Women early into their pregnancy are being recruited at Monash Health for a study looking into the link between their menstrual symptoms and pregnancy complications including preterm birth, fetal growth restriction and stillbirth.
Associate Professor Miranda Davies-Tuck, a perinatal epidemiologist at Hudson Institute of Medical Research, has developed and is leading the research program ‘Your period, your pregnancy’ — a collaboration between Monash Health, the Hudson Institute of Medical Research, and Monash University — School of Clinical Sciences at Monash Health.
She hopes to recruit 1,104 pregnant women by early next year and that all the participants will have given birth by the end of 2026.
The study aims to discover new causes that may result in challenges for mum and baby during pregnancy and lead to new treatments to support a healthier pregnancy.
‘Current discovery research aimed at better understanding and preventing stillbirth focuses almost exclusively on the role of the placenta. This is because the placenta is implicated in up to 65% of stillbirths and leads to the most common causes of stillbirth, preterm birth and fetal growth restriction.
‘The origins of the poor placental function, however, are poorly understood. There is growing evidence that the endometrial environment in which the embryo implants and the placenta develops is essential to determining the trajectory of pregnancy.
‘Excitedly, characteristics of a woman’s menstrual cycle could be used as a new clinical tool,’ she said.
A/Prof Davies-Tuck said a third of the sample size has been recruited at Monash Health antenatal clinics.
The participants are women aged 18 to 45 with a singleton pregnancy who do not have a known diagnosed endometrial pathology such as endometriosis, adenomyosis, endometrial cancer or an endometrial submucosal fibroid or have had an endometrial ablation, which is a surgical procedure that reduces or stops heavy menstrual bleeding.
The women will complete a menstrual history survey to record their menstrual cycle length, regularity, level of pain, heaviness of flow, and other symptoms.
The primary outcomes sought for the study are stillbirth, spontaneous preterm birth, pre-eclampsia or fetal growth restriction.
Participants are also invited to complete an optional fetal movements survey between 28 to 32, and 36 plus weeks’ gestation. Consent for placental collection at the time of birth will also be sought.
A/Prof Davies-Tuck said the objective of the study is to uncover new causes of placental dysfunction that lead to stillbirth, preterm birth, and fetal growth restriction (FGR). This is to allow her team to develop new or repurpose treatments.
‘This research may also result in menstrual health forming part of routine pregnancy care screening, identifying women at risk of stillbirth and preterm birth or FGR, who were not previously visible to clinicians, to guide their clinical care.
‘This may include additional monitoring to guide the timing of birth decisions. It may also identify a group of women who may benefit from stillbirth prevention treatments such as Aspirin, which has been effective in reducing preeclampsia and is increasingly being considered to prevent recurrent stillbirth,’ she said.
Monash Health’s Head of Maternal Fetal Medicine Associate Professor Kirsten Palmer is the clinical obstetric lead in this study, and Director of Gynaecology and Research Professor Beverley Vollenhoven AM is the clinical gynaecological lead.
A/Prof Palmer works closely with A/Prof Davies-Tuck, the study’s chief investigator, to bring clinical expertise and input into the study design, goals, and outcomes, as well as the interpretation of its findings.
She said there is a lot that we still don’t understand about how to prevent, predict or treat complications of pregnancy.
‘Unfortunately, 1 in 3 women will experience some form of complication during their pregnancy and research, such as ‘Your period, your pregnancy’ is important to hopefully yield valuable information that we can use clinically in the future to better guide and support the care of pregnant women,’ she said.
A/Prof Palmer said the information from this study will inform future clinical trials or research programs aimed at further understanding these associations and how we can use these knowledge advances to improve patient care directly.
‘Ultimately, this work is part of a larger body of work aiming to better understand the endometrial and uterine environment in the lead-up to pregnancy, where issues can contribute to pregnancy complications such as miscarriage, recurrent pregnancy loss, placental insufficiency, which causes preeclampsia and fetal growth restriction, and preterm birth.
‘Many of these complications we still poorly understand, so we hope this research will give hope of improved approaches to clinical care in the future,’ she said.
We thank A/Prof Davies-Tuck, A/Prof Palmer, Prof Vollenhoven and the rest of the team for their work in advancing women’s health.