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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

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Preventing Preterm Birth
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A Population-Based Cohort Study in Matlab, Bangladesh: Establishing a Center of Excellence in Preterm Birth and Stillbirth Investigation

Anisur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (Dhaka, Bangladesh)
Feb 1, 2014
Grand Challenges in Global Health> Preventing Preterm Birth

Anisur Rahman of the Matlab Health Research Centre at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICCDR,B) will lead a prospective cohort study of pregnant women, building on the ICDDR,B community-based surveillance site, to enroll more than 4,000 pregnant women over three years. His team will visit women monthly at their homes for early identification of pregnancy, followed by accurate gestational age dating by ultrasound and follow up throughout pregnancy and at delivery for collection of clinical data and specimens. The study includes standardized systems for documentation of complications of pregnancy and assessment of birth outcomes. Data and specimens will be used to advance innovative research into the causes of preterm birth and identify novel strategies for prevention.

Preventing Preterm Birth in Zambia

Jeffrey Stringer, University of North Carolina at Chapel Hill (Chapel Hill, North Carolina, United States)
Oct 1, 2013
Grand Challenges in Global Health> Preventing Preterm Birth

Jeffrey Stringer of the University of North Carolina Global Women's Health group in the U.S. will oversee a team of Zambian and U.S. researchers in a prospective cohort study of 2,000 pregnant women over a three-year period in Lusaka, Zambia. The study will assess gestational age by early ultrasound and collect data and specimens throughout pregnancy and at delivery with standardized systems to document complications of pregnancy and assessment of birth outcomes. Data and specimens will be used to evaluate the causes of preterm birth and investigate novel strategies for prevention.

Determinants of Preterm Birth Associated with Bacterial Trafficking from the Lower Genital Tract

David Eschenbach, University of Washington (Seattle, Washington, United States)
Jul 1, 2013
Grand Challenges in Global Health> Preventing Preterm Birth

David Eschenbach and his team from the University of Washington in the U.S. will determine the effect of disturbances in the vaginal microbiome on preterm birth. Their research will investigate how specific vaginal bacterial infections and changes in the female reproductive tract are associated with preterm birth. The long-term goal is to identify new ways for early identification and treatment of women at risk of preterm birth and develop a point-of-care diagnostic test appropriate for low-resource settings, which would function much like a home pregnancy test, indicating an elevated risk of premature birth.

Systems Biology of Preterm Birth: A Pilot Study

Stephen Lye, Mount Sinai Hospital (Toronto, Ontario, Canada)
Feb 1, 2013
Grand Challenges in Global Health> Preventing Preterm Birth

Stephen Lye at Mount Sinai Hospital in Canada and his team will initiate a pilot study that will use a systems biology analysis of genomic, proteomic and plasma markers to identify novel pathways and biomarkers to preterm birth, as well as define the risk of preterm birth in pregnant women. Previous efforts to identify pathways or biomarkers associated with preterm birth have focused on single methodological approaches. With new capabilities in computational analyses, it is now possible to integrate information from multiple analytic techniques - collectively known as systems biology - to derive informative pathways and potential diagnostic biomarkers.

Balance of Th17 Cells and Regulatory T Cells in Candidal Vaginal Colonization in Pregnant Macaques and Humans

Margaret Hostetter, Cincinnati Children's Hospital Medical Center (Cincinnati, Ohio, United States)
Jan 1, 2012
Grand Challenges in Global Health> Preventing Preterm Birth

Margaret Hostetter from Cincinnati Children's Hospital Medical Center in the U.S. and her co-investigators will examine how disruption of the normal bacteria and other micro-organisms (the microbiome) of the lower female genital tract may increase risk of preterm birth. These investigations will focus on vaginal Candida infections in pregnancy, inflammation, and regulation of the immune response. Research will be conducted using animal models and laboratory investigations connected to studies of women in low-resource countries. Their goal is to investigate protective and pathogenic mechanisms of preterm birth and identify novel treatment strategies for vaginal fungal infections to prevent preterm birth. Funding partners: Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and Bill & Melinda Gates Foundation.

Biomarkers and Interventions to Prevent Preterm Birth and Stillbirth Associated with Placental Malaria

Kevin Kain, University Health Network (Toronto, Ontario, Canada)
Jan 1, 2012
Grand Challenges in Global Health> Preventing Preterm Birth

Kevin Kain of the University Health Network and the University of Toronto in Canada will investigate malaria infections of the placenta to reveal specific roles of the immune response that lead to preterm birth, low birth weight, and stillbirth. This project will focus on discovering biomarkers to identify at-risk pregnancies as well as new interventions to prevent adverse pregnancy outcomes. Funding partners: Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and Bill & Melinda Gates Foundation.

Development of Gene-Specific Progesterone Receptor Modulators to Prevent Preterm Birth

Sam Mesiano, Case Western Reserve University (Cleveland, Ohio, United States)
Jan 1, 2012
Grand Challenges in Global Health> Preventing Preterm Birth

Sam Mesiano of Case Western Reserve University School of Medicine in the U.S. and his team will investigate the body's receptors for progestin-based therapies in pregnancy to identify ways to enhance anti-inflammatory processes in all pregnant women and prevent preterm birth. The long-term goal of this project is to develop an inexpensive oral therapy that will reduce the prevalence of preterm birth worldwide. Funding partners: Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and Bill & Melinda Gates Foundation.

Inflammatory Pathways to Preterm Birth

David Olson, University of Alberta (Edmonton, Alberta, Canada)
Jan 1, 2012
Grand Challenges in Global Health> Preventing Preterm Birth

David Olson from the University of Alberta in Canada will work to better understand how infections can cause preterm birth. Using animal models and later in studies of women in low-income countries, he and his team will investigate multiple mediators of inflammation in the uterus early in pregnancy, as well as test new diagnostics and therapeutics that can identify women at risk, modulate the inflammatory response, and prolong pregnancy. Funding partners: Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and Bill & Melinda Gates Foundation.

Mechanisms of Intrauterine Group B Streptococcal Infections During Pregnancy

David Aronoff, University of Michigan (Ann Arbor, Michigan, United States)
Jan 1, 2012
Grand Challenges in Global Health> Preventing Preterm Birth

David Aronoff of the University of Michigan in the U.S., with an interdisciplinary team of experts in microbiology, immunology, reproductive biology, and vaccine development, will examine how infections of the female reproductive tract interact with and evade the immune system, resulting in infections of the uterus that cause preterm birth and stillbirth. This work will research potential targets for prevention of invasive infections of the female genital tract, including plans to investigate strains of group B Streptococcus (GBS) from low-income countries for vaccine and drug development. Funding partners: Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and Bill & Melinda Gates Foundation.

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