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Table 2 Abnormal Gestational Biology

From: Global report on preterm birth and stillbirth (7 of 7): mobilizing resources to accelerate innovative solutions (Global Action Agenda)

Overarching Goal: To understand the mechanisms contributing to preterm birth and stillbirth, with emphasis upon infectious, genetic, and environmental factors, abnormal placental vascular development, and early gestational events
  Milestones*  
Output Post-Conference (by 2010) Short-Term (by 2012) Intermediate (by 2015) Long-Term (beyond 2015) Success Metrics
A. Determine causes and differential susceptibility to infection, and maternalrfetal immune response associated with PTB and SB utilizing high-dimensional systems biology approaches 1. Identify existing cohorts to characterize the pregnancy "biome" 2. Treat existing known infectious causes of PTB/SB
2. Establish cohort to characterize pregnancy "biome"
3. Characterize human vaginal microbiome
5. Identify polymorphisms and immunoregulatory genes associated with PTB/SB
6. Utilize systems biology to identify non-invasive biomarkers for PTB/SB
7. Study vaginal and cervical mucosal immunity and the biology of the microbial flora
8. Validate models to assess intervention strategies
9. Study short-and long-term conseguences of inflammation on fetal origin of adult disease and neurodevelopmental outcome
• Cost-effective interventions to reduce morbidity/mortality associated with inflammation- induced prematurity
B. Determine causes of vascular mal-adaptation resulting in abnormal uteroplacental perfusion, fetal growth restriction and abruption associated PTB and SB utilizing high-dimensional systems biology approaches 1. Increase grant RFAs by national and international research funding agencies 2. Study origins of spiral artery adaptation
3. Study genetic and environmental influences on vasculopathy
4. Develop models for vascular pathology, including endometrial modifications
5. Develop cost-effective interventions to promote normal placentation 6. Study short-and long-term conseguences on fetal origin of adult disease and neurodevelopmental outcomes • Cost-effective interventions to reduce morbidity/mortality associated with vascular associated prematurity linked to abnormal uteroplacental vasculature
C. Determine if preconceptual and/or antenatal micronutrient exposure contributes to PTB/SB 1. Systematic review of available evidence 2. Cohort studies to confirm associations 3. RCTs of micronutrient support or environmental modification
4. Assess translational feasibility
5. Specific trials for LMICs • Identification of cost-effective micronutrient interventions to reduce PTB/SB
  1. *Milestones are to be reached by no later than December of the year indicated.
A GLOBAL ACTION AGENDA ON PRETERM BIRTH AND STILLBIRTH