Effect of Iatrogenic Delivery at 34-38 Weeks on Pregnancy Outcome

Around 25% of all deliveries result from a clinical decision rather than the spontaneous onset of labor, including labor induction and prelabor cesarean delivery. While there are severe problems that require immediate delivery, e.g., severe preeclampsia, many of the indications for intervention are subtle and allow for a lot of discretion in whether or when interventions are performed. This is particularly true in the late preterm/early term period of 34-38 weeks' gestation. To assess the impact of interventional delivery on the health of the mother and infant, we identified the three primary indications for early delivery: hypertensive disorders, diabetic disorders, and fetal growth restriction. We abstracted ~12,000 records to obtain detailed information on clinical indications bearing on delivery. We will be analyzing the data using propensity scores to assess the independent effect of interventional delivery on maternal
health (cesarean delivery, duration of hospital stay) and infant health (NICU admission, respiratory conditions, duration of hospital stay). Primary Investigator: David Savitz, Ph.D.

Fetal and Infant Response to SRI Treatment

Approximately 600,000 infants born each year are exposed to maternal depression. At least 30% of those infants will also be exposed to psychotropic medication. Fetal exposure during pregnancy to maternal depression and the medications to treat the disorder have been associated with neurobehavioral differences in infants. It has been suggested that these differences are transient and it is not known if they are related to the mother's depression or the medication used to treat the depression. The F.I.R.S.T. is studying the clinical course of newborns' symptoms directly after birth and for the infants' first 30 days after birth. Fetal neurobehavior measures are obtained by ultrasound and fetal heart rate evaluation at 28-30 and 32-34 weeks gestational age. After delivery, we observe the infants motor patterns, reflexes, behavior, sleep, and attention. Primary Investigator: Amy Salisbury PhD. 

Of Mice and Methylation

Psychotropic drugs (SRIs) are often used to treat maternal depression during depression. These drugs can affect the infant and perhaps have negative long-term consequences. Translational research is often used to study mechanisms that cannot be studies in humans. In this study we are developing a mouse model of prenatal SSRI exposure to compare with human infant data to study epigenetic mechanisms that may be responsible for the effects of these drugs on newborn neurobehavior. Primary Investigators: Kevin Bath PhD, Barry Lester PhD.