Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) Scientific Vision
Pregnancy and Pregnancy Outcomes Workshop
Bethesda, MD
February 22-23, 2011

Views expressed in the workshop presentations are those of the
presenters alone and do not necessarily reflect those of the NICHD.

DAY 1


7:30 a.m.

Breakfast

8:00 a.m.

Welcome
Alan Guttmacher, M.D.
Director, NICHD

8:15 a.m.

Workshop Overview
Co-chairs
Patrick M. Catalano, M.D.
Case Western Reserve University School of Medicine
Michelle A. Williams, Sc.D.
University of Washington School of Public Health

8:30 a.m.

Plenary Presentations
How to Incorporate Newer Research Technologies, Molecular Systems, and Networks in Addressing Pregnancy-related Research
Andrew Kasarskis, Ph.D.
Senior Director
Pacific Biosciences

This talk will present an overview of a multi-scale biological approach to understanding and treating pregnancy-related disorders in the 21st century. Rapid innovations in imaging, cell-based screening, sequencing, and other data-acquisition technologies offer us unprecedented ability to measure biological systems. Fortunately, advances in data management, computing, and statistics may allow us to harness a good fraction of the potential of all these measurements and to integrate them into models that are increasingly predictive of biology. This talk will highlight some new capabilities in the analysis and integration of such data, suggest approaches that have the potential to transform the work of biological researchers and clinicians over the next decade, and discuss mitigating barriers to the adoption of such transformative approaches. The focus will be on analysis of molecular data in the context of the larger environment, including societal structures, with the ultimate aim of developing a cohesive translational approach to addressing complex pregnancy-related conditions such as premature birth and the prevention of long-term women’s health issues.

9:00 a.m.

Discussion

9:15 a.m.

Bridging Biology and Social Science, Social Determinants of Disease, Health Disparities (PDF - 280 KB)
Michael S. Kramer, M.D.
Scientific Director
Institute of Human Development, Child and Youth Health
Canadian Institutes of Health Research
McGill University, Canada

This talk will highlight the complex environmental, biological, behavioral, social, and health care factors influencing pregnancy and perinatal outcomes. several issues will be addressed, including the need for team science to provide the multidisciplinary breadth to address these diverse domains, scientific challenges inherent in adequately measuring the “exposome,” overcoming the scientific double-standard of weak scientific designs for evaluating far-reaching and expensive public health interventions, and the value of integrated knowledge translation involving community-based decision makers as collaborators in framing key questions and carrying out research. The speaker will highlight current examples of pregnancy and perinatal research that illustrate these issues and will discuss barriers to and strategies for overcoming them.

9:45 a.m.

Discussion

10:00 a.m.

Break

10:15 a.m.

Life Course Approaches to Health and Disease in Pregnant Women (PDF - 713 KB)
Debbie Lawlor, Ph.D.
Professor of Epidemiology
University of Bristol, United Kingdom

The specific aim of This talk will be to consider pregnancy as a paradigm for understanding the physiological challenges and adaptations that occur during the reproductive life of a woman. During human pregnancy, there are interactions among a woman’s social, lifestyle, and nutritional environments that affect her maternal metabolism, cardiovascular function, and physiological adaptations—changes which may become clinically manifest only later in life. The speaker will briefly outline current evidence for associations between pregnancy and pregnancy-related characteristics and long-term chronic disease outcomes in mothers (with a focus on diabetes and cardiovascular disease), address the methods by which we can improve our understanding of causal mechanisms underlying these associations, and discuss implications for intervention and evaluation research in this area. She will emphasize the importance and implications of considering long-term outcomes in both mother and offspring at the same time rather than viewing these as two separate research areas.

10:45 a.m.

Discussion

11:00 a.m.

Applying Emerging Science to Key Problems in Obstetrics (PDF - 757 KB)
Gordon Smith, M.D., Ph.D.
Rosie Maternity Hospital, United Kingdom

In this talk, the speaker will set the stage for the breakout group discussions by illustrating the potential utility of applying these and other novel scientific approaches to persistent, complex problems in obstetrics and maternal health. The speaker will focus on two of the breakout topics: “Mode of Delivery: Preventing the First Cesarean” and “Placental Medicine, Placental Syndromes.” the existing approaches to screening and intervention that are used to address the associated clinical problems will be summarized. In each case, the potential for novel scientific approaches will be addressed; and possible basic, clinical, and epidemiological approaches will be outlined. the need for translational research to encompass methodological excellence in all three of these areas will be emphasized. The importance of high-quality observational studies to the design of practice-changing randomized controlled trials will be discussed.

11:30 a.m.

Discussion

11:45 a.m.

Panel Discussion with Morning Speakers and Charge to Participants

12:15 p.m.

Lunch

1:00 p.m.

Breakout Sessions

  • Breakout Session 1: New Methodologies
    Michelle Williams, Sc.D.
    University of Washington School of Public Health

    In this session, we will seek to identify and discuss novel study designs for evaluating pregnancy and related outcomes that are able to assess the effectiveness of new technologies in clinical practice. As technologies are advancing rapidly, it is becoming increasingly important to evaluate them in large populations. Studies must be efficient, well-designed, and able to account for issues inherent in evaluating this biological process, such as time-dependent or time-modified confounders (e.g., proteomics) and dimensionality (e.g., genetics). Given that pregnancy is of a relatively short duration, we have the opportunities to develop revolutionary study designs that will change the way we evaluate evidence. Potential study designs include case-cohort, pooling, and two-stage designs. The following questions are important to consider when designing new studies: What types of information do we need to collect to efficiently estimate risk? When is the most appropriate time-sensitive window to collect data? How can we simultaneously study multiple pregnancy outcomes? How should these outcomes be defined? How can we avoid rushing into incorporating newer technologies before more detailed evaluations of clinical effectiveness are completed (by, for example, foregoing routine, continuous, and electronic fetal monitoring)?

  • Breakout Session 2: Balancing Maternal and Fetal Risks
    George Saade, M.D.
    University of Texas Medical Branch

    The purpose of this breakout session will be to identify future research that will allow better-informed decisions relating to timing of delivery versus expectant management in late-preterm patients. The management of preterm patients with medical conditions (e.g., preeclampsia, preterm premature rupture of membranes) has to take into account the risk to the mother of expectant management versus the risk to the fetus of early delivery. Currently, there is a lack of accurate methods to inform this decision. Examples of research that would address this field include noninvasive methods to evaluate fetal well-being or maturation (e.g., noninvasive fetal echocardiograph [ECG] monitoring, magnetic resonance imaging [MRI]) and methods to distinguish between mothers who may safely be managed expectantly and those who would be at high risk for major complications if undelivered (e.g., proteomics, Doppler). Only by knowing the risks to the mother and fetus of each management option (delivery versus expectant) can one determine the appropriate management plan.

  • Breakout Session 3: Mode of Delivery: Preventing the First Cesarean
    Brian Mercer, M.D.
    MetroHealth Medical Center

    One-half of cesarean sections performed are repeat cesarean sections. Attempts at encouraging vaginal birth after cesarean have had a limited impact. The exponential rise in the rate of cesarean section will continue unless we find ways to prevent the first cesarean section. Most first cesarean sections are performed for “failure to progress in labor” or “non-reassuring fetal status.” Research into what constitutes “failure to progress” and into new methods to evaluate the fetal status intrapartum are needed. Examples of such research, including novel methods to evaluate cervical dilatation and progress of labor, research into the safety of continuing labor beyond the current time limits, and research into more accurate methods to evaluate fetal well-being in labor (e.g., fetal ECG, scalp sampling), would fall within the focus of this workgroup.

Back to top

  • Breakout Session 4: Pregnancy as a Physiologic Paradigm to Maternal Chronic Diseases
    Patrick Catalano, M.D.
    Case Western Reserve University School of Medicine

    Pregnancy is an excellent model of metabolic and other physiologic changes, which occur over decades in a non-pregnant individual. Thus, the development of problems such as preeclampsia and gestational diabetes are mechanistically linked to the chronic problems of metabolic syndrome (e.g., chronic hypertension, type 2 diabetes, hyperlipidemia, atrioventricular septal defect). Important questions to be addressed in this session include the following: With the increased prevalence of obesity in the population, what is the role of avoiding excessive gestational weight gain versus other lifestyle measures in decreasing the disease burden in later life? Is there a role for pharmacologic treatments during pregnancy versus lifestyle measures? Although we tend to focus on the metabolic syndrome, are there additional subclincal alterations in other physiological functions that may affect long-term immune function, risk for infectious disease, and epigenetic modification of the developing oocyte?

  • Breakout Session 5: Prenatal Diagnosis and Treatment
    Diana Bianchi, M.D.
    Natalie V. Zucker
    Professors of Pediatrics, Obstetrics, and Gynecology
    Tufts University

    What do pregnant women want to know about their fetuses? How has the availability of first-trimester screening affected the prevalence of diseases and the use of invasive prenatal diagnostic procedures such as amniocentesis? What effect does the relatively rapid incorporation of technologies such as array comparative genomic hybridization have on clinical care and the education of health care providers? How will high-throughput sequencing of DNA affect prenatal care? What will prenatal diagnosis look like in 10 years? While there has been a lot of interest in surgical approaches to fetal treatment, there has been less research in fetal medical therapies. Will it be possible to take a “personalized-medicine” approach to the fetus?

  • Breakout Session 6: Placental Medicine, Placental Syndromes
    Yoel Sadovsky, M.D.
    Magee-Womens Research Institute
    University of Pittsburgh School of Medicine

    All adverse pregnancy outcomes that are believed to be linked to abnormal placentation will be included in this session, including preeclampsia, abruption, stillbirth, and intrauterine growth restriction. Insight into research focusing on prediction, prevention, and management of these conditions is urgently needed. How good are the animal models? Can the placenta provide us with a door to understanding fetal development in utero? How important is early placental development relative to late fetal conditions? What is the role of placental inflammation? Is it necessary for fetal growth and development? Is it beneficial, or does it always portend adverse consequences?

  • Breakout Session 7: Prevention of Prematurity
    Paul Wise, M.D., M.P.H.
    Richard E. Behrman
    Stanford University School of Medicine

    This session will address the growing appreciation of the heterogeneity of preterm birth and its etiologic pathways. An effort will be placed on identifying research strategies that can integrate promising arenas of investigation, including genetics, epigenetics, clinical risk identification, and the social sciences. The session will also explore the potential impact of different intervention strategies. Special emphasis will be placed on research strategies that address the role of prematurity on social disparities in neonatal and infant outcomes.

3:00 p.m.

Break

3:15 p.m.

Breakout Sessions Continue

5:00 p.m.

Discussion

6:30 p.m.

Working Dinner and Development of Presentations for Day 2

Back to top

DAY 2


7:30 a.m.

Registration and Breakfast

8:00 a.m.

Breakout Sessions Continue

9:00 a.m.

Breakout Group 1 Presentation

9:30 a.m.

Breakout Group 2 Presentation

10:00 a.m.

Breakout Group 3 Presentation

10:30 a.m.

Break

10:45 a.m.

Breakout Group 4 Presentation

11:15 a.m.

Breakout Group 5 Presentation

11:45 a.m.

Breakout Group 6 Presentation

12:15 p.m.

Breakout Group 7 Presentation

12:45 p.m.

Working Lunch

2:00 p.m.

Adjourn

Back to Top

Last Updated Date: 04/04/2011
Last Reviewed Date: 04/04/2011