Division Of Reproductive Health Research Articles

Strengthening Maternal and Infant Health Resilience Before Weather and Climate Disasters: Preparedness Resources from CDC's Division of Reproductive Health.

This report describes opportunities to address emergency preparedness to incorporate the needs of pregnant and postpartum populations. This report briefly summarizes data on the impacts of weather and climate disasters on maternal and infant health and outlines opportunities for individuals, health care providers, and public health practitioners to increase capacity to prepare for these occurrences, which are becoming more frequent and costly. Specific resources from the U.S. Centers for Disease Control and Prevention's Division of Reproductive Health are shared to support individual preparedness, communication of disaster safety messages, and emergency preparedness planning capacity among health care providers and health departments.

Centers for Disease Control and Prevention Harvard Program Evaluation Practicum: 10 Years of Partnership in Public Health Program Evaluation.

The Centers for Disease Control and Prevention (CDC)'s Division of Reproductive Health and Harvard T.H. Chan School of Public Health (HSPH) Program Evaluation Practicum (CDC/HSPH Practicum) is a mutually beneficial workforce development partnership formed to provide state, local, and tribal public health organizations with an evaluation plan for a maternal and child health (MCH) program. State, local, and tribal public health organizations submit an MCH program in need of evaluation for inclusion consideration. Student pairs are matched with the selected programs in a 3-week practical field-based experience. This Practicum provides didactic training for both program staff and students followed by field work at the public health organizations. Students provide organizations with comprehensive evaluation plans, complete with logic model, methodology, and indicators. Since the Practicum's inception in 2013, 104 HSPH graduate students have been trained and 30 states and 1 territory have participated and received evaluation plans for their MCH programs. The utility and importance of the CDC/HSPH Practicum is evidenced by program staff and student feedback. Multiple states have implemented the plans designed by the students, with some evaluations leading to program enhancements. The CDC/HSPH Practicum prepares students for the workforce and adds much needed capacity to public health organizations by providing them with evaluation knowledge and skills, and usable evaluation plans to improve MCH-a win-win for all.

Road to Equity in Maternal and Child Health: Honoring the Past and Blazing New Paths.

This paper is a historical account of an initiative, as recalled by the authors who were directly involved, that brought to the forefront the long-standing and unjust reproductive health inequities in the United States. It is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health. This paper is composed of three distinct but interrelated parts that together map the past, present, and future of addressing racial inequities in Maternal and Child Health.Part I recounts the history and achievements of a Centers for Disease for Control and Prevention initiative in the 1980-90's, led by the Prematurity Research Group in the Division of Reproductive Health, Pregnancy and Infant Health Branch. This initiative stimulated a paradigm shift in how we understand and address black infant mortality and the inequities in this outcome. Part II illustrates examples of some exemplary programmatic and policy legacies that stemmed either directly or indirectly from the Centers for Disease for Control and Prevention paradigm shift. Part III provides a discussion of how effectively the current practice in Maternal and Child Health applies this paradigm to address inequities and proposes a path for accelerating Title V agencies' progress toward birth equity. This CDC initiative was transformative in that it raised the visibility of African American researchers,moved the field from a focus on traditional epidemiologic risks such as personal health promotion and medical interventions, to include racism as a risk factor for inequitable birth outcomes. The paradigm examinedthe specific roles of historical and structural racism, and the racialized, contextualized, and temporal exposures that are unique to Black women's experiences in the United States. The initiative radically changed the narratives about the underlying factors contributing to inequities in birth outcomes of Black women, altered the way we currently approach addressing inequities, and holds the keys for transforming practice to a more holistic and systematic approach to building sustained organizational structures in maternal and child health that accelerate the achievement of birth equity.

Improving Access to and Quality of Sexual and Reproductive Health Services for Adolescents in the United States.

Equitable access to high quality adolescent sexual and reproductive health (ASRH) services can help reduce unintended pregnancies, sexually transmitted diseases, and disparities in these outcomes. The Centers for Disease Control and Prevention (CDC), Division of Reproductive Health, has a long history of working to improve access to and quality of ASRH services through applied research and public health practice. This report from CDC summarizes the evolution of these efforts from more than a decade of work-from community-based demonstration projects to an initiative to support wide-scale implementation. We describe a community-wide teen pregnancy prevention program model that includes a component addressing ASRH services (2010-2015), focused efforts related to quality improvement (QI) of and community-clinic linkages to ASRH services (2015-2020), and the development of a QI package that collates implementation strategies and tools to improve ASRH services (2020-2022). We conclude by discussing future directions. In disseminating key strategies and resources from this work, we aim to support broader public health and clinical efforts to strengthen ASRH care in the United States in ways that promote health equity.

Emergency Preparedness and Response: Highlights from the Division of Reproductive Health, 2011-2021.

This report provides historical context and rationale for coordinated, systematic, and evidence-based public health emergency preparedness and response (EPR) activities to address the needs of women of reproductive age. Needs of pregnant and postpartum women, and infants-before, during, and after public health emergencies-are highlighted. Four focus areas and related activities are described: (1) public health science; (2) clinical guidance; (3) partnerships, communication, and outreach; and (4) workforce development. Finally, the report summarizes major activities of the Division of Reproductive Health's EPR Team at the Centers for Disease Control and Prevention.

The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of Design and Methodology.

Data System. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing state-based surveillance system of maternal behaviors, attitudes, and experiences before, during, and shortly after pregnancy. PRAMS is conducted by the Centers for Disease Control and Prevention's Division of Reproductive Health in collaboration with state health departments. Data Collection/Processing. Birth certificate records are used in each participating jurisdiction to select a sample representative of all women who delivered a live-born infant. PRAMS is a mixed-mode mail and telephone survey. Annual state sample sizes range from approximately 1000 to 3000 women. States stratify their sample by characteristics of public health interest such as maternal age, race/ethnicity, geographic area of residence, and infant birth weight. Data Analysis/Dissemination. States meeting established response rate thresholds are included in multistate analytic data sets available to researchers through a proposal submission process. In addition, estimates from selected indicators are available online. Public Health Implications. PRAMS provides state-based data for key maternal and child health indicators that can be tracked over time. Stratification by maternal characteristics allows for examinations of disparities over a wide range of health indicators.

The sixth vital sign: what reproduction tells us about overall health. Proceedings from a NICHD/CDC workshop.

Does the fertility status of an individual act as a biomarker for their future health? Data support an association between reproductive health and overall health for men and women. Various chronic conditions, such as diabetes, obesity and cancer, can compromise fertility, but there are limited data for the converse situation, in which fertility status can influence or act as a marker for future health. Data reveal an association between infertility and incident cardiovascular disease and cancer in both men and women. A National Institute of Child Health and Human Development-Centers for Disease Control and Prevention workshop in April 2016 was convened that brought together experts in both somatic diseases and conditions, and reproductive health. Goals of the workshop included obtaining information about the current state of the science linking fertility status and overall health, identifying potential gaps and barriers limiting progress in the field, and outlining the highest priorities to move the field forward. Approximately 40 experts participated in the workshop. While the etiology remains uncertain for infertility, there is evidence for an association between male and female infertility and later health. The current body of evidence suggests four main categories for considering biological explanations: genetic factors, hormonal factors, in utero factors, and lifestyle/health factors. These categories would be key to include in future studies to develop a comprehensive and possibly standardized look at fertility status and overall health. Several themes emerged from the group discussion including strategies for maximizing use of existing resources and databases, the need for additional epidemiologic studies and public health surveillance, development of strategies to frame research so results could ultimately influence clinical practice, and the identification of short and long-term goals and the best means to achieve them. Further research may not indicate an association between fertility status and overall health. Currently medical care is compartmentalized. Reproductive medicine physicians treat patients for a short period of time before they transition to others for future care. Going forward, it is critical to take an interdisciplinary patient care approach that would involve experts in a broad range of medical specialties in order to more fully understand the complex interrelationships between fertility and overall health. If infertility is confirmed as an early marker of chronic disease then screening practices could be adjusted, as they are for patients with a family history of malignancy. Funding for the workshop was provided by the Fertility and Infertility Branch, National Institute of Child Health and Human Development, National Institutes of Health and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control. There are no conflicts of interest to declare. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health. Not applicable.

Monitoring survey after intervention on the organization of a public service in senegal.

To better demonstrate the importance and usefulness of a scientific managerial approach in public health-care institutions to "team building" and institutional performance, this study aimed to evaluate the impact of interventions for organizational development of the Division of Reproductive Health (DRH) in Senegal. This cross-sectional assessment study, conducted in April-May 2014, focused on a sample of 25 DRH staff members and 4 key informants among partners/consultants after a review of the documentation relating to the process from design to implementation. Self-administered questionnaires and interviews provided the data. All respondents, including 19 women and 6 men, came from DRH offices. Staff unanimously noted the benefits of organizational development process, including improved understanding of DRH's vision, mission, and objectives, clarification of the roles and responsibilities of all staff members, improvement of the work environment, and the development of collective awareness, etc. Staff members noted the encouraging results. Nonetheless, the definitive establishment of an organizational culture remains to be shown.

CDC Online Course: Reproductive Health in Emergency Preparedness and Response.

In an emergency, the needs of women of reproductive age, particularly pregnant and postpartum women, introduce unique challenges for public health and clinical care. Incorporating reproductive health issues and considerations into emergency preparedness and response is a relatively new field. In recent years, several resources and tools specific to reproductive health have been developed. However, there is still a need for training about the effects of emergencies on women of reproductive age. In an effort to train medical and public health professionals about these topics, the CDC Division of Reproductive Health developed Reproductive Health in Emergency Preparedness and Response, an online course that is available across the United States.

Placental amino acid transporter function adapts to maternal and fetal nutrient conditions

s / Placenta 35 (2014) A1eA23 A10 O-026. PLACENTAL AMINO ACID TRANSPORTER FUNCTION ADAPTS TO MATERNAL AND FETAL NUTRIENT CONDITIONS Eiji Shibata David, J. Askew, Yukiyo Aiko, Chiharu Tomonaga, Satoshi Aramaki, Hirohide Inagaki, Toru Hachisuga. Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Japan Background: Studies suggest that placental nutrient uptake activity is responsive to both maternal and fetal nutrient demands. We hypothesize that under conditions of limited nutrient availability to the fetus, as often present in preeclampsia (PE), IUGR, and insufficient weight-gain during pregnancy, a general adaptive response aimed to increase amino acid transport activity may be observed in the placenta. Method: A total of 40 placentas from full-term (n1⁄410) and pre-term (n1⁄410) normal pregnancies, IUGR (n1⁄410), and PE (n1⁄410) associated pregnancies were looked at by immunohistochemistry followed by relative qualitative scoring to compare expression levels and localization of System L, ASCT2, and mTOR proteins. Result: Syncytiotrophoblast (ST) in placenta of pregnancies complicated by IUGR or PE showed significant increases in the levels of 4F2hc and LAT1 compared to both full-term control and pre-term pregnancies seperately. Elevated mTOR protein was uniquely higher in IUGR placentas compared to full-term controls. Total cellular ASCT2 transporter protein levels were similar in all groups, however, levels of ASCT2 protein localized to the ST microvillous membrane (MVM) were significantly lower in IUGR compared to both full-term and pre-term pregnancies. Additionally, ASCT2 and mTOR protein levels were positively associated with maternal prepregnancy BMI. Conclusion: First, in conditions of limited nutrient availability, such as PE or IUGR, there is an overall increase in the level of System L and mTOR protein expression in the ST, suggestive of an adaptive response. Second, a decrease in ASCT2 protein at the ST MVM suggests a post-translational event that may decrease AAT activity in IUGR placentas. Third, a physiological link between transporter expression and pre-pregnancy BMI is suggested based upon a positive association observed with ASCT2 and mTOR expression values. O-027. ENDOMETRIAL PERIVASCULAR CELLS ESTABLISH UNIQUE CYTOKINE GRADIENTS IN DECIDUAL PROCESS Keisuke Murakami , Keiji Kuroda , Shintaro Makino , Atsuo Itakura , Satoru Takeda , Jan J. Brosens . Department of Obstetrics and Gynaecology, Juntendo University Faculty of Medicine, Japan; Division of Reproductive Health, Clinical Science Research Laboratories, Warwick Medical School, University of Warwick, Japan Aim: The endometrial perivascular microenvironment is rich in mesenchymal stem-like cells that express type 1 integral membrane protein Sushi domain containing 2 (SUSD2) but the role of these cells in the decidual transformation of this tissue in pregnancy is unknown. We used an antibody directed against SUSD2 to isolate perivascular (SUSD2+) and non-perivascular (SUSD2-) fibroblasts from mid-luteal biopsies. Method: SUSD2+ and SUSD2cells were purified from mid-luteal endometrial biopsies by magnetic bead separation and each cell population were expanded in vitro, then, subjected to RNA-seq analysis or differentiation experiments induced by cAMP andMPA to assess secretome profile. Result: On average, positive cells comprised 6.8% of endometrial stromal cells and 6-fold enriched in clonogenic cells. RNA sequencing revealed that cultures derived from SUSD2+ progenitor cells remain phenotypically distinct by the enrichment of novel and established endometrial perivascular signature genes including AOC3, NOTCH3, ELN, MYH11, DES, ACTA2, MCAM, and CSPG4. Decidualization transformed perivascular SUSD2+ -derived cells into the dominant source of a range of chemokines and cytokines, including CCL7, LIF and LTA. Conclusion: Our findings confirmed that SUSD2+ -derived cells remain the expression of perivascular signature genes even after in-vitro culture. Decidual response is spatially organized at the feto-maternal interface with differentiating perivascular cells establishing distinct cytokine and chemokine gradients that could have the key role in decidual process. O-028. LOCALIZATION OF TRPV5 (TRANSIENT RECEPTOR POTENTIAL VANILLOID RECEPTOR 5) PROTEIN IN HUMAN PLACENTAL TROPHOBLASTS Yoko Aoyama, David J. Askew, Yukiyo Aiko, Chiharu Tomonaga, Satoshi Aramaki, Hirohide Inagaki, Toru Hachisuga, Eiji Shibata. Department of Obstetrics and Gynecology, University of Occupational and Environmental

Perinatal quality collaboratives: improving care for mothers and infants.

Perinatal morbidity and mortality are key indicators of a nation's health status. These measures of our nation's health are influenced by decisions made in health care facilities and by health care providers. As our health systems and health care for women and infants can be improved, there is an expectation that these measures of health will also improve. State-based perinatal quality collaboratives (PQCs) are networks of perinatal care providers including hospitals, clinicians, and public health professionals working to improve pregnancy outcomes for women and newborns through continuous quality improvement. Members of the collaborative are healthcare facilities, primarily hospitals, which identify processes of care that require improvement and then use the best available methods to effect change and improve outcomes as quickly as possible. The Division of Reproductive Health at the Centers for Disease Control and Prevention is collaborating with state-based PQCs to enhance their ability to improve perinatal care by expanding the range of neonatal and maternal health issues addressed and including higher proportions of participating hospitals in their state PQC. The work of PQCs is cross-cutting and demonstrates how partnerships can act to translate evidence-based science to clinical care.

Maternal mortality and morbidity in the United States: where are we now?

This article provides a brief overview of the work conducted by the Division of Reproductive Health at the Centers for Disease Control and Prevention on severe maternal morbidity and mortality in the United States. The article presents the latest data and trends in maternal mortality and severe maternal morbidity, as well as on maternal substance abuse and mental health disorders during pregnancy, two relatively recent topics of interest in the Division, and includes future directions of work in all these areas.

Collaboration at the federal, state, and local levels to build capacity in maternal and child health: the impact of the Maternal and Child Health Epidemiology Program.

This article provides a description of the Maternal and Child Health Epidemiology Program housed in the Division of Reproductive Health at the Centers for Disease Control and Prevention. The article highlights programmatic efforts to build capacity and increase infrastructure within states, localities, and among tribes in the field of maternal and child health by leveraging partnerships with other federal, nonprofit, private, and academic agencies.

Integrating HIV Prevention in Reproductive Health Settings

This article describes results of a process evaluation of a cooperative agreement between the Centers for Disease Control and Prevention's Division of Reproductive Health and 10 regional training centers to increase the number of reproductive health (RH) settings that integrate human immunodeficiency virus (HIV) prevention services at an appropriate level into routine care. Our goal was to learn about the process of integrating HIV prevention into RH settings. We conducted a retrospective evaluation, using qualitative methods. The clinics were from 10 US Department of Health and Human Services regions. We interviewed 16 key informants from 10 selected model clinics. The main outcome was organization change. The most common obstacles to integration were staff issues, logistics barriers, inadequate clinic structure to support integration, and staff training barriers. Using the transtheoretical model (TTM) applied to organizations, we documented organizational change as informants described their clinics' progression to integration and overcoming obstacles. All model clinics began in the contemplation stage of transtheoretical model. Every clinic exhibited at least 1 process of change for every stage. In the contemplation stage, most informants discussed fears about not changing, stated that the integration was consistent with the agency's mission, and described thinking about commitment to the change. In the preparation stage, all informants described building teams that supported integration of HIV prevention. During the action stage, informants talked about assessments of facilities, staff and protocols, commitments through grants or agreements, and then using training to support new behaviors and adopting new cognitions. In the maintenance stage, all reported changing policies, procedures, or protocols, most promoted helping relationships among the staff, and nearly all reported rewards for the new ways of working. RH settings were able to integrate HIV prevention services by employing a systematic process.

A Perspective on CDC's Efforts in Safe Motherhood: 2001 to the Present

This article reviews selected activities to promote Safe Motherhood through scientific and programmatic activities conducted by CDC's Division of Reproductive Health.

Building Capacity of State Adolescent Pregnancy Prevention Coalitions to Implement Science‐Based Approaches

A central question in adolescent reproductive health circles is how to effectively disseminate research to practitioners in a way that supports them in using the most scientifically sound and effective programming. In 2002, the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC) tackled this question by funding three national-level and five state-level organizations focused on adolescent pregnancy prevention to promote the use of science-based programs and approaches. Healthy Teen Network (HTN) and Education, Training and Research Associates (ETR), two national organizations, have partnered under this CDC funding to implement an effective model for capacity building. This paper provides an overview of the approaches used by HTN and ETR in capacity building using a seven-step process. We describe how we modified the Interactive Systems Framework for Dissemination and Implementation (ISF) for science-based innovations to apply to capacity-building for adolescent reproductive health (ARH) programs, and how we developed relevant, sustainable training and technical support. We conclude by reviewing some of the results of this training, and discuss the future work that will likely continue to advance the science behind effective dissemination of ARH research to practice.

723: Use of progesterone to prevent preterm births: Attitudes and practices of U.S. Obstetrician-Gynecologists

PRACTICES OF U.S. OBSTETRICIAN-GYNECOLOGISTS ZSAKEBA HENDERSON, MICHAEL POWER, EVE LACKRITZ, VINCENZO BERGHELLA, JAY SCHULKIN, Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, American College of Obstetricians and Gynecologists, Research Department, Washington, District of Columbia, Thomas Jefferson University, Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Philadelphia, Pennsylvania OBJECTIVE: To determine current attitudes and practices regarding the use of progesterone to prevent preterm birth among members of the American College of Obstetricians and Gynecologists (ACOG). STUDY DESIGN: A self-administered mail survey was sent to members of the ACOG Collaborative Ambulatory Research Network in March-May 2007. Clinicians were eligible to complete the survey if they currently practiced obstetrics in the U.S. The survey consisted of 36 questions, including respondents= demographic characteristics, their preterm birth risk factor knowledge and screening practices, and their understanding and use of progesterone for the prevention of preterm birth. RESULTS: The overall response rate, adjusted for eligibility, was 52% (N 345). The primary specialty of 89% of respondents was general Ob/Gyn, followed by maternal-fetal medicine (8%). Seventy-four percent reported that they currently recommend or offer progesterone for prevention of preterm birth; of those (n 254), 42% reported recommending it to women with any prior preterm birth 37 weeks, and 55% reported recommending progesterone to women without a prior preterm birth for other conditions in the current pregnancy (39% for prematurely dilated or effaced cervix, 35% for short cervix on ultrasound, and 27% for cerclage). Of all respondents, 55% considered prophylactic use of progesterone for high risk patients an effective treatment to reduce the incidence of preterm birth. However, some were very concerned that it was not easily available (36%), not covered by insurance (31%), that more data are needed (28%), and that there may be long-term fetal or neonatal effects (27%). CONCLUSION: Nearly three-fourths of responding physicians reported recommending or offering progesterone for the prevention of preterm birth, and over half of them reported offering it to women without a prior preterm birth. Despite this widespread use of progesterone, concerns still remain regarding long-term effects and the need for more data to support its use.

UNDERREPORTING OF PREGNANCY-ASSOCIATED DEATHS

In the March issue of the Journal, Chang et al. call attention to the finding that homicide is a leading cause of death among pregnant and postpartum women.1 However, their findings substantially underestimate the magnitude of the problem, because data on pregnancy-associated deaths collected by the Centers for Disease Control and Prevention’s Division of Reproductive Health (DRH) through the Pregnancy Mortality Surveillance System are incomplete. To collect data for the Pregnancy Mortality Surveillance System, the DRH asks states to voluntarily send death certificates for all maternal deaths, that is, deaths resulting from medical causes related to the pregnancy that occur during pregnancy or within 42 days of delivery or termination of pregnancy. The DRH also asks states to send information on pregnancy-associated deaths, that is, deaths from any cause that occur during pregnancy or within a year of delivery or termination of pregnancy. This would include homicides. Because it is impossible to identify all pregnancy-associated deaths with only the information contained on death certificates, and few states use additional sources of data to identify pregnancy-associated deaths,2 the information reported to the DRH is incomplete. Our Maryland study showed that only a small proportion of pregnancy-associated deaths can be identified from death certificates alone and that comprehensive identification of pregnancy-associated deaths requires collection of data from additional sources, including medical examiners’ records and linkage of death records with birth and fetal death records.3 Medical examiners’ records are a critical source of information on homicides that occur among women who are pregnant at the time of death, but Maryland may be the only state that routinely reviews medical examiners’ records for this purpose. Linkage of death records with birth and fetal death records is important in identifying homicides among postpartum women, but few states routinely link these records at all and even fewer do so for a full year following pregnancy. Further evidence of underreporting in Chang’s study is that their reported pregnancy-associated homicide rate of 1.7 per 100000 live births is substantially lower than rates cited in other reports. The pregnancy-associated homicide rate in Maryland was found to be 10.5 per 100000 live births when death records, linkage of records, and medical examiner records were used to identify deaths.3 Using only death certificates and linked records to identify deaths, Parsons and Harper4 in North Carolina and Nannini et al.5 in Massachusetts found rates of 7.2 and 3.5, respectively. Both states and the Centers for Disease Control and Prevention must improve their efforts to collect complete and accurate data on pregnancy-associated deaths. This is a critical step in the prevention of pregnancy-associated mortality from all causes.

Perinatal Outcome Among Singleton Infants Conceived Through Assisted Reproductive Technology in the United States

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Schieve, Ferre) School of Public Health, University of North Carolina, Chapel Hill, North Carolina (Peterson)

Highlights from the National Summit on Safe Motherhood: Investing in the Health of Women.

From September 5-7 2001 the Centers for Disease Control and Prevention (CDC) Division of Reproductive Health held a National Summit on Safe Motherhood in Atlanta Georgia. Over 300 people participated. One of important themes discussed was that pregnancy for women during the 21st century poses challenges vastly different from those of the past. The Internet late childbearing and infertility technology have all had a profound impact on women’s health. Concurrent sessions addressed specific topics such as pregnancy weight gain pregnancy-related illness domestic violence and intrapartum care. Discussions moved beyond an emphasis on the absence of disease and toward a focus on improving the overall well-being of childbearing women and their families in an effort to ensure their physical mental emotional and socioeconomic health. The plenary sessions focused on collaborative research and advocacy efforts and on societal forces that influence safe motherhood. Planning is under way for several post-summit activities.