Institute Activities and Advances
Obstetric and gynecologic research at the Institute is aimed at understanding all facets of human labor and childbirth, ranging from intrauterine growth retardation, congenital anomalies, and preeclampsia to factors influencing family formation and starting and maintaining healthy families. Many of the NICHD intramural and extramural research programs are engaged in this research, as described below.
Preterm labor, fetal well-being, high-risk pregnancy, and labor are all topics of investigation supported by the Pregnancy and Perinatology Branch (PPB). The mission of the PPB is to improve the health of mothers and children with a focus on maternal health, pregnancy, fetal well-being, labor and delivery, and the developing child. The Branch supports both basic and clinical research, including defining the basic mechanisms that underlie normal and disease processes; and identifying new drug treatments, treatment methods, and preventive health strategies.
The PPB conducts studies that target a wide range of topics related to obstetrical/gynecological care and pregnancy, including research on high-risk pregnancy, labor and delivery, including preterm labor, and fetal pathophysiology and normal development. In addition, the Branch also supports a great deal of research on Infant Care and Infant Health. Among the supported studies include research to expand and improve prenatal screening methods; define placental biology; evaluate how women with physical disabilities experience pregnancy; develop markers of fetal growth; define immune responses during pregnancy; and identify ways to prevent prematurity. In addition to research, the Branch supports training programs for investigators and clinicians.
The Program in Perinatal Research and Obstetrics, which is within the Division of Intramural Research (DIR), emphasizes a multidisciplinary approach to address key issues in obstetrics and gynecology and neonatology, including basic and clinical research to improve pregnancy and birth outcomes. The Program’s research includes studies involving diagnostic imaging, perinatal pathology, molecular and cell biology, and clinical epidemiology.
Clinical laboratory research in this program focuses on:
- Prenatal diagnosis of congenital anomalies
- Prevention of preterm labor
- Diagnosis of intrauterine growth retardation
- Maturation and regulation of the cardiovascular, hematopoietic, and central nervous systems in the fetus and newborn
The Program in Reproductive and Adult Endocrinology, also in the DIR, advances research in the areas of endometriosis, fibroids, infertility, and endocrine aspects of disease.
Researchers in the Division of Intramural Population Health Research (DIPHR) conduct a range of studies related to obstetrics and gynecology. DIPHR’s research includes major studies to investigate the practice of labor management and other obstetric practices through the Consortium on Safe Labor. Also, a multidisciplinary team of researchers from DIPHR and the University of Buffalo are conducting an epidemiologic study called the Endometriosis Natural History, Diagnosis, and Outcomes (ENDO) study. One paper from this study has already been published; two others are currently under review.
Within the Epidemiology Branch of DIPHR, researchers track trends in preterm deliveries; such practices as induced labor; maternal characteristics; and how environmental and other factors may influence fertility, pregnancy, and pregnancy outcomes over time. Research initiatives utilize state-of-the-art methodologies for empirical investigation. Epidemiology Branch programs in the area of reproductive epidemiology include the following:
In the extramural program, the NICHD’s Obstetric and Pediatric Pharmacology and Therapeutics Branch (OPPTB) conducts research to improve the safety and efficacy of pharmaceuticals used to treat pregnant women, infants, and children. The Branch also supports major training programs in obstetric, pediatric, and developmental pharmacology.
The NICHD supports other obstetric-related research through its Contraceptive Discovery and Development Branch (CDDB), which promotes contraceptive research and development for preventing or reducing unintended pregnancies. This includes developing safe and effective contraceptives for women across their reproductive lives, including the safe and effective use of contraceptives during the postpartum period and between pregnancies. Another focus within the Branch is pelvic floor disorders, which can be a consequence of pregnancy.
The Maternal and Pediatric Infectious Disease Branch (MPIDB) supports research examining mother-to-child transmission of HIV and how this can be prevented during pregnancy and labor, or after birth. A range of obstetric- and gynecologic-related studies are supported by the Branch’s program in Pediatric & Maternal Biomedical HIV-Related Research.
Other Activities and Advances
- Through the PPB, the NICHD supports the Maternal-Fetal Medicine Units Network, which 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 PPB also established the Maternal-Fetal Surgery Network to evaluate and compare in utero surgery (surgery in the womb during pregnancy) versus standard postnatal surgery to repair the most severe form of spina bifida. Completed in 2011, the study shows how the surgery may improve some fetal outcomes but also may increase such complications as preterm birth. The Network is conducting a follow-up study to evaluate outcomes among infants at ages 5 to 8 years old. To find out more about the study and its results, see PMID: 21306277 and the NICHD Spotlight Spina Bifida Surgery In the Womb Decreases Complications.
- In partnership with the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Deafness and Other Communication Disorders, the NICHD supports the Prenatal Alcohol and Sudden Infant Death Syndrome (SIDS) and Stillbirth Network, which has clinical sites in the United States and South Africa. Network researchers investigate various aspects of the association between prenatal alcohol exposure and the risk for SIDS, stillbirth, fetal alcohol spectrum disorders, and other adverse outcomes.
- The PPB-supported Stillbirth Collaborative Research Network was established to conduct surveillance regarding stillbirth trends in the United States, evaluate factors that contribute to stillbirth risk, and assess families’ strategies for coping with grief.
- The Obstetric-Fetal Pharmacology Research Unit Network is supported by the OPPTB and provides expertise for clinical trials of medication to treat certain conditions in pregnancy, such as gestational diabetes, severe nausea, cancer, high blood pressure, and preterm labor. The goal is to find ways to protect women’s health, improve birth outcomes, and reduce infant mortality.
- Improving maternal health and birth outcomes worldwide is also a central focus of the Global Network for Women’s and Children’s Health Research, supported by the NICHD’s Division of Extramural Research. Network investigators conduct training in emergency obstetric care, evaluate drug treatments for high-risk pregnancies, and assess the role of community nurses in resource-poor settings.
- The CDDB established the Pelvic Floor Disorders Network in 2001 to encourage collaborative research on pelvic floor disorders and to improve patient care. Pelvic floor disorders affect as many as one-third of U.S. women and include pelvic organ prolapse, urinary and fecal incontinence, and other sensory and emptying abnormalities of the lower urinary tract and the gastrointestinal tract.
- Research training in obstetrics is also offered through the NICHD-supported Women’s Reproductive Health Research Career Development Program through the Institute’s FI Branch. Through a variety of partnerships with national, international, and nonprofit organizations, the program supports training in maternal-fetal medicine, gynecologic oncology, reproductive endocrinology, infertility, and adolescent gynecology and urogynecology. Significant findings have already shown how to save the lives of mothers and infants in many resource-poor settings (see Scientific Articles Related to Obstetrics and Gynecology).
- The FI Branch also founded the Reproductive Medicine Network in 1990 to carry out large, multicenter clinical trials of diagnostic and therapeutic interventions for male and female infertility and reproductive diseases and disorders. The Network is comprises seven research sites and a data-coordinating center.
- Also under the umbrella of the FI Branch is the Specialized Cooperative Centers Program in Reproduction and Infertility Research (SCCPIR)—a national network of centers aimed at improving human reproductive health through the accelerated transfer of basic science findings into clinical practice. The research-based program is designed to promote multidisciplinary interactions between basic and clinical scientists. SCCIPR supports research leading to improved outcomes across the spectrum of assisted reproductive technologies, as well as development of new approaches for assisted reproduction.
- Research on mother-to-child transmission of HIV/AIDS, complications of HIV infection in pregnant women, and drug treatment are carried out through the following supported networks:
- The NICHD created the National Child & Maternal Health Education Program (NCMHEP) to provide a forum for reviewing, translating, and disseminating new research in the field of maternal and child health. The goals of the NCMHEP are achieved through a coalition of the nation's most prominent health care provider associations, federal agencies, nonprofit maternal and child health organizations, and other partners. The NCMHEP addresses one maternal and child health issue at a time for a period of 12 to 18 months; the specific length of this period depends on the issue. The program’s first of several focus areas is late preterm birth and elective term deliveries.
- The NICHD also supports research and discoveries on obstetrics and gynecology by sponsoring conferences on relevant topics. These efforts include two NIH Consensus Development Conferences related to cesarean delivery, including the Vaginal Birth after Cesarean: New Insights conference on March 8-10, 2010, and the Cesarean Delivery on Maternal Request conference on March 27-29, 2006. The NICHD is also sponsoring the NIH Consensus Development Conference Diagnosing Gestational Diabetes Mellitus on March 4, 2013.