DAHLIA - Deciphering maternal markers & pathology of late miscarriage
Research type
Research Study
Full title
Deciphering the antenatal signature and pathological placental lesions in second trimester miscarriage (DAHLIA - a proof of concept study)
IRAS ID
358903
Contact name
Andrea Woolner
Contact email
Sponsor organisation
University of Aberdeen
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Late miscarriage, defined as the death of a baby in the second trimester of pregnancy, at a time before a baby can survive outside the womb (and hence below the legal threshold defining stillbirth), is devastating. Often there is no warning, no explanation and there are often no means to prevent late miscarriage from happening again. The prevalence of second trimester miscarriage in the UK is between 0.7% and 3%1 thus affecting 1-3 in every 100 pregnancies.2 The cause is unknown in half of second trimester miscarriages.3 We know the placenta has a role in many adverse outcomes of later pregnancy such as pre-eclampsia, fetal growth restriction and stillbirth. But the role of the placenta in late miscarriage is much less studied. We know that women who have had a stillbirth or recurrent miscarriage are at increased risk of adverse pregnancy outcomes in subsequent pregnancies, but no high-quality studies exist on the effect of second trimester miscarriage on future pregnancy outcomes.3 In addition, couples after a third trimester pregnancy loss (a stillbirth) are offered specialist antenatal care in many hospitals, but there are no national guidelines to determine what care should be offered after a late miscarriage nor on any specialist antenatal care in a subsequent pregnancy.
This proof of concept study will determine feasibility of deciphering the antenatal signature of pregnancies which end in late miscarriage using maternal health records stored in the Aberdeen Maternity and Neonatal Databank (AMND) with linkage to and laboratory assessment of historical placental pathology tissue blocks taken for routine diagnostic work up. We will prospectively compare placental phenotypes from miscarried placentas to “normal” continuing placentas by using an established novel cohort of second trimester placental tissue from the SaFER 4 study. We will use data in the AMND to determine if there are particular maternal phenotypes associated with pathological placental lesions. This research will produce new insights on maternal risk factors and placental biomarkers for second trimester miscarriage through research employing data science and laboratory science. Due to the close relationship between placental structure and function, identifying how miscarried placentas differ in structure from a placenta from an ongoing pregnancy could be key to understanding how environmental, lifestyle and molecular changes affect the risk of late miscarriage. We will identify maternal factors associated with a higher risk of repeat loss and identify risk factors for developing placental pathology in the second trimester. The ultimate aim of this research is to identify aetiological factors which could be addressed in future to prevent late miscarriage and importantly, prevent recurrence of late miscarriage in couples who have already lost a baby.
REC name
East Midlands - Derby Research Ethics Committee
REC reference
26/EM/0023
Date of REC Opinion
20 Jan 2026
REC opinion
Favourable Opinion