成人大片

Conception is the foundation event for each new life. Every child's development, growth trajectory and health over the life course is set in motion from the moment sperm and oocyte unite to form an embryo.

Research聽is focused on defining biological and social factors that manifest from before pregnancy to influence the events that allow healthy conception. These include generation of gametes, fertilisation and embryo development, and uterine receptivity for implantation and placental formation. These factors ultimately determine not only whether pregnancy can commence, but also the progression of pregnancy, the growth of the fetus in utero and the health of the infant after birth.

Achieving healthy natural conception is a challenge for many people - and most prospective parents are unaware of the enormous impact of early events on their child's future. Infertility is common with 1 in 6 couples being classified as clinically infertile, and now almost 1 in 25 children are conceived by IVF. The reasons are often not readily identifiable, but there is substantial evidence that age, health conditions and lifestyle factors - obesity, infection, nutrition, exercise, alcohol, smoking and chemical exposure - are major contributors to reproductive health in men and women.

Our aim is to generate new knowledge of reproductive biology and to provide leadership in advancing reproductive medicine. Our research will maximise fertility and pre-conception health, to reduce the incidence of infertility and related reproductive conditions and diseases, to more cost-effectively alleviate and treat infertility and to give consumers and practitioners more insight, greater control and informed choice in effectively managing their reproductive potential.

To achieve this, our research is focused on:

• expanding knowledge of the molecular and cellular biology of each phase of the reproductive cycle
• defining genetic and non-genetic mechanisms of epigenetic modification and developmental programming in gametes and embryos
• understanding the causes of fertility and subfertility and their relationship with health conditions, lifestyle choices and experiences
• reducing reliance on assisted reproductive technology and providing alternative options to IVF
• understanding the pathophysiological mechanisms of diseases that affect reproductive capability
• developing improved advice, interventions and treatments for infertility and reproductive diseases聽
• empowering couples of make informed decisions regarding their fertility through establishment of聽, and sharing our research findings.

Most prospective mothers anticipate healthy, problem-free pregnancies. In reality, complications are common, with a quarter of Australian pregnancies affected by one or more of the following conditions: preeclampsia, preterm birth, fetal growth restriction or gestational diabetes. These complications can have serious life-long health implications for both the mother and her baby. The cost of these conditions for individuals, families and communities is enormous and is judged by the WHO to be equivalent to cancer as measured in lifetime disability.

This聽theme leads research into maternal health during and after pregnancy, with a focus on optimising fetal and infant health.

Our aim is to improve outcomes for mothers and babies by understanding the molecular, cellular and physiological mechanisms involved in placental and fetal growth, and maternal health in pregnancy, so we can devise effective interventions and treatments. This includes identifying all modifiable risk factors that affect pregnancy, for example overweight and obesity, smoking, alcohol consumption, diet and micronutrients.

To progress this research we are focusing on:

• Defining the biological pathways and processes enabling healthy pregnancy and fetal growth
• Understanding the genetic and environmental factors and pathophysiological events leading to pregnancy complications
• Biological and social factors influencing maternal health
• Indigenous womens' health and the special challenges facing disadvantaged women
• The maternal immune response to implantation and the immune adaptations allowing placental formation
• Placental development, its vascular supply and nutrient transport function
• The immune and inflammatory mechanisms controlling the timing of birth and disposing some women to preterm birth
• Maximising infant health and well-being after birth

The health of every child is profoundly influenced by events in early life. Early life environment determines the trajectory of future metabolic and cardiovascular health, immune and reproductive health, and neurological function. Parental health and well-being prior to conception, during pregnancy and in early postnatal life determines the quality of this crucial early environment.

We seek to understand the mechanisms underlying these links. This is essential to develop effective interventions, to identify early prognostic markers of risk and to define optimal parental health and lifestyle. This knowledge and tools are needed to inform pregnancy care guidelines and public health policy and their application, including stratification of individuals and groups for targeted interventions.

Common factors that affect the gametes, embryo, fetus, infant or child, to alter offspring health, include:

• Poor nutrition, lack of or excess physical activity, infection, stress, shiftwork,
• Obesity, diabetes, hypertensive disorders, asthma and
• Prematurity and intrauterine growth restriction.

These links in part reflect shared genetics and postnatal familial environments, but an additional pathway is now recognised, that of developmental programming. This phenomenon is not confined to maternal influences - the health of the father can also program the health of the next generation.

We also understand that many adverse parental factors are strongly associated with disadvantage, including for Indigenous people; their socio-cultural context must therefore be understood, to develop and adapt interventions and policy to be effective for the most affected.

Our major findings in this area include:

• Showing that dietary and lifestyle intervention in pregnant women who are overweight or obese, improves diet quality and increases physical activity, reducing the number of babies weighing more than 4kg at birth
• Demonstration that metformin compared to insulin treatment of women with gestational diabetes may increase subcutaneous adiposity in children
• Identifying in late preterm babies an increased risk of impaired neurological function in childhood
• Showing that food insecurity and number of house moves predict child obesity, independent of other factors, highlighting pathways or mediators whereby social disadvantage contributes to health outcomes
• Defining how insulin action impaired by IUGR impairs metabolic health in offspring showing that neonatal treatment to promote insulin secretory capacity can improve some outcomes;
• Demonstrating that paternal obesity and poor diet programs obesity and impaired metabolic health in the next two generations of offspring in a non-human species model, and identifying some of the paternal signals to offspring that may be involved

The future health of our society depends on the health of our children. Many chronic physical and mental disorders originate in childhood and some of these, particularly non-communicable diseases, are on the increase. We need to develop safe and effective interventions that where possible, prevent disease and can be administered in early life.

Our members聽consists of world-leading clinicians and researchers who are working to detect, prevent and treat serious childhood diseases, to improve the health of all children and adolescents.

To reach this goal, our research strives to:

• Improve the effectiveness of immunisation to prevent serious infections in children
• Establish better treatments for diabetes, sleep and neurological disorders, allergies, joint disease and cystic fibrosis
• Identify biomarkers to ensure early diagnosis and treatment of autoimmune disease, allergies and asthma
• Define the genetics of intellectual disability, cerebral palsy, and epilepsy to provide targets for new treatment
• Work to prevent childhood diabetes and obesity聽
• Strengthen the mental health of young children聽
• Support adolescent mental health in the community

Many of these conditions are now known to be influenced by early life exposures and experience, including during fetal growth in utero. The strength of this theme lies in the interconnectedness with other Robinson Research institute themes focused on conception, pregnancy and early origins of health. Internationally, we are particularly known for our advances in mental health and diabetes, both of which are substantially affected by programming of the fetus in utero and perinatal events. We are also identifying ways to improve the effectiveness of maternal immunisation programs, to enhance the dual benefit to both mothers and their newborn babies in preventing serious infections.

Our ongoing diabetes research features a current national study to determine which factors in the environment are crucial in driving the epidemic of type 1 diabetes in children. We are also identifying novel biomarkers of immune function in children, in order to predict and diagnose these diseases sooner.

To combat early childhood mental health disorders, we are investigating innovative e-learning programs for mothers that recognise the significance of maternal-infant bonding in the days and weeks after birth.

Additionally we are national leaders in immunisation research and developing capability and efficacy for using vaccines to prevent childhood and adolescent infectious disease. We particularly seek to understand how and why some health conditions, such as pregnancy, obesity and immune compromise, impact on vaccine effectiveness. Our vision is to reduce deaths from serious infectious diseases by improving the uptake and effectiveness of vaccines. Using data linkage and e-health our research is helping to increase vaccine uptake and safety for all Australian children.