Setting the Foundation for Healthy Pregnancies and Lifelong Wellness
Highlighted Programs and Activities
NEW:NICHD Maternal-Fetal Medicine Units (MFMU) Network
NICHD is updating the MFMU Network program to better achieve its goals of improving obstetric care, pregnancy health, and outcomes for pregnant and lactating people and their babies. Updates include finding ways to: reduce maternal mortality, complications, and morbidities related to pregnancy, labor, and postpartum recovery; reduce prematurity, low-birth weight, infant mortality, and morbidities; and expand the evidence base about the safety and efficacy of therapeutic products used during pregnancy and lactation. NICHD expects the MFMU Network to be its primary and first-line infrastructure involved in implementing multisite obstetric clinical trials. The network infrastructure will include clinical sites, a data coordinating center, and, for the first time, separate grants awarded under separate funding opportunity announcements. Learn more: RFA-HD-23-016 and RFA-HD-23-017.
NEW: Advancing integrated models of care to improve maternal health outcomes among women who experience persistent disparities
The purpose of this initiative, led by the National Institute of Nursing Research, is to support intervention research that addresses structural inequities and reduces disparities in severe maternal morbidity and maternal mortality. More specifically, NICHD is partnering on this initiative to advance the development, implementation, and evaluation of models of integrative supportive care—addressing healthcare access, healthcare quality, and social conditions—to prevent adverse maternal health outcomes among disproportionately impacted populations. Learn more: RFA-NR-22-002 and RFA-NR-22-003.
Innovative screening approaches and therapies for screenable disorders in newborns
NICHD is supporting research related to the development of novel screening approaches and/or therapeutic interventions for potentially fatal or disabling conditions identifiable through newborn screening. Activities on "high-priority" genetic conditions, for which newborn screening may soon be possible, are also encouraged. Learn more: PAR-21-353, PAR-21-354, PAR-21-355.
Selected Recent Advances
NEW:More than one-fifth of U.S. pregnancy-associated deaths due to drugs, suicide, and homicide (PMID: 34991132)
Researchers estimated both the percentage of pregnancy-associated death overall in the United States, and the percentage attributable to drug use, suicide, and homicide from 2010 to 2019. After identifying 11,782 pregnancy-associated deaths of women ages 15 to 44 years, the researchers attributed 11% to drugs, 5% to suicide, and 5% to homicide. Pregnancy-associated deaths from these causes increased over the study period. The proportion of deaths due to drugs, suicide, and homicide were larger among pregnant or postpartum women compared to all women of reproductive age. Non-Hispanic American Indian/Alaska Native women had the highest pregnancy-associated death ratios for drug-related causes and for suicide. Non-Hispanic Black women had the highest pregnancy-associated deaths due to homicide.
NEW: Firearm relinquishment laws associated with reduction in homicide of pregnant and postpartum women (PMID: 34550804)
Some states have implemented laws that prohibit the possession of firearms by people convicted of domestic violence misdemeanors or who are under domestic violence restraining orders. These state laws often, but not always, also explicitly require relinquishment of firearms once the possession prohibition is in effect. Researchers evaluated the impact of these state laws, with and without the mandated relinquishment, on state-level rates of homicide among pregnant and postpartum women. The results showed that firearm prohibition laws could be effective in preventing homicide of pregnant and postpartum women, but only when the laws also included a firearm relinquishment requirement.
NEW:COVID-19 may increase risk of pregnancy complications (PMID: 35129581)
Researchers studied nearly 2,400 pregnant women infected with SARS-CoV-2, the virus that causes COVID-19. They found that those with moderate to severe infection were more likely to have a cesarean delivery, deliver preterm, die around the time of birth, or experience serious illness from hypertensive disorders of pregnancy, postpartum hemorrhage, or from infection other than SARS-CoV-2. They also were more likely to lose the pregnancy or to have an infant die during the newborn period. Mild or asymptomatic infection was not associated with increased pregnancy risks.
Researchers link depression during pregnancy to placental gene modifications (PMID: 34585950)
In an epigenome-wide association study, researchers found that episodes of maternal stress or depression during pregnancy were associated with chemical modifications to placental genes. The modifications involved DNA methylation—binding of compounds known as methyl groups to DNA—which can alter a gene’s activity. Some of these associated methylation changes occurred near genes involved in fetal brain development, suggesting that maternal depression in pregnancy could have long-term implications for brain development and function of children.
Lab-grown placental stem cells may yield insights into preeclampsia (PMID: 33723311)
The disease processes responsible for preeclampsia are not well understood, but abnormal development and functioning of trophoblasts are thought to play a role. Scientists used new technology to generate trophoblast cell lines from placentas of pregnancies with and without preeclampsia. They also used advanced techniques to analyze the trophoblasts’ gene activity and assess DNA methylation patterns, which can alter a gene’s activity. Compared to trophoblast cells generated from healthy placentas, cells from placentas with preeclampsia were slower to form syncytiotrophoblasts, a subtype of more mature trophoblast cells. These cells were also less effective at exchanging oxygen, nutrients, and waste between mother and fetus. The findings provide information that may inform future research to diagnose and treat preeclampsia early in pregnancy.
Initiative reduces disparities in severe maternal morbidity (PMID: 31978432)
Researchers analyzed results of an initiative undertaken at 99 California hospitals to reduce the risk of severe maternal morbidity from obstetric hemorrhage, a common major complication of childbirth. The initiative benefited Black women more than White women, successfully reducing disparities.