Maternal and Fetal Medicine

Staff

• Dr. Mary H.Y. TANG
• Dr. C.P. LEE
• Dr. Noel W.M. SHEK
• Dr. Amelia P.W. HUI
• Dr. Anita S.Y. KAN
• Dr. K.W. CHEUNG
• Dr. Carman W.S. LAI
• Dr. Mimi T.Y. SETO
• Dr. Kelvin Y.K. Chan
• Ms Grace MA

Our division provides tertiary service of pre-pregnancy counselling, antenatal care, prenatal diagnosis and fetal intervention. Our unit is a recognized maternal fetal medicine subspecialist training center accredited by both the Royal College of Obstetricians and Gynaecologists and the Hong Kong College of Obstetricians and Gynaecologists. Our unit is an accredited baby friendly hospital by the Hong Kong Baby Friendly Hospital Initiative. Research mainly focuses on preventive medicine, strategies to improve pregnancy outcome, novel biomarkers to predict obstetric complications and advanced genetics. Multicenter multidisciplinary collaborations are actively ongoing.

1. Study on prevention of preterm birth in singleton and twin pregnancies

   Preterm birth (PTB) is a major challenge to perinatal health, which accounts for majority of perinatal deaths and long-term neurological disabilities. For singleton pregnancy, progesterone treatment is shown effective in prevention of preterm birth in women with asymptomatic short cervix or with history of preterm birth. However, a large proportion of preterm birth is still not preventable. Twin pregnancy is associated with a higher risk of PTB when compared to singleton pregnancy. Various strategies have been investigated for the prevention of PTB in twin pregnancy however, evidence so far does not reveal any beneficial effect of these treatments. Our team is current carrying out interventional study to identify the best approach to prevent preterm birth in singleton and twin pregnancies.

2. Prevention of hepatitis B immunoprophylaxis failure in Hong Kong

   Hepatitis B virus (HBV) infection is the commonest cause of chronic hepatitis which leads to significant morbidity and mortality. Interruption of mother-to-child transmission during pregnancy is a crucial step to begin HBV elimination. A prospective multicenter study carried out by our team which identified high viral load and HbeAg were determining factors for persistent HBV infection in newborn infants. Antiviral therapy for HBV women with high viral load is now suggested to reduce the risk of immunoprophylaxis failure in Hong Kong. Out team will continue to evaluate the impact of such strategy in infants’ HBV prevalence.

3. In-utero stem cell transplant for fetal haemoglobin Bart’s disease

   Alpha-thalassemia is common in Southern China. Fetal haemoglobin (Hb) Bart’s disease (alpha thalassemia major) is associated with severe fetal anaemia, hydrops fetalis, stillbirth and maternal pre-eclampsia. Previous local study estimated that 145 pregnancies were at risk of fetal Hb Bart’s disease annually. Fetal stem cell therapy has the potential to treat congenital genetic, haematologic and immune disorders. In-utero environment provides a potential window for stem cell therapy. Our team is planning for a clinical trial for in-utero haematopoietic stem cell transplant for treatment of fetal Hb Bart’s disease in parallel to the conventional serial in-utero transfusion.

4. Folate status and folic acid supplementation in pregnancy

   Folic acid supplementation is recommended in the periconception period to prevent neural tube defects and generally given throughout the pregnancy in women with thalassemia. Hong Kong does not have food fortification. Our team is currently conducting studies to determine the baseline folate status in pregnant women and those with thalassaemias, and to study the effect on various dosages of folic acid supplementation on antenatal anaemia.

5. Application of genomic technologies for prenatal diagnosis

   Conventional karyotyping had been in use for prenatal diagnosis of chromosomal abnormality for decades. Chromosomal microarray, also called molecular karyotyping, had the advantage of improving the diagnostic yield and turn-around time. Studies were conducted on the application of rapid aneuploidy detection by polymerase chain reaction followed by chromosomal microarray for prenatal diagnosis in Hong Kong. The cost-effectiveness of this algorithm for prenatal diagnosis in the local healthcare setting was demonstrated and led to implementation in the public hospital setting. Whole exome sequencing were also performed for fetuses with multi-system abnormalities to aid the genetic diagnosis of monogenic conditions. Ongoing work of using advanced molecular techniques like whole genome sequencing for delineation of breakpoints at single nucleotide level for balanced rearrangement demonstrated the analytical validity and clinical utility, to allow accurate and personalized disease risk prediction. This will continue to benefit patient care and genetic counselling.

6. Mother Infant Singing Program to Reduce Stress and Anxiety Level

   Stress and anxiety are not uncommon in postpartum period, particularly among breastfeeding mothers. We study the application of mother infant singing program to reduce stress and anxiety level in postpartum breastfeeding mothers. Measuring tools including DASS-21, HADs, PANAs are used. We hope to promote enjoyment in motherhood and to empower mother t build a positive mentality towards breastfeeding.

7. Effect of antenatal expression of breastmilk at term

   An interventional pilot study was done to assess the effect of antenatal expression of colostrum in terms of feasibility, safety and efficacy. The aim was to reduce non-medically indicated supplementation of formula milk. Hurdles of patients’ compliance to antenatal expression of breast milk program was identified.