Researcher Highlights
Maternal influence: reducing the risk of childhood asthma

Dr Vanessa Murphy is determined to reduce the rates of asthma in our communities by controlling a mother’s asthma in pregnancy.

When Vanessa graduated High School with top marks she was quoted in the local paper as saying that she would like to be a researcher. “I looked back on that years later and thought, ‘well, what do you know, I’ve always wanted to get into research’. “

“I don’t remember consciously thinking that at the time, I just knew that I really enjoyed science.”

Vanessa enrolled in a degree called Medicinal Chemistry at the University of Wollongong as the first steps on her research path. “I soon realised that I tended more towards the biochemistry side of things, but I soon moved more toward clinical sciences,” Vanessa said.

“I want to do things that help people.”

Specifically, Vanessa wants to help people with asthma. As someone who has asthma, Vanessa knows how debilitating and dangerous it can be. After completing her undergraduate degree, Vanessa worked in Laureate Professor Roger Smith’s Mothers and Babies lab and just loved the pregnancy work – so combining asthma research with the topic of pregnancy during her PhD became her next step.

Parental responsibility

Around 11% of the Australian population has asthma, a condition that is one of the most common reasons for visits to a hospital or doctor in children. “We know that the number one risk factor for a child developing asthma is if their mother has asthma,” Vanessa says. “And that risk is even higher than if you have a father with asthma, which suggests that there is an environmental component in addition to the genetic component.”

“We believe that the in-utero environment has some role to play in sending you on the trajectory of either developing asthma or not,” Vanessa adds.

“I think that pregnancy is such a crucial time in determining a child’s future.”

One common problem with many people living with asthma is that they don’t have an active Asthma Plan - so their asthma isn’t as well-controlled as it can be. Ideally, people living with asthma should have regular check-ups to assess their lung function and use a preventative medication to control their asthma as part of an Asthma Plan.

However, for many, this isn’t a priority or a consideration. In pregnancy, this adds another layer of complexity. “There is a body of literature that supports the fact that asthma is not necessarily taken seriously by women themselves,” Vanessa says. “And there’s a large proportion of women who stop taking mediation when they’re pregnant. That could be for any number of reasons, such as they personally don’t think they need to, they worry it will impact the baby or they might even have health professionals telling them not to take it, which unfortunately still happens.”

Controlling asthma in pregnancy is vital not just for the woman, but also for her developing baby.

“Many obstetricians and midwives don’t know how important asthma can be to pregnancy outcomes with women with asthma at higher risk of having low birthweight babies and a pre-term birth among many other adverse outcomes,” Vanessa explains.

Vanessa is working to address this issue by publishing work in the obstetric field to demonstrate that pregnancy really is a key time when women are at risk of having an asthma attack. “And to note that an asthma attack puts them at higher risk of a poor pregnancy outcome – which they’re already at increased risk of anyway.”

“You really need to understand what’s happening in pregnancy, how to prevent asthma attacks (exacerbations) happening and how do we improve the management of the woman’s asthma to get the best possible outcome both at birth and into the future.”

Multidisciplinary collaborations

“I’m not a clinician, I’m a scientist,” Vanessa says. “So my research program has brought together antenatal clinicians such as midwives and obstetricians, along with specialists from other disciplines such as psychology and also statisticians.”

“We need to understand those early life influences and we know that women with asthma are more likely to have depression and anxiety than those without that’s an important factor in controlling their asthma and it’s also important in the early years of parenting.”

In 2021 Vanessa was awarded an MRFF (Medical Research Future Fund) Investigator Research Fellowship to continue her work in this field. With this Fellowship, Vanessa aims to provide evidence that improving clinical practice in the area of asthma management in pregnancy will lead to better long-term outcomes for children.

Patient experience

One of Vanessa’s major research achievements has been the Breathing for Life Trial where pregnant women with asthma have been monitored, along with their babies. The study started recruiting in 2013, with the last baby born at the end of 2019, with over 1200 mothers and babies providing qualitative and quantitative evidence to build on Vanessa’s work.

One of the most important aspects of Vanessa’s research is the learning aspect, and understanding a patient’s motivation in order to deliver better outcomes. “We know that only 15% of pregnant woman have an Asthma Action Plan so we need to address that and there is also a need for better education around self-management of asthma in pregnancy.”

With a long-term aim of improving health outcomes for asthma, Vanessa doesn’t narrow her focus.

Another of her recent pieces of work involves exploring the link between asthma and autism; with many studies suggesting that rates of autism are higher in children with asthma. There’s also evidence that women with asthma or an auto-immune disease seem to be at higher risk of having a child with autism. For this study she’ll be collaborating with a multidisciplinary team looking at biomarkers in pregnancy and maternal immune activation and rates of autism in children. It’s all part of a broad body of work.

Vanessa is also bringing her expertise to research groups who are exploring the impact of societal and environmental factors on pregnancy. One of these is the impact of bushfire smoke on asthma and how this, and other air pollution impacts pregnancy outcomes in children – particularly in regard to lung function.

It’s a broad remit with one long-term goal. Ultimately, Vanessa wants to see asthma better managed now so that less children develop asthma in the future.