Why Federally Funded Research Is Important to Maternal-Fetal Medicine

By Kristen A. Cagino, MD

As physicians, we recognize that medical practice is built on a foundation of research. Discovering new therapies, navigating a global pandemic, and identifying the safest, evidence-based management strategy for complex conditions all rely on rigorous, well-designed studies with comprehensive data collection and analysis.  

We are indebted to the physicians and scientists who carry out this essential work, and we also acknowledge the critical role of federally funded grants in making it happen. Financial support from federally funded grants provides us with the research staff, equipment, and technology necessary to conduct large-scale studies across multiple institutions with the potential to demonstrate a clinically meaningful impact. At an institutional level, the financial resources, staffing, and study size are often inadequate. Without federally funded support, the advancement of medical knowledge—and our ability to deliver informed, effective patient care— simply would not be possible.  

The Value of MFM Research Hits Home - A Personal Story 

I was a second-year Ob/Gyn resident when I got the call from my older sister. She was pregnant with her first child and had just undergone her mid-pregnancy fetal anatomy ultrasound. I’ll never forget the sadness and fear in her voice. Her baby had been diagnosed with spina bifida, a congenital condition that occurs when the spinal cord does not close completely. Left unprotected by the usual bony vertebrae and skin, the spinal cord is vulnerable to injury from the surrounding amniotic fluid. The long-term health challenges of spina bifida can include paralysis, bowel and bladder dysfunction, excess fluid in the brain (hydrocephalus) requiring shunting, and developmental delay. 

Historically, the standard treatment for spina bifida consisted of surgically repairing the defect after birth (postnatal). However, in 2011, a landmark trial changed that approach. The Management of Myelomeningocele (MOMS) trial, supported by the National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health (NIH), compared the outcomes of prenatal repair— surgery before birth and while the baby is still in the womb—with those of postnatal repair (after birth). Closing the spinal defect prenatally has the potential to limit injury to the exposed spinal cord and improve newborn outcomes. The MOMS trial results were truly groundbreaking. Prenatal repair significantly reduced the need for brain shunting and improved motor function, giving children a better chance of walking. 

Thanks to this research, prenatal repair of spina bifida became a standard treatment option, and I was able to refer my sister to a fetal center where the surgery was performed. At the time, as a young Ob/Gyn resident, fetal surgery for spina bifida felt rare and novel. Now, as a graduating MFM fellow in a busy high-risk pregnancy center, I see the surgery offered on a regular basis. Yet it continues to fascinate me. Even more powerful are the moments when families return to introduce us to their thriving children — walking, growing, and defying the odds. As both a sister and an MFM physician, I am deeply grateful for the research and medical advancements that made these moments possible. 

The CHAP Trial Impact on Treating Chronic Hypertension in Pregnancy 

Chronic hypertension affects up to 2% of pregnancies. Among these, 20% to 50% will go on to develop preeclampsia, a serious hypertensive disorder that can lead to organ damage, particularly involving the kidneys, liver, and brain. Preeclampsia remains one of the leading causes of maternal morbidity and mortality worldwide. Careful management of chronic hypertension is critical to reducing the risk of progression to preeclampsia.  

During my training, I witnessed a significant evolution in the approach to managing blood pressure in pregnant patients with preexisting chronic hypertension. Historically, we often deferred treatment until the blood pressure reached severe levels due to concerns that lowering blood pressure too early might compromise blood flow to the fetus and restrict fetal growth. However, delaying treatment increases the risk of maternal complications, including the development of preeclampsia. Balancing maternal and fetal risks is one of the most complex challenges we face as MFM physicians. Fortunately, emerging research funded by the federal government has provided clearer guidance to help optimize outcomes for both mother and baby. 

A pivotal advancement came in 2022 with the publication of the Chronic Hypertension and Pregnancy (CHAP) trial, a research study funded by NIH’s National Heart, Lung, and Blood Institute. This randomized controlled study evaluated the effects of starting antihypertensive medication to achieve a lower blood pressure (<140/90 mm Hg) compared to withholding medication until blood pressure became severe (>160/105 mm Hg).  

Investigators found that using medications to maintain blood pressure at less than 140/90 mm Hg resulted in a lower risk of one or more outcomes: preeclampsia, medically indicated preterm birth at less than 35 weeks, placental abruption (early separation of the placenta from the uterus), or fetal or newborn death. Importantly, the study also found no increase in the incidence of low birthweight infants.  

The CHAP trial has fundamentally changed the standard of care for chronic hypertension in pregnancy. Its findings continue to shape clinical practice and improve maternal and infant outcomes. 

Optimizing Preterm Newborn Outcomes Thanks to the BEAM Trial and the Mercer Protocol 

Preterm birth, defined as delivery before 37 weeks, affects approximately 10% of all pregnancies and remains a common and significant obstetric complication. Among the many concerns associated with early preterm birth is the risk of neurodevelopmental impairment, specifically cerebral palsy.  

The Beneficial Effects of Antenatal Magnesium Sulfate (BEAM) trial, published in 2008 and supported by research grants from NIH’s NICHD and the National Institute of Neurological Disorders and Stroke, introduced a critically needed intervention to reduce the risk of cerebral palsy in extremely preterm infants born before 32 weeks. In this randomized controlled trial, pregnant women at risk of delivering between 24 and 31 weeks were given either magnesium sulfate or a placebo prior to delivery. Infants were then followed until the age of two. The study found a significant reduction in the incidence of moderate to severe cerebral palsy among those who received magnesium sulfate, establishing it as a cornerstone therapy in the management of early preterm birth. 

Another landmark trial, published in 1997 and supported by NICHD, led to what is now commonly known as the Mercer protocol, which remains the standard antibiotic regimen for preterm premature rupture of membranes (PPROM). This trial evaluated pregnant women who experienced membrane rupture between 24 and 32 weeks of gestation, assigning them to receive either a course of antibiotics or a placebo. The underlying hypothesis was that intrauterine infection could trigger membrane rupture and subsequently preterm labor, and that antibiotic treatment might reduce the risk of preterm labor in those who experienced membrane rupture. The trial results demonstrated not only an increased duration of pregnancy in those treated with antibiotics but also a significant reduction in neonatal complications (including fetal or infant death, respiratory distress, intracranial hemorrhage, or infection). 

For decades, the findings from the BEAM trial and the Mercer protocol have guided preterm birth management. Magnesium sulfate administration for delivery before 32 weeks and antibiotic therapy for PPROM before 34 weeks have become essential standards of care. These two interventions represent some of the most impactful strategies we have available to optimize newborn outcomes related to preterm birth.  

Supporting Federal Funded Research Is Vital to MFM 

Through my personal experience and training, I’ve witnessed firsthand how research and clinical trials directly shape the care I provide to my patients each day. These studies, among many others, collectively form the foundation of evidence-based management for the complex conditions we routinely encounter in maternal-fetal medicine.  

Calling federally funded research “necessary” doesn’t capture its full importance—it is vital. The health of mothers and babies depends on it, and without such research, our ability to deliver the highest standard of care would be compromised.  

Kristen A. Cagino, MD, is a third-year MFM fellow at the University of Texas, Houston.  

Read SMFM’s recent Position Statement: Prioritizing and investing in pregnancy research.