Thursday, September 01, 2022

Anti-cancer drug brewed from reprogrammed yeast

Engineered yeast cells can synthetically produce the essential cancer medicine vinblastine, an international team of scientists proved in a new study published in Nature

Peer-Reviewed Publication

TECHNICAL UNIVERSITY OF DENMARK

In the summer and fall of 2019, some cancer patients experienced interruptions in their treatment. The reason was a shortage of the drugs vinblastine and vincristine, essential chemotherapeutic medicines for several types of cancer.

There are no alternatives to these drugs that are isolated from the leaves of the Madagascar periwinkle plant, Catharanthus roseus. Two active ingredients from the plant - vindoline and catharanthine – together form vinblastine, which inhibits the division of cancer cells.

Although the plant is commonupwards of 2000 kg of dried leaves are needed to produce 1 g of vinblastine. The 2019 shortage that lasted until 2021 was mainly caused by delays in the supply of these ingredients.

A cross-disciplinary international team of scientists led by DTU researchers has genetically engineered yeast to produce vindoline and catharanthine. They have also managed to purify and couple the two precursors to form vinblastine. Thus, a new, synthetic approach to making these drugs has been discovered. Their results are published today in the journal Nature.

The research may result in new sources of vindoline, catharanthine and other alkaloids that are wholly independent of factors affecting crop farming, such as plant diseases and natural disasters. Since the essential ingredients to make these compounds are baker's yeast and simple renewable substrates such as sugars and amino acids, production is also less vulnerable to pandemics and global logistics challenges, according to Senior Researcher at DTU Biosustain, Jie Zhang, lead author of the new paper:

“In the past few years, we have seen several incidences of shortage of these drugs in the market. They are occurring more often and will most likely reoccur in the future. Of course, we envision establishing new supply chains for these and other molecules. This result is a proof of concept, and there is still a long way to go in terms of upscaling and further optimising the cell factory to produce the ingredients in a cost-effective way."




The possible new supply chain for anti-cancer drug

Apart from being the first study to demonstrate an entirely new supply chain for these essential drugs against cancer, the study showcases the longest biosynthetic pathway – or "assembly line" - inserted into a microbial cell factory. According to Jie Zhang, the latter is a promising result in and of itself.

Vinblastine belongs to the so-called monoterpene indole alkaloids - in short, MIAs. MIAs are very biologically active and useful in treating various diseases. However, they are highly complex molecules and, therefore, difficult to produce synthetically. This study aimed to prove that the researchers could do it.

"To prove the feasibility of microbial manufacturing of all MIAs, we chose one of the most complex chemicals known to plant chemistry. We didn't know the full pathway needed to make vinblastine when we started back in 2015. We also weren't aware of the shortages facing society. It was the longest pathway we knew of, and we knew that it likely encoded 30-something enzymatic reactions. The big challenge was how to program a single yeast cell with 30 plus steps and still ensure that the reprogrammed cell would function as needed while being able to sustain itself. That was the main challenge and the biggest part of our research. It wasn't straightforward at all," says Jie Zhang.

Michael Krogh Jensen, senior researcher at DTU and one of the corresponding authors of the study, adds:

"We must put the right 'personnel' along the cell's assembly line. We also need supplementation from other assembly lines already in the yeast cell to make it work smoothly. We need what are called co-factors. You also need to make sure that, at the same time, the starting material is in place for other essential functions in the cell."

The team performed fifty-six genetic edits to program the 31-step biosynthetic pathway into baker's yeast. Though the work was difficult, and more work is needed, the authors expect that yeast cells will be a scalable platform for producing more than 3000 naturally occurring MIAs and millions of new-to-nature analogues in the future.

"In this project, we were looking for new ways of manufacturing complex chemistry essential for human health, although the technology may also be useful in agriculture and material sciences. Biotechnology offers something exciting because chemical synthesis is difficult to scale, and natural resources are finite. We believe a third approach is needed: Fermentation or whole-cell manufacturing. The assembly lines known from nature are plugged into microbial cells and allow the cells to produce some of these complex chemicals," says Michael Krogh Jensen.

According to the authors, among the many new essential MIAs that may now be produced based on their new platform are the chemotherapeutical drugs vincristine, irinotecan, and topotecan. All of which are also on the World Health Organization's essential medicines list together with vinblastine.

Yeast cells show promise in medicine production.

The research further underlines recent developments within synthetic biology, where engineered yeast is used for medicine production. Other molecules that cell factories can now produce include potential drugs for treating cancer, pain, malaria, and Parkinson's disease.

Producing medications that are otherwise sourced from plants in industrial-scale fermenters using cheap and renewable substrates may alleviate future shortages and create a more sustainable economy independent of farmed or rare organisms.

Corresponding author Jay D. Keasling, Professor of Chemical & Biomolecular Engineering at the University of California, Berkeley and Scientific Director at DTU Biosustain, has long been a synthetic biology pioneer at the fore in utilizing it to produce essential molecules. Case in point: In 2003, he successfully engineered E. coli bacteria to produce a precursor to artemisinin, an anti-malarial drug. Later, he would engineer the entire pathway into yeast cells, much like yeast cells may now be used to produce vindoline and catharanthine.

"The metabolic pathway that we constructed in yeast is the longest biosynthetic pathway that has ever been reconstituted in a microorganism. This work demonstrates that very long and complicated metabolic pathways can be taken from nearly any organism and reconstituted in yeast to supply much needed therapeutics that are too complicated to synthesize using synthetic chemistry. Because yeast is inherently scalable, this engineered yeast could one day supply vinblastin as well as the 3,000 other related molecules in this family of natural products. Not only will this increase the supply and reduce the cost of these products for consumers, but the production is also environmentally friendly because it eliminates the need to harvest sometimes rare plants from sensitive ecosystems to obtain the molecules."

FACT BOX

International collaboration

The research project started in 2015 with a total budget of 9M € co-funded by the Novo Nordisk Foundation, the European Union, and the BioInnovation Institute. It involved a cross-disciplinary team of scientists specialised in, i.a., chemistry, analytics, imaging, bioinformatics, machine learning and characterisation.

Taylor & Francis launches new resources to support better understanding of monkeypox

Business Announcement

TAYLOR & FRANCIS GROUP

Academic publisher Taylor & Francis today launched a Monkeypox Hub and journal article collection. These new resources will help scientists, practitioners, and members of the public find the trusted, peer-reviewed research they need to understand every aspect of the current outbreak.

The World Health Organization declared the 2022 monkeypox outbreak a Public Health Emergency of International Concern. As of August 29, there have been nearly 49,000 confirmed cases across 99 locations (countries, territories, and areas), the vast majority in locations that haven’t historically reported monkeypox cases. The rapid daily increase in cases, with some resulting in death, is causing understandable concern among the public and spurring on scientists to further improve understanding and treatment of the disease.

The new Taylor & Francis Monkeypox Hub is designed for a broad spectrum of users, including public health workers and the public. Across eight sections, the microsite introduces visitors to articles and book chapters on transmission, treatment, and vaccination. The hub also features useful research on tackling health-related stigma and on effective health communication. This is supported by links to advice from a range of authoritative health organizations. 

The monkeypox article collection on Taylor & Francis Online brings together, in one place, over 150 papers covering, monkeypox, smallpox, vaccinia, and related vaccines, as well as historical and broader perspectives. The collection was developed for scientists working in these areas, to help advance research discoveries in the fight against monkeypox.

All the articles and book chapters featured in these resources are free to access, in line with the recent call by the White House Office of Science and Technology Policy for public access to monkeypox-related research. In addition, Taylor & Francis is working with PubMed Central on plans to deposit journal articles in a dedicated monkeypox section of the repository. 

New research articles will continue be added to both resources as they are published, so users are encouraged to bookmark the pages to keep up to date with the latest findings and advice.

WE CALLED THEM 'SMOKE BREAKS'

“Micro-breaks” from tasks show promise in boosting wellbeing

Multi-study review also suggests short breaks may improve performance in certain settings

Peer-Reviewed Publication

PLOS

Energy levels can be preserved with micro-breaks. 

IMAGE: ENERGY LEVELS CAN BE PRESERVED WITH MICRO-BREAKS. view more 

CREDIT: MICHAƁ JAMRO, PIXABAY CC0 (HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)

A review of 22 previously published studies suggests that taking micro-breaks—discontinuing a task for periods of 10 minutes or less—is generally associated with reduced fatigue and increased vigor. Patricia Albulescu of the West University of Timioara, Romania, and colleagues present these findings in the open-access journal PLOS ONE on August 31, 2022.

Concerns are rising over the heavy workloads and long shifts faced by many employees currently in the work force. An increasing number of studies explore various aspects of employee energy management and recovery, often focused on recovery after the workday is over. However, the potential effects of recovery processes during the workday remain unclear.

To improve understanding, Albulescu and colleagues conducted a meta-analysis of 22 studies from 19 manuscripts published within the last 30 years, all of which examined the potential benefits of taking micro-breaks from assigned tasks. Tasks varied between experiments and included work simulations, real work-related tasks, and non-work-related cognitive tests. Types of breaks varied as well, including physical breaks, relaxing activities, and more engaging activities, such as watching videos.

Statistical analysis of the combined study results revealed an overall association between micro-breaks, higher levels of vigor, and lower fatigue in participants, suggesting that micro-breaks may contribute to wellbeing.

No overall association was found between micro-breaks and better performance on tasks. However, when taking a closer look at the data, the researchers did find that longer breaks tended to be linked to better performance, especially for creative or clerical tasks, but less so for more cognitively demanding tasks.

These findings support micro-breaks as a potential strategy for boosting wellbeing in the workplace. However, when it comes to job performance, longer breaks may be needed for recovery from more cognitively demanding tasks. Future research could investigate longer breaks as well as address other remaining questions, such as optimal activities to engage in during a micro-break.

The authors add: "Our results revealed that micro-breaks are efficient in preserving high levels of vigor and alleviating fatigue." 

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In your coverage please use this URL to provide access to the freely available article in PLOS ONEhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272460

Citation: Albulescu P, Macsinga I, Rusu A, Sulea C, Bodnaru A, Tulbure BT (2022) "Give me a break!" A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. PLoS ONE 17(8): e0272460. https://doi.org/10.1371/journal.pone.0272460

Author Countries: Romania

Funding: The work of A.R. was supported by a grant of the Romanian Ministry of Education and Research, CNCS - UEFISCDI, project number PN-III-P1-1.1-TE-2019-2032, within PNCDI III.

WORKPLACE SOCIAL RELATIONS

First impressions formed during “small talk” may influence future strategic interactions

Study participants co-operated more with partners they believed to be extroverts in strategic games

Peer-Reviewed Publication

PLOS

Two people having a conversation. 

IMAGE: TWO PEOPLE HAVING A CONVERSATION. view more 

CREDIT: PRISCILLA DU PREEZ, UNSPLASH, CC0 (HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)

In a new study, participants who engaged in small talk with others formed impressions about their conversation partners’ personalities that subsequently appeared to influence their behavior when playing strategic games with them. Neha Bose and Daniel Sgroi of the University of Warwick, U.K., present these findings in the open-access journal PLOS ONE on August 31, 2022.

Numerous prior studies have examined the role of people’s personalities on strategic behavior in the field of economics. However, less is known about how people’s impressions of others’ personalities might influence strategic interactions. Previous research has explored how personality impressions may arise through face-to-face interactions, observing others’ physical appearance, or observing their behavior.

To expand understanding of personality impressions and strategic behavior, Bose and Sgroi conducted a study focused on impressions formed through “small talk.” Specifically, they asked 168 participants to engage in 4 minutes of instant-messaging-based conversation with another participant. Next, participants noted their impressions of their conversation partners’ personality, with a focus on extraversion and neuroticism. Finally, participants were asked to engage their conversation partner in two strategic games. For comparison, 170 additional participants did not engage in small talk before playing the games.

The researchers found that participants who engaged in small talk formed impressions about their partners’ personalities—particularly regarding their level of extraversion, and these impressions appeared to influence their strategic behavior during the games.

The influence of small-talk-derived personality impressions varied depending on the specific game. In one game with both competitive and cooperative elements, participants behaved more cooperatively if they believed their partner to be extraverted. In a competitive game involving prediction of the opponent’s behavior, participants faced greater difficulty in out-guessing opponents if they felt they shared similar personality traits with each other.

The authors note that this study is exploratory, and that it could serve as a first step towards future research into the links between personality impressions and strategic decision making across a range of real-world contexts.

The authors add: “Our work highlights the importance of regular “small talk” communication, even when it doesn’t seem relevant or important. Through short seemingly trivial interactions with others we become better able to predict the personalities of those we talk with which in turn boosts our performance when we interact with them in the future.”

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In your coverage please use this URL to provide access to the freely available article in PLOS ONEhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269523

Citation: Bose N, Sgroi D (2022) The role of personality beliefs and “small talk” in strategic behaviour. PLoS ONE 17(8): e0269523. https://doi.org/10.1371/journal.pone.0269523

Author Countries: UK, Germany

Funding: Funding for this project was provided by the ESRC CAGE Centre (Grant Ref RES-626-28-0001). University of Warwick Departmental IRB approval obtained (12-03-2018). The experiment for the study is registered at the AEA RCT Registry (RCT ID AEARCTR-0002903) https://www.socialscienceregistry.org/trials/2903. The authors are grateful to Thomas Hills, Kirill Pogorelskiy, Anu Realo, Gordon Brown and Sharun Mukand from Warwick University for helpful discussions related to the paper and to John Taylor from Warwick Business School for help with the experimental sessions. The authors would also like to thank Andis Sofianos for providing the Raven’s test matrices used in Proto, Rustichini, and Sofianos, 2019. Relevant data and code is available via GitHub at https://github.com/boseneha/Personality-beliefs-andsmall-talk.

How can a welfare state boost population health?

Researchers analyzing 21 countries from 1971 to 2010 found an association between decommodification and a lower age-standardized death rate.

Peer-Reviewed Publication

PLOS

“Social Security” written on a typewriter. 

IMAGE: “SOCIAL SECURITY” WRITTEN ON A TYPEWRITER. view more 

CREDIT: MARKUS WINKLER, PEXELS, CC0 (HTTPS://CREATIVECOMMONS.ORG/PUBLICDOMAIN/ZERO/1.0/)

Welfare state decommodification is associated with a lower age-standardized death rate and improved population health due to both direct and indirect mechanisms, according to a new study published this week in the open-access journal PLOS ONE by Olivier Jacques and Alain NoĂ«l of the University of Montreal, Canada.

Decommodification—the reduction in the scope and influence of the free market on citizen’s lives—is an outcome of welfare states that provide strong social programs. Previous research has established a relationship between overall welfare state generosity and population health, but the exact mechanisms associating decommodification with health are poorly understood. 

In the new study, the researchers used data spanning 1971 to 2010 on the age-standardized death rate per 100,000 inhabitants in 21 countries belonging to the Organization for Economic Cooperation and Development (OECD). They found a negative correlation between the death rate and levels of decommodification. When they analyzed separate correlates of decommodification, they found that decreased labor market polarization—the ratio of jobs with lower and higher skill and pay— and decreased labor market risk, which describes the risk associated with unemployment, were associated with improved population health, particularly in men. However, income redistribution was not associated with health.

The authors conclude that population health relates less to the direct redistribution of income and more to the reduced vulnerability to risks and social insecurity associated with welfare state generosity.

The authors add: “The welfare state contributes to healthier lives, directly by providing resources and services to individuals, and indirectly by reducing labor market income polarization and risks.”

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In your coverage please use this URL to provide access to the freely available article in PLOS ONEhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272698

Citation: Jacques O, NoĂ«l A (2022) Welfare state decommodification and population health. PLoS ONE 17(8): e0272698. https://doi.org/10.1371/journal.pone.0272698

Author Countries: Canada

Funding: Research contract with the MinistĂšre de la SantĂ© et des Services Sociaux du QuĂ©bec. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Going with the flow: Study shows the blend of blue and green space at former industrial canals helps boost your mood

Peer-Reviewed Publication

PLOS

Birmingham Main Line Canal 

IMAGE: BIRMINGHAM MAIN LINE CANAL. view more 

CREDIT: CANAL AND RIVER TRUST, CC-BY 4.0 (HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/)

Going with the flow: study shows the blend of blue and green space at former industrial canals helps boost your mood

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Article URL:  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0271306

Article Title: The mental health benefits of visiting canals and rivers: An ecological momentary assessment study

Author Countries: UK

Funding: This study was supported by a grant from The Medical Research Council (MRC; https://www.ukri.org/councils/mrc/) (grant number MR/S026428/1) awarded to AM and ST. This study was also supported by a the The National Institute for Health and Care Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (https://www.maudsleybrc.nihr.ac.uk) awarded to AM. Finally, the study was also supported by The Canal & River Trust (CRT; https://canalrivertrust.org.uk/) awarded to JG and ND. Jenny Shepherd (CRT) and Graham Reeves (CRT) provided feedback on the study design and preparation of the manuscript. No other funders had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Racehorses perform just as well with female jockeys as males in training and races, per analysis of Australian race yard

Peer-Reviewed Publication

PLOS

Racehorses training with Equimetre data-logging device. 

IMAGE: RACEHORSES TRAINING WITH EQUIMETRE DATA-LOGGING DEVICE. view more 

CREDIT: ARIONEO LTD, CC-BY 4.0 (HTTPS://CREATIVECOMMONS.ORG/LICENSES/BY/4.0/)

Racehorses perform just as well with female jockeys as males in training and races, per analysis of Australian race yard

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Article URL:  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273310

Article Title: Does sex of the jockey influence racehorse physiology and performance

Author Countries: UK, France, Belgium

Funding: The authors received no specific funding for this work. Arioneo Ltd provided all data used in this study but had no role in study design or analysis, decision to publish, or preparation of the manuscript.



Old drugs hint at new ways to beat chronic pain

A newly identified link between chronic pain and lung cancer in mice offers hope for pain management

Peer-Reviewed Publication

IMBA- INSTITUTE OF MOLECULAR BIOTECHNOLOGY OF THE AUSTRIAN ACADEMY OF SCIENCES

Visualizing pain in mouse sensory neurons (I) 

IMAGE: MOUSE SENSORY NEURONS ARE SHOWN IN MAGENTA. BH4, THE MOLECULE DRIVING CHRONIC PAIN, IS SHOWN IN GREEN. HENCE, THE NEURONS “IN PAIN” ARE SEEN IN GREEN/WHITE. view more 

CREDIT: ©CRONIN/IMBA

Pain is an important alarm system that alerts us to tissue damage and prompts us to withdraw from harmful situations. Pain is expected to subside as injuries heal, but many patients experience persistent pain long after recovery. Now, a new study published in Science Translational Medicine points to possible new treatments for chronic pain with a surprising link to lung cancer. The work was spearheaded by an international team of researchers at IMBA – Institute of Molecular Biotechnology of the Austrian Academy of Sciences, Harvard Medical School, and Boston Children’s Hospital. Their findings of the research, conducted in laboratory mouse models, open up multiple therapeutic opportunities that could allow the world to improve chronic pain management and eclipse the opioid epidemic.

 

Acute pain is an important danger signal. By contrast, chronic pain is based on persistent injury and can even be experienced in the absence of a stimulus, injury, or disease. Despite the hundreds of millions of people affected, chronic pain is among the least well-managed areas of healthcare. To improve how persistent pain is managed and considering the raging opioid crisis, it is paramount to develop novel drugs based on a fundamental understanding of the underlying mechanisms. “We had previously shown that sensory neurons produce a specific metabolite, BH4, which then drives chronic pain, such as neuropathic pain or inflammatory pain,” says project lead and co-corresponding author Shane Cronin, a staff scientist in the Penninger lab at IMBA and a former postdoc in the Woolf lab at Harvard Medical School and F.M. Kirby Neurobiology Center, Boston Children’s Hospital. “The concentrations of BH4 correlated very well with the pain intensity. So, we naturally thought that this was a great pathway to target.

To identify drugs that reduce BH4 levels in pain neurons, the researchers performed a “phenotypic screen” of 1000 target-annotated, FDA-approved medications. This approach allowed the scientists to start their search using medications that are currently in use for various indications, and to identify undescribed, off-target analgesic properties. Among the first findings of this hypothesis-driven search, the team was able to link the previously observed analgesic effects of several drugs, including clonidine and capsaicin, to the BH4 pathway.

However, our phenotypic screen also allowed us to ‘repurpose’ a surprising drug,” says Cronin. The drug ‘fluphenazine’, an antipsychotic, has been used to treat schizophrenia. “We found that fluphenazine blocks the BH4 pathway in injured nerves. We also demonstrated its effects in chronic pain following nerve injury in vivo.” The researchers also found that the effective analgesic dose of fluphenazine in their experiments in the mouse model is comparable to the low end of the doses safely indicated for schizophrenia in humans.

In addition, the screen uncovered a novel and unexpected molecular link between the BH4 pathway and EGFR/KRAS signaling, a pathway involved in multiple cancers. Blocking EGFR/KRAS signaling reduced pain sensitivity by decreasing the levels of BH4. The genes of EGFR and KRAS are the two most frequently mutated genes in lung cancer, which prompted the researchers to look at BH4 in lung cancer. Surprisingly, by deleting an important enzyme, GCH1, in the BH4 pathway, the mouse models of KRAS-driven lung cancer developed fewer tumors and survived much longer. Hence, the researchers uncovered a common signaling pathway for chronic pain and lung cancer through EGFR/KRAS and BH4, thus opening up new avenues of treatment for both conditions.

Chronic pain is currently subjected to often ineffective palliative treatments. Furthermore, effective painkillers such as opioids can lead, if used inappropriately, to severe addiction. It is therefore critical to find and develop new and repurposed drugs to treat chronic pain,” says co-corresponding author Clifford Woolf, professor of neurology and neurobiology at Harvard Medical School and director of the F.M. Kirby Neurobiology Center at Boston Children’s Hospital.

One intriguing aspect of the study is the mechanistic link between pain and lung cancer. “The same triggers that drive tumor growth appear to be also involved in setting the path to chronic pain, often experienced by cancer patients. We also know that sensory nerves can drive cancer, which could explain the vicious circuit of cancer and pain,” adds co-corresponding author Josef Penninger, IMBA group leader and founding director, who is currently also the director of the Life Sciences Institute at the University of British Columbia (UBC), Vancouver, Canada. “Understanding these cross-talks is therefore not only critical for cancer treatments but might also help to improve the quality of life for cancer patients towards less pain.

Mouse sensory neurons are shown in green. BH4, the molecule driving chronic pain, is shown in magenta. Hence, the neurons “in pain” are seen in magenta/white.

CREDIT

©Cronin/IMBA

Original publication:

Cronin, S. J. F., et al., “Phenotypic drug screen uncovers the metabolic GCH1/BH4 pathway as key regulator of EGFR/KRAS-mediated neuropathic pain and lung cancer”. Science Translational Medicine, 2022. DOI: 10.1126/scitranslmed.abj1531

 

About IMBA:

IMBA – Institute of Molecular Biotechnology – is one of Europe's leading biomedical research institutes. IMBA is located at the Vienna BioCenter, the vibrant cluster of universities, research institutes, and biotech companies in Austria. IMBA is a subsidiary of the Austrian Academy of Sciences, the leading national sponsor of non-university academic research. The stem cell and organoid research at IMBA are being funded by the Austrian Federal Ministry of Science and the City of Vienna.

More than half of hospital-based maternal deaths occur at times other than childbirth

Study suggests hospital-based maternal deaths are occurring earlier in pregnancy or postpartum – while maternal deaths occurring at the time of delivery are declining in the U.S.

Peer-Reviewed Publication

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

Hospitalizations that occur in the antenatal period – or during pregnancy, but before giving birth— and those that occur in the postpartum period, made up over half of in-hospital maternal deaths between 2017-2019, a new study reveals.

The findings, published in JAMA Network Open, estimated rates of in-hospital maternal deaths from the National Inpatient Sample from the years 1994 to 2015 and from 2017 to 2019 among antenatal, childbirth, and postpartum hospitalizations in the United States. 

“Maternal mortality rates are high in the United States, higher than as seen in all other industrialized countries”, said lead author Lindsay Admon, M.D., MSc, an assistant professor of obstetrics and gynecology at the University of Michigan Medical School and obstetrician-gynecologist at University of Michigan Von Voigtlander Women’s Hospital.

“Maternal mortality continues to increase in the U.S, and we wanted to understand trends in hospital-based deaths: Are they happening during pregnancy, at birth, or postpartum? Has this changed over time? Basically, we wanted to generate data that could help design clinical and policy interventions for preventing the most adverse of all obstetric outcomes in the hospital setting, maternal death.

In their recent study, Admon and co-authors found that over the 20-year period between 1994- 1995 and 2014-2015, in-hospital maternal deaths occurring at the time of childbirth declined by more than half (56%). During the same period, rates of in-hospital maternal death occurring during the antenatal and postpartum periods remained unchanged.

In looking at the most recent data from 2017 to 2019, the research team found that hospitalizations for childbirth accounted for nearly 90% of hospitalizations occurring during pregnancy through a few weeks after childbirth – but for only half of in-hospital maternal deaths. 

In contrast, antenatal and postpartum hospitalizations accounted for less than 10% of all hospitalizations occurring during pregnancy through a few weeks after childbirth, but half of the in-hospital maternal deaths identified.

“It’s important to note that it appears progress has been made in lowering the rate of maternal death at the time of childbirth,” said Admon. “At the same time, we know that maternal mortality continues to increase in the U.S. To further lower rates of maternal death occurring in the hospital, we need to focus not only on the time of delivery but also examine risks and complications occurring during antenatal and postpartum hospitalizations as well.”

Perinatal Quality Collaboratives and resources such as patient safety bundles provided by The Alliance for Innovation on Maternal Health have been implemented in hospitals across the U.S. to reduce preventable maternal mortality, and research has shown that in many cases this has improved rates of maternal morbidity and mortality at the time of childbirth.

With this new study, Admon says there needs to be a renewed focus on examining the causes of in-hospital maternal death during pregnancy periods other than delivery.

“We’re ready to dig into this work further and determine the main drivers of maternal deaths occurring during antenatal and postpartum hospitalizations and whether these differ from those influencing delivery-related outcomes,” she explained.

“Detailed reviews of each case are so important. Once the root causes are identified, clinical and policy changes can be more clearly directed towards improving maternal health and reducing maternal morbidity and mortality.”

Study cited: “Trends and Distribution of In-Hospital Mortality Among Pregnant and Postpartum Individuals by Pregnancy Period,” DOI: 10.1001/jamanetworkopen.2022.24614