Carmel McEniery
University of Cambridge
The POPPY STUDY (Preconception to post-partum cardiovascular function in primigravid pregnancy) Novel use of pressure pulse waveform analysis technologies to identify early risk factors for preeclampsia and other placental syndromes.
#Cardiovascular #Women's Health
How will the SphygmoCor® technology enable, enhance, or accelerate your research?
The POPPY study is the first, adequately powered, study of its kind to provide a comprehensive picture of haemodynamic adaptations to pregnancy, by monitoring women before conception, during pregnancy and again post-partum. Integration of SphygmoCor technology at all timepoints within the POPPY study will provide extremely novel data, allowing us to examine any associations between vascular measures and occurrence of placental syndromes including preeclampsia, gestational hypertension, and fetal growth restriction. Utilising central pressure and pulse wave analysis parameters will enable the characterisation of distinct phenotypes at risk of placental syndromes and better understand long term cardiovascular impacts on women’s health. Utilising accessible technology such as the PULSE device will also expand data collection beyond in-clinic visits to at home or remote monitoring. The POPPY study has a Ugandan arm, which will enable assessment of the feasibility of integrating SphygmoCor technology in low resource settings – a potential game-changer. Additionally, Sub-Saharan populations are at greater risk of placental syndromes with worse pregnancy outcomes, therefore investigating this demographic will provide invaluable insights. For example, incorporating the ConneQt data cloud, we can demonstrate the capabilities of remote monitoring and its potential for providing easier access to specialists in remote or disadvantaged communities. Feasibility assessments can inform future health policies helping democratise access to healthcare services, particularly for marginalized communities, reducing health disparities and advancing global health equality. The POPPY study will identify at risk vascular phenotypes with SyphgmoCor technology, which will integrate vascular measures in practise to ensure early detection of at-risk women for targeted treatment facilitating proactive prevention of placental syndromes.
Executive Summary
Women who experience placental complications during pregnancy, such as pre-eclampsia (high blood pressure and kidney problems), gestational hypertension (high blood pressure during pregnancy) and fetal growth restriction (baby being small) are at a two-fold higher risk of developing heart disease and diabetes later in life compared to women who do not. However, it is unclear whether placental syndromes have a direct adverse effect on cardiometabolic health, whether a healthy pregnancy is protective, or whether women who experience a placental syndrome simply had poorer cardiometabolic health prior to pregnancy. The POPPY study will assess 3500 women over 7 UK sites and at least one Ugandan site for vascular biomarkers and other risk factors before conception, during pregnancy, and post-partum to better understand the relationship between placental syndromes and pre-conception and post-partum maternal cardiometabolic health. The POPPY study aims to establish the haemodynamic phenotype of preeclampsia and other placental syndromes and whether clues to any haemodynamic abnormalities can be detected either prior to, or early in, pregnancy. The study will also inform haemodynamic phenotypes in a sub-Saharan Arican population, where there is both a higher prevalence of placental syndromes and incidence of maternal and fetal deaths. Identification of vascular phenotypes can be used to establish simple, widely available, risk-screening measures based on vascular assessments, which facilitate early identification of ‘at-risk’ phenotypes either before, or in early pregnancy. Such earlier identification of at-risk phenotypes will ultimately promote the development of preventative treatment plans to mitigate the detrimental impact of placental complications and uphold the long-term cardiovascular well-being of both mother and child.
Research Setting
The POPPY study is being led by the University of Cambridge. The team is led by chief investigator Professor Ian Wilkinson current president of the British and Irish Hypertension Society and Director of the Cambridge Clinical Trials Unit and Cambridge Principal Investigator, Dr Carmel McEniery, current president of the ARTERY Society and Principal Research Associate in the Division of Experimental Medicine in Cambridge. The POPPY study involves 7 universities across the UK – Imperial College London, King’s College London, St George’s University of London, University College London, University of Bristol, University of Cambridge and University of Glasgow as well as 7 NHS organisations (Addenbrooke’s Hospital (Cambridge), Glasgow Royal Infirmary (Glasgow), St George’s Hospital (London), St Thomas’ Hospital (London), Queen Charlotte’s and Chelsea Hospital (London), University College Hospital (London) and St Mary’s Hospital (Manchester). The study includes a Ugandan site with established collaborators to explore the feasibility of conducting POPPY in a low resource setting. Each of the study sites has suitable staffing and infra-structure for conducting world-leading clinical research (Principal Investigators, research nurses/mid-wives, clinical research facilities). The POPPY study is funded by the Wellcome trust, a global charitable foundation that supports science and research into urgent health challenges that face the population. As such, the POPPY study is a funded, world-leading collaborative research study which will provide highly novel insights into the links between placental syndromes such as preeclampsia and cardiovascular health.