Executive Summary The mission of the Pregnancy and Perinatology Branch (PPB), within the Center for Developmental Biology and Perinatal Medicine (CDBPM), National Institute of Child Health and Human Development (NICHD), 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 seeks to acquire scientific information that supports the mission through basic and clinical research, including: determining basic mechanisms that underlie normal and disease processes; identifying new treatments, methodologies, and preventive strategies that arise from translational and evidence-based research; assessing the dissemination and impact of therapeutic and preventive interventions; and increasing scientific resources through recruitment and training of investigators.
Since its last report to the National Advisory Child Health and Human Development (NACHHD) Council, Branch funding in current dollars has increased from $70 million to $93.4 million. The PPB utilizes many existing National Institutes of Health (NIH) funding mechanisms to support its activities, which extend from basic research to clinical trials (see Figure 1).
Over the past four years, the Branch has expanded significantly, making considerable strides in incorporating the obstetrical, neonatal, and basic science fields. The Branch's long-term Networks, the Neonatal Research Network (NRN) and Maternal-Fetal Medicine Units (MFMU) Network, continue to be very successful. Each year, the Networks have each given more than 20 national presentations. In addition, through the success of a number of initiatives, the Branch has expanded its portfolio to incorporate fetal surgery, stillbirth, perinatal alcohol exposure, health disparity of preterm birth, and perinatal genetics.
In fiscal year 2002, the PPB launched a Maternal-Fetal Surgery Network, involving three sites and a data center, to perform a randomized trial on in utero versus postnatal repair of spina bifida, a devastating neurological condition that results from failure of the fetal spine to close.
In fiscal year 2003, the PPB established three collaborative networks: - The Branch, in collaboration with the NICHD's Center for Population Research (CPR), initiated a Community Child Health Network (CCHN) to support community-research institution partnerships that study how community, family, and individual level influences interact with biological influences and result in health disparities in pregnancy outcome and infant and early childhood mortality and morbidity.
- The Stillbirth Collaborative Research Network (SCRN), with five clinical research sites and a data center, was established to develop and implement common research protocols to study stillbirths (defined as fetal death at 20 weeks' gestation or later) in the United States.
- The PPB, in collaboration with National Institute on Alcohol Abuse and Alcoholism (NIAAA), started the Prenatal Alcohol in SIDS and Stillbirth (PASS) Network to develop community-linked studies that investigate the role prenatal alcohol exposure in high-risk populations plays in the risk for Sudden Infant Death Syndrome (SIDS) and adverse pregnancy outcomes, such as stillbirth and fetal alcohol syndrome, and how they may be interrelated.
In fiscal year 2004, the Branch funded a new portfolio on mechanisms of fetal growth restriction. In addition, many members of the Branch are involved in planning the National Children's Study, a longitudinal study of environmental influences on the health and development of more than 100,000 children across the United States.
| In addition to its work with the CPR and the NIAAA, the Branch has also had significant interaction and partnership with other Institutes and agencies, including (but not limited to): The Branch members also serve as liaisons to major societies in their respective fields, including the American Academy of Pediatrics (AAP), the Committee on Fetus and Newborn, the Society for Maternal Fetal Medicine, the American College of Obstetricians and Gynecologists (ACOG), and the Liaison Committee for Obstetricians and Gynecologists. Findings from Branch initiatives and studies have also resulted in policy and practice changes. For instance, in 2000, the PPB convened an NIH Consensus Development Conference on repeat courses of antenatal corticosteroids in pregnancy and their effectiveness and safety in enhancing fetal maturation. After reviewing the research evidence, the panel concluded that, although a single course was beneficial and safe, | | | | PPB Areas of Interest
Branch activities are organized around five maternalfetal emphasis area, which complement each other and build a comprehensive approach to research during the pre-, peri-, and postnatal periods:
High-Risk Pregnancy is concerned with those factors, both normal and abnormal, that influence the course and outcome of pregnancy, including maternal physiology, environmental variables, conditions, and treatments that occur during pregnancy, all of which contribute to adverse outcomes (e.g., low birth weight). Studies in this area include (but are not limited to): elucidating the mechanisms involved in the pathophysiological states of pregnancy; the health impact of pregnancy-related disorders on mother and infant; pathogenesis of symptomatic and asymptomatic maternal infections and their effects on fetal development, with the aim of improving treatment and prevention; the effect of maternal medications and mother’s use and abuse of drugs on fetal development; and adolescent pregnancy.
Fetal Pathophysiology includes studies of the physiologic, metabolic, endocrine, and pharmacologic events related to abnormal development of the fetus, such as the morphology, function, and metabolism of the placenta and uterine blood flow. Studies in this area are encouraged to improve existing methodologies for antenatal diagnosis regarding fetal status, growth, position, maturity, and well being.
Premature Labor and Birth promotes studies of the factors that affect the initiation and completion of labor, as well as the physiology, endocrinology, and pharmacology of parturition. Of special concern are causes and prevention of premature labor, threatened and habitual pregnancy loss (miscarriage), prolonged and dysfunctional labor, and dystocia.
Disorders of the Newborn includes basic and clinical studies concerned with the etiology, pathophysiology, therapy, and follow-up of conditions associated with the perinatal and neonatal period, such as adaptation to extrauterine life, hyperbilirubinemia, and sequelae of prematurity (i.e., asphyxia, respiratory distress, bronchopulmonary dysplasia, hypoglycemia, anemia, and infection).
SIDS encompasses studies to elucidate underlying mechanisms of SIDS and its probable cause(s). Additional research strives to identify infants at risk for SIDS and to develop preventive approaches. |
the data were inadequate to support using repeated courses outside of ongoing clinical trials. As a result, providers now administer only a single dose (for more information on this finding, go to http://consensus.nih.gov/2000/2000AntenatalCorticosteroidsRevisted112html.htm). Similarly, a recently completed study from the MFMU Network identified, for the first time, a treatment for recurrent preterm birth that has changed obstetric practice. This trial was highlighted in the national news, including CNN and the front page of the New York Times (for more information on this finding, go to page 24). The PPB is convinced that investing efforts and funds in basic and clinical research for mothers' and infants' health problems will result in significant savings of later expenses for the care of patients who develop preventable disabilities and/or diseases. Most importantly, these investments will help promote the birth of healthy infants, able to achieve their full potential for healthy and productive lives. first | previous | next | last |
