Preterm Birth in Nulliparous Women: An Understudied Population at Great Risk

描述（由申请人提供）：本提案的目的是证明匹兹堡大学作为临床站点参与nichd赞助的解决未产妇女早产问题的网络（“Nullipara网络”）的能力。20多年来，我们的网站一直成功地为不良妊娠结局的单中心和多中心研究做出了贡献。我们特别适合成为该网络中的临床站点，因为我们的数量，临床研究基础设施和跟踪记录，基础和转化经验和专业知识，以及我们可以为这样一个多中心企业带来的专业资源。每年大约有10,000名妇女在magee妇女医院分娩，其中85%的妇女在不到10周的时间内开始在我们的系统进行产前护理。通过我们广泛的研究基础设施，我们成功地招募了妊娠早期的妇女，并对她们进行了从怀孕到分娩的纵向跟踪，并对生物样本和超声数据进行了系列收集和处理。我们的研究操作是理想的队列研究，如由Nullipara网络进行。此外，我们的网站还提供临床产科、胎儿成像、基因组学和蛋白质组学、胎盘病理学和流行病学方面的独特内容和技术专长。所有这些领域在我们的教师中都有代表，我们在富有成效的合作方面有着悠久而成功的历史。Nullipara网络有4个目标：确定影响和/或预测不良妊娠结局的母体特征，包括遗传学、表观遗传学、对妊娠的生理反应以及与环境暴露的相互作用。确定导致不良妊娠结局的胎盘发育和功能的特定方面。确定怀孕期间的评估和潜在干预措施是否可以提供有用的信息，以减少不良妊娠结局的发生率。我们的网站有跟踪记录、患者基础、研究基础、内容和技术专长，可以设计和执行一项队列研究，实现所有这些目标。

DESCRIPTION (provided by applicant): The purpose of this proposal is to demonstrate the capabilities of the University of Pittsburgh to participate as a Clinical site in a NICHD-sponsored network addressing Preterm Birth in Nulliparous Women ("Nullipara Network"). Our site has been a long-standing track record of successful contribution to single and multicenter studies of adverse pregnancy outcomes for more than 20 years. We are particularly well suited to be a clinical site in this Network because of our volume, clinical research infrastructure and track record, basic and translational experience and expertise, and specialized resources that we can bring to such a multicenter venture. Approximately 10,000 women deliver per year at Magee-Womens Hospital, and 85% of these women initiate prenatal care in our system at < 10 weeks. Through our extensive research infrastructure, we have successfully enrolled women in the first trimester, followed them longitudinally through pregnancy to delivery, with serial collection and processing of biological samples and ultrasound data. Our research operation is ideal for cohort studies such as that to be conducted by the Nullipara Network. Additionally, our site brings unique content and technical expertise in clinical obstetrics, fetal imaging, genomics and proteomics, placental pathology, and epidemiology. All of these areas represented among our faculty, and we have a long and successful history of productive collaboration. The Nullipara Network is charged with 4 objectives: 7 Determine maternal characteristics that influence and/or predict adverse pregnancy outcome to include genetics, epigenetics, physiological response to pregnancy, and the interaction with environmental exposures 7 Identify specific aspects of placental development and function that lead to adverse pregnancy outcome 7 Characterize genetic, growth, and developmental parameters of the fetus that are associated with adverse pregnancy outcome 7 Determine whether assessments and potential interventions during pregnancy may provide useful information to reduce the incidence of adverse pregnancy outcome Our site has the track record, patient base, research infrastructure, content and technical expertise to design and execute a cohort study that achieves all four of these objectives. PUBLIC HEALTH RELEVANCE: At least 12% of women in their first pregnancy will have a preterm delivery, with associated high rates of neonatal mortality and long term morbidity. Because nulliparas are a large proportion of pregnant women, understanding the mechanism for future prevention of preterm birth and other related adverse pregnancy outcomes will have a significant public health impact.