Winner 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.