Preeclampsia and MicroRNAs

Preeclampsia is a critical gestational condition that threatens the life of both mother and child. One of the most serious aspects of preeclampsia hampering both clinical management and scientific understanding is that there are, as yet, no early warning signs or risk markers. The discovery of microRNAs (miRNAs), tiny post-transcriptional regulators of gene expression, offers potentially fertile ground for developing such markers. The current state of knowledge about miRNAs in preeclampsia is presented along with information regarding miRNA detection in peripheral fluids that could lead to minimally invasive risk assessment

Division of Reproductive Science Research

The Division of Reproductive Science Research at the University of Iowa has a long tradition and was formally organized in 2009. Since then, the division has enjoyed extensive growth and development in many areas of reproductive research. Sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the NIH Office of Research on Women’s Health, a Women’s Reproductive Health Research Career Development Center, was established to train future physician-scientists. Further, to enhance our capability to perform translational research, the Women’s Health Tissue Repository was established. This robust bio-repository includes the Maternal Fetal Tissue Bank, the Paternal Contributions to Children’s Health Biobank, the Well Woman Bank, the Reproductive Endocrinology and Infertility Biobank, and the Gynecologic Malignancies Biobank. Together, these biobanks collect samples from all stages of women’s lives and have deep clinical annotations

Elevated Chemokine C-C motif ligand 2 (CCL2) early in pregnancy is associated with increased risk of preeclampsia in obese parturients

The objective of this study is to measure plasma CCl2 and leptin early in control and obese women and associate pregnancy outcomes with these levels. We hypothesize that early elevations of plasma CCL2 will be predictive of the development of poor pregnancy outcomes

Developing a program for residents to support training in research

Physicians are expected to be life-long learners and to assimilate and evaluate new knowledge gained from research. Many residencies also require completion of a scholarly project during their residency. However, the majority of residency training is dedicated to enhancing clinical knowledge base and skills. Because residents are quite busy clinically in residency, the research curriculum is designed to help divide the projects into manageable pieces to be accomplished each year. Research-centered education sessions and frequent feedback about their scholarly project progress help to bolster their research training. Overall, we find that a structured research curriculum results in generally positive perceptions of research and increases the ability of residents to successfully complete projects that are worthy of presentation at conferences as well as of publication

Recovery from cesarean delivery at UIHC: a comparison to Enhanced Recovery Protocols

Enhanced Recovery After Surgery programs (ERAS) have been used by some specialties for years, and are now becoming popular for gynecologic and obstetrics surgeries. ERAS programs consist of evidence-based interventions during a patient’s hospital stay that are intended to promote early return to activities such as eating, ambulation, and voiding and to manage pain. These programs reduce the risk of complications post-operatively and shorten a patient’s hospital stay. The University of Iowa Hospitals and Clinics (UIHC) is developing an ERAS protocol for cesarean deliveries. Our goal was to determine how current practices and outcomes for cesarean deliveries at UIHC compare to established ERAS programs. We also sought to identify which patients would be appropriate candidates for an ERAS protocol at UIHC

Simulation training in forceps assisted vaginal birth: trainee competence, clinical behavior and procedural competence

To determine whether simulation training in forceps assisted vaginal delivery affected: · The confidence of the trainee in offering and performing forceps assisted vaginal delivery before and after the intervention · The frequency with which forceps assisted vaginal delivery is offered to the parturient compared to vacuum assisted vaginal delivery

Evaluation of the VNTR region in the IDO promoter in women with preeclampsia

Indoleamine 2,3 – dioxygenase (IDO) is an enzyme that aids in immunosuppression and tolerance. Previous studies have shown decreased IDO activity in pregnancies affected by preeclampsia, but the mechanism for this altered activity is unknown. Our study was designed to analyze the promoter region of IDO in preeclamptic and control women and identify the frequency of a VNTR genotype that has been shown to be significantly correlated with tryptophan levels in women; a surrogate marker for IDO activity

Global fetal DNA methylation and birth outcomes in obese women

Pregnant women who are obese are more likely to have gestational diabetes, gestational hypertension, pre-eclampsia, macrosomia, operative vaginal delivery, and cesarean delivery. Obesity also has adverse implications for the neonate. Congenital anomalies are more common in children born to obese women. These include neural tube defects, gastroschisis, cardiovascular anomalies, and others. Although the connection between maternal obesity and chronic health conditions has been described, the mechanism by which this occurs is less well understood. Changes to the epigenetic structure of offspring DNA have been proposed as one such mechanism

Introducing e-consents in a clinical setting

Preeclampsia (PE) is a multiorgan hypertensive-disorder in pregnancy that causes significant maternal-fetal mortality and morbidity. The diagnostics and therapeutics for PE are limited due to its unclear etiology. Using the UI Maternal Fetal Tissue Bank, our lab has demonstrated that copeptin is robustly predictive of PE. To investigate copeptin further, we developed the Rule Out Pre-Eclampsia Study (ROPE). The ROPE study recruits women admitted to Labor and Delivery for evaluation of PE. Women are admitted for PE evaluation at all hours. Research team members are not available at all times to obtain consent which limits recruitment. Our project aimed to develop an electronic informed consent (e-IC) that is compliant with the Federal Regulation for Human Research Protection and is easy to use and readily understood by study participants. After obtaining IRB approval, simulated patients were given an iPad on which to read and evaluate the e-IC using a validated questionnaire, the Quality of Informed Consent (QuIC). Based on the QuIC, the e-IC was modified and re-tested. Participants demonstrated good comprehension of the e-IC as evidence by QuIC scores ranging from 61 to 96. Based on our results, the e-IC is an effective and efficient method for the Informed Consent process