UH scientists labor to prevent preterm birth
They form a sisterhood of scientists, 13 researchers, clinicians, technicians, students and nurses. Whether signing on for a single semester or a career, they collectively focus creative energies and painstaking efforts, determined to understand a health problem of particular interest to women—preterm birth.
Solving this riddle (and this team has made significant headway) is no small matter. Insurance companies and health management organizations could realize millions of dollars in savings. Fewer children born prior to 37 weeks gestation would mean fewer children suffering long-term health problems and fewer families enduring the psycho-social hardships that accompany raising such children.
Presiding over this effort is Gillian Bryant-Greenwood. The British-trained molecular endocrinologist is a professor of cell and molecular biology and director of one of the 10 programs operating under the University of Hawai'i at Manoa's Pacific Biomedical Research Center (PBRC). Her lab examines samples of fetal membranes from women who give birth prematurely at Kapi'olani Medical Center for Women and Children.
Thirty years ago, such research was unheard of. “We believed that if we understood what goes on in animals, we would understand what is happening in humans,” Bryant-Greenwood says. “We now know that it's very, very different.” For one thing, no animals adequately mimic human gestation. Also, spontaneous preterm birth is unusual, even unknown, in non-human species. The reasons are unclear—it could be because of our upright posture, which imposes a great mechanical challenge on the embryonic sac—but the reality is that preterm birth occurs in 11 percent of all pregnancies, and the rate is rising in the United States in spite of the emphasis on making prenatal care available to more women.
Bryant-Greenwood's group has determined that relaxin is a prime suspect in preterm birth. Relaxin, one of many hormones involved in childbirth, relaxes the pelvic ligaments and causes cervical dilation, essential events as a woman's body prepares for birth. Because it is expressed in the cellular lining of the fetal membrane, relaxin can cause the extremely thin layers of the lining to rupture, sometimes weeks too soon for a fetus.
When that happens before 26 weeks gestation, surviving infants spend more than four months in neonatal intensive care units at an average cost of $250,000, according to an article in the New England Journal of Medicine last August. The article, “Extremely Preterm Birth—Defining the Limits of Hope” describes a study that tracked more than 300 such babies born in the United Kingdom and Ireland. Nearly half of the babies suffered some type of disability by the time they were toddlers, and hyperactivity, learning disabilities and motor difficulties sometimes don't surface until age 5. The disabilities shown by 23 percent of the toddlers included general slowness in mental growth, seizures and difficulty walking or sitting. Other problems included impaired sight, hearing, communication and motor skills. A quarter of the children in the study suffered severe disabilities such as paralysis and blindness.
The risk of preterm delivery is higher in unmarried women in low-income and poor-education stratums. These are women most likely to experience inadequate prenatal care, poor nutrition, untreated illnesses and infections. Black women, more than those in any other racial group, are more likely to suffer premature deliveries. Bryant-Greenwood says these demographics make funding a challenge.
“Women have not lobbied for it, not the way they have for breast cancer research,” Bryant-Greenwood explains. “Preterm birth disproportionately affects women in lower economic groups, not the high-society ladies who get out there and talk or write letters to their congressmen.”
Bryant-Greenwood, right, has found an ally in another woman—Lynnae Millar, associate professor in the UH medical school's Department of Obstetrics and Gynecology and the department's director of research. Seven years ago, Millar joined Bryant-Greenwood in investigating preterm birth.
“She approached me because she wanted to collaborate with a clinician,” Millar says. “She wanted to make her research more clinically relevant, in particular working on the etiology of preterm birth.” Despite mandates by the National Institutes of Health to promote women's and children's health issues, research efforts still lag in those areas. Critics suggest that drug companies focus on problems affecting groups who can afford to pay for medication and that the still male-dominated world of research is slow to respond to what is perceived as women's health issues. “More public awareness would help,” says Millar. “There is a paucity of well-trained investigators active in this type of research.”
That could change as more young people gain the kind of education and experience that comes from working in Bryant-Greenwood's lab and pursue research careers. She sees a key part of her role as nurturing young talent, so Bryant-Greenwood takes time from conducting and reporting on research to compose grant requests. Grants pay researchers, undergraduates and other staff members and cover the $75,000-per-year cost of lab supplies, repairs and maintenance. Some faculty members and technicians are funded wholly or in part by the Minority Access to Research Careers and Research Centers in Minority Institutions programs of the National Institutes of Health. Bryant-Greenwood has received federal support from the National Institute of Child Health and Human Development for the past 28 years, and she and her colleagues also receive funds from PBRC, Kapi'olani Health Research Institute and the Clinical Research Center, a joint program of UH and Kapi'olani Medical Center for Women and Children.
She also encourages members of her team pursue their own grants. “I want them to become independent of me while contributing to the group as a whole,” Bryant-Greenwood says. The more investigators there are pursuing health research, the better the chance of solving important health problems. Such as the riddle of preterm birth.