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Cynthia Gyamfi-Bannerman, MD, MSc
Ellen Jacobson Levine and Eugene Jacobson Professor of OBGYN
Principal Investigator, MFMU Network—Columbia
Co-Director, Preterm Birth Prevention Center
• Unrestricted grant from SMFM/AMAG for prematurity research
• Attended NY Sera Advisory Board Meeting
• Obstetrical management, especially for high-risk patient, had often adopted practices without objective evaluation
• To address the need for well-designed clinical trials in maternal fetal medicine, the NICHD established the MFMU Network in 1986
• The MFMU Network conducts clinical studies to improve maternal, fetal and neonatal health with greatest priority given to randomized trials
• The aim is to: – Reduce morbidity to mom and baby, related to
preterm birth, fetal growth abnormalities & maternal complications
– Provide rationale for evidence-based, cost-effective, obstetric practice
Brown University
Case Western Reserve University
Columbia University
Northwestern University
The Ohio State University
University of Alabama — Birmingham
University of North Carolina — Chapel Hill
University of Pennsylvania
University of Pittsburgh
University of Utah
University of Texas — Galveston
University of Texas — Houston
Brown University
Case Western Reserve University
Columbia University
Northwestern University
The Ohio State University
University of Alabama — Birmingham
University of North Carolina — Chapel Hill
University of Pennsylvania
University of Pittsburgh
University of Utah
University of Texas — Galveston
University of Texas — Houston
Dwight Rouse
Edward Chien
Cynthia Gyamfi-Bannerman
Bill Grobman
Mark Landon
Alan Tita
John Thorpe
Sam Perry
Hy Simhan
Michael Varner
George Saade
Suneet Chauhan
• Centers participate collaboratively in common protocols
• Racial/ethnic, geographic diversity
• Conducts mainly randomized trials, but also observational studies
• Co-funding by other NIH institutes
• Complex studies- require IND/IDE/multidisciplinary
• Only Federally funded obstetric research network
RFA ISSUED EVERY FIVE YEARS
• Academic productivity - clinical trials
• Minimum of 3,000 deliveries per year with a minimum of 30% documented to be high-risk pregnancies
• 4 board-certified MFMs with clinical, academic, administrative and research commitments
• Available population for clinical studies
• Facilities and clinical capabilities• Follow-up Program up to 5 years of age-
Neonatology/Pediatric subspecialists• Imaging and assessment techniques,
proteomics, genomics, microanalysis, placental function assessment, clinical pharmacology
• Perinatal data system• Departmental and institutional commitment• Acceptance of budgetary mechanism
Steering Committee Center PIs
Data Coordinating Center PINICHD Project Scientist
Data Coordinating
Center
NICHD
Advisory BoardMFM
NeonatologyBiostatistics
Ad hoc
Data & Safety Monitoring Committee
MFM EthicsNeonatology Biostatistics
Obstetrics Lay person
• Principal Investigator (PI)
• Alternate PI
• Other investigators
• Research nurse coordinator
• Research nurses / staff
• Data entry clerk Academic
MFMcenters
• Columbia Center:
– Columbia and Allen
– Christiana
– Drexel
– St. Peter’s
– NY Hospital Queens
• Columbia Center staff:
– PI: Gyamfi
– Alt PI: Wapner
– Nurse Coordinator: Bousleiman
– PI and site coordinator for each of the 5 sites
Cynthia Gyamfi-Bannerman, MD
Principal Investigator
Ronald Wapner, MD
Alternate Principal Investigator
MFM Faculty/Study
Site PI - CUMC
Lauren Plante, MD
Site PI - Drexel
Cheryl Tocci
Site Coordinator- Drexel
MFMU Research Staff
Matthew Hoffman, MD
Site PI - CCHS
Carrie Kitto
Site Coordinator-CCHS
MFMU Research Staff
Kristy Palomares, MD
Site PI- SPUH
Shoan Davis
Site Coordinator- SPUH
MFMU Research Staff
Daniel Skupski, MD
Site PI- NYPQ
Rosalyn Chan-
Site Coordinator – NYPQ
MFMU Research Staff
Michelle DiVito
Administrative Director of Research
Sabine Bousleiman
MFMU Nurse Coordinator
Mary Talucci
QA Coordinator
Vilmarie Carmona
Site Coordinator- CUMC
MFMU –Research Staff
Dark color-Recruitment periodLight color-Follow-up period
36 RCTs
23 Observational studies
12 Major Ancillary Studies
• 340 MFMU Publications to date
• 15 MFMU Publications in 2018
• 19 NEJM
• 92 OBGYN
• 120 AJOG
• 34 AJP
• Concept
– 2/3 vote to be approved to move to next step
• Mini-protocol
– Simple majority to move to next step
• Full protocol
– Simple majority to move to next step
• External Advisory Board Review
• Prioritization
• Prevent Congenital Cytomegalovirus Infection
(CMV)– In follow-up phase
• Hepatitis C Virus Child to Mother Transmission
(HCV)
• Pessary and Progesterone for Preterm Prevention in
Twin Gestation with a Short Cervix (PROSPECT)
• Pessary in Singleton Pregnancies with a Short Cervix (TOPS)
• ALPS pulmonary follow-up in offspring– Co-funded by NHLBI (Dr. Aruna Natarajan)
• ALPS neurologic follow-up in offspring
• Sleep Apnea Treatment in Pregnancy to Reduce Frequency of Hypertensive Disorders of Pregnancy– Co-funded by NHLBI (Dr. Aaron Laposky)
• Tranexamic Acid for the Prevention of Obstetrical Hemorrhage after Cesarean Delivery
• Beneficial Effects of Antenatal Magnesium Sulfate (BEAM)• Beneficial Effects of Antenatal Corticosteroid Regimens (BEARS)• Cesarean Section and Vaginal Birth After Cesarean Section Registry• Mid-Trimester Endovaginal Sonography in Women at High Risk for
Spontaneous Preterm Delivery• Observational Study of Women with Factor V Leiden Mutation in
Pregnancy• High-Dose Aspirin to Prevent Preeclampsia in High-Risk Women• Low-Dose Aspirin as a Preventative of Preeclampsia• Obstetrical Determinants of Neonatal Survival Registry• Screening for Risk Factors for Spontaneous Preterm Delivery in
Singletons and Twins• 17-OHPC for Prevention of Preterm Birth in Multifetal Gestation
• Contact the Biostatistical Coordinating Center
– PI is Elizabeth Thom, PhD
• Request access to data
• Can also request access to biospecimens
• GDM F/u study– Both women and children
• Short cervix and nulliparous women
• CAPPS
• BEAM (Beneficial Effects of Mag Sulfate)
• BEARS (Beneficial Effects of Antenatal Repeat Steroids)
• STTARS—17-OHPC for twins and triplets
• Omega 3
• Factor V Leiden
• Progesterone (Meis)
Global Alliance to Prevent Prematurity and Stillbirth
• $20 million program funded by the Bill & Melinda Gates Foundation
• Global
• Preventing Preterm Birth (PPB)
– PPB 1: FINDING NEW SOLUTIONS (TRANSLATIONAL)
– PPB 2: INTERNATIONAL RESEARCH SITES
– PPB 3: SYSTEMS BIOLOGY APPROACH
Prematurity Research Centers (6)
• Stanford
• University of Pennsylvania
• Ohio Collaborative
• Washington University in St. Louis
• U. Chicago/Northwestern/Duke
• Imperial College London
MOD Database for Preterm Birth Research
• contains information from 15 molecular studies, with aggregated genetic data from almost 25,000 patients, and molecular measurements on more than 8,000 samples
• Announced last month
• http://www.immport.org/resources/mod
Cynthia Gyamfi-Bannerman, MD, MSc
Ellen Jacobson Levine and Eugene Jacobson Professor of OBGYN
Principal Investigator, MFMU Network—Columbia
Co-Director, Preterm Birth Prevention Center
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