Outcomes We Study

Preterm birth is birth before 37 weeks of pregnancy. The expected length of a pregnancy is 40 weeks, and births that are 3 weeks early or more are considered preterm. Preterm birth is a primary area of investigation within the consortium and is led by the UCSF California Preterm Birth Initiative (PTBI-CA). The PTBi-CA is a founding partner of the HOPE Consortium as is its PI, Dr. Larry Rand and its Director of Discovery and Precision Health, Dr. Laura Jelliffe-Pawlowski. The PTBi-CA includes a Discovery Collaborative where many individual members of the HOPE Collaborative also serve as investigators.

Preterm birth is the leading cause of infant mortality in the world and is associated with both short-term and long-term illness and disability. The earlier a child is born, the greater the likelihood of death and illness there is across their lifetimes. Little is known about what causes a person to go into labor early. Known risk factors include hypertension, diabetes, and smoking. Social factors also play a major role in driving risk for preterm birth - especially chronic and systematic racism which can take a toll on a person's well-being including on their mental and physical health. The PTBi-CA is do ground-breaking work examining how racism gets under the skin of Black, Latinax, Native American and other women of color and causes preterm birth and other poor pregnancy outcomes. See the PTBi-CA website for a list of PTBi-CA publications focused on preterm birth

Given how common and devastating preterm birth can be, it is closely associated with many of exposures and adverse pregnancy and infant outcomes studied as part of the consortium including as part of the HOPE COVID-19 study  and as part of other ongoing studies including the California Prediction of Poor Outcomes of Pregnancy (CPPOP) study, the PRedicting Maturity, MOrtality and Morbidity in PreTerm Newborns (PROMPT) study, the Cancer and Pregnancy Outcomes study, and the Social Determinants of Heart Defects study. 

Small for gestational age and intrauterine growth restriction refer to a baby that is not growing appropriately, and is consequently smaller than we would expect based on the length of pregnancy. 

Small for gestational age babies usually have a birthweight below the 10th percentile for babies the same gestational age (delivered at the same week of pregnancy). 

A baby may be small because they did not receive necessary nutrients and oxygen needed for proper growth and development during pregnancy. This can cause problems for the baby during pregnancy, delivery, or afterwards. 

Babies born small for gestational age may have any of the following problems after birth: 

·       Decreased oxygen levels

·       Low Apgar scores (an assessment that helps identify babies with difficulty adapting after delivery)

·       Meconium aspiration (inhalation of the first stools passed in utero) which can lead to difficulty breathing

·       Hypoglycemia (low blood sugar)

·       Difficulty maintaining normal body temperature

·       Polycythemia (too many red blood cells) 

* See CHOP_Small for Gestational Age for more information.

Example Consortium Partner publications that include a focus on small for gestational age birth and infants include: 

1. Bandoli G, Singh N, Strouse J, Baer RJ, Donovan BM, Feuer SK, Nidey N, Ryckman KK, Jelliffe-Pawlowski LL, Chambers CD. Mediation of Adverse Pregnancy Outcomes in Autoimmune Conditions by Pregnancy Complications: A Mediation Analysis of Autoimmune Conditions and Adverse Pregnancy Outcomes. Arthritis Care Res (Hoboken). 2020 Feb;72(2):256-264. 
2. Hamad R, Collin DF, Baer RJ, Jelliffe-Pawlowski LL. Association of Revised WIC Food Package With Perinatal and Birth Outcomes: A Quasi-Experimental Study. JAMA Pediatr. 2019 Jul 1. 
3. Strouse J, Donovan BM, Fatima M, Fernandez-Ruiz R, Baer RJ, Nidey N, Forbess C, Bandoli G, Paynter R, Parikh N, Jeliffe-Pawlowski L, Ryckman KK, Singh N. Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study. RMD Open. 2019 Apr 14;5(1):e000878. 
4. Pantell MS, Baer RJ, Torres JM, Felder JN, Manchikanti Gomez A, Chambers BD, Dunn J, Parikh NI, Pacheco-Werner T, Rogers EE, Feuer SK, Ryckman KK, Novak NL, Tabb KM, Fuchs J, Rand L, Jelliffe-Pawlowski LL. Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. AJOG MFM. Nov 2019. Vol 1(4).

Pregnancy factors that contribute to small for gestational age birth and outcomes of babies born small for gestational age are studied as part of several consortium studies including as part of the HOPE COVID-19 study and as part of other ongoing studies including CPPOP, PROMPT, Cancer and Pregnancy Outcomes, and Social Determinants of Heart Defects. 

Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Left untreated, preeclampsia can lead to serious, even fatal, complications for both mother and baby. 

Complications include:

·       Intrauterine growth restriction (link to SGA/IUGR) 

·       Preterm birth

·       Placental abruption

·       HELLP syndrome (which stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count — syndrome)) is a more severe form of preeclampsia, and can rapidly become life-threatening for both mother and baby

• Eclampsia. When preeclampsia isn't controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. It is very difficult to predict which patients will have preeclampsia that is severe enough to result in eclampsia.
• Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on the severity of preeclampsia.
• Cardiovascular disease. Having preeclampsia may increase the risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater for women who have had preeclampsia more than once or have had a preterm delivery. 

* See Mayo Clinic_Preeclampsia for more information.

Example Consortium Partner publications focused on preeclampsia include: 

1. Hamad R, Collin DF, Baer RJ, Jelliffe-Pawlowski LL. Association of Revised WIC Food Package With Perinatal and Birth Outcomes: A Quasi-Experimental Study. JAMA Pediatr. 2019 Jul 1. 
2. Ross KM, Baer RJ, Ryckman K, Feuer SK, Bandoli G, Chambers C, Flowers E, Liang L, Oltman S, Dunkel Schetter C, Jelliffe-Pawlowski L. Second trimester inflammatory and metabolic markers in women delivering preterm with and without preeclampsia. J Perinatol. 2019 Feb;39(2):314-320.
3. Ross KM, Dunkel Schetter C, McLemore MR, Chambers BD, Paynter RA, Baer R, Feuer SK, Flowers E, Karasek D, Pantell M, Prather AA, Ryckman K, Jelliffe-Pawlowski L. Socioeconomic Status, Preeclampsia Risk and Gestational Length in Black and White Women. J Racial Ethn Health Disparities. 2019 Dec;6(6):1182-1191.
4. Jelliffe-Pawlowski LL, Rand L, Bedell B, Baer RJ, Oltman SP, Norton ME, Shaw GM, Stevenson DK, Murray JC, Ryckman KK. Prediction of preterm birth with and without preeclampsia using mid-pregnancy immune and growth-related molecular factors and maternal characteristics. J Perinatol. 2018 Aug;38(8):963-972.

Pregnancy factors that contribute to preeclampsia are studied as part of several consortium studies including as part of the HOPE COVID-19 study and other ongoing studies including CPPOP, PROMPT, and Cancer and Pregnancy Outcomes.

The placenta is an organ that develops in the uterus during pregnancy. It provides oxygen and nutrients to the growing baby and removes waste products from the baby's blood. The placenta attaches to the wall of the uterus, and the baby's umbilical cord arises from it. 

Problems with the placenta can be dangerous for mother or baby. During pregnancy, possible placental problems include placental abruption, placenta previa and placenta accreta. These conditions can cause potentially heavy vaginal bleeding. 

• Placental abruption. If the placenta peels away from the inner wall of the uterus before delivery — either partially or completely — a condition known as placental abruption develops. This can deprive the baby of oxygen and nutrients and cause a pregnant person to bleed heavily. Placenta abruption could result in an emergency situation requiring early delivery. 
• Placenta previa. This condition occurs when the placenta partially or totally covers the cervix — the outlet for the uterus. Placenta previa is more common early in pregnancy and might resolve as the uterus grows. Placenta previa can cause severe vaginal bleeding during pregnancy or delivery. The management of this condition depends on the amount of bleeding, whether the bleeding stops, how far along the pregnancy is, the position of the placenta, and the mother and baby's health. 
• Placenta accreta. Typically, the placenta detaches from the uterine wall after childbirth. With placenta accreta, part or all of the placenta remains firmly attached to the uterus. This condition occurs when the blood vessels and other parts of the placenta grow too deeply into the uterine wall. This can cause severe blood loss during delivery. In aggressive cases, the placenta invades the muscles of the uterus or grows through the uterine wall. 

* See Mayo Clinic_Placenta for more information.

Example Consortium Partner publications focused on placental abnormalities include: 

1. Beckert RH, Baer RJ, Anderson JG, Jelliffe-Pawlowski LL, Rogers EE. Maternal anemia and pregnancy outcomes: a population-based study. J Perinatol. 2019 Jul;39(7):911-919.
2. Lyell DJ, Faucett AM, Baer RJ, Blumenfeld YJ, Druzin ML, El-Sayed YY, Shaw GM, Currier RJ, Jelliffe-Pawlowski LL. Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol. 2015 Aug;35(8):570-4. 
3. Blumenfeld YJ, Baer RJ, Druzin ML, El-Sayed YY, Lyell DJ, Faucett AM, Shaw GM, Currier RJ, Jelliffe-Pawlowski LL. Association between maternal characteristics, abnormal serum aneuploidy analytes, and placental abruption. Am J Obstet Gynecol. 2014 Aug;211(2):144.e1-9.

Pregnancy factors that contribute to placental abnormalties are studied as part of several consortium studies including as part of the HOPE COVID-19 study and other ongoing studies including CPPOP and Cancer and Pregnancy Outcomes.

Infant death is when an infant dies in the first year of life. The leading causes of infant death in the US are birth defects, preterm birth and low birth weight, and maternal pregnancy complications. 

* See CDC_Infant Mortality for more information.

Example Consortium Partner publications focused on infant mortality include: 

1. Oltman SP, Rogers EE, Baer RJ, Anderson JG, Steurer MA, Pantell MS, Partridge JC, Rand L, Ryckman KK, Jelliffe-Pawlowski LL. Initial Metabolic Profiles Are Associated with 7-Day Survival among Infants Born at 22-25 Weeks of Gestation. J Pediatr. 2018 Jul;198:194-200.e3.
2. Anderson JG, Rogers EE, Baer RJ, Oltman SP, Paynter R, Partridge JC, Rand L, Jelliffe-Pawlowski LL, Steurer MA. Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study. Neonatology. 2018;113(1):44-54.
3. Steurer MA, Anderson J, Baer RJ, Oltman S, Franck LS, Kuppermann M, Rand L, Ryckman KK, Partridge JC, Jelliffe-Pawlowski LL, Rogers EE. Dynamic outcome prediction in a socio-demographically diverse population-based cohort of extremely preterm neonates. J Perinatol. 2017 Jun;37(6):709-715.
4. Anderson JG, Baer RJ, Partridge JC, Kuppermann M, Franck LS, Rand L, Jelliffe-Pawlowski LL, Rogers EE. Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study. Pediatrics. 2016 Jul;138(1). pii: e20154434.

Pregnancy and infant factors that contribute to infant mortality are studied as part of several consortium studies including as part of the HOPE COVID-19 study and as part of other ongoing studies including CPPOP, PROMPT, Cancer and Pregnancy Outcomes, Geographic Patterning of Birth Outcomes, and Social Determinants of Heart Defects.

Preterm babies may have more health problems (morbidities) or need to stay in the hospital longer than babies born on time. Some of the problems a preterm baby develops can cause long-term health impacts. Impacts are sometimes observed with respect to: 

• Brain function and Neurodevelopment  -  Premature birth can lead to long-term intellectual and developmental disabilities for babies. These difficulties can cause a person to have trouble or delays in physical development, learning, communicating with others, getting along with others, and taking care of him/herself;
  • Some long-term cognitive disabilities caused by premature birth include: 
    •  Behavior problems, including attention deficit hyperactivity disorder (also called ADHD) and anxiety;
    • Neurological disorders, like cerebral palsy, that affect the brain, spinal cord and nerves throughout the body;
• Lung function -  Preterm birth can lead to both short- and long-term difficulties with breathing and lung function. This includes an increased liklihood of being diagnosed with bronchopulmonary dysplasia (also called BPD). This is a chronic lung disease that causes the lungs to grow abnormally or to be inflamed. Over time, the lungs usually get better, but a premature baby may have anthma or asthma-like symptoms (e.g. difficulty getting enough air, wheezing) throughout his/her life;
• Intestinal problems - Preterm birth can also cause difficulties with intestinal function. A disease that sometimes affects babies born preterm is called necrotizing enterocolitis (also called NEC). This disease affects a baby’s intestines. Intestines help your body break down (digest) food. While most babies with NEC get better, some may have intestinal problems later in life. For example, scarring may cause the intestine to become blocked. And some babies who’ve had surgery to remove part of the intestine may have trouble later getting nutrients from food;
• Vision problems - Children born prematurely are more likely than children born on time to have vision problems. This may include retinopathy of prematurity (ROP) which can cuase blindess.

* See March of Dimes_Preterm Birth for more information.

Example Consortium Partner publications focused on complications related to prematurity include: 

1. Anderson JG, Rogers EE, Baer RJ, Oltman SP, Paynter R, Partridge JC, Rand L, Jelliffe-Pawlowski LL, Steurer MA. Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study. Neonatology. 2018;113(1):44-54.
2. Steurer MA, Anderson J, Baer RJ, Oltman S, Franck LS, Kuppermann M, Rand L, Ryckman KK, Partridge JC, Jelliffe-Pawlowski LL, Rogers EE. Dynamic outcome prediction in a socio-demographically diverse population-based cohort of extremely preterm neonates. J Perinatol. 2017 Jun;37(6):709-715. 
3. Sylvester KG, Kastenberg ZJ, Moss RL, Enns GM, Cowan TM, Shaw GM, Stevenson DK, Sinclair TJ, Scharfe C, Ryckman KK, Jelliffe-Pawlowski LL. Acylcarnitine Profiles Reflect Metabolic Vulnerability for Necrotizing Enterocolitis in Newborns Born Premature. J Pediatr. 2017 Feb;181:80-85.e1.
4. Anderson JG, Baer RJ, Partridge JC, Kuppermann M, Franck LS, Rand L, Jelliffe-Pawlowski LL, Rogers EE. Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study. Pediatrics. 2016 Jul;138(1). pii: e20154434.

Pregnancy and infant factors that lead to complications of prematurity are studied as part of several consortium studies including as part of the HOPE COVID-19 study and as part of other ongoing studies including CPPOP, PROMPT, Cancer and Pregnancy Outcomes, and Geographic Patterning of Birth Outcomes.

Chromosomal and Structural birth defects are health conditions that are present at birth. They result from genetic abnormalities and from abnormalities in fetal development.

Birth defects can cause problems in overall health including in how the body develops or how the body works. Common chromosomal birth defects include trisomy 21 (Down syndrome) which results from three copies of chromosome 21, trisomy 18 (Edward syndrome) which results from three copies of chromosome 18, and trimsomy 13 (Patau sundrome) which results from three copies of chromosome 13. Common structural defects include cleft lip and cleft palate, spina bifida, and heart defects. 

* See March of Dimes_Birth Defects for more information.

Example Consortium Partner publications focused on chromosomal and structural birth defects include: 

1. Steurer MA, Peyvandi S, Baer RJ, Oltman SP, Chambers CD, Norton ME, Ryckman KK, Moon-Grady AJ, Keller RL, Shiboski SC, Jelliffe-Pawlowski LL. Impaired Fetal  Environment and Gestational Age: What Is Driving Mortality in Neonates With Critical Congenital Heart Disease? J Am Heart Assoc. 2019 Nov 19;8(22):e013194. 
2. Strouse J, Donovan BM, Fatima M, Fernandez-Ruiz R, Baer RJ, Nidey N, Forbess C, Bandoli G, Paynter R, Parikh N, Jeliffe-Pawlowski L, Ryckman KK, Singh N. Impact of autoimmune rheumatic diseases on birth outcomes: a population-based study. RMD Open. 2019 Apr 14;5(1):e000878.
3. Baer RJ, Chambers CD, Ryckman KK, Oltman SP, Rand L, Jelliffe-Pawlowski LL. High risk of spontaneous preterm birth among infants with gastroschisis. Am J Med Genet A. 2019 Jan;179(1):37-42. 
4. Peyvandi S, Baer RJ, Moon-Grady AJ, Oltman SP, Chambers CD, Norton ME, Rajagopal S, Ryckman KK, Jelliffe-Pawlowski LL, Steurer MA. Socioeconomic Mediators of Racial and Ethnic Disparities in Congenital Heart Disease Outcomes:  A Population-Based Study in California. J Am Heart Assoc. 2018 Oct 16;7(20):e010342. 
5. Steurer MA, Baer RJ, Burke E, Peyvandi S, Oltman S, Chambers CD, Norton ME, Rand L, Rajagopal S, Ryckman KK, Feuer SK, Liang L, Paynter RA, McCarthy M, Moon-Grady AJ, Keller RL, Jelliffe-Pawlowski LL. Effect of Fetal Growth on 1-Year Mortality in Neonates With Critical Congenital Heart Disease. J Am Heart Assoc. 2018 Sep 4;7(17):e009693.

Pregnancy factors that contribute to placental abnormalties are studied as part of several consortium studies including as part of the HOPE COVID-19 study and other ongoing studies including CPPOP, Cancer and Pregnancy Outcomes, and Social Determinants of Heart Defects.