Maternal and Child Health Research at Rollins

May 15, 2017

Dr. Carol Hogue has spent a substantial part of her career researching maternal and child health, particularly as it relates to outcomes of pregnancy. As the Jules and Uldeen Terry Chair in Maternal and Child Health and director of the Women's and Children's Center at Rollins, Hogue's passion for the subject is immediately apparent when you visit her at Rollins' Department of Epidemiology, where the center is administered.

"The Women's and Children's Center research is really a kind of applied research, which means we have a service component to the research we do," says Hogue. This year the Center is celebrating its 25th anniversary, with a series of seminars and a symposium scheduled for the fall 2017.

As of June 2015, this Center has been funded by an HHS Maternal and Child Health Training Program which—through the hard work of Hogue and colleagues—awarded the school with a Center of Excellence in Maternal and Child Health grant. This grant funds 13 schools of public health with maternal and child health programming.

Collaboration is an essential component of the grant and has led to the Center's leadership collaborative among Rollins' Maternal and Child Health Certificate program, the Morehouse School of Medicine's Satcher Health Leadership Institute, and Georgia State University's Center for Leadership in Disability. In addition, the grant has enabled Rollins to offer a select number of fellowships to underrepresented students seeking an MPH or PhD with a focus on maternal and child health.

A search for the cause of stillbirth

"Stillbirth has been largely understudied in the U.S., " says Dr. Lauren Christiansen-Lindquist, research assistant professor and Deputy Director of Emory's Center of Excellence in Maternal and Child Health, Education, Science, and Practice. "We have been doing a lot of work to bring it out of the shadows." Christiansen-Lindquist used data from a large population-based case control study about stillbirth while writing her dissertation as a PhD student at Rollins.

"[From those data] we learned a lot of great things about what factors are associated with stillbirth, but I pulled back even further to look at vital records and to see how well we are reporting stillbirths. The answer is, not very well." Post graduation, Christiansen-Lindquist has continued work in this area and is looking for ways to collect better data.

"I conducted a pilot study to expand an existing surveillance system that surveys women who have had a recent live birth to see if we could ask questions of women [who had a stillbirth] and learn about their experiences. CDC has taken that and [plans to implement it] in one state. I'm especially interested in issues around autopsies for stillbirth; if they are offered or not, and when they are available and not conducted, why not. Christiansen-Lindquist and Hogue have also partnered with pathologists from the University of Alabama-Birmingham and Rutgers on a grant application proposing to create web-based training materials for pathologists who can or should be doing autopsies for stillbirth but don't know how.

"There are as many incidences—if not more—in this country of stillbirth as there are infant death," advises Hogue. "We know about many of the causes of infant death and how to prevent them, which is why the rate of infant death is going down in the U.S. We don't know how to prevent stillbirth, so one of the issue is that we are not effectively framing those questions because we don't have the data and the vital records aren't helping us. If we had more placental exams and autopsy results, we could dig deeper."

The life course of women and children

Hogue and colleagues at the Women's and Children's center are also looking at women and children's health along the life course—pregnancy up through the reproductive years. Among their research in that area is a project studying how what happens during pregnancies can later affect infants (the microbiome study is the parent study of this).

The Center is also involved in numerous NIH-funded studies that are being led by the School of Nursing. "Our work [in the latter] is focused on the variables that are psychosocial: racism, stress, etc.; how those are embodied in biomarkers of stress; and how those affect pregnancy outcomes," says Hogue, who has studied this area of research for the last 30 years. "We developed the Jackson, Hogue, Phillips Contextualized Stress Measure which is being used in the study."

Certificate in maternal and child health

Since 2012, the Women's and Children's Center has facilitated an intensive certificate in maternal and child health open to Rollins MPH and MSPH students. Capped at just 40 students (divided into 20 each year), the certificate begins with an in-depth foundations course taught by four faculty members that incorporates collaborations with outside agencies. In the last semester of the certificate program, students have the opportunity to link one on one with a local family that has a child with a physical or neurodevelopmental disability through Rollins' collaboration with the Georgia LeND Program administered by the Georgia State University Center for Leadership in Disability, led by Dr. Daniel Crimmins.

Starting in 2017, applicants interested in the maternal and child health certificate program will be able to apply during the regular admissions cycle and can note their interest on the SOPHAS application.