Department of O&G -Research Activities

Study on the epidemiology and the management of gestational diabetes mellitus
A series of retrospective and prospective studies have identified a number of risk factors and conditions associated with gestational glucose intolerance that are of relevance to our population. One of these factors is maternal iron status, and a prospective randomised study on the effect of maternal iron supplementation is being conducted. One pathophysiological mechanism in the development of gestational diabetes mellitus and its associated complications is oxidative stress and antioxidant intake. Laboratory studies on cultured muscle and liver cell lines have optimised protocols for the study of oxidative stress generated by high glucose concentration in the medium and the antioxidant effect of lyceum fruit, which will be extended to the study of a cytotrophoblast cell line established by local researchers. Current studies have also expanded to examine the placental adaptation and damage in diabetic pregnancy in form of changes in the expression of insulin degrading enzyme and the thioredoxin system, as well as the relationship between maternal inflammatory response and oxidative stress in diabetic pregnancies and the establishment of an in vitro model to explore the therapeutic potential of nutritional supplements as antioxidants to mitigate the complications of diabetes. Other aspects of management being studied include the role of Doppler studies in fetal monitoring, the relationship between glycaemic status and the metabolic changes in relationship to diet treatment. The mothers are also being followed up after delivery to determine the long term incidence of diabetes.

Study on the management of Pre-term labour in Singleton and Twin Pregnancies
The prediction and treatment of pre-term labour in singleton and twin pregnancies has been controversial. Retrospective studies on the epidemiology, and prospective studies on the cervical changes are being conducted. Twin pregnancy is associated with a higher risk of preterm labour when compared with singleton pregnancy. Various preventive measures have been suggested, including prophylactic hospitalization, bedrest, beta agonist, magnesium sulphate and cerclage. A recent study showed that prophylactic administration of vaginal progesterone suppository in high risk obstetric patients with singleton pregnancy could reduce the number of preterm birth before 34 weeks from 18.5% (placebo group) to 2.7% (progesterone group) (p<0.05). In this study, the effects of vaginal progesterone in twin pregnancy will be studied. Patients will be randomised into progesterone group and placebo group. The incidence of preterm birth and perinatal outcomes will then be compared.

Studies on trophoblast apoptosis and proliferation in normal and complicated pregnancies and the role of IGF and IGF-BP, oxidative stress and antioxidants
Placental growth and development determines the outcome of pregnancy. It has been found that the placental size is disproportionally enlarged in certain pregnancy complications, which suggested some form of placental adaptation. Apoptosis and proliferation in trophoblast are processes that regulate placental growth and remodelling. Studies on the inter-relationship among the rate of apoptosis and proliferation in placenta from complicated pregnancies, the expression of IGF and IGF-BPs, and the vascular indices in the fetal and placental circulations, with pregnancy outcome are being conducted. Current studies have extended to examine the effect of oxidative stress and antioxidants on placental apoptosis.

Hawthorne effect in Obstetrics
The incidence of birth trauma and birth asphyxia related to instrumental deliveries was high in 1998 & 1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence of birth trauma and birth asphyxia related to instrumental deliveries reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (BJOG 2003; 110: 319-22). It is now more than three years after the study. The incidence remained low in 2001, 2002 & 2003. We cannot always say that it is the Hawthorne effect. A number of confounding factors are present. The most striking one is the significant increase in the number of direct 2nd stage LSCS.

RR1= relative risk (95% CI) for post-study vs study period
RR2 = relative risk (95% CI) for post-study vs pre- study period

Fetal growth in pregnancies conceived after assisted reproduction
Studies have shown that the obstetric complications and pregnancy outcomes in women conceived after in vitro fertilization were different from those conceived spontaneously. There have been reports of an increased incidence of preterm labour and small for gestational age babies in pregnancies conceived after assisted reproduction. We have carried out a study to compare the fetal parameters and the levels of various biochemical markers pregnancies from natural conception and assisted reproduction. Preliminary result showed that the growth velocity for fetuses from assisted reproduction was comparable to that from natural conception. Further analysis is conducting for the biochemical markers.

Domestic violence in Chinese pregnant women (collaboration with Department of Nursing Studies)
Domestic violence against women is well recognized as an important health problem worldwide, resulting in injuries and other short and long term health consequences. We have formed a Domestic Harmony Study Group to study the effects of domestic violence on pregnant women and to find more effective ways to help them. In 1998, we performed the first study on the incidence of domestic violence in pregnant women in Hong Kong which was also the first study in a Chinese community. We found the nature of abuse in our culture was mainly verbal rather than physical as in the Western world. Verbal abuse can also be the warning sign of physical abuse or even a major family tragedy. Currently we are studying the effectiveness of various intervention models in reducing violence and improving the quality of life of victims identified during pregnancy. Our ultimate goal is to put forward routine screening of domestic violence in pregnancy and to establish an effective intervention model.

Studies on the relationship between placental size and ratio with placental inflammation and fetal status at birth
The placental size and ratio are increased in response to changes in maternal environment. One of the common factors that can influence both placental size and fetal status at birth is inflammatory reaction in the placental tissues as shown hsitologically by evidence of chorioamnionitis. Earlier studies have established some baseline values in normal term pregnancies, and currently the study is extended to those with clinical evidence of inflammation, to relate the cytokine levels with placental changes and fetal physiological function at the time of delivery.

Effect of a birth plan on the anxiety levels in Chinese pregnant women
Birth Plan is a documented plan that is made by the woman to select certain aspects of care during labour and their selection or wishes is being documented in a more structured manner. It had been widely used in foreign countries as it is believed that individualized care and feeling of control by the women during labour can be enhanced. We are investigating if there is any significant difference in the anxiety levels of the Hong Kong Chinese pregnant women in relation to the use of a birth plan. Basic demographic data, the presence of antenatal/postnatal complications and the pregnancy outcome will be obtained. All of these factors can affect the anxiety levels of the women.