The Perelman IntraUterine Growth Restriction Study

WITH GRATITUDE FOR

Anna Chapman, MD, Ronald G. Perelman and the Perelman Family Foundation, Inc.

THE PERELMAN IN TRAUTERINE GROWTH RESTRICTION STUDY —

I M P A C T

R E P O R T

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A L A S T I N G PA RT N E R S H I P Thank you for your investments in the Perelman IntraUterine Growth Restriction Study. Over the past five years, we have made significant progress in advancing research, and improving the lives of children and their families. We are grateful for your lasting partnership.

It has been a privilege to serve your family as your physician, and an honor to work with you closely to ensure more children begin healthy lives. Together, we have deepened our understanding of intrauterine growth restriction, and improved our ability to prevent, and even treat, this condition.

Our faculty’s accomplishments are detailed here in this report.

Sincerely, John C. Hobbins, MD Endowed Professorship in Maternal Fetal Medicine Clinical Professor, CU Department of Obstetrics and Gynecology

“Dr. Hobbins is an ‘idea factory’ and is perpetually enthusiastic about testing new ideas. And, together, we have made great strides in improved care and better health outcomes for LEADERS IN THE FIELD:

mothers, babies and families.

K . J O S E P H H U R T, M D , P H D

They are our driving

Assistant Professor, CU Division of Internal Fetal Medicine

motivation and the reason

Director, Preterm Labor Research Laboratory

we pursue and advance

With insights gained through the Perelman study, Drs. Hurt and Hobbins

medicine every day. Good

launched investigations testing new ideas about how mothers’ diets and

science is difficult to achieve,

metabolic composition could help us better understand what triggers

but we are hopeful that

intrauterine growth restriction. Currently, Dr. Hurt is working to identify markers of the condition in mothers in order to accurately determine those

we will change the world

who need close monitoring during their pregnancies. Because there are few

by making life better and

tools for predicting low-risk pregnancies, all mothers receive full monitoring.

healthier for our patients.”

Therefore, they experience extra stress and oftentimes deliver early. Dr. Hurt’s research could lead to reduced monitoring for lower-risk pregnancies, allowing for delivery at a later gestational age. This work has significantly added to the body of knowledge around preventing complications of prematurity.

“The Perelman study is the first of its kind – the only study to follow women and their babies over the course of a pregnancy and monitor growth and neurodevelopment following birth. The results from this study will provide critical insight into intrauterine growth restriction pregnancies, helping us predict health outcomes in infants and potentially open windows during pregnancy

LEADERS IN THE FIELD:

LAURA BROWN, MD Associate Professor, CU Department of Pediatrics, Section of Neonatology In her laboratory, Dr. Brown is using animal models to study how the developing baby is affected by intrauterine growth restriction. With these models, she can investigate the cellular mechanisms that slow growth

in which interventions could

of the baby. She focuses her research on growth of the skeletal muscles,

be applied to improve babies’

which are particularly small in babies with intrauterine growth restriction,

growth and organ function.”

and how to improve muscle growth through nutritional interventions.

Using the Perelman study findings, Dr. Brown can translate her results from animal experiments to the human, ultimately to design studies that improve growth in the womb.

OUR ACCOMPLISHMENTS

THE PERELMAN INTRAUTERINE GROWTH RESTRIC TION RESEARCH STUDY We have made great strides in understanding the impact of intrauterine growth restriction from birth to early childhood, and developing strategies for the prevention and treatment of the condition. We are grateful that you have joined us on this journey to protect and improve the health of our youngest and most vulnerable patients. The progress highlighted here has been made possible with your generous support.

OUR ACCOMPLISHMENTS INV ES TIGA T E D PO SSI B L E IND IREC T PRE DI C TO R S O F B A B Y’S H E ALT H

I D EN T I F I E D RELI ABLE M ET H O D S TO M EAS URE B I RT H W E I G H T

Ultrasound evidence has indicated that abnormally small babies with evidence of nutrient deprivation have a greater tendency to accumulate fat than normal-sized babies. 3D ultrasound techniques allow us to measure muscle mass and fat deposition, which are possible indirect predictors of the baby’s health. Our results will allow pediatricians to apply early preventative measures to children who are at a greater risk for metabolic syndrome and obesity, helping to address these widespread public health problems.

In practice today, standard ultrasound formulas are used to calculate the baby’s size with reasonable accuracy. However, since many factors affect birthweight such as size of parents, baby’s gender and ethnicity, often a customized formula is preferred to assign a weight percentile based on variables appropriate to the baby. Unfortunately, this approach is cumbersome and has not been completely tested. Our studies have determined that a customized formula to identify intrauterine growth restriction is not necessary and simple methods identify more babies with low birth weight.

Our Aims 1.

Determine how babies adapt to diminished nutritional supply, either early or late in pregnancy.

2.

Correlate the structure and function of baby’s heart and brain with later developmental problems.

CORR ELAT E D BRAI N S T RU C T U R E WITH BRA I N FU N C T I ON Previously, it was thought that only MRI was capable of precisely imaging and measuring various brain structures tied to intrauterine growth restriction. Now using 3D ultrasound techniques, it is possible to measure vulnerable areas of the brain including the corpus callosum, the cerebellar vermis and Sylvian fissure.

We are correlating our brain structure findings with brain function in children to determine which structures are associated with specific developmental difficulties.

3.

Inform decisions regarding the timing of delivery, using findings of baby’s heart and brain function

4.

Develop strategies to treat babies in the womb, sparing them from the risk of premature delivery.

5.

Establish protocols for delivery that are cost-effective, and will diminish patients’ health care costs.

B E TTER SC RE E N I N G F O R CARD IAC DYSFU N C T I ON

I M P ROV ED D EC I S I ON- M AK I NG A ROU N D DELI VERY

There is a misconception that abnormally small babies with

Currently, the only treatment for intrauterine growth

normal blood flow in the umbilical cord and brain are not

restriction is to deliver babies early, thereby exposing

deprived of oxygen. Previous studies have focused on specific

them to the potential complications of premature birth.

parts of the umbilical cord and brain to assess the condition

Care providers are reluctant to induce early labor unless

of these babies. With a new ultrasound screening test and

there is strong evidence of the baby being in jeopardy.

novel software program, we have demonstrated that the

Using color Doppler ultrasound, we have discovered that

majority of these small babies have cardiac dysfunction, and

the vertebral artery is the last to be spared in babies with

that the heart is the most sensitive indicator of when the

intrauterine growth restriction, and could play an important

baby is deprived of an adequate supply of oxygen. Using our

role in making decisions that will have long-term impact on

screening methods, which can be applied in most centers

the baby and family.

in the country, cardiac dysfunction can be detected in the womb. Once diagnosed with intrauterine growth restriction, children can be protected from long-term cardiovascular effects through preventative therapies like dietary and lifestyle routines.

“Thank you for your forethought and vision in investing in the Perelman IntraUterine Growth Restriction Study, and for placing your trust in the capable hands of Dr. John Hobbins. What he has built here and the integrity with which he has done it is inspiring. The research taking place in our labs today is deepening our knowledge around abnormalities in babies, and will soon lead to tomorrow’s highly effective therapies.

Support from benefactors like you makes it possible for us to elevate our visibility as a model for what a campus can do to promote the health and well-being of women and their children. We could not be more grateful for your belief in our mission, and your investments in our future.”

— Nanette Santoro, MD, Professor and Chair, Department of Obstetrics & Gynecology, E. Stewart Taylor Endowed Chair

NANETTE SANTORO, MD Professor and Chair, Department of Obstetrics & Gynecology E. Stewart Taylor Endowed Chair Today at CU Anschutz, key leaders are reimagining women’s health, and leveraging top talent, a collaborative spirit and innovative culture to bring a bold new vision into reach. We have the leadership and expertise to stake our claim at the forefront of the field. The progress we are making is going a long way toward creating a destination for women and families in Colorado and around the country, making healthier, more hopeful futures possible for everyone.

A GIANT IN OBSTETRICS AND GYNECOLOGY

Dr. Hobbins is an undisputed giant in obstetrics and gynecology. He has been a pioneer of ultrasound imaging in the field with influence 2

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on the evolution of modern obstetrical practice. Even more so, the inspirational vitality of such an extraordinary man is perhaps best reflected in the legions of residents and fellows he trained. They, in turn, have taught others, building on what

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become leaders in obstetrics and

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they learned from Dr. Hobbins to

1. Dr. Hobbins and his beloved pet. | 2. John C. Hobbins, MD | 3. A special event celebrating Dr. Hobbins’ accomplishments on the occasion of the Annual Congress of the International Society of Ultrasound in Obstetrics and Gynecology. | 4. Dr. Hobbins using the contact scanner in the 1970s. | 5. Dr. Hobbins looking at a Polaroid picture from the contact scanner in the 1970s. | 6. Dr. Luciano Bovicelli, MD, of the University of Bologna, where Dr. Hobbins spent a sabbatical year and initiated a long-term collaboration. | 7. Dr. Hobbins in action on the tennis court. | 8. Dr. Hobbins in his office, relaxing between procedures. | 9: Dr. Hobbins playing the piano.

gynecology and transforming the field through their work. We invite you to enjoy some moments of Dr. Hobbins’ life and storied career, and we hope that you share in our pride for the part he has played in history.

WITH GRATITUDE As we reflect on our incredible progress, our thoughts turn to you in deep appreciation and gratitude. We are proud of what we have accomplished together, and look to new horizons with shared hopes and aspirations for all that lies ahead. The future is bright for generations yet to come.