In the United States at least 1 in 10 babies is born preterm (< 37 weeks), our ranking falling far behind those of other industrialized nations. In fact, prematurity rates here have risen over 36 percent in the last 25 years. About $51,600 is spent for every infant who is born prematurely, with annual medical costs associated with preterm birth exceeding $3 billion in the state of California alone. We also see disparities between racial and ethnic groups, with substantially elevated rates of preterm birth among African Americans. All things considered, it’s a seemingly intractable public health problem despite medical advances in obstetrics and newborn intensive care.
At Stanford we’re changing the way we think about preterm birth as traditional models in academia have failed to solve the problem. In 2011, with a generous $20 million grant from the March of Dimes, we launched the March of Dimes Prematurity Research Center at Stanford University. Over 130 scientists, doctors, researchers and staff are dedicated to reducing the rate of preterm birth and shrinking the disparity in prematurity among racial and ethnic groups. Our investigation requires the integration of researchers from multiple disciplines that together develop a new trandisciplinary language to facilitate understanding. Biologic, behavioral, social, physical and environmental disciplines converge to form new structures of scientific discovery.
Evidence suggests that gene-to-gene and gene-environment interactions are much more complex than we previously believed them to be. Where limits on resources and technology had once stalled progress, we are now studying large populations in a more comprehensive way using state-of-the-art approaches. The Center collects and analyzes unique, diverse data sets, including vital statistics and hospital discharge data from > 1 million preterm births (50,000 births for 20 years) in California and across the country. Working with our colleagues at the California Department of Public Health, Center investigators can access newborn bloodspots on every birth in California since 1983, and a mid-pregnancy blood specimen on >1,000,000 women.
The Center draws upon the patient base at Lucile Packard Children’s Hospital Stanford and partners with other Schools across Stanford University and elsewhere, combining the expertise of those in the fields of computer science, mathematics, engineering, biological and social science. With additional funding from the Children's Health Research Institute, we strive to improve outcomes for babies born in California. Our hope is that advancements will be extended nationally, and globally shortly thereafter.
Key Areas of Inquiry
- THEME 1 / The Microbiome and Preterm Birth: Dr. David Relman’s laboratory aims to establish a benchmark description of the microbiome during pregnancy by studying both normal and abnormal pregnancies with a focus on early spontaneous birth. Conducting the largest study of its kind to date, Relman and colleagues are characterizing changes in the microbiome using sampling data from multiple body sites of women before pregnancy, during pregnancy and post pregnancy. The goal is to identify specific microbes or microbial communities associated with preterm birth.
- THEME 2 / The Transcriptome and Preterm Birth: Dr. Stephen Quake’s laboratory aims to characterize the transcriptome of the various phenotypes of preterm birth. Sequencing genetic material from pregnant women using robust computational approaches has led researchers to identify which circulating RNA molecules in a pregnant woman belong to the fetus and which belong to mom. In a pilot study, Quake's group recently demonstrated non-invasive blood tests for fetal development can predict gestational age and preterm birth. Further study of the transcriptome may lead us to identify specific genes and gene pathways that could reveal underlying causes of preterm birth and suggest potential targets for intervention.
- THEME 3 / The Immunome and Preterm Birth: A mother's immune system during pregnancy is precisely calibrated to tolerate a growing fetus while protecting herself and her fetus from infection. The goal is to understand how the maternal immune systems adapts to a normal pregnancy and to identify immunological anomalies associated with preterm birth. Drs. Brice Gaudilliere, Martin Angst, and Nima Aghaeepour head up this work. Once the researchers described what they call the "immune clock" in a 2017 paper in Science Immunology, the March of Dimes set in motion the establishment of this new theme that links up with our microbiome and transcriptome themes.
- The March of Dimes Database for Preterm Research, powered by Immport, aims to aggregate scientific data across the six Prematurity Research Centers with the goal of enhancing collaboration and accelerating the pace of discovery. Database efforts are led by Marina Sirota, PhD, from the Institute for Computational Health Sciences at UCSF.
ASSISTANT PROFSSOR, DIRECTOR OF THE NIMA AGHAEEPOUR LAB