A doctor talks to a patient who is pregnant.

RESEARCH FEATURE

Moms helping moms through research

June 30, 2023

When Jasmin Eralte first became pregnant 12 years ago, she enrolled in a study for first-time moms. She wanted to contribute to its goal of helping researchers identify factors that may increase risks for pregnancy complications.

The timing was just right. Eralte, a New York City nurse, had noticed a decrease in women giving natural births without having significant problems. This introduced a series of “what if” scenarios for her first pregnancy. She also knew that obesity, which she had, created an increased risk. These are among many reasons she joined the NIH-supported Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), which she figured would support her chances of having the best outcome.

Eralte had her baby, who today is a healthy tween. Yet, her pregnancy experience included scary twists and turns.

First, she developed high blood pressure. Then, her cervix thinned prematurely, raising her risk of miscarriage. After that, she experienced preeclampsia, a sudden rise in blood pressure that occurs after 20 weeks of pregnancy. Next, she went into labor early, requiring her baby to be treated in the neonatal intensive care unit. “It was a rollercoaster,” she recalled.

All this occurred after Eralte followed the doctor’s orders. She ate a healthy diet, exercised, and stayed on top of her medical appointments. The only thing she couldn’t follow was strict bedrest.

The bumpy ride didn’t end there. In the years following, Eralte gave birth four more times and her pregnancy challenges were nearly identical. These experiences, she said, gave her an even greater appreciation for this research. “These are things that I think women can look back on and say, oh this is something that was studied for years and this could possibly be happening to me,” she said. Ultimately, she hopes the research enables more women to have full-term pregnancies.

Other moms have shared similar hopes. The nuMoM2b study started in 2010 and followed more than 10,000 first-time moms throughout their pregnancy.

More than 6,000 participants also enrolled in a follow-up study called the nuMoM2b Heart Health Study, which has already found that certain pregnancy complications have been associated with increased risks for heart disease, such as developing high blood pressure, years after pregnancy. Using additional data collected throughout the study, researchers are also tracking how pregnancy-related issues may affect changes in cognitive health and overlap with future risks for stroke and dementia.

The study occurs at a time when about one in 10 people who are pregnant experience complications related to having high blood pressure. Other research has found these types of problems are associated with a 63% increased risk of future cardiovascular events, such as a heart attack or stroke. It’s why certain pregnancy complications are now considered independent risk factors for heart disease.

Precious Veriguette, who also lives in New York City, enrolled in the nuMoM2b study 10 years ago when she was pregnant with her oldest daughter. However, she had a miscarriage before she joined the study, which she notes is one reason why she’s interested in following the ongoing research.

It wasn’t until she completed follow-up questionnaires, which asked about her physical and emotional health, that she thought about what happened earlier in her life — after the miscarriage and throughout her two healthy pregnancies. “It brings the memories back,” she said.

It's now easy for Veriguette to see that she had symptoms of postpartum depression after the miscarriage. Veriguette also become aware of how her experiences during her second pregnancy, including having borderline high levels of blood sugar and blood pressure, may affect her current health. She’s already taking steps to reduce her risk for diabetes as well as high blood pressure, which runs in her family.

She’s been watching something else, too: Her brain health. Researchers working with another study, nuMoM2b-Brain, are using information collected from the nuMoM2b Heart Health Study to follow the cognitive health of participants like Veriguette. This includes looking at feedback from self-reported surveys, medical samples, and brain-imaging exams, such as the MRI Veriguette had, to assess the health of blood vessels in the brain and changes in memory.

The goal, similar to the heart-health study, is to identify potential risks for chronic conditions, including vascular dementia, but earlier in life.

“The fact that these are all aspects being looked into, and at different levels, is exciting,” Veriguette said. She’s curious to see how it may influence the steps she’s already taking to support her long-term health. After all, she said, “I have two kids I need to think about and take care of.”

Noelia M. Zork, M.D., a maternal-fetal medicine specialist and researcher at Columbia University Irving Medical Center, understands the challenges that new moms face, including squeezing in time to support their health and the health of their families.

Finding ways to support women, especially during one of the most critical points of their life, is why Zork enrolled in the nuMoM2b study when she was pregnant with her oldest child. She also wanted to understand her own health better.

Zork didn’t experience pregnancy complications, but she was at risk for having gestational diabetes. Since type 2 diabetes runs in her family, she wasn’t surprised. Through diet and exercise, she kept her blood sugar levels in a healthy range.

Throughout the nuMoM2b Heart Health Study, she’s tracked other health metrics. At one point, she kept a sleep diary and wrote down when she went to bed and woke up every day. After seeing that she needed more sleep, she created a strict bedtime. “Making sure I got adequate amounts of sleep has been one of the benefits of this study,” she said.

The study’s focus on following changes in women’s cardiovascular health after pregnancy, however, may offer one of the biggest benefits, Zork said, as the findings could shape how she and other physicians practice medicine in the future. “Cardiovascular disease is the number one killer of women,” she noted. “If there’s anything we can do during pregnancy to prevent long-term complications for women, then that’s key.”

To aggregate and distill findings from this ongoing research, nuMoM2b Heart Health Study investigators are forging scientific partnerships with others working throughout NIH, academia, and in medical industries. Their goal is to find better ways to screen, detect, and mitigate risks for pregnancy complications and chronic disease.

“We know getting healthy before pregnancy is important,” said Victoria Pemberton, R.N.C., a program officer at NHLBI. The challenge, she explained, is finding ways to help people figure out how best to do that. That’s where these types of studies, supported by thousands of women, can make a difference.

“The study’s success comes from moms helping other moms,” she added. “Without participants, we wouldn’t have findings to share to help other women before, during, and after pregnancy.”