Generously funded by Marc and Lynne Benioff, PTBi-CA focuses on those at highest risk of preterm birth — women of color and lower income — within three communities: San Francisco, Oakland, and Fresno.
PTBi-CA takes a disruptive approach, bringing together UCSF researchers from across numerous specialties and disciplines, public health agencies and community leaders to work in direct partnership with members of affected communities. We rely on the wisdom of mothers who have experienced preterm birth and the clinical providers who treat them at all phases of the research process — from developing the research agenda to sharing the results.
Our initiative recognizes the critical role that "place"— daily life context—plays in influencing a woman's health and pregnancy outcomes. In fact, the socioeconomic profile of an infant's neighborhood is the strongest determinant of his or her risk for preterm birth.
By taking a "deep dive" into prematurity within a particular local context — examining not only genetics, but also the physical and social environment within neighborhoods where at-risk patients live as well as health, work and social policies that affect women's health before during and after pregnancy — we will develop a much more precise understanding of the drivers of this epidemic — and of how to stop it. This is truly Precision Health, an innovative approach that takes into account individual differences in people's genes, environments, and lifestyles.
Every day in the U.S., there are 1,052 preterm births. That's 384,000 each year.
PTBi-CA has four aims:
Aim 1: Discovery
African-American and Latina women, as well as poor women of all races and ethnic groups, are more than 50 percent more likely to deliver preterm. Psychosocial, physical, and environmental stressors such as depression, hypertension, drug abuse and smoking, food and housing insecurity and air pollution increase the risk of preterm birth. However, it is unclear how these stressors relate to preterm birth at a molecular level. PTBi-CA engages in research aimed at understanding interconnected, stress-related, cell-to-society drivers of preterm birth.
Aim 2: Interventions
Previous research has shown several interventions to be effective in reducing preterm birth, but they have not been implemented under real-world conditions or scaled-up to a population level. These include:
- Use of long-acting reversible contraceptives to prevent poorly timed pregnancy
- Group prenatal care
- Progesterone administration among women at particularly high risk of preterm birth
- Kangaroo (skin-to-skin) care and breastfeeding for preterm infants
- Home care and support for families of babies born preterm
Our goal is to unlock the reasons for low uptake and remove the barriers that impede scale up of these effective interventions.
We also are studying promising interventions for which limited or no preliminary data exists, including technologies to improve early detection of at-risk pregnancies and to help better manage premature newborns.
Aim 3: Collective Impact
Collective impact is a collaborative strategy that brings together diverse groups to work together to achieve a well-defined health-related or social change. Preliminary evidence shows this approach is working in health-related efforts in San Francisco around HIV/AIDS, pedestrian safety, and chronic disease. PTBi-CA is bringing together hospitals, primary care clinics, public health-funded programs, and community organizations that usually deliver services in isolation to work together to reduce preterm birth rates. During our planning year, we selected Fresno as our first collective impact effort.
Aim 4: Communication, Collaboration, and Capacity Building
This aim is a joint effort with our PTBi East Africa colleagues to reimagine how information on prematurity and risk reduction is created, packaged, transmitted, and interpreted among a variety of important and diverse stakeholders. We will work to disseminate knowledge, partner with diverse stakeholders, and build the capacity of academic and community leaders domestically and globally.