March of Dimes, whose mission is to give every baby a healthy start, has launched an exciting new research program in partnership with Stanford University, one of the premier research intuitions in the world. This video demonstrates the commitment and enthusiasm of some of the 130 renowned medical and biological researchers embarking on a unique transdisciplinary approach to put an end to premature birth.
In 1952, James Watson was an unknown scientist who applied to the March of Dimes for a fellowship proposing research on X-ray diffraction patterns of proteins and nucleic acids. Knowing that the March of Dimes funded basic science as well as polio prevention, Watson hoped that the grant he would receive might enable him to conduct a year of research and cover his lab expenses. His modest grant award of $5,678, roughly equivalent to $50,000 today, led to one of the most momentous discoveries of the age. On April 25, 1953 Watson and his colleague Francis Crick published “A Structure for Deoxyribose Nucleic Acid” in the journal Nature. The field of molecular genetics was launched. They had discovered the double-helical structure of DNA.
Much has been written about Watson and Crick’s famous discovery, for which they received the Nobel Prize in 1962. Their path-breaking research vastly expanded the field of genetics, leading to knowledge unimaginable in their day. Their accomplishment also prefigured what the March of Dimes would do next. After funding the vaccines that brought the scourge of polio to a halt, the Foundation turned to the riddle of birth defects, knowing that the keys of genetics would open further doors to this intractable problem.
By the 1960s, the March of Dimes sponsored birth defects and clinical genetics conferences to keep medical professionals up-to-date with progress in the field. We helped to develop a universal standardized language (the karyotype) to describe human chromosomes. At a March of Dimes conference in 1969, Dr. Victor McKusick proposed that science might create a molecular map of all genes. His idea sparked the March of Dimes to organize a series of human gene mapping workshops that ultimately led to the Human Genome Project of the 1990s.
Our interest in genetics goes beyond science itself to assisting individuals and families. We have developed the field of genetic counseling to help parents and parents-to-be understand the risks of inherited disorders. We helped to establish the first master’s degree program in genetic counseling at a U.S. college. In the 1980s we sponsored an educational program on Genetic Decision Making and Pastoral Care, enabling clergy from different religions to understand the complexities of genetics in order to give appropriate counseling to concerned families. At the same time, our funding of scientific research has remained fundamental. Our grantees have identified the gene for Fragile X Syndrome and have created therapies for other life-threatening disorders.
As we note the 60th anniversary of Watson and Crick’s famous article on the double helix of DNA, we look forward to a time when birth defects and premature birth have receded into the past just as polio has done. Our steadfast commitment to “stronger, healthier babies” is grounded in the building blocks of genetics that help us identify the causes of disease.
This week, April 21-27, is National Volunteer Week and we want to give an enormous shout out to all our wonderful volunteers. These are the extraordinary folks who make this organization great.
More than 3 million volunteers enable the March of Dimes to achieve its goals. Every year, these leaders march more than 5 million miles, speak to tens of thousands of people about the mission and help raise millions of dollars. From the very earliest days, volunteers have been full partners in the March of Dimes, working to raise funds, heighten awareness and implement critical programs to help support our mission.
This diverse group of volunteers, led by a local volunteer leadership of approximately 3,000 chapter and division board members, brings knowledge, business experience and passion to ensure the March of Dimes is the leading nonprofit organization for pregnancy and baby health. We celebrate their leadership and that of our corporate partners and national service partners! We also have bright and energetic youth councils working in high schools and colleges. We have had celebrity volunteers from the early years (Eddie Cantor, Marilyn Monroe, Elvis Presley…) to today’s hot tickets like Pink, Dee Snider, and Thalia!
With the support of these exceptional, high-impact volunteers, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality.
Thank you all so, SO much for what you do during this special week and all throughout the year!
Most of us have heard that Halle Berry is pregnant at the age of 46. Wow, you go girl! And did you see the recent episode of Call the Midwife where a first-time pregnant woman (a twin) in her 40s gave birth to twins of her own? Some women are asking us “If they can, why can’t I?” Good question, complicated answer.
Women over age 35 may be less fertile than younger women because they tend to ovulate (release an egg from the ovaries) less frequently. Certain health conditions that are more common in this age group also may interfere with conception. These include endometriosis, blocked fallopian tubes and fibroids.
If you are over 35 and haven’t conceived after 6 months of trying, make an appointment to see your health care provider. Studies suggest that about one-third of women between 35 and 39 and about half of those over age 40 have fertility problems. At age 47, most babies are conceived with some form of fertility treatment. This can be time consuming and expensive and there is no guarantee the treatment will work.
Most miscarriages occur in the first trimester for women of all ages, but the risk of miscarriage increases with age. Studies suggest that about 10 percent of recognized pregnancies for women in their 20s end in miscarriage. The risk rises to about 35 percent at ages 40 to 44 and more than 50 percent by age 45. The age-related increased risk of miscarriage is caused, at least in part, by increases in chromosomal abnormalities.
The good news is that women in their late 30s and 40s are very likely to have a healthy baby. However, they may face more complications along the way than younger women. Some complications that are more common in women over 35 include: gestational diabetes, high blood pressure, placental problems, premature birth, stillbirth. About 47% of women over age 40 give birth via cesarean section. You can see why it’s so important to keep all appointments with your health care provider.
All these things taken into consideration, many women who do conceive in their late 40s, either on their own (unlikely but not impossible) or with some fertility treatment, do manage to have healthy babies. The important thing to remember is to have a preconception checkup and early and regular prenatal care. Know the signs of preterm labor, and give your doc or midwife a call whenever you have a question or concern.
A study published today in Obstetrics & Gynecology shows that hospital-based quality improvement programs across many states can be remarkably effective at reducing early elective deliveries of babies.
The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.
The March of Dimes, which partly funded the study, calls the findings good news, because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.
“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” says Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study.
“Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” says Edward R.B. McCabe, MD, medical director of the March of Dimes. “This project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied. Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital’s overall preterm birth rate.”
This was the first project of a collaborative with perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Florida, Illinois, New York, and Texas. These five states account for an estimated 38 percent of all births in the United States.
The March of Dimes urges hospitals, health care providers, and patients to follow the American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own. The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing.
“A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology, Vol. 121, No. 5, May 2013.
A maternal-fetal medicine specialist is an obstetrician who concentrates on the care of pregnant women and babies in high-risk situations. Another name for this doctor is a perinatologist.
A maternal-fetal medicine specialist treats women with a number of conditions. Complications with mom’s health, include:
• A history of multiple miscarriages or premature birth
• Diabetes (gestational or preexisting)
• Hypertension (high blood pressure)
• Preeclampsia
• Infectious disease (toxoplasmosis, parvovirus, HIV/AIDS, etc.) or chronic illness
• Rh disease
• A family history of heart, kidney, or other disease
A maternal-fetal medicine specialist often treat pregnant women who are carrying multiples (twins, triplets or more) as the risk for preterm birth is significantly increased.
This doctor also specializes in the care of women whose baby is known to have:
• Abnormal fetal growth
• A known birth defect or suspected genetic disorder, such as Down syndrome, Trisomy 13 or Trisomy 18
• A baby with macrosomia (too large)
• A baby with fetal growth restriction (too small)
If you find yourself in a position where the risk of complications is higher than the average pregnancy, ask your current health care provider for a referral to a maternal-fetal medicine specialist. You may or may not need the extra care, but it will be good to get a second opinion.
Your risk may be a little higher, but just because you’ve already had a premature baby, it doesn’t mean your next baby will be born early.
Your health care provider may not have been able to tell you why your baby was born early. Sometimes labor just starts early without any warning. Other times doctors have to deliver a baby early if a mother’s health or the baby’s health is in danger.
There may be things you and your doctor or midwife can do to help you stay pregnant longer. It’s best to have an open conversation about these things before you get pregnant again. When you decide you’re ready to get pregnant again, talk to your provider about seeing a specialist who is trained to care for women who are likely to have pregnancy complications, including premature birth. These doctors are sometimes called maternal-fetal medicine specialists, or perinatologists. Your doctor or midwife can help you find a specialist.
There are some risk factors that make a woman more likely to have her baby too early. Some risk factors are things you can’t change, such as already having had a baby born too early. But other risk factors are things you can do something about, such as quitting smoking. Click on this link to read about different risk factors and what you can do about them.
What can you do about preterm labor? Learn the signs of preterm labor (labor that begins before 37 completed weeks of pregnancy) and what to do if they happen to you.
If you’d like to talk to other women like you who are thinking about pregnancy after having a premature baby, visit the discussion group “Pregnant? On Bedrest? Trying Again?” in the March of Dimes online community Share Your Story. You’ll be able to connect with lots of women who are or have been in your shoes.
While 17P, a form of progesterone, has been shown to prevent premature delivery among about one-third of women who are pregnant with a single baby and who have experienced a prior preterm delivery, the latest research shows that 17P prescriptions can’t do the same for moms having twins.
“Twins are very high risk for preterm delivery, in fact, 60 percent of twins are born too soon. We can’t assume that what works for singleton pregnancies will work with multiples such as twins or triplets,” says Edward R. B. McCabe, MD, PhD, March of Dimes senior vice president and medical director. “This research finding is valuable because it will guide the care of women with a multi-fetal pregnancy, and highlights the need to better understand how to prevent preterm births for multiples.”
“We found that 17P was not effective in women with twin pregnancies and a short cervix (defined as less than 25 mm between 24 and 32 weeks),” says Philippe Deruelle, MD, with the Department of Obstetrics and Gynecology at Hôpital Jeanne de Flandre, Université Lille 2, France, and one of the study’s authors. “We actually seemed to have found an increase in the rate of preterm delivery before 32 weeks in the treatment group when compared to the non-treatment group.”
For the study, Dr. Deruelle and his colleagues conducted their trial on 165 women over the age of 18 at 10 university hospitals between June 2006 and January 2010. Outcome data was available for 161 of the 165 (97.6%) women. (The study’s title is Prevention of preterm delivery by 17 alpha-hydroxyprogesterone caproate in asymptomatic twin pregnancies with a short cervix: a randomized controlled trial, and was presented at the Society for Maternal-Fetal Medicine’s 33rd annual meeting last week.)
Dr. Deruelle recommends that women who know they are pregnant with twins get an ultrasound to measure their cervical length, as this factor has shown to predict which women with twins are at higher risk for premature pregnancy.
Hopefully, future research will help to shed light on ways to prevent pretem births for women who are pregnant with multiples.
Working with our partners, the March of Dimes strives to develop and implement local programs that will ultimately improve the health of babies. Through our network of chapters and volunteers, these programs reach over a million people across the country and Puerto Rico each year. We provide information and services designed to prevent premature birth and birth defects and to promote healthy pregnancies.
Community grants are awarded annually to fund the best programs. Local programs like Centering Pregnancy®, group prenatal care, are focused on improving the availability and quality of health care. We also support services that help promote the health and well-being of women and couples before pregnancy to increase their chances of having a healthy baby. Other programs educate doctors and nurses about reducing the rates of elective labor inductions and c-sections before the 39th week of pregnancy.
Through NICU Family Support®, we provide information and comfort to families coping with the experience of having a baby in a newborn intensive care unit (NICU). NICU Family Support complements and enhances family-centered care practices in partner hospitals, addresses the needs of families and provides professional development to NICU staff.
Contact your local chapter of the March of Dimes to find out how we’re helping moms in your community.
