Two Cedars-Sinai physician-researchers have been awarded grants totaling $4 million from the National Institutes of Health to study how the environment - both in the womb and in the hospital where the baby is born - can affect the newborn and the mother.
Pregnancies resulting from fertility treatments are at increased risk for complications, including low birth weight, birth defects and infant mortality. Approximately 2 percent of babies born in the United States are conceived using assisted reproductive technologies.
Margareta D. Pisarska, MD, director of the Fertility and Reproductive Medicine Center and director of the Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology at Cedars-Sinai, is the lead investigator of the study examining the causes of pregnancy complications couples can face when they get help to conceive. The study, sponsored by the National Institute of Child Health and Human Development, is believed to be the first ever to examine the causes of problems in pregnancies resulting from fertility treatments.
"We are trying to understand what is causing the increased risk of problems for pregnancies achieved by in vitro fertilization," said Pisarska. "It is the first study of its kind in humans and it is unique because we will be able to look at the earliest point in human pregnancy, when the fertilized egg implants, to determine if the adverse outcomes are the result of the genetic make-up of the parents that led to problems conceiving in the first place, or whether it is the result of the infertility treatments themselves."
The study, titled "Adverse Outcomes of Assisted Reproductive Technologies: Genetics or Epigenetics," is funded by a $3.37 million grant from the NIH and is expected to take five years to complete. During the study, researchers also will be looking into the fetal origins of adult diseases to gain insight into how normal pregnancies develop in the womb. "We hope to determine how environmental changes during our development in utero will influence long-term health risks such as heart disease and diabetes, even through adulthood," said Pisarska.
The second study, funded by the Agency for Health Care Research and Quality, will examine the effect a hospital's environment has on childbirth. Kimberly D. Gregory, MD, MPH, vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology at Cedars-Sinai, will investigate the role obstetrical resources and available levels of care play in labor and delivery.
"Maternal morbidity and mortality continue to be a problem in California and nationally, and it is estimated that 40 percent of maternal deaths are preventable," said Gregory, who has served on numerous state and federal health policy committees. To address the problem, healthcare policymakers are considering the creation of obstetrical levels of care at hospitals, much like what is in place for newborns.
"For the past 40 years, hospitals have standardized the care of newborns into 'levels,' with Level I offering basic neonatal care to child and mother, up to Level III or Level IV - neonatal intensive care units, or NICUs, for newborns recovering from serious illness or who were born extremely premature," Gregory said. "Our study seeks to identify what would constitute a Level I, or low-risk obstetrical unit, and what would be required for a Level IV designation for high-risk pregnancies.
"The challenge for hospitals is that a low-risk woman can become high-risk without many signs or symptoms," Gregory added. "There is a need to have the right clinical policies and procedures in place to handle a suddenly complicated pregnancy, and that is what this research will identify."