March of Dimes Prematurity Research Center at

Stanford University School of Medicine

David K. Stevenson, MD

Aspen Children’s Forum:

Investing in Children’s Health and Well-being

July 22-24, 2012

Aspen, Colorado

March of Dimes Prematurity Research Center at Stanford University School of Medicine

Why preterm birth?

• Preterm infants more likely to die or be disabled.

• Social disparity in the preterm birth rate, consequences and costs.

• Multi-faceted phenotype:

– Spontaneous 45%, PROM 25%, Medically Indicated 30%

• Complex gene-environment (physical and social) interaction.

• Intractable problem.

• Resistant to traditional approaches.

March of Dimes Prematurity Research Center at Stanford University School of Medicine

March of Dimes Prematurity Research Center at

Stanford University School of Medicine Transdisciplinary Team Science

• Assemble scholars from diverse fields in the life

sciences, physical sciences, social sciences, as well as many other disciplines.

• Share knowledge and integrated data systems in order to transform one another’s perspectives and craft a unified analytic framework to solve a complex problem.

Strategy • Utilize new informatics capabilities and an array of

racially/ethnically-diverse, biologic, clinical, and environmental population–based datasets.

• Collaborative research models:

– multidisciplinary-scholars work independently but interact intermittently.

– interdisciplinary-scholars collaborate but utilize their own disciplinary frameworks.

– transdisciplinary—scholars collaborate to transform one another’s perspectives.

March of Dimes Prematurity Research Center at Stanford University School of Medicine

Using Language as a Metaphor for the Development of a Transdiscipline

Language Development:

• Mono-lingual (unidiscipline)

• Multi-Lingual (multidiscipline)

• Pidgin (interdiscipline)

• Creole (transdiscipline)

March of Dimes Prematurity Research Center at Stanford University School of Medicine

Goals of Transdisciplinary Research

• Address a joint topic / develop shared knowledge [ontological]

• Develop new methods / tools that reveal new insights [methodological]

• Facilitate a new synthesis [epistemological]

• Solve a real world problem [practical]

March of Dimes Prematurity Research Center at Stanford University School of Medicine

How are we doing it?

• Partnership with the March of Dimes National and Global Networks.

• Preferential focus on disparities.

• Not limited by a priori assumptions about causation.

• Translating what we learn into effective interventions.

March of Dimes Prematurity Research Center at Stanford University School of Medicine

Beyond the traditional database • Anatomy of our transdisciplinary database:

– Linking extant, population-based datasets – newborn screens, vital statistics, hospital discharge, clinical, air and water quality, and other databases.

– Accessing extant biobanks for relevant research materials.

– Collecting new clinical data and biologic specimens by establishing a network of collaborating research centers around the country.

March of Dimes Prematurity Research Center at Stanford University School of Medicine

The Power of Unique, Large, Linked Databases

• Maternal and neonatal clinical information systems (320 birthing hospitals; over 500,000 births/yr; 141,343 clinical records on sick newborns, 102,311 preterms).

• California hospital discharges (3,370,022 last year; 589,678 pregnancy related).

• California’s Children from Birth to 21 (inpatient/outpatient clinical data).

• Biobank: existing and new specimens (15 million newborn and 800,000 maternal blood samples).

• Pesticides, Toxics, Air and Water Quality.

• US live birth certificates (4,138,349 last year).

March of Dimes Prematurity Research Center

at Stanford University School of Medicine

Explore patterns county by county.

What can we learn from changes over time?

17,000 events

14,000 events

55,000 total county-year pairs

How will we measure success?

• Improve transdisciplinary science.

• Make new discoveries that reduce preterm birth.

• Effect policy change.

March of Dimes Prematurity Research Center at Stanford University School of Medicine