Research Goals & Objectives
The goals, with objectives, of the AMOR-IPAT research project are threefold:
Goal 1
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.
Goal 2
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.
Goal 3
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.