The Pregnancy Outcome Prediction (POP) Study is a prospective cohort study of 4,512 women who have never given birth, recruited at the Rosie Hospital (Cambridge, UK) between January 2008 and July 2012.
Staff and funding The Principal Investigator is Gordon Smith of the Department of Obstetrics and Gynaecology (University of Cambridge, UK). Lab work using the biobank of samples is led by Stephen Charnock-Jones of the same department. The POP study is supported by the Women's Health and Paediatrics theme of the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre (BRC), which is based at the Cambridge Biomedical Campus (UK). Other funding sources for the projects related to the POP study are the Medical Research Council (UK), the NIHR, the Wellcome Trust, the British Heart Foundation, and the Stillbirth and Neonatal Death Society (now known as Sands), as well as Industry supported studies.
Background In 2007, Cambridge (UK) received funding from NIHR to establish a comprehensive Biomedical Research Centre (BRC). The Cambridge BRC Women's Health and Paediatrics theme focuses on tackling the origins, treatment and prevention of many of the health issues that affect women during their reproductive years. The bulk of the Cambridge BRC funding for the first five years of the theme supported the POP study. Over recent years, we have witnessed a great improvement in population-based screening methods for fetal abnormalities as a result of technological developments in ultrasound, biochemical screening and molecular genetics. However, the methods for screening the low risk population for other complications of pregnancy such as fetal growth restriction (FGR), pre-eclampsia and stillbirth have remained largely unchanged for the past 20–30 years. The UK National Institute for Clinical Excellence (NICE) has highlighted a number of research priorities in their guidelines for pregnancy care. These include a focus on improving the screening of apparently healthy pregnant women and identify those at high risk of complications. This area is the main focus of the POP study.
Design and aims Nulliparous women with a viable singleton pregnancy were recruited to the POP study when attending their dating ultrasound scan at The Rosie Hospital (Cambridge, UK). The only clinical exclusion criterion was multiple pregnancy. Participants had serial ultrasound scans and blood obtained at recruitment, 20, 28 and 36 weeks of gestation. DNA samples and height/weight measurements of the partners were also collected. After delivery, biopsies of the placenta, placental membranes, umbilical cord, and a sample of cord blood were collected. Thorough design of the POP study and careful sample collection allowed the creation of an extensive, optimally phenotyped biobank of complicated and healthy pregnancies, including approximately 230,000 blood and tissue samples stored in -80 °C freezers, 24,000 formalin fixed placental biopsies, and 4,000 paternal DNA samples. The types of samples collected during the POP study reflect, first of all, the focus on the role of the placenta and its altered development and function in several major complications of pregnancy. Second, they reflect the interest in circulating biomarkers since, despite years of intensive research, screening for these conditions is still largely based upon clinical grounds rather than ultrasonic and/or biochemical assessment of placental function. Therefore the projects based on the samples from the POP study have the following aims:
understanding the mechanisms leading to placentally-related complications, such as pre-eclampsia, FGR and stillbirth; studying the association between pregnancy complications and the presence of infectious agents in the placenta; evaluating the performance of known biomarkers and serial ultrasonography in assessing maternal and fetal well-being; discovering novel, placentally-derived circulating biomarkers which reflect the underlying pathology and are highly sensitive and specific in predicting the associated disease.
Key findings Multiple projects based on this data have been published and many are currently on-going. The key findings obtained so far studying the samples from the POP study are (see paragraph "Research papers" for a complete list of publications):
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