PhD students who are funded by the Medical Research Council are invited to write about why their research matters. Immune therapies for cancer, Scotland's drug-related death rate and the neglected tropical disease schistosomiasis were some of the topics that made the cut. The high quality of the entries made it difficult to judge. Emily said she was thrilled to have won the prize.
Amy gave birth in the middle of the night. Everyone in the operating theatre was holding their breath as he cried. I was standing in a corner holding a bucket of ice and waiting to collect the baby's body parts. The stakes were really high. Two of baby William's sisters were stillborn because of a disorder in the uterus.
The majority of obstetricians don't know of CHI. It is a rare condition that affects one in 2,000 pregnant women and can only be diagnosed after the baby is born. My PhD goal is to find the cause of this disease.
In a healthy pregnant woman, the mother's blood flows through a channel called the intervillous space, where it comes into contact with tree-like branching structures known as placental villi. This is where the vital exchange of gases and vitamins takes place. In CHI, the channel gets blocked with maternal immune cells, which can lead to serious consequences for the baby. Some babies have to be delivered several months early by emergency caesarean to have a chance of survival, as only half of these pregnancies result in live births.
Women who are fit and well are more likely to be affected by Chi. Couples hoping to have a baby are devastated by it. Eight times out of 10, CHI will recur in a subsequent pregnant woman.
For most parents a stillbirth is not likely to happen again. CHI is different in this location. After her second daughter was stillborn, Amy experienced a double grief, not only for the loss of Grace, but also for the loss of the future and the family she had envisioned. These subsequent pregnancies require close monitoring because there are no tests that can reliably predict the return of CHI. Many women will have scans every fortnight in order to suppress their fear as they return to the same departments where their previous losses were diagnosed.
It is not known what caused CHI. When you look at a placenta through a microscope, you can see that it is very similar to a rejection of a transplant. My hypothesis is that mothers attack the developing placenta. There is an increase of maternal immune cells. When couples affected by CHI have their own eggs and sperm and transfer the embryo into a surrogate, the pregnancy progresses normally with no signs of CHI. The problem comes from the mother's immune system.
It was difficult to design a research study focusing on CHI when the disease is so rare. I was saved by a woman and a group on the internet.
Four sons were lost to CHI in a three year period. She became determined to raise the profile of the disease after she learned to live without her children. She helps to run a Facebook support group for women who have been affected by CHI. The group is a great place for parents to come to terms with their diagnoses.
Finding a miracle cure is unrealistic, but my vision is to make concrete advances in our understanding of this disease
Thanks to the group of women, I have been able to get more than 30 women to join my study. I collect blood and placental samples from them to look for immune cells that could be related to their pregnancies. I look for variations in their genetic code to see if they're more likely to become a CHI patient.
I have shown that women with CHI react differently to placental proteins when compared to women who have had uncomplicated pregnancies. My next challenge is to figure out what causes this reaction and how it leads to the destruction of the placental tissue. This knowledge can be used to develop new, targeted treatments that can prevent recurrence.
The team is working on the last question. When she lost her children 10 years ago, she decided to have children of her own. Over the last few months we have become cautiously optimistic about a new treatment protocol that involves suppressing the mother's immune system during pregnancies. We drew on the similarities between rejected transplants and CHI placentas. People with organ transplants take the same treatment to stop their bodies rejecting the organ. Regular blood tests and close vigilance are required for early signs of potentially dangerous side-effects. Most of the women we've treated have gone home with a baby.
These treatments are guesses until we discover the cause of CHI. Nine months into my PhD, I am aware that finding a miracle cure is not realistic. I want to make concrete advances in our understanding of CHI so that future treatments can be tailored to the exact defect in women's immune systems.
She felt like she had been kicked out of the motherhood club after losing her daughters. She decided to take the gamble because she didn't want to lose another baby and she also didn't want to get pregnant with a lot of medication. During her pregnancies with William, Amy injected herself with a blood thinner at least 200 times. She traveled to the hospital on commuter trains and had blood tests almost every week because of the Covid visiting policy.
The courage and determination of the women who embark on this regime is inspiring. The women who have experienced it are very motivated and want to educate us. Spending my evenings crouching in an operating theatre with an ice bucket is worth it if my research can help affected families.
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