Snapshots in NICHD Science 1962-2012: Pregnancy and Infant Development

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Over the past 50 years, NICHD research has expanded fundamental knowledge of the processes that underlie reproduction and fertility and has helped to improve health, with a focus on maternal health, pregnancy, fetal well-being, labor and delivery, and infant health.

In 1969, Nobel Prize-winners Roger Guillemin and Andrew Schally discover the master fertility hormone, known as gonadotropin-releasing hormone (GnRH), profoundly changing our understanding of how the brain regulates reproduction and fertility. This finding expands the possible treatments for infertility and for cancers of the reproductive system through the development of GnRH analog peptides. Research from an NICHD network shows that, among pregnant women at risk for preterm delivery, a single course of prenatal corticosteroids matures the fetus and reduces the risk of respiratory distress syndrome and other adverse outcomes in preterm infants. As a result, a single course of prenatal corticosteroids becomes the standard of care for improving outcomes among preterm infants. An Institute workshop is the first to highlight the health challenges of late preterm infants, those born at 34 to 36 weeks' gestation. Because these infants are less physiologically and metabolically mature than term infants (37 weeks' gestation or greater), they are at greater risk for illness and death. These data provide evidence that, unless there are complications, birth at or after 39 weeks in the womb improves outcomes for both mothers and babies. Findings from a collaboration between researchers in the United States and in resource-poor countries provide safe, convenient, and inexpensive interventions that greatly reduce the maternal and infant deaths in these countries. Based on this effort, skilled birth attendants in more than 30 countries receive training in basic newborn care to reduce infant deaths from asphyxia, and the drug misoprostol reduces the incidence of postpartum hemorrhage, a major killer of women in developing countries.
Focused research to prevent mother-to-child transmission of HIV results in several important findings and reduces the transmission rate to less than 1 percent in the United States. Among the findings are that performing cesarean delivery before the membranes rupture and using combination anti-HIV drug regimens during pregnancy significantly reduce transmission. Research also shows that giving anti-HIV drugs to either the HIV-infected mother or the infant during breastfeeding significantly reduces the risk of HIV transmission through breast milk. This latter finding is especially important in developing countries, where breastfeeding is critical for infant survival but safe replacement feeding is not available, unlike in developed countries where HIV infected women are advised not to breastfeed. NICHD research provides evidence that treating preterm infants with synthetic surfactant reduces the risk of respiratory distress syndrome, the need for mechanical ventilation, overall morbidity, and the risk of death. Thus, surfactant becomes a standard treatment for preterm infants. The number of sudden infant death syndrome (SIDS) deaths in Mississippi, a state which has consistently had one of the highest SIDS rates for decades, decreases by 35 percent statewide from 2006 to 2009, the years during which NICHD conducts outreach and other activities to promote safe sleep practices in African American communities. In a landmark study of prenatal surgical treatment to repair the most severe form of spina bifida, researchers find better overall outcomes–including a greater likelihood of being able to walk independently and less likelihood for the need of a shunt–among infants. The study also shows that mothers and infants who receive the prenatal surgery are at greater risk for complications than are those who receive the surgery after birth.
The Food and Drug Administration approves 17 alpha-hydroxyprogesterone caproate (17P), a synthetic form of the naturally occurring hormone progesterone, after NICHD research shows that it reduces the chances of preterm delivery by one-third among high-risk pregnant women. NICHD research provides evidence that hypothermia treatment improves outcomes for infants who experience hypoxic-ischemic encephalopathy, a severe oxygen deficiency, without increasing the risk of long-term disability. Clinical research demonstrates that giving magnesium sulfate to pregnant women who are at risk for preterm delivery significantly reduces the risk of cerebral palsy among their preterm infants without increasing the risk of death. Investigations of maternal glucose levels enhance our understanding that events during pregnancy have long-<br />term effects on mother and baby. Findings from an international study demonstrate that glycemia is a continuum, with maternal glucose levels positively associated with birth weight and cord-blood serum C-<br />peptide levels, a marker for hypoglycemia. NICHD research also provides the first conclusive evidence that mothers and babies have better overall outcomes when the mother is treated for mild gestational diabetes.

Looking to the Future

As we look to the future, we seek to better understand the basic mechanisms of pregnancy, fetal development, and birth outcomes, with the ultimate goal of decreasing the life-long impact of pregnancy on women, enhancing the prospects of a healthy pregnancy for women with disabilities, improving birth outcomes, and reducing health disparities for both mothers and infants.

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