NICHD Maternal Morbidity and Mortality Research Information

An overarching goal of NICHD research is to advance scientific evidence and knowledge about ways to promote healthy pre-pregnancy, pregnancy, childbirth, and post-pregnancy states and improve outcomes for mothers, fetuses, and infants.

Some NICHD goals related to maternal morbidity and mortality include studies to understand the following:

• Physiological processes of pregnancy and childbirth and factors that may alter those processes, such as advanced maternal age
• Effects of pregnancy and childbirth on women’s health across the lifespan
• Effects of pregnancy-related disorders on women and offspring in the short and long terms
• Effects of non–pregnancy-related disorders on pregnancy and pregnancy outcomes
• Effects of pregnancy on women with chronic medical conditions and disabilities
• Impact of non-clinical factors, such as access to high-quality healthcare, on maternal mortality and morbidity
• Disparities in rates of pregnancy complications, treatment success, and short- and long-term outcomes
• Appropriate use of medication and medical devices during pregnancy and in newborns
• Ways to improve reliability and use of data on pregnancy, complications, morbidity, and mortality

NICHD also supports specialized training for obstetricians and researchers to advance pregnancy and maternal health research.

NICHD research on maternal morbidity and mortality includes basic research on specific complications of pregnancy, such as preeclampsia and eclampsia; studies of contexts related to pregnancy and childbirth; studies of the safety and effectiveness of interventions and treatments for both pregnancy-related conditions and those not related to pregnancy; research on risk factors and risk-reduction methods; and other topics.

Because maternal morbidity and mortality are complex and varied, relevant research crosses multiple NICHD branch, center, and division research portfolios, including those of Division of Extramural Research branches (Fertility and Infertility, Gynecologic Health and Disease, Maternal and Pediatric Infectious Disease, Obstetric and Pediatric Pharmacology and Therapeutics, Population Dynamics, and Pregnancy and Perinatology), the Epidemiology Branch in the Division of Population Research, the Pregnancy Research Branch and other parts of the Division of Intramural Research, and the National Center for Medical Rehabilitation Research. This research includes studies on maternal morbidity, maternal mortality, pregnancy-related deaths, pregnancy-associated deaths, and other pregnancy-related topics.

Some recent findings from research supported and conducted by NICHD include the following:

Findings Related to Maternal Deaths

• Homicide is a leading cause of pregnancy-associated death in Louisiana
• Analysis of inpatient maternal deaths, by timing of death and by race
• A quality improvement effort reduced severe maternal morbidity due to hemorrhage
• Analyzing postpartum hemorrhage trends using electronic health records and other data
• Maternal mortality in the United States: Updates on trends, causes, and solutions
• NIH scientists call for coordinated research to improve pregnancy-related health in the United States
• NICHD workshops aim to change conversations about maternal health
• Research on maternal deaths and childbirth complications
• Rate of life-threatening childbirth complications increasing sharply across U.S. racial, ethnic groups
• Setting a national research agenda to prevent maternal deaths
• Known risk factors may account for only part of the U.S. increase in life-threatening childbirth complications
• Reduced time between pregnancies may increase risk for maternal mortality, severe maternal morbidity, and other pregnancy complications
• Black and Hispanic women over age 40 have a much higher risk of death associated with giving birth than white women
• A prospective cause of death classification system for maternal deaths in low- and middle-income countries: Results from the Global Network Maternal Newborn Health Registry

Findings Related to Maternal Morbidity

• Advancing women’s health: research to reduce maternal mortality and morbidity
• Breastfeeding may reduce type 2 diabetes risk among women with gestational diabetes, NIH study suggests
• Genetic profile may predict chance of type 2 diabetes among women with gestational diabetes
• NIH scientists link higher maternal blood pressure to placental gene changes
• Pregnancy, breastfeeding may lower risk of early menopause, NIH-funded study suggests
• Low-dose aspirin may reduce preterm birth risk among first-time mothers
• Many pregnant women with HIV prescribed treatment that does not meet federal guidelines
• Living in ethnic enclaves may improve pregnancy outcomes for Asian/Pacific Islanders, NIH study suggests
• Experimental treatment for preeclampsia effective in animals, NIH-funded researchers show
• NIH-funded study shows placenta imaging method may aid early diagnosis of pregnancy complications
• Sleeping position during early and mid-pregnancy does not affect risk of complications, NIH-funded study suggests
• Differences in fatty acid metabolism as early as the first trimester may provide insight into gestational diabetes risk, NIH study suggests
• Air pollutants may increase risk of pregnancy-related blood pressure disorders, NIH study suggests
• Composition of the gut microbiota transcends genetic determinants of malaria infection severity and influences pregnancy outcome
• Trends and state variations in out‐of‐hospital births in the United States, 2004–2017
• Maternal outcomes by race during postpartum readmissions
• Exposures to air pollution and risk of acute-onset placental abruption: A case-crossover study
• Use of antihypertensive medications and uterotonics during delivery hospitalizations in women with asthma
• Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery
• Prevalence of depression among women of reproductive age in the United States
• Timing and risk factors for postpartum stroke

Many NICHD components address pregnancy, pregnancy-related complications (morbidities), and maternal deaths. The following pages provide information on NICHD research for some topics relevant to maternal morbidity and mortality:

• Breastfeeding and breast milk
• Diabetes
• High-risk pregnancy
• HIV/AIDS
• Labor and delivery
• Obesity and overweight
• Pelvic floor disorders
• Pelvic pain
• Pre-pregnancy care and prenatal care
• Preeclampsia and eclampsia
• Pregnancy
• Pregnancy loss
• Preterm labor and birth
• Stillbirth
• Stroke

Other NICHD-led efforts related to maternal morbidity and mortality include the following:

• Global Network for Women’s and Children’s Health Research 
  This network supports and conducts clinical trials in resource-limited countries by pairing foreign and U.S. investigators, with the goal of evaluating low-cost, sustainable interventions to improve maternal and child health and simultaneously building local research capacity and infrastructure.
• Human Placenta Project (HPP) 
  HPP is a collaborative research effort to understand the role of the placenta in health and disease. HPP aims to develop new tools to study the placenta in real time to learn how it develops and functions throughout pregnancy.
• International Maternal, Pediatric, Adolescent AIDS Clinical Trials (IMPAACT) Network 
  The IMPAACT Network is a cooperative group of institutions, investigators, and other collaborators focused on evaluating potential therapies for HIV infection and its related symptoms in infants, children, adolescents, and pregnant women.
• Maternal-Fetal Medicine Units (MFMU) Network 
  NICHD established the MFMU Network in 1986 to respond to the need for well-designed clinical trials in maternal-fetal medicine and obstetrics. The network aims to reduce maternal, fetal, and infant morbidity related to preterm birth, fetal growth abnormalities, and maternal complications and to provide the rationale for evidence-based, cost-effective obstetric practice.
• Moms’ Mental Health Matters 
  This initiative from NICHD’s National Child & Maternal Health Education Program helps educate consumers and health care providers about who is at risk for depression and anxiety during and after pregnancy, the signs of these problems, and how to get help.
• NICHD Domestic & International Pediatric & Maternal HIV & Other High-Priority Infectious Diseases Clinical Studies Network (NICHD Network) 
  The NICHD Network, comprising sites around the United States and the world, conducts clinical trials on preventing and treating HIV and its complications.
• Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) 
  This study followed pregnant women to explore the underlying, interrelated mechanisms of several common adverse pregnancy outcomes, which can be unpredictable in women who have little or no pregnancy history, to help guide their treatment.
• Maternal and Pediatric Precision in Therapeutics (MPRINT) Hub 
  The mission of the OPRC Network is to improve the safety and effective use of therapeutic drugs in women during pregnancy and lactation.
• Opioid-related research 
  NICHD is involved in multiple efforts to advance our understanding of opioids, including coordination of research projects as part of the NIH Helping to End Addiction Long-term^SM Initiative, or NIH HEAL Initiative^SM.
• Pain-related research 
  NICHD conducts and supports research related to pain in children, pregnant and lactating women, people with disabilities, and other groups.
• Pelvic Floor Disorders Network (PFDN) 
  PFDN is a network of U.S. centers hat conduct research aimed at improving diagnosis, care, treatment, and quality of life for women who have pelvic floor disorders.
• Pregnancy for Every Body 
  This initiative from NICHD’s National Child & Maternal Health Education Program educates plus-size pregnant women about healthy pregnancy and the importance of working with a healthcare provider to develop a pregnancy plan. The website also offers recommendations and communication tips to help providers guide their plus-size patients through pregnancy.
• Prevention research 
  NICHD conducts and supports research on preventing health problems, including preterm labor and birth and pregnancy-related diseases.
• Task Force on Research Specific to Pregnant Women and Lactating Women (PRGLAC) 
  The 21st Century Cures Act established PRGLAC to advise the Secretary of Health and Human Services regarding gaps in knowledge and research on safe and effective therapies for pregnant women and lactating women. PRGLAC was tasked with identifying these gaps and reporting its findings back to the Secretary.