If you ask people “What is your why?” almost universally they’ll tell you: they want love, they want more time, and they fear death. This summarises my motivation for research and clinical medicine (high risk obstetrics). Most people experience love from their families, they want to spend as much time with their families as possible, and they want to grow old with their families. There are too many perinatal deaths though stillbirth and the complications of preterm birth. We know the consequences of preterm birth and failing to reach your growth potential in utero, but there is little we can do about these major complications of perinatal medicine. My research addresses the major challenges in obstetrics and their lifelong complications – reducing these will allow more love and more time within families and less death and its consequences.
I became involved in research in the Developmental Origins of Health and Disease (DOHaD) over fifteen years ago when it became clear it was possible for interventions in pregnancy and the first 1000 days to alter the life course trajectory to the diseases that affect over 65% of the global population – obesity, hypertension, diabetes and high cholesterol. I was ‘sparked’ by the concept that my work as an obstetrician effected more than the day of birth. We have been working on how to couple precision medicine and early interventions to allow everyone to reach optimal health.
I have two ultimate goals for my research; they relate to preterm birth and DOHaD.
For pregnancy, the goal is to develop four tests. The first would be performed ‘prior’ to pregnancy to provide information to couples about their future pregnancies – will they be high risk or low risk pregnancies? This would be followed by a test ‘early’ in pregnancy, at 10 weeks, that would personalise the risks for the ‘current’ pregnancy and allow families to be offered the most appropriate model of care. If the woman began to develop early signs of a complication, we would offer individuals the ‘prevent’ test that will inform us of the right treatment for the right patient at the right time. We would be able to provide the most effective treatment for each individual patient. Finally, if someone presented with contractions, we would perform another precision medicine test to identify true labour from false labour to direct women should receive specific treatments. Our work since 2004 has made substantial progress to the development of three of these four tests. With further research grants and the generous contribution of patients, this package of precision medicine for pregnancy and beyond is within our reach. This broad program of precision medicine for preterm birth has been done with my long-term collaborators from Canada and through the Global Preterm Birth Genome Project involving collaborators from the United States, Mexico, Sweden, China and Korea.
The ultimate goal of our DOHaD research is to identify, prior to birth, babies who will go on to develop obesity, hypertension, diabetes and high cholesterol as adults. We will use this knowledge to help families manipulate the environment in the first 1000 days (for e.g. by changing nutrition) to return them to a life of health rather than disease. We have been working on this issue with consortiums around the world – looking at up to 800,000 people to assess the genetics linking fetal growth and adult disease. We then bring what we’ve learned back to our local cohorts and trial interventions to put people on pathways to health.
Professor Craig Pennell is Chair of Obstetrics and Gynaecology, School of Medicine and Public Health, Faculty of Health and Medicine and Professor Maternal Fetal Medicine at the University of Newcastle. He works clinically as a subspecialist in Maternal Fetal Medicine at the John Hunter Hospital in Newcastle and is a principal researcher at the Hunter Medical Research Institute.
Professor Pennell has managed high risk pregnancies as a subspecialist for over 15 years in Canada, Perth, and now Newcastle. His clinical work focuses on preterm birth prevention and pregnancy after stillbirth; he has managed more than 1500 women’s pregnancies after stillbirth. In 2012 he was awarded the Pride of Australia Award for Care and Compassion after he was nominated by his patients.
Professor Pennell is an accomplished researcher with more than 200 publications, $28M of competitive national and international research grants and holds three patents. His current research is focused on prediction of preterm birth in early pregnancy, the impact of ethnicity and migration on stillbirth and the role of genetics in the relationship between early life events and adult disease.
He is currently Chair of the Red Nose National Scientific Advisory Board. Red Nose is a not-for-profit charity whose purpose is saving the lives of babies and children and supporting people impacted by the death of a child.
The first 1000 days of life can put people on a trajectory for health instead of disease; it’s a crucial time for intervention and attention. The Newcastle 1000 project will follow mother, father and baby from the start of pregnancy until adult life. There will be a strong focus on the first 1000 days after birth. In addition to recruitment at 12 weeks, will also begin on a cohort considering pregnancy in the next two years. These preconception families will eventually become the basis of the entire cohort. This bold research program is an integrated, cross-disciplinary program that builds on the inextricable link between maternal and early childhood factors and the risk of developing both early and late onset non-communicable diseases.
Since mid-2018 we have been working collaboratively with teams across the University of Newcastle, HMRI and Hunter New England Health District to establish our first recruitment cohort by mid 2019. The difference between this cohort and others is that there is no end date for recruitment; it will grow to be the largest prospective pregnancy cohort in the world. Further, within 2-5 years, recruitment preconception will be the primary mechanism for families to enter the study.
Of the 4500 deliveries in at John Hunter Hospital each year, we’re looking to recruit around 25% of the pregnant population – looking at mothers, fathers and the babies. It is acknowledged that simply being involved in a trial results in a better outcome – we are looking for people who want to be involved in Newcastle 1000; to improve their health outcomes and help the broader community worldwide.