Institute Activities and Advances
Many programs within the NICHD's Division of Intramural Research and extramural research programs conduct and support research on pregnancy. Researchers investigate a wide variety of topics related to improving the health of mothers and their fetuses, from before conception to the weeks and months after birth.
Preconception and Prenatal Care
Increasing awareness of and access to preconception care and prenatal care to ensure a healthy pregnancy and good pregnancy outcomes is of paramount importance to the NICHD. Some current studies in this area include, but are not limited to:
- Evaluating techniques to develop and refine prenatal screenings. The Intellectual and Developmental Disabilities (IDD) Branch supports studies leading to the development and refinement of screening methods for conditions leading to IDDs.
- Investigating the role of nutrition during pregnancy and its role in the prevention of neural tube defects (NTDs) such as spina bifida. Researchers supported by the NICHD and the National Institute of Neurological Disorders and Stroke have reported new findings related to the interaction between folic acid supplementation, an important tool in prenatal care, and genetic pathways that could inform strategies to optimize NTD prevention. (PMID: 20843827). A study through the Pediatric Growth and Nutrition Branch is studying iron-deficiency anemia in newborns to determine if identifying and treating iron deficiency in pregnancy can reduce this prevalent problem.
- Establishing a national standard for fetal growth. A current trial led by the NICHD's Division of Epidemiology Statistics and Prevention Research (DESPR) focuses on establishing a standard for both singleton and multiple pregnancies. Researchers will measure fetal growth via ultrasound, working with 2,400 women from their first trimester through delivery.
- Studying medication use during pregnancy. The Effects of Aspirin in Gestation and Reproduction (EAGeR) Study, supported by the DESPR, is examining the therapeutic value of low-dose aspirin in prenatal care. The research will analyze the effects of low-dose aspirin in combination with the intake of folic acid, compared with folic acid alone, on the incidence of miscarriage and other outcomes. The Obstetric and Pediatric Pharmacology and Therapeutics Branch promotes research to improve the safety and effectiveness of medications for pregnant women. Some current studies include the study of clonidine to treat high blood pressure and metformin for the treatment of diabetes.
- Evaluating effects of drinking alcohol and smoking tobacco on pregnancy outcomes. The DESPR is studying alcohol use during pregnancy and its effects on infants. Other studies through the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network are investigating the impact of alcohol use and tobacco smoking, both before and during pregnancy, on risk for sudden infant death syndrome (SIDS).
Maternal Health Issues
The bulk of pregnancy research sponsored by the NICHD is supported by the PP Branch, which seeks to improve the health of mothers and infants through research on maternal health, pregnancy, and fetal well-being. Two of the current studies are on:
- Complications causing or exacerbated by a high-risk pregnancy, including medication use and adolescent pregnancy, as well as a study of the pathogenesis of symptomatic and asymptomatic maternal infections
- The state of women's mental health during pregnancy and the etiology and pathophysiology of sleep-disordered breathing in pregnancy
The Obstetric and Pediatric Pharmacology and Therapeutics Branch supports studies on the use of medication during pregnancy to relieve problems such as nausea and vomiting and to lessen the risk of complications from gestational diabetes and type 2 diabetes. A recent study on the effectiveness of Dilectin for nausea and vomiting found that the medication resulted in dramatically improved symptoms compared to placebo. (PMID: 20843504)
- Preterm birth. The NICHD served as the scientific lead for the Surgeon General's Conference on Preventing Preterm Birth in 2008, which developed the national agenda and action plan aimed at preventing preterm birth. This topic is an active research focus for the NICHD. The following current research efforts are supported by the PP Branch:
Researchers participating in the Maternal-Fetal Medicine Units Network, also supported by the PP Branch, found that use of progesterone by women at risk for preterm birth due to a prior preterm birth reduces the chances of a subsequent preterm birth by one-third.
- Evaluating whether treatments with antenatal steroids between 34 and 36 weeks of pregnancy will decrease infants' need for oxygen support
- Investigating the mechanisms of disease responsible for preterm birth, including how certain maternal antibodies might induce labor
- Studying women who are pregnant for the first time, with the goal of identifying factors in women who may be at risk for complications, including pregnancy-induced hypertension, preterm delivery, and low-birth-weight infants, during their first pregnancy.
- Gestational diabetes. The DESPR Epidemiology Branch is currently studying the increased risk of hypertension in women with gestational diabetes mellitus.
- Preeclampsia. Studies are ongoing to determine whether abnormal levels of certain substances in the blood can predict preeclampsia. NICHD researchers and others have found that women who develop preeclampsia have higher levels of a substance called soluble fms-like tyrosine kinase 1 (sFlt1) and lower levels of placental growth factor and vascular endothelial growth factor than women who do not develop preeclampsia.
- Infections. Researchers investigating the expression and regulation of a group of innate immune receptors, called Toll-like receptors (TLRs), discovered that TLRs may play a role in infection-associated pregnancy complications by regulating the infection-induced inflammatory responses at the maternal-fetal interface.
The Consortium on Safe Labor, within the DESPR Epidemiology Branch, is evaluating the appropriateness of relying on the Friedman curve, which has traditionally been used to plot hours of labor against cervical dilation in centimeters, to guide decision making. This study is evaluating labor progression to determine the appropriate time to perform a C-section in women with protracted labor and/or arrest. Researchers are tracking trends in preterm deliveries, practices such as induced labor, and how environmental and other factors may influence fertility, pregnancy, and pregnancy outcomes over time.
In addition, the Maternal and Pediatric Infectious Disease Branch supports research examining mother-to-child transmission of HIV and how this can be prevented during pregnancy and labor. Current research includes:
- Studies on the epidemiology of HIV infection and complications in pregnant women and the safety of using new medications during pregnancy
- Investigating interventions to identify, prevent, and treat women at risk for obstetric fistula
An NIH State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request (2006) (PDF - 3.59 MB), formed in response to the growing trend in requests for cesarean deliveries, assessed the potential benefits and risks of requested cesarean deliveries versus vaginal deliveries.
Current studies in the Developmental Biology and Structural Variation Branch include immunobiology of the placenta and maternal-fetal interactions. The Branch also funds opportunities for and studies on understanding embryonic development and the origin and development of structural birth defects.
The National Center for Medical Rehabilitation Research funds the Center for Research on Women with Disabilities (CROWD), which completed the National Study of Women with Physical Disabilities. That report found that pregnant women with disabilities face significant challenges in finding health care providers who are knowledgeable about their disability to help them manage their pregnancy.
Other Activities and Advances
To achieve its goals for research on pregnancy and related disorders, the NICHD supports a variety of programs, networks, and centers. A number of examples are included below.
- National Child and Maternal Health Education Program (NCMHEP)
NCMHEP was created by the NICHD in 2008 to provide a forum for reviewing, translating, and disseminating new research in maternal and child health. A coalition of health care provider associations, federal agencies, nonprofit organizations, and other partners pinpoint one issue pertaining to maternal and child health on which to focus for a set period of time, typically 12 to 18 months. The first focus area is Late Preterm Birth and Elective Term Deliveries.
- Stillbirth Collaborative Research Network
Established in 2003 by the Pregnancy & Perinatology Branch, the network is currently studying stillbirth cases at five clinical sites around the country and completing a case-control study that is the first large stillbirth study in the U.S. to simultaneously include population-based controls and complete fetal autopsy and placental pathology examinations.
- Maternal-Fetal Surgery Network
Created in 2001, the network, also part of the Pregnancy & Perinatology Branch, has validated positive outcomes of in utero surgery to repair myelomeningocele, the most severe form of spina bifida. The clinical trial, called Management of Myelomeningocele Study, was named the 2012 "Trial of the Year" by the Society for Clinical Trials.
- The Birth Defects Research Group
The Birth Defects Research Group is a multicenter, multidisciplinary group led by the NICHD to investigate the etiology of birth defects, particularly NTDs. The group was the first to discover that homocysteine levels were elevated for women carrying fetuses affected by NTDs. This group is supported by the NICHD's DESPR.
- PASS Network
NICHD supports this network in partnership with the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Deafness and Other Communication Disorders with the aim of studying the effects of prenatal alcohol exposure on the risk for SIDS, stillbirth, and other adverse outcomes.
- The Obstetric-Fetal Pharmacology Research Unit Network
Supported by the Obstetric and Pediatric Pharmacology and Therapeutics Branch, this network provides expertise for clinical trials of medication to treat various conditions in pregnancy, such as gestational diabetes, severe nausea, high blood pressure, and preterm labor.