A Mother’s Day Message: Time for Action to Improve Maternal Health

Guest post by Diana W. Bianchi, MD, Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development and Janine Clayton, MD, Director, Office of Research on Women’s Health

For many of you, this past weekend likely had its share of greeting cards, flowers, video calls, and, perhaps, even a tasty brunch celebrating the special maternal figure(s) in your life. Maybe it was your mother, grandmother, or another special person who always looked out for you when you were growing up. For others, this past weekend may have been bittersweet—a time to remember a mom or someone special who is no longer with you, but who left an indelible mark on your lives, giving you joy, wisdom, and resilience. Mother’s Day is a wonderful holiday filled with love and appreciation.

Sadly, hundreds of children each year in the United States do not get the chance to celebrate Mother’s Day with their moms because of a growing maternal health crisis. In a wealthy nation like ours, a healthy pregnancy and childbirth should be a given, but it’s not. According to the Centers for Disease Control and Prevention (CDC), nearly 700 women die each year from complications from pregnancy or giving birth. In addition, American Indian/Alaska Native and Black women are 2 to 3 times more likely to die from a pregnancy-related cause than white women. The CDC estimates that two-thirds of maternal deaths are preventable.

Understanding and reducing pregnancy-related deaths and complications—or maternal morbidity and mortality—is a high priority for the National Institutes of Health (NIH). In the past year, with an estimated $223 million in funding, Institutes, Centers and Offices across NIH have worked together, and with their federal and community partners, to support scientific research for this crucial endeavor. In a year dominated by both the COVID-19 pandemic and renewed calls to address health disparities and inequities, NIH is facing these challenges head-on and accelerating efforts to reduce maternal morbidity and mortality.

Engaging the Community to IMPROVE Pregnancy Outcomes

Improving maternal health requires strong partnerships with local communities, particularly with racial and ethnic minority populations that experience stark disparities in access to quality prenatal and postpartum care.

To that end, several NIH Institutes held activities to hear first-hand how patient communities can inform future research and what strategies might enhance local efforts. Workshops and forums included:

A common refrain from these discussions reinforced the importance that research conducted within a community should be developed with and vetted by that community to ensure its success. These exchanges informed the development of NIH’s Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) initiative, which aims to build an evidence base that will enhance maternal care and outcomes from pregnancy through one year postpartum. IMPROVE receives funding support from several NIH Institutes and is co-led by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NIH Office of the Director, and the NIH Office of Research on Women’s Health.

To date, the IMPROVE initiative has awarded more than $7 million in grants in research areas related to maternal heart disease, hemorrhage or bleeding, and infection (the leading causes of U.S. maternal deaths); contributing conditions, such as diabetes, obesity, mental health disorders, and substance use disorders; and structural and healthcare system factors that may contribute to delays or disruptions in maternal care.

Pivoting to Address COVID-19

Like GRAVID, studies funded by NIH and others continue to produce data to help inform medical care for pregnant women during the pandemic. For example, the CDC’s V-safe registry collects data on COVID vaccine side effects from people across the country. Their recently published findings show that so far, the vaccines are safe and effective for pregnant women, which is reassuring news to people who are undecided about getting the vaccine. 

Looking Ahead

Many factors contribute to maternal morbidity and mortality, and NIH will continue to fund projects to develop tailored, evidence-based solutions for pregnant women across the country. This year, IMPROVE will fund new research to understand the effects of SARS-CoV-2 infection and the COVID-19 pandemic on maternal mental health, well-being, functioning, and quality of life. These research awards also seek to address the impact of structural racism and discrimination on maternal health outcomes in the context of COVID-19.

Every maternal death is one too many.

We encourage pregnant women to get care as early as possible in pregnancy, and to discuss their health and lifestyle habits with their health care providers. In turn, health care providers (including non-obstetricians) should take a health history that includes recent pregnancies and listen to women, especially if they have health factors that increase the risk of complications.

NIH will continue to advance research to help ensure healthy pregnancies and reduce maternal morbidity and mortality. For researchers, whether you’re studying fundamental science, leading clinical studies, conducting population or social/behavioral research, or developing new technologies, an important opportunity exists to improve maternal health and help families across the country.

What opportunities do you see to improve maternal health in your community?

Dr. Bianchi is a co-lead of the NIH’s IMPROVE Initiative. As director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Dr. Bianchi oversees NICHD’s research on pediatric health and development, maternal health, reproductive health, intellectual and developmental disabilities, and rehabilitation medicine, among other areas.

Dr. Clayton is a co-lead of the NIH’s IMPROVE Initiative. As director of the NIH Office of Research on Women’s Health (ORWH), Dr. Clayton has strengthened NIH support for research on diseases, disorders, and conditions that affect women.

Holiday Greetings from the NLM Director!

I consider myself an upbeat person and am most upbeat during the winter holiday season. I’ve always been drawn to this time of year – it’s cold, often snowy, and brings many traditions I love, including spiritual customs, family gatherings, fabulous food, and gift-giving. It also brings about an annual pause in the lives of many people, and an opportunity to celebrate the many holiday observances that take place across various cultures in the world.

This year I’m struck by the importance of light as a symbol across many religions and cultures, such as the Festival of Lights celebrated by Hindus, Jains, and Sikhs known as Diwali; the Jewish Festival of Lights known as Hanukkah, or Chanukah; the Christian tradition of Christmas; or the celebration of African and African American culture, known as Kwanzaa.

Light is almost a universal symbol.

Light represents hope, transcendence over darkness, and knowledge. We experience light through lamps, candles, in the flames of a fire, through the brilliance of the sun, and the twinkles of color that appear on holiday decorations. In some religious traditions, light represents spiritual power or guidance. In common parlance, light reflects joy and invites engagement. Light stands in a positive contrast to the short days and long nights of winter experienced in the Northern Hemisphere, where I’ve spent most of my life.

Light also serves as an indication of illumination – the increased clarity, insight and awareness about situations and ideas. NLM serves as an illuminating force in the world – bringing knowledge to bear to increase enlightenment and awareness about complex biomedical situations and ideas. I’ll bet you haven’t often connected the idea of holiday lights and NLM resources — bear with me — it really works!

Information alone – unread and unused – is not enough, just as the benefits of light are limited when the light is obstructed or not in view. This idea holds true for NLM resources too.  

As a leader in biomedical and health data science research and the world’s largest biomedical library, NLM’s research and information services are most valuable when they are readily available to those who need it. Thanks to our NLM team, we continue to be able to provide free and unencumbered access to information to people from around the world.

Individuals perceive light through a complex physiological and psychological process and their reaction to light builds on history and prior experiences. When NLM users discover new articles or preprints through our search process and read them, they do so against the backdrop of their own life experiences and knowledge – adding even more value to research, both new and old! Finally, one of the greatest things I love about light is that it can be experienced and perceived by many without being diminished. So too for our NLM resources that serve many without ever being exhausted!

This year, I am observing and celebrating the Christmas holiday and want to share the light of this holiday season with all of you, and particularly with my son, who is far away from me in Seattle. This season, many of us will be connecting with loved ones near and far through the light of a computer screen!

Certainly, the challenges of 2020 have made it ever so much more important to enjoy the spark that friends and family near and far provide. Please share your special views on light with each other and with the readers of this blog.

Happy holidays from ours to yours!

One NLM: I Am Thankful for How Far We Have Come!

In the spirit of Thanksgiving, I am excited to share what I am grateful for this year. In years past, I’ve used this space to reflect with gratitude on the efforts of the 1,700 men and women who work at NLM. Other times, I’ve reflected on the impact of individuals who have contributed to my life in a meaningful way over the previous year. This year, I want to use this opportunity to reflect with gratitude on the progress we’ve made as an organization in our journey towards “One NLM.”

On January 3, 2017, only four months into my new role as NLM director, I introduced the concept of One NLM through this blog. At the time, I proposed …

One NLM emphasizes the integration of all our valuable divisions and services under a single mantle, and acknowledges the interdependency and engagement across our programs. Certainly, each of our stellar divisions – for example, the Lister Hill Center for Biomedical Communications, Library Operations, or Specialized Information Services – have important, well-refined missions that will continue to serve science and society into the future. The moniker of One NLM weaves the work of each division into a common whole. Our strategic plan will set forth the direction for all of the National Library of Medicine, building on and augmenting the particular contributions of each division.

So why do we need One NLM?

Achieving excellence as a resource for discovery and science demands that we efficiently leverage the work of each division toward common goals. Additionally, One NLM encourages sharing the expertise found in any one division across all our efforts. Finally, the idea of One NLM entreats us to bring together all the Library’s resources to meet the key challenges of the future across biomedical knowledge collection, curation, and dissemination – ensuring a talented workforce, enabling every staff member to work at the top of his or her skill set, creating collections that accelerate discovery and address global health needs, and anticipating (and resolving!) the health information challenges of the future.

Now, 4 YEARS into this role, I look back on these words with gratitude and recognition of the awesome naivety that led me to make the bold statement: One NLM – many parts, many people – but One NLM!

Strategic Report

I  am writing today as part of our efforts to assess the implementation of the NLM Strategic Plan. We’ve received more than 100 responses to a request for information to ensure that implementation of the strategic plan continues to be relevant and resonate with the needs of our stakeholders. We solicited and received input from NLM’s Board of Regents, Board of Scientific Counselors, and the Literature Selection Technical Review Committee. We polled our leadership and our own staff, as well as colleagues across NIH, asking them to respond to three questions:

  1. Major opportunities or challenges that have emerged over the last five years and have implications for the future of NLM in the areas of:
  • Science 
  • Technology 
  • Public health, consumer health, and outreach  
  • Library functions  
  • Modes of scholarly communication  
  • Perspectives, practices, and policies  
  • Workforce needs 
  1. Major opportunities or challenges that have emerged in the last five years and have implications for the future of NLM in other areas or areas not well captured above.
  2. Opportunities or challenges on the horizon over the next five years that fall within the purview of the NLM’s mission.

Not surprisingly, in many cases we received guidance that would be best addressed by one of our many stellar divisions – to increase investments here or to expand efforts there.

The NLM of 2020 shares many features with the NLM of 2017, and yet it is a whole new operation. Our budget has grown by over $50 million and we’ve put it to good use! We released a new version of PubMed, and moved some of our critical molecular resources into commercial cloud services. We expanded both our extramural and our intramural research programs — adding two new investigators, developing new artificial intelligence and machine learning analytics — and pivoted some of our research efforts to the computational biology challenges of COVID-19. We’ve aligned our consumer education efforts into a single platform, streamlined our outreach, education and training initiatives, and this year alone approved 50 new journals for MEDLINE indexing. We’ve also launched major updates to our physical and technical operations. Whew!

We are also recognizing that NLM is more than the sum of its parts – it’s a highly interdependent enterprise, one that now emphasizes mutual learning and cross-division engagement as a key strategy for the future. The NLM leadership team meets twice a month to devise strategies and evaluate alternatives that bring solutions to challenges faced across the entire NLM, including cybersecurity, creating an affirming and welcoming workplace where our team can perform to their maximum potential, and doing our part to respond to the COVID-19 pandemic.

As we face rapidly growing data science challenges, we hear the question from across NIH – “What can NLM do?” And the answer is, “A lot!”

One NLM means that we harmonize the expertise from each of our divisions in a way that lets us characterize problems and identify sustainable solutions. We bring together the very best that each of us has to offer – computational skills, large scale data management, indexing and cataloging strategies, application and use of health data standards – and unite them into a cohesive approach. We share the responsibility and the resources to extend the reach of NLM with innovative strategies to meet new challenges. We create pathways for growth and encourage staff to populate those pathways.

Becoming One NLM requires that we identify new ways of engagement to our well-established ways of doing business. Becoming One NLM means that we don’t simply fill jobs, we search for talented people with an eye to how they might contribute to the total enterprise – not just fulfill a set of tasks. Leading One NLM means that each member of our leadership team understands and integrates our goals into the activities of their divisions as they create plans to lead NLM into the future. Being One NLM means that we bring to science and society the talents and offerings of this great, nearly 200-year-old organization.

So, this year, I am thankful for the progress that we’ve made towards One NLM. I know it happened with the support of family and friends, through the efforts of everyone who works at NLM, and it is worthy of our many thanks!

The Holiday Season — What Ever Way Works Best for You

As the Andy Williams song goes, “It’s the holiday season / So whoop-de-do and hickory dock / And don’t forget to hang up your sock.”

This song from my childhood matches my mood and warms my soul. It brings back memories of growing up in a house full of kids, making presents for parents and cards for grandparents, and enjoying the sounds and smells of the holiday season.

In high school, I learned that not every home had a Christmas like mine. My best friend’s grandfather died in the hospital on Christmas morning when we were freshman. For her, holidays became a poignant reminder of loss. And I began to realize that some families had other celebrations, or even multiple celebrations.

I entered high school in 1967, the year after Dr. Maulana Karenga created the festival called Kwanzaa, a pan-African holiday that celebrates family, community, and culture. As time went on, I developed an appreciation of the many ways that different people mark holidays, from the winter solstice celebrations of the Wiccans in central Wisconsin to the celebration of Diwali around the world.

Here at NLM, our resources offer interesting and helpful information related to holiday seasons.

If you enter the word “Christmas” or “solstice” in our PubMed search box, you’ll retrieve over 3,000 citations. One of these is Dr. Jori Bogetz’s article in the Journal of Palliative Medicine reflecting on why she works on Christmas. An article from the British Veterinary Association describes how to choose a holiday meal that supports animal health and welfare. A third, in the Medical Journal of Australia, warns about the risks inherent in Christmas celebrations, and the journal Nature provides an unusual description of a winter solstice celebration. Some investigators sought to uncover evidence of a Christmas spirit through functional magnetic resonance imaging, while others examined the surge in myocardial infarction during certain holiday periods.

Indeed, this time of year can be complicated.

Another of NLM’s resources, MedlinePlus, provides guidance on a range of health topics — everything from managing seasonal affective disorder to encouraging healthy holiday eating to coping with sadness and grief — both for the people affected and for those around them who are wondering how to help.

In many ways, holidays allow us time to pause amid our everyday lives. Ideally, we can use the moment to be more observant and more mindful, of both ourselves and others.

I hope you find the joy and peace that the season holds, and that you extend some of that joy and peace to those around you, throughout the holidays and beyond.

Thanksgiving – What I am Giving Thanks for This Year

This time of year reminds us to reflect with gratitude on our lives and our work. This week, I want to share what I am thankful for as the director of NLM. I could go on forever, as evidenced by this list. While I tried to do a top 10, that wasn’t enough — which is yet another thing to be thankful for!  

I am particularly thankful for

  • the 1,700 women and men working at NLM to advance biomedical science and improve access to trustable health information. There isn’t a day that passes that I’m not touched, moved, and impressed by the efforts of those around me.
  • the countless staff who are advancing NLM’s strategic plan, leading to the creation of our new Office of Engagement and Training, an expanded and more responsive Office of Communications and Public Liaison, and a stronger Office of Computer and Communications Systems. With great change can come great challenges, but the Library’s staff have gone above and beyond to create an even more efficient, effective, and impactful organization.
  • our budget office, who is working across NLM to improve our budget management process and bring together our program staff and acquisitions office to better manage the contracts and services required to make NLM offerings available 24 hours a day, seven days a week.
  • my team in the Office of the Director, who are managing the increased workflow with competence and goodwill. I know I can lean on them, and that makes every day easier.
  • the renovation team who are engaging with designers and architects to oversee our many important and necessary building improvement and reconstruction projects. This is a daunting task, but they are facing it head on, with great mindfulness and vision.
  • the people around the world who communicate with me directly via Twitter (@NLMdirector), letting me know how they like our products and offering suggestions for improvements. Their feedback goes a long way.
  • the Public Services Division staff, who promptly respond to the wide-ranging questions we receive about our resources and services.
  • the innovative Lister Hill National Center for Biomedical Communications investigators who, through their collaborations across NIH, are developing advanced Artificial Intelligence models that interpret complex images, from blood smears to diagnostic samples.
  • our growing Extramural Programs Division in biomedical informatics and data science. The strategic investments being made are positioning NLM as a key contributor to data science developments across NIH.
  • NLM’s National Center for Biotechnology Information staff, who have used NLM’s platform and expertise to help guide NIH as it accelerates access to big data, while devising ways to ensure that data rights management and patient privacy considerations are respected.
  • our Division of Library Operations staff, who guide the selection, acquisition, preservation, and management of more than 11 centuries of health and biomedical literature.
  • our building maintenance staff, who keep our space clean and make it a pleasant place to work.
  • my NIH Institute and Center director colleagues, all 27 of them. When I became director, I was encouraged to manage up, manage down, but — most importantly — treasure and cultivate peer relationships. What sound advice!
  • my leadership team, whose counsel not only helps me set the course, but keeps me from veering off course as we move NLM toward its third century.

Finally, I’m grateful for my friends and family, particularly my sisters and my son, Conor, who provide me with the personal sustenance that gives me the energy and drive to lead this amazing organization!

Best wishes for the Thanksgiving holiday to you and all of yours. And, as I mentioned, your input means a lot. So, let me know what NLM provides that you’re thankful for!