Professor Shakila Thangaratinam MRCOG, MD, PhD

Professor Shakila Thangaratinam

Institute of Metabolism and Systems Research
Professor of Maternal and Perinatal Health
Joint Director of WHO Collaborating Centre for Global Women's Health
Theme Lead Maternal and Reproductive Health & IMSR Deputy Director

Contact details

Address
WHO Collaborating Centre for Women's Health
Institute of Translational Medicine
Heritage Building
Mindelsohn Way
B15 2TH

Shakila Thangaratinam is a professor of maternal and perinatal health at University of Birmingham. As Consultant Obstetrician she is involved in the care of high-risk mothers at Birmingham Women’s and Children’s NHS Foundation Trust.  

Professor Thangaratinam has established a strong portfolio of research in maternal and perinatal health. Her work focuses on prediction, prevention and treatment of complications in mothers with pre-eclampsia, epilepsy, diabetes, and obesity. Her publications include papers in high-impact journals such as the Lancet and the BMJ, and she has accrued research income of £9 million. She leads the International Weight Management in Pregnancy (i-WIP) collaborative group (40 researchers, 16 countries), with the largest live repository of individual data of over 30,000 participants (BMJ 2017). The findings of this work informed the UK Chief Medical Officers’ recommendations on physical activity in pregnancy. She leads the prediction of pre-eclampsia IPPIC (International Prediction of Complications in Pregnancy) collaborative network (73 collaborators, 21 countries), one of the largest global repositories of standardised Individual Participant Data (IPD) of over five million pregnancies. She has published in first or last author position in Lancet (2019, 2015, 2012), BMJ (2017, 2016, 2012, 2011), Lancet Global Health (2017), HTA monographs (2018, 2017, 2017, 2012).

Shakila has launched a project with the World Health Organization (WHO) offering insight into COVID-19's global effects on pregnancy. The PregCOV-19 project, led by the WHO Collaborating Centre for Global Women’s Health at University of Birmingham, aims to evaluate the rapidly emerging evidence on maternal and offspring outcomes and risks in women with suspected or confirmed COVID-19.

Shakila is also taking part in online workshops aimed at improving the care of pregnant women during the current COVID-19 pandemic, particularly in low- and middle-countries with international women’s health charity Elly.

Qualifications

Medical School                   

MBBS        1996 (Dr MGR Medical University, Chennai, India)

Postgraduate qualification  

MD             1999 (Dr MGR Medical University, Chennai, India)

MRCOG     2003

CCT            2010

PhD            2011 (University of Birmingham)

Biography

Professor Thangaratinam started her research career as a Clinical Research Fellow at Keele University in 2004, and subsequently joined University of Birmingham in 2006 as a Clinical Lecturer in Obstetrics and Gynaecology. In 2011, she was awarded a PhD in ‘Health Technology Assessments in Maternal and Perinatal Health’.

After the completion of her clinical and academic training, she was appointed by Queen Mary University of London (QMUL) to the post of Clinical Senior Lecturer in 2011, and was a full professor at QMUL between 2012-2019. She established the research support network,  Katherine Twining Network (9 NHS hospitals, 3 Universities) in North and East London to deliver women’s health research, and Katie’s Team, the only dedicated and funded Patient and Public Involvement group for Women’s Health in the UK. As R and D Director for Women’s Health at Barts Health NHS Trust until 2019, she was instrumental in integrating research within everyday clinical practice. She was the joint Director of Barts Research Centre for Women’s Health (BARC) and undertook cutting-edge research on the problems facing women and children in East London.

She currently leads a portfolio of work in Women’s Health in areas such metabolic disorders in pregnancy (obesity, gestational diabetes), epilepsy, pre-eclampsia, stillbirth, fetal growth, and preterm birth. She co-leads the WHO Collaborating Centre for Women’s Health at University of Birmingham.

Clinical

She completed her Advanced Training in Specialist Medicine (ATSM) modules in maternal medicine, labour ward management and medical education, and completed her Core Training (CCT) in obstetrics and gynaecology in August 2010 at the Birmingham Women’s Hospital, the largest and busiest tertiary obstetric unit in West Midlands. Her academic work complemented her interest in maternal medicine with projects in pre eclampsia and epilepsy.

She is an Honorary Consultant at Birmingham Women’s and Children’s NHS Foundation Trust.

Teaching

Research support for full time clinicians

Under Professor Thangaratinam’s supervision, 10 clinical trainees and 6 NHS Consultants in obstetrics, obstetric anaesthesia, dietetics, endocrinology, neurology and neonatology departments in Barts Health published papers during their time with her.

She helped to improve the evidence based skills of clinicians through the Critical Appraisal of a Topic (CAT) journal club sessions. Here are some of the results of the evaluation of the CAT club:   88.9% stated CAT definitely improved their critical appraisal skills; 77.8% stated they would definitely recommend CAT club to a friend or colleague. The CAT training was used 54.5% of the time for direct patient care and teaching and presenting, and 36.4% changed patient care in choice of drugs or other treatments.

She engages undergraduate students in research and offers research governance training. Over 10 students have recruited in trials, and co-authored 5 papers.

She has experience of being the lead for NIHR academic trainee appointment in Women’s Health

Postgraduate supervision

Professor Thangaratinam’s trainees have obtained prestigious fellowships from the Wellcome Trust and the NIHR.

Completed

PhD     B Wattar - (2013-2017) - Improving health outcomes for pregnant women with metabolic risk factors

PhD     J Allotey (2014-2018)  Improving the prediction of adverse pregnancy outcomes

PhD     E Rogozinska (2014-2017)  Diet and/or physical activity based interventions for antenatal weight management

PhD     A Hamilton (2013-2019)  Views of women and healthcare professionals on lifestyle interventions in pregnancy

MD      S Sobhy (2015-2017)  Risks of adverse maternal and perinatal outcomes in low and middle-income countries (LMIC)

MD      F Cheong-See (2012-2017) - Predictors of adverse maternal and fetal outcomes in high risk pregnancies

MSc    M D’Amico (2016) - Clinical trials methodology

In progress

PhD     Pundir J (2016-) Interventions to improve fertility outcomes in polycystic ovary syndrome

PhD     Chiamaka E (2016-)  Prevention of gestational diabetes and type 2 diabetes in high-risk women

PhD     Bolou A (2017-)  Effects of lifestyle interventions to prevent type 2 diabetes after gestational diabetes

MD      Marleen S (2016-)  Prediction of preterm birth in twin pregnancies

Research

Professor Thangaratinam leads several national and international collaborative research networks, and her work has influenced national and international guidelines. She undertakes major collaborative work with teams in Monash University, Melbourne; Amsterdam Medical Centre, Amsterdam; WHO, Geneva; CREP, Argentina; Utrecht Medical Centre, Utrecht; Ramon Y Cajal Hospital, Spain.

Trials related experience and grants

Chief Investigator

  • National Institute for Health Research (NIHR) Health Technology Assessment (HTA): Accuracy of a rapid intrapartum test for group B streptococcal colonisation and its potential to target antibiotic usage (GBS2): cluster randomised trial £1.1 m (2015-2019)

20 centres in UK, successful recruitment to target of 1,687 women

  • Barts Charity: Barts Research Centre for Women’s Health (BARC) Prevention of GDM Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes (EMMY), Type 2 Diabetes (OMAHA), Time Lapse Imaging (TILT) £2 m (2017-2021)
  • Barts Charity: Effect of simple, targeted diet in pregnant women with metabolic risk factors on pregnancy outcomes (ESTEEM): A randomised trial £498K (2014-2016)

5 centres in UK, successful randomisation to target of 1,252 women (PLOSMed 2019)

Project Lead

  • NIHR HTA: AntiEpileptic drug Monitoring in Pregnancy: a double-blind randomised trial (EMPiRE trial) £1.8 m (2011-2015)

50 centres in UK, recruited 580 women (Health Technol Assess 2017)

Co-investigator

  • NIHR Efficacy and Mechanism Evaluation (EME): TABLET Trial (Multicentre randomised trial of levothyroxine) £1.4 m (2011-2018)
  • NIHR HTA: A randomised trial of mifepristone and misoprostol versus misoprostol alone for management of missed miscarriage (MifeMiso). £1.8 m (2016-2019).

Chair of Independent Trial Steering Committees

  • NIHR HTA - Alife2 Anticoagulants for Living Foetuses in women with recurrent miscarriage and inherited thrombophilia: randomised trial
  • SOLVE trial: Randomised Controlled Trial of synthetic osmotic dilator for induction of labour

Member of Data Monitoring Committees

  • JGHT - AIMS trial:  A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery. 3,412 patients in Malawi, Pakistan, Tanzania, and Uganda; NEJM 2019
  • MRC joint funders – CRADLE trial: Effect of novel vital sign device on maternal mortality and morbidity in low-income countries. 10 clusters in Africa, India, Haiti (536,223 deliveries)

Research Funding Board membership

  • Research for Patient Benefit (RfPB) London (2016-2020)
  • Wellbeing of Women, RCOG, London (2017-2019)

R and D Director for Women’s Health

  • Manages a team of 15, responsible for over 10 trials at Barts Health NHS Trust; Top recruiting team in North Thames CRN; HSJ Finalist for research impact

 

Other grants

Chief Investigator

  • NIHR HTA: Individual Participant Data (IPD) Meta-analysis on prediction of pre-eclampsia International Prediction of Complications in Pregnancy (IPPIC pre-eclampsia) £490k (2015-2018)
  • NIHR HTA Prediction of Fetal Growth Restriction: IPD Meta-analysis (IPPIC- FGR) £265k (2019-2021)
  • NIHR HTA: Effects of weight management interventions in pregnancy: IPD meta-analysis of randomised trials and model based economic evaluation £250k (2013-2015)

UK Principal Investigator

  • National Health and Medical Research Council (NHMRC): Centre for Research Excellence (CRE) maternal obesity AUS$2 million (2020-2025)
  • NHMRC: Prediction and prevention of spontaneous preterm birth: Individual Participant Data Meta-Analysis comprising of prognostic and therapeutic data AUS$1.1 million (2018-2020)

Project Lead and co-investigator

  • NIHR HTA: Development and Validation of a rule for Prediction of Risk of Complications in Early Onset Pre-eclampsia (PREP) study £730k (2011-2014)
  • Sands Charity Prediction and prevention of perinatal death: IPD meta-analysis (IPPIC Stillbirth) £129K (2018-2020)

Co-investigator

  • NIHR HTA: Severe disease in late preterm pre-eclampsia (PEACOCK) £250K (2016-2019)
  • NIHR HTA: Urinary protein: creatinine ratio (SPCr) pre-eclampsia (DAPPA) £560K (2012-2016)
  • Barts Charity: Probiotics to prevent preterm birth (Pre-Pro) £250K (2015-2018)

Research areas of interest

Metabolic disorders: Obesity, diabetes and polycystic ovary syndrome

Evidence synthesis through NIHR and WHO funded aggregate and Individual Participant Data (IPD) meta-analysis to determine the effects of diet and physical activity in pregnancy. Shakila led the  ESTEEM study, the largest randomised trial on Mediterranean diet in pregnancy to prevent maternal and offspring complications.  She is currently leading three pilot/feasibility studies funded by Barts Charity and North Thames Collaborations for Leadership in Applied Health Research (CLAHRC): EMmY trial on the effects of myo-inositol to prevent gestational diabetes; prevention of progression to type 2 diabetes in mothers with gestational diabetes with metformin:  Optimising health outcomes by using metformin to reduce risk of diabetes after pregnancy (OMAhA); and with Mediterranean diet for prevention of progression to type 2 diabetes in women with gestational diabetes (MERIT).

Maternal and perinatal medicine: Pre-eclampsia, epilepsy, stillbirth, fetal growth, infection

She leads the International Prediction of Complications in Pregnancy (IPPIC) IPD meta-analysis project funded by NIHR HTA and supported by the WHO. The IPPIC collaborative network consists of 73 collaborators from 21 countries, and is the largest global repository of standardised IPD of over three million pregnancies (15 UK, 66 international datasets). She led the Prediction of complications in women with pre-eclampsia (PREP) study funded by NIHR HTA which led to the development of an app that is accurate to predict complications. She led the NIHR HTA funded EMPiRE trial, the first randomised trial involving women with epilepsy. Her work on risk of stillbirth in twin pregnancies (BMJ 2016) garnered significant media attention.

Global Health: Caesarean section, anaemia

Assessment of the safety of caesarean section in Low and Middle Income Countries (LMIC) through large meta-analyses on risks associated with anaesthesia (Lancet Global Health 2016) and the burden of maternal death following caesarean section in LMIC (Lancet 2019). The focus on the effective prevention of anaemia in pregnancy and its complications in women and children with iron fish and also with use of intravenous iron.

Other activities

As member of National Institute for Health Research (NIHR) for Patient Benefit (RfPB) Board for London, Professor Thangaratinam plays a crucial role in peer review and decisions on funding for portfolio studies.

She is on the Academic Board of the Royal College of Obstetricians and Gynaecologists (RCOG) as a HEI (Higher Education Institution) representative, and developed the annual RCOG academic training course that is mandatory for trainees taking the Advanced Professional Module (APM) module.                                                           

As an executive committee member of the RCOG Maternal Medicine CSG (Clinical Study Group) she is involved in the prioritisation of research questions.

She led the development of the national RCOG Greentop guideline on epilepsy in pregnancy. As a member of the UK Chief Medical Officers’ infographic development group on physical activity in pregnancy, she was involved in making UK wide recommendations. She provided expert input into the UK Government review led by Baroness Cumberledge on the effects of sodium valproate on congenital abnormalities in offspring born to women with epilepsy.

As a member of the International guideline committee on treatment of infertility in women with polycystic ovary syndrome, in addition to making recommendations, she identified gaps to inform future research, including the promising role of myo-inositol for ovulation induction in these women.

She chairs the trial steering committees of multicentre trials LOTUS, PREVIEW, SOLVE and Alife 2, which are national and international NIHR funded studies.

Her evidence synthesis on association of complications in women with epilepsy (Lancet 2015) directly informed RCOG Green Top guidelines on the management of pregnant women. Professor Thangaratinam's work on risk of stillbirth in twin pregnancies (BMJ 2016) informs the national guidelines and garnered significant media attention.

Publications

Professor Thangaratinam's selected publications

2014-2019

Sobhy S, Arroyo-Manzano D, Murugesu N, Karthikeyan G, Kumar V, Kaur I, Fernandez E, Gundabattula SR, Betran AP, Khan K, Zamora J, Thangaratinam S. Maternal and perinatal mortality and complications associated with caesarean section in low and middle-income countries: A systematic review and meta-analysis involving 12 million pregnancies. The Lancet. 2019; 393: 1973-1984

Allotey J, Fernandez-Felix BM, Zamora J, Moss N, Bagary M, Kelso A, Khan R, van der Post JAM, Mol BW, Pirie AM, McCorry D, Khan KS, Thangaratinam S. Predicting seizures in pregnant women with epilepsy: Development and external validation of a prognostic model. PLoS Med. 2019;16:e1002802

H Al Wattar B, Dodds J, Placzek A, Beresford L, Spyreli E, Moore A, Gonzalez Carreras FJ, Austin F, Murugesu N, Roseboom TJ, Bes-Rastrollo M, Hitman GA, Hooper R, Khan K, Thangaratinam S;  ESTEEM study group. Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial. PLoS Med. 2019; 23; 16(7): e1002857.

Muglu J, Rather H, Arroyo-Manzano D, Bhattacharya S, Balchin I, Khalil A, Thilaganathan B, Khan KS, Zamora J, Thangaratinam S. Risks of stillbirths and neonatal deaths with advancing gestation at term: a systematic review and meta-analysis of cohort studies of 15 million pregnancies. PLoS Med. 2019; 16(7):e1002838

Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo Olufemi, Morisaki N, Tuncalp O, Torloni MR, Mittal S, Jayaratne K, Lumbiganon P, Togoobaatar G, Thangaratinam S, Khan KS. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Health. 2018;6(5):e548-e554

International Weight Management in Pregnancy (i-WIP) Collaborative Group (Last Author  Thangaratinam S) Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials.  BMJ. 2017;358:j3119

Cheong-See F, Schuit E, Arroyo-Manzano D, Khalil A, Barrett J, Joseph KS, Asztalos E, Hack K, Lewi L, Lim A, Liem S, Norman JE, Morrison J, Combs CA, Garite TJ, Maurel K, Serra V, Perales A, Rode L, Worda K, Nassar A, Aboulghar M, Rouse D, Thom E, Breathnach F, Nakayama S, Russo FM, Robinson JN, Dodd JM, Newman RB, Bhattacharya S, Tang S, Mol BW, Zamora J, Thilaganathan B, Thangaratinam S; Global Obstetrics Network (GONet) Collaboration. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ. 2016; 354:i4353.

Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, Mccorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S; EBM CONNECT Collaboration. Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health. 2016;4(5):e320-7.

Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, Mccorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S; EBM CONNECT Collaboration. Epilepsy in pregnancy and reproductive outcomes. The Lancet. 2015; 386(10006):1845-52.

HTA Monographs

Allotey J, Snell KIE, Chan C, Hooper R, Dodds J, Rogozinska E, Khan KS, Poston L, Kenny L, Myers J7, Thilaganathan B, Chappell L, Mol BW, Von Dadelszen P, Ahmed A, Green M, Poon L, Khalil A, Moons KGM, Riley RD, Thangaratinam S; IPPIC Collaborative Network. Accuracy of clinical characteristics, biochemical and ultrasound markers in predicting pre-eclampsia: External validation and development of prediction models using an Individual Participant Data (IPD) meta-analysis Health Technol Assess 2019 (in press)

Thangaratinam S, Allotey J, Marlin N, Mol BW, Von Dadelszen P, Ganzevoort W, Akkermans J, Ahmed A, Daniels J, Deeks J, Ismail K, Barnard AM, Dodds J, Kerry S, Moons C, Riley RD, Khan KS. Development and validation of a prediction model for the risk of adverse outcomes in women with early onset pre-eclampsia (PREP): Prospective cohort study. Health Technol Assess. 2017;21(18):1-100.

Thangaratinam S, Marlin N, Newton S, Weckesser A, Bagary M, Greenhill L, Rikunenko R, D'Amico M, Rogozińska E, Kelso A, Hard K, Coleman J, Moss N, Roberts T, Middleton L, Dodds J, Pullen A, Eldridge S, Pirie A, Denny E, McCorry D, Khan KS. Antiepileptic drug management in pregnancy: A double blind randomised trial on effectiveness and acceptability of monitoring strategies (EMPIRE study). Health Technol Assess. 2018 May;22(23):1-152.

Rogozińska E, Marlin N, Jackson L, Rayanagoudar G, Ruifrok AE, Dodds J, Molyneaux E, van Poppel MN, Poston L, Vinter CA, McAuliffe F, Dodd JM, Owens J, Barakat R, Perales M, Cecatti JG, Surita , Yeo S, Bogaerts A, Devlieger R, Teede H, Harrison C, Haakstad L, Shen GX, Shub A, Beltagy NE, Motahari N, Khoury J, Tonstad S, Luoto R, Kinnunen TI, Guelfi K, Facchinetti F, Petrella E, Phelan S, Scudeller TT, Rauh K, Hauner H, Renault K, de Groot CJ, Sagedal LR, Vistad I, Stafne SN, Mørkved S, Salvesen KÅ, Jensen DM, Vitolo M, Astrup A, Geiker NR, Kerry S, Barton P, Roberts T, Riley RD, Coomarasamy A, Mol BW, Khan KS, Thangaratinam S. Effects of antenatal diet and physical activity on maternal and fetal outcomes: Individual patient data (IPD) meta-analysis and health economic evaluation. Health Technol Assess. 2017;21(41):1-158

2000-2013

Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012;344:e2088.

Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association of thyroid antibodies with miscarriage and preterm birth: A meta-analysis. BMJ 2011; 342:2616

Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK. Pulse oximetry screening for critical congenital heart defects (CCHD) in asymptomatic newborn infants: A systematic review and meta analysis involving 229,421 babies. The Lancet 2012.379:2459-2464

Wilson A, Lissauer D, Thangaratinam S, Khan KS, MacArthur C, Coomarasamy A. Clinical officers versus medical doctors for Caesarean surgery in the developing world: A meta-analysis of controlled studies. BMJ 2011; 342:2600

Ewer AK, Middleton LJ, Furmston AT, Bhoyar A, Daniels JP, Thangaratinam S, Deeks JJ, Khan KS; PulseOx Study Group. Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study. The Lancet. 2011;378(9793):785-94.

Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Duda W, Borowiack E, Roseboom T, Tomlinson J, Walczak J, Kunz R, Mol BW, Coomarasamy A, Khan KS. Interventions to reduce or prevent obesity in pregnant women: a systematic Review. Health Technol Assess. 2012 Jul;16(31):iii-iv, 1-191 

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