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Research Opportunities for Fellows

The research opportunities for the Maternal-Fetal Medicine fellows are based on the following elements:

1. Availability of Obstetric Populations.
The clinical activities of the Division of Maternal-Fetal Medicine operates at two primary hospitals (RWJUH and Jersey Shore University Medical Center). Of the 4000+ deliveries, approximately one-third are clinic patients whose care is provided by the UMDNJ-Robert Wood Johnson Medical School residents and fellows under the direct supervision of Maternal-Fetal Medicine faculty members. In addition, the MFM Division directly cares for over 200 high-risk obstetrical patients per year in their private practice as well as approximately 200 patients transported from other health care facilities. The Division also supervises the care of nearly 200 high-risk clinic patients annually referred from around Central New Jersey.

The various ultrasound facilities are equipped with state-of-the-art 3D/4D ultrasound machines with color flow Doppler capabilities. Approximately 18,000 ultrasound examinations are performed each year with half of the examinations being performed on clinic as well as MFM patients. The MFM fellows and faculty provide the entire coverage for the ultrasound unit in which a variety of procedures are carried out including targeted sonography to assess fetal anomalies, nonstress tests, biophysical profiles, Doppler velocimetry, fetal echocardiography, percutaneous umbilical blood sampling, chorionic villus sampling and amniocentesis.

2. Large MFM Division with Diversity in Clinical Talent and Expertise.
The Division of Maternal-Fetal Medicine consists of 8 full-time faculty members. The diversity in talent and expertise of the MFM physicians are reflected in their functional titles as follows:

Joseph C. Canterino, MD
Associate Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center
Director, Perinatal Genetics

Susan Janeczek, DO
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Director, Undergraduate Medical Education in Maternal-Fetal Medicine
Director, Diabetes in Pregnancy Program

Maria E. Martins, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Director, Chorionic Villus Sampling Services

Paul Matta, DO
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Myriam Mondestin-Sorrentino, MD
Assistant Professor
Associate Director, Pregnancy Loss Evaluation Service
Department of Obstetrics, Gynecology and Reproductive Sciences
Jersey Shore University Medical Center

Yinka Oyelese, MD
Assistant Professor
Director, High-Risk Pregnancy Services
Department of Obstetrics, Gynecology and Reproductive Sciences

3. Basic Research Facilities.
The OB/GYN Department Perinatal Biology laboratories, directed by Morgan R. Peltier, PhD, are located in New Brunswick, New Jersey adjacent to our clinical and academic offices and offers resources for cell biology studies, protein analysis, PCR and immunohistochemistry. Areas of interest include a) inflammation pathways, b) mycoplasma virulence, c) and immunity mechanisms of the cervix, vagina, and placenta. Additional laboratory facilities located in Piscataway, New Jersey are directed by William Moyle, PhD and four technicians. The research activities of this group fall into two broad categories, namely (a) studies of the structure and function of glycoprotein hormones and (b) studies of the structure and function of the receptors of glycoprotein hormones. The main focus of the laboratory is to provide new information about the interactions of reproductive hormones and their receptors as related to fertility and pregnancy. An additional research laboratory is being established within the department to support a variety of molecular biology related studies involving RNA expression, PCR, protein isolation, electron microscopy and immunohistochemistry. Basic research opportunities also exist in collaboration with: (1) the Department of Pediatrics Genomics Laboratories; (2) the Division of Neonatology, Cytokine/Inflammation program; (3) the Rutgers School of Pharmacy Extracellular Matrix laboratories directed by Emmy Gordon, PhD; (4) the environmental laboratories of the Environmental and Occupational Health Sciences Institute; (5) Proteomics New Jersey Medical School, Newark; and (6) UMDNJ Child Health Institute, New Brunswick.

4. Availability of a Full-Time Epidemiologist and Biostatistician.
The department has a Division of Epidemiology and Biostatistics staffed by a full-time perinatal epidemiologist/biostatistician. The Division Director is Cande V. Ananth, PhD, MPH. Dr. Ananth is available to the MFM fellows for helping with study design, statistics and statistical analysis and participates in all weekly research meetings of the Division. He also provides bimonthly lectures on biostatistics and epidemiology. Additional personnel are being recruited to assist Dr. Ananth as the Division grows.

5. Availability of a Full-Time Research Nursing Staff.
The Division of Maternal Fetal Medicine has one full-time nurse researcher. The research nurse is experienced in protocol development, study coordination, data collection, data base design and patient recruitment. In addition, she is available to assist with informed consent and enrolling patients into clinical research protocols.

6. Availability of computerized Perinatal Data Systems.
The MFM Division has already in place and fully functioning two clinical information systems for the Labor and Delivery Suite and the ultrasound unit. A newly updated Observerâ„¢ computer system for our ultrasound unit runs on a departmental wide network. There are data entry workstations located in the ultrasound examination rooms and workstations in the dedicated reporting rooms. This data storage and reporting system provides the capability for the direct downloading of biometric information acquired during the ultrasound evaluations, as well as image archiving. The described perinatal data systems provide a unique opportunity for the fellows to conduct clinical research studies.

7. Availability of a Clinical Research Center.
The clinical research center of the Robert Wood Johnson Medical School is a combined in-patient and out-patient facility with extensive experience in administration of clinical research protocols. It includes 12 licensed in patient beds with a capacity to expand to 16, including 4 beds equipped with electronic monitors for electrocardiographic and invasive physiologic studies. There are also 4 out-patient clinic rooms in the facility with a phlebotomy suite which can accommodate several hundred patient visits per week. The center offers the fellows the opportunity to conduct many safety and tolerability studies, as well as pharmakokinetic drug trials.

8. Divisional Research Interests

Pre-Pregnancy Health

Screening strategies to correctly identify women at high-risk for perinatal
complications
Folic acid supplementation to prevent birth defects
Treatment of medical conditions that can affect perinatal outcomes
Define racial and ethnic contributions to pre-pregnancy health that affect perinatal outcomes
Pre-pregnancy evaluations of previous medical, obstetric and neonatal complications to help design treatment strategies for before, during and after pregnancy
Preterm Birth Research

Infection
Apoptosis (programmed cell death)
Ultrasound as a screening tool to predict preterm birth
Population-based risk factor analyses
Population-based infant outcome studies
Preterm infant follow-up studies (prediction of morbidity and mortality, respiratory function, neurodevelopmental function)
The extracellular matrix in membranes, cervix and uterus
The extracellular matrix in newborn vascular adaptation to life outside the uterus
Immunologic aspects of prematurity (inflammation, immune tolerance, immune system dysfunction)
Hypertensive Diseases of Pregnancy

Screening for at-risk women using ultrasound and Doppler evaluations
Monitoring and managing pregnancies with preeclampsia
Placental abnormalities with preeclampsia
Blood clotting disorders (thrombophilias) as risk factors
Population-based risk factor analyses
Population-based infant outcome studies
Markers of oxidative stress with preeclampsia
Prevention trials
Vascular reactivity
Fetal Growth

Non-invasive ultrasound Doppler assessments of altered maternal vascular reactivity and uteroplacental blood flow blood flow
Management of pregnancies at high risk for abnormal fetal growth
Mechanisms of fetal and neonatal nutritional compromise
Neonatal and infant outcomes
The long-term consequence of abnormal fetal growth
Population-based risk factor and outcome studies
Prevention trials
Fetal and Neonatal Brain Development

Normal and abnormal fetal behavior as a predictor of neurologic function
New techniques for assessing fetal and neonatal neurologic function
Imaging: Ultrasound, (MRI), and EEG
The role of oxidative stress and inflammatory injury in neurologic development
The effects of abnormal fetal growth and low birth weight on neurologic function
Predictors of developmental outcomes
Interventions to improve developmental outcomes in at-risk infants
Long-term follow-up of at risk infants
Birth Defects and Prenatal Diagnosis

Epidemiological studies of congenital abnormalities
Improved ascertainment and tracking of diagnosed congenital abnormalities
UMDNJ New Jersey Fetal Abnormalities Registry which is a cooperative effort with the NJ Department of Health and Senior Services and the Centers for Disease Control and Prevention, Atlanta, GA.
Etiology studies
Application of cost efficient screening strategies
New diagnostic modalities (testing and imaging)
Management of diagnosed congenital abnormalities
Short and long-term outcomes
Economics of congenital abnormalities
Early Origins of Adult Disease

Fetal growth restriction/malnutrition
Prematurity
Congenital malformations
Infection
Hypoxia
Interventions that can moderate the impact of these conditions on later health
Follow-up outcome studies
Pregnancy Loss

Epidemiology
Cost-effective and evidence-based evaluation strategies
Immunologic mechanisms of fetal loss
Disorders of blood clotting systems and fetal loss
Placental dysfunction
Gene-environment interactions
Prevention studies
Perinatal Health Economics

Information systems development and implementation
Cost effectiveness/benefit analyses
Database design and data management
Relevant outcome assessments
Condition specific care research
Perinatal Epidemiology and Outcomes Research

Black-white disparities in adverse perinatal outcomes in the US, including prematurity, fetal growth restriction, fetal and infant mortality.
The role (both content and timing) of prenatal care on adverse perinatal outcomes.
Provide recommendations on indication-specific "optimal" prenatal care in the US.
Secular and temporal trends in the incidence of preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
Causes of temporal trends in preterm delivery, small for gestational age births, and fetal and neonatal mortality among US blacks and whites.
The role of age, period and birth cohort effects on preterm delivery and small for gestational age births among US blacks and whites.
Risk factor profiling of obstetric complications among singleton and twin births in the US.
Gene-environment interactions, as well as familial aggregation of placental abruption, fetal growth restriction, and stillbirth, through family-based case-control studies.
Developing innovative statistical methodologies for analysis of studies, especially focusing on methods for longitudinal and repeated measures (clustered) data.