Georgia CTSA CPTR Graduate Wins NIH Challenge by Exploring Social Determinants of Health in Maternal Mortality and Morbidity

smiling pregnant woman

“If we want different results, we need to do things differently. When researchers deeply connect with the communities we are serving and bring everyone to the table, then we have an opportunity to make a significant impact,” says Dr. Nicole Carlson.

As a double award winner for innovation and addressing health disparities in NIH’s Decoding Maternal Morbidity Data Challenge, Nicole Carlson, PhD, CNM, Assistant Professor, Emory University’s School of Nursing, and Georgia Clinical & Translational Science Alliance (Georgia CTSA) Certificate Program in Translational Research (CPTR) graduate, was eager to analyze the National Institute of Child Health and Human Development’s (NICHD) data set to identify risk factors for first-time pregnancies.

“Being a nurse-midwife researcher, I have questions about how the maternal environment – prior to pregnancy, prenatally, and during labor – affects birth outcomes. It was exciting to find a publicly-available data set with rich information on pregnancy, labor, and birth,” explains Dr. Carlson.

In addition to receiving an award for developing an innovative method to analyze the data to identify risk factors in first-time pregnancies, Dr. Carlson received a prize for accurately flagging cases that were high-risk for complications by exploring social determinants of health.

The data set was created by NICHD of moms-to-be across the US who were having their first baby. Data were included from the sixth week of pregnancy through birth. NICHD reported that the methods used by the winning teams can be used to analyze additional pregnancy data with the ‘potential to make a real difference and save lives.’

“Over the past several years, Georgia has been last or in the bottom five states for maternal morbidity and mortality. The US consistently ranks last among other industrialized countries. It is utterly unacceptable that we have a country with the type of output in terms of the money that we spend on our healthcare system and yet our statistics remain dismal. Being a native Georgian and working as a nurse-midwife researcher in Georgia, I feel doing this work is very important not only for people across the country but especially for people in our state,” comments Dr. Carlson.

“In my previous research, I focused on unplanned cesarean birth, as this outcome increases risk for maternal morbidity/mortality. Again and again, I saw a relationship between obesity and having an unplanned cesarean delivery in my analyses. Then I looked at race and ethnicity. After I adjusted for the influence of every factor affecting the labor process and pregnancy, including maternal obesity, I found that Black participants in my studies were two times more likely to end their labor with an unplanned cesarean delivery. I realized something else is happening besides obesity that is causing Black pregnant people to have worse outcomes.”

After reaching out to a Black colleague who is also researching maternal mortality, Dr. Alexis Dunn-Amore, Dr. Carlson remarks, “We discussed health equity and the realities of living in the US as a Black woman in terms of stress, and how systemic racism affects the social determinants of health. I realized that what was missing in my research to understand poor labor outcomes was systemic racism and the social determinants of health. When our team incorporated these factors, we found evidence that the intersectional experiences of pregnant people affected their labor and birth outcomes, including their risk of maternal morbidity.”

“No matter what type of provider, whether obstetrician, family practice, or nurse-midwife, when you are caring for a pregnant person, your care has to target systemic racism and the social determinants of health if you are going to make a difference for better outcomes. This information can help transform care by providers partnering with their patients during the prenatal phase, providing them with social support, and better linkages to resources they need. This research also helps us understand how we can transform care by addressing systemic racism in our healthcare systems.”

In August 2021, Dr. Carlson also received an R01 award, ‘Biologic Mechanisms of Labor Dysfunction: A Systems Biology Approach.’ The grant provides funding for five years to investigate how the social determinants of health affect the metabolism and labor outcomes of Black pregnant people. Informed by a community advisory board of Black and Latinx women, this study will also examine if pregnancy care in a freestanding birth center compared to a hospital changes the pregnancy experience, maternal metabolism, or labor outcomes.  

Dr. Carlson credits the Georgia CTSA Certificate Program in Translational Research program with helping to prepare her for her work on this recent R01 award, “Several parts of the CPTR program were invaluable, such as learning how to conduct community-based participatory research. Research investigators partner with community partners to design the study and disseminate the results, so the research project is better able to make a true difference.”

“The CPTR program has helped me expand my network outside the School of Nursing. Now, I collaborate with people across Emory and our partner universities with specific knowledge they can bring to the study – from designing the study to helping with the interpretation.”

“While the CPTR program provides excellent grant writing support, their talented team also helps researchers in putting together an independent research project, defining the scope, structuring the research question, determining the size of the budget, and identifying co-investigators to assist with the study,” adds Dr. Carlson.

The Certificate Program in Translational Research (CPTR) is a formal 16-credit Emory Laney Graduate School program for trainees who seek to conduct research at the interface between basic and translational science and clinical medicine. The CPTR enhances and transforms translational research training for predoctoral PhD and PharmD students, postdoctoral fellows, and junior faculty at Emory, MSM, Georgia Tech, and UGA College of Pharmacy. Applications for the upcoming cycle are due April 29, 2022.

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The Georgia CTSA is a statewide partnership between Emory, MSM, Georgia Tech, and UGA and is one of over 60 in a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) and the National Institutes of Health's Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.