March of Dimes has selected Penn Medicine to be the home of its inaugural March of Dimes Research Center for Advancing Maternal Health Equity.
The new center launched in January 2023 under the leadership of Dr. Elizabeth A. Howell, chair of the Department of Obstetrics and Gynecology in the Perelman School of Medicine, will centralize, coordinate and expand the work Penn is already doing to address poor health outcomes and longstanding racial disparities in obstetrics care. It will also aim to bridge gaps between the evidence base and implementation in patient care.
"The United States has one of the largest racial and ethnic disparities in pregnancy-related morbidity and mortality. Black, indigenous and other people of color die at a rate two to three times higher than white patients. In Philadelphia, 80 percent of maternal mortalities were among those patient populations. Many of those mortalities involve several social or structural barriers that may have been drivers," says Sindhu K. Srinivas, MD, MSCE, who will help lead the center. "The Research Center for Advancing Maternal Health Equity will develop and test innovative strategies to improve equity in maternal health, then scale and disseminate those strategies throughout Philadelphia and beyond."
According to Elizabeth A. Howell, MD, MPP, there is growing recognition that structural racism, poor maternal health and socio-economic status contribute to this problem. "This center will examine what we can we do to address these systemic inequities. What are the data-driven policies that can really help interrupt the perpetuation of these disparities over generations?" she says. "This significant public health crisis impacts not just mother and baby, but the entire family and the community. This gap is unacceptable, and we really want to give every opportunity to every family to have a healthy start."
The Research Center for Advancing Maternal Health Equity will establish an infrastructure to support cutting-edge interdisciplinary research. It will also establish internal and external partnerships, including:
- Another successful partnership between the March of Dimes and Penn: March of Dimes Prematurity Research Center, one of only six internationally
- Children's Hospital of Philadelphia
- Community advisory board to help the center plan research and interventions that will be effective in the populations of interest
- Community-based organizations that focus on maternal health in Philadelphia and beyond
- Historically Black Colleges and Universities, Tribal Colleges and Universities and Hispanic-Serving Institutions
- Multiple schools and departments at Penn Medicine, including all disciplines that touch women's health, epidemiology and biostatistics and informatics
- Payers
- Philadelphia and Pennsylvania departments of health
The center's research agenda will aim to:
- Characterize and understand how racial disparities correlate to maternal health outcomes
- Identify new ways to detect morbidities
- Leverage technology to increase access to care and promote early intervention
The center will strive to create a competitive funding mechanism to fund pilot programs to research these innovative ways to protect maternal health.
Importantly, the Research Center for Advancing Maternal Health Equity will help take research findings and implement actionable, proven solutions to improve maternal health equity. For example:
PeliCaN: Post-partum Care in the NICU (PeliCaN) is a pilot study led by Heather Burris, MD, MPH, to explore feasibility of a novel model of doula-coordinated, midwife-delivered postpartum care in the neonatal intensive care unit.
VIBE study: The research explores the postpartum experience during the COVID-19 pandemic and how stress affects postpartum health, with a focus on blood pressure trajectories. The study population is women of color at four hospitals in New York and Philadelphia.
Doula care delivery: This project is developing and evaluating a way to make doulas an integral member of the care team for birthing people. Penn is partnering with CocoLife Foundation and will begin stakeholder interviews of patients, physicians, nurses, and community doulas.
Cardiovascular Risk: Implementation and Evaluation of a Perinatal CV Risk-Assessment Algorithm to Improve Maternal and Infant Health During Pregnancy, Peri and Postpartum: IMPACT P3, led by Lisa D. Levine, MD, MSCE, and Abike James, MD, MSCE, is one of several nationwide projects funded by the American Heart Association as part of its Health Equity Research Network on Disparities in Maternal-Infant Health Outcomes, a $20 million program with the goal of improving heart health, particularly around women of color. This project aims to explore factors involved in the disproportionate number of pregnancy complications and deaths among Black and Native American pregnant people by integrating a tool to identify cardiovascular risk factors among pregnant and postpartum patients. Cardiovascular disease is a leading contributor to maternal mortality in the United States, particularly among patients of color. The risk-assessment tool seeks to standardize the way healthcare providers assess and evaluate risk, identify bias and prevent cardiovascular deaths.
Labor induction at home: Dr. Levine is the principal investigator on a five-year, $2.5 million R01 from the National Institute of Child Health and Human Development. The study is examining feasibility, safety and outcomes when starting labor induction at home rather than the hospital. The researchers have enrolled 2,300 full-term, first-time mothers and randomized them. They will explore C-section rates, maternal safety, neonatal safety, infection rates, length of time in hospital, patient satisfaction, labor agency score, bleeding and more. Learn more about Dr. Levine's work in the Penn Maternal Fetal Medicine Program and the Penn Pregnancy and Heart Disease Program.
HeartSafe Motherood: Penn's HeartSafe Motherhood program uses technology to monitor postpartum blood pressure without office visits. The program, developed by Dr. Srinivas and Adi Hirshberg, MD, helps mothers, especially those at risk for skipping postpartum care, identify this health risk early to protect their health. The program is now extending beyond Penn and has been selected by the U.S. Department of Health and Human Services (HHS) Office on Women's Health (OWH) Racial Equity in Postpartum Care Challenge.