Fetal Longitudinal Assessment of Growth (FLAG) Study

What is the Study About?

Improving the Prediction and Detection of Risk Factors for Term Stillbirth

Babies that are born small have an increased risk of problems in late pregnancy, and around the time of delivery. Babies are considered small if they are found to be under the 10th centile, that is, in the bottom 10% of birthweight for their gestational age. While many babies born small are healthy, some of these babies are small because the placenta is not working well to supply oxygen and nutrition efficiently to the baby. These babies have a higher chance of becoming stressed in labour and, extremely rarely, these babies are lost in late pregnancy, resulting in stillbirth.

While measuring the baby at each pregnancy visit identifies many small babies, some are missed. It would help if we could find a simple test that could tell us if the placenta is starting to fail. If we knew this in advance, it would mean we could watch the baby closely in late pregnancy and organise for delivery to occur before the baby experienced any complications.

In this study, we wish to look at two new ways of identifying babies who are not growing well. The first involves a blood test, and the second involves ultrasound, both performed in the last 3 months of pregnancy.

What are we looking for with the blood test?

In our laboratory, we have been looking at genetic messengers that come from the placenta and are released into the mother's blood stream. Our studies so far suggest that the placenta increases some genetic markers in response to low oxygen levels (or hypoxia) that can then be measured in the mother's blood. These results are very encouraging, but we need to confirm these findings in a bigger study. If a simple blood test could tell us if the placenta is starting to fail, this would be a major breakthrough. By knowing in advance, we could watch the baby closely in late pregnancy and organise for delivery to occur before the baby experienced any complications.

What are we looking for with ultrasound?

It is possible that the placenta may not work perfectly in late pregnancy, resulting in slowing of fetal growth in late pregnancy, but these babies are still found to be above the 10th centile when they are born. Our previous studies suggest that some of these babies behave like small babies (that is, babies under the 10th centile), with changes in their blood flow patterns in late pregnancy, and becoming more stressed than usual in labour. If we can confirm in a larger study that slowing of fetal growth is an important measure of placental function, this would be useful to know, because these babies may need closer surveillance as they approach term.



Anthropometry and Peapod Measurements

After birth, body composition measurements of our participating babies will provide useful information correlating placental function with fat distribution.  Measurements have either been captured by skinfold thickness and/or the neonatal PEAPOD. 

Please refer to this brochure that explains how the neonatal PeaPod is used in this study. 


The FLAG Team:

Principle Researchers:

Professor Sue Walker              Head Perinatal Medicine, Perinatal Medicine

Professor Stephen Tong          Professor and Head, Translational Obstetrics Group


Associate Researchers:

Dr Teresa McDonald                PhD Candidate, Translational Obstetrics Group

Dr Lisa Hui                               Associate Professor,  Maternal Fetal Medicine

Dr Alice Robinson                    FRANZCOG, Mercy Hospital for Women

Dr Clare Whitehead                 MRANZCOG trainee and Post Doctorate Scientist

Kirsten Dane                            Research Midwife, University Department

Anna Middleton                        Research Midwife, University Department

Valerie Kyritsis                         Research Midwife, University Department

Elizabeth Lockie                       Researcher, University of Melbourne

Special thanks to the following staff that have greatly assisted throughout the project:

Translational Obstetrics Group Staff:  Roxanne Hastie, Minh Deo, Sally Beard, Tu'Uhevaha Lino, Ping Cannon, Vi Nguyen, and Minh Nguyen

University Research Midwives: Gay Pell, Genevieve Christophers, Deb Jinks, Rachel Murdoch

University of Melbourne Staff: Sue Hill, Heather Hanson

Austin Pathology Staff

Health Information Services Staff

Outpatient, Postnatal and Birth Suite Midwives

Caesarean Midwives

NICU Nurses

Private Consultants and assisting staff:  Dr Alison Fung, Dr Charlotte Elder, Dr Carol Vance, Dr Owen Stock, Dr Lenore Ellet, Lynn Bullock  


How is the Study Progressing?



Contact Us:


Telephone:            +613 8458 4354

Email:                    flagstudy@mercy.com.au

Address:               University Department

                               Mercy Hospital for Women

                               Level 4/163 Studley Road

                               Heidelberg  VIC 3084



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