughout pregnancy, they say.

While the UK provides national statistics for losses such as stillbirth and neonatal death, it does not for miscarriage. The team is calling for the UK – and all countries globally – to routinely publish their national miscarriage statistics to provide a vital benchmark to improve from; accelerate further research; develop public health policy; and ultimately improve care and support for families.

Together, following analysis of systematic reviews; appraisal of existing guidelines; and a UK-wide conference of experts, the researchers have developed recommendations for healthcare practice grouped into three categories: diagnosis of miscarriage, prevention of miscarriage in women with early pregnancy bleeding, and management of miscarriage.

An estimated 23 million miscarriages occur every year worldwide – equating to 44 pregnancy losses each minute. Miscarriage (defined as the loss of a pregnancy before 24 weeks) costs the UK at least £471 million a year due to direct impact on health services and lost productivity. However, scientists expect costs surpass £1 billion per year when factoring in longer-term physical, reproductive and mental health impacts.

Women have a 15% risk of miscarriage, and the team’s review of existing research shows risk factors for miscarriage include older age in both males and females, previous miscarriages, smoking, alcohol, and stress levels.

While the link between age and miscarriage is well established, the review uncovered a significant risk to black women, with 40% higher miscarriage rates in this group than their white counterparts. The researchers say further investigation is needed to understand the reasons for this stark contrast, and they are exploring whether it could be related to other health issues that more commonly affect black women that can complicate pregnancy, such as fibroid conditions and autoimmune disorders.

While some risk factors can be controlled, such as alcohol consumption and smoking, many cannot. Therefore, the researchers say care and support must be targeted at these higher-risk groups in addition to nation-wide changes to ensure quality services are consistently available to all.

The consequences of miscarriage are both physical, such as bleeding or infection, and psychological. The team of Tommy’s and University of Birmingham researchers found profound psychological effects on both parents – miscarriage almost quadrupled the risk of suicide, doubled the risk of depression, and similarly raised the risk of anxiety. Previous studies from another team at Tommy’s National Centre for Miscarriage Research showed that one in five mothers and one in twelve partners experience long-term symptoms of post-traumatic stress after loss.

Senior research author Arri Coomarasamy, Professor of Gynaecology & Reproductive Medicine at the University of Birmingham and Director of Tommy’s National Centre for Miscarriage Research, said: “Despite the many advances in miscarriage research and care, we are really just at the beginning, with many more avenues to investigate – for example, we need to understand why there is a higher rate of miscarriage in black women and why miscarriage is associated with an increased future risk of premature birth.

“We don’t even know exactly how many miscarriages happen in the UK; without this data, the scale of the problem is hidden, and addressing it will not be prioritised.

“As we work to open the ‘black box’ of miscarriage in the hope of unpicking its causes and finding new therapies, the UK must change its approach to miscarriage care, not only to reduce the risk wherever possible but also to better support those who do tragically lose their babies.”

Tommy’s CEO Jane Brewin said: “The variation in quality and availability of miscarriage care across the UK can lead to life-long problems for families already enduring an unbearable experience; it shouldn’t matter who you are or where you live, and you shouldn’t have to endure repeated heart-breaking losses before you get the right help.

“Everyone should be given care and advice after each miscarriage to reduce the chance of it happening again, with specialist support for those most at risk. Mothers’ care must consider their long-term risks, especially in future pregnancies, and both parents must be offered mental health support.

“We know what to do and how to do it – now we need a commitment from the NHS to put the knowledge we have into practice everywhere. With national targets to reduce premature birth and stillbirth, it’s time to prioritise miscarriage too.”

Recommendations outlined in The Lancet papers include:

    • Individualised care according to women’s and their partners’ needs and preferences.
    • Early pregnancy services focused on providing an effective ultrasound service and miscarriage management pathway, including medical management and surgical management.
    • Prescribing vaginal micronized progesterone for pregnant women with the dual risk factors of early pregnancy bleeding and a history of previous miscarriage.
    • Training for clinical nurse specialists and doctors to deliver comprehensive miscarriage care in dedicated early pregnancy units.
    • A defined and universally available minimum set of investigations and treatments to be offered to couples suffering recurrent miscarriages.
    • Screening and care for mental health issues and future obstetric risks incorporated into the care pathway for couples with a history of recurrent miscarriage.
    • Structured care using a ‘graded model’ where women are offered online healthcare advice and support, care in a nurse or midwife-led clinic, and care in a medical consultant-led clinic, according to clinical needs.

To find out more about the research, visit Tommy’s ‘Miscarriage Matters’ campaign, and sign a campaign petition stating mothers should not have to experience three miscarriages before they receive specialist care.