Research Priority Areas
Our research priorities are areas where Institute members can make a real difference, leading to lasting change in the community, both here, and around the globe.
- Preventing and Alleviating InfertilityEnabling the best start in life
Led by Prof Jeremy Thompson
Most parents expect to conceive naturally and give birth to healthy children. Unfortunately this isn't always the case as infertility is common with one in six couples being diagnosed as clinically infertile.
Infertility is attributed to a wide range of issues including:
- Immunological disorders including incompatibility between partners
- Infection and associated fallopian tube damage
- Lifestyle choices including smoking, poor diet and chemical exposure
- Genetics in both men and women
- Older age in both parents, particularly women where the ovary has a finite number of healthy oocytes
In a large proportion of couples, difficulty conceiving cannot be attributed to a specific cause and emerging understanding is that the holistic health of both men and women affects their gametes and reproductive function in pervasive ways. Most importantly, poor metabolic health can impair both capacity to conceive and when conception does occur, developmental competence of the embryo and fetus is affected. Maternal and/or paternal obesity at conception affects the gametes and the embryo, and this intergenerational link elevates the likelihood of obesity in offspring.
Currently, infertility is treated using In Vitro Fertilisation (IVF) and other assisted reproductive technologies. IVF has substantial limitations and there are rising concerns about over-reliance on IVF. These include the small but real increase in risk of pregnancy disorders and developmental anomalies, the often-overlooked reality that at best half of couples will achieve success, and the substantial public health cost of subsidized service.
The Robinson Research Institute strives to prevent and alleviate the burden of infertility, by advancing knowledge and building awareness of reproductive health, and providing more options for couples wishing to become parents. We aim to assist all prospective parents in their reproductive careers and to provide the optimum start in life for their children.
Our collaborative projects that will help achieve this goal include:
- Defining the physiological and immunological basis of conception and early embryo development, and the events that are disrupted in infertility
- Investigating how diet, infection and lifestyle choices alter reproductive capability and health of offspring
- Understanding how metabolic conditions such as obesity and diabetes cause infertility and perturbed fetal growth, and uncovering intervention strategies to ensure optimum fetal outcomes and child health
- Where IVF is indicated, improving the process to make it more accessible, simpler and less invasive
- Pioneering new infertility treatments to provide targeted approaches and greater choice to consumers
- Fetal GrowthUnderstanding and optimising growth of the fetus
Led by Prof Claire Roberts
The average birth weight of Australian babies is 3.4kg with over 6% of babies weighing less than 2.5kg and nearly 12% weighing more than 4kg. Many health issues can arise when babies have low or high birth weights.
Both small and large for gestational age babies are more likely to require admission to the neonatal nursery. They will be at greater risk of perinatal morbidity and mortality, and will be more likely to develop a variety of adult onset diseases, indicating intrauterine growth predicts lifelong health.
The Robinson Research Institute aims to uncover how genetic and epigenetic factors and the environment interact in women who give birth to small or large babies, and to develop effective interventions so all babies are born at a healthy weight.
For example, we know that smoking reduces birth rate on average by 300g. However, some mothers have genetic variants that amplify this effect, as they are less able to detoxify the toxins in cigarette smoke. These mothers may give birth to a child up to 1.2kg lighter than average if they smoke during pregnancy. Conversely, obese pregnant women are more likely to deliver a large baby.
Our researchers are focused on providing the best evidence to educate pregnant women and the community about the risk factors associated with unhealthy birth weight. These risk factors include:
- Poor quality diet
- Drinking alcohol
- Drug use
- Mental health problems
- Uncontrolled diabetes
- Obesity or underweight
- Low socioeconomic status and disadvantage
We are very interested in indigenous women's health. Indigenous women are much more likely than other Australian women to have low birth weight or preterm babies, and suffer other pregnancy complications. We are working with indigenous women with the aim of improving outcomes for mothers and their babies.
- Born Too SoonPreventing preterm birth and improving outcomes for babies born preterm
Led by Prof Ben Mol
1 in 10 babies are born prematurely, at less than 37 weeks gestation. This carries immediate risks to the infant's health and survival as their brain and other organs are not fully developed. The respiratory, gastrointestinal and neurological systems are at particular risk and many babies will suffer ongoing impairment. There is growing evidence to indicate that the effects of preterm birth persist over life. Babies born preterm often face life-long setbacks in development and education, and may be prone to health challenges for life.
While the risks increase the earlier a baby is born, even being slightly preterm increases the risk of future problems. Consequently, some clinicians are suggesting preterm birth should be re-defined to less than 39 weeks gestation.
The Robinson Research Institute aims to improve outcomes for babies born early, and ultimately to predict and prevent preterm birth, so all children are provided the healthiest start to life.
To progress this agenda, researchers with expertise in obstetrics, immunology, nutrition and clinical trials are together working on:
- Understanding how multiple causes of early births converge to affect the maternal immune response in pregnancy
- Defining how genes, health conditions and environmental factors contribute to establishing risk
- Identifying and evaluating preventative treatments for mothers at risk
- Developing treatments to improve outcomes for babies born preterm
Our progress towards alleviating adverse consequences for babies born early include:
- Administering magnesium sulphate which reduces the incidence of cerebral palsy by protecting babies' brains
- Administering corticosteroids to reduce the risk of death as lungs are immature at birth
Our challenge is to understand how factors such as infection, stress and immune response interact in some women to trigger early labour and birth. We have developed a range of animal models that assist in defining how these various inflammatory triggers all integrate to impact timing of birth, and how nutritional and pharmacologic interventions may protect from inflammatory insults.
The next phase of our research will utilise large cohort studies to identify immune and genetic markers that predict susceptibility and may be modifiable with targeted interventions.
- Brain PowerMaximising neurodevelopmental potental
Led by Dr Julia Pitcher
The development of the brain and nervous system is fundamental to our identity and function in society throughout life. It is responsible for our ability to contribute to society and affects our career, earning potential, where and how we live, and our physical and psychological health.
Preterm delivery accounts for approximately 10% of births, and children born early often experience problems in neurodevelopment. Those born extremely preterm can have severe problems including cerebral palsy, deafness and blindness. However, most preterm children are born only a few weeks early. While their problems are less severe than in very premature infants, poor motor skills and learning and memory difficulties can have a huge impact on educational outcomes and opportunities.
The Robinson Research Institute aims to understand how and why neurodevelopment is affected in children born late preterm (33 - 37 weeks gestation) without brain injury, and to develop effective interventions to minimise difficulties experienced at school.
To further the limited understanding of neurodevelopment our research is focused on:
- Characterising the physiology that underlies subtle changes in neurodevelopment for preterm babies, and determining whether changes are due to being born early, or growth restriction in utero
- Understanding how adverse environments in utero and events in early life contribute to neurodevelopmental outcomes
- Developing targeted interventions to ameliorate neurodevelopmental changes through improving the strength of neuron connections in the brain and improving environmental learning settings for children
- Gaining a better understanding of how socioeconomic disadvantage effects cognitive and motor abilities
We are trialing a number of interventions including; understanding the role cortisol plays in learning and memory, and gaining a better understanding of plasticity by training specific cognitive abilities and monitoring flow on effects.
Additionally, we are building capability in clinical neurodevelopmental assessment. Our assessment centre will offer neurological assessment services for researchers. The services will be accessible to researchers who are members of the Institute, as well as those from the wider community and external to the Institute. We will assemble and integrate data from projects in this area to advance the understanding of neurodevelopment, and to increase the capacity for researchers working in this field.
- Parental Influences and Child ObesityPreventing and reversing weight disorders
Led by Prof Julie Owens
Currently, 56% of women, 70% of men and 23% of children are overweight or obese. This includes pregnant women, where obesity and excess weight gain in pregnancy lead to adverse pregnancy health outcomes, poor cardiometabolic health and adverse behavioural and cognitive outcomes in the child. Obesity is now the single largest contributor to compromised health in pregnancy, and may be a key factor in the rise in childhood obesity. Paternal obesity is now also implicated in contributing to child obesity.
‘Obesity' and a ‘Healthy Start for a Healthy Life' are priorities of the Australian government and many influential health bodies. Despite this, no adequately evidence-based guidelines or interventions for pregnancy care in maternal obesity, even for pregnancy outcomes exist. There are no diagnostic or prognostic tools to identify and stratify women and children at greatest risk of adverse health outcomes.
Obesity is highest in disadvantaged groups, including Indigenous people, which is a challenge to the efficacy and reach of typical interventions.
This Robinson Research Institute priority will build the evidence base, and develop and implement evidence based guidelines for optimal management of maternal obesity and gestational weight gain, to improve pregnancy and child health.
We are uniquely placed to achieve this, by:
- Using our large scale randomised controlled trials, evaluating interventions during pregnancy in overweight and obese women in different settings, and established birth cohorts, to understand how antenatal lifestyle or other interventions affect pregnancy outcomes and subsequent child health
- Developing tools to match women to the most appropriate and cost-effective form of intervention, especially in disadvantaged and Indigenous women
- Identifying key dietary, metabolic or other factors in obese mothers that are causally related to key health outcomes via new 'omics approaches', and apply these to refine current and develop novel prognostic and diagnostic tools for stratified and targeted care
- Undertaking discovery research in our non-human models to better understand the mechanisms linking maternal (and paternal) obesity to obesity and poor metabolic health in offspring, and to test novel interventions and identify candidate prognostic markers of future risk
- Developing guidelines and tools for improving clinical care, and justification and plans for new trials and seek to undertake translation, involving health practitioners and care workers, health care delivery and health promotion organisations, industry and the community
- Building networks and linkages with other world leading research programs and centres and the health sector, to establish sustainable collaborative networks and teams in pregnancy cardio-metabolic health, across multi-disciplinary and intersectoral boundaries
- Reproductive CancersDiscovering causes and finding cures
Led by Prof Darryl Russell
Breast and prostate cancers are the most prevalent forms of cancers with around one in nine Australian women and men being diagnosed each year. This equates to 25,000 new cases each year and the incidence is rising. Ovarian cancers are less prevalent but are associated with a high proportion of mortality. Of the 1,200 women who are diagnosed each year, approximately 800 die from cancer-associated causes.
When localised, these cancers are usually curable, but one third of cases spread to other organs and these people often experience a series of relapses as the cancer spreads, which eventually results in death.
The Robinson Research Institute aims to uncover how and why reproductive cancers develop, and to establish effective treatments to prevent cancer-related disability and mortality.
To progress this research we are focused on:
- Uncovering the common features of reproductive organs which are likely to contribute to reproductive cancers
- The role of hormone responsive tissues that undergo frequent remodeling involving the immune system on cancer development
- The role of diet, endocrine disruptors or other physiological abnormalities on cancer development
We are well-placed to tackle reproductive cancers as we have a large group of scientists and clinicians working together with overlapping expertise in the molecular mechanisms of normal function and regulation of reproductive organs, as well as cancer development and progression.
- AllergyResearching origins of immune disorders
Led by Dr Kathy Gatford
Allergy is a global health issue that affects hundreds of millions of people worldwide, and currently there is no cure. Asthma, rhinitis, eczema, dermatitis, food allergies and anaphylaxis are all increasing - in Australia, 20% of the population suffers from at least one allergy and this is expected to rise to 30% by 2050. The reason for the rising prevalence is unknown but is likely to be linked to modern lifestyle and exposures.
Allergies originate very early and have a major impact on development and quality of life - affected individuals may live with congestion, skin conditions, difficulty breathing, restricted physical activity, or avoidance of particular environmental stimuli. Long-term consequences can be severe, leading to systemic inflammation and affecting vital organ function.
The Robinson Research Institute strives to progress allergy and immunity research utilising our unique capacity to link events before birth to immune function in children. Research leaders with expertise in immunology, placental function, fetal development and genetics are together addressing the important question of how events in pregnancy contribute to establishing allergy susceptibility after birth. Our ultimate aim is to prevent the development of allergies in children.
To advance this goal we are focusing our research on:
- Identifying prenatal conditions and events - either maternal or other exposures - that increase susceptibility to allergy in childhood
- Identifying the genetic and epigenetic mechanisms altered in the placenta and fetal immune system that program immune function in early childhood and increase susceptibility to allergy
- Identifying biomarkers that determine the risk of allergy in childhood, and create non-invasive tests for the rapid detection of these biomarkers
- Developing effective interventions for allergy prevention either during pregnancy or after birth
We have achieved progress in this area, with studies in human tissues and animal models exploring the links between maternal inflammation in pregnancy and altered immune development in the fetus.
Importantly we have also established the Asthma and Pregnancy Management Clinic. This clinic improves understanding of the necessity to utilise appropriate asthma medication in pregnancy and teaches pregnant women how to better manage their asthma. Through education and simple interventions, expecting mothers now experience less asthma attacks during pregnancy. Fewer babies develop bronchiolitis as a result of better asthma management in their mothers, which may reduce the number of children who are asthmatic in childhood.
Another achievement is the discovery of a protein biomarker in cord blood, which can identify those babies predisposed to developing allergic diseases. SA Pathology are utilising this finding and a non-invasive test is in development.
- Protecting Children from Life-Threatening DiseaesOptimising prevention against serious infection
Led by Prof Helen Marshall
Protecting children and adolescents from serious diseases is a national priority to secure the future health of the nation. The Robinson Research Institute aims to eliminate life-threatening conditions in children by improving the effectiveness of preventative strategies such as immunisation to reduce death and disability from serious infections.
To achieve this goal our research is focused on six key areas:
- Eliminating life threatening infections in infants, children and adolescents such as meningococcal and pneumococcal disease by optimising infectious disease prevention
- Improving effectiveness of recommended vaccine programs for pregnant women to increase protection for both pregnant women and their babies against serious infections such as influenza and whooping cough
- Ensuring new vaccines for babies, children and adolescents are safe and effective
- Understanding how and why some health conditions, such as pregnancy, obesity and immune compromise, impact on vaccine effectiveness
- Identifying biomarkers to assess vaccine effectiveness
- Engaging the community in research to incorporate community views and values into immunisation policy
Our researchers comprise a team of scientists, clinicians and public health practitioners collaborating to understand the mechanisms involved in disease and its prevention. Proximity to the clinical forefront at the Women's and Children's Hospital means we are well-placed to prevent life-threatening conditions in children.
To ensure our research improves the health of the community, we are establishing a Centre of Research Excellence (CRE) in Maternal and Adolescent Immunisation. Immunisation of pregnant women is considered the best way to protect vulnerable newborns from serious infectious disease. Pregnant women and adolescents have been identified as having the lowest uptake of vaccinations, and therefore it is a priority to undertake high-quality and multidisciplinary research to guide and generate current and future policy.
The CRE will establish a collaborative approach to the prevention of serious infectious disease, by engaging clinicians, public health researchers, immunisation providers, policy makers, government leaders, health economists and consumers. As part of this initiative we will investigate the unique challenges faced by Aboriginal and Torres Strait Islander people.
- Nurturing Human CapabilitiesPopulation interventions to secure a better start for all children
Led by Prof John Lynch
Human capabilities include physical, mental, social and emotional health, cognitive ability and academic achievement. Intervening early is important for helping children fulfil their health and development potential, and to improve future human capability. The Robinson Research Institute and the BetterStart Child Health and Development Research Group aim to understand how to ensure children have the best start in life.
Our focus is on pragmatic, preventive interventions across the multiple systems that support human capability formation, including health, child care, education, welfare, and child protection systems, from the perinatal period into adolescence. We focus on the potential for a diverse range of interventions related to perinatal health, parenting, child care, diet, self-regulation, and cognitive ability to improve child health and development, particularly among disadvantaged populations.
Our research uses innovative epidemiological methods spanning randomised controlled trials, pragmatic trials, data linkage and data from observational studies to support our translational research activities in South Australia, nationally and internationally. Our group consists of researchers with backgrounds in epidemiology, public health, nutrition, paediatrics, biostatistics and psychology.
We compiled the South Australian Early Childhood Data Project that links de-identified administrative data for all children born in South Australia between 1999 and 2013. This resource includes aspects of the life experiences of 280,000 South Australian children, and contains information from more than 15 data sources spanning health, education and welfare services.
Professor Lynch leads an NHMRC funded Centre for Research Excellence “EMPOWER: Health Systems, Adversity and Child Well Being” which aims to develop, implement and evaluate interventions designed to mitigate the consequences of significant adversity experienced between a child’s conception and school entry. This is a collaboration between the University of Adelaide School of Public Health (John Lynch, Murthy Mittinty, Lisa Smithers, Cathy Chittleborough), Robinson Research Institute (Michael Sawyer, Ben Mol, Claire Roberts, Gus Dekker), Division of General Practice (Nigel Stocks, Oliver Frank), University of Sydney School of Economics (Stefanie Schurer, Deborah Cobb-Clark), University of Melbourne and ViCBiostat (Lyle Gurrin), Women’s and Children’s Health Network (Naomi Dwyer, Deborah Jeffs, Lynda Dandie), Child and Family Health Service, and University College London Institute of Child Health (Catherine Law).
- Treatment InnovationsPioneering interventions to improve the health of children
Led by Prof Jennifer Couper
Many serious physical and mental disorders of adulthood begin in childhood. To prevent the development of these diseases, interventions need to be administered in early life, be safe, and as targeted as possible.
The Robinson Research Institute aims to uncover the mechanisms of childhood disease and to develop effective treatments to alleviate disease progression and prevent chronic adult conditions.
Our strategy is to build understanding and evidence for effective interventions through leadership in well-designed randomised clinical trials and related clinical studies.
Type 1 diabetes, the incidence of which has doubled in Australian children over the last 20 years, is a major research challenge. We are conducting two international diabetes trials; prevention of vascular complications in diabetes, and prevention of type 1 diabetes in children who are at high risk.
A second focus is to devise treatment strategies that have optimal effectiveness and reach. In response to the online environment transforming the provision of healthcare services, we are conducting two unique trials in e-health delivery:
- Surveillance of vaccines and their adverse effects - in Australia vaccination is universally recommended yet surveillance of adverse events is deficient. For example, recognition of severe febrile seizures was delayed following the seasonal influenza vaccine (Fluvax/CSL) administered to young children in 2010
- Support for new mothers as they develop parenting skills and confidence during the rapidly changing first 6 months of their infants life
Thirdly we are focusing on the prevention and treatment of allergies. One in ten children in Australia have a food allergy. Many allergies are life-long and reactions may be life threatening. Our recent trial of omega 3 supplementation in pregnancy showed a reduction in the chance of sensitisation to egg before 3 years of age.