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Jeff Stringer

A team led by Jeff Stringer, MD, associate director of research for the Institute for Global Health & Infectious Diseases, has received $14 million from the Bill & Melinda Gates Foundation to conduct two studies aimed at improving pregnancy outcomes in the world’s poorest countries. The interdisciplinary group from departments within UNC’s  School of Medicine and Gillings School of Global Public Health will direct the studies, both of which will explore the role of technology in predicting and addressing key risk factors associated with pregnancy, labor and delivery.

Each year, around 300,000 women and 3 million babies worldwide die during childbirth or shortly thereafter, according to the World Health Organization. Environmental and structural factors, underlying infectious diseases burden, nutritional factors, and underperforming health systems are just some of the major reasons for this.

“In many parts of the world, the days surrounding childbirth are the riskiest period a mother and her newborn will ever face,” says Stringer, who directs the Division of Global Women’s Health in the medical school’s obstetrics & gynecology division and is an adjunct professor of epidemiology in the Gillings School. “These studies will develop resource-appropriate technologies to make that time much safer.”

The Limiting Adverse Birth Outcomes in Resource-Limited Settings, or LABOR, study will focus on the period of pregnancy between the onset of labor through delivery. It will evaluate 15,000 women at high-volume clinical sites in three developing countries, including the Institute’s flagship site in Zambia. The team will provide wearable physiologic sensors to monitor laboring mothers and their fetuses and carefully document their clinical course and birth outcomes.

Using participant data, researchers will develop new algorithms that can both identify individual women’s risk of specific adverse outcomes and help predict and plan for the specific interventions women will likely need. These precision approaches can lead to earlier intervention and better health outcomes for mothers and newborns.

“The data produced by this study will allow us to create a new collection of precision medicine tools that can be used in developing countries to help medical providers better manage patients’ unique needs and result in healthier mothers and babies” says Michael Kosorok, chair of biostatistics at the Gillings School.

The second study, the Fetal Age Machine Learning Initiative, or FAMLI, aims to develop a robust, affordable ultrasound device that can be deployed in limited-resource settings to assess gestational age and other important obstetric information while requiring minimal operator expertise. The team will produce large sets of ultrasound data that can be used to train machine learning algorithms to assess gestational age and make other diagnoses.

“An ultrasound scanner is as important as a stethoscope to the obstetrician, yet these devices are frustratingly absent from prenatal clinics in much of the developing world. The FAMLI project will leverage new techniques in artificial intelligence and machine learning to develop a simplified ultrasound device that can radically improve care in settings where skilled sonographers are not available.” — Jeff Stringer

Upon completion, data from both studies will be made publicly available through the Gates Foundation’s Knowledge Integration team for interested groups to access and continue improving maternal-child health.

Collaborators on the LABOR study are drawn from UNC’s ob/gyn and pediatrics medical departments and the biostatistics and epidemiology public health departments, Brown University, and Northwestern University. The FAMLI study team includes faculty members from the UNC’s ob/gyn and psychiatry departments and N.C. State University’s College of Engineering.

The Gates Foundation grant supports For All Kind: the Campaign for Carolina, UNC-Chapel Hill’s historic fundraising drive that aims to raise $4.25 billion by Dec. 31, 2022. The campaign supports the Blueprint for Next, the University’s overall strategic plan built on two core strategies: “of the public, for the public,” and “innovation made fundamental.”