Dr Adam Brook – Fetal growth restriction

Fetal growth restriction, the main cause of stillbirth, affects 1 in 20 pregnancies

Dr Adam Brook, University of Manchester: Ameliorating the detrimental endothelial effects of free fetal haemoglobin in fetal growth restriction using hydroxychloroquine

£18,686 over 24 months

About Fetal Growth Restriction

Fetal growth restriction (FGR) is a condition in which babies are born small. The condition is associated with poorer life outcomes and future health problems.

“Not only does poor growth predict pregnancy complications, and complications in new-born babies, but it has longer term implications for adult health,” said Dr Adam Brook.

Infants with FGR have an increased likelihood of cardiovascular disease, stroke and diabetes later in life.

Doctors can recognise FGR and monitor the infant closely in the womb, but there are few treatment options after birth.

Fetal growth restriction, the main cause of stillbirth, affects 1 in 20 pregnancies. Our researcher Dr Adam Brook and his team at St Mary’s Hospital, Manchester are looking at repurposing the drug Hydroxychloroquine to treat fetal growth restriction.

Risks of FGR

A Cesarean section deliver or early delivery may be necessary if the baby’s health become very compromised, but these methods are only possible if it has some chance of surviving outside the womb.

“Worrying signs of increased shunting of blood to baby’s brain and liver at the cost of other organs on ultrasound scans are associated with a high risk of baby dying in the womb before delivery,” said Dr Brook.

Finding treatment options

Dr Brook is investigating one possible origin of FGR.

“A damaging substance, called fetal haemoglobin (HbF), seems an important part of the story.”

Babies suffering from FGR tend to have an excess of this substance in their bloodstreams.

“Alterations in circulating levels might occur when red blood cells containing haemoglobin burst open, or if the placenta overproduces this substance because of oxygen starvation.”

When untreated, this excess substance disrupts the processes that regulate blood pressure and maintain healthy organ function.

“We are now at the crossroads of considering how this insult might be treated or better still prevented,” Dr Brook said. “Our investigation has led us to look at a new treatment for very small babies in pregnancy using the drug HCQ.”

People suffering from autoimmune diseases use the drug HCQ as treatment – and it appears to be safe.

Before HCQ can be used to treat FGR, laboratory tests need to be conducted on human placentas.

“We need to study whether this medicine can indeed reverse some of the harmful placental effects we already know HbF brings about.”