The Department of Obstetrics & Gynecology and Women's Health

Maternal-Fetal Medicine

Overview

The Maternal-Fetal Medicine Division of the Department of Obstetrics & Gynecology and Women's Health at the Albert Einstein College of Medicine, Montefiore Medical Center is comprised of 17 full time physicians, 13 of whom are board certified in Maternal-Fetal Medicine, 3 in Clinical Genetics, 7 fellows, and 3 doctorally prepared nurses (an epidemiologist, an educational research specialist, and a public policy specialist). The division has demonstrated excellence in teaching, research and clinical practice. Faculty in this division are responsible for teaching residents, fellows and medical students at Jacobi Medical Center and at the Jack D. Weiler Hospital Division of the Montefiore Medical Center. Their clinical practice at these sites affords these faculty the opportunity to direct the high risk obstetric care in institutions with over 10,000 births each year. At the Jacobi Medical Center, division faculty direct the maternal fetal assessment unit, direct the many high risk outpatient clinics (such as those for high risk medical and surgical conditions, diabetes in pregnancy, and adolescent pregnancy), and act as consultants to residents and faculty. At the Weiler Hospital, MFM division faculty offer inpatient and outpatient consultation services to the generalists' faculty high risk patients, and provide direct patient care for high risk patients at both faculty practice offices and at the Comprehensive Family Care Center of Montefiore Medical Center. The MFM division also provides prenatal ultrasound services and participates in an interdisciplinary program for fetal anomalies.

Varied in their research interests, faculty in this division are very active in both clinical and bench research, and are frequent presenters at national meetings. Research interests of divisional faculty include substance use in pregnancy, umbilical artery Doppler velocimetry, antepartal testing and its effects on neonatal outcome, gestational diabetes, social interventions in pregnancy, educational interventions in pregnancy, women's health educational needs, preterm labor prevention, content of prenatal care, induction of labor, outcomes research, fetal hematopoietic stem cell research, obesity, hypertensive disorders of pregnancy, maternal HIV infection, fetal growth restriction, fetal origins of adult disease, and recombinant DNA techniques for fetal diagnosis.

Research Initiatives

Prochieve Study 

The Division of Maternal Fetal Medicine is participating in a Phase III trial of vaginal progesterone for the prevention of Preterm delivery (PTD) sponsored by Columbia Laboratories. This is a multicenter, randomized placebo controlled trial of daily vaginal progesterone in women with a prior preterm delivery. Women are recruited in the second trimester and start study drug at 18 to 22 6/7 weeks gestation. The primary outcome is rate of preterm delivery prior to 32 weeks of gestation. Secondary outcomes include measures of maternal and neonatal morbidity. Children will be followed until 2 years of age. Both Montefiore/Weiler and Jacobi Medical Center sites are participating in the trial. Key study personnel include Drs. Cindy Chazotte, Ashlesha Dayal, and Peter Bernstein. The Department is currently participating in the next phase of the PROCHIEVE trial which is focusing on the usefulness of the same preparation of vaginal progesterone for the prevention of preterm delivery among women with shortened cervical lengths.

Educational Research and Initiatives

Divisional research has also focused on educational issues. With funding from the March of Dimes, Dr. Chazotte spearheaded an educational program for health care providers in several different specialities concerning preconceptional health. This project included pediatricians, internal medicine specialists, family practice physicians, midwives and nurses. The outcome was 5 sets of educational slides, each developed as a one hour educational session for that particular specialty about their special role in preconception health. These slides can be viewed and downloaded at the March of Dimes website: http://www.marchofdimes.com.

Under the leadership of Dr. Peter Bernstein, the division is undertaking the development and evaluation of a simulation center for training in obstetrical emergencies. In addition, Dr. Ashlesha Dayal has recently been awarded an APGO/Solvay fellowship to study the training of medical students using obstetrical simulation.

Dr. Margaret Comerford Freda has undertaken extensive research on issues of how best to educate women about various health topics including prevention of preterm birth, informed consent, fetal movement counting, colposcopy, and lifestyle modification. Dr. Chazotte has also developed and evaluated a major curriculum to teach residents about substance abuse in women.


Public Health Initiatives

A strong interest in public health exists among many division members, and is reflected in their publications, presentations and clinical practice. Several division members hold Master's of Public Health degrees.

Program to Reduce Obstetrical Problems and Prematurity

The division has been involved in many community projects designed to improve the health of the community surrounding the medical school, including the nationally known program PROPP (Program to Reduce Obstetrical Problems and Prematurity). This was a large grant-funded program from the Robert Wood Johnson Foundation and Greater New York Chapter of the March of Dimes which viewed the problem of preterm birth as a community problem requiring community solutions. PROPP was developed by Drs. Irwin R. Merkatz and Karla Damus, with the community educational efforts coordinated by Dr. Margaret Comerford Freda. Through PROPP, linkages were formed with all the other providers of prenatal care in the Bronx.

Common protocols were developed, a common interdisciplinary medical record was introduced, education was provided to all providers of care, and patient education was initiated with PROPP-developed materials which are now being distributed nationally. Complementing the PROPP was a department-inspired Bronx Perinatal Consortium, a program funded by the state of New York as part of an expanded funding of prenatal care. All women in the state whose income placed them under 185% of the poverty level became eligible for this new funding, thus correcting a major financial barrier of access to care for the working poor. Through the Bronx Perinatal Consortium, the department provided leadership in community organization, computer expertise, and the formulation of important state and local public policy to assist women in the Bronx in obtaining both comprehensive care and access to more sophisticated technologies.


USAID Exchange Program with Albania

Another public health initiative in which the division faculty has been involved is an exchange program with the country of Albania, sponsored by the US Agency for International Development. Division members have visited Albania on several occasions, and hosted Albanian health care providers in the Bronx. Also through this program, a joint conference was held with obstetrics/gynecology providers in Tirana, Albania in December 1995. This first-ever Albanian/American health care conference focused on Obstetrics, Anesthesia and Neonatal Issues. This program was spearheaded by Nancy DeVore, CNM, MS.
Centering Pregnancy

Dr. Peter Bernstein has received a grant from the March of Dimes Greater New York Chapter to initiate an innovative prenatal care program at Comprehensive Family Care Center where he is the Medical Director. The Centering Pregnancy program bases it philosophy on the concept that women need not only medical care, but also education and counseling during pregnancy, and that all those services are difficult to provide in the short visits mandated by health insurance companies. Using Centering Pregnancy, prenatal care is offered in group sessions, with prescribed education and counseling during each session and much interaction between the women and the health care providers. This model is in use in sites all over the country, and is currently the subject of a large NIH funded evaluation project. At Comprehensive Family Care Center (CFCC), Dr. Bernstein along with Susan Bellinson, CNM and Carole Moleti, CMN offer Centering Pregnancy to women who agree to be randomized to that program or to conventional prenatal care. Evaluation at the grant's completion, evaluation will consist of tracking pregnancy outcomes, patient satisfaction, patient knowledge of health and pregnancy topics, and other markers.

Comprehensive Preconception/Interconception Care

Dr. Ashlesha Dayal has created the Comprehensive Preconception/Interconception Care Program at Montefiore Medical Center (CPIC), and secured a grant from the Greater New York Chapter of the March of Dimes Birth Defects Foundation to bring the program to fruition. This new program addresses the problem of preterm birth, which now complicates 12% of all births in the United States. In the Bronx, the preterm birth rate is closer to 17%, signaling the need to take special action to reduce its incidence. Dr. Dayal's CPIC program will target Bronx women at risk for a poor pregnancy outcome. These women will have a visit with an MFM specialist, individualized referrals to community resources, and specialized teaching by a perinatal nurse. By identifying these women's individualized risk factors and intervening, Dr. Dayal hopes that risk factors for preterm birth will be ameliorated before the woman becomes pregnant again. Outcomes to be tracked throughout this program include numbers of referrals from providers and to community resources, patient and provider satisfaction with the program, percentage of women taking folic acid interconceptionally, patient compliance with care, and women's knowledge of pregnancy complications such as preterm birth. She hopes to enroll 300 women during the first year of the grant.

Reflecting our division's longstanding expertise in preconception health, division members Drs. Peter Bernstein and Margaret Comerford Freda were asked to participate in the CDC Select Panel on Preconception Health during 2004-2006, advising the CDC on all matters related to preconception care. This collaboration resulted in the CDC's National Summit on Preconception Care, a special MMWR on the topic (April, 2006), and a supplement to the Maternal Child Health Journal (September, 2006), in which several articles were authored by division and department members.

MACS Study

The Division of Maternal Fetal Medicine was part of a multinational randomized controlled trial comparing single dose antenatal steroids with multiple doses given at 14 day intervals until 33 weeks gestation. The MACS (Multiple Antenatal Corticosteroid Study) was funded by the Canadian Health Research Institute (the equivalent of the NIH in Canada), with the primary site at the University of Toronto, under the direction of Dr. Kelly Murphy, a former AECOM resident in our Department. This study is another in a long line of prematurity related studies in which we have participated over the past 16 years.

PORT Prevention of Low Birthweight

The division participated in a Patient Outcome Research Team (PORT) grant dealing with the prevention of low birthweight in minority women funded by the Agency for Healthcare Policy and Research. Dr. Irwin Merkatz served as co-principal investigator in collaboration with Dr. Robert Goldenberg at the University of Alabama at Birmingham. The program was designed to improve implementation of techniques known to impact on the morbidity associated with low birthweight and is divided into four stages. The first consisted of an extensive data analysis which supported the conclusion that the underutilization of antenatal corticosteroids useful in accelerating pulmonary maturity was likely an important deficit in current practice activities. Subsequent phases dealt with data accumulation and the demographics to confirm underutilization, an analysis of the data obtained and the dissemination of educational material designed to improve utilization of antenatal corticosteroids, together with the evaluation of those efforts.

Recent Extramural Funding Excellence

The summer of 2009 was truly a summer of excellence in extramural funding for our Department, especially for the MFM Division. Departmental Chairman Dr. Irwin R. Merkatz is rightfully proud of the all the efforts put into these accomplishments. Some examples of the plethora of recent successes are:

Dr. Francine Einstein, Division of Maternal Fetal Medicine, has been awarded a highly sought-after and prestigious independent researcher R01 Award from the NIH’s Roadmap Epigenomics Program ($2.03 million). Dr. Einstein will study “Genome-Wide DNA Methylation Profiles Associated with Abnormal Intrauterine Growth”, offering a novel hypothesis that conditions during fetal development alter epigenetic patterns of DNA methylation in non-embryonic stems cells which may be a marker for, or contribute to, susceptibility to Type 2 Diabetes Mellitus and other age-related diseases. The study will utilize an innovative technology, developed by Dr. John Greally, Director of the Center for Epigenomics at Einstein and co-Investigator for this study, to map epigenome-wide DNA methylation in non-embryonic stem cells of neonates exposed to abnormal intrauterine conditions marked by the extremes of birth weight. Dr. Einstein hopes that understanding the complex epigenetic underpinnings of fetal origins of adult disease may not only provide insight in to the developmental contributions to chronic diseases, like diabetes but may further enhance our understanding of many other age-related diseases.

Dr. Siobhan Dolan, Divisions of Reproductive Genetics and Maternal Fetal Medicine, has been awarded a 2 year NIH grant entitled “Ethical & Social Implications of Genetic Testing In the Case of Unexpected Deaths”. This grant award was offered under the American Recovery and Reinvestment Act of 2009, and was one of very few funded. This project brings together an outstanding Yeshiva University team including Dr. Robert Marion of CERC and Pediatric Genetics, Dr. Christine Walsh and Dr. Tom McDonald of Cardiology, Dr. Louise Silverstein of the Ferkauf Graduate School of Psychology and Mr. David Wasserman of the Center for Ethics. This research project grew from the work being done at the Montefiore-Einstein Center for Cardiogenetics, where state-of-the-art testing and intervention to families that have experienced a sudden unexpected death (SIDS in an infant, SUDS in an older individual) is being offered through a collaborative effort of clinicians and researchers. In this funded research, Dr. Dolan and her colleagues will examine the ethical, legal and social issues that arise in the translation of genetic knowledge to clinical care in the area of cardiogenetics based on input from expert advisors and affected families. This multidisciplinary approach will provide new insights into the ethical, legal and social issues that accompany advances in translational medicine.

Dr. Mary King has been named a Phase 1 RSDP awards winner (Research Science Development Program). This award will allow Dr. King to train in research laboratories for additional years, preparing her to qualify as an independent scientist for future NIH research.

Ongoing Collaborative Research in Basic Science Laboratories

Fellows have worked collaboratively in several laboratories of basic science researchers at the Albert Einstein College of Medicine and the Montefiore Medical Center. Dr. Francine Einstein of the MFM Division has being working in the laboratory of Nir Barziilai, MD, Departments of Medicine and Molecular Genetics in the area of insulin resistance in an animal model. Dr. Peter Van Eerden was an active member of the research team of Dr. Jacob Rand, Department of Pathology, a leading researcher in the role of Annexin V in adverse pregnancy outcome. The MFM Division has also worked collaboratively with Maureen Charron, PhD, Department of Biochemistry, in investigations of glucose transport across the placenta in pregnancies complicated by diabetes.

Maternal-Fetal Medicine Faculty

 

Past and Current Fellows in the Division of Maternal-Fetal Medicine

Adiel Fleischer, MD 1979-1981
Janet Mitchell, MD 1980-1982
George Farmakides, MD 1982-1984
Wayne Cohen, MD 1982-1984
Luis Bracero, MD 1982-1984
Ralph Cavalieri, MD 1983-1985
Cassandra Henderson, MD 1984-1986
Oded Langer, MD 1984-1986
Akolisa Anyaegbunam, MD 1985-1987
Cynthia Chazotte, MD 1985-1987
Lois Brustman, MD 1986-1988
Denise Guidetti, MD 1986-1988
Barbara Girz, DO 1987-1989
Linda Wyse, MD 1987-1989
Michael Divon, MD 1988-1990
John Deaver, MD 1988-1990
Deborah Platek, MD 1989-1991
Raphael Pollock, MD 1989-1991
Janice Whitty, MD 1990-1992
Marie Morel, MD 1990-1992
Christine Edwards, MD 1991-1993
Ruel Stoessel, MD 1991-1993
Christopher O'Reilly-Green, MD 1991-1993
Jonathan "Yoni" Barnhard, MD 1992-1994
Leena Shah, MD 1992-1994
Karen Drake, MD 1993-1995
Camille Ross, MD 1993-1995
Paul Bobby, MD 1994-1996
Jerry Gilles, MD 1994-1996
Daryoush Jadali, MD 1994-1996

 

Peter Bernstein, MD, MPH 1995-1997
Juan Garcia, MD 1995-1997
Joseph Polcaro, MD 1995-1997
David Binder, MD 1996-1998
Chukwuma Onyeije, MD 1996-1998
David Sherer, MD 1996-1998
Georges Sylvestre, MD 1997-2000
Ashlesha Dayal, MD 1998-2000
Sonia Bancej, MD 1999-2002
Karen Koscica, DO 2000-2003
David Cole, MD 2000-2003
Francine Hughes-Einstein 2001-2004
Peter Van Eerden, MD 2002-2005
Rodney Wright MD 2002-2005
Esther Schmuel, MD 2003-2006
Mary King, MD 2003-2006
Susan Fong, MD 2003-2006
Brian Wagner, MD 2004-2007
John Illagan, MD 2005-2008
Dena Goffman, MD 2005-2008
Avanee Patel, MD 2006-2009
Jye Jung Heo, MD 2006-2009
Kavitha Ram, MD 2006-2009
Avishai Alkalay, MD 2007-2010
Nelli Fisher, MD 2007-2010
Shilpi Mehta, MD 2008-2011
Juliana Gebb, MD 2008-2011
Eve Karkowsky, MD 2009-2012
Scarlett Karakash, MD 2009-2012
Mara Rosner, MD 2009-2012
Roopali Varma Donepudi, MD 2010-2013
Rolanda Lister, MD 2010-2013
Karla Bermudez-Wagner, MD 2010-2013
Jean-Ju Sheen, MD 2010-2013
Ivan Ngai, MD 2010-2013
 

For additional information about the Fellowship in Maternal Fetal Medicine, click here.

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