Pre-Pregnancy care and prenatal care are critical components of promoting a healthy pregnancy. NICHD supports and conducts a broad range of research projects to increase the likelihood of a healthy birth. Short descriptions of this research are included below.
NICHD conducts and supports many studies that confirm and reinforce the importance of pre-pregnancy care and prenatal care for a healthy pregnancy. Several organizational units focus their research on ways that pre-pregnancy and prenatal care can reduce complications during pregnancy and reduce the effects of environmental and lifestyle factors on the developing fetus.
The Pregnancy and Perinatology Branch (PPB) seeks to extend and enhance research in prevention of preterm birth, preeclampsia, fetal surgery, stillbirth, periconceptional exposure to alcohol, sudden infant death syndrome (SIDS), health disparities, and perinatal genetics. PPB research related to pre-pregnancy care and prenatal care includes the following:
- Supporting the Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium, along with the National Institute of Diabetes and Digestive and Kidney Disease; the National Heart, Lung, and Blood Institute; and the National Center for Complementary and Alternative Medicine. The LIFE-Moms Consortium is conducting clinical trials of lifestyle interventions, for example, changes in diet and physical activity, among overweight and obese pregnant women to help them gain the appropriate amount of weight during pregnancy and improve the health of both mother and baby after delivery.
- Examining the causes of SIDS, stillbirth, fetal alcohol spectrum disorders, and other adverse outcomes related to prenatal exposure to alcohol. The Safe Passage Study, part of the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network, seeks to decrease fetal and infant mortality and improve child health in communities at high risk for prenatal maternal consumption of alcohol.
- Supporting clinical trials in maternal-fetal medicine and obstetrics, particularly with respect to the continuing problem of preterm birth. The trials are conducted through the Maternal Fetal Medicine Units (MFMU) Network, which is composed of 14 sites across the United States and a data coordinating center. Current studies include a randomized clinical trial of antibodies from pooled human plasma for preventing congenital cytomegalovirus (CMV) and an observational trial of hepatitis C in pregnancy
- Examining how community, family, and individual level influences interact with biological influences to affect allostatic load (physiologic consequences as a result of stress), and how resiliency factors operate to alter allostatic load. The Community Child Health Network (CCHN) study studies the effects of allostatic load on perinatal outcomes and on health disparities in pregnancy outcomes.
- Studying the causes of stillbirth, improving the reporting of stillbirth, and developing preventive interventions for stillbirth through the Stillbirth Collaborative Research Network (SCRN).
- Studying the mechanism and prediction of adverse pregnancy outcomes in nulliparous women (women in their first pregnancy). The aim of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) study is to determine factors/tests in the first and early second trimesters that will identify women at the highest risk for preterm birth, preeclampsia, fetal growth restriction, and stillbirth in 10,000 women. In addition, a study of sleep disordered breathing during pregnancy is being conducted.
The Perinatal and Obstetrical Research Group, within the Division or Intramural Research, examines the genetic and environmental etiologies and mechanisms of spontaneous preterm birth. Using state-of-the-art molecular approaches, such as genome-wide association studies and global serum protein profiling, the Group aims to identify new biomarkers that increase the risk of a preterm delivery and to delineate molecular mechanisms responsible for a preterm birth.
The Division of Intramural Population Health Research (DIPHR) conducts studies on the following:
- Neural Tube Defects (NTDs). The Division currently supports studies examining the role of abnormal folate metabolism in NTDs. Researchers are also studying the role of genetics in spina bifida and other NTDs.
- Gestational diabetes. Ongoing research through the Diabetes and Women's Health Study in the area of perinatal epidemiology is investigating etiology, risk factors, and short- and long-term health implications of gestational diabetes on both women and their children through their life spans. A number of pre-pregnancy risk factors have been identified that may allow for the prevention of gestational diabetes. Women with gestational diabetes were demonstrated to have significantly increased risk of type 2 diabetes and hypertension. Researchers are also studying genetic and non-genetic determinants for the progression from gestational diabetes to type 2 diabetes and cardiovascular disorders after pregnancy and for the elevated risk or childhood obesity among children born from pregnancies complicated by gestational diabetes.
- Alcohol use during pregnancy. Researchers are studying the mechanisms by which prenatal exposure to alcohol causes slow growth in infants and children.
- Leptin signaling. Leptin signaling is being studied as the mechanism by which maternal obesity influences the risk for spina bifida.
- Measurement of fetal growth as a critical part of a healthy pregnancy, through the NICHD Fetal Growth Studies—Singletons and Twins (see PMID: 26410205 and PMID: 27143399) and the Fetal 3D Study.
- The relationship between high levels of folic acid and vitamin B12. Increased folate can mask vitamin B12 deficiencies. Researchers studied the effects of consuming foods fortified with folate on people with low levels of vitamin B12.
- Investigating the long-term health implications of pregnancy and neonatal complications through the Collaborative Perinatal Project Mortality Linkage Study.
The Obstetric and Pediatric Pharmacology and Therapeutics Branch promotes research to improve the safety and efficacy of pharmaceuticals and to ensure centralization and coordination of research, clinical trials, and drug development activities for obstetric and pediatric populations. Much of this work is conducted through the Maternal and Pediatric Precision in Therapeutics (MPRINT) Hub, which the Branch funds.
The Maternal and Pediatric Infectious Disease Branch (MPIDB) supports both domestic and international research into the epidemiology, natural history, pathogenesis, transmission, treatment, and prevention of HIV infection and its complications in infants, children, adolescents, pregnant women, mothers, women of childbearing age, and the family unit as a whole. Branch-supported research efforts seek to enhance knowledge about the elevated risk of transmitting HIV to infants among women who acquire HIV during pregnancy.
In addition, the MPIDB supports and conducts research into other important infectious diseases. For example, NICHD, along with several other NIH Institutes, is prioritizing Zika virus research as it relates to the mother-infant dyad and the effects of infection. The Branch is supporting a wide range of research activities, including the trans-NIH Zika in Infants and Pregnancy (ZIP) study, a large epidemiologic study of pregnant women in areas affected by Zika virus. Another observational study of pregnant women in Brazil will help improve understanding of the effects of Zika virus infection on reproductive health and the developing fetus.
The Intellectual and Developmental Disabilities Branch supports studies focused on developing safe and accurate techniques for making prenatal diagnoses for various intellectual and developmental disabilities and other conditions that might have long-term effects on health and well-being.
To better understand pre-pregnancy care and prenatal care and how they can promote a healthy pregnancy, NICHD supports a variety of other activities. Some of these activities are managed through the components listed above; others are part of NIH-wide or collaborative efforts in which NICHD participates. Some of these activities are listed below.
- The Birth Defects Research Group is a multicenter, multidisciplinary group led by NICHD's DIPHR to investigate the etiology of birth defects, particularly neural tube defects. The National Human Genome Research Institute, the Health Research Board of Ireland, and the Department of Biochemistry, Trinity College, Dublin, also collaborate on this effort.
- The Human Placenta Project is a collaborative research initiative launched by NICHD to understand and monitor the development of the human placenta during pregnancy. The project will support the development of new technologies to assess the health of the placenta as it grows and matures, with the ultimate goal of improving the health of mothers and children.
- The Maternal-Fetal Surgery Network was created in 2001 through the PPB to investigate surgical treatment for spina bifida, specifically in utero surgery as compared with postnatal surgery for myelomeningocele.
- The Reproductive Medicine Network, funded through the NICHD Fertility and Infertility (FI) Branch, currently leads several clinical trials to determine whether specific pre-pregnancy care activities in women with polycystic ovary syndrome can help them conceive and deliver a healthy infant.
- The Maternal and Pediatric Precision in Therapeutics (MPRINT) Hub, supported by the Obstetric and Pediatric Pharmacology and Therapeutics Branch, provides the infrastructure and expertise needed to test therapeutic drugs during pregnancy. It allows researchers to conduct safe, technically sophisticated, and complex studies that will help clinicians protect women's health, improve birth outcomes, and reduce infant mortality.
- NICHD created the National Child and Maternal Health Education Program (NCMHEP) in 2008 to provide a forum for reviewing, translating, and disseminating new research in maternal and child health. Current NCMHEP initiatives include:
- Is It Worth It?—the Initiative to Reduce Elective Deliveries Before 39 Weeks of Pregnancy
- The Know Your Terms Initiative
- The Moms' Mental Health Matters initiative to raise awareness about depression and anxiety during and after pregnancy