The identification of novel biomarkers for the small for gestational age human fetus

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Babies who grow poorly in the womb (called small for gestational age [SGA]) are at increased risk of a number of adverse outcomes, including stillbirth. Screening pregnant women in an attempt to detect SGA babies has the potential to reduce the number of these adverse outcomes, in particular stillbirth, which accounts for the death of about 4000 babies per annum in the UK. Current practice in the UK in screening the general population for SGA babies is confined to measuring the woman?s bump (technically called ?symphysis-fundal height?) with a tape measure. However, this approach is known not to be particularly good at picking up small babies. The approach to SGA is very crude in comparison to the approach to screening for Down?s syndrome babies in pregnancy. Down?s syndrome screening utilises a combination of scan and blood markers and now detects 90% of cases with only a small proportion of women requiring further tests. There are also a number of scan and blood markers for SGA babies, but none of these is good enough on its own to predict them. We believe that it will be possible to identify novel markers which may be more effective than existing blood tests. In fact, relatively few studies have systematically looked for better markers and most of the existing blood tests which could help predict SGA were discovered by chance. We have access to scan information, blood samples and placental (afterbirth) samples from a large scale study of unselected women in their first pregnancy ( 2800 women and on target to recruit 5000). The overarching aim of the present application is to see if we can find better markers in the mother?s blood of poorly grown babies. Specifically, we plan to determine the key differences in the genes expressed in the placenta of SGA babies and matched controls. We then aim to see if the proteins encoded by these genes are found at different concentrations in the placenta and in the mother?s blood. Finally, we aim to determine whether information about the levels of these proteins improves the prediction of SGA babies. The end result will be a predictive tool (algorithm) to detect small babies. We could then design trials of the tool to see if it improved outcome. The ultimate aim is to make care of pregnant women more effective and to reduce the number of babies lost to stillbirth.