Maternal-Fetal Medicien and Reproductive Genetics
MATERNAL-FETAL MEDICINE
AND REPRODUCTIVE GENETICS
Louise Wilkins-Haug, MD, PhD, Director
DIVISION MEMBERS
David Acker, MD
Daniela Carusi, MD
Karen M. Davidson, MD
Lisa Dunn-Albanese, MD
Katherine Economy, MD, MPH
Mehmet Genc, MD, PhD
Thomas McElrath, MD, PhD
Rosemary E. Reiss, MD
Julian Robinson, MD
Thomas Shipp, MD
Joaquin Santolaya, MD, PhD
Ruth E. Tuomala, MD
Katherine Bennett, RN
Virginia Silva, RN
Maureen Fagan, RN
Barbara Ludman, RN, FNP
Karen McCarthy, RN
Fellows
Alison Stuebe, MD
Deidre McCullough, MD
Alison Cape, MD
Corrina Oxford, MD
Mission
The Division strives to provide quality obstetrical care to high-risk patients, contribute substantially to the knowledge base of the discipline and train leaders in the field of maternal-fetal medicine and reproductive genetics.
We are dedicated to the care of women who require evaluation, treatment or hospitalization for a wide range of pregnancy complications. Physicians across New England transfer almost 300 women yearly for antepartum hospitalization, delivery and postpartum care. Over 2,000 patients are referred annually for ambulatory consultation while off-site consultative sessions bring ultrasound and perinatal care to patients in their communities. We provide clinicians and researchers an opportunity to explore translation of genetic advances into patient care. Clinical subdivisions include the Faculty Ambulatory Obstetrics Practice, the Center for Fetal Medicine and the Center for Labor and Birth. The diversity of interests and skills within the Division reflects the complexity of our patients’ needs.
ACCOMPLISHMENTS IN AY 2007-2008
CLINICAL HIGHLIGHTS
§ An ultrasound unit on Labor and Delivery under Drs. Rosemary Reiss and Louise Wilkins-Haug completed its first year. Ultrasound services at the site of high risk maternal care assures patient safety and facilitates education and consistent documentation.
§ Under Drs. David Acker, Julian Robinson, and Kathy Economy, a multidisciplinary, comprehensive service for parents of multifetal pregnancies, a subgroup with a particularly high risk for adverse outcome, entered its fourth year. Initiated in the first trimester when possible, consultation, co-management or transfer can facilitate the care of monochorionic pregnancies at increased risk for discordant congenital anomalies, growth aberrancies and preterm labor. A program for twin-to-twin transfusion will be in operation in the fall of 2008.
§ Drs. Dunn-Albanese, Economy, Reiss and Genc provided, under Dr. Karen Davidson, ultrasound and consultative services at NSMC, Emerson and Exeter Hospitals and genetic counseling and co-management of patients who will deliver at BWH.
§ Under Dr. Julian Robinson, the consultative program at Newton-Wellesley Hospital completed its fifth year. Dr. Dunn-Albanese will join the NWH/MFM team, providing ultrasound and consultation three days a week.
§ Multi-departmental subspecialty sessions expanded, focusing on cervical incompetence (Dr. Tom McElrath), diabetes in pregnancy (Dr. Ruth Tuomala), and maternal cardiac disease (Dr. Katherine Economy). Dr. Dani Carusi continues to build an infrastructure of physicians, interventional radiology and support systems to manage complicated deliveries with abnormal placentation.
RESEARCH HIGHLIGHTS
· Under Dr. McElrath, MFM entered the second half of a large research initiative, POPPS (Prediction of Preeclampsia in Pregnancy Study) to assess specific maternal serum markers at four points in pregnancy. Prediction or early detection will set the groundwork for understanding the biologic variability of preeclampsia and potential interventions. A cohort of 2000 women with normal and adverse pregnancy outcomes will be recruited.
· Dr. Mehmet Genc continued investigating the role of placental microRNA expression in pre-eclampsia with Expanding the Boundaries support. He was co-organizer of the international Symposium of Cervical and Vaginal Ecology: Impact on Health and Reproduction held in Sweden.
· Dr. Antonio (Tony) Borrell, a world leader in first trimester ultrasound assessment, contributed his expertise while spending a year sabbatical with us.
· Dr Alison Stuebe was recognized for outstanding presentation by a fellow by the Society of Gynecologic Investigation.
§ Dr. McElrath completed his fifth year as a Women’s Reproductive Health Research Career Development Fellow with research on inflammatory changes and pregnancy outcomes. He transitioned to a faculty appointment and is Director of Labor and Delivery Research.
· Drs. Wilkins-Haug and McElrath continue to work closely with the Center for Gender Based Biology to facilitate interdepartmental research activities, many focused on sex differences in cardiovascular disease in women.
TEACHING HIGHLIGHTS
· Drs. Nicole Smith and Chloe Zera were accepted as fellows in July 2008. Expansion of the fellowship allows further development of MFM critical care and provides earlier experience in outpatient care and mentored research. Dr. Deidre McCullough transitions to her third year and will research risk factors for preeclampsia in HIV infected women. Dr. Alison Stuebe completed her third year and her Master of Public Health degree. She accepted a faculty position at the University of North Carolina where she will continue her research on maternal factors that impact long-term health.
· Our members presented at national and international meetings, postgraduate courses, regional CME forums and within the Harvard system.
GOALS FOR AY 2008-2009
· Further development of maternal critical care and a high acuity postpartum service, with recruitment of faculty and emphasis on coordination of multidisciplinary services for management of complex cases.
· Development of Life Codes, a research infrastructure, is paramount; allocation of resources, development of clinical and specimen databases and accessing funding are on-going. Exploration of underlying genetic mechanisms for adverse events and the role of genetic variation and epigenetics in outcomes remains a unifying focus.