Bao receives FOE Diabetes Research Center grant

A portrait of Assistant Professor Wei Bao of the Department of Epidemiology in the University of Iowa College of Public Health.
Wei Bao

The Fraternal Order of Eagles (FOE) Diabetes Research Center is pleased to announce the results of its sixth round of pilot and feasibility research grants.  Three 2016-17 recipients were selected to receive $50,000 to support their research proposal, with the possibility of $100,000 over a two-year period.

The committee unanimously selected an additional proposal by Wei Bao, MD, PhD, CPH assistant professor of epidemiology, to receive $20,000 to support his research proposal, “Nontraditional glycemic markers in early pregnancy as predictors of gestational diabetes,” for one year.

Project Summary
Gestational diabetes mellitus (GDM) is a common pregnancy complication that affects ~9% of all pregnancies in the United States. GDM is usually diagnosed at 24-28 weeks of gestation by measuring fasting and post-load glucose in an oral glucose tolerance test (OGTT). Since GDM is associated with adverse health outcomes in the fetus and children, early prediction of GDM is imperative. However, the utility of glucose in early pregnancy for GDM prediction is limited because fasting glucose and OGTT are usually not available at that time. Using non-fasting blood glucose for GDM prediction is problematic due to the substantial glucose variability influenced by food intake. Nontraditional glycemic markers, including fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG), do not require fasting; therefore they are perfect fit to the current clinical practice and can be measured in the same blood samples collected in early pregnancy for other routine lab tests.

We propose to conduct a nested case-control study in a prospective cohort of pregnant women. In this pilot study, we will measure nontraditional glycemic markers in first-trimester maternal plasma samples of pregnant women, and associate these markers with the risk of incident GDM. Moreover, we will assess the utility of these markers in the discrimination and prediction of GDM, as indicated by improved C-statistic and reclassification measures. Previous studies on the use of these markers for GDM prediction mainly used blood samples collected at the time of GDM diagnosis and the results have been conflicting. The proposed study is innovative because it represents a departure from the status quo by examining nontraditional glycemic markers in early pregnancy as early predictors for GDM. If successful, the proposed study may change the clinical paradigm in the screening and prediction of GDM. Findings from this study will be important to develop Specific Aims for subsequent NIH R01 projects that integrate multiple biochemical and genetic markers for improved GDM prediction in the era of “Precision Medicine.”

UI researcher finalist in challenge to improve maternal, newborn health

Atifa Begum with her new born baby at LAMB hospital.
Atifa Begum with her newborn baby at LAMB Hospital. Photo: GMB Akash

This July, creative thinkers from around the world will gather in Washington, D.C., to pitch their ideas for a chance to secure funding that will take their innovations to the next level. While it may sound like an episode of Shark Tank, the event, called the DevelopmentXChange, is dedicated to finding innovative ideas that address a pressing global health challenge: maternal and newborn mortality.

Will Story, assistant professor of community and behavioral health at the University of Iowa College of Public Health, is among the participants invited to the DevelopmentXChange July 26-28. The event – an inspired mashup of tradeshow, networking opportunities, and mentoring workshops – brings together 50 finalists selected from nearly 650 applications submitted to Saving Lives at Birth: A Grand Challenge for Development.

Story, along with co-principal investigator Dr. Louise Day, a clinician-researcher practicing in Bangladesh, will be presenting their innovation, an illustration-based decision-making tool that helps pregnant, semi-literate women and their families in rural Bangladesh know how and when to seek skilled care for the safe delivery of their baby.

A Vulnerable Time

Every two minutes, a woman dies in childbirth worldwide, according to the Saving Lives at Birth website. The onset of labor marks the start of the highest-risk period for both mother and baby, which continues until at least 48 hours after birth. During this short period of time, 145,000 maternal deaths, 1.45 million neonatal deaths, and 1.2 million stillbirths occur each year, Saving Lives at Birth reports. The vast majority of these deaths occur in low- and middle-income countries.

Women with their infants sitting outside in Bangladesh
Women with their newborns. Photo: LAMB Hospital

The Saving Lives at Birth partnership, launched in 2011, includes the U.S. Agency for International Development, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada (funded by the Government of Canada), the U.K’s Department for International Development, and the Korea International Cooperation Agency.

The partnership issues an annual global call for groundbreaking, scalable prevention and treatment approaches for pregnant women and newborns in poor, hard-to-reach communities around the time of delivery. From the hundreds of applications, the most promising ideas are selected to present as finalists at the DevelopmentXChange for a chance to receive additional funding.

Obstetric Care in Rural Bangladesh

In rural Bangladesh, where Story and Day’s research is taking place, only a third of women deliver their babies in a health facility where they have better access to life-saving interventions. One of the primary barriers to obtaining skilled obstetric care is a delay in care-seeking, which is caused by a lack of recognition of the risk during labor by the family and caregivers. Another factor is a lack of support for the mother from the decision makers, including the male family members.

The goal of the team’s project is to expedite obstetric care-seeking among semi-literate women and their families in rural Bangladesh by combining a new home-based, pictographic decision-making tool – also known as a “pictorial partograph” – with a novel approach to involving men during labor and delivery.

The team has already pre-tested a working draft of the pictorial partograph with a group of semi -literate family caregivers and community health workers, who gave it very positive feedback. The pictorial partograph is a two-page, color-printed decision tool with simple illustrations that depict mothers in low-risk, at-risk, and high-risk scenarios with guidance on caregiving, when to seek advanced care, and possible outcomes for mothers and babies.

“Right now, there’s no male-specific component to the tool,” explains Story. “We want to talk to men and women in rural Bangladesh to find out what is most helpful for men to do during labor and delivery, then integrate it into the pictorial partograph.”

Some possible tasks for the men are logistical, Story says, such as arranging for transportation to a qualified health care provider, negotiating any needed financial support, finding appropriate blood donors (since clinics in limited-resource settings typically don’t have blood banks), and offering social support during labor and delivery.

Next Steps

Outside of LAMB hospital in northwest Bangladesh
LAMB Hospital. Photo: GMB Akash

The researchers are seeking $250,000 in seed funding at the DevelopmentXChange event to further test, refine, and evaluate the pictorial partograph in a clinical setting before finalizing it for use at home by rural families and caregivers. The study would be conducted in LAMB Hospital located in Dinajpur, a rural district in northwest Bangladesh.

Currently, Story and Day are honing their elevator speeches about the pictorial partograph in preparation for the DevelopmentXChange event.

“It’s exciting, because our tool is low cost, low tech, and focused on behavior change,” says Story. “We’re different, because a lot of the finalists are more technology-driven.”

In addition to Story and Day, the research team includes co-investigators Shirajum Munira, a Bangladeshi researcher; Stacy Saha, director of the LAMB Management Information Systems- Research Department; and Kavita Singh, a research associate professor in the Department of Maternal and Child Health at the University of North Carolina.

Read more about the DevelopmentXChange finalists.


Study finds domestic violence doubles risk of premature birth

Domestic violence by a partner or ex-partner during pregnancy doubles the risk of pre-term birth and low birth weight, according to a study conducted by University of Iowa  researchers. The team also found that domestic violence slightly increased the risk of a baby being small for gestational age. The researchers  included first author Brittney Donovan, doctoral student in epidemiology, Audrey Saftlas, Cassie Spracklen, and Kelli Ryckman from the Department of Epidemiology, and Marin Schweitzer from the Department of Internal Medicine.

This story has been covered by several media outlets:

The Guardian

Huffington Post

Times of India

Business Standard

Study: Domestic violence during pregnancy doubles risk of preterm birth, low birth weight

Domestic violence by a partner or ex-partner during pregnancy increases the risk of preterm birth, low birth weight and small-for-gestational-age babies, finds a study in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).

Researchers from the University of Iowa 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 was increased further for women who experienced two or more types of domestic violence during their pregnancy.

A portrait of Audrey Saftlas of the University of Iowa College of Public Health
Audrey Saftlas

There were fewer studies which looked into the effect of domestic violence by a partner or ex-partner on the baby being small-for-gestational-age, however the results indicated a small increased risk.

“Domestic violence by a partner or ex-partner is of particular concern during pregnancy when not one, but two lives are at risk,” says Audrey Saftlas, UI professor of epidemiology and lead author of the study.

“Although rates of domestic violence differ across the world, the detrimental effects of abuse on pregnant women are very clear and we must continue to establish effective interventions globally in order to prevent violence and to support women who report abuse,” Saftlas says.

Domestic violence by a partner or ex-partner is one of the most common forms of violence against women and includes physical, sexual, financial, psychological or emotional abuse.

Domestic violence by a partner or ex-partner can directly affect the growing fetus, through physical or sexual trauma, or indirectly due to increased maternal stress, inadequate nutrition and poor prenatal care.

“This is a strong study bringing together data from around the world,” says Professor John Thorp, deputy editor-in-chief of BJOG.

“While it provides robust evidence about the association between domestic violence by a partner or ex-partner, violence during pregnancy and adverse infant outcomes, further research is needed to understand the biological mechanism behind this link, as well as addressing the effectiveness of interventions to prevent domestic violence during pregnancy,” Thorp added.

In addition to Saftlas, the research team at the University of Iowa included first author Brittney Donovan, doctoral student in epidemiology, Cassie Spracklen and Kelli Ryckman from the Department of Epidemiology, and Marin Schweitzer from the Department of Internal Medicine.

UI College of Public Health to recognize women’s health pioneer Byllye Avery

Thursday, October 8, Avery will present the 2015 Hansen Distinguished Lecture entitled “Why Black Women’s Health Matters.” The lecture begins at 10 a.m. in Callaghan Auditorium in the College of Public Health Building

The University of Iowa College of Public Health has named women’s health pioneer Byllye Avery the recipient of its 2015 Richard and Barbara Hansen Leadership Award and Distinguished Lecture. For more than 40 years, Avery has been on the front lines of the women’s health movement in the United States, leading advocacy, educational, and  self-help initiatives that explore how race, gender, and class affect women’s empowerment.

Portrait of Byllye Avery, recipient of the 2015 Hansen Award.
Byllye Avery

Through activism and a commitment to social justice, Avery has fostered a national forum for the discussion of the health issues of African American women. The founder of the Black Women’s Health Imperative and co-founder of Raising Women’s Voices for the Health Care We Need, she continues to document and speak on black women’s health experiences in America, highlighting the effects of factors such as poverty, crime, violence, and racism.

“Byllye Avery is a true pioneer in the field of women’s health,” says Sue Curry, dean of the College of Public Health. “Her efforts to promote the physical, mental and emotional well-being of women, overcome health disparities and empower women about their health choices is public health work at its very best. We are pleased and honored to recognize her with our college’s highest award.”

Avery’s commitment to women’s health began in the mid-1970s, when she co-founded both the Gainesville (Fla.) Women’s Health Center and Birthplace, a midwifery birthing center, known today as the Birth and Wellness Center. Throughout the ensuing four decades, she led grassroots advocacy efforts to develop both national and international networks focused on issues related to women’s wellness, sexuality, and reproduction.

Prior to her entry into the health care arena, Avery taught special education to emotionally disturbed students and consulted on learning disabilities in public schools and universities throughout the southeastern United States. She studied psychology at Talledega (Ala.) College and earned an M.A. in special education from the University of Florida.

Avery has been the recipient of many honors and awards, including a MacArthur Foundation Fellowship and the Institute of Medicine’s Gustav O. Lienhard Award for the Advancement of Health Care. Avery has served on the Charter Advisory Committee for the Office of Research on Women’s Health of the National Institutes of Health and has served as a visiting fellow at the Harvard School of Public Health. She has honorary degrees from Thomas Jefferson University, State University of New York at Binghamton, Gettysburg College, Bowdoin College, Bates College and Russell Sage College.

On Thursday, October 8, Avery will present the 2015 Hansen Distinguished Lecture entitled “Why Black Women’s Health Matters.” The lecture begins at 10 a.m. in Callaghan Auditorium in the College of Public Health Building. A panel discussion will follow the lecture.

Later that day, Avery will participate in a Q&A discussion about spirituality and public health. The discussion, which begins at 4:00 p.m. in the Callaghan Auditorium in the College of Public Health Building, will be moderated by Dr. Miesha Marzell, assistant professor of community and behavioral health. A reception will follow the discussion.

Both events are free and open to the public.

The Hansen Leadership Award is presented annually by the UI College of Public Health to honor individuals who have made sustained contributions in the public health field. The award recognizes exemplary leadership, high ethical standards, and an enduring commitment to improving health on a national and international level. The award is made possible by a gift from Richard and Barbara Hansen of Iowa City.

Individuals with disabilities are encouraged to attend all UI-sponsored events. If you are a person with a disability who requires a reasonable accommodation in order to attend this lecture, contact Ryan Bell in advance.

A quest for clean water

CPH faculty member Kelly Baker studies the cascade of health issues connected to water, sanitation, and hygiene.

A child drinks water from a running pipe.

Water has been a consistent theme running through Kelly Baker’s work, one that has led her from her home state of Oklahoma to California, Mexico, India, Ghana, and elsewhere around the globe.

“I’ve always been a bit of a vagrant,” says Baker, who joined the College of Public Health in 2014 as an assistant professor of occupational and environmental health. “Even before getting into global health work, I traveled a lot.”

After completing her undergraduate studies in biology and ecology, Baker moved to California intending to earn a PhD in oceanography.

“I wound up a bit disillusioned with the potential for career success in that field,” says Baker, who took time to rethink things. “I’d work then travel – typically into Mexico and Ecuador – and I settled on the concept of public health because it tied into a lot of the problems I observed in my travels.”

Baker then attended the University of Maryland-Baltimore, where she completed a PhD in microbiology and immunology.

“I started off studying bacterial pathogenesis and molecular diagnostics,” Baker says. “It was very bench-based work and I enjoyed it, but I realized it wasn’t where my interests were. I wanted to do fieldwork.”

Field Experience

After Baker graduated, she was offered a fellowship with the University of Maryland’s Global Enteric Multicenter Study (GEMS), one of the largest, most comprehensive studies of childhood diarrheal diseases ever conducted in developing country settings.

“My role was the environmental component of the study – understanding how water sanitation and hygiene affected a child’s odds of diarrhea,” Baker explains. “In Bangladesh, I designed questionnaires to understand the practices specifically related to water quality in the home or to hand washing. I collected environmental samples, and identified and measured how much contamination was in these samples. That was really my introduction to a lot of different disciplines, from field epidemiology to environmental microbiology to behavioral data collection methodologies.

“It resonated very strongly as the pathway I wanted to go in,” Baker continues. “In low-income countries, people are exposed over time to many different organisms. For me, improvements in fundamental environmental health offered a panacea against disease spread. You could prevent exposure to lots of different things over time, and, hopefully, prevent a child from ever getting to the point where they would have diarrhea or be malnourished from it.”

Baker’s next stop was Accra, Ghana, where she worked as an in-country investigator for the Emory University-based SaniPath study, an assessment of exposure to human waste in low-income urban environments. That experience in Ghana helped inform Baker’s current work in understanding the relationship between water and contamination.

“Water is a means by which we consume contamination, such as through drinking water or accidentally swallowing water while swimming,” Baker says. “But water is also is a mechanism by which contamination is introduced into the environment. For example, at an open defecation site, water can move beyond one centralized location and wind up contaminating a much broader area and exposing a broader population. It all leads back to containment of waste being a really important component of preventing the disease cycle from occurring again.”

Understanding Exposure

A portrait of Kelly Baker, professor of Occupational and Environmental Health at the University of Iowa College of Public Health.
Kelly Baker

Baker’s experience strengthens the College of Public Health in several areas, says Peter Thorne, CPH professor and head of occupational and environmental health.

“We’re pleased to have Kelly’s expertise in water quality, sanitation, and global public health,” says Thorne. “These are important areas of environmental health where we have needed more scholarship and student mentoring. While Kelly is doing great international work, we also look to her expertise to address problems with water quality in Iowa.”

Baker’s current research falls into three interconnected areas. “On the exposure side of things, my lab is developing a tool that simultaneously detects and quantifies over 20 known types of microorganisms that cause diarrheal disease,” Baker says. “We’re going to use this tool to better understand waterborne, watershed exposure risks in a low-income country.”

Worldwide, the lack of adequate sanitation facilities allows diarrheal pathogens to enter the environment, Baker explains.

“So the overall likelihood of being infected and experiencing illness is extremely high for those living in those areas,” she says. “We’re going to use this tool to identify the pathways by which groups of organisms spread in the environment and come into contact with people. We can use this information as a baseline for evaluating the impact of sanitation-related interventions on environmental safety and human health risks.”

The research team will be conducting projects this summer in Kenya and Iowa. “While Iowa may be relatively clean in terms of human waste, there’s zoonotic transmission through wildlife and livestock. Comparing the patterns we find in Iowa versus in Kenya will help us better understand what the inherent risks are in a place where there are good human sanitation systems versus a place where there are not.”

Maternal and Child Health

Another part of Baker’s work is exploring whether and how water and sanitation impact maternal and child health.

“We’re in the process of completing a project in India where we’re exploring what the patterns of sanitation use are for women across the life course, and how it impacts their health,” Baker says. “In India, for a number of reasons, open defecation is rampant even where public toilets are available. For women, fear of violence is an issue.”

Women’s struggles to access safe, private sanitation and obtain clean water create extremely stressful mental and physical environments, Baker explains. One finding from the project is that women with poor sanitation access are twice as likely to experience pre-term birth or give birth to a low-birth-weight infant.

“The next phase of our work is to understand why,” Baker says. “And not just why, but what are the downstream ramifications? Is the stress related to poor water and sanitation access something that is biologically linked to preterm birth? We want to understand what these pathways are so that we can design interventions that potentially can alleviate stressors for pregnant women.”

Baker emphasizes that the impact is not just on the woman, but also the child. “We hypothesize that how and when a child enters the world is a major predictor of whether that child, two years from now, will have a higher incidence of diarrheal disease, or is more likely to be stunted (low height for age) and wasted (low weight for height). We’re trying to understand that cascade — how is the disparity from poor water and sanitation access passed from mother to offspring, and what are the consequences?”

Assessing Interventions

Baker’s third area of work is, as she puts it, “How do we identify effective interventions, and how do we understand whether those interventions work?”

Baker is collaborating with Safe Water Network, a non-governmental organization that partners with communities in Ghana and India to develop market-driven, financially sustainable, locally owned and managed water systems. Safe Water Network plans to conduct a heath-impact assessment, Baker explains, and her role is to help them understand when and how their programs are working.

“I have a lot of irons in the fire,” Baker admits, but the passion for her work is evident. “The three parallel tracks of my work are all really engaging, and none of them really stand alone. I’m a big picture person, and I really like projects where I have collaboration with and can learn from other people.”

This story originally appeared in the spring 2015 issue InSight magazine for alumni and friends of the UI College of Public Health.