Deborah Ashtree

At the beginning of my PhD, I wasn’t sure where to start, so I decided to do (yet another) systematic review. My main aim was to identify what was already known about the developmental origins of cardiometabolic health in twins. Basically, I wanted to know whether events occurring between conception and age two led to risk factors for cardiovascular disease in twins, such as obesity or diabetes. I found so much research on the role of birthweight, but birthweight is only supposed to be used as an indicator for events occurring during pregnancy, and there was an overwhelming lack of information on other pregnancy exposures. One in particular caught my attention – gestational weight gain, the weight gained by the mother during the pregnancy.

Gestational weight gain contributes to birthweight, and in non-twin studies has been linked to birth complications and long-term cardiovascular health for the mothers and children. So, I dug a little deeper. I found international recommendations for gestational weight gain in twin pregnancies. Yay!

Except, these recommendations had some serious flaws. Not so yay…

These recommendations were based on one study of less than 1000 women pregnant with twins, and used inclusion/exclusion criteria which meant that more than half of twin pregnancies would be excluded. So, I began to question whether these recommendations would actually be useful for women pregnant with twins.

I then spoke to three practitioners – an obstetrician, a paediatrician and a dietician (hmm, this kind of sounds like the beginning of a lame joke…) – and discovered that in Australia, women pregnant with twins were only being told the recommendations for a non-twin pregnancy. Given that gestational weight gain is linked to pregnancy and birth complications (such as preeclampsia, gestational diabetes and preterm birth), giving women information which may not be applicable to them could potentially be harmful.

And so, my research project was born (yes, I know, I’m very punny). I began looking into whether women pregnant with twins in the Peri/Postnatal Twins Study (PETS), based in Melbourne, were meeting the current recommendations, and whether there were any links between gestational weight gain and the health of the twins. I found that less than half of the women were gaining the recommended amount of weight, and that gestational weight gain was associated with all measures of size at birth, admission to neonatal intensive care (an indication of a complicated pregnancy) and preterm birth. I also found that gestational weight gain may have implications for the long-term health of the twins.

During this project, I was invited by Twins Research Australia to present at a workshop outlining national research priority areas for twin research. I would be presenting to researchers, stakeholders, investors, and twins and their families, and trying to convince them that gestational weight gain was an important research area. No pressure, right? I questioned whether I was the right person to give this kind of presentation – I didn’t think I was qualified enough (major imposter syndrome!).

Before I studied science communication, there was no way I would have agreed to something like this. I used to get so nauseous just thinking about presenting. But then I remembered some of the lessons I learned from Jenny. My presentation wasn’t about me, it was about the audience, and it was about women pregnant with twins. I needed to change my perspective from “what could I possibly tell these people?” to “what is it these people need to know?” I thought about all the things I had learned whilst researching gestational weight gain, and how hard it would be for a non-researcher to discover all this information. So, I agreed to present.

On the day, I was nervous, but also excited. If I could communicate my research well enough, I could potentially affect change. I discussed the limitations of the current recommendations and what we could do to improve them. Whilst I was presenting, I took a deep breath, and looked around the room. People were nodding and smiling, and I even managed to get a laugh (intentionally). I relaxed, then was able to speak to the audience as if I were having a conversation, rather than lecturing them. By the end, I think I had successfully convinced a room full of strangers how important this issue was, and by the end of the workshop, we were discussing realistic ways to improve research and make a difference. I was also asked to write a piece for the Twins Research Australia Annual Report.

Soon after the workshop, I was invited to speak about gestational weight gain at a conference in London (which was postponed for obvious reasons). And so, my science communication adventure continues…