Obstetrics and Gynaecology

Diet and Lifestyle Intervention in Early Pregnancy to Mitigate the Development of Women with Gestational Diabetes

Supervisor: Professor Bee Tan (bee.k.tan@leicester.ac.uk) 

To undertake preliminary research in terms of setting up a research project for a research fellowship leading to a PhD on the topic of Gestational Diabetes.

A systematic review on this topic is in progress and we hope to publish this work soon.

This will form the basis to design a study of diet and lifestyle intervention in early pregnancy to mitigate the development of gestational diabetes in different ethnic groups.

The trainee will:

1. Actively participate in designing a pilot RCT of diet and lifestyle intervention in early pregnancy (10 to 12 weeks gestation); the specific diet and lifestyle intervention would be based on the outcome of our systematic review.  The trainee will also work with statisticians with respect to statistical aspects of the study such as power calculations of the study, what data to be collected and how analysed.

2. Actively participate in the ethical (as well as other approvals) application process together with supervisor.

Maternal Cardiovascular profiling for precision stratification of pregnant women with early onset type 2 diabetes (EOT2D)

Supervisors: Professor Tommy Mousa (hm282@leicester.ac.uk) and Professor Claire Meek (cm881@leicester.ac.uk)

Background: Diabetes mellitus is one of the most common medical disorders in pregnancy, affecting up to 5% of pregnancies in the United Kingdom (UK). Pregnancy in women with early-onset type 2 diabetes (EOT2D; diagnosis <40 years old) is increasingly common and associated with increased risk of placental-mediated diseases, such as pregnancy-induced hypertension (PIH) and preeclampsia (PET), and features of endothelial dysfunction, even in the absence of obesity or hypertension. This suggests that maladaptation of the cardiovascular system in pregnancy may be an important pathophysiological mechanism in EOT2D.

Our Leicester Maternal Haemodynamic Research Group have examined and reported on changes in maternal haemodynamic profiles, including arterial stiffness, a recognised cardiovascular risk factor, among pregnant women with gestational diabetes. We observed unique changes in arterial stiffness suggesting that vascular health may also be important in the development of complications in EOT2D. 

Aims: This project will assess longitudinal changes in maternal haemodynamics among pregnant women with EOT2D and will evaluate its role in the aetiology of pregnancy complications, as part of a large multicentre observational study (Leicester Diabetes Research Centre project led by Prof Meek; DOMINO study).

Hybrid closed loops and risk of placental-mediated diseases in women with type 1 diabetes (T1D) in pregnancy

Supervisors: Professor Tommy Mousa (hm282@leicester.ac.uk) and Professor Claire Meek (cm881@leicester.ac.uk)

Background: Women with type 1 diabetes (T1D) in pregnancy have increased risk of placental-mediated diseases (Hypertension, pre-eclampsia, fetal growth restriction), preterm delivery, birthweight extremes, congenital anomaly, stillbirth and neonatal death. Hybrid closed loops (HCL), novel automated insulin delivery systems, are now the standard of care for pregnant women with T1D. HCLs improve maternal glycaemia, but their effect upon perinatal outcomes has not been assessed in real-world clinical practice.

Our Leicester Maternal Haemodynamic Research Group have identified that the type of therapy influences longitudinal changes in maternal haemodynamic profile among pregnant women with diabetes. However, it is unclear if HCLs are associated with improved maternal haemodynamics and reduced rates of vascular complications.

Aims: This project will assess the real-world effect of HCL use on perinatal complications, maternal glycaemia and cardiovascular health in women with T1D. This project will be embedded in a large multicentre observational study (Leicester Diabetes Research Centre project led by Prof Meek; DOMINO study) providing opportunities for publications, presentations and to learn about the end-to-end clinical research process.

Ethnic differences in Postpartum haemorrhage

Supervisor: Manjiri Khare (mk537@leicester.ac.uk)

Postpartum haemorrhage is one of the leading causes of maternal mortality and morbidity. Black and Asian women are more likely to die during or after childbirth compared to the Caucasian women.

Differences in iron stores, dietary habits, cultural and social differences may increase risks for postpartum haemorrhage. Risk stratification could be improved by customising to the maternal height, weight, ethnicity, indirect assessments of intravascular and extravascular fluid assessments by non-invasive techniques in labour.

The project will include pregnant women from Asian, Black and White backgrounds over one year. The risk factors, quantification and resuscitation will be included in the comparison for the three groups. There will be a short survey of staff about their knowledge about any differences in the management of postpartum haemorrhage in the different ethnic groups of women. The findings of the study will help in understanding any strategies to reduce the differences in the outcome following postpartum haemorrhage between the various groups and also have a customised approach in management based on the differences.

The project will contribute to the colleges research strategy as this is an innovative approach to the management of postpartum haemorrhage focussing on what matters to transform lives.

Identification of biomarkers to personalise management of uterine cancer

Supervisor: Dr Esther Moss (em321@le.ac.uk)

Uterine cancer is the most common gynaecological cancer in the UK with nearly 10,000 new cases every year. There is great concern that the uterine cancer mortality rate is rising. Reasons for this worrying trend are multifactorial but are impacted by a lack of efficacious treatments for advanced/recurrent disease. There is a need for the identification of biomarkers to guide treatment options for metastatic uterine cancer.

This study will explore the genomic and molecular profile of uterine cancers and drug resistance/sensitivity in order to identify biomarkers that can predict response. This will include collection and analysis of patient samples, multiplex immunofluorescence, and genomic analysis.

The results will give new insights into the potential role of a biomarkers to predict drug response enabling personalisation of uterine cancer management, with a view to improving survival.