High-Risk Pregnancy: Research Activities and Scientific Advances

Institute Activities and Advances

Research supported by the Pregnancy and Perinatology Branch (PPB) is looking into ways to help prevent preterm labor and birth as well as identify markers and predictors of preterm labor and birth. Research on high-risk pregnancy focuses on factors, both normal and abnormal, that influence the course and outcome of pregnancy, including maternal physiology, environmental variables, and conditions and treatments occurring during pregnancy. Examples include studies on clarifying mechanisms in the pathophysiological states of pregnancy, the health impact of pregnancy-related disorders, the pathogenesis of symptomatic and asymptomatic maternal infections and their effects on fetal development, the effect of maternal medications and maternal use and abuse of drugs on fetal development, and adolescent pregnancy.

Through 2006, the Pediatric Growth and Nutrition Branch supported the Hyperglycemia and Pregnancy Outcome (HAPO) study, which investigated pregnancy outcomes and the need for caesarean deliveries among women with varying blood sugar levels. More than 25,000 pregnant women and their offspring in 11 countries participated in the study. Now, a HAPO Follow-up Study will measure levels of body fat in these children and any development of diabetes in the mothers following birth.

Research specifically about the risks of HIV/AIDS during pregnancy and ways to prevent transmission is conducted through the Maternal and Pediatric Infectious Disease Branch (MPIDB).

The NICHD's Division of Intramural Population Health Research (DIPHR) conducts research on preterm labor and birth, preeclampsia, labor patterns, and other pregnancy-related topics.

DIPHR researchers have been studying substances in the blood to see whether abnormal levels of certain substances can predict the development of preeclampsia. In addition, a recent study found that women with gestational diabetes may be able to prevent the development type 2 diabetes by following a healthy diet after pregnancy. Learn more about this finding.

DIPHR researchers also led the Consortium on Safe Labor research that has followed trends in obstetrical practice and documented changes in labor patterns. Their findings suggest that new evidence-based definitions of labor protraction and arrest are needed.

The Program in Perinatal Research and Obstetrics, within the Division of Intramural Research (DIR), focuses on the causes of premature labor, including studying the role of progesterone. Recent findings include the safety and effectiveness of vaginal progesterone in reducing the rate of preterm birth, specifically for women with shortened cervixes in their second trimester.

Researchers in the Unit on Perinatal and Developmental Neurobiology, also within the DIR, recently used an animal model to study the role of neuroprotective peptides and found that they reduce changes in the immune system that are caused by prenatal exposure to alcohol.

Other Activities and Advances

  • The Stillbirth Collaborative Research Network (SCRN) is supported by the PPB. The objectives of this network of clinical research sites with central data collection and analysis are to:
    • Develop a standard stillbirth postmortem protocol that includes review of clinical history, protocols for autopsies and pathologic examinations of the fetus and placenta, and other postmortem tests to illuminate genetic, maternal, and other environmental influences.
    • Obtain a geographic, population-based determination of the incidence of fetal deaths at 20 weeks' gestation or greater, their causes, and risk factors.
    • Determine maternal and fetal risk factors associated with increased risk of stillbirth.
  • The PPB also supports the Maternal-Fetal Medicine Units (MFMU) Network. Established in 1986, the MFMU network focuses on clinical questions in maternal-fetal medicine and obstetrics, including maternal health, fetal health and development, gestational diabetes, asthma, thyroid disorders, and preterm labor.
  • The Maternal-Fetal Surgery Network, also supported by the PPB, was created to conduct a clinical trial to evaluate the efficacy of in utero surgery versus standard post-natal surgery to repair myelomeningocele, the most severe form of spina bifida The study, called MOMS, began in 2003 and found that surgery reduced the chance of death by one-third; however, it also increased dramatically the incidence of preterm birth. The network is currently conducting a follow-up study, MOMS2, to evaluate outcomes of the children at 5 to 8 years.
  • Another study, called nuMoM2b, also led by the PPB, is currently evaluating nulliparous pregnancy outcomes to determine factors that can influence or predict adverse outcomes such as preeclampsia, preterm birth, and fetal growth restriction.
  • The PPB also supports the Obstetric-Fetal Pharmacology Research (OPRU) Network, which conducts research on the safety and efficacy of medication use during pregnancy. Current studies include evaluating oral hypoglycemics for the treatment of gestational diabetes and broader studies on the use of a range of medications from antibiotics to antidepressants.
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