The Hunt for a Blood Test to Reduce the Risk of Stillbirth

June 28, 2021
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Fetuses’ that are growth restricted are at increased risk of stillbirth. Unfortunately, the clinical tools currently used to detect small babies perform modestly.

We are undertaking a large research program to discover new molecules in the mum’s blood that could flag babies that are growth restricted, and at risk of stillbirth. We hope to generate a new clinical test that can reduce rates of stillbirth across the globe.

Tong photoProfessor Stephen Tong is an academic OB/GYN based in Melbourne. He received his education at Monash University in Melbourne, Victoria, Australia.  He is Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynecologists.  He is currently Professor of Obstetrics and Gynaecology, University of Melbourne and Consultant Obstetrician, Mercy Hospital for Women in Heidelberg, Victoria, Australia.

Over the past decade he has led the translation of new treatment for ectopic pregnancy and preeclampsia, from laboratory concept to phase I-III clinical trials running across many countries (from South Africa, UK to New Zealand). He also leads a program of research that is hunting for a new blood test that may help women avoid a stillbirth.

Professor Tong has disclosed that she does not have any real or perceived conflicts of interest in making this presentation.

This presentation was part of the Stillbirth Summit 2021.   This individual lecture will be awarded .75 hours of continuing education credit to include viewing the lecture and completing evaluation and post-test.  Once received a certificate will be emailed to the address you provide in the post-test.  If you did not register for the Summit WITH Continuing Education, you can purchase the continuing education by clicking here.  This purchase will provide you access to all Stillbirth Summit 2021 lectures including continuing education credit. There is no charge for viewing the presentation.

To receive continuing education credit for this lecture, the participant must complete the evaluation and post-test.

Please feel free to ask questions of the presenter.  We will obtain their answers/comments and provide them here as received.  


Where does this 10% SGA cutoff line come from? Should we be looking at each individual baby’s growth curves and flagging when s/he falls off them, even when they are a “large” baby?

Dr. Tong’s reply:
We absolutely agree 10% birthweight cut-off is not perfect. It will capture some babies that are not growth restricted. Conversely (as the questions rightly notes), it may miss some cases of growth restricted babies that have been falling in growth but did not fall below the 10% centile threshold .
However, we think it is still a very good ‘tangible’ line in the sand we can pragmatically focus on to develop a test.

Dr Tong’s reply (continued):
– We think <10th centile birthweight threshold still captures a majority of growth restricted fetuses’.
- It has been shown in many populations that this is associated with a 3-4 fold increased stillbirth risk. Hence, it is a highly relevant cut-off.
- The Gardosi paper (BMJ 2013) famously showed identifying fetuses <10th centile and actively managing them seemed to have the risk of stillbirth (compared to cases of SGA that were not identified at all).

I would also add that we are looking at 5th centile threshold as well (this cut-off will enrich cases of severe fetal growth restriction, although it will also miss a few cases that are at the 5-10th centile).

Annie Kearns
Have you looked at SPINT in conjunction with other biomarkers (PAPP-A, MSAFP etc) to see if using them all together may be an even better predictor for individual perinatal outcomes?

Dr. Tong’s reply:
We most certainly have – our current obsession!

We have screened hundreds of proteins (including PAPPA but not MSAFP as yet) and we have used sophisticated modelling to see whether combining them offers superior performance to SPINT1 alone.

While some biomarker combinations have lifted the performance of SPINT1 a little (an example was presented), it has been remarkable (and annoying) that nothing has been able to substantially improve its performance (and nothing has proved remotely as good).

Our large team continues to hunt for other markers to add to SPINT1.

Dr. Jolly’s reply:

It is still some distance from the market. But we are keen on developing it as a commercial test. On this note, we have developed our own in house diagnostic test and we have found a great commercial partner to do it (see disclosure slide).

Our strategy before bringing it to market is:
– Spend another year or two hunting for other markers, and to combine them with SPINT1 to find the best performing combination. (Even if we can’t find something that improves on SPINT1 along, it is possible the current performance may be clinically acceptable – it’s already far better than the tape measure)
– Make the assay as perfect as possible. We are using some scientific techniques to try to improve the performance of SPINT1 alone (ultrasensitive ELISA methods).

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