Across the country, about one in 10 babies is born prematurely, arriving at least three weeks early. These infants can face serious health problems in early life, as well as long-term developmental challenges. The best way to avoid such problems is to help women carry their pregnancies to term, but that’s challenging since many preterm births happen without warning.
Fortunately, Stanford scientists are leading the field of prematurity prevention with research conducted at the March of Dimes Prematurity Research Center at Stanford University. The center, the first of its kind, was established with a $20 million donation from the March of Dimes in 2011 and has produced several advances in the field.
“Through this research, we are homing in on certain risk factors that predict preterm birth, with the hope of finding treatments to prevent it,” said neonatologist Alexis Davis, MD, medical director of the Neonatal Intensive Care Unit in the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital Stanford. “We’re also conducting studies that raise awareness about how to prevent a repeat preterm birth in women who have already had a premature baby.”
Predicting early births
In 2018, Stanford researchers developed a new, noninvasive blood test that predicts premature births. The scientists, led by bioengineer Stephen Quake, PhD, tested blood samples from pregnant women to predict premature deliveries with 75 to 80 percent accuracy. The test also predicts a woman’s due date as reliably as a prenatal ultrasound.
The method relies on cell-free RNA, a messenger molecule that transmits instructions from the body’s genes. After their signaling role is complete, tiny fragments of these molecules travel from the fetus and placenta to the mother’s bloodstream, enabling them to be measured in blood samples. Signals from a few specific genes indicate prematurity risk, the Stanford team demonstrated.
The technology has been licensed to a biotech company, which is validating the test and preparing to make it commercially available. “It’s starting to move toward the clinic,” Quake said. “It’s super exciting.”
Educating new moms
Women who have a premature baby are at increased risk for future preterm births. To help them understand how to lower the risk, Stanford Medicine Children’s Health neonatologist Jeffrey Gould, MD, and his colleagues recently piloted an education project for new mothers of preemies.
“We realized we need to empower these moms,” Gould said. “If the goal is to have a second pregnancy that’s healthy, we need to increase the health of moms in general. We can’t just deal with obstetric issues.”
Gould’s team conducted one-on-one conversations with 14 new mothers whose babies were in the Packard Children’s Hospital NICU. They explained how aspects of the mothers’ health history—such as diabetes or hypertension—could contribute to their risk of future premature births. They also educated women about the risk of short inter-pregnancy intervals and encouraged them to consider options for contraception. Pregnancies that closely follow the previous ones are at greater risk for premature delivery, a topic that pediatric public health expert Gary Shaw, DrPH, has been studying at the Stanford University School of Medicine.
Gould’s team also helped mothers plan to deal with possible barriers to caring for their own health.
“We know there can be a bit of a competition between the mom’s and baby’s needs,” Gould said. With a premature infant to care for, mothers sometimes forgo their obstetric checkup six weeks after birth, for instance. The team helped women identify the resources they needed to care for themselves, such as finding a family member who could watch their baby while they attended their own checkup. Gould and his colleagues are now working to extend the pilot program to other hospitals.
Stanford scientists are also examining many other questions around premature birth, from cataloging the timing of immune-system changes during pregnancy, to seeking new medications that may help prevent premature birth, to studying how to make sure every child born prematurely gets the follow-up care she or she needs after leaving the hospital.
And the team provides world-class care for expectant mothers and premature infants. Davis and her colleagues have all the clinical expertise needed to help these groups, even in the most difficult circumstances.
“When a pregnant woman is at risk of early delivery, we do what we can to reduce that likelihood, or at least extend the pregnancy as long as possible,” Davis said. Premature birth is associated with risk for breathing problems, an intestinal disease called necrotizing enterocolitis, and hearing and visual impairment, among other complications. “With advancing gestational age, premature babies’ survival improves dramatically, and the lasting effects of prematurity go down dramatically,” Davis said.
The team also has the skills and services to help extremely premature infants. For instance, caregivers undergo simulation training in the resuscitation of extremely preterm infants, whose lungs are especially fragile, at Stanford Medicine’s Center for Advanced Pediatric and Perinatal Education. The Packard Children’s NICU includes a special small-baby unit, the Nest, for babies born before 29 weeks’ gestational age, where care is provided with specially designed protocols to promote parent-infant bonding and optimize neurologic outcomes.
Consistently recognized as having one of the top 10 neonatology programs in the country, Packard Children’s Hospital offers unique advantages because its neonatal and obstetric services are provided under one roof.
“Our collaborative and multidisciplinary approach to maternal and neonatal care really works,” Davis said. “And it’s a huge advantage that the people involved in clinical care are also at the forefront of research. We’re very grateful for the support of the March of Dimes, which is helping our team advance knowledge and care in this important area.”
