UK researchers have found a potential way of preventing premature births by healing unwanted ruptures in the delicate membrane that surrounds a foetus in the womb.
The scientists from Queen Mary University of London and University College London presented their discovery at the British Science Festival in Brighton on Tuesday.
“To have potentially found a way to reduce preterm births and prevent the early deaths of young babies worldwide is incredibly exciting,” said Tina Chowdhury, who leads the bioengineering research programme at Queen Mary.
About one in nine pregnancies ends in premature birth before 37 weeks, said Anna David, a professor at UCL Institute of Women’s Health. In the UK, 50,000 babies a year are premature, 10,000 of whom die in infancy. Forty per cent of preterm births are caused by a break in the foetal membrane.
Unlike other mammals, humans have no healing mechanism for the foetal membrane. Once broken as a result of mechanical stress, weakness, bleeding or prenatal surgery, it will either fail and cause premature birth, or allow amniotic fluid to leak out of the womb with potentially fatal results.
The London researchers have discovered the biological reasons for this poor healing response. The culprit is a membrane protein called connexin 43, which stops healing cells that would otherwise produce collagen to repair the break from entering the wound.
The biological reason for the failure is not clear. Prof David said it might have evolved as a response to infections in pregnancy that weaken the membrane.
She added the team of researchers is “developing bioengineering strategies that encourage rebuilding of the foetal membranes through enhanced tissue healing”.
The healing treatment will involve inhibiting the activity of connexin 43 in the area of the membrane break, while stimulating collagen-producing cells. Stem cells could also be introduced.
The treatment could be particularly useful and straightforward in cases where surgery is carried out on the foetus — for example to correct a defect identified through prenatal scanning. The medical team could then make sure that the hole left by the operation will heal.
At present, 40 per cent of antenatal surgeries are followed by leakage of amniotic fluid and premature labour.
But treatment for foetal membrane defects is still a long way from the clinic. It is unlikely to be ready for testing in patients for at least three years. Several subsequent years of clinical trials would be required to demonstrate that any treatment would be safe and effective for commercial approval.
Prof David called obstetrics a neglected area of medical research.
“It is ethically challenging, difficult and expensive to develop a treatment,” she said. “The drug pipeline for obstetrics is only 1 per cent of that for cancer or cardiovascular disease. Yet 10 per cent of the global disease burden results from perinatal problems.”