Preterm birth
Preterm birth is an important health concern in this country, as it is in industrialized nations around the world. In Canada, preterm birth (before 37 completed weeks of pregnancy) accounts for about 80% of all infant mortality in the period just before or after birth.
There's even more concern in Alberta, which has the highest rate of preterm birth in the country: more than 9% of live births. While many of these babies do well, preterm birth is associated with developmental disorders, respiratory issues, learning difficulties, and behavioural problems.
The Preterm Birth and Healthy Outcomes team focuses on preterm birth in three areas: prediction of who is at risk for preterm birth; prevention of preterm birth; and interventions to improve outcomes for preterm babies. The team is composed of 20 researchers from 13 disciplines, and is led by Dr. David Olson from the University of Alberta and Dr. Suzanne Tough from the University of Calgary.
"We hypothesize that preterm birth is a complex interplay between environment, genetic disposition, fetal factors, and the context within which women live," says Dr. Tough, a Heritage Population Health Investigator. "There's no single factor that would allow us to point to someone and say, ‘You're the one who will deliver preterm.' Given all these different types of factors, it makes sense to approach the problem of preterm birth from many angles. That's how we've structured our team."
The team is a collaboration between basic scientists and population researchers: The basic scientists work in areas such as genetics, behavioural neuroscience, and immunology. The population researchers conduct community-based research on the influences of a wide range of socio-economic factors. They will follow one group of 1,000 pregnant women to investigate how they obtain prenatal services; for the major study of prenatal care in Calgary, they will draw their data from another group of 1,200 women. The will investigate the benefits of delivering prenatal care and education to groups of women at the same stage of pregnancy. Previous work by Dr. Tough has shown that women who are least likely to receive adequate prenatal care are those who are isolated as a consequence of poverty, poor social support, and poor mental health.
"We'll have this amazing database on many, many aspects of women's lives. It will help us understand who is at greater risk for preterm birth," adds Dr. Tough. "The beauty of the team-grant funding is that it will allow for additional data to be collected from the women in this trial, which is supported by the Calgary Health Region."
The potential of the new database has led to some exciting new collaborations. For example, Dr. Inge Christiaens, a Ph.D. student working under the supervision of team co-leader Dr. David Olson at the University of Alberta, has begun to work with Heritage Scholar and team member Dr. Gerlinde Metz from the Canadian Centre for Behavioural Neuroscience at the University of Lethbridge. Dr. Christiaens is studying the role stress plays in preterm birth; Dr. Metz has developed an animal model of stress-induced preterm labour. "We're very fortunate to have Dr. Metz join our team, because it adds a new dimension to our research," notes Dr. Olson. "We'll be able to test insights from our work with patients in her model, and vice versa."
Another advantage of the team approach is the way it introduces new expertise into Alberta. The preterm-birth team includes a group of scientists from Toronto and from Perth, Australia, who are specialists in identifying specific patterns of RNA (ribonucleic acid) called RNA signatures. This group has had particular success identifying an RNA signature for women who are in true preterm labour as opposed to threatened preterm labour ("false alarm"), a common cause of hospitalization.
"We want to see if they can get RNA signatures from non-symptomatic women, whose pregnancies are ticking along just fine," says Dr. Olson. "The idea is that we may be able to predict who is at risk for preterm birth from the RNA signature. If this is possible, we would then watch these women more closely and manage them better to reduce risk.
"Whatever the project, our goal is to improve the health outcomes for pregnant women. I'm confident that at the end of five years, we'll be better able to predict which women are at greater risk for preterm labour. We will have developed more sophisticated interventions to help prevent preterm birth and to sustain pregnancy. And for those children who are born preterm despite our best efforts, we will have interventions that parents can use to ensure better outcomes.
"Beyond what our team will accomplish, we'll have established a legacy in the form of a data repository that will have health records and other linked records on a very large cohort of women and their babies. This will be an enormous research resource for years to come. Another key piece of infrastructure that we will set up is a biobank of DNA and reproductive tissue, which will allow [future] researchers to obtain cells and study something that we might not recognize as being of significance today."
And when those researchers look at the data or study the samples, Dr. Tough hopes they will also be working as part of a team. "Science is changing. While there's still a great deal that can be accomplished by individuals working on individual projects, we desperately need people who can work in teams to tackle the more complicated questions. It's not easy; it requires a higher level of collaboration, and you have to learn how to do it. We hope to inspire our next generation of researchers to work in this way, to be able to take the results of research to their community of stakeholders-whether they are other scientists, policy-makers, or health professionals. We want them to make a difference."