Setting the Foundation for Healthy Pregnancies and Lifelong Wellness
Highlighted Programs and Activities
NEW: The road to prevention of stillbirth
According to vital statistics, stillbirth affects as many as 1 in 160 pregnancies, with 24,000 babies stillborn each year. More than 60% of stillbirth cases remain unexplained, after the exclusion of common causes, such as congenital anomalies, obstetric complications, infections, placental insufficiency or abruption, and umbilical cord complications. The rate of stillbirth is considerably higher among Black, American Indian, and Alaska Native people. NICHD is establishing an integrated and collaborative Stillbirth Research Consortium to support cutting-edge basic, translational, clinical, and/or data sciences research to generate knowledge for advancement in stillbirth-relevant research across the United States, with a particular emphasis on approaches that utilize an equity lens to identify ways to decrease the incidence of stillbirth in vulnerable populations. International collaboration is encouraged and allowable. The program may also actively collaborate on studies and projects with other NICHD networks and initiatives to strengthen research efforts. Learn more: RFA-HD-25-010 and RFA-HD-25-011
Selected Recent Advances
- Birth certificate data tended to understate maternal morbidity and disparities (PMID: 38176017)
Since 2014, all states have revised their birth certificate data collection to include information about serious conditions of pregnancy. An increasing number of studies now measure morbidity using only these data, but the quality of maternal morbidity data from birth certificates has been questioned. Researchers used data from California and Michigan to assess specific maternal morbidity measures available on birth certificates and then compared this information to hospitalization data. They also re-created the Centers for Disease Control and Prevention’s severe maternal mortality (SMM) measure using hospitalization data. The analysis showed that maternal morbidity measures using birth certificate data alone were substantially underreported and had poor validity. The incidence of SMM was more than three times as large for the hospitalization data compared with birth certificate data. Moreover, Black-White disparities were smaller in the birth certificate data compared with the hospitalization data. - No evidence that blood transfusion raises the risk of necrotizing enterocolitis (NEC) in the days following transfusion (PMID: 38700862)
NEC is a serious condition that occurs when a portion of the intestine becomes inflamed and starts to die. It primarily affects premature babies. It has been unclear whether giving red blood cell transfusions to infants born premature may increase their chance of developing NEC. Existing studies have focused on infants’ overall risk of developing NEC, but researchers haven’t looked specifically at when or how soon after a transfusion infants’ risk of NEC may increase, if at all. Scientists assessed whether infants’ risk of developing NEC in the 72 hours following a blood transfusion was greater than their risk in the period before receiving a transfusion. Using data from NICHD’s Neonatal Research Network (NRN), investigators analyzed records from 1,690 infants who were born premature and were classified as having extremely low birth weight (ELBW), since these infants are at particular risk for NEC. The researchers found no evidence that receiving a blood transfusion increased infants’ risk of developing NEC during the following 72 hours, adding to growing clinical evidence that blood transfusions do not raise the risk of NEC for ELBW infants. - Placental particles in maternal bloodstream may signal less fetal growth (PMID: 38353485)
Infants weighing below the 10th percentile for their stage of pregnancy are referred to as small for gestational age (SGA). These infants are at risk for stillbirth and infant death, admission to the newborn intensive care unit, and lower neurodevelopmental scores. Although some SGA infants are born preterm, most are born at term and are not diagnosed before delivery. Tiny, balloon-like particles are released from the placenta into the maternal bloodstream beginning in early pregnancy. Known as extracellular vesicles, these structures are larger and less numerous in pregnancies with growth-restricted fetuses and have a different fat composition compared to pregnancies on a normal growth trajectory. Researchers isolated extracellular vesicles from the maternal blood of 236 people who gave birth and then analyzed the samples for potential biomarkers that might indicate a higher risk for SGA. The scientists found that extracellular vesicles from pregnancies that yielded SGA infants tended to be larger than those from non-SGA pregnancies, particularly in late pregnancy. These findings may lead to the development of biomarkers that health care providers can use to identify pregnancies at risk for SGA infants.
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