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The New Zealand Pioneer Who Changed Maternity Care
Mont Liggins: making one of the most important medical discoveries in New Zealand History.
In 2024, Our Health Journeys partnered with Saint Kentigern College in Auckland and challenged a number of students to conduct research into an aspect of the medical history of Aotearoa New Zealand. The students, ranging from Years 8-13, produced their research in written, oral, or video format and the top projects were chosen for publication to Our Health Journeys. A new project will be published weekly until October.
Mont Liggins - The New Zealand Pioneer Who Changed Maternity Care
Heralded as one of the most important New Zealand medical discoveries to date is the benefit of antenatal corticosteroids for preterm babies. The distinguished Dame Professor Jane Harding stated, “Arguably the greatest contribution to the improvement in health outcomes for babies born preterm over the last 50 years has been the use of antenatal corticosteroids.” This discovery is estimated to have saved countless babies' lives and reduced morbidity for many others.
In the 1960s, Dr Graham Liggins was studying the initiation of labour in sheep. His prediction was that the foetus, not the mother, triggered the onset of labour. After removing the gland that produces glucocorticoid, he could delay the onset of labour. Inversely administration of glucocorticoid to the foetus resulted in labour independent of gestation period. However, during this experiment, he made an unrelated observation that would change the health outcomes of babies born preterm across the globe. Lambs born prematurely die as their immature lungs don’t inflate properly. This is very similar to human babies born prematurely. His key observation was that lambs born prematurely after being administered with glucocorticoids didn’t die, instead they survived with perfectly inflated lungs. He predicted that it might be a result of accelerated appearance of surfactant activity. Surfactant is a mixture of proteins and fat that coats the alveoli. It prevents your alveoli from sticking together when you breathe out. The hypothesis was that if glucocorticoids help preterm lambs inflate their lungs, then so will it help preterm babies.
At around the same time at National Woman’s Hospital, the first infant ventilators were being introduced by Professor Ross Howie. Working together Liggins and Howie devised a randomised trial to test their theory that antenatal corticosteroids would reduce the risk of respiratory complications for preterm babies. In 1969 they started recruiting women and in this first trial, they gathered 282 results. The findings were that preterm mortality was reduced from 15% to 3% and respiratory distress syndrome from 26% to 9%. This study continued until they had collected data on 1142 women and 1248 babies. The study continued to find positive results for glucocorticoids.
Over the years further research has been done to investigate the effectiveness of antenatal corticosteroids. The 2020 Cochrane review found 27 studies that involved 11,272 women and 11,925 infants. The studies were set in high‐, middle‐ and low‐income populations in 21 different countries. They found “Corticosteroids given to women at risk of premature birth improve the chances that, once they are born, their babies will be able to breathe and survive and that the evidence available suggests that corticosteroids are probably not associated with risks for the baby or mother.”
However, despite the life changing benefits, uptake of antenatal corticosteroids was variable. One of the reasons for the slow uptake was the initial concern about the long-term health risks. 50 years on and this lifesaving treatment is widely accepted and used around the world. Liggins was made a Knight Bachelor for services to medical research, in the 1991 Queen’s Birthday Honours.
