Joining the dots through four generations
10 November 2020
A family connection to Mont Liggins that began in the 1960s is benefiting the latest great grandchild born this year.
When Olivia Rothwell’s waters broke at 33 weeks pregnant, she was called into hospital for antibiotics and a dose of antenatal corticosteroids to help prevent breathing problems in her baby who was coming early. Isla was born just 12 hours later, before the recommended second dose could be given, but breathing perfectly on her own and able to have skin-to-skin contact with Olivia straightaway.
Baby Isla had of course benefitted from Sir Graham ‘Mont’ Liggins’ 1972 discovery that steroids given to mums at risk of preterm birth could speed up lung maturation and reduce breathing difficulties in their babies. But it was only four days earlier that Olivia discovered baby Isla’s paternal grandfather played a key role in supporting Mont’s ground-breaking research. She’d been reading ‘Against All Odds’, her mother-in-law Jill Rothwell’s recently published book about her father’s escape to New Zealand from the horrors of Nazi-occupied Vienna in 1938, when she realised baby Isla’s great grandfather had been instrumental in the treatment she received.
Supplying the drugs for Mont’s research
Lewis Bieder, a practising doctor back in Vienna, married a fourth-generation Kiwi and made his home in Palmerston North where he worked as a gastroenterologist. He was appointed NZ Medical Director for the Kiwi company Glaxo (now Glaxo Smith Kline) where he had a long career in drug research.
It was the late 1960s when Mont Liggins first contacted him looking for the steroid medication he needed for his pregnancy trials. Realising the importance of the research, Lewis arranged with Glaxo to supply Mont with betamethasone for free.
In December 1969 Mont Liggins and Ross Howie began the clinical trial that, by its end in 1977, would involve more than 1,000 women. The participants were women expected to give birth at 24–36 weeks’ gestation. Each was given either betamethasone or a placebo, and unless delivery had already taken place, a second injection of the same substance 24 hours later. The initial results were compelling: the betamethasone-treated group had a far smaller number of deaths than the control group. We now know it’s because steroids speed up the development of a baby’s lungs, gut, cardiovascular and immune systems, which do not fully mature until after 36 weeks’ gestation. Today the administration of antenatal corticosteroids is a routine treatment world-wide for pregnant women at risk of giving birth before 35 weeks and thousands of babies have survived thanks to this Kiwi discovery.
Mont the obstetrician
When Lewis’s daughter Jill became pregnant, he asked for Mont to be her obstetrician. “He was a lovely obstetrician,” recalls Jill, “and he was obviously very fond of Dad because every time he came in he’d ask ‘how’s Lewis’ and I’d pass on messages between them”.
Jill’s first baby, Sam, was small for gestational age and Jill was in National Women’s for six weeks. “In those days, small for dates babies were treated with bedrest and it was terrible! I wasn’t allowed home, it was very strict.” Mont also delivered Jill’s second baby, Barnaby, now father to Isla.
Jill has fond memories of Mont and recalls him being very cool and calm. “He had a forestry block in Northland and he used to come in and his hands were black – ingrained with dirt from digging and planting trees," she says.
Paving the way for clinical trial participation
The day after baby Isla was born, the Liggins Institute DIAMOND Study team paid Olivia a visit to ask if she and Isla would like to be involved in a new clinical trial. The study is looking at different ways of providing nutritional support to preterm babies learning how to breastfeed. After Olivia agreed to take part, the link to Liggins clicked.
It was amazing timing having just read Jill’s book about Isla’s great grandfather and then receiving Mont’s treatment, and then joining a Liggins Institute study
Babies grow very fast in the last trimester of pregnancy, doubling their weight and tripling their brain development. In utero they receive all their nutrition from their mother, but we know very little about the nutrition they need if they’re born early, and how this can affect their brain growth and development. The DIAMOND Study is trying to find out whether the type of nutrition and the way it is provided can influence this, as well as investigating whether babies who get to smell and taste milk before a feed learn to breastfeed quicker.
“We didn’t need to think much about whether or not to take part in the study, knowing that Liggins was attached to it. It seemed like a fairly easy thing to do that would be a big help and have massive implications for others,” says Isla’s father, Barnaby, a University of Auckland alumnus.
So, baby Isla got to smell and taste her food before feeds. She also had an MRI scan shortly after she was born and another one when she was equivalent to full-term. She’ll also have developmental follow-ups until she’s two and a half to see how she tracks against others of a similar age. Compared to the experience of most new mums, “there’s not much you’re doing that would be different,” says Olivia.
Support every step of the way
Olivia and Barnaby have noticed a greater level of support from being involved in a clinical trial, with regular visits and updates from the study team. “The MRI was an extra level of information that was scary to hear about at first as Isla had a small brain haemorrhage, but the doctor reassured us that this is perfectly normal in preterm babies,” says Olivia. “I was a bit anxious that day, but the study team made sure all the specialists were available to talk about it if needed.”
Although it was a little overwhelming to be asked to participate in a trial just after having a preterm baby, Olivia and Barnaby are happy to be part of research that is trying to improve outcomes for babies. “It’s a bit full on right at the start being asked about being in a trial, but there’s absolutely no harm happening to your child, it’s just a different range of options being given,” says Olivia.
The steroids that helped Isla were trialled for a long time so if we can in a small way help future parents with preterm babies grow into strong, healthy kids then it’s pretty amazing to be a part of that.
The DIAMOND Study began recruiting participants in March 2017, and now has four sites in Auckland and one in Palmerston North. The team has recruited 364 of the target 528 babies, with just over 30% to go, and hope to finish at the end of 2021.