Perinatal Epidemiology

About the Program

The Perinatal Epidemiology Unit serves as a nexus of epidemiologic and biostatistical expertise at WSU in support of the PRB. The Unit is designed and staffed specifically to lead/assist in investigations of the causes, distributions and consequences of disparities in perinatal health and to provide training on the appropriate conduct of perinatal epidemiologic research.

Together, this Unit provides on-site constantly available direction, collaboration and training on topics including study design, sampling, data analysis and interpretation in perinatal epidemiology with particular emphasis on longitudinal studies involving repeated measures (e.g., those designed to identify developmentally regulated biomarkers of poor pregnancy outcomes).

Objectives

  • The mission of the Perinatal Epidemiology Unit is to collaborate in leveraging the physical and intellectual resources of Wayne State University (WSU) and its partnering research institutions including the Perinatology Research Branch (PRB) of the National Institute of Child Health and Human Development (NICHD) to improve population-level health by:

    1. investigating the antecedents, distributions, consequences and opportunities for prevention of pathological perinatal outcomes including childhood handicap with roots in pregnancy; and
    2. providing faculty and fellows involved in scholarship at WSU/PRB training on optimal study designs, analytic methods and interpretations in observational investigations of the epidemiology and prevention of pathological perinatal outcomes.

    Programmatic justification (why this unit exists and what is its relationship with the rest of the PRB):

    Epidemiology has been recognized as “a fundamental science for translating basic discoveries into population health benefits” (1, pg. 522). The constantly available unqualified on-site access to epidemiology and biostatistics support provided by the Perinatal Epidemiology Unit is accordingly crucial to the PRB mission “...to reduce adverse pregnancy outcomes, infant mortality and handicap”. Specifically, the overarching aim of these daily interactions is to synthesize the knowledge of novel discoveries made across all PRB units in providing the key data needed to inform further basic and clinical research, practice and policy development with the goal of improving maternal and child health. In short, services provided by the Perinatal Epidemiology Unit are among the most important in traversing the translation gap from basic PRB discoveries to public health improvement. Without these services, the ability of the PRB to meet the public’s expectation that federally funded research will reduce the burden of disease would be severely compromised.

    1. Khoury et al. The emergence of translational epidemiology: from scientific discovery to population health impact. American Journal of Epidemiology. 2010;172:517-24

Research Questions

  • What are the mechanisms of pregnancy-related morbidity and mortality, how do we identify at-risk patients, and how do we use this knowledge to advance maternal and child health?
  • How do we ensure that clinical practice is aligned with emerging scientific knowledge in operating evidence-based medicine to prevent poor pregnancy outcomes?
  • How do we ensure that public health practices are optimally meeting maternal & child health objectives and how do we inspire evidence-based practice?
  • How can we best leverage available data resources and bio-banks to learn about maternal and child health?

Important Points & Discoveries

  • Korzeniewski et al report that children exposed to transient hypothyroxinaemia of prematurity (THOP) were at increased risk of autism spectrum disorders (ASD) when born to mothers unaffected by hypertension during pregnancy. While the primary relation between THOP and ASD among all low birth weight children was not statistically significant, the magnitude of association and significant relationship observed in the subgroup whose mothers did not have hypertension during pregnancy suggest further investigation is warranted.
  • Upon performing the first prospective cohort study to examine maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) at 30-34 weeks of gestation, Chaiworapongsa et al report that risk assessment for stillbirth and severe late preeclampsia in the third trimester is possible with the determination of these factors.
  • Whitten and colleagues report that an imbalance of angiogenic/antiangiogenic factors is present in patients with Massive perivillous fibrin deposition (MPFD) prior to the diagnosis and further propose that these changes participate in the mechanisms responsible for adverse pregnancy outcomes in patients with MPFD.
  • Hernandez-Andrade and colleagues report that in patients with a cervical length of <25 mm by transvaginal ultrasound, transabdominal measurement of the cervix overestimated this parameter by an average of 8 mm (95% LOAs, -10.5 to 26.4 mm). Yet, among women without a short cervix, transabdominal ultrasound underestimated cervical length on average by 1.1 mm (95% LOAs, -13.2 to 11.0 mm). Overestimation among women with a short cervix resulted in the under-diagnosis of 57% of these cases.
  • Korzeniewski et al report that newborn screening programs that operate primary thyrotropin blood spot testing protocols and do not incorporate serial screens may fail to identify approximately half of newborns with congenital thyroid hormone deficiency that are transferred to the NICU after birth.

Selected Publications

  • Stampalija T, Romero R, Korzeniewski SJ, Chaemsaithong P, Miranda J, Yeo L, Dong Z, Hassan SS, Chaiworapongsa T. Soluble ST2 in the fetal inflammatory response syndrome: in vivo evidence of activation of the anti-inflammatory limb of the immune response. J Matern Fetal Neonatal Med 2013 Sep;26:1384-93.
  • Chaiworapongsa T, Romero R, Korzeniewski SJ, Kusanovic JP, Soto E, Lam J, Dong Z, Than NG, Yeo L, Hernandez-Andrade E, Conde-Agudelo A, Hassan SS. Maternal plasma concentrations of angiogenic/antiangiogenic factors in the third trimester of pregnancy to identify the patient at risk for stillbirth at or near term and severe late preeclampsia. Am J Obstet Gynecol 2013 Apr;208:287.e1-287.e15.
  • Korzeniewski SJ, Pinto-Martin JA, Whitaker AH, Feldman JF, Lorenz JM, Levy SE, Movsas TZ, Pappas A, Paneth N. Association between transient hypothyroxinaemia of prematurity and adult autism spectrum disorder in a low-birthweight cohort: an exploratory study. Paediatr Perinat Epidemiol 2013 Mar;27:182-7.
  • Movsas TZ, Pinto-Martin JA, Whitaker AH, Feldman JF, Lorenz JM, Korzeniewski SJ, Levy SE, Paneth N. Autism spectrum disorder is associated with ventricular enlargement in a low birth weight population. J Pediatr 2013 Jul;163:73-8.
  • Lee J, Romero R, Xu Y, Miranda J, Yoo W, Chaemsaithong P, Kusanovic JP, Chaiworapongsa T, Tarca AL, Korzeniewski SJ, Hassan SS, Than NG, Yoon BH, Kim CJ. Detection of anti-HLA antibodies in maternal blood in the second trimester to identify patients at risk of antibody-mediated maternal anti-fetal rejection and spontaneous preterm delivery. Am J Reprod Immunol 2013 Aug;70:162-75.
  • Whitten AE, Romero R, Korzeniewski SJ, Tarca AL, Schwartz AG, Yeo L, Dong Z, Hassan SS, Chaiworapongsa T. Evidence of an imbalance of angiogenic/antiangiogenic factors in massive perivillous fibrin deposition (maternal floor infarction): a placental lesion associated with recurrent miscarriage and fetal death. Am J Obstet Gynecol 2013 Apr;208:310.e1-310.e11.
  • Romero R, Kadar N, Miranda J, Korzeniewski SJ, Schwartz AG, Chaemsaithong P, Rogers W, Soto E, Gotsch F, Yeo L, Hassan SS, Chaiworapongsa T. The diagnostic performance of the Mass Restricted (MR) score in the identification of microbial invasion of the amniotic cavity or intra-amniotic inflammation is not superior to amniotic fluid interleukin-6. J Matern Fetal Neonatal Med 2014 May;27:757-69.
  • Stampalija T, Chaiworapongsa T, Romero R, Chaemsaithong P, Korzeniewski SJ, Schwartz AG, Ferrazzi EM, Dong Z, Hassan SS. Maternal plasma concentrations of sST2 and angiogenic/anti-angiogenic factors in preeclampsia. J Matern Fetal Neonatal Med. 2013 Sep;26:1359-70.
  • Hong JS, Romero R, Kusanovic JP, Kim JS, Lee J, Jin M, El Azzamy H, Lee DC, Topping V, Ahn S, Jacques S, Qureshi F, Chaiworapongsa T, Hassan SS, Korzeniewski SJ, Than NG, Kim CJ. "Trophoblast islands of the chorionic connective tissue" (TICCT): a novel placental histologic feature. Placenta 2013 Apr;34:360-8.
  • Whitten AE, Romero R, Korzeniewski SJ, Tarca AL, Schwartz AG, Yeo L, Dong Z, Hassan SS, Chaiworapongsa T. Evidence of an imbalance of angiogenic/antiangiogenic factors in massive perivillous fibrin deposition (maternal floor infarction): a placental lesion associated with recurrent miscarriage and fetal death. Am J Obstet Gynecol 2013 Apr;208:310.e1-310.e11.
  • Romero R, Korzeniewski SJ. Are infants born by elective cesarean delivery without labor at risk for developing immune disorders later in life? Am J Obstet Gynecol 2013 Apr;208:243-6.
  • Hernandez-Andrade E, Hassan SS, Ahn H, Korzeniewski SJ, Yeo L, Chaiworapongsa T, Romero R. Evaluation of cervical stiffness during pregnancy using semiquantitative ultrasound elastography. Ultrasound Obstet Gynecol 2013 Feb;41:152-61.
  • Korzeniewski SJ, Kleyn M, Young WI, Chaiworapongsa T, Schwartz AG, Romero R. Screening for congenital hypothyroidism in newborns transferred to neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2013 Jul;98:F310-5.
  • Korzeniewski SJ, Grigorescu V, Kleyn M, Young WI, Birbeck G, Todem D, Romero R, Paneth N. Transient hypothyroidism at 3-year follow-up among cases of congenital hypothyroidism detected by newborn screening. J Pediatr 2013 Jan;162:177-82.
  • Korzeniewski SJ, Grigorescu V, Kleyn M, Young W, Birbeck GL, Todem D, Romero R, Chaiworapongsa T, Paneth N. Performance metrics after changes in screening protocol for congenital hypothyroidism. Pediatrics 2012 Nov;130:e1252-60.
  • Hernandez-Andrade E, Romero R, Ahn H, Hussein Y, Yeo L, Korzeniewski SJ, Chaiworapongsa T, Hassan SS. Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. J Matern Fetal Neonatal Med 2012 Sep;25:1682-9.

Distinguished Faculty

 

Percy Pacora, MD, MPH

Associate Professor- research. Department of Obstetrics and Gynecology. Wayne State University

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