Reducing research waste through team science

Abstract

Medical research that neither influences clinical practice nor helps to improve people's lives could be considered an expensive waste of time. A co-ordinated team science approach is critical to ensuring patient-centred research ideas are carefully honed, meticulously executed and ultimately translated into measurable improvements in human health (1). Several studies published in this issue of BJOG emphasise the importance of diverse multidisciplinary teams for ensuring complementary expertise, effective problem-solving and innovation in research.

A systematic review by Ewington and colleagues found that none of the 111 published models to predict fetal macrosomia and large for gestational age are ready for clinical implementation. Most of the 58 included studies were at high risk of bias, few models had been externally validated and some used predictors that are not routinely measured in clinical practice, rendering them impracticable for clinical translation. In his associated mini-commentary, Jack Wilkinson asserts that teams with appropriate methodological expertise to guide model design, analysis and reporting are key to preventing research waste. He points out that models developed using flawed methods may actually do more harm than good and notes the essential gatekeeping role journals play by refusing to publish studies that lack methodological rigour.

Other research featured in this issue of BJOG includes a propensity score-matched analysis of 50 565 singleton live births exploring the relationship between in utero aspirin exposure and child neurocognitive development by Zhu and colleagues. Their study found that second trimester aspirin exposure was associated with improved child neurocognitive development. Sharp and colleagues found no improvement in 2-year neurodevelopmental outcomes in infants whose mothers were treated with sildenafil during severe early-onset fetal growth restriction pregnancies. They conclude that sildenafil should not be prescribed for this condition. Ghandhi and colleagues showed in a retrospective cohort study that antenatal pyelonephritis admissions are decreasing in the USA, however, those hospitalised have a higher risk for sepsis and severe maternal morbidity. Socio-economic deprivation was shown to be associated with increased risk.

Sanders and colleagues assessed maternal and neonatal outcomes among spontaneous vaginal births occurring in and out of water following intrapartum water immersion in a cohort study of 73 229 women. They found no increased risk of obstetric anal sphincter injury (OASI) or adverse fetal outcomes, including fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48 h of birth. The authors conclude that among women using intrapartum water immersion, remaining in the pool and giving birth in the water is as safe for mothers and their babies as leaving the water before birth.

Prasad and colleagues share the results from their international cross-sectional survey of 113 clinicians involved in the management of monochorionic diamniotic twin pregnancies with selective fetal growth restriction. They conclude that there is significant variation in clinician attitudes to the management of these pregnancies, especially for type II and type III cases, highlighting the need for evidence based clinical guidelines to support a consistent approach to patient care.

Haem and colleagues present a systematic review of six studies including 412 pregnancies in women with vascular Ehlers-Danlos syndrome. They found an elevated risk of uterine rupture, vascular events, digestive events and death during pregnancy with the highest risk during the peripartum period. They recommend that the patient's cardiologist initiates treatment with beta blockers and monitors for aortic dilatation in pregnancy. The authors assert that to avoid expulsive efforts, a caesarean section should be scheduled at 37 weeks.

Tang and colleagues report the results of their prospective cohort study assessing fasting blood glucose as a screening measure for late-onset diabetes in the third trimester. They found 6.3% of a 1130 singleton cohort who had a normal gestational diabetes mellitus screen in the first and second trimester were found to have late onset gestational diabetes mellitus by additional fasting blood glucose screening at 32–24 weeks. This research further documents an association between elevated fasting blood glucose in late pregnancy and adverse perinatal outcomes including macrosomia and neonatal intensive care unit admission.

Latt and colleagues present a population-based record linkage cohort study evaluating postpartum haemorrhage (PPH) and risk of cardiovascular disease in later life. They show in a cohort of 70 904 women that 25 177 women had at least one PPH. They found that having at least one PPH was associated with a near two-fold increased risk of developing cardiovascular disease in the first year after birth, with residual increased risk continuing for up to 15 years after giving birth.

A review of the current evidence for cervical cerclage by Story and Shennan highlights many important clinical questions that have not yet been addressed by research. They recommend good quality evidence from large RCTs to assess which women would most likely benefit from cervical cerclage and how it should be optimally performed.

In a descriptive study of the International Network on Cancer, Infertility and Pregnancy Registry, Heimovaara and colleagues found that 5.6% of women diagnosed with cancer during pregnancy died. Lung cancer, gastro-oesophageal cancer and acute leukaemia had the highest rates of maternal mortality. Maternal death was associated with fewer live births, more elective caesarean sections, lower gestational age and more preterm births. The authors conclude that the early identification of women at risk of cancer-related death in pregnancy allows for a fair discussion with the woman and her partner, and the initiation of adequate palliative care including psychological support for the family that experience a maternal death.

In this issue of BJOG, Huang and colleagues describe the current global burden of vaginal cancer with 17 908 newly reported cases in 2020 and highest age-standardised rates in south-central Asia and southern Africa. The most significant rising trends were seen in the UK, Chile and Bahrain. Targeted interventions, including HPV vaccination and education, particularly in regions with a lower human development index and a higher prevalence of HPV infection, are needed to reverse these trends.

Almadori and colleagues present a scoping review showing limited evidence that reconstructive surgery improves quality of life, satisfaction with vulval appearance and sexual function in survivors of female genital mutilation. They conclude that high quality clinical trials are now warranted to confirm these findings.

Fayyad and Hasan describe the laparoscopic mid-urethral autologous rectus fascial sling (LMAFS) technique to treat female stress urinary incontinence necessitated by the serious concerns being raised over the safety of vaginal mesh tapes. All ten patients who underwent this procedure report cure from stress urinary incontinence with normal voiding at 12 month review. The benefit of this technique is its minimal access approach and avoidance of over tightening of the sling.

Levin and colleagues undertook a bibliometric analysis of USA publications indexed in pubmed over five decades on the topic of abortion and showed significantly higher numbers of funded studies, publications and scholarly impact of those publications in states that protect abortion care versus those with more restrictive policies. The observed disparities may be amplified by the recent Supreme Court ruling and subsequent new anti-abortion legislations in many US states.

Finally, Crawford and colleagues offer some hope for improved ovarian cancer detection by measuring serum HE4 alongside CA125.