Tuesday, August 19, 2025 8/19/2025

Building a causal pathway framework to identify interventions to prevent severe maternal morbidity

Award Number: R01NR020335
ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/17/2021
PERIOD OF PERFORMANCE END DATE: 06/30/2026

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Building a causal pathway framework to identify interventions to prevent severe maternal morbidity - The US is in the midst of a maternal health crisis. The US has worse maternal mortality (MM) than any other high-income country and is the only one for which the rate is increasing. Severe maternal morbidity (SMM), which encompasses conditions that put pregnant women most at risk of dying, doubled in the last two decades. This proposal focuses on SMM, as a sentinel outcome leading to MM, yet 100 times more common. Most prior research on SMM has focused on proximal clinical factors (primarily related to co-morbidities and obstetric management); these factors alone are insufficient for understanding SMM. The objectives of this proposal are: 1) develop a causal pathway framework to understand how social determinants and more proximal health-related factors together contribute to SMM risk, and 2) use this framework to identify actionable strategies to reverse current trends. We will create a unique dataset that harmonizes 4 years of data from 6 states on 4.4 million births and 66,000 women with SMM. These states collectively include 1 in 4 US births and sufficiently varied social environments to disentangle complex multi-level drivers of maternal health. Our focus is on social determinants from two specific domains: community resources and health care access, characterized at the county, neighborhood (census tract), and individual level. Health-related intermediaries include birth hospital quality of care, mode of birth, and maternal morbidities (eg, hypertension, anemia). These domains and intermediaries were selected for their known relevance to maternal health. In addition, we will evaluate impacts of 3 Quality Improvement (QI) collaboratives on SMM, which were designed to improve specific aspects of hospital quality of care and implemented by state-wide perinatal quality collaboratives (PQCs). Our Specific Aims are: 1) Assess the relative and joint contributions of multi-level social determinants to SMM; 2) Identify potential health-related mechanisms by which multi-level social determinants affect SMM risk by conducting causal pathway analyses; and 3) Evaluate the impact of 3 QI collaboratives designed to reduce SMM (3a), and apply what we learn from the causal framework developed in Aims 1 and 2 to these state-specific contexts, to identify state-specific strategies for preventing SMM (3b). We currently have very limited understanding of how social determinants contribute to SMM. The proposed research will fill this important knowledge gap, which is an essential part of realizing sustainable improvement of maternal health.


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 = $645,103 )
2025	2025	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	5	7/18/2025	NON-COMPETING CONTINUATION	$645,103
														Subtotal = $645,103

Issue Date FY: 2024 ( Subtotal = $659,256 )
2024	2024	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	4	7/5/2024	NON-COMPETING CONTINUATION	$659,256
														Subtotal = $659,256

Issue Date FY: 2023 ( Subtotal = $913,650 )
2023	2023	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	2	11/30/2022	SUPPLEMENT FOR EXPANSION	$116,607
2023	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	3	6/30/2023	NON-COMPETING CONTINUATION	$680,999
2023	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	002	3	7/11/2023	SUPPLEMENT FOR EXPANSION	$116,044
														Subtotal = $913,650

Issue Date FY: 2022 ( Subtotal = $693,899 )
2022	2022	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	2	6/30/2022	NON-COMPETING CONTINUATION	$693,899
2022	2022	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	2	9/8/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $693,899

Issue Date FY: 2021 ( Subtotal = $748,515 )
2021	2021	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	001	1	9/21/2021	NEW	$2,583
2021	2021	LELAND STANFORD JUNIOR UNIVERSITY, THE	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Nursing Research	000	1	9/17/2021	NEW	$745,932
														Subtotal = $748,515

Grand Total All Awards = $3,660,423

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Building a causal pathway framework to identify interventions to prevent severe maternal morbidity

Award Number: R01NR020335

ORGANIZATION: NATIONAL INSTITUTE OF NURSING RESEARCH

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 09/17/2021

PERIOD OF PERFORMANCE END DATE: 06/30/2026

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