Stanford Named a New NIH Maternal Health Research Center of Excellence

The Department of Obstetrics and Gynecology at Stanford University was selected as an NIH Maternal Health Research Center of Excellence (U54) for our proposal Stanford PRIHSM (PReventing Inequities in Hemorrhage-related Severe Maternal morbidity). The program, which resides under the Dunlevie Maternal-Fetal Medicine Center for Discovery, Innovation, and Clinical Impact, is led by Yasser El-Sayed, MD, and Suzan Carmichael, PhD, with project leadership by Deirdre Lyell, MD, and Elliott Main, MD. The program also includes investigators from multiple Stanford University departments and institutes in collaboration with community, academic, and state partners, and is supported with funding of $14 million total over 7 years. Stanford is one of ten centers selected through a competitive peer review process.

The team is looking forward to working with NICHD and the NIH IMPROVE initiative to help reduce one of the leading causes of maternal morbidity and severe maternal morbidity: postpartum hemorrhage. A leading cause of maternal death and several maternal morbidity, postpartum hemorrhage disproportionately affects socially marginalized groups.

The goal of PRIHSM is to reduce postpartum hemorrhage by reducing and addressing disparities in precursors to postpartum hemorrhage-related severe maternal morbidity and mortality: iron deficiency anemia and cesarean-section births.

• Iron deficiency anemia affects approximately 16% of pregnancies in the U.S. with rates 3-4x higher among Black people and 1.5-2x higher among Latinx people compared to the rest of the population. This translates to higher rates of postpartum hemorrhage-related severe maternal morbidity.
• Almost 1 in 3 U.S. births are by cesarean delivery, rates vary 10-fold across hospitals, and Black and Asian individuals have the highest prevalence of cesarean section among low-risk pregnancies. While cesarean section can be a lifesaving intervention when appropriate, it is associated with significant risks, including postpartum hemorrhage.

The team has a bold yet achievable agenda that will address these disparities. Our first aim is to reduce antenatal iron deficiency anemia by developing, implementing, and disseminating a patient-informed Anemia Prevention Toolkit. This toolkit will standardize the evaluation, diagnosis, and treatment of iron deficiency anemia as well as reduce the prevalence of iron deficiency anemia and racial/ethnic disparities in iron deficiency anemia at birth admission and postpartum hemorrhage-associated severe maternal morbidity.

Our second aim is to reduce disparities in rates of primary cesarean birth and cesarean-linked postpartum hemorrhage by conducting a mixed methods study to understand drivers of hospital-level disparities in these outcomes, and implementing a patient-informed Maternal Equity Guide. The work will involve community-university partnerships focused on improving maternal health equity and be driven by perspectives of patients, providers, and healthcare leadership. The team will provide training opportunities to build research and clinical expertise relevant to postpartum hemorrhage, especially among individuals who represent diverse perspectives and experiences within academic and community-based settings, and underserved areas.

“We are committed to being leaders in reducing maternal health inequities through our Center’s research projects and training initiatives, and through deepening ties to our local, regional, and national communities,” says El-Sayed.