Welsh Study of Mothers and Babies

Cardiff University (partner)

Professor Shantini Paranjothy & Dr Lisa Hurt

Early Years

Set-up of the cohort and analysis of prevalence and adverse pregnancy outcomes funded by Welsh Assembly Government /Medical Research Council Health Research Partnership project grant.  Analysis of renal outcomes funded by NISCHR Research for Patient Benefit project grant

Ongoing

Improvement in ultrasound imaging has led to the identification of subtle non-structural markers during the 18 – 20 week fetal anomaly scan, such as echogenic bowel, mild cerebral ventriculomegaly, renal pelvicalyceal dilatation, and nuchal thickening. These markers are estimated to occur in between 1% and 4% of pregnancies. Their clinical significance, for pregnancy outcomes or childhood morbidity, is largely unknown. The aims of this study are:

1. To estimate the prevalence of individual markers at the 18 to 20-week anomaly scan in an unselected population of pregnant women attending for routine antenatal care in Wales;
2. To assess inter- and intra-sonographer variability in the detection of markers;
3. To investigate associations between the presence of markers and adverse pregnancy outcomes (chromosomal abnormality, stillbirth, pre-term birth and small for gestational age);
4. To establish a cohort of children to investigate associations between specific markers and longer-term health outcomes in childhood.

This is a population-based cohort study embedded within the routine antenatal services offered to pregnant women by NHS Wales. All pregnant women receiving antenatal care within six of seven Welsh Health Boards who had an 18 to 20 week ultrasound scan in Welsh NHS Trusts between July 2008 and March 2011 were eligible for inclusion. 30,000 women consented to take part, and data from the anomaly scans of 22,045 were available to the study.

Data from the first phase of the study has been analysed and published. In this, we found that the prevalence of markers ranged from 43.7 per 1000 singleton pregnancies for cardiac echogenic foci [95% confidence interval (CI): 38.8, 51.1] to 0.6 for mild-to-moderate ventriculomegaly (95% CI: 0.3, 1.0). Isolated echogenic bowel was associated with an increased risk of congenital anomalies [risk ratio (RR) 4.54, 95% CI: 2.12, 9.73] and preterm birth (RR 2.30, 95% CI: 1.08, 4.90). Isolated pelvicalyceal dilatation was associated with an increased risk of congenital anomalies (RR 3.82, 95% CI:  2.16, 6.77).  Multiple markers were associated with an increased risk of congenital anomalies (RR 5.00, 95% CI: 1.35, 18.40) and preterm birth (RR 3.38, 95% CI 1.20, 9.53).

In the second phase of the study, the scan data is being linked with routine healthcare records to examine whether children with markers have more hospital admissions, investigations and procedures in the first five years of life than children without markers. An analysis of renal admissions is currently being completed and funding is currently being sought to examine cardiac markers.