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Obesity-Related Causes of Stillbirth Detailed in Pitt Analysis

PITTSBURGH, Aug. 26, 2015 – Obese women are nearly twice as likely as their lean counterparts to have stillborn babies for several specific, potentially preventable medical reasons, a new University of Pittsburgh Graduate School of Public Health analysis reveals.

Placental diseases and hypertension were the most common causes of stillbirth among obese women, according to the study, published online and scheduled for the October issue of the American Journal of Clinical Nutrition. The research was supported by the National Institutes of Health (NIH).

“We’ve known for some time that obese women are more likely to have stillbirths, but this is one of the first and most comprehensive efforts to figure out why,” said lead author Lisa Bodnar, Ph.D., M.P.H., R.D., associate professor in Pitt Public Health’s Department of Epidemiology. “Our hope is that this work can be used to better counsel women on the importance of a healthy pre-pregnancy weight and monitor them for complications during pregnancy that may threaten the survival of their fetuses.”

“This study also could be used to guide prevention efforts at a societal level,” she said. “If we can reduce pre-pregnancy obesity by even a small amount, through environmental or policy changes, we could significantly reduce the burden of stillbirth.”

Annually there are 3.2 million stillbirths worldwide and, of high-income countries, the U.S. is among those with the highest rates. Recent research shows that obesity is likely responsible for more stillbirths in high-income countries than other risk factors, such as smoking or advanced maternal age.

Dr. Bodnar and her colleagues examined records from 658 stillbirths that occurred between 2003 and 2010 at Magee-Womens Hospital of UPMC, which has one of the largest labor and delivery units in the country. Stillbirths were defined as cases where the baby had reached at least 16 weeks gestation and showed no evidence of life after delivery. A panel of obstetricians reviewed each case and assigned a cause of the stillbirth.

The mothers were classified as lean (normal weight or underweight), overweight, obese or severely obese based on their pre-pregnancy body mass index, a measure of weight versus height.

The rate of stillbirth per 1,000 births ranged from 7.7 for lean women to 17.3 for severely obese women.

Maternal hypertension – or high blood pressure in the mother; placental diseases or disorders where the placenta does not properly sustain the unborn baby; fetal abnormalities where the baby would have been unlikely to live if it made it to birth; and umbilical cord abnormalities were all more common in the more obese women.

“Obstetricians should monitor obese patients for these complications and quickly treat conditions like hypertension if they arise in order to reduce risk of stillbirth,” said senior author Hyagriv N. Simhan, M.D., professor and chief of the division of maternal-fetal medicine and medical director of obstetrical services at Magee. “However, we’d like to see these women before they even become pregnant. When a doctor has an obese patient who is considering pregnancy, she should be referred to a maternal-fetal medicine specialist who can counsel her on the benefits of losing weight before pregnancy, as well as safe approaches to weight loss.”

Additional authors on this research are W. Tony Parks, M.D., Kiran Perkins, M.D., Sarah J. Pugh, M.P.H., Maisa Feghali, M.D., Karen Florio, D.O., Omar Young, M.D., and Sarah Bernstein, M.D., all of Pitt; and Robert W. Platt, Ph.D., of McGill University.

This research was funded by NIH grant R21 HD067851.

Children’s Hospital of Pittsburgh Foundation Invests in Cardiovascular Regeneration Research

PrintPITTSBURGH, Aug. 20, 2015Bernard Kühn, M.D., a scientist at the Richard King Mellon Foundation Institute for Pediatric Research at Children’s Hospital of Pittsburgh of UPMC, is being awarded a $200,000 grant from the Children’s Hospital of Pittsburgh Foundation.

The grant is being provided from the Fund for Genomic Discovery, which was raised by the Foundation’s Research and Education Program Committee. Established in 2012, the Research and Education Program Committee promotes the awareness of funding needs and priorities of physician-scientists at Children’s Hospital. Through various fundraising initiatives, the committee seeks to broaden the network of philanthropists, raise money to fund the gaps between government grants, and provide seed funding for new avenues of scientific investigation.

Through hosting two events, combined with additional fundraising efforts, more than $520,000 has been raised for research.

“This funding will allow my team to enter the field of fibrosis research, a new area of investigation for my lab. If successful, this project will provide a broadly applicable molecular-genetic blueprint for the field of cardiovascular development and for developing new drugs to reduce fibrosis in heart disease,” said Dr. Kühn, associate professor of pediatrics at the University of Pittsburgh School of Medicine. “Working directly with me on this research is Dennis Kostka, Ph.D., an expert in Developmental Biology and Computational & Systems Biology, who will offer his expertise on the computational aspects of the research.”

Dr. Kühn, also the director of research at Children’s Heart Institute, joined the faculty in September 2014, and has been focused on the unique workings of heart muscle cells. His long-term objective is to provide novel approaches and molecular targets for the treatment of heart failure, primarily by studying the mechanisms of growth and regeneration of the myocardium, the muscle tissue of the heart.

Dr. Kühn and his team of researchers are focused on cardiomyocytes, the cells of the heart muscle, and discovering ways to make them replicate and proliferate so as to enable the heart to heal itself in cases of heart failure or congenital defects.

“Dr. Kühn is one of the leading researchers in heart regeneration and this funding will give him the opportunity to further explore the growth of heart cells and the advancement of treatments for heart failure,” said David H. Perlmutter, M.D., physician-in-chief and scientific director, Children’s Hospital, and Distinguished Professor and Vira I. Heinz Endowed Chair, Department of Pediatrics, Pitt School of Medicine.

Dr. Kühn is the recipient of numerous grants and awards, including the American College of Cardiology’s prestigious Young Investigator Award, the Basil O’Connor Award from the March of Dimes Birth Defects Foundation, and Scientist Development Grant from the American Heart Association.

For more information on Dr. Kühn, please visit www.chp.edu.

Pitt School of Medicine Leads Sepsis Care Guidance in Preparation for Nationwide Hospital Requirements

PITTSBURGH, Aug. 18, 2015 – As hospitals nationwide brace for rigorous mandates for care of septic patients that will be adopted by the Centers for Medicare & Medicaid Services in October, a University of Pittsburgh School of Medicine review unveils research-based guidance to improve compliance when treating this common and deadly syndrome.

Christopher Seymour, MD, MScSepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. It occurs in more than 230,000 U.S. patients every year, with most initially receiving care in an emergency department. Despite best practice, more than 1 in 5 septic shock patients do not survive.

In this week’s issue of the Journal of the American Medical Association, Pitt researchers incorporate the results of several high-profile clinical trials into a concise clinical diagnosis and treatment algorithm to aid hospitals in the implementation of the National Quality Forum (NQF) Severe Sepsis and Septic Shock Management Bundle.

“The NQF sepsis bundle comes on the heels of several high-profile sepsis deaths that highlighted the need for better recognition, prompt treatment and frequent re-assessment of patients with septic shock,” said lead author Christopher W. Seymour, M.D., M.Sc., assistant professor in Pitt’s departments of Critical Care Medicine and Emergency Medicine. “The sepsis problem is clear, but the solution for patients remains elusive. This new algorithm provides doctors and hospitals with a best-practice approach to assessing and treating septic shock patients as supported by the most recent evidence.”

Dr. Seymour and co-author Matthew R. Rosengart, M.D., M.P.H., associate professor in Pitt’s Department of Surgery, use their review to stress what is known about good sepsis care – that prompt clinical diagnosis is crucial, and the first step in treatment is promptly addressing the infection. Their review also points out what is less certain, such as various diagnostic and monitoring tools that can be useful in certain subgroups of patients. They highlight new evidence that suggests rigorous, one-size-fits-all septic shock protocols are not superior to good clinical assessments among patients who already received timely treatment. A variety of medications and fluid therapies also can be used to support the patient’s circulatory system, but one is not always better than another.

“We’re at an interesting juncture where major policy changes are being implemented across the U.S. for patients with sepsis, but the ‘right’ approach still has many areas of uncertainty,” said Dr. Seymour. “As a start, we know that doctors must be able to quickly diagnose sepsis and begin treatment without delay. And they must be well-versed in the different treatments available and which ones are likely to work best in different septic shock situations.”

This work was supported in part by National Institutes of Health grant K23GM104022, and more information can be found at https://www.ccm.pitt.edu/CRISMA.

Sepsis infographic

UPMC Will Host Unprecedented Gathering of Concussion Experts to Share Best Treatments, Practices

PITTSBURGH, Aug. 18, 2015 – Nearly 30 leading, independent concussion clinicians and researchers from around the United States will convene at UPMC Oct. 15 and 16 with a unique purpose: to propose standard guidelines on the best practices, protocols and active therapies for treating concussions today, resulting in a white paper to be published in a medical journal and shared nationwide.

For the first time in the relatively infant science of concussion, U.S. experts are coming together to discuss what the UPMC organizers call Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion. Representatives from the National Institutes of Health and the U.S. Department of Defense, among others, also have been invited to participate.

“There’s a gaping need for a consistency of care for concussions across the country, if not the world. To try to fill that void, we’re thrilled to host a meeting of some of the greatest minds in concussion science and clinical care,” said Micky Collins, Ph.D., executive and clinical director of the UPMC Sports Medicine Concussion Program and the chairman of the conference to be held at the U.S. Steel Tower in Pittsburgh, headquarters to UPMC. “It is a privilege to bring together such a group, discuss the issues truly facing concussion health care today, and attempt to share with caregivers everywhere what we find to be the best evidence, science and practices in getting people better.”

The white paper is intended to make scientific, clinical and therapy recommendations for other health care providers to replicate and researchers to study further.

Over the past decade, there have been summits and conferences abroad where participants agreed upon definitions, evaluations and on-field protocols, but this marks the inaugural U.S. meeting focused strictly on active therapies, treatments and best clinical practices for concussions.

“Never before has evidence-based science and clinical experience been brought to bear in advancing concussion treatment like we’re attempting here,” said Anthony Kontos, Ph.D., research director for the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery, and co-director of the meeting. “We believe that this meeting will bring together cutting-edge research knowledge and clinical approaches to this injury that will blaze a trail for concussion treatment moving forward.”

The invitees cut across academic, scientific and health care environments. Among those expected to attend are Julian Bailes, M.D., NorthShore University Health System (Chicago) and chairman of the medical advisory board for Pop Warner Football, and retired Gen. Peter Chiarelli, former U.S. Army vice chief of staff and an outspoken leader in research and treatment for traumatic brain injury (TBI), mild TBI such as concussion, and post-traumatic stress.

“There have been numerous advances in our understanding of concussion treatment, and this conference should facilitate the implementation of best practices to make participation in all sports safe,” Dr. Bailes said.

“I am honored to be among this group of leading concussion clinicians and researchers for a meeting that will be a critical step forward in the standard of care for concussions,” Gen. Chiarelli said. “A published consensus statement on concussion treatment will give every patient the opportunity to receive the best care, no matter where they are injured. It’s time to put aside our differences, collaborate and work together for the sake of patients everywhere.”

Added conference co-director David Okonkwo, M.D., Ph.D., professor of neurological surgery and clinical director of the Brain Trauma Research Center at the Pitt School of Medicine: “It is high time to assemble neurosurgeons, neurologists, neuropsychologists, emergency medicine physicians, physiatrists, athletic trainers, physical therapists and all the multidisciplinary health care professionals who are the primary caregivers to people, and not just athletes, troubled by concussions. Let’s effect change and improve outcomes now and for the future.”

UPMC received support to host this meeting because it is aligned with Pittsburgh’s long-standing place at the center of the field: the first sports-medicine concussion program to open its doors (2000), a leading institution in concussion research and innovation, and a model clinic with successful assessment, treatment and outcomes amid its nearly 18,000 concussion-patient visits yearly.

“We are fortunate that we have this opportunity to carry out this idea of spreading better care practices and ultimately helping so many,” Dr. Collins said. “We are looking forward to a wide-ranging, stimulating discussion that is overdue, and we feel our science, innovation and clinical experience make us well suited to serve as hosts.”

The two-day meeting is fully funded by a grant from the NFL Foundation.

“Because of the vital nature of the concussion conversation, it’s critical to support leading institutions in the country, like UPMC, that are promoting science in an effort to advance treatment, evidence and clinical experience,” said Charlotte Jones Anderson, chair of the NFL Foundation and executive vice president of the Dallas Cowboys. “The NFL Foundation is dedicated to improving the health and safety of sports, youth football and the communities in which we live, and we look forward to learning from the experts who will meet in October to further that mission.”

The conference will conclude with a panel discussion and media availability that is expected to be streamed live.

First-of-its-Kind Partnership: UPMC Lemieux Sports Complex Opens

CRANBERRY TWP., Pa., Aug. 17, 2015 – The UPMC Lemieux Sports Complex, a partnership between UPMC and the Pittsburgh Penguins®, officially opened to the public today. The 185,000-square-foot facility is a comprehensive outpatient center for UPMC Sports Medicine and the primary practice and training center for the Penguins, as well as home to their Tier 1 Elite youth programs.

This multi-use facility will be a destination for athletes of all ages and skill levels seeking leading-edge injury prevention and treatment from experts in sports medicine. It focuses on sports medicine and hockey-related research, including injury prevention, training, treatment, and rehabilitation.

“It’s a true partnership between elite hockey and elite sports medicine,” says Vonda Wright, MD, medical director of the UPMC Lemieux Sports Complex. “We have full clinical facilities with experts in orthopaedic surgery, sports performance, primary care sports medicine, physical therapy, athletic training, nutrition, sports psychology, concussion, and musculoskeletal radiology.”

The Lemieux Complex also houses a sports performance center and an expansion of the UPMC Sports Medicine Concussion Program, with both clinical and research space. “We’re expanding on the legacy of elite sports medicine at UPMC,” Dr. Wright says. “We’ll do novel research not only on how to prevent and treat injury, but also how to predict it.”

Five research laboratories come together at the UPMC Lemieux Sports Complex to form the Institute for Sports Performance and Innovative Research (InSPIRe). The core research initiatives of InSPIRe are concussion and traumatic brain injury (TBI), cell therapy and biologics, sports performance, BioDynamics, and material science. Research will aim to answer the prevention, performance, and protection research questions that are important to the futures of young and professional athletes.

The first-of-its-kind facility includes:

  • More than 50 sports medicine experts
  • A sports performance program led by former Pittsburgh Penguins winger, Gary Roberts
  • A practice rink for the Pittsburgh Penguins and a community rink for public use
  • More than 1,500 square feet of hockey skills performance space with a RapidShotTM system, three RapidHandsTM training stations, and a resistance skating lane made of synthetic ice
  • 54,000 square feet of clinical space
  • A physical therapy gym overlooking the Penguins practice rink
  • Aquatic therapy
  • On-site MRI and x-ray imaging
  • Dedicated sports performance space including a sprinting track and batting cages
  • Café and retail space
  • Free parking

For more information about the complex, please visit UPMCLemieuxSportsComplex.com.

Places with More Marijuana Dispensaries Have More Marijuana-Related Hospitalizations

PITTSBURGH, Aug. 10, 2015 – People who live in areas of California with a higher density of marijuana dispensaries experience a greater number of hospitalizations involving marijuana abuse and dependence, a University of Pittsburgh Graduate School of Public Health analysis discovered.

The National Institutes of Health-funded research, published online and scheduled for the Sept. 1 issue of the scientific journal Drug and Alcohol Dependence, could be informative as more states consider legalizing marijuana for medical and recreational use. It is the first analysis of the statewide impact of marijuana dispensaries on abuse and dependence, as well as the first look at population characteristics associated with marijuana-related hospitalization rates.

“As marijuana is approved for medical or recreational use, we need to carefully consider where we allow dispensaries to be placed,” said lead author Christina Mair, Ph.D., assistant professor in Pitt Public Health’s Department of Behavioral and Community Health Sciences. “Our study indicates that there are real problems associated with a higher density of marijuana dispensaries in neighborhoods. More study and monitoring, coupled with thoughtful legislation and community discussion, will be prudent to ensure that marijuana laws have the fewest negative consequences for vulnerable populations.”

In 1996, California was the first state to legalize medical marijuana, allowing physicians to prescribe the drug for medical purposes. Since then, 22 states and Washington, D.C., have enacted similar laws, and four of those states also have legalized recreational use. Pennsylvania doesn’t allow either, though it is considering permitting medical marijuana.  

Dr. Mair and her team looked at data on California hospital discharges that had either a primary or secondary medical code for marijuana dependence or abuse with at least one overnight hospital stay. The research covered 2001 through 2012, the most recent years for which consistent data were available.

Hospitalizations with marijuana abuse or dependence codes increased from 17,469 in 2001 to 68,408 in 2012. More than 85 percent of marijuana-related hospitalizations were coded as abuse, rather than dependence, and 99.2 percent were secondary codes, meaning the person was primarily hospitalized for something other than marijuana.

When the research team mapped the location of marijuana dispensaries and cross-referenced it with the ZIP code of each patient’s home, they found that each additional dispensary per square mile in a ZIP code was associated with a 6.8 percent increase in the number of hospitalizations linked to marijuana abuse and dependence.

In addition, Dr. Mair and her team found that marijuana dispensaries and hospitalizations were more likely to be located in areas with lower household incomes and lower educational attainment.

“It’s unclear if the marijuana dispensaries are simply locating in neighborhoods that tend to be more disadvantaged and already have underlying problems with marijuana abuse, or if the presence of the dispensaries is causing an increase in abuse and hospitalizations,” said Dr. Mair. “It could be a combination of both factors.”

Dr. Mair noted that research on the location of marijuana dispensaries has a parallel precedent in the location of liquor stores. This gives policymakers and public health practitioners the opportunity to learn from previous studies on the health effects of density and location of liquor stores in order to design studies that can provide similar data on marijuana dispensaries.

“Once dispensaries open, it is much harder to go back and create regulations to guide their location and density,” said Dr. Mair. “Passage of laws permitting marijuana use and sale is likely to continue, so it is critical that we continue to research the impact of dispensaries on the health of local communities to provide guidance on regulations and public health outreach to prevent abuse.”

Additional researchers on this project include senior author Bridget Freisthler, Ph.D., of UCLA’s Luskin School of Public Affairs. Co-authors are Andrew Gaidus, M.E.M., and William R. Ponicki, M.A., of the Prevention Research Center in Oakland, California.

This research was funded by the NIH’s National Institute on Drug Abuse grant R01-DA-032715.

UPCI Researcher Named Outstanding Investigator by NCI, Awarded $6.3M for Studying How Food Can Lower Cancer Risks

PITTSBURGH, Aug. 6, 2015 Thomas Kensler, Ph.D., professor of pharmacology and chemical biology and co-leader for the Cancer Epidemiology and Prevention Program at the University of Pittsburgh Cancer Institute (UPCI), was awarded a $6.3 million Outstanding Investigator Award from the National Cancer Institute (NCI). This new award acknowledges experienced researchers and provides them with long-term support for their exceptional work.

Dr. Kensler’s research focuses on chemoprevention, or how food can be used to lower the risk of developing cancer caused by unavoidable environmental toxins.

“The NCI Outstanding Investigator Award addresses a problem that many cancer researchers experience:  finding a balance between focusing on their science while ensuring that they will have funds to continue their research in the future,” said Dinah Singer, Ph.D., director of NCI’s Division of Cancer Biology. “With seven years of uninterrupted funding, NCI is providing investigators the opportunity to fully develop exceptional and ambitious cancer research programs.”

The seven-year grant is one of just 60 awarded in its inaugural year.

Research has shown that controlling diet, increasing exercise and quitting smoking can decrease the risk of developing cancer; however, environmental toxins such as fossil fuel combustion products are more difficult to mitigate. Past studies by Dr. Kensler’s team in China, where environmental controls are less rigorous, have examined the bioactive molecules in broccoli and how they may help people there detoxify air pollutants.

“Pollution is a global problem and its effects are seen most often among the elderly, disabled, children and minorities. We need effective and affordable interventions, and using food-based strategies could be the ideal way to address this,” Dr. Kensler said.

He and his team will focus on a biological pathway known to play a role in detoxification, identify and validate biomarkers of its activity, and examine the molecular consequences of its chronic activation.

“It’s truly an honor for Dr. Kensler to be among the first to receive this prestigious award. He has pioneered our understanding of how chemically reactive constituents in foodstuffs can profoundly and positively impact tissue defense and repair mechanisms. We’re proud of the work he is doing to try and lessen the burden of cancer, not only in western Pennsylvania but around the globe,” said Bruce Freeman, Ph.D., UPMC-Irwin Fridovich Professor and Chair of Pharmacology and Chemical Biology.

Research reported in this publication was supported by the NCI under award number 1R35CA197222-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Cancer Researcher at Children’s Hospital of Pittsburgh of UPMC Receives Grant from St. Baldrick’s Foundation

PrintPITTSBURGH, Aug. 6, 2015 Edward V. Prochownik, M.D., Ph.D., director of oncology research at Children’s Hospital of Pittsburgh of UPMC, and the Paul C. Gaffney Professor of Pediatrics, has been awarded a research grant of $100,000 from the St. Baldrick’s Foundation, a volunteer-driven charity dedicated to raising money for childhood cancer research.

The award to Dr. Prochownik is one of 70 grants totaling more than $21.1 million nationally and internationally awarded by St. Baldrick’s in support of pediatric oncology research. These grants provide resources to institutions to conduct more research and enroll more children in ongoing clinical trials. Dr. Prochownik and his team will explore the implications of new observations of cancer cell growth.

“Cancer cells must alter their metabolism to provide the necessary energy and metabolic building blocks needed to support their rapid division,” said Dr. Prochownik, who also is professor of molecular genetics and biochemistry, University of Pittsburgh School of Medicine. “We have identified some of the key means by which the cell can control these changes. Confirming and extending these findings as we propose to do could provide novel and specific ways to interfere with this process and thus inhibit tumor growth while minimizing long-term side effects.”

Over the past year, Dr. Prochownik and his research team have developed a model of hepatoblastoma, the most common childhood liver cancer, which in advanced states is difficult to treat and requires use of drugs that can cause long-term toxicities.

“We have discovered that the mitochondria of these hepatoblastoma cells appear to be reprogrammed so as to allow them to function at maximal capacity and thus provide large amounts of energy and metabolic building blocks needed by the rapidly growing and dividing cancer cells,” explained Dr. Prochownik. “We hope that our observations at this level can be translated into new and specific ways of treating this cancer while at the same time reducing toxicity.”

This past year, three St. Baldrick’s head-shaving events were hosted in Pittsburgh, where more than 140 people “braved the shave” and raised nearly $86,000.

For more information about Dr. Prochownik, please visit www.chp.edu.

Pitt Team Gets the Beat, Develops Method of Quantifying Ciliary Movement

PITTSBURGH, Aug. 5, 2015 – Researchers at the University of Pittsburgh School of Medicine have figured out how to objectively quantify the beating action of cilia, the tiny, hair-like projections on cells that line nasal passages, the lungs and almost every other body tissue, according to a study published online today in Science Translational Medicine. Such digital signatures could help doctors more quickly and accurately diagnose ciliary motion (CM) defects, which can cause severe respiratory airway clearance defects and also developmental defects including congenital heart disease.

Currently, doctors try to identify CM defects using video-microscopy or indirectly via the examination of cilia ultrastructural defects using electron microscopy. This usually entails analysis of cilia movement in respiratory cells obtained from nasal passages, explained senior investigator Chakra Chennubhotla, Ph.D., assistant professor of computational and systems biology, Pitt School of Medicine.

“Visual reviews like these can be subjective, time-consuming and error-prone,” he said. “In this project, our team used computational methods to objectively and reliably identify CM defects.”

The researchers used two independent data sets – one from Children’s Hospital of Pittsburgh of UPMC (CHP) and the other from Children’s National Medical Center (CNMC) in Washington, D.C. – from healthy individuals as well as patients already diagnosed with either congenital heart disease or primary ciliary dyskinesia (PCD) to identify the digital signatures of normal and abnormal movement, accounting for factors such as how frequently the cilia beat back and forth, the breadth and rotation of their beat pattern, and their synchronicity.

The researchers then validated their technique by testing the patient samples in blind fashion, finding that the computational tool correctly identified more than 90 percent of PCD cases at CHP and all of the cases at CNMC. PCD is a rare condition in which the cilia are immotile or beat abnormally, leading to limitation of airway mucus clearance, compromised respiratory function and increased risk for lung infections and other bronchial problems.

“We hope to start a clinical trial in which doctors from around the country can upload a video of their patient’s nasal lining to a website for assessment of ciliary motion with this technique,” said co-investigator Cecilia Lo, Ph.D., Dr. F. Sargent Cheever Professor and chair of Developmental Biology, Pitt School of Medicine. “If successful, this approach may in the future serve as a rapid first-tier screen to identify at-risk patients.”

Team members included Maliha Zahid, M.D., Ph.D., John Durkin, M.D., and Richard Francis, Ph.D., all of the University of Pittsburgh; and Shannon Quinn, Ph.D., now a faculty member at the University of Georgia.

The project was funded by National Institutes of Health grants HL-098180 and GM104412-01A1, and the Pennsylvania Department of Health.

Magee Surgeon Leads Treatment Guidelines for Identical Twin Pregnancies

PITTSBURGH, August 5, 2015 – A monochorionic twin pregnancy, a pregnancy in which identical twins share one placenta, faces unique complications that can threaten the health and life of both babies, requiring an increased understanding of treatment techniques for the mother. Today, in work led by Stephen Emery, M.D., a maternal-fetal medicine surgeon with Magee-Womens Hospital of UPMC, the North American Fetal Therapy Network published evidence-based and consensus-driven recommendations for the management of such pregnancies in the journal Obstetrics and Gynecology.

“Identical twin pregnancies present some of the most challenging complications a maternal-fetal medicine specialist can face,” said Dr. Emery, who is the paper’s lead author. “With timely diagnosis and intervention, we can improve pregnancy outcomes. We hope these guidelines help general obstetric practitioners understand some of the complexities that can affect the development of identical twins sharing one placenta. These guidelines also should help with patient counseling, including when a woman experiencing a complication should be referred to a regional treatment center and how to co-manage her care when she returns after treatment.”

The North American Fetal Therapy Network is a consortium of 30 medical institutions across the U.S. and Canada with established expertise in fetal therapy and complex fetal disorders. For this publication, the consortium identified nine disorders to highlight, including:

  • Twin-to-twin transfusion syndrome, a disease of the placenta in which blood passes disproportionately from one baby to the other through connecting blood vessels within their shared placenta. One baby receives too much blood, overloading his or her cardiovascular system while the other baby doesn’t receive enough and develops low blood volume. Left untreated, this condition is almost always fatal for both twins.
  • Selective growth restriction, when a disproportionate share of the placenta causes inadequate nutrition and consequently growth restriction in one of the twins. Increasingly, selective growth restriction is being recognized as a major complication for monochorionic twin pregnancies because it is frequently associated with pregnancy loss and poor neurological outcomes.
  • Twin anemia polycythemia sequence, a form of twin-to-twin transfusion syndrome characterized by chronic, slow blood transfusion between the twins, which is believed to develop due to very small caliber artery-to-vein vessels that develop between the twins. One twin becomes severely anemic while the other has too many red blood cells (polycythemia), resulting in serious problems for both.
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