Winner of the £1000 Evelyn Ashley Smith Nurse Award 2015 was Breidge Boyle PhD RGN RSCN, Maternal, Fetal and Infant Research: Institute for Nursing and Health Research, Ulster University

Maternal thyroid disease, thyroid drug use in pregnancy and the risk of adverse pregnancy outcomes: including specific congenital anomalies and later physical and intellectual development

I am a Registered Sick Children’s Nurse with more than thirty years’ experience. Much of my career was spent working in neonatal surgery where I have looked after babies with structural congenital anomalies; including congenital heart defects and other, mainly gastrointestinal and urinary defects. For the past six years I have been working with EUROCAT, an organisation which registers fetuses and babies with congenital anomalies throughout Europe, carrying out epidemiological research with a view to prevention; and laterally with the daughter organisation EUROmediCAT which is concerned with drug exposure in early pregnancy and its association with congenital anomalies.

I am thrilled to receive the Evelyn Ashley Award and intend to use it in two ways. Firstly I will use the money to pay for my time while I write a protocol for a piece of research which, when fully funded, I will carry out with the expert team here at Ulster University. We will use the EUROmediCAT data base to estimate the association between thyroid disease in pregnancy and specific congenital anomalies, looking at hypothyroidism and hyperthyroidisms separately. As maternal illness, both chronic illness and those which occur during pregnancy are recorded in the database we hope that we will be able to look at both treated and untreated disease. Hypothyroidism during pregnancy has been associated with congenital anomalies, but many women suffer from both thyroid disease and diabetes which can also lead to congenital anomalies; and we hope to be able to begin to separate the effects of both in our analysis. There is some evidence that hyperthyroidism and/or the drugs used to treat it during pregnancy are associated with specific congenital anomalies. This is very difficult to research as hyperthyroidism is rare as are specific congenital anomalies, and it takes a huge population to power such a study. The strength of EUROmediCAT is that we have such a population.

Our team is building expertise in linking data from national datasets and I will also be able to investigate what sources of data are available in the UK to examine thyroid disease in pregnancy. This will include thyroid disease, the medications used and any associated diabetes in pregnancy and birth outcomes such as miscarriage, premature birth and stillbirth. It may also be possible to link these to developmental outcomes for the live born children, but this has not been carried out so far Unfortunately, since not every pregnant woman gets her thyroid function tested, we will not be able to look at the effects of subclinical hypothyroidism, but we may be able to plan more research in the future.

Like most other researchers, I am funded to carry out specific pieces of research. What The Evelyn Ashley Award will allow me to do is to spend time planning, and most importantly, writing protocols for some of the research needed in this very significant area. The protocol which the award will fund is the first step, and I hope to be able to report that we have identified funding to actually carry out the research in the near future.

bridget knightWinner of the BTF Evelyn Ashley Smith Nurse £500 Award 2015 was Bridget Knight, Research Midwife, NIHR Exeter Clinical Research Facility.

She used the Award to travel to the recent British Endocrine Society conference in Edinburgh where she presented findings of the project she has been involved in: Breech presentation in pregnancy and risk of maternal hypothyroidism.

Bridget explains: ‘A breech presentation (buttocks or feet first) occurs in 3 to 5% of all full-term pregnancies and can cause problems for both mother and baby. Reasons include the mother going into labour early (before 37 weeks of pregnancy), the baby being small, or being a twin or triplet. Recently research has also suggested that thyroid deficient mothers are also at increased risk, possibly because thyroid deficiency is known to reduce muscle tone (making the uterus more relaxed), or may impact on the reflexes involved in the baby moving and changing its position. We wanted to explore this in more detail.

‘We recruited a group of mothers with no known thyroid problems to establish if there is in fact a link between thyroid function and a breech presentation. We recruited two groups of mothers from clinic during their routine 36-38 week antenatal visit: 156 mothers with a single baby in the breech position, and 154 with a single baby in the cephalic (normal head first) position. They all provided a one-off blood sample for routine thyroid function tests. We then looked for differences between the breech and cephalic groups. First we compared ‘baseline’ information: this included the mother’s age, her body mass index (BMI), did she smoke, did she take vitamins, and was it her first baby? There was no difference in any of the measurements This was important as it meant we could then safely compare the results from the thyroid tests and be confident any differences seen were not because of other differences between the groups.

Within this group of 310 women with no history of known thyroid diseases, we actually found that 5% were TPO-Ab positive (antibodies present), 11% had hypothyroidism (most with subclinical hypothyroidism) and 15% had isolated hypothyroxinaemia (subnormal thyroxine level in the blood). When we compared these rates of reduced thyroid function in the two groups there was no difference. Our study suggests that a breech presentation in late pregnancy is not associated with known markers of maternal thyroid dysfunction. While thyroid problems may cause problems in pregnancy unless carefully managed during pregnancy, it is unlikely that these mothers are at extra risk of having a breech birth.