Premature Birth Research Center To Open In St. Louis
Officials from Washington University, St. Louis Children’s Hospital and the March of Dimes announced Monday they will launch a new March of Dimes Prematurity Research Center at Washington University in St. Louis.
“Preterm birth has really been a vexing problem for us in OB/GYN for, really, many, many years,” Dr. George Macones told “St. Louis on the Air” host Don Marsh on Tuesday. Macones is the program director of the new research center, as well as the chairman of the Department of Obstetrics and Gynecology at Washington University’s School of Medicine. “I think we need to have new ideas and new scientists coming together to try to figure out why this is happening, and then what we can do about it.”
Preterm birth refers to “a birth that happens before 37 weeks’ gestation,” Macones said. “That’s three weeks before a woman’s due date, just to put it in perspective.”
The premature birth rate in the United States is 11.4 percent each year, according to research from the March of Dimes, which promotes the health of babies. In Missouri, the preterm birth rate is 11.3 percent. In St. Louis and St. Louis County, it’s more than 15 percent, Macones said.
More than 10 years ago, March of Dimes president Jennifer Howse said the nonprofit’s scientific advisers noted that prematurity rates in the United States had been on the rise for 30 years.
“So 10 years ago, we launched a prematurity prevention campaign to do two things: identify what could be done — what did we know that we could put into effect that would prevent premature birth,” Howse said. “We’ve gotten some good results from that. The second question is what don’t we know and how can we go about learning the answers?”
Howse said the March of Dimes’ five research centers, including the one at Washington University, will help find those answers.
“We’re going to be creating five centers, creating a network, and again with our scientific advisers, March of Dimes has identified about 30 different questions or 30 different areas that need to be investigated,” Howse said. She said the five-center, five-year project is expected to cost $75 million.
Overall, Howse said the network will try to understand labor.
“We are trying to understand the complex biology of labor — of normal labor. Why do women go into labor? What are all of the triggers and all the pathways, the biological pathways, that are activated in order for labor to begin and in order for labor to conclude successfully at the right time?” Howse said. “Once we understand all of these different ingredients, then it’s possible to study in much more depth what goes wrong in a premature labor — why do women go into labor too soon.”
In St. Louis, researchers will focus on three areas: a better understanding of cervical biology, whether pacemakers in the uterus play a role, and how sleep disruptions affect preterm birth.
To better understand cervical and uterine biology, the center will use imaging techniques developed with the School of Biomedical Engineering at Washington University.
“Our understanding of cervical biology is rudimentary at best, and this noninvasive imaging technique is going to allow us to really look at the cervix at almost the molecular level during pregnancy,” Macones said.
The School of Biomedical Engineering also has developed a technique to look for pacemakers in the heart.
“We’re going to apply that same technology to the uterus to better understand uterine biology,” Macones said. “In terms of outside-the-box thinking, depending on what we find, we might be able to counterpace the uterus to prevent preterm birth.”
If a connection between sleep patterns and premature birth is found, it may be one of the easier problems to solve.
“There’s a lot of information in the medical literature that suggest that women, for example, who are shift workers have higher rates of preterm birth compared to women who have more routine hours,” Macones said. “So we’re going to really delve into that problem in great detail and to try to understand how disruptions in sleep-wake cycles or circadian rhythms influence preterm birth. That’s something that we could modify.”
The research center is already seeking its volunteers.
“We’re starting to recruit our first hundred patients right now,” Macones said. “We’re recruiting women who are planning on getting pregnant soon, and then we’re going to follow them through their pregnancy with some of these techniques. Ultimately, probably about halfway through this five-year grant, we’re going to be recruiting a thousand women who are pregnant into our research study.”
Factors Contributing To Preterm Birth
While Macones and Howse said there’s no profile for which woman is more likely to have a premature birth, they did say there are some risk factors.
“The first risk factor that a good obstetrician will ask a woman is, particularly with a first pregnancy, has anyone in your family delivered a premature baby,” Howse said. “Were you premature? Because there’s a very high risk associated with familial preterm birth.
“Also there are some lifestyle factors, like smoking. So smoking cessation during pregnancy, (is) very important ’cause it lowers the risk of a preterm birth,” she said. “Diet and nutrition are very important. And, if a woman and her physician are going to choose to have an elective induction or C-section — elective, which means it’s not a high risk pregnancy necessarily — it’s quite important that the decision about timing be tied to 39 weeks or more of completed gestation.”
Before the 39-week mark, a baby’s brain, lungs and liver are not fully developed, she said. A baby also is less likely to have vision and hearing problems after that point.
“I don’t think there’s been good evidence until recently that those last few weeks of pregnancy really, really count,” Howse said. “What we’ve learned recently is that even a few weeks can make a difference in the health of a baby.”
Other factors may be contributing to the high preterm birth rate in St. Louis.
“I think that economic status, living in high crime areas, stress are all associated with preterm birth,” Macones said.
“St. Louis on the Air” discusses issues and concerns facing the St. Louis area. The show is produced by Mary Edwards and Alex Heuer and hosted by veteran journalist Don Marsh. Follow us on Twitter: @STLonAir.