Tuesday, August 19, 2025 8/19/2025

Severe Maternal Morbidity: An Investigation of Joint Impacts of Risk Factors and Cumulative Risks Across Successive Pregnancies

Award Number: R01NR017020
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 01/19/2018
PERIOD OF PERFORMANCE END DATE: 03/31/2028

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Severe Maternal Morbidity: An Investigation of Joint Impacts of Risk Factors and Cumulative Risks Across Successive Pregnancies - Severe maternal morbidity (SMM), which encompasses conditions that put pregnant people most at risk of dying (e.g., hemorrhage, sepsis, organ failure), doubled in the last two decades. The most common precursors to SMM – anemia, hypertensive disorders of pregnancy (HDP), and cesarean birth – are also increasing. This Renewal proposal builds on our prior work to address maternal outcomes. Via the Parent Grant, our team enhanced current understanding of the contribution of social context and maternal pre-pregnancy health to SMM risk, using a unique data resource we built of California (CA) births. This Renewal addresses several remaining gaps in our understanding of maternal health in the U.S. that were illuminated by the Parent Grant. We will build a unique resource of 14 million births in four states from 1997-2022. The dataset longitudinally links vital records (live birth and fetal death certificates) with hospital discharge data for mother and baby; includes residential census tracts; and links data for repeat pregnancies to the same person over time, thus providing the type of large-scale data with high-quality information on maternal health and social context that the field needs to advance population-level research on maternal health. All phases of the research will be guided by a community advisory board (CAB). Aim 1 will examine joint impacts of multiple risk factors on risk of SMM, its subtypes (i.e., hypertension-, hemorrhage-, and sepsis-related SMM), and its precursors (i.e., HDP, anemia, mode of birth). Risk factors include education, health care payer, and census tract-level markers of social disadvantage (e.g., unemployment, rurality). Using a reproductive life-course framework, Aim 2 will determine the cumulative impact of risk factors across successive pregnancies on maternal health (i.e., SMM, SMM subtypes, SMM precursors). We will examine how factors related to social context (e.g., persistently high census tract unemployment), morbidity (e.g., persistent hypertension), and mode of birth (primary cesarean birth) affect subsequent occurrence and recurrence of the study outcomes. Aim 3 will use findings from Aims 1 and 2 to identify and prioritize strategies to improve maternal health. We will use a) causal inference methods (mediation and g-computation) to understand mechanisms and compare the potential impact of selected hypothetical interventions on study outcomes, and b) community-engaged prioritization methods to synthesize our findings and prioritize next steps. By understanding risks across multiple risk factors and successive pregnancies, and guided by rigorous analytics and patient input, our work will contribute to advancing the next generation of actionable population-level SMM research.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $543,297 )
2025	2025	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	8	7/15/2025	NON-COMPETING CONTINUATION	$543,297
2025	2024	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	7	12/4/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $543,297

Issue Date FY: 2024 ( Subtotal = $551,435 )
2024	2024	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	002	7	4/19/2024	NON-COMPETING CONTINUATION	$551,435
2024	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	6	2/27/2024	COMPETING CONTINUATION	$161,038
2024	2022	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	5	2/27/2024	NON-COMPETING CONTINUATION	-$161,038
														Subtotal = $551,435

Issue Date FY: 2023 ( Subtotal = $600,845 )
2023	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	6	5/30/2023	COMPETING CONTINUATION	$600,845
2023	2022	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	5	5/23/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $600,845

Issue Date FY: 2022 ( Subtotal = $541,847 )
2022	2022	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	5	4/25/2022	NON-COMPETING CONTINUATION	$54,185
2022	2022	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	5	11/30/2021	NON-COMPETING CONTINUATION	$487,662
														Subtotal = $541,847

Issue Date FY: 2021 ( Subtotal = $541,847 )
2021	2021	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	4	1/12/2021	NON-COMPETING CONTINUATION	$54,185
2021	2021	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	4	11/11/2020	NON-COMPETING CONTINUATION	$487,662
														Subtotal = $541,847

Issue Date FY: 2020 ( Subtotal = $742,514 )
2020	2020	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	3	1/23/2020	NON-COMPETING CONTINUATION	$487,563
2020	2020	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	3	2/14/2020	NON-COMPETING CONTINUATION	$54,174
2020	2020	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	002	3	8/25/2020	SUPPLEMENT FOR EXPANSION	$200,777
2020	2020	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	003	3	9/24/2020	SUPPLEMENT FOR EXPANSION	$0
														Subtotal = $742,514

Issue Date FY: 2019 ( Subtotal = $541,602 )
2019	2019	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 SERRA MALL	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	2	4/10/2019	NON-COMPETING CONTINUATION	$0
2019	2019	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 SERRA MALL	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	2	11/27/2018	NON-COMPETING CONTINUATION	$541,602
														Subtotal = $541,602

Issue Date FY: 2018 ( Subtotal = $566,907 )
2018	2018	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 SERRA MALL	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	1	3/28/2018	NEW	$0
2018	2018	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 SERRA MALL	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	1	1/18/2018	NEW	$566,907
														Subtotal = $566,907

Grand Total All Awards = $4,630,294

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Severe Maternal Morbidity: An Investigation of Joint Impacts of Risk Factors and Cumulative Risks Across Successive Pregnancies

Award Number: R01NR017020

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 01/19/2018

PERIOD OF PERFORMANCE END DATE: 03/31/2028

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