Push to IMPROVE Health Outcomes for Pregnant Women

African American pregnant mother and her daughter.

Understanding and reducing pregnancy-related deaths and complications—or maternal mortality and morbidity—is a high priority for NICHD. The COVID-19 pandemic has added even more urgency to this work, as we move quickly to recognize how this disease affects maternal, fetal, and newborn health outcomes. It is against this backdrop that we join our colleagues across the National Institutes of Health (NIH) to launch a new initiative that will combat the growing problem of maternal mortality and morbidity in the United States.

The Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) initiative is supported by multiple NIH institutes and co-led by NICHD, the NIH Office of the Director (OD), and the NIH Office of Research on Women’s Health (ORWH).

The IMPROVE initiative has recently awarded approximately $7.2 million in grants through a Notice of Special Interest on Maternal Mortality. Areas of research include heart disease, hemorrhage or bleeding, and infection (the leading causes of U.S. maternal deaths); contributing conditions, such as diabetes, obesity, mental health disorders, and substance use disorders; and structural and healthcare system factors that may contribute to delays or disruptions in maternal care. NICHD is supporting four of these awards, totaling about $1 million. More trans-NIH funding opportunities are expected in the coming year.

As the name says, this initiative gives us the opportunity to improve health outcomes for pregnant women across the country. The Centers for Disease Control and Prevention (CDC) estimates that approximately 700 women die each year in the United States from pregnancy-related complications. Disparities exist among Black and American Indian/Alaska Native women, who are about three times as likely to die from a pregnancy-related cause compared to white women. In addition, women over the age of 35 are at higher risk for complications. More than 50,000 women a year have severe pregnancy complications (severe maternal morbidity), which can result in “near misses” for maternal death.

Research shows that up to 60 percent of these deaths are preventable. More studies are needed to better understand the causes of these severe complications and deaths, the circumstances that contribute to them, and how to prevent them. The IMPROVE initiative provides funding to identify biological, behavioral, sociocultural, and structural factors that contribute to disparities in maternal health. The initiative also encourages researchers to investigate the potential effects of emerging infections, such as SARS-CoV-2, on pregnancy-related deaths and complications in different geographic regions and communities.

NICHD has a long history of supporting maternal health research and building research infrastructure, domestically and globally, to conduct large-scale studies. The institute was established more than 50 years ago to help understand maternal health and improve pregnancy outcomes. Today, NICHD continues its mission by funding more than 65 percent of NIH research on maternal health and co-leading many trans-NIH initiatives.

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