DAN Women & Babies Research

The research focus of our pregnancy program has been in the conduct of international randomized controlled trials (RCTs). Several of our landmark studies have changed the practice of obstetrics worldwide.

Our scientists are working on the following studies:

• Benefits and risks of different approaches to the management and delivery of twins and breech presentations (Barrett, Asztalos)
• Outcomes of pregnancies in which fetuses are at increased risk of death and long-term neurodevelopmental problems after birth (Barrett, Asztalos)
• Role of the specialized twin clinics
• Normal hematology of twin pregnancy
• Use of a patient-carried record in an antenatal clinic setting (Barrett, Brown)
• Benefits and risks of treatments (e.g., repeating courses of antenatal corticosteroids, tocolytics) to reduce mortality and neurodevelopmental problems associated with preterm birth (Barrett, Asztalos)
• Use of simulation technologies in patient safety and the evaluation of obstetric team management (Pittini, Morgan)
• Role of various genes including TGF, SGLIT-I and endoglin on placental function (Nevo)
• Use of first trimester anomaly screens (Nevo)
• Thermoregulatory response in labour (Akoury)
• Effect of small epidural needles on the incidence and severity of posdtural puncture headache (Angle)
• Use of ultrasound technology to determine needle placement for spinal and epidural anesthesia more accurately (Halpern)
• Use of high-fidelity simulation for obstetrical team training in order to enhance safety in high-risk situations (Morgan)

We have an active nursing research team focused on studies related to:

• Fluid management in labour, including breastfeeding problems including mastitis and low milk supply
• Experiences of nurses in labour and delivery in caring for families whose babies have died
• Women’s experiences of sleep during hospitalization for high-risk pregnancies

We also have obstetrical anesthesiologists involved in clinical trials to make labour analgesia safer and reduce the incidence of side effects.

Traditionally, evaluative clinical sciences is the main research platform associated with the neonatal component of the DAN Women & Babies Program. Members of DAN Women & Babies have played important roles in the design and execution of mechanistic, descriptive and therapeutic trials in neonatology.

Our group has made major contributions to the field through translational research, specifically in surfactant replacement therapy and different approaches to preventing bronchopulmonary dysplasia, a chronic lung disease seen in premature newborns treated with ventilation or oxygen therapy at birth.

In recent years, we have become leaders in the evaluation of the impact of certain aspects of care in the neonatal intensive care unit on long-term outcomes.

Much of our research draws on partnerships and networks. Connections with other neonatal practitioners locally, nationally and internationally have contributed to many of our clinical trials.

We have nurtured successful relationships with industry partners, such as drug companies and equipment manufacturers, to get support to run clinical trials. We are also involved in the following:

• The Canadian and Vermont Oxford Neonatal Networks;
• randomized controlled trials and projects on variations in outcome; and
• many multicentre trials as principal investigators, site investigators or members of study steering committees.

One of our major areas of focus is on practice-based research. This venture is supported by Sunnybrook Health Sciences Centre, the Centre for Research in Women’s Health and by the appointment of a head of interdisciplinary research and evidence-based practice. Contact Sharyn Gibbins for more information.

Our scientists are currently involved in the following neonatology studies:

• Long-term effects of neonatal and obstetrical therapies, such as corticosteroids, using caffeine for apnea in premature infants (Asztalos)
• Red blood cell transfusions (Asztalos)
• Using dexamethasone to treat chronic lung disease (Asztalos)
• Hypothyroxinemia, an abnormally low concentration of thyroxine in the blood, and its effects on the neurodevelopment of preterm infants (Asztalos)
• Long-term effects of different doses of inhaled corticosteroids, a neonatal therapy to treat chronic lung disease in premature infants (Dunn)
• Different approaches to the respiratory support of premature neonates in the delivery room (Dunn)
• Neura and muscular control of breathing in preterm infants (Dunn)
• Stabilization and thermal control in the first hour of life for extremely preterm infants (Dunn)
• The differential modulation of oxygen-mediated pulmonary hypertension and parenchymal lung injury in newborn rats (Jankov)
• Treatment of pain and stress in neonates, including:
  • sucrose for procedural pain
  • skin-to-skin contact for procedural pain
  • premedication for endotracheal intubation
  • topical and systemic analgesia for insertion of peripherally inserted central catheter (PICC) lines
• The effect of breast milk fortification after hospital discharge for babies born prematurely (Asztalos)
• The methods and ethics of research in neonatology (Golec)

There are several lines of research in women’s reproductive health. Our researchers are focused on the following studies:

• Treatments for abnormal Pap smears (Shier)
• Assessment of human papillomavirus (HPV) vaccinations (Shier)
• Minimally invasive surgery techniques for abdominal hysterectomy and uterine fibroids (Nitsch, Wong, Liu, Lie)
• The impact of bacterial vaginosis on gynecological procedures
• The use of magnetic resonance imaging (MRI)-direct thrombus imaging for assessment of lesion response to standard treatment in endometriosis
• Better approaches to education in obstetrics and gynecology (Shime, Pittini, Bodley, Blake, Kung):
  • teaching invasive obstetrical procedures
  • mentoring residents
  • determining barriers to promotion

We are also involved in collaborations with several programs:

• Neurosciences: The relationship between estrogen and memory loss (Blake, Tierney)
• Gynecologic oncology: Clinical trials to test treatments for gynecologic cancers and assess fertility-sparing surgery for cervical cancer (Covens, Osborne)

Our oncologists (Covens, Osborne, Shier, Kupets) are a major part of the National Cancer Institute (NCI) and Gynecologic Oncology Group (GOG). They are involved in the use of several chemotherapeutic regimes in a variety of gynecological malignancies, including:

• The development of the HPV vaccine (Shier)
• The establishment of clinical practice guidelines (CPGs) to assist in decision-making about appropriate care for patients with cancer (Kupets)

Our reproductive biology division is active in several areas internally and in collaboration with several other university departments, through research studies including:

• he examination of early human embryonic molecular expression of immune modulators to understand immune tolerance of the human fetus (Librach)
• The effects of the maternal immune system on conditions later in pregnancy from recurrent pregnancy loss to preeclampsia (Librach)
• Molecular markers of polycystic ovary syndrome and sperm developmental markers (Librach)
• Recurrent pregnancy loss from the following perspectives:
  • immunologic (Librach)
  • genetic (Sierra)
  • placentation (Dixon)
• Fertility preservation for patients with cancer (Glass)

We are involved in several clinical trials on methods to improve in vitro fertilization (IVF) outcome by investigating markers of embryo viability, laser-assisted hatching and sperm DNA fragmentation.

We also have several research projects on the psychosocial aspects of infertility (Silverman) and an active research program in stem cells derived from human umbilical cords (Librach). In addition, we are involved in investigating the expression of genetic factors by microarray analysis in women with recurrent miscarriage and implantation failure (Sierra).