Pre-Term Birth Prevention with Kristin Ashford - Podcast Transcript


Have you ever wondered who was doing the research that will impact your future? The research podcast lets you met those people, and learn how the University of Kentucky is exploring and strengthening our understanding of the world through research and discovery.   

Here's Alicia Gregory, director of Research Communications. 


Alicia: Today I’m talking with Kristin Ashford. She is the Assistant Dean of Research and an Associate Professor in the UK College of Nursing. In 2016, Ashford won the Sarah Bennett Holmes Award. This award honors female employees at UK who have achieved professional and personal success while promoting the growth and well-being of all women. With funding from the Centers for Medicare and Medicaid Services, the Kentucky Department for Public Health, and the National Institute on Drug Abuse, Ashford’s research focuses on pre-term birth prevention.


Kristin Ashford: So, if you think about an umbrella, what encompasses pre-term birth; there's several different aspects. It's really a multi-faceted disease process. There's not just one gene that affects pre-term birth, so... I do a variety of types of research projects. Some of them involve tobacco, because we know tobacco is the most modifiable risk factor associated with poor pregnancy outcome and pre-term birth. So, certainly the research I do has to take into account tobacco, or tobacco exposure, or even second-hand smoke exposure. I'm also looking at new, innovative ways to provide prenatal care. We've found this new type of research, called CenteringPregnancy. And, what that is, it's group prenatal care that offers a lot of support to women, especially vulnerable women, low-income women, potentially be women with high-risk categories. And so, what we've found is, the women that have these more, increased stressors, they benefit from this support and it actually has been shown to reduce their risk for pre-term birth. 


Alicia: Okay, so, how did you first get interested in this field of research? 


Kristin Ashford: My nursing career started out as a labor and delivery nurse. I was a labor and delivery nurse for ten years, and certainly it's one of the most happy places to work as a nurse. I absolutely loved it. And so, in that role, I began to also see births that aren't so happy, or aren't so healthy. And, specifically, the births I was really focused on was pre-term births, and the additional stressors that the moms and the families have to go through when they experience a pre-term birth. It really, got me interested in how to help these women more. Not only reduce their risk, but also to help them emotionally cope with the pre-term birth. 


Alicia: You got your PhD from UK, why did you decide to stick around? 


Kristin Ashford: I'm originally from Wisconsin, but my husband is from the Lexington area. And, so we have four children, and we want to stay in the Lexington community. So, it really made sense for me to find a post-doctoral opportunity that was here at UK. And, I just love UK. 

Alicia: Let's talk a little bit about your NIDA-funded e-cig project. How is e-cig use during pregnancy putting Kentucky babies are risk? And, then, how is your intervention trying to make a difference with that? 


Kristin Ashford:  Women of child-bearing age are the population that is at the fastest usage rates for electronic cigarettes. And, so certainly, women of child-bearing age include pregnant women, and we don't know a lot about the long-term effects of electronic cigarettes in health, and specifically in pregnancy. And so, it's going to be really important for us to understand how tobacco, via electronic cigarette, can adversely affect childbirth outcomes. What we do know, is that tobacco causes birth defects in pregnancy. That's known. It's undebatable. And, so it's very clear that electronic cigarettes contain tobacco. And, so certainly there's risks associated with electronic cigarette use in pregnancy. 


I think that one of the most important things that we're learning now is that most women that are using electronic cigarettes in pregnancy are also simultaneously using traditional cigarettes. So, we have this, phenomenon of dual use. So potentially, electronic cigarettes may not be as harmful as traditional, potentially they could be more, but then we have this dual usage concept that they're using both during pregnancy. So, there's a lot to learn about this area. 


In addition to tobacco use, I think some women don't understand the importance of how second-hand smoke exposure can affect their pregnancy as well. And, I think that women that are in homes with people that smoke don't realize that they are putting themselves just as high as a risk if they're actually smoking during pregnancy. So, I think, more education to nursing students, to nurse professionals, to health professionals in general about the significant impact of second-hand smoke exposure on birth outcomes is very important. 


Alicia: So, tell us a little bit more about the CenteringPregnancy program.


Kristin Ashford: The centering pregnancy grant was a Medicaid grant that we got three years ago, to examine the impact of CenteringPregnancy, which is group prenatal care, on pre-term birth. And so what we did here at UK, we put women in high-risk groups. Traditional CenteringPregnancy puts all women together, whether or not they have one risk factor, two risk factors; but our UK program actually wants to put women together that have more in common with one another. So, in addition to being put in the group about the same time that they're pregnant, they also are put in based on their most high-risk factor for pre-term birth. So, for example, we have a group of women that is just tobacco users. We have a group of women that are diabetic. We also have a group of women that are addicted to opioids. And, we also have a Hispanic centering group. So, we're really finding that women that are put together with common interest, common pregnancy time periods, as well as high-risk factors, has really helped their risk for pre-term birth. 


Alicia: So how is partnering Kentucky's health departments critical to the component of your research? 


Kristin Ashford: I think it's really important to reach out to the community when you're doing research. And, health departments are in every county of Kentucky. And I've had the opportunity to work with Dr. Ruth Ann Shepherd, at the Department of Material and Child Health. And, she is also very interested in reduction of pre-term birth. Because, Kentucky does rank high among adverse pregnancy outcomes, not only pre-term birth, but also low birth weight. Our women in Kentucky also have high obesity rates, as well as opioid use rates. So, trying to address these types of chronic health issues in local communities is really important. And, so what we're doing right now, is we're going to piloting our CenteringPregnancy project in several Eastern and Western Kentucky counties. And so, hopefully we’ll be able to offer those women the benefit of CenteringPregnancy as well. 


Alicia: What is the most challenging aspect of your work? 


Kristin Ashford: I think sometimes, when you're dealing with vulnerable women that have addiction, certainly tobacco and women addicted to opiates, that their addictions.... I think certainly sometimes, it can be frustrating to not have them have the outcome that you want. You know, we can provide the tools, we can provide the support, but we can't necessary make all women's behaviors change. And, so sometimes that can be frustrating. But I think, ultimately, if we give them the tools, even if it may not be successful this time, in potentially a research study or intervention, hopefully they will use those tools later on in life and hopefully get some benefit from that. 


Alicia: What has been the most rewarding moment, or moments, in your research? 


Kristin Ashford: I think that any time that you can prolong a pregnancy, it is a rewarding experience. Certainly, we know that there's high stress, high family dynamics related to a sick child. And so, if you can prevent the child from being sick, prevent that family stress, and prevent life-long complications associated with that risk, that's extremely rewarding. 


Alicia: In March, you received the Sarah Bennett Holmes Award from the UK Women's Forum. What was your reaction to that recognition? 


Kristin Ashford: When I received the Sarah Bennett Holmes award, I was just... surprised. I was humbled. I was just really appreciative, and just felt such a sense of warmth and acceptance. And, I was just honored that I was recognized with such outstanding women. And, in the spirit of the Sarah Bennett, I felt like I had somewhat of a connection with her. We both were mothers of four children, both were professors here at UK, and both had had hardships in our lives. Like most women, I think. I don't know that we can necessarily get through life without having some hardships. But, it was just really meaningful. That was one of the most special awards I think I've received to date. 


Alicia: Tell me a little bit about what you like most about the community here at UK.


Kristin Ashford: Well, I've been here at UK for 23 years, so there's obviously lots of things that I like about the community at UK. I like that we have really a multi-faceted mission. We encompass education, we prioritize research, dissemination of research, and community involvement and service. And I think, really, that's the full package. And, I think, one in itself… I think some universities strive to really be great in one, but I think UK really tries to be great in all three. And, I think that's what's important. I think if you don't disseminate your research, get into community and do community service, do education with our undergraduate and graduate students, it's just… it’s just kind of wasted. And, so, I really feel like UK does a wonderful job with all three missions. 


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