Research Goals & Objectives
The goals, with objectives, of the AMOR-IPAT research project are threefold:
First, we hope to study, in a variety of ways, the relationship between the use of non-indicated labor induction during the term period of pregnancy and the incidence of important birth outcomes. This could be done in a variety of ways, but must start with the concept that comparison of groups must model the inherent choice present when considering a non-indicated labor induction, which is: delivery now with induction vs. expectantly managing until sometime later (where labor might start either spontaneously or by induction). Hence, retrospective cohort studies comparing a labor induction cohort to a spontaneous labor cohort are fundamentally flawed. Thus, we will continue to pursue studies that compare the outcomes of groups with differing non-indicated labor induction rates.
- Objective 1 – Find databases with variable population rates of non-indicated labor induction and measure (and compare) rates of important birth outcomes.
- Objective 2 – Generate graphs comparing data from Objective 1.
- Objective 3 – Write articles highlighting the importance of using properly generated cohorts for study.
Second, we hope to eventually be able to show that every pregnancy is unique, that every pregnancy has its own set of variables (maternal, fetal, socio-economic, emotional, etc.), and that the optimal time for delivery for major outcomes, such as term stillbirth, might be different from pregnancy-to-pregnancy depending on the presence or absence of specific risk factors. For example, a recent study showed that race may have a significant impact of stillbirth risk.
- Objective 1 – Write articles validating the concept of risk modeling using gestational age as a modifiable variable.
- Objective 2 – Search out providers in the USA, or throughout the world, who have used an approach similar to AMOR-IPAT and assist with publishing their data.
Third, the long-term goal is to definitively evaluate the impact of risk-based preventive labor induction on important birth outcomes through the use of adequately powered, multi-site, randomized clinical trials (RCTs). To that end, we continue to apply for funding for such studies. Despite "beliefs" to the contrary, basic questions about the impact of non-indicated labor induction have not been answered. Furthermore, the impact of risk-based non-indicated labor induction in the 38th week of the pregnancy has not been determined using RCT methodology, and recent research suggests that preventing pre-39 week non-indicated labor induction may increase the incidence of term stillbirth.
- Objective 1 – Generate grant applications for multi-site RCTs (PCORI, NIH/NICHD, other).
- Objective 2 – Consider initiating RCTs at centers interested in the AMOR-IPAT concept that will provide funding for their own research assistants.