Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) Initiative


An estimated 700 U.S. women die each year from conditions related to or associated with pregnancy or childbirth, the highest rate among developed nations. More than 50,000 women experience severe maternal morbidity (SMM), life-threatening health problems that are present at delivery.

The trans-NIH IMPROVE initiative will support research on how to mitigate preventable maternal mortality, decrease SMM, and promote health equity. Using an integrated approach to understand biological, behavioral, sociocultural, and structural factors contributing to maternal mortality, SMM, and maternal morbidity, IMPROVE will build an evidence base for improved care and outcomes in specific populations and regions of the country.

IMPROVE will be a multipronged, innovative research initiative designed to understand and eliminate health disparities among populations disproportionately affected by maternal morbidity and mortality, including African American, American Indian/Alaskan Native, Asian Pacific Islander, Hispanic/Latina, very young women, women of advanced maternal age, and women with disabilities. The IMPROVE approach will also address geographic disparities and social determinants of health, including education, racism, and socioeconomic standing.

NICHD co-chairs the NIH Task Force on Maternal Mortality, which leads the IMPROVE initiative. Maternal health is central to NICHD’s research mission and is part of the NICHD Strategic Plan, Scientific theme 3: Setting the Foundation for Healthy Pregnancies and Lifelong Wellness. Because of the broad nature of maternal mortality and morbidity research, NICHD relies on nearly all of its branches, offices, and labs across all of its divisions and centers to conduct and support these efforts.

Topic Areas

The IMPROVE initiative aims to address the following goals:

  • Incorporate community partnerships and participation in domestic maternal mortality and pregnancy-related and pregnancy-associated morbidity research to resolve health disparities and attain equity in maternal health.
  • Expand research on the leading causes of maternal mortality and pregnancy-related and pregnancy-associated morbidity to strengthen evidence-based care and prevention strategies and improve outcomes.
  • Develop an integrated understanding of pregnancy-related and pregnancy-associated morbidity and maternal mortality causes, including underlying comorbidities, and mechanisms to identify preventable risk factors and develop early effective interventions.

A recent Notice of Special Interest: Administrative Supplements for NIH Grants to Add or Expand Research Focused on Maternal Mortality (NOT-OD-20-104) outlines several areas of research interest for IMPROVE, including:

  • Determinants of risk or protection to detect the most vulnerable populations and provide points of intervention in cardiovascular, stroke, abnormal placentation, hemorrhage, gestational diabetes, infection and immunity, mental health, and substance abuse research areas
  • Factors related to race, ethnicity, and age and their effects on the underlying leading causes, contributors, and mechanisms of maternal mortality and pregnancy-related and pregnancy-associated morbidity
  • Multilevel (individual, interpersonal, community, and sociocultural) determinants of maternal health disparities, as well as factors that contribute to optimal maternal outcomes in high risk communities
  • “Omics” and other novel technologies to accelerate identification of diagnostic, predictive, or therapeutic biomarkers (including brain structure and function alterations) for pregnancy-related adverse maternal health outcomes
  • Contribution(s) of immune system dysregulation and autoimmunity during pregnancy and the postpartum period leading to poor pregnancy and maternal health outcomes
  • Predictors and contributions of postpartum anxiety and depression or harmful substance use and drug overdoses, including relevant environmental and social factors (e.g., institutional racism, access to care, intimate partner violence, etc.), to maternal mortality
  • Interventions that address stress, perinatal and postpartum depression and harmful substance use (e.g., peer support, complementary health approaches, strategies to coordinate or integrate obstetric/gynecologic and mental health and substance use treatment services) and their impact on maternal health outcomes
  • Approaches or interventions that target pregnancy-related cardiovascular disease and/or underlying cardiovascular risk factors during the perinatal and postnatal periods and their impact on maternal health status
  • Barriers, opportunities, and strategies for implementing clinical guidelines on blood pressure management, physical activity, and diet tailored to high risk communities
  • Linkages between/among existing datasets, electronic health records, and clinical and biomarker data from existing national cohorts, biobank data, national surveys and registries
  • Tools (e.g., Smartwatch with ECG, blood pressure, sleep monitor and heart rate monitor, devices to measure real-time stress level, wearable devices to detect postpartum depression, predictive modeling tools, etc.) to recognize pregnancy complications-related warning signs
  • Pregnancy and postpartum-related ischemic stroke (arterial and venous), intra-cerebral hemorrhage, epilepsy, migraine, nervous system infections, headache, encephalopathy syndromes, or cognitive impairment
  • Strategies for enhancing community partnerships that engage women and their families, community healthcare providers and systems, and local governments to identify barriers to and community-specific opportunities for optimal maternal health equity
  • Improvements to interdisciplinary coordinated care, particularly during transition periods, from prenatal to one year postpartum to prevent mortality and adverse health outcomes

NICHD Awardees

Visit NIH’s IMPROVE website for the full list of IMPROVE awardees.

More Information

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