Off to a good start: Obstetrics research nurtures healthier pregnancies and healthier babies
As head of IWK’s Department of Obstetrics & Gynecology, Dr. Tony Armson has seen how devastating preterm birth can be for babies, mothers and families. Technology has steadily improved outcomes for babies born too early (before 37 weeks), but preterm birth still poses risks to the baby’s wellbeing. That’s why Tony focuses a great deal of his research on finding better ways to predict – and prevent – preterm birth.
He began by developing and testing a preterm birth risk-assessment score with IWK epidemiologist Dr. Linda Dodds. “We wanted to see if known risk factors, such as a previous preterm birth, multiple fetuses, or cervical changes, would accurately predict preterm births,” Tony explains. “By examining pregnancy and birth records in the Atlee database, we discovered that only 15 to 20 per cent of preterm births occur in women with known risk factors. We had to find other markers of risk.”
The researchers found the key in a glue-like protein called fetal fibronectin, which binds the amniotic membranes to the uterine wall. It can be detected in vaginal secretions, but normally not before the 35th week of pregnancy.
“In a regional clinical study, we found that when fetal fibronectin shows up before 35 weeks, it accurately predicts preterm birth 50 or more per cent of the time,” says Tony. “This makes it a useful test when a woman presents with contractions. If it’s negative, which it is 90 per cent of the time, health professionals can safely send the woman home. When it’s positive, the woman should be admitted or transferred to the IWK right away.”
Based on this study, which reduced unnecessary transfers while ensuring truly high-risk situations were properly managed, fetal-fibronectin testing has been adopted across Nova Scotia and is on the way to becoming policy in this and several other provinces.
In the area of prevention, Tony and his colleagues have developed a campaign to educate physicians and pregnant women about pre-term warning signs, such as contractions, low-back pain and vaginal pressure, and steps to take to minimize risk. “Rest is most important,” notes Tony. “Pregnant women tend to work as long and hard as they can before their baby’s birth, but our evidence suggests that restricting activity may help prevent a preterm birth.”
Managing diabetes in pregnancy is another key interest for Tony, who is medical director of the IWK’s Pregnancy Diabetes Program. He and several colleagues are assessing which tests most accurately diagnose gestational diabetes.
At the same time, Tony and Linda are building an interdisciplinary research network at the IWK and Dalhousie to study the causes and impact of obesity on pregnancy outcomes, and develop treatment and prevention strategies to reduce complications of obesity for mothers, infants, children and adolescents.
Dr. Tony Armson - Printable PDF