Preterm Birth Committee Report

Lord Winston Excerpts

Friday 6th June 2025 Lords Chamber

[Lord Winston (Lab)]

My Lords, I pay tribute to my noble friend—to misuse the convention—Lord Patel, who, as usual, was an outstanding chairman, as he has so often been for the past inquiries with which I have been associated. I thank him very much indeed.

There is no point in making a treatment unless you can make a diagnosis, and the diagnosis must depend on the understanding of the cause. The problem, frankly, is that various causes have been postulated for over 40 years in this area. I will take a slightly different line, because, otherwise, I will only repeat what the report said and what will be said by others in this debate. I suggest that we need to link much more closely the loss of babies in the uterus well before term, in the early stages of pregnancy—namely, miscarriage—with preterm birth, because the causes are almost certainly related and important. I will discuss this in my short speech.

So many causes have been suggested: chromosome abnormality; changes in the DNA; different genetic predispositions; abnormalities of gene expression; hormone imbalances; metabolic problems; immune changes; molecules that affect implantation; the insufficiency of the placenta or afterbirth; anatomic abnormalities of the genital tract; failure of the eggs to mature properly; blood flow abnormalities; vaginal, oral, uterine and gut bacteria; and infections by either viruses or bacteria and parasitic infections. The fact is that it is very difficult to decipher where we are going with this research. I regret to say that much of the scientific evidence we have received has been rather confusing. The evidence has not been well focused, and we need to consider why that is the case.

There are also associations with the environmental factors that my noble friend Lord Patel mentioned, including pesticides; pollution; smoking; poor diet; alcohol; ingestive toxins; aberrant weight, such as obesity; male and female age; and, obviously, the link with infertility, which is the area in which I am particularly interested. We do not understand why it is more common in some animals than others. We know, for example, that it is not particularly common to lose pregnancies in primates. That seems to be associated with stress in primates and may be related to changes in family circumstances, particularly with the dominant male, which is quite interesting. I am not pretending to suggest that it is relevant here; the point is that it is just another example of why we are very much at a loss.

In 1987, I met a lady called Pamela, who had three preterm babies. They all died. She had one boy who died a few weeks after birth, in addition to the three who died before birth. She also had at least six miscarriages; she thought that she had had more, but she felt that the doctors were not regarding them as miscarriages. She had this constant problem. At one stage, her partner, not surprisingly, left her.

Pamela went on, finally, to deliver James. He was born premature and severely disabled at birth. It became obvious much later, when the medics came to look at him, that there was a genetic disease. The diagnosis of Lesch-Nyhan syndrome, a rare disease which usually affects boys but not girls, was finally diagnosed. Indeed, he was so disabled that he lived strapped in a wheelchair. He was not able to move his arms deliberately, because if he did, he would mutilate himself. Eventually his teeth were extracted because he was biting off his lips and tongue. That is the nature of that disease, which of course causes miscarriage.

After the diagnosis was made, we started to get very concerned about whether we could do some research to understand what was going on. We took three years to identify the diagnosis of Lesch-Nyhan syndrome in embryos. Two embryos were transferred at different stages, but Pamela did not get pregnant. Eventually, she had a normal baby, free of the disease, some four years after we started the research. Her NHS treatments, as noble Lords might imagine, were pretty costly. In fact, the costs of looking after that woman and her children were very considerable. Our research was not funded; in fact, we got our inadequate funding mostly by persuading women to cycle around the world on different bike rides. Those women raised huge sums of money because they felt very compassionately about the cause.

There are at least 23 million miscarriages annually, which means that about 44 pregnancies are lost every minute. The pool of single miscarriages is very high: over 15% of pregnancies are lost in this way. It is a massive medical problem, which is indeed linked to premature birth; sometimes it is a marker for premature birth. That is why we therefore have to consider these things together and why I am focusing on this in my speech today. If you add in premature births, you start to see the colossal consequences in handicap that we have seen, as well as the grave psychological problems that affect people. We need to consider this and ask: why is this happening?

When you look at world figures, it is very puzzling. In the studies of miscarriage, for example, prevalence varies across the world. You might expect it to be much more common in areas with poverty, but let us look at this in detail. Ethiopia is the country with the most serious miscarriage rate that I could find; it is about eight times more common there than it is in the United Kingdom, and the country is certainly very poor. It is also far more common in Guyana and Bolivia. In Eritrea and Zambia, miscarriage is quite prevalent, but in Malawi, which is perhaps the poorest African country of them all, the rate is actually not much dissimilar from that in Britain. That is very interesting, but quite unclear. It is clearly not related to the causes that we imagine are associated with poverty—poor nutrition, smoking and so on. There are a lot of other things going on.

There are many things that we could do which have not been mentioned here. One is this: we have to understand, and have much better recognition of, people who are going through miscarriage, with the proper recording of what is going on and, indeed, with much more investigation at the expense of the health service. I plead with my noble friend Lady Merron that she might see how we could do that. These investigations are not that expensive, but pathology should certainly be part of it. Unfortunately, that is often missed out. We do not look at the products of conception when the miscarriage occurs; they are just ignored. Women come out of hospital without any idea of what has happened, feeling absolutely desperate and bereaved.

It is worth bearing in mind that these women remember the date of the miscarriage years afterwards. They do not have a funeral and they do not have any recognition from other people of what they have gone through; they do not even tell people at work, because of course they cannot. They, along with their partners, have to suffer alone, and sometimes with the very serious problem of continuing infertility, blood loss, and generally feeling really unwell from having had an anaesthetic and an operation, having never been in hospital before for any serious disease. We have to recognise that this is so important.

We have a great opportunity here to do that which we do so well in Britain. We are extremely good at cohort studies. We have, among other things, one of the best examples in Biobank. Biobank is making a massive difference at the moment. If you take the world of ophthalmology, we now begin to understand that Biobank is giving us clues as to the causes of macular degeneration, which has a whole range of causes, just like infertility and other such things. We can now see specific genetic predispositions, which in the next few years is going to lead to much better treatment of this blindness, which prevents people being in work, for example.

I urge the Government to think about this, because this scientific research is much needed. There is a strange paradox here. In the data Bill, we have discussed science, but we have forgotten that science is often due to serendipity; it is not related to careful recognition. Looking at figures in the right way is serendipitous. It is very likely indeed that, if we did that properly, with proper data collection, we would end up with some very useful hypotheses. If we did that then we would be able to focus research on the areas that are most relevant, and we would make real progress in treatment.

This would be so much more than a blanket funding of lots of research. I do not think that that is what is needed. The research councils show that they have been funding up to 35% of grant applications, which is a very high number and much higher than in most other areas of medicine. What we need is much better research, and we need to do it if we are going to change the heartache and suffering, which is so often ignored, with totally healthy women going through this and being ignored. We need to do something about that. It would not mean masses of expense, but it would mean looking at how we do data collection in the NHS a bit better—which we can do—and trying to focus where we are going with better research, which, at the moment, is not in fact present.