Dr Eduard Gratacós – Why health starts before birth

Dr Gratacos

Our research team at the University of Barcelona looks at identifying deviations in foetal brain development as early as possible to help prevent and/or minimise childhood disability.

Dr Eduard Gratacós explains his journey into research and why he believes that health starts before birth:

“I was trained in Obstetrics & Gynecology in the early 1990s. Soon after starting my medical residency, I found two new worlds I was not aware of, the fetus and research. Two discoveries that changed my ideas about what I wanted to be in my professional life.

Concerning fetal life, I had always thought that Obstetrics was just helping women to deliver. It struck me to realise that inside the mother there was the infinite world of another patient. Twenty-five years ago this concept was still quite new. Ultrasound had just revolutionised pregnancy follow-up. The mystery of what was happening inside the womb, hidden for all the history of medicine and humanity, was now becoming visible, and in real time! We were just in the beginning, but it was so amazing to think about the fetus as a patient, just as a child or an adult was. This notion impressed me so profoundly that I decided to dedicate my career to fetal medicine.

Research was my second discovery. During medical school, my ideas about me in the future were of a surgeon spending most of his day performing complicated operations. Just a few weeks after I became a resident, I started collaborating in research projects, and this quickly transformed the way I saw things. I suddenly realised that medicine existed thanks to research. The concept that you could create new knowledge that could eventually change the lives of people was amazing. It seems so obvious but you can study medicine for years and rarely think in these terms. Within a few months I was completely decided to dedicate my professional life to research.

So I ended up as a clinical researcher in fetal medicine. I first did my PhD in Barcelona and then moved to Belgium for a few years, where I had the privilege of joining one of the groups that pioneered fetal surgery in the world. When I came back to Spain in the early 2000’s I started a fetal medicine and surgery program. Over these years, we grew from a very small group of enthusiastic young people to a renowned international research centre with more than 75 people and one of the greatest scientific output in fetal medicine. I think our main findings can be summarised in one sentence: health starts before birth. The way our brain and heart will work during our lives is largely influenced by the life conditions in our mother’s womb. Pregnancy complications like preterm birth or fetal growth restriction may affect as much as one in ten pregnancies, and these fetuses and future children will be more prone to suffer neurodevelopmental and other health problems. We are looking for ways of reducing the burden of these pregnancy complications.

We have been supported by Cerebra for the last 13 years. We first demonstrated how children born preterm or with growth retardation had more neurodevelopmental problems. We later showed that ultrasound and magnetic resonance imaging were useful to understand how these problems occurred, and could help to identify those fetuses and babies at highest risk. Some of our research findings have been incorporated to current clinical practice. For instance, most medical societies recognise that brain Doppler must be used to identify and timely deliver fetuses with late-onset growth restriction. This change in clinical practice may benefit thousands of women in the UK, and hundreds of thousands in Europe and the world. In our current Cerebra research program we are investigating interventions that could protect the fetal brain and limit the consequences of brain injury. We also hope to demonstrate how maternal well-being is related with fetal and child neurodevelopment, and how we could provide tools to foster healthy brain development in utero.

Disease is part of nature. We as humans have the privilege and the capacity of investigating disease to understand it and trying to counter its effects on individuals. It may be hard for those suffering a disease to learn that research is so expensive and that it often takes a long time to achieve results that effectively improve things in “real life”. However, when we see where we are every ten years, we realise the impact of research. We must continue on this enterprise, for us and for the future generations.

Cerebra invests large amounts in promoting research and it does that in the most effective manner. With a policy of funding ambitious research programs for long periods, Cerebra allows researchers to undertake projects with a much higher chance of leading to real improvements. I think all Cerebra members, associates and supporters must be extremely proud and reassured that they are investing their money wisely and in a way that will change the life of many people in the future.

Cerebra has been with me for a substantial part of my research career, and I am extremely grateful and honoured for that. I hope that we can still do many important things together in the future. Thank you very much”.

Dr Gratacós is Professor of Obstetrics and Gynaecology and Director of the BCNatal national and international referral centre in Maternal Fetal Medicine.

This article is the latest in a series written by our Academic Chairs:


Book Review: The Girl with the Curly Hair

Our librarian Jan reviews The Girl with the Curly Hair, by Alis Rowe.

‘The Girl with the Curly Hair Asperger’s and Me’ by Alis Rowe

2013  Lonely Mind Books
ISBN  9780956269324

This book is a real insight into what life is like with Asperger’s. Particularly for a girl with Asperger’s, as many of the typical Aspie traits seen in boys aren’t necessarily there in girls. Alis, the author finally got a diagnosis when she was in her twenties. She writes very candidly about school life, home life and social life and gives tips for friends and family to help them see things how an Aspie sees them. There are also sections on hypermobility, hypersensitivity and co-ordination issues, which so often go hand in hand with having an autism spectrum disorder.  This is such an accessible book, you feel you are having a conversation directly with the author. It would be particularly good for parents and other relatives to read.

Other books in the ‘Girl with the Curly Hair’ series that we have in the library

Asperger’s Syndrome in 5-8 Year Olds

ISBN 9781512034950

Written for the parents and teachers of children with Asperger’s. Using a series of cartoons this book explains how an Aspie feels in everyday situations. This one covering 5 to 8 year olds looks at play, feelings, friendships and life at home.

Asperger’s Syndrome in 8 – 11 Year Olds

ISBN 9781511611893

This one is the next in the series and covers children with Asperger’s as they develop. This book focuses on behaviours, like anxiety and how to understand how it feels from the child’s perspective. Great for parents, other relatives and friends and ideal for the child to read themselves.

The 1st Comic Book

ISBN 9780956269317

This one is new in the library and explains social situations going into adulthood. It explains how everyday situations feel quite different to a person with Asperger’s compared to a person who is neurotypical.

You can find out more about The Curly Hair Project on their website http://thegirlwiththecurlyhair.co.uk/ The Project has been set up to help girls and women with Asperger’s. They are a social enterprise offering things like workshops, a bookshop and ASD training for teachers and NHS staff. There is also an online blog that you can subscribe to.

To borrow any of these books contact Jan on janetp@cerebra.org.uk or 01267 244203.

Nicola’s Story

Nicola and Alfie

We meet Nicola Tilson, our newest charity Ambassador.

“Hello, my name’s Nicola. I’m mum to two very beautiful boys, Sam, aged 10 and Alfie, who’s 4. I’m married to Lee and we live in Yorkshire with our chocolate Labrador, Honey.

Our youngest son, Alfie was born with a rare genetic condition called HHT (hereditary haemorragic telangiectasia). It’s a condition that can cause abnormal connections between arteries and veins and it can present differently from person to person. Unfortunately, Alfie became very poorly at 6 weeks old when they found he had a very rare complication of HHT. He had something called AV Fistula in the right side of his brain which had created a very large and fragile aneurysm (a sack of blood).

Alfie was taken to Great Ormond Street Hospital to undergo a life saving procedure but suffered bleeding on his brain. He spent almost a month in intensive care. Initially we were were told it was unlikely he’d make it and, if he did, he would suffer from severe disabilities.  Despite this, Alfie held on and when he was eventually woken up from his induced coma his recovery was remarkable.  Alfie went on to have this procedure a further four times before they could fully close off the blood through this AVM. All of this before he turned two.

Alfie and Sam

Amazingly Alfie’s development was truly wonderful, he hit all milestones early or on time and I think we all let out a deep breath after what had been a very frightening two years.  But at  2 1/2, Alfie started to regress. All the language he had learnt and used he seemed to lose,  he was reluctant to talk and he drifted off into his own world. It was a very worrying time and it seemed to take so long to get the answers we desperately wanted.

He was diagnosed with autism just before his 4th birthday,  I remember the lady giving us a big folder full of information and then off we went.  I didn’t understand autism, I didn’t know any one with autism,  I only knew what I thought I knew which turned out to be all wrong.  I would spend hours when the children were in bed reading and researching as much as I could on everything and anything autism related, hoping something would click, something I could use to bring Alfie back to us.

On a piece of paper in the pack was a website address for Cerebra. It didn’t say anything else but I thought I’d take a look.  I’m so glad that I did.  We were put in touch with Laura, Cerebra’s Regional Officer in our area. Initially her visit was to help us complete some forms but she did so much more.  She signposted support in the community, recommended sites where I could find sensory activities for Alfie and then pointed us in the direction of ABA (applied behavioural analysis).  She even loaned me her own personal book.

Laura, Sam and Alfie

Laura was so informed and understood us completely.  I was really lost and Laura helped me make sense of everything. Within a week of Laura’s visit, Alfie was asking me to play with him-this was huge! He had stopped doing this, preferring his own company.  One year on and I’m still in touch with Laura. She has helped us with understanding his education rights and the EHCP process and much more.  I tell everyone about Laura and Cerebra and just the massive difference she made to our lives.  I will be forever grateful.  Alfie still has struggles but is making massive progress every day.  He plays with me, his Dad and his big brother. His speech is improving and he is just much more involved in school and in home life. He is an absolute joy.

I started fundraising for Cerebra as a way of saying thank you. I made reindeer food at Christmas, organised book sales and raffles and have found homes for collection boxes. My family have also started trying to help with my sister and aunty both raising funds. I’m now looking forward to my new ambassador role and to finding new opportunities to raise funds and spread the word about the good work of Cerebra.”

Cerebra has a team of ambassadors, made up of parents, carers and professionals, who are passionate supporters of our work. If you’d like to become an Ambassador for us please get in touch with elainec@cerebra.org.uk