The Women’s Health Research Institute (WHRI) is very pleased to congratulate the recipients of the 2024 Women’s Health Research Institute Catalyst Grants. This competition was funded thanks to the dedicated support of the BC Women’s Health Foundation. One of the ten awards is related to capacity-building funds provided by CIHR’s Sex and Gender Science Chair Program and will support a biomedical health research project involving investigations in female animals. Two of the ten awards are related to funding provided to the BC Women’s Health Foundation by the Diamond Foundation and will support research projects focused on breast health.
This grant competition provides support for pilot studies in women’s and newborn’s health, which aim to generate preliminary data; test new approaches, methodologies or tools; bring new teams together; and/or support new research in women’s and newborn’s health from established researchers.
This competition has two applicant streams which are evaluated separately from one another: the Academic Researcher stream and the Clinician-Investigator stream. The WHRI typically funds three awards for each of the two main applicant streams for this competition. However, this year, there was a two-way tie for one of the three top-ranked applications in the Clinician Investigator steam. With the generous support of the BC Women’s Health Foundation, the WHRI has been able to fund four awards in the Clinician Investigator stream for this year’s competition.
Academic Researcher Stream Recipients
PROJECT TITLE:
Comparing Adverse Maternal and Fetal Outcomes in Women with Multiple Previous Cesarean and Vaginal Deliveries
PRINCIPAL INVESTIGATOR:
Sarka Lisonkova, Associate Professor, Department of Obstetrics & Gynaecology, University of British Columbia
CO-INVESTIGATORS:
Kenneth Lim, Janet Lyons, Sofia Nicolls, Yasser Sabr, Julianne van Schalkvyk and Marianne Vidler
SUMMARY:
British Columbia (BC) has experienced a surge in cesarean delivery rates, reaching 37.8% in 2020/21, the highest rate in Canada. Prior studies have shown inconsistent results concerning various risks associated with repeat cesarean vs. vaginal delivery and trial of labor after cesarean (TOLAC). In particular, little research has explored how adverse birth outcomes change with increasing parity, especially in women with three and more previous cesarean deliveries. This study aims to compare adverse maternal and fetal outcomes, e.g., uterine rupture and infant birth trauma, among women with prior cesarean and vaginal deliveries, stratified by parity. We will further examine adverse outcomes following TOLAC. Our retrospective cohort study will draw data from the Perinatal Database Registry (BCPDR), including all BC births from 2004/05 to 2023/24, and providing comprehensive information on maternal risk factors and pregnancy outcomes. Preliminary data from 2011/12-2020/21 showed that 1753 women had three prior cesarean deliveries and 305 had four or more previous cesareans, indicating adequate statistical power for our study period. Modified Poisson regression will be used to estimate adjusted rate ratios of adverse outcomes. Our research findings will provide crucial insights into family planning considerations for women with a history of prior cesarean, particularly for those facing barriers to contraception due to religious or other reasons. If successful, this catalyst grant will lead to a broader pan-Canadian study investigating the effects of various medical indications for prior cesarean delivery on future pregnancies.
PROJECT TITLE:
Characterizing energy expenditure and dietary requirements in individuals with endometriosis
PRINCIPAL INVESTIGATOR:
Sarah Purcell, Assistant Professor, Division of Endocrinology & Metabolism, Department of Medicine, Southern Medical Program, University of British Columbia
CO-INVESTIGATORS:
Bernard Crespi, Jerilynn Prior, Paul Yong and Michael Chen
SUMMARY:
Endometriosis is a common condition in people with ovaries and can cause severe menstrual cramps, abdominal pain, and digestive issues. Some aspects of endometriosis such like altered inflammation, hormones, body composition (muscle and fat), and physical activity may also influence how much energy our body uses (‘energy metabolism’). Energy metabolism informs how much food we need to eat. Thus, current ‘one–size-fits-all’ energy needs guidelines may not be ideal for people with endometriosis. Surprisingly, no studies have looked at energy metabolism in people with endometriosis, which means we do not have the information needed to give proper nutrition advice to this group. Our research will fill this knowledge gap by 1) examining energy metabolism in people with endometriosis compared to current guidelines for healthy people, 2) comparing energy metabolism in people with and without endometriosis, and 3) exploring factors like body composition and hormones that may affect energy metabolism in people with endometriosis. To do this, we will measure energy metabolism using non-invasive techniques in a subset of participants from a larger study. We will compare energy metabolism from people with endometriosis to that from healthy people in an existing database and collect information about inflammation, hormones, and body composition. This study will provide new insights into energy balance in people with endometriosis and help create personalized dietary and symptom management strategies for this population.
PROJECT TITLE:
Interviewing the implementors to close the injury prevention knowledge-practice gap in girls community soccer
PRINCIPAL INVESTIGATOR:
Allison Ezzat, Clinical Assistant Professor, Department of Physical Therapy, University of British Columbia; Implementation Scientist, BC Injury Research and Prevention Unit
CO-INVESTIGATORS:
Christian Barton, Shelina Babul, Michelle Bauer, Anthony Cooper, Harpreet Chhina, Jennifer Keefer and Cole Hogarth
SUMMARY:
Soccer is a popular sport for girls, but injuries are common. Injury prevention programs done as part of a warm-up, can prevent 2 out of 3 injuries, but these programs are not commonly done by girls soccer teams on a regular basis. This study will explore, combine, and merge the knowledge and lived experiences of sport injury prevention experts about the challenges, successes, and future recommendations for developing and using injury prevention programs in girls soccer. A sample of experts (academics and physiotherapists) who have worked with injury prevention programs in girls ball sports will be recruited. We will aim for diverse participants by gender, age, location, and type/level of program (professional vs. amateur). We will conduct 26 one-on-one interviews over Zoom; each interview will be audio-recorded and transcribed. Each transcript will be reviewed by multiple readers, coded to identify meaningful information, which will then be discussed by the research group to identify themes. Two community members (physiotherapists) will provide their thoughts on the findings. NVIVO software will manage data. This will be the first qualitative study to bring together injury prevention experts lived experience in program design and program use. It will allow us to make recommendations for injury prevention program content and new strategies to increase the use of effective injury prevention programs in girls’ soccer.
Clinician-Investigator Stream Recipients
PROJECT TITLE:
EndoEducate: Development of an Endometriosis Pain Neuroscience Education Program
PRINCIPAL INVESTIGATOR:
Catherine Allaire, Clinical Professor and Head, Division of Gynaecologic Specialities, Department of Obstetrics and Gynecology, University of British Columbia; Medical Director, BC Women’s Centre for Pelvic Pain and Endometriosis, BC Women’s Hospital + Health Centre
CO-INVESTIGATORS:
Rebecca Weaver, Heather Noga, Natasha Orr, Ria Nishikawara, Fuchsia Howard, Katherine Penfold, Erin Fernie, Navneet Gill and Paul Yong
SUMMARY:
Affecting over 2 million people in Canada, endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, causing severe pelvic pain. Treatment for endometriosis includes hormonal medication and surgical removal of the endometriosis, yet pain can persist. The BC Women’s Centre for Pelvic Pain and Endometriosis, a tertiary centre for endometriosis and pelvic pain, offers a multidisciplinary treatment plan, including medical management, surgical management, physiotherapy, counselling, and a pain neuroscience workshop. Pain neuroscience education has been shown to be an important part of the treatment plan, but the current workshop is not based on the most recent evidence and is not in an interactive, accessible format. This project aims to 1) revitalize the current pain neuroscience workshop to create a scalable, evidence-based, interactive program for people with endometriosis and pelvic pain, and 2) evaluate the feasibility and acceptability of the program among people with endometriosis and endometriosis care providers. This project will develop evidence-based, culturally safe, and engaging resources that will educate people with endometriosis about their pain; ultimately empowering them to take control of their pain and improve their quality of life.
PROJECT TITLE:
Recurrent Pregnancy Loss: Prospective patient registry (ProRPL Registry), predictors, and outcomes
PRINCIPAL INVESTIGATOR:
Mohamed Bedaiwy, Professor and Division Head, Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynaecology, University of British Columbia
CO-INVESTIGATORS:
Paul Yong
SUMMARY:
If an individual experiences ≥2 pregnancy losses before 24 weeks’ gestation, it is called recurrent pregnancy loss (RPL). Even with thorough testing, the RPL cause remains unknown in half of cases, leading to treatments that aren’t backed by scientific evidence. That’s why we need a better way to identify the causes of RPL. Pregnancy loss can be identified through ultrasound or tissue examination (VPL) or may go unnoticed (NVPL). NVPL includes biochemical pregnancy loss (BCL) and pregnancy of unknown location. Though often overlooked, NVPLs may impact future pregnancies like VPLs. More research is needed to confirm this. Our goal is to enhance RPL care and advance its research. To do so, we started a prospective RPL database and a registry (ProRPL Registry) to collect long-term information from those who were cared for at BC Women’s Hospital. We’ll use this information to achieve two aims. First, we’ll look at the success of a new way to find the cause of RPL. This method adds genetic testing of tissue from lost pregnancies to the RPL workup, which usually doesn’t include this testing. Second, we will compare the RPL causes and outcomes between patients with only BCLs and those with at least one VPL with normal number of chromosomes. This project is expected to improve care for individuals with RPL by finding a better way to diagnose its cause and helping patients with BCLs better understand their future pregnancy outcomes. Plus, the ProRPL Registry will be a valuable resource for researchers nationwide.
PROJECT TITLE:
Term Premature Rupture of Membranes (TPROM): Does timing of induction of labor impact maternal and newborn infectious outcomes?
PRINCIPAL INVESTIGATOR:
Julie van Schalkwyk, Clinical Professor, Division of Gynaecologic Specialties, Department of Obstetrics and Gynaecology, University of British Columbia; Site Head, Obstetrics & Gynecology, BC Women’s Hospital & Health Centre
CO-INVESTIGATORS:
Sarka Lisonkova, Janet Lyons and Kenneth Lim
SUMMARY:
Rupture of fetal membranes prior to the onset of labor after 37 weeks’ gestation (TPROM) affects approximately 10% of pregnancies. Prolonged TPROM increases the risk of maternal and fetal infection; for instance, the rates of chorioamnionitis increase from 4% to approximately 9% when labor induction is delayed beyond 24 hours. Current evidence-based best practice is to offer labour induction at the time of presentation to hospital with TPROM, however this is not always possible. Approximately 700 cases of TPROM occur annually at BC Women’s Hospital (BCWH). Preliminary data indicate that the majority of women deliver spontaneously within 24 hours of TPROM, however, up to 20% may experience delays. Our study aims to assess the impact of this practice on birth outcomes among mothers and their newborns. We will examine the association between various maternal risk factors, duration from TPROM to delivery and adverse birth outcomes, including operative delivery, fever during labor, chorioamnionitis, sepsis, endometritis, surgical site infection and neonatal sepsis. Data on all term births will be obtained from BC Perinatal Database Registry (BCPDR) for years 2004/05 to 2023/24. BCPDR provides comprehensive information on maternal and delivery characteristics and birth outcomes. The study will add to the existing literature related to birth outcomes following TPROM and establish best practices for the care of pregnant women in British Columbia.
PROJECT TITLE:
Assessing the Effectiveness of Cerebroplacental Ratio Measurement for Monitoring Post-Dates Pregnancies: A Pilot Study
PRINCIPAL INVESTIGATOR:
Yasser Sabr, Clinical Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia; Lead, Skidmore Goodman Perinatal Research IMaging and Evaluation Centre, BC Women’s Hospital + Health Centre
CO-INVESTIGATORS:
Sarka Lisonkova and Michelle Rougerie
SUMMARY:
There is a gap in the monitoring of pregnancies that extend beyond 40 weeks, known as post-dates pregnancies. Current fetal assessment methods, such as non-stress tests (NST) and amniotic fluid index (AFI), may not provide sufficient information to predict complications. These pregnancies are associated with increased risks for both the mother and fetus, highlighting the need for more reliable monitoring tools. Our study aims to evaluate the cerebroplacental ratio (CPR), a Doppler ultrasound measurement of blood flow between the fetus’s brain and placenta, as a potential predictor of adverse outcomes in post-dates pregnancies. While CPR has demonstrated value in high-risk pregnancies, its role in managing post-dates pregnancies remains underexplored. We will recruit 100 women with pregnancies exceeding 40 weeks of gestation. These participants will undergo weekly assessments until delivery, during which CPR measurements will be taken alongside routine NST and AFI evaluations. By comparing the predictive accuracy of CPR with current standard methods, we aim to determine whether CPR can serve as a more effective tool for identifying at-risk fetuses and improving clinical decision-making in post-dates pregnancies.
Biomedical Project Involving Investigations in Female Animals Recipient
PROJECT TITLE:
Optimizing pertussis immunization in pregnancy – a combined experimental and modelling approach
PRINCIPAL INVESTIGATOR:
Manish Sadarangani, Associate Professor, Department of Pediatrics, University of British Columbia
CO-INVESTIGATORS:
Daniel Coombs and Jonah Hall
SUMMARY:
This study aims to find the best schedule for whooping cough (pertussis) vaccinations in pregnant women and their babies. Whooping cough is a serious lung infection caused by a bacterium, Bordetella pertussis, and is especially dangerous for newborns and young infants. Even though there are effective vaccines, there has been an increase in cases in Canada this year. Past research showed that vaccinating pregnant women can reduce how well their babies’ immune systems respond to the vaccine. Using mathematical models, scientists tested millions of possible vaccination schedules to find the best timing for vaccines during pregnancy and infancy. Their model suggests that giving the vaccine earlier in pregnancy and later to babies may give better protection. This study will compare the immune responses to the new schedule and the standard schedule by measuring antibodies. The results from this mouse model will help plan a future clinical trial, aiming to improve how well the vaccine works for mothers and their babies.
Breast Health Research Project Recipients
PROJECT TITLE:
Identifying Barriers and Facilitators of the Cancer Rehabilitation and Exercise – Advanced Cancer (CaRE-AC) Program: Towards Enhanced Delivery through Resource Development
PRINCIPAL INVESTIGATOR:
Kelcey Bland, Postdoctoral Research Fellow, Department of Physical Therapy, University of British Columbia
CO-INVESTIGATORS:
Kristin Campbell and Helen McTaggart-Cowan
SUMMARY:
Living with metastatic breast cancer can significantly affect a person’s quality of life. Cancer treatments can lead to reduced physical function, making participation in daily activities more difficult. When cancer spreads in the body, it may also cause symptoms such as pain, further impacting a person’s physical function. Reduced physical function is especially distressing if it interferes with a person’s ability to work, spend time with others, or engage in activities they enjoy. Cancer rehabilitation is a specialized service designed to improve physical function and quality of life. Yet, not enough women with metastatic cancer utilize these services, despite their increased potential need. The Cancer Rehabilitation and Exercise – Advanced Cancer (CaRE-AC) program is a nationally funded initiative designed to address existing gaps in advanced cancer care. CaRE-AC offers group–based exercise and patient education tailored for advanced cancer. To date, most CaRE-AC participants are women with metastatic breast cancer. The proposed project aims to ensure the ongoing success of CaRE-AC by identifying factors that hinder or support rehabilitation delivery from the perspectives of women with metastatic breast cancer who took part in the program and the healthcare providers involved in program referral, recruitment, and delivery. Feedback from patients and healthcare providers will also be used to develop and evaluate resources intended to train the next generation of individuals involved in delivering CaRE-AC. These practical resources will ensure the program is delivered as effectively as possible and is accessible to more women with metastatic breast cancer across BC and Canada.
PROJECT TITLE:
Development of a novel extracellular vesicle isolation platform for use as a non-invasive screening platform in early breast cancer detection
PRINCIPAL INVESTIGATOR:
Karla Williams, Associate Professor, Faculty of Pharmaceutical Sciences, University of British Columbia
CO-INVESTIGATORS:
None
SUMMARY:
One in eight women will be diagnosed with breast cancer within their lifetime. Of those diagnosed with breast cancer, approximately 20% will die from their disease. Detecting cancer at the earliest stage supports the best outcome for patients. It is well established that an early stage, Stage I, breast cancer diagnosis is associated with the highest rate of patient survival. However, even with the use of current screening strategies only ~40% of breast cancers are diagnosed at Stage I. Mammography screening has demonstrated benefit for women; however, it also results in a significant overdiagnosis and misdiagnosis. Thus, mammography does not always accurately detect cancer and can suggest that an individual is healthy when in-fact they have a tumor that is undetectable by mammography. This is because very small breast tumors are difficult to detect with common imaging techniques. What is needed is a blood-based test for non-invasive and precise breast cancer screening to improve the detection of clinically relevant disease at its earliest stage (Stage I). We propose that small particles, called extracellular vesicles (EVs), found in the blood can provide detailed information on an individual’s status of breast cancer or healthy. Breast cancer cells release numerous EVs into the blood. These EVs contain information about the breast cancer; thus, if we could isolate them we could learn about the protein content and identify breast cancer-specific biomarkers. Our proposed research will aim to develop a method to isolate EVs from blood for the identification of breast cancer biomarker.