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NYU Langone Health’s institute receives US$12.5m in funding to address maternal mortality crisis

In 2021, Black pregnant women in the US died at a rate 2.6 times higher than their white counterparts, research shows

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NYU Langone Health’s Institute for Excellence in Health Equity has received US$12.5m for new digital intervention to address the “growing” maternal mortality crisis. 

The maternal mortality rate in the US, which has doubled in the past 20 years, is higher than in any other industrialised nation.

At least half of these deaths are preventable, and many are driven by systemic racism and social determinants of health such as poor access to quality and culturally appropriate care; gaps in insurance coverage before pregnancy; food insecurity, housing, and others, researchers say.

In 2021, Black pregnant women died at a rate 2.6 times higher than their white counterparts. Although Hispanic women experience relatively lower maternal mortality, this rate has jumped sharply in recent years, particularly during the pandemic.

To reverse this alarming trend, the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health (NIH), created in 2021 the Maternal Health Community Implementation Project (MHCIP).

MHCIP aims to engage communities to implement interventions targeted at poor maternal outcomes such as hypertension, obesity and gestational diabetes in minoritised populations.

As part of the four coalitions supported by MHCIP, the Institute for Excellence in Health Equity was awarded US$12.5m over five years with Natasha Williams, associate professor in the department of population health, as principal investigator.

The programme will adapt and implement the Starting Early Program (StEP), an individual and group-based supportive nutrition and lifestyle counselling programme for pregnant women.

According to the Institute for Excellence in Health Equity, Williams will lead adaptation of StEP to meet the needs of diverse patient populations and to facilitate implementation in low-income practices that serve minoritised populations.

The newly adapted programme, called JustMothers, will be delivered digitally by community health workers using culturally relevant text messaging and video links. Community health workers are lay members of a community, who have similar ethnicity, language, socioeconomic status, and/or life experiences with the people they serve.

Williams said: “We are excited and honoured to offer this first-of-its kind digital intervention to Black and Hispanic pregnant women in New York City, where there is a high burden of maternal health inequities.

“This research programme enables us to move beyond descriptive accounts of health inequities, by implementing practical, and sustainable solutions to address the crisis of maternal morbidity.

“We are deeply appreciative to our community partners and people with lived experience who will play a critical role in not just our ability to engage with pregnant persons, but also in building lasting community engagement networks to achieve health equity.

“This grant will contribute to NYU Langone’s efforts to promote maternal health equity and health justice.”

The research team will evaluate adoption and dissemination of JustMothers across NYC Health + Hospitals, the largest municipal health system in the country, and the Family Health Centers at NYU Langone in Sunset Park and Flatbush in Brooklyn, New York.

Isaac Dapkins, chief medical officer of the Family Health Centers at NYU Langone, said: “The Family Health Centers at NYU Langone has a longstanding commitment to providing comprehensive women’s health services in Brooklyn.

“This proposal builds on that commitment to offer enhanced services to the pregnant people receiving care in Sunset Park, Brooklyn.”

Wendy Wilcox, chief women’s health officer at NYC Health + Hospitals, said: “Addressing social determinants of health, such as food insecurity and unstable housing, is an essential part of addressing social justice and advancing the health equity of our pregnant and postpartum patients.

“Nutrition is medicine, as it can help manage or even reverse chronic conditions like high blood pressure and diabetes. We are proud to serve all New Yorkers, and we look forward to partnering with NYU Langone Health on this important study.”

This first year of the award is dedicated to building the infrastructure to support the research. The investigators are planning to enrol 900 pregnant women, with the enrolment set to start by December.

Menopause

High street bakery chain Gail’s reveals menopause plan

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Gail’s has unveiled a menopause action plan offering new workplace support to thousands of staff ahead of legal reforms due in 2027.

The high street bakery chain will offer new benefits including 24/7 digital GP access and a new employee assistance programme, according to The Times.

It will also explore new online training for staff, including specific training for management.

Gail’s people director Miranda Burgum told The Times: “All we’re trying to do is talk freely and for it not to be a forbidden subject. It’s helping our managers and teams understand that this isn’t a taboo.”

“We’re going to develop the education with our managers, so it will be threaded through all our policies

“It will look at induction training, it will look at the types of people we need to make sure that we make reasonable adjustments for.

“And if somebody needs some sort of risk assessment, we’re going to be looking at [that].”

The move comes ahead of reforms due to be introduced in spring 2027 under the Employment Rights Act.

UK employers with 250 or more employees will be legally required to publish and update official menopause action plans.

The plans are intended to support employers to take effective action to improve workplace gender equality and support employees experiencing menopause.

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Fertility

Paracetamol use may impact future fertility, studies suggest

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Paracetamol use in pregnancy was not linked to autism or ADHD, while separate research found reproductive differences in girls exposed before birth.

One study analysed health records from more than 120,000 children and found no increased risk of autism following prenatal paracetamol exposure.

A separate analysis of nearly 100,000 children also found no increased risk of ADHD among those born to mothers who used the painkiller during pregnancy.

Researchers from the Hong Kong Hospital Authority examined electronic health records covering pregnancies between January 2001 and December 2023.

The autism analysis included 124,333 children, who were nine years old on average and split almost evenly between males and females. There were 3,445 autism diagnoses, representing 2.8 per cent of the group.

The ADHD analysis involved 97,285 children, who were seven years old on average and also split evenly between males and females. There were 5,168 ADHD diagnoses, representing 5.3 per cent.

Women prescribed paracetamol during pregnancy were more likely to be older and have pre-existing conditions including psychiatric disorders, as well as reasons for taking the drug such as infection, fever or chronic pain.

No association was found between prenatal paracetamol exposure and either autism or ADHD.

The findings did not differ according to the trimester in which paracetamol was taken or whether use was intermittent or daily. Advanced maternal age, defined as pregnancy in women over 35, did not alter the findings.

The researchers wrote: “Paracetamol remains a safe and essential analgesic [pain reliever] and antipyretic [fever reducer] during pregnancy, whereas alternatives, such as NSAIDs and opioids carry well-documented risks.

“Unwarranted reluctance to use paracetamol could lead to undertreatment of pain and fever, or the use of more harmful alternatives, both posing risks to the pregnancy and developing fetus.”

The authors said women should assess paracetamol use with guidance from their doctor.

A separate study involving 685 pregnant women without pre-existing conditions and 302 infant daughters found associations between prenatal paracetamol exposure and differences in reproductive organs and hormone levels.

Researchers from Copenhagen University Hospital enrolled the women during their first trimester and assessed them during the first trimester, third trimester and again when their babies were three months old.

At around three months, infants experience a temporary rise in reproductive hormones sometimes called mini-puberty.

Pregnant participants completed questionnaires every two weeks about their use of pain medicines including paracetamol. Infant girls underwent ultrasound scans of their reproductive organs and blood tests to measure hormone levels.

Researchers also examined a separate group of 1,210 girls followed from infancy to adolescence whose mothers reported paracetamol use during the third trimester.

Three-month-old girls exposed to paracetamol before birth had an average 40 per cent smaller ovarian volume, 13 per cent smaller uterine volume and 23 per cent fewer ovarian follicles.

Girls exposed during the first trimester also had lower levels of Anti-Müllerian hormone, a marker of ovarian function.

Among the older girls, those exposed before birth were more likely to have smaller uteruses at puberty and smaller ovaries during their teenage years.

Dr Margit Bistrup Fischer, lead study author and postdoctoral researcher in the Department of Growth and Reproduction at Rigshospitalet hospital in Denmark, said: “Animal studies have demonstrated that impaired formation of ovarian follicles can lead to reduced fertility and earlier reproductive aging.

“Whether the differences observed in our study have implications for fertility and age at menopause in humans remains unknown and will require long-term follow-up of the girls in our cohort.”

She cautioned that women who had used paracetamol during pregnancy “should not be alarmed by our findings”, as the study found associations rather than direct causation and outcomes for individual women and children are unclear.

“Importantly, our study does not evaluate whether [acetaminophen] causes reproductive problems, nor does it provide evidence that prenatal exposure affects future fertility or age at menopause,” she said.

“Although we observed similar associations in an independent cohort, long-term follow-up is needed to determine whether these early-life differences have any clinical significance later in life.”

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Insight

Research uncovers potential new target for breast cancer therapy

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Targeting CD1d altered immune cells slowed tumour growth and improved immunotherapy responses in mouse models of breast cancer, researchers found.

The findings suggest blocking the molecule could make the environment around breast tumours more favourable to anti-cancer immune responses.

Further work is needed to understand how these immune changes occur and how the approach could be safely used in patients.

Researchers from King’s College London, the Francis Crick Institute and University College London investigated how immune cells inside breast tumours influence cancer growth.

They focused on myeloid cells, a group of immune cells found in large numbers within tumours that can either support an immune attack against cancer or contribute to tumour growth and immune evasion.

The team examined CD1d, a molecule found on the surface of myeloid and other immune and tissue cells that helps regulate immune responses.

When CD1d was genetically removed from cells in a mouse model of breast cancer, the mice were more resistant to tumour growth. Researchers also saw changes in myeloid cell populations, including increased activity among cells that can help attack cancer.

The team then blocked CD1d using an antibody and again observed changes in myeloid cells and slower tumour growth. Blocking CD1d also improved responses to immunotherapy in the mouse model.

Researchers used single-cell RNA sequencing, a technique that examines gene activity in individual cells, to investigate the immune changes in more detail.

They identified a population of myeloid cells called monocytes that expressed genes associated with inflammation, an important part of the immune response. These cells were particularly important in restricting tumour growth in the mouse models.

A similar pattern of gene activity was identified in data from human breast cancer tumours. Its presence in myeloid cells was associated with positive responses to immunotherapy in breast cancer patients.

However, the findings in people were based on gene expression data and did not test CD1d-targeting treatment in patients.

Professor Patricia Barral, professor of immunobiology at King’s College London and senior author of the study, said: “Many breast cancers do not respond well to current immunotherapies.

“Our findings reveal a previously unrecognised mechanism by which immune cells within tumours are regulated.

“While CD1d is best known for helping immune cells recognise lipid molecules, we found that it also plays a role in shaping the behaviour of myeloid cells within tumours.

“These findings suggest that targeting the immune cells that surround and support tumours could boost anti-cancer immunity and potentially improve treatment responses in the future.”

Researchers now plan to investigate how the immune changes occur and how they can be safely harnessed in patients.

They also want to examine whether targeting CD1d could enhance existing treatments and influence treatment responses in different cancer types.

The work was supported by UKRI BBSRC, Breast Cancer Now and the Cancer Research UK City of London Centre.

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