18 December 2020, Singapore – Singapore’s three public hospitals offering maternity services - KK Women’s and Children’s Hospital (KKH), Singapore General Hospital (SGH) and the National University Hospital (NUH), have established a collaborative research network, Singapore Obstetrics and Gynaecology Research Network (SORN), to better synergise and promote high quality translational research. The aim is to improve health outcomes of future generations of women, children and families in Singapore.

Established in July 2020, SORN is the first obstetrics and gynaecology research network in Singapore, and was mooted by KKH, SGH, and NUH. The inaugural Chair at SORN is Professor Jerry Chan, Senior Consultant, Department of Reproductive Medicine, KKH, and Senior National Medical Research Council Clinician Scientist. He explains the need for SORN, “Under the SingHealth Duke-NUS OBGYN Academic Clinical Programme¹, KKH and SGH have been exchanging ideas and sharing resources to excel in academic medicine through research, education and clinical work. With NUH, the network is complete to take research and multi-centre trials to a higher level. SORN is unified towards improving health outcomes nationally, for women, children and their families.”

The network aims to achieve national-level goals to create more opportunities for multicentre clinical trials, enhance access to research grants, and facilitate high-impact research findings that can improve clinical practices, as well as enable the translation of research findings into clinical practice. Under SORN, KKH, SGH and NUH are working together on research in COVID-19, and common yet severe obstetrics and gynaecology conditions such as atypical endometrial hyperplasia (an overgrowth of abnormal cells causing a precancerous condition) and pre-eclampsia (high blood pressure during pregnancy).

Associate Professor Yong Tze Tein, Head and Senior Consultant, Department of Obstetrics and Gynaecology, SGH, said, “SGH’s O&G department always places the priority of our patients first. We are constantly looking for innovative ways to better our patient care. This new network will further enhance the research work we do, which forms the cornerstone of the department’s work. It will provide evidence on how to improve our current models of care, build on our strengths and make a difference to future generations of women and their families."

Associate Professor Mahesh Choolani, Head and Senior Consultant, Department of Obstetrics & Gynaecology, NUH, and Group Chief for Obstetrics & Gynaecology, National University Health System, said: “Over the years, NUH, KKH and SGH have each developed deep capabilities in obstetrics and gynaecology. The COVID-19 pandemic has brought us all closer, capitalising on each other’s strengths to look after women and children during this period. It is timely now for us to bring our individual strengths together and adopt a collaborative approach to advance translational research and find novel solutions for the pressing issues in obstetrics and gynaecology faced by women, children and families, as well as strengthen the obstetrics and gynaecology ecosystem in Singapore."

First research involving pregnant women with COVID-19 in Singapore

The first milestone achieved by SORN is the publication of a research involving 16 pregnant women with COVID-19 in Singapore². Through this study, SORN members set out to evaluate the outcomes in this group of women to determine risk factors for severe maternal disease and mother-to-baby infection in the womb due to global concerns over mother-to-baby transmission of COVID-19.

Recently published in the journal Annals of the Academy of Medicine, Singapore, the study tracked the clinical course and outcomes of 16 pregnant women from 23 to 36 years of age, infected with COVID-19 in all three trimesters of pregnancy, between 15 March 2020 and 22 August 2020. The study results were reassuring. The authors of the study concluded that while most pregnant women with COVID-19 were mildly infected, severe COVID-19 could occur in older pregnant women with high body mass index (BMI). All infected patients in the study made a full recovery. This demonstrates that the incidence and severity of COVID-19 among pregnant women parallels general population trends, and that the majority of patients will recover from COVID-19. The study also found no evidence of vertical transmission of COVID-19 from mother to baby in this group of patients.

In summary, among 16 patients seen at all four public healthcare institutions – KKH, SGH, NUH, and National Centre for Infectious Diseases:

• 37.5 per cent, 43.8 per cent and 18.7 per cent of the patients were infected in the first, second and third trimesters of pregnancy respectively.
• To-date, five women had delivered at term and displayed both maternal and neonatal immunity to SARS-CoV-2 at birth, with no evidence of viral transmission from mother to baby.
• Two pregnant women had severe pneumonia, and two experienced pregnancy loss.
• One pregnant woman required transfer to an intensive care unit for supplemental oxygen support.
  

As the joint senior author of the study, Professor Jerry Chan and co-authors are glad that their findings are reassuring, and show no vertical transmission between mother and baby, and that pregnant women with COVID-19 recover well. The low number of pregnant women infected with COVID-19 is reflective of the low community transmission rate in Singapore, thanks to government measures against COVID-19. However, communities with higher transmission rates may report more aggressive disease progression in pregnant women. To some extent, this suggests that severe complications and deaths in pregnant women reflect the effectiveness of community containment.

This COVID-19 study is an example of how generations of women and families in Singapore will benefit from SORN’s future work, and results. As COVID-19 is expected to continue beyond this year, healthcare professionals providing maternity care will need to continue to maintain vigilance in managing labour and delivery. Therefore, members of SORN will continue to study evolving maternal risk factors, severe infection, and mother-to-baby infection in the womb, related to COVID-19.

¹ Clinicians from KKH and SGH are part of the SingHealth Duke-NUS OBGYN Academic Clinical Programme which aims to be a leading academic medical centre of excellence in Obstetrics and Gynaecology through clinical initiatives, education, research and collaboration to improve women’s health and well-being.

² Mattar et al., Pregnancy outcomes in COVID-19: A prospective cohort study in Singapore. Annals Academy of Medicine Singapore 2020;49(11):857-869. https://doi.org/10.47102/annalsacadmedsg. 2020437