Preconception care and prenatal care are critical components of promoting a healthy pregnancy. The 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.
Institute Activities and Advances
The NICHD conducts and supports many studies that confirm and reinforce the importance of preconception care and prenatal care for a healthy pregnancy. Several organizational units focus their research on ways that preconception 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 preconception 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 being conducted include quality measures of obstetric care; use of 17 alpha-hydroxyprogesterone caproate for prevention of preterm birth in nulliparous women with a short cervix; use of antenatal corticosteroids in late preterm births; trial of Fetal ECG ST Segment and T Wave Analysis as an Adjunct to Electronic Fetal Heart Rate Monitoring; and a trial of Thyroxine Therapy for Subclinical Hypothyroidism or Hypothyroxinemia Diagnosed During 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.
- Examining 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, to identify new biomarkers that increase the risk of a preterm delivery and to delineate molecular mechanisms responsible for a preterm birth.
- 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 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 the potentially increased risk for hypertension in women diagnosed with gestational diabetes. Researchers are also studying the reduction of pre-pregnancy dietary intake of iron for its potential to reduce the risk for gestational diabetes.
- The relationship of angiogenic factors to the pathogenesis of preeclampsia. These factors are being evaluated for their potential for identifying women at high risk for preeclampsia.
- 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.
- The effects of aspirin in gestation and reproduction. Scientists think that aspirin may improve aspects of fertility, from conception to preterm birth, and thus the Effects of Aspirin in Gestation and Reproduction (EAGeR) Study seeks to determine the effect of low-dose aspirin in combination with folic acid treatment versus folic acid alone on live birth rates.
- Measurement of fetal growth as a critical part of a healthy pregnancy, through the National Standard for Normal Fetal Growth.
- 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.
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. Current studies seek to determine why pregnancy alters the metabolism of hepatic drugs.
The Maternal and Pediatric Infectious Disease Branch 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. Current studies seek to understand the elevated risk of transmitting HIV to infants among women who acquire HIV during pregnancy.
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.
Other Activities and Advances
To better understand preconception care and prenatal care and how they can promote a healthy pregnancy, the 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 the NICHD participates. Some of these activities are listed below.
- The Birth Defects Research Group is a multicenter, multidisciplinary group led by the 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 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 preconception care activities in women with polycystic ovary syndrome can help them conceive and deliver a healthy infant.
- The Obstetric-Fetal Pharmacology Research Unit (OPRU) Network, 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.
- Prevention of the First Cesarean Conference, held in early 2012, was co-sponsored by the NICHD, the Society for Maternal-Fetal Medicine, and the American Congress of Obstetricians and Gynecologists. Attendees reviewed the available information regarding factors leading to the first cesarean (maternal indications, fetal indications, induction of labor, labor management, non-medical factors); the implications of the first cesarean on future reproductive health (subsequent cesarean(s), placentation issues, uterine rupture risk, morbidity and mortality); and recommendations for practice management to control rates of first Cesarean delivery and to inform future research regarding these issues were discussed. An executive summary of the meeting will be published.
- NIH Consensus Development Conference: Diagnosing Gestational Diabetes Mellitus
At this conference, originally scheduled for October 2012 but rescheduled for March 2013, an independent panel will evaluate scientific data and prepare a consensus statement addressing key questions related to gestational diabetes and its long-term health effects on mother and baby.