Stanford University Prematurity Research Center

One of the most promising areas of inquiry in our search for the causes of and preventions for premature birth is the interaction between the mom and her microbiome, which is the community of microorganisms in her body. We know that inflammation as a result of infection is responsible for at least 50 percent of all cases of premature birth. And typically, that infection triggers a complex series of actions and reactions.

These include the activation of cells of the immune system, such as neutrophils, which can precipitate the physical transformations of collagen breakdown, cervical shortening, fetal membrane stretching, contractions and ultimately, premature labor and birth. 

From the moment a woman gets pregnant, every system in a woman’s body begins undergoing profound changes, but perhaps none more so than her immune system. What’s fascinating is that the immune system, which is normally finely attuned to the presence of any foreign body however small, changes to achieve a delicate balance between tolerating the growing fetus—complete with its father’s antigens, which would normally be rejected—while still protecting the mother from infection. 

During pregnancy, the immune system adapts right along with the growth of the fetus. The process is so precise that researchers believe that by tracking those changes and their interaction with the other systems (also being studied), we can gain an important new understanding not only of the gestational length of normal pregnancies, but also the potential signaling pathways that are triggered in the event of premature birth.
 

One foundational belief of March of Dimes is that environment, racial and social inequities must be addressed to give all babies a healthy start. But just when does that “start” begin? And how do these differences affect mom versus her baby? Environmental factors, stress, economics, and structural racism are some of the many determining factors of disparity and health equity. 

By example, does the lifelong chronic and/or acute perinatal stress experienced by mothers in at-risk populations trigger epigenetic changes and alterations of gene expression in their babies? 

African American women living in low- income, urban environments have chronic and acute stress, both of which have been found to negatively affect perinatal outcomes, such as preterm birth, and infant health. Acute stressors, including random community violence, and chronic stressors, including financial insecurity, housing, discrimination and being the sole provider for a family, are all factors.
 

Identifying risk for preterm birth and getting the right care in the right place is key to saving lives. This PRC theme supports the development and exploration of biomarkers that indicate premature birth. 

There are many components the blood of the mother and baby (for example, ribonucleic acid (RNA), deoxyribonucleic acid (DNA)). While DNA is like a blueprint of biological guidelines that a living organism must follow to exist and remain functional, RNA is what carry out this blueprint’s guidelines. It’s been known for decades that blood contains miniscule amounts of free-floating DNA and RNA released by dying or damaged cells throughout the body. Often this cell death represents natural cellular turnover; sometimes it’s the result of disease processes. But, until recently, analyzing this genetic material has been difficult due to its scarcity. Research in this area has led to promising diagnostics for early detection of preterm birth, preeclampsia, and other risks to the health of Moms and Babies.
 

A number of maternal medical conditions are associated with an increased risk of indicated or spontaneous preterm birth, including, for example, hypertensive disorders (preeclampsia/eclampsia, pre-existing, gestational, etc), cardiovascular disease, diabetes (both pre-existing and gestational), and increasingly recognized and reported mental health disorders and substance abuse.

This PRC theme aims to uncover the links between major systemic and localized comorbidities and preterm birth so that we can begin to mitigate and prevent preterm birth and maternal and infant mortality. 

The major success of the PRCs comes through the active collaboration and networking across centers. Sharing data & discoveries, while making connections across several themes requires integrating the work of researchers and clinicians from a broad range of disparate disciplines. More than 200 scientists, engineers, statisticians, sociologists and medical professionals work together to foster innovation that will accelerate discoveries of the unknown causes of preterm birth and new ways to prevent it. The March of Dimes Data Repository for Preterm Birth Research is truly the backbone of the research effort. 

The Data Repository was designed to be both a catalog and catalyst. It provides the capability to ask new and important questions about preterm birth. Dedicated to enhancing research collaboration and coordination, the Data Repository currently contains information from 13 studies, with individual molecular profiles on 365 patients, aggregated genetic data from more than 30,000 patients, and molecular measurements on more than 8,000 samples. More data is being added every day, and the Data Repository’s contents were recently opened to all the other researchers studying preterm birth around the world, in an effort to encourage them to add their own findings to the Data Repository