MRC Centre for Reproductive Health

Lead Research Organisation: University of Edinburgh
Department Name: Royal (Dick) School of Veterinary Scienc

Abstract

Reproduction is a fundamental feature of all life, essential for the continuation of our species. The birth of a healthy baby represents the culmination of a remarkable series of events and a defining moment in our progress towards ?living a long and healthy life?. The reproductive tissues that provide the platform for our fertility and nurture a successful pregnancy are characterised by their remarkable ?resilience? ? namely their ability to withstand or recover quickly from ?challenges? that might otherwise have an adverse impact on their function. Other tissues cannot usually show such resilience. Our new Centre will link scientists studying the ways in which reproductive tissues regenerate, repair and renew themselves enabling them to withstand the impacts of our modern lifestyle including stress and obesity, with teams of doctors and scientists who are focusing their research on stem cell biology, tissue regeneration, inflammation and fetal growth in the brain, liver, lung and kidney. This multidisciplinary approach will ensure we can apply our research findings to the development of new therapies for common reproductive problems such as infertility, heavy periods, premature birth, low birth weight, but also that they are applied towards therapies for diseases that affect the liver, brain, lung and vascular system such as cirrhosis and cancer. Crucially, we will train the next generation of basic and clinician scientists in reproductive medicine and its broader exploitation and communicate our new and exciting research findings to the general public, through our public lecture and schools outreach programmes.

Technical Summary

Reproduction is a fundamental feature of all life, essential for the continuation of our species. The remarkable integrative biology of human reproductive tissues is responsible for their outstanding resilience, characterised by long-term maintenance of stem cell populations and repeated episodes of regeneration and scarless healing. In Edinburgh there is now an exciting opportunity to understand the fundamental mechanisms responsible for the resilience and repair of reproductive tissues by bringing together, under new leadership and in a new Centre, outstanding strengths in reproductive health and tissue biology, the stem cell niche, resolution and repair of inflammation, developmental programming by steroids, epigenetics, systems and computational biology and tissue and organ imaging. The added value delivered will enable investigators and trainees in the proposed MRC/University of Edinburgh Centre for Reproductive Resilience (CRR) to address three linked questions of crucial importance in reproductive health and beyond:



[1] What mechanisms deliver the optimal tissue niches for repeated regeneration of reproductive tissues?

[2] How do reproductive tissues normally achieve scarless healing and what goes wrong when this fails?

[3] How is reproductive resilience programmed by developmental effects of steroids?

The proposed research strategy will offer unparalleled opportunities to understand fundamental processes with implications for resilience and repair in many organs. We will exploit this knowledge to develop novel treatments for the major unmet clinical challenges in reproductive health, to exploit this for impacts across medicine and to provide a rich environment for interdisciplinary research training. We specifically request funding to establish a new 4 year PhD training programme and for a postdoctoral fellowship for capacity building in this innovative area of medicine.

Publications

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Akcora D (2013) The CSF-1 receptor fashions the intestinal stem cell niche. in Stem cell research

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Anderson RA (2011) Can ovarian reserve assessment predict fertility following breast cancer treatment? in Women's health (London, England)

 
Description Membership of NICE panel
Geographic Reach National 
Policy Influence Type Participation in advisory committee
 
Description Report for European Environment Agency
Geographic Reach Europe 
Policy Influence Type Membership of a guidance committee
Impact Report on impacts of endocrine disruptors - impact on european regulatory framework
 
Description Centre's Open Funding
Amount £1,444,459 (GBP)
Funding ID MR/N022556/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 09/2016 
End 09/2021
 
Description Clinical Fellowship
Amount £1,036,882 (GBP)
Organisation Wellcome Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2012 
End 03/2016
 
Description Confocal Funding
Amount £360,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 10/2013 
End 03/2014
 
Description Developmental Clinical Studies
Amount £1,600,000 (GBP)
Funding ID MR/J003611/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 12/2012 
End 12/2016
 
Description Minor Equipment
Amount £100,000 (GBP)
Funding ID G1002033/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start  
 
Description Project Grant
Amount £298,051 (GBP)
Funding ID Pg/11/72/29334 
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 09/2011 
End 08/2014
 
Description Project grant
Amount £302,368 (GBP)
Funding ID BB/J015105/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 07/2012 
End 06/2015
 
Description Project grant
Amount £655,547 (GBP)
Funding ID BB/J01687X/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 10/2012 
End 09/2015
 
Description Project grant
Amount £294,079 (GBP)
Funding ID Bb/102137x/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 08/2011 
End 07/2013
 
Description Project grant
Amount £220,194 (GBP)
Funding ID Chz/4/688 
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 02/2012 
End 10/2013
 
Description Project grant
Amount £54,365 (GBP)
Funding ID Czg/2/575 
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 04/2012 
End 03/2013
 
Title Fetal scalp monitor 
Description Monitoring of babies during labour using non-invasive rapid method based on novel device 
Type Diagnostic Tool - Non-Imaging
Current Stage Of Development Initial development
Year Development Stage Completed 2012
Development Status Actively seeking support
Impact new funding and links to engineering department identified. Inventor won an innovation competition 
 
Company Name Icthus Therapeutics 
Description Icthus Therapeutics is a new spin out from the University of Edinburgh's College of Medicine and Veterinary Medicine focused on women's health, and in particular on endometriosis. The founders are academics and clinicians from the MRC Centre for Reproductive Health and the Royal Infirmary of Edinburgh, including Dr Andrew Horne of the University of Edinburgh. 
Year Established 2013 
Impact The company is funding 'PURFECT' - a pilot clinical trial to determine whether purified fatty acids are effective in the treatment of endometriosis-associated pelvic pain. The company has a product in development.
 
Description A long-term study into the causes of premature birth has been launched by Sarah Brown, wife of former prime minister Gordon Brown. 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact The Theirworld Edinburgh Birth Cohort will track the development of 400 babies, mostly born before 32 weeks, following them through to adulthood.
The research at the University of Edinburgh MRC Centre for Reproductive Health is being funded with a £1.5m grant from the global children's charity Theirworld, of which Ms Brown is founder and president.
Year(s) Of Engagement Activity 2016
 
Description BBC News Interview 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Prof Jeffrey Pollard gave an interview to the BBC broadcasted live on Friday 4th March 2016. In this interview Prof Pollard commented on Nicholas Mc Granahan, Andrew Furness and Rachel Rosenthal's recent paper "Clonal neoantigens elicit T cell immunoreactivity and sensitivity to immune checkpoint blockade" published in Science.
Year(s) Of Engagement Activity 2016
URL http://www.bbc.co.uk/news/health-35718491
 
Description Bid to ease burden of heavy periods steps up with new drug trial 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Women who suffer heavy periods are being invited to join a research study to test a new treatment for their condition.

The trial will find out if boosting levels of a hormone produced in the lining of the womb can reduce blood loss during menstruation and ease women's symptoms.

Researchers believe that a hormone - called cortisol - helps the small blood vessels in the womb lining to function well.

If cortisol levels are too low in the womb, it can increase blood loss, researchers say.

This study will test whether a drug that mimics the actions of cortisol - called dexamethasone - will boost the hormone to typical levels and reduce menstrual blood loss.

The research aims to identify whether a short course of the drug, at a low dose, could also be used to manage heavy periods.

Women who join the study will be asked to monitor their periods for two months.

They will then be randomly assigned to receive either a short course of dexamethasone or a placebo pill for five days before their period is due, for the following three months.

As is usual in clinical trials, neither the doctors nor the participants will know which medication they receive.

Professor Hilary Critchley of the University of Edinburgh's MRC Centre for Reproductive Health, who is leading the trial, said: "Women who experience heavy bleeding during their period will often struggle with very challenging symptoms that impact their daily life.

"Many of the current treatment options such as the contraceptive pill or hysterectomy affect a woman's fertility, and so we are keen to develop treatments that offer women a greater choice. Now we need more participants - to complete this vital research".
Year(s) Of Engagement Activity 2016
 
Description Cancer drug may cause women to grow new eggs, study suggests 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Women treated with a common chemotherapy drug combination have more young eggs in their ovaries afterwards, research has found.

A small study indicates that a therapy commonly used to target Hodgkin's lymphoma appears to increase the number of non-growing eggs in women's ovaries.

Researchers say it is too soon to link the outcome to fertility, but believe more research is needed to better understand the findings and their implications.

Scientists from the University of Edinburgh analysed samples of ovary tissue donated by 14 women who had undergone chemotherapy, and from 12 healthy women.

They found that the ovaries from eight of the cancer patients, who had been treated with a drug combination known as ABVD, had a much greater incidence of immature, or non-growing, eggs compared with tissue from women who had received a different chemotherapy, or from healthy women of a similar age.

The ovary tissue was seen to be in healthy condition, appearing similar to tissue from young women's ovaries.

If further research can reveal the mechanism by which treatment with ABVD results in increased production of eggs, this would aid understanding of how women might be able to produce more eggs during their lifetime, which was until recently thought to be impossible.

Researchers had set out to better understand why treatment with ABVD is one of the few cancer drug combinations that does not impact on women's fertility.

Future studies will examine the separate impact of each of the four drugs that combine to make ABVD - known as adriamycin, bleomycin, vinblastine and dacarbazine - to better understand the biological mechanisms involved.

The study, published in Human Reproduction, was supported by the Medical Research Council.

Lead researcher Professor Evelyn Telfer, of the University of Edinburgh's School of Biological Sciences, said: "This study involves only a few patients, but its findings were consistent and its outcome may be significant and far-reaching. We need to know more about how this drug combination acts on the ovaries, and the implications of this."
Year(s) Of Engagement Activity 2016
 
Description Edinburgh Science Festival 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Type Of Presentation Workshop Facilitator
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Again school kids loved our participation at this festival

Highlighted our field of research
Year(s) Of Engagement Activity 2013
 
Description Egg & Sperm Race 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Greenman Music Festival

attracted young people
Year(s) Of Engagement Activity 2013
URL http://eggandspermrace.com/
 
Description Frozen tissue service offers fertility hope for children with cancer 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Young people with cancer are set to benefit from a new service that aims to restore their fertility following chemotherapy.
Scientists are freezing tissue from the reproductive organs of boys and girls as young as one, which can be re-implanted once they reach adulthood.
The announcement follows the birth of the first baby in the UK to be born after his mother had a transplant of her own, previously frozen ovary tissue.
The 33-year-old from Edinburgh had a section of her ovary removed 11 years ago after being diagnosed with a rare form of cancer.
Following her chemotherapy, doctors re-implanted the tissue last year in the hope of restoring her fertility.
The woman, who wishes to remain anonymous, conceived naturally and gave birth to a healthy baby boy earlier this month.
Her success, which was led by a team at the University of Edinburgh, has been welcomed as a milestone in the effort to help young people with cancer and other diseases whose treatment threatens their fertility.
Chemotherapy and radiotherapy are known to have serious side effects on reproductive organs. If children are given these treatments before they reach puberty, it can render them infertile in later life.
By removing the tissue from children before they undergo cancer treatment, it is possible to protect it from side effects that can render patients infertile.
Scientists say restoring fertility in men can be more challenging than in women because the testicular tissue of prepubescent boys is not yet able to produce sperm. By comparison, girls are born with a full complement of egg cells which can be frozen for transplant at a later stage.
Researchers say the new service, led from the University of Edinburgh, is open to NHS patients.
Year(s) Of Engagement Activity 2016
 
Description Greenman music festival 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact A group of postdoctoral staff organised a public engagement activity at a music festival - their activity 'the egg and sperm race' appealed to both adults and children.
http://eggandspermrace.com/
http://www.crh.ed.ac.uk/public-activities/

Media interest, positive feedback from members of public, education on health problems e.g. impact of chlamydia on fertility
Year(s) Of Engagement Activity 2011,2012,2013
 
Description New project to beat 'hidden' disease puts patients at its heart 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Women with endometriosis - a painful, debilitating disease linked to infertility - are being invited to join a research project that aims to shape possible future treatments.
The initiative will team up women with endometriosis, carers, and healthcare professionals to prioritise areas of research they believe have not yet been tackled.
The project's aim is to identify the top ten leading challenges that women with endometriosis face, with a view to influence the prioritisation of future research in this area.
Endometriosis affects an estimated 176 million women. It occurs when tissue similar to the lining of the uterus is found elsewhere - most commonly in the abdomen, on the ovaries, bladder and bowel.

This misplaced tissue behaves like the lining of the uterus, bleeding every month and creating local inflammation. It is associated with chronic pain, heavy bleeding, and infertility, and can impact on mental, and social wellbeing.
Anyone affected by endometriosis - patients, carers, employers and professionals - is invited to contribute to the project through a survey which can be found here:
Endometriosis priority-setting survey
The project is being run in partnership with the James Lind Alliance, and is supported by the World Endometriosis Research Foundation (WERF).
Professor Andrew Horne, who is leading the research at the University of Edinburgh's MRC Centre for Reproductive Health, said: "Endometriosis is as common in women as diabetes and asthma, and yet it fails to attract the same attention, support and funding as those diseases.
"It is important that we ensure medical researchers are focussing on the issues that really matter for women living with this debilitating condition, and deliver treatments that make a genuine difference to their quality of life."
Year(s) Of Engagement Activity 2016
 
Description Painkillers in pregnancy 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Pregnant women who take common painkillers could unwittingly be putting the fertility of their unborn daughters at risk, a study suggests.
Year(s) Of Engagement Activity 2016
 
Description Paracetamol use in pregnancy can cut female fertility, study finds 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Using painkillers in pregnancy may reduce fertility in subsequent generations, research suggests.

Tests in rats found that when a mother was given painkillers during pregnancy, her female offspring had fewer eggs, smaller ovaries and smaller litters of babies than those not exposed to the drugs.

Exposed male offspring were also found to be affected at birth - showing smaller numbers of cells that give rise to sperm in later life. However, their reproductive function recovered to normal levels by the time they reached adulthood.

Researchers say the findings are significant given the similarities between the reproductive systems of rats and humans, although it is difficult to directly extrapolate these results to pregnant women.

The team recommends that pregnant women should stick with current guidelines to use painkillers at the lowest possible dose, for the shortest possible time.

Scientists tested the effects of two painkillers in pregnant rats - paracetamol and a prescription-only painkiller called indomethacin, which belongs to the same class of drugs as ibuprofen and aspirin.

Rats were given the drugs over the course of several days - four days for indomethacin or nine days for paracetamol. The effects of the drugs were seen within one to four days of the start of treatment. Scientists say that because the pace of foetal development in humans is slower than it is in rats, it is hard to say from this study how this would translate in human use.

In addition to affecting a mother's immediate offspring, the study showed that painkillers taken in pregnancy also affected the subsequent generation of rats.

The team found that the resulting females - the granddaughters of the mother given painkillers in pregnancy - also had reduced ovary size and altered reproductive function.

Scientists say the results suggest that some painkillers may affect the development of the cells that give rise to eggs and sperm - called germ cells - while a foetus is in the womb.

This may be because the painkillers act on hormones called prostaglandins. These are known to regulate female reproduction and control ovulation, the menstrual cycle and the induction of labour.
The study has been published in the journal Scientific Reports. It was funded by the Medical Research Council and the Wellcome Trust.

Prof Richard Sharpe, who co-led the study at the University of Edinburgh's MRC Centre for Reproductive Health, said the results follow previous research that indicates painkillers should be used with caution during pregnancy.

He said: "It's important to remember that this study was conducted in rats not humans, however, there are many similarities between the two reproductive systems. We now need to understand how these drugs affect a baby's reproductive development in the womb so that we can further understand their full effect."

Prof Richard Anderson, Elsie Inglis Professor of Clinical Reproductive Science at the University of Edinburgh, who co-led the study, said: "These studies involved the use of painkillers over a relatively long period. We now need to explore whether a shorter dose would have a similar effect, and how this information can be usefully translated to human use."
Year(s) Of Engagement Activity 2016
 
Description Prolonged exposure to acetaminophen reduces testosterone production by the human fetal testis in a xenograft model 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Dr Rod Mitchell has received media wide attention after the publication of the following Research Article:
FETAL DEVELOPMENT
Prolonged exposure to acetaminophen reduces testosterone production by the human fetal testis in a xenograft model
Year(s) Of Engagement Activity 2016
 
Description Public Lecture Series 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Pupils, public were invited to these talks which sparked questions.

Interest from school kids in Reproductive Biology and lab visits.
Year(s) Of Engagement Activity 2012,2013
 
Description Public Lecture Series 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Paper Presentation
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact up to 120 members of the public (including school pupils) attended a series of talks by members of the Centre and collaborators. Series was entitled 'Lets talk about...'

Increased profile for research activity, media interest, recruitment of students to biomedical science and medical degree courses.
Year(s) Of Engagement Activity 2011,2012,2013
 
Description Public Lecture Series 2015 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact raising awareness
Year(s) Of Engagement Activity 2015
URL http://www.crh.ed.ac.uk/wp-content/uploads/2015/11/Public-lecture-series-poster.pdf
 
Description Public Talk, Edinburgh Science Festival 2012 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Title of talk 'Sex,steroids: bodies, babies and brains'. Edinburgh Science Festival. 2011. Wide media coverage.

Raised my profile and public awareness of reproductive science. Excellent feedback.
Year(s) Of Engagement Activity 2012
 
Description Sperm grown in lab 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Professor Sharpe offered a quote through Science Media Centre on this particular study.
Year(s) Of Engagement Activity 2016
URL http://www.telegraph.co.uk/news/science/science-news/12173317/Sperm-grown-in-lab-could-allow-inferti...
 
Description Talks at Edinburgh Science Festival 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Type Of Presentation Keynote/Invited Speaker
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact attracted many school children

requests for lab tours
Year(s) Of Engagement Activity 2012,2013
 
Description The Jennifer Brown Research Laboratory celebrates 15 years of saving lives 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Professor Sir John Savill welcomed guests and we celebrated past achievements during presentations from Sarah and Gordon Brown, and Professor Andrew Calder and Dr Ian Laing who were founder members of the JBRL.

Dr James Boardman, scientific director of the JBRL, gave a presentation about current and future work of the laboratory and the Theirworld Edinburgh Birth Cohort (TEBC), which is a new initiative designed to improve life course outcome after perinatal brain injury caused by preterm birth and / or sub-optimal growth in utero. The TEBC places patients at the centre of a research journey that encompasses medicine, imaging, biology, education and socio-economics, to deliver new understanding of, and accelerate the translation of treatment for, perinatal brain injury.

We were honoured to listen to the parent perspective given by Catherine Smith, daughter of the late Labour leader John Smith. Catherine delivered her baby daughter at 28 weeks' gestation and she gave powerful testimony to the importance of perinatal research for driving improvements in care. We were delighted to be joined by family participants in our research, and by senior members of the University's academic community who represent a diverse field of expertise, thereby reflecting the interdisciplinary nature of the work of the JBRL.
Year(s) Of Engagement Activity 2016
 
Description Therapy to stop premature birth safe but ineffective, study finds 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A therapy widely recommended in the UK, Europe and the US to stop babies from being born too soon is ineffective, research shows.
The treatment does not appear to pose any harm to mother or baby but has no effect on preventing an early birth, the findings reveal.
Researchers say that use of the medicine should be reviewed. They also call for a re-doubling of efforts to find alternative interventions to prevent premature births.
Previous research suggested that the therapy - a hormone called progesterone - may stop pregnant women from giving birth early but little was known about its long term effects.
This latest trial - involving more than 1200 women - is the largest to assess the effects of the treatment on women and the first to study its effects in babies born after the therapy.
Researchers focused on women who are considered to have a greater risk of premature delivery - either because they have previously delivered a baby early or have lost a baby late in pregnancy.
Around a half of the women were given progesterone and the others were given a dummy pill.
The team found that whilst the therapy appeared to be safe, it did not reduce the risk of premature delivery and offered no notable health benefits for mother or baby.
More than 64 hospitals from around the UK were involved in the research, which was led by the Tommy's Centre for Maternal and Fetal Health at the University of Edinburgh.
The study is published in The Lancet. It was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a partnership between the Medical Research Council and National Institute for Health Research.
Professor Jane Norman, Director of the Tommy's Centre for Maternal and Fetal Health at the University of Edinburgh, said: "Babies born too early have a much greater risk of short-term and long-term health problems. We need to find new strategies that help mums carry their babies to term."
Year(s) Of Engagement Activity 2016