High-Risk Pregnancy: Research Activities and Scientific Advances

• Institute Activities and Advances
• Other Activities and Advances

Institute Activities and Advances

Research supported by the Pregnancy and Perinatology Branch (PPB) is looking into ways to help prevent preterm labor and birth as well as identify markers and predictors of preterm labor and premature birth. Research on high-risk pregnancy focuses on factors, both normal and abnormal, that influence the course and outcome of pregnancy, including maternal physiology, environmental variables, and conditions and treatments occurring during pregnancy. Examples include studies on clarifying mechanisms in the pathophysiological states of pregnancy, the health impact of pregnancy-related disorders, the pathogenesis of symptomatic and asymptomatic maternal infections and their effects on fetal development, the effect of maternal medications and maternal use and abuse of drugs on fetal development, and adolescent pregnancy.

The NICHD’s Division of Epidemiology, Statistics, and Prevention Research (DESPR) conducts research on preterm labor and birth, preeclampsia, labor patterns, and other pregnancy-related topics. DESPR researchers have been studying substances in the blood to see whether abnormal levels of certain substances can predict the development of preeclampsia.

In addition, DESPR researchers led the Consortium on Safe Labor research that has followed trends in obstetrical practice and documented changes in labor patterns. Their findings suggest that new evidence-based definitions of labor protraction and arrest are needed.

Through 2006, the Pediatric Growth and Nutrition Branch supported the Hyperglycemia and Pregnancy Outcome (HAPO) study, which investigated pregnancy outcomes and the need for caesarean deliveries among women with varying blood sugar levels. More than 25,000 pregnant women and their offspring in 11 countries participated in the study.

Research specifically about the risks of HIV/AIDS during pregnancy and ways to prevent transmission is conducted through the Maternal and Pediatric Infectious Disease Branch (MPIDB).

Other Activities and Advances

• The Stillbirth Collaborative Research Network (SCRN) is supported by the PPB. The objectives of this network of clinical research sites with central data collection and analysis are to:
• Develop a standard stillbirth postmortem protocol that includes review of clinical history, protocols for autopsies and pathologic examinations of the fetus and placenta, and other postmortem tests to illuminate genetic, maternal, and other environmental influences.
• Obtain a geographic, population-based determination of the incidence of fetal deaths at 20 weeks’ gestation or greater, their causes, and risk factors.
• Determine maternal and fetal risk factors associated with increased risk of stillbirth.
• The PPB also supports the Maternal-Fetal Medicine Units (MFMU) Network. Established in 1986, the MFMU network focuses on clinical questions in maternal-fetal medicine and obstetrics, including maternal health, fetal health and development, gestational diabetes, asthma, thyroid disorders, and preterm labor.
• The NICHD sponsored the 2-day Pregnancy in Women with Physical Disabilities workshop in 2010 to review the body of evidence on management of pregnancy in women with physical disabilities, identify key gaps in knowledge, and recommend priority avenues for future research. The meeting was organized by the NICHD’s PPB and the National Center for Medical Rehabilitation Research.
• As a part of the NICHD Health Disparities Seminar Series, the Institute hosted the Racial and Ethnic Disparities in Pregnancy Outcomes: Exploring the Role of Paternal Involvement workshop in July 2012 to address the role of prospective fathers in pregnancy outcomes. The workshop was organized by the Office of Health Equity.
• The NICHD is sponsoring the NIH Consensus Development Conference on Diagnosing Gestational Diabetes to examine the benefits and risks of various screening and diagnostic approaches for gestational diabetes.
• Research on mother-to-child transmission of HIV/AIDS, complications of HIV infection in pregnant women, and drug treatment are carried out through the following supported networks:
• Global Partnerships for Social Science and Behavioral Research on HIV/AIDS (supported by the Population Dynamics Branch)
• International Maternal, Pediatric, Adolescent AIDS Clinical Trials (IMPAACT) Network (supported by the MPIDB)
• NICHD Domestic and International Pediatric/Maternal HIV Clinical Studies Network (supported by the MPIDB)