Risk of preterm birth reliably predicted by blood tests

A new study published in the Journal of Perinatology, suggests that blood tests can be used to predict the risk of preterm births among pregnant women with and without preeclampsia.

Portrait of Kelli Ryckman, professor in the Department of Epidemiology at the University of Iowa College of Public Health.The researchers found that screening for specific biomarkers along with understanding certain demographic information about the patient could identify the risk of most of the women in the study during their second trimester of pregnancy.

Senior author Kelli Ryckman, associate professor of epidemiology at the University of Iowa College of Public Health, says that knowing which women are in the high risk group would allow providers to suggest additional monitoring and even offer an opportunity for intervention.

“For example, our test identified about 95 percent of women who had a preterm birth with preeclampsia before 32 weeks,” Ryckman says. “These women could be offered low-dose aspirin as a way to help lower their risk for preeclampsia.”

The test, developed and studied in 400 women during their second trimester, screened for 25 biomarkers or substances in the blood that were signs of inflammation and immune system activation, as well as certain protein levels, indicative of a possible preterm birth risk.

While the results of the study are encouraging, Ryckman notes that the test is still in very early stages of development, and more research is needed to determine its accuracy and safety.

Additional authors of the study are Laura L. Jelliffe-Pawlowski, Larry Rand, and Mary E. Norton, University of California San Francisco School of Medicine; Bruce Bedell and Jeffrey C. Murray, University of Iowa Carver College of Medicine; Rebecca J. Baer and Scott P. Oltman, University of California San Diego; and Gary M. Shaw and David K. Stevenson, Stanford University School of Medicine.

Funding for the study was provided by the Bill & Melinda Gates Foundation, NIH/NHLBI, the March of Dimes Prematurity Center at Stanford University School of Medicine, the Stanford Child Health Research Institute at Stanford University School of Medicine, the Stanford Clinical and Translational Science Award CTSA to Spectrum, the March of Dimes Prematurity Center—Ohio Collaborative, March of Dimes, and the California Preterm Birth Initiative at the University of California San Francisco Benioff Children’s Hospital.

Related Media Coverage

CNN
https://www.cnn.com/2018/06/07/health/blood-test-preterm-birth-risk-study/index.html

EurekAlert
https://www.eurekalert.org/pub_releases/2018-05/uoc–rop052118.php

HealthLine
https://www.healthline.com/health-news/new-test-better-predicts-risk-of-premature-birth#1

Daily Mail
http://www.dailymail.co.uk/health/article-5766977/New-test-spot-preeclampsia-preemie-risk-weeks-pregnancy-study-finds.html

Collaboration + Laboratory = Collaboratory

A creative partnership model brings teams of experts together to solve complex public health problems.

 

“We have to abandon the conceit that isolated personal actions are going to solve this crisis,” former Vice President Al Gore has said of climate change. Whether a problem is as monumental as global warming, or more emerging, such as the relatively sudden worldwide use of an insecticide whose effects are not fully understood, solutions will rarely arise from a single person or even a single laboratory. Rather, such difficult problems necessitate collabora­tions that span disciplines and organizations, challenge accepted methods, and even push established lexicons to shift.

This is the founding principle behind the Iowa Institute of Public Health Research and Policy’s collaboratory initiative. Two inaugural collaboratory teams just completed their first year of work via this new funding source available to teams anchored in the College of Public Health but extending beyond it. One team is focused on better understanding neonicotinoids, a relatively new class of insecticides. The other team is invested in creating data that can be leveraged by providers and public health professionals to improve the health outcomes of children born in Iowa.

 

THE TEAMS INCLUDE research scien­tists, physicians, public policy experts, epidemiologists, engineers, geologists, chemists, and others. This rich array of expertise and the fertile network of knowledge and contacts that members bring with them is what makes this model so ripe with possibility.

Vickie Miene, interim director of the Iowa Institute of Public Health Research and Policy (IIPHRP), says that in addition to spanning a spectrum of disciplines, the new program is intended to encourage team-building strategies. It is one part of the burgeoning institute’s work, which is focused on fostering new relationships within and outside of the University of Iowa.

Funded by a gift from Dale and Linda Baker and supplemented by the Roy J. Carver Charitable Trust, the collabo­ratory program is intended to create teams that are ready to respond rapidly to opportunities.

“In today’s funding world, you get maybe 60 days to respond to a call for a new grant or contract, and most of the time they’re looking for existing partnerships that are multidisciplinary,” says Miene.

Ideally, a successful collaboratory will lead to a sustainable research initiative that bolsters and builds upon the college’s three areas of excellence: rural health, comparative effectiveness research, and community engagement. Finding the kinds of complex topics that call for this approach isn’t difficult, but locating faculty leaders who appreciate the necessity and utility in an approach that can take many people out of their comfort zones is another matter. Miene is impressed by the success of the initial two collaboratories, both in the depth of their work and in their willingness to embrace the team-building aspects of the process.

“People have to be willing to get their hands dirty in learning collaboration,” says Miene. “They are the content experts, and our role at IIPHRP is to support them in their efforts.” To do so, the institute helps the teams to develop memorandums of understanding, create a team process, and make a plan for disseminating their work.

According to Miene, the institute could not have chosen better directors for the inaugural collaboratories. CPH Professors Kelli Ryckman and R. William Field, she says, “have been all in and completely willing to learn.”

 

Photo of William Field
William Field

FIELD LEADS THE TEAM “Human Exposure and Heath Risks from Neonicotinoid Insecticides,” which grew out of his graduate student Darrin Thompson’s strong interest in the occurrence and potential health effects of these emerging chemicals as a dissertation topic.

“Neonicotinoids have only been around for about 20 years,” explains Thompson, “but they are already the most widely used class of insecticides in the world.”

Although they were developed as a safer alternative to other insecticides, there is already substantive evidence that neonicotinoids are playing a role in the decline of honey bee popula­tions. Beyond initial laboratory tests done by the manufacturers, there has been little research on human health effects of this insecticide, which is used by farmers, gardeners, and the timber industry, among others. According to Thompson, laboratory tests simply cannot take into account the myriad of variables that exist when these chem­icals interact with environmental factors and other chemicals.

Field says the topic is especially pertinent to the state “since neonicotinoids are used as a seed coating for the majority of corn and soybean seeds in Iowa.” In the long-term, the collaboratory intends to study the potential health risk, if any, posed by chronic exposure to low concentrations. In the shorter term, the central research is that of Thompson’s dissertation, which includes measuring the levels in groundwater and in the urine of people who apply the pesticide. The team now comprises more than 15 active members and includes researchers from the UI College of Engineering, the Iowa Geological and Water Survey, the State Hygienic Laboratory, the U.S. Geological Survey, the Center for Health Effects of Environmental Contamination, and the National Cancer Institute. The collaboratory is ready to publish a paper that will open a whole new portfolio of research, Miene says.

Describing one of their meetings, Miene adds, “I was in awe of the expertise around the table. There were geologists, engineers, epidemiologists, and a major scientist calling in from California. It’s really impressive how they are thinking about sustainability and the intricacies of the conversation.”

Field agrees. “It sort of reminds me—in a real sense rather than an imaginary one—of The Field of Dreams: If you start the collaborative, researchers with a shared interest and vision will come, and with each addition, the collaborative expertise expands.”

 

Portrait of Kelli Ryckman, professor in the Department of Epidemiology at the University of Iowa College of Public Health.
Kelli Ryckman

RYCKMAN HAS HAD A similar experience as her team, the Iowa Perinatal Health Research Collaborative, has grown since its inception. Ryckman’s biggest challenge wasn’t finding researchers, but rather creating a team committed to sharing research. “There has had to be some breaking down of barriers of what is mine and what is ours,” says Ryckman, a genetic epidemiologist.

“This first year has really been about creating shared resources and a similar language,” she observes. “There were already many projects out there related to this topic, but instead of us each doing our own siloed thing, we were challenged to consider if we could create some synergy to share and collect data. Is there a way to connect initia­tives so that we can all benefit?”

The perinatal collaboratory has 12 regular members, including UI researchers from obstetrics and gynecology, neonatology, and pediatric neurodevelopment; as well as partners from the Iowa March of Dimes, the Iowa Department of Public Health, and the State Hygienic Laboratory.

Miene says that how to do research better is a key part of Ryckman’s project: “They are building and testing a database that will allow them to answer a lot of questions about outcomes of children born in Iowa, particularly those born preterm or low birth weight. They are gaining crucial understanding of how kids born under these circumstances are doing in multiple ways.”

It’s such an important issue, Miene adds, that the team has already received generous gifts from donors Dale and Linda Baker and Dr. Roger Williamson to help continue its work.

Traditionally, research comes with a strong sense of turf since success leads to future funding. There is under­standable concern for who gets credit and what department or unit “owns” the grant funding around a project. As she’s created and nurtured her team, Ryckman simply wasn’t accepting that model.

As though summing up the modus operandi of the collaboratory and why the College of Public Health initiated it, Ryckman says, “Everything I have is ours—that’s my stance, and you have to give me the same buy-in. That’s the difference between simply collabo­rating versus really creating something beneficial to the broader research community and to the public.”

This story originally appeared in the spring 2018 issue of Insight magazine.

UI research paper awarded the David Liu Prize

A University of Iowa research paper on intimate partner violence during pregnancy and the risk for adverse infant outcomes has been awarded the David Liu Prize by the Royal Academy of Obstetricians and Gynaecologists.

The paper appeared in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG) in 2016.

Researchers analyzed 50 studies into the effects of domestic violence by a partner or ex-partner on risk of preterm birth, low birth weight (less than 2500g) and small-for-gestational-age babies. The combined results evaluated more than 5 million women from 17 countries, 15,000 of whom had experienced domestic violence.

Overall, the results found that domestic violence doubled the risk of preterm birth and low birth weight. This risk further increased for women who experienced two or more types of domestic violence during their pregnancy.

The research team included Audrey Saftlas, professor of epidemiology; Brittney Donovan, doctoral student in epidemiology; Kelli Ryckman, associate professor of epidemiology; Cassie Spracklen, doctoral student in epidemiology; and Marin Schweitzer, assistant professor of internal medicine.

Mr. David T. Y. Liu, author of the classic text Labour Ward Manual and pioneer in chorion villus sampling, generously funds this prize to encourage research and publication in obstetrics and prenatal diagnosis.

The award recipient is chosen annually from papers in the field that have been published in BJOG over the previous 12 months. Contending articles are appraised on their validity, the likelihood of the findings being adopted into practice regionally and internationally, whether the paper is explained sufficiently for replication, and the quality of outcomes relevant for patients.

Researchers take a ‘collaboratory’ approach to public health concerns

Researchers at the UI College of Public Health will use a “collaboratory” approach for two projects that tackle public health concerns. Funded by the Iowa Institute of Public Health Research and Policy (IIPHRP), the first project will investigate health risks from exposure to insecticides, and the second will work to improve health outcomes for low-birth-weight and premature children.

“A collaboratory is a creative group process designed to solve complex problems,” says Vickie Miene, interim director of the IIPHRP. “The process generates the opportunity for new organizational networks to form. This approach expands the scope, scale, and impact of public health research.”

The projects, which were selected through a competitive application process, provide an opportunity to gather collaborators from different backgrounds and disciplines around a topic to develop an innovative research proposal. A successful collaboratory stimulates an aspirational research proposal such as a large research service or center grant that bolsters and builds upon areas of research closely linked to the college’s three collective areas of excellence: rural health, comparative effectiveness research, and community engagement. The collaboratory leverages existing strengths within the college, while fostering new collaborations within and outside the University of Iowa.

Human Exposure and Health Risks from Neonicotinoid Insecticides

A portrait of William Field of the Department of Occupational and Environmental Health at the University of Iowa College of Public Health.
Bill Field

Bill Field, professor of occupational and environmental health, is the leader of the Collaboratory to Identify Human Exposure and Health Risks from Neonicotinoid Insecticides. Neonicotinoids are a relatively new class of insecticide, but have become the most widely used class of agricultural insecticides in the world.

Historically, neonicotinoid insecticides have been viewed as ideal replacements for more toxic compounds, such as organophosphates, due in part to their perceived limited potential to impact the environment and human health. Within the agricultural sector, they are preferred over other pesticides for several reasons, including their ability to be applied using a variety of methods; lower toxicity in birds, fish, and mammals; and high selectivity and potency for insects.

Few studies have been conducted to characterize human exposure to neonicotinoids or the insecticides’ potential health risks. The collaborative team will develop the infrastructure and preliminary data required to investigate the emerging potential risks of neonicotinoid exposure.

To the researchers’ knowledge, the collaborative is the first group in the U.S. to directly evaluate the potential human exposure of neonicotinoid insecticides. The study is also the first to assess neonicotinoid insecticide contamination in private wells used for drinking water, and the first to validate biomarkers necessary for future neonicotinoid-human health investigations.

Members of the team include: Wei Bao, MD, PhD; Susie Dai, PhD; Manuel Gadogbe, PhD; Michelle Hladik, PhD; Christopher Jones, PhD; Dana Kolpin, MS; Hans-Joachim Lehmler, PhD; Bob Libra, MS; Charles Lynch, MD, PhD; Keith Schilling, PhD; Darrin Thompson, MPH; John Vargo, PhD; and Peter Weyer, PhD.

The collaborative has also received letters of support from the Center for Health Effects of Environmental Contamination, Heartland Center for Occupational Health and Safety, Agricultural Health Study, Environmental Health Sciences Research Center, the Iowa Registry for Congenital and Inherited Disorders, Iowa Center for Agricultural Safety and Health, Iowa Department of Natural Resources, State Hygienic Laboratory at the University of Iowa, and U.S. Geological Survey.

Iowa Perinatal Health Research Collaborative

Portrait of Kelli Ryckman, professor in the Department of Epidemiology at the University of Iowa College of Public Health.
Kelli Ryckman

Kelli Ryckman, associate professor of epidemiology, is the leader of the Iowa Perinatal Health Research Collaborative (IPHRC). The central mission of the IPHRC is to develop a network of perinatal care providers and public health professionals working to improve the health outcomes of children born low birth weight (LBW) and/or preterm through innovative and multidisciplinary research initiatives.

Advances in neonatal intensive care have drastically reduced perinatal mortality related to LBW and/or preterm births. In infants born before 27 completed weeks of gestation, there is a 65% chance of survival and a 56% chance of survival without severe impairment, nationally. In Iowa, survival without severe impairment is even higher.

Follow-up of “high risk” infants is recommended by the American Academy of Pediatrics; however, standard guidelines are lacking on how long follow-up should occur and which infants qualify as “high risk.” Individuals identified for further follow-up widely varies based on the resource availability, and children who may benefit from resources or specialized programs are undoubtedly missed or excluded. This underscores the need for perinatal research collaboratives that bring together providers, public health care professionals, and families to identify outcomes and health care utilization gaps for children born LBW and/or preterm.

The project will focus on three intersecting thematic areas:

  1. The Database Development thematic area will establish a statewide database of children born LBW and/or preterm that provides a platform for outcomes research, quality improvement initiatives, and interventions.
  2. The Health Services and Outcomes thematic area will develop a hospital services and outcomes data source to better understand the health care needs and outcomes in this population of Iowa children.
  3. The Family and Community Engagement thematic area will engage families in research initiatives and provide and promote existing resources for families.

Team members include Mary Charlton, assistant professor of epidemiology; John Dagle, professor of pediatrics; and Lane Strathearn, professor of pediatrics and co-director of the University of Iowa Center for Excellence in Developmental Disabilities. In addition, graduate students Allison Momany and Nichole Nidey will contribute to this work.

Charlton, Hamann, Ryckman named IIPHRP Policy Fellows

Photo of Mary Charlton, professor in the Department of Epidemiology at the University of Iowa College of Public Health.
Mary Charlton

The Iowa Institute of Public Health Research and Policy (IIPHRP) is pleased to announce the participants selected for its inaugural Policy Fellow Program. The 2016-2017 Policy Fellows are Mary Charlton, assistant professor of epidemiology; Cara Hamann, associate in epidemiology; and Kelli Ryckman, associate professor of epidemiology.

The year-long Policy Fellow Program creates opportunities for primary faculty to enhance their skills for translating public health research into practice and policy. Policy Fellows will attend training workshops, be linked with experts, interact with policymakers and stakeholders, and work as a team to accomplish individualized goals.

Each Policy Fellow proposed an Action Learning Project (ALP) as part of the application process. The ALP is an opportunity for each Fellow to incorporate policy impact into their research portfolio while developing new skills as they are supported by the IIPHRP.

Charlton’s project involves engaging stakeholders to make policy changes and revisions to the Iowa administrative code that will strengthen cancer reporting requirements in the state.

A portrait of Kelli Ryckman of the Department of Epidemiology Health in the College of Public Health at the University of Iowa.
Kelli Ryckman

“I know it won’t be a quick and easy road, but with connections to the right people and the support of the program, I look forward to working with experts who can help me navigate around barriers and reach consensus that will bring about positive change,” Charlton says.

“My passion is finding ways to improve the care of preterm, low-birth-weight, and sick newborns in the Neonatal Intensive Care Unit,” says Ryckman about her motivation to apply to the program. Her project is to refine the newborn screening policy for babies in the NICU that will result in fewer false-positive screens.  “Through the program, I hope to build consensus based on the evidence and disseminate a uniform set of guidelines for newborn screening in the Neonatal Intensive Care Unit that allows for better utilization of resources across the state of Iowa and beyond.”

The ALP approach requires including at least one stakeholder meeting and a product, such as a policy brief, proposed legislative language, or a “how-to-guide” to disseminate at the end of the Fellowship. Hamann intends to develop an issue brief to highlight bicycling safety research, a topic that has received more attention recently due to an increasing number of automobile and bicycle crashes in Iowa.

Cara-Hamann
Cara Hamann

“I was motivated to apply to this program to develop skills that can take my research and translate it into tangible products to be used for policy change that can have a real impact on safety,” says Hamann. “I want to use this opportunity to draw attention to bicycle safety and complement the current grassroots efforts underway in the bicycling community.”

“As researchers, we have a desire to impact our community, and that means translating evidence into policy or practice change. Building stakeholder coalitions and creating effective dissemination plans are strategies that work, but are not skills most researchers have been formally trained in,” adds CPH Dean Sue Curry. “The Policy Fellow Program provides a supportive and individualized learning environment for faculty to experiment and learn these important skills while simultaneously translating their research into public health practice.”

Policy Fellows will participate in learning activities, generate policy documents, and participate in efforts to better educate community members and governmental leaders on the importance of research. In addition, each Policy Fellow may access funds to enhance their learning. The program will invite a variety of experts to share knowledge on important topics, such as how the legislative process works and how to interact with the media to best communicate research findings.