Among key achievements
For 40 years, HRP – The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – has been the main instrument within the United Nations system for research in human reproduction, bringing together policy-makers, scientists, health care providers, clinicians, consumers and community representatives to identify and address priorities for research to improve sexual and reproductive health.
Research into hypertension during pregnancy to improve maternal and newborn health
Pre-eclampsia and eclampsia are responsible for 12% of maternal deaths worldwide and for a considerable proportion of maternal morbidity. In addition, they significantly contribute to perinatal mortality and morbidity.
HRP conducted a large multicentre randomized trial in six developing countries that showed that calcium supplementation in pregnant women with low-calcium intake reduced the risk of most severe complications in cases of hypertensive disorders of pregnancy. The study showed a trend towards reduced maternal mortality. Importantly calcium supplementation in pregnancy was associated with a 30% reduction in neonatal mortality. Calcium supplementation is an effective preventive intervention which is affordable, acceptable and feasible for use in low-resource settings.
HRP has been involved in two major randomized clinical trials that have shown that magnesium sulfate:
- Reduces by half the risk of developing eclampsia in women with pre-eclampsia, as well as possibly reducing the risk of maternal death.
- Is the drug of choice and reduces mortality in women with eclampsia. The wider introduction of magnesium sulfate in country health care programmes will greatly improve pregnancy outcomes.
HRP has also led studies that have shown that in areas where dietary calcium intake is low, calcium supplementation during pregnancy is beneficial for the prevention of pre-eclampsia in all women, and especially those at high risk of developing pre-eclampsia.
WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia were published in 2011.
HRP is currently conducting a multicentre study to test whether changes in serum and urinary angiogenic proteins, substances potentially involved in the genesis of hypertension in pregnancy, can be used as an effective method for identifying women at high risk of developing pre-eclampsia. If proven effective, dipsticks and other ready-to-use methods to detect angiogenic factors could be developed for use at point of care. The study is a collaboration with the Perinatal Research Branch of the National Institute of Child Health and Development (PRB/NICHD). This collaboration will allow HRP and PRB/NICHD to test rapidly new research hypotheses without having to establish new ad-hoc research protocols and infrastructures.
A pregnant woman’s risk of an adverse outcome from pre-eclampsia can now be calculated with the aid of the six-component Pre-eclampsia Integrated Estimate of Risk (or PIERS) model that was developed by HRP and partners. The model uses clinical and laboratory data, such as gestational age on admission and measures of cardiorespiratory, renal, hepatic and haematological functions, to predict the 48-hour probability of an adverse maternal outcome.
Other key HRP achievements
- Preventing mother-to-child transmission of HIV
- Preventing unsafe abortion to reduce maternal mortality and morbidity
- Eliminating female genital mutilation
- Widening choice and access to family planning
- Reducing unintended pregnancies through emergency contraception
- Reducing maternal deaths by preventing postpartum haemorrhage
- Eliminating congenital syphilis