Friday, March 1, 2019

By Roxanna Van Norman

To Stephanie Leonard, PhD, institutional support is a critical resource for young investigators like herself who feel empowered to conduct research in maternal health, a field that lags far behind in funding compared to other fields in medicine. Support for maternal health, which includes pregnancy, infant mortality, and preterm births, comprises a mere 3% of the National Institutes of Health (NIH) annual support.

At a time when there is much competition for federal funding, researchers are drawing attention to a more strategic investment in pregnancy-related studies and competitive funding for training of new perinatal and pediatric investigators. That is where the Stanford Maternal and Child Health Research Institute (MCHRI) can provide the means for researchers like perinatal epidemiologist Dr. Leonard to receive the resources they need to address challenging questions and be able to translate their discoveries into action.

Dr. Leonard is a postdoctoral fellow in the Division of Neonatal and Developmental Medicine in the Department of Pediatrics at the Stanford University School of Medicine. Through the MCHRI Postdoctoral Support Program, she receives support for her research in understanding trends in severe maternal morbidities. She is also a recipient of a postdoctoral fellowship award through the National Institute of Child Health and Human Development (NICHD).

The support enabled Dr. Leonard and her colleagues to conduct a study of California hospital records from 2007 to 2014 to determine if there was an association between the rise of pre-pregnancy health and cesarean delivery and the rise of life-threatening pregnancy complications. Findings from their study were recently published in BMC Pregnancy & Childbirth with Dr. Leonard as the lead author on the paper. Suzan Carmichael, PhD, a professor of pediatrics and an MCHRI member, is the senior author and serves as the primary mentor to Dr. Leonard. Elliott Main, MD, a clinical professor of obstetrics and gynecology, is the co-author on the paper.

None of this would have been possible without the funding support of both MCHRI and NICHD, and we’re so grateful for that because, traditionally, this is not a very well-studied topic and has not been well-funded.

“None of this would have been possible without the funding support of both MCHRI and NICHD, and we’re so grateful for that because, traditionally, this is not a very well-studied topic and has not been well-funded,” says Dr. Leonard.

The direction of Dr. Leonard’s project may have taken a different turn had it not been for the MCHRI selection panel who provided compelling feedback to strengthen her research plan. Each MCHRI program has a designated scientific review panel that provides a thorough evaluation of applications based on the overall assessment of the proposal, relevance to maternal or child health, and any recommendations for improving the project. Dr. Leonard feels that reviewers have a similar mindset as when they review for the NIH, which helps teach applicants how to develop strong proposals.

“Speaking on behalf of other postdocs and trainees in this field, it’s really appreciated how much we’re supported by MCHRI and other institutions at Stanford,” Dr. Leonard notes. They can have the assurance there is a lot of support for developing strong proposals and achieving their research goals, she says, as well as developing the skills and toolkit to go out and become an independent investigator.

She further comments, “Reviewers, like those for MCHRI awards, are trying to help improve your research so I think incorporating as much feedback as possible is the way to go.” Her own experience from the review process encouraged her to consider the feedback from the reviewers, which made the study much stronger.

The study examines a collection of delivery hospitalization data in California to see if advanced maternal age, pre-pregnancy obesity, preexisting medical conditions, and cesarean delivery explained the increase in life-threatening pregnancy complications, or severe maternal morbidity (SMM), over time.  Since 2004, the rate of life-threatening pregnancy complications has more than doubled, affecting more than 50,000 women in the United States.

“We were really interested in understanding these [maternal characteristics] because they obviously have implications for women’s short- and long-term health, and the health of their babies and family," says Dr. Leonard. It turns out, findings from the study point out pre-pregnancy health did not contribute to the severe pregnancy complications. The same goes for cesarean delivery, which has actually decreased over time, in that did not explain the rise of SMM.

Although it is not clear what is causing the increase in pregnancy complications during delivery, Dr. Leonard hopes the study will draw attention to other factors beyond the individual’s pre-pregnancy health characteristics. Institutional support provides investigators the opportunity to address gaps in their analysis, giving Dr. Leonard and her colleagues the opportunity to look at factors beyond they had examined in their research, such as looking at overall healthcare and quality of care for moms.

“People, me especially, are really happy that there’s been funding focused on looking at both the mom and the baby,” Dr. Leonard remarks. The study is laying the foundation for such discussion, she believes, and will eventually lead to opportunities for more research in maternal care and delivery.

Dr. Leonard will have two papers coming out in the next few months related to the SMM project. One will be looking at the contribution of maternal comorbidities and cesarean delivery to racial-ethnic disparities in SMM prevalence and trends over time. The other will look at maternal obesity and SMM to gain a better understanding of why women who have high body mass index (BMI) when they become pregnant are at higher risk of complications during delivery.

Roxanna Van Norman is the marketing manager for the Stanford Maternal and Child Health Research Institute.