Our Work
Explore our current and past research projects.
Current Projects
PRISMA Maternal and Newborn Health Study
Dr. Smith is a principal investigator for the Pregnancy Risk, Infant Surveillance, and Measurement Alliance (PRISMA) Maternal and Newborn Health Study: a multi-center, prospective cohort study of ~20,000 moms and 16,000 babies in Kenya, Ghana, Pakistan, Zambia and India. PRISMA aims to address gaps in our understanding of the burden and causes of maternal, fetal, and infant morbidity and mortality. The study seeks to produce harmonized data on pregnancy risk factors and key health outcomes throughout pregnancy and up to one year postpartum. Among other responsibilities, our team at GW serves as the protocol, data, and laboratory harmonization center, supporting consistent protocol implementation, standardized data collection and analysis, maintainence of a central data warehouse, and publication and dissemination of key findings. We also organize across-site training and capacity building. Read more here: https://prisma-mnh.org/
Redefining Anemia in Pregnancy & Postpartum (ReMAPP) Study
Dr. Smith and colleague Dr. Kwaku Poku Asante at the Kintampo Health Research Centre in Ghana are co-Principal Investigators for the Redefining Maternal Anemia in Pregnancy and Postpartum (ReMAPP) study. Recent evidence indicates that a reevaluation of hemoglobin thresholds during pregnancy is needed to better diagnose anemia. ReMAPP seeks to advance clinical knowledge of anemia during pregnancy and contribute high-quality data toward establishing more globally-representative hemoglobin thresholds. This multicenter, population-based study will enroll up to 12,000 women at each of the six sites in Kenya, Ghana, Zambia, India, and Pakistan. Women will be enrolled early in pregnancy and undergo serial measurements of hemoglobin by complete blood count through 6 weeks postpartum. Hemoglobin thresholds will be established using multiple approaches (reference limits in a healthy subpopulation and clinical decision limits) and anemia etiology during pregnancy will be explored.
Multiple Micronutrient Supplementation for Maternal Anemia Prevention in Tanzania (MMS-MAP)
What is the optimal daily dose of iron to include in Multiple Micronutrient Supplementation (MMS) in pregnancy? Dr. Smith and colleagues are conducting an individually randomized controlled trial to assess the effect of MMS containing 60 and 45 mg iron as compared to MMS that contains 30 mg of iron (standard iron dose in UNIMAP MMS formulation) on maternal anemia and other important maternal and newborn health outcomes. This study will also assess side effects and adherence. The trial will be conducted in Dar es Salaam, Tanzania, in collaboration with colleagues at Ifakara Health Institute, Africa Academy for Public Health, Muhimbili University of Health and Allied Sciences, and Harvard TH Chan School of Public Health. This study will help inform countries like Tanzania (that currently use IFA containing 60 mg of iron) as they transition to using MMS. (https://clinicaltrials.gov/study/NCT06079918)
Molecular Methods for Maternal Nutrition
Dr. Smith is studying optimal nutrition during pregnancy through the Molecular Methods for Maternal Nutrition (MM4MN) project, including a trial on vitamin B12. This project aims to enhance understanding of the bioavailability of vitamin B12 during pregnancy in patients with sufficient and insufficient baseline B12 status. Further, this study aims to identify the priority dose regimens of vitamin B12 in pregnancy to be investigated in future phase clinical trials & identify novel biomarkers of vitamin B12 intake that are suitable for pregnancy. This study is conducted alongside colleagues at Penn State University, Baylor College of Medicine, University of Maryland School of Pharmacy, Ifakara Health Institute, and Muhimbili University of Health & Allied Sciences. (https://clinicaltrials.gov/study/NCT05426395)
Previous Projects
Multiple Micronutrient Supplementation (MMS) in Pregnancy
Dr. Smith led pooling and analysis for an individual patient data meta-analysis intended to inform policy surrounding Multiple Micronutrient Supplementation (MMS) in pregnancy (Smith et al. Lancet Global Health. 2017). Despite concerns about potential health risks raised in the World Health Organization (WHO) 2016 Antenatal Care Guidelines, the meta-analysis and a second study published in the Journal of Nutrition (Smith & Sudfeld. 2019) found clear evidence that MMS containing iron and folic acid is safe and superior to iron and folic acid alone. MMS in pregnancy reduces the risk of low birth weight, preterm birth, and being born small-for-gestational-age. Further, MMS reduces the risk of neonatal and infant mortality for girls, and there was no evidence of increased risk among the 26 subgroups examined. Dr. Smith is a member of the Taskforce on Maternal Micronutrient Supplementation in Pregnancy hosted by the New York Academy of Sciences and is an advocate for improving evidence-based maternal nutrition services during pregnancy.
Perinatal COVID Prospective Meta-Analysis
Dr. Smith collaboratively organized the Perinatal COVID-19 Sequential Prospective Meta-Analysis (PMA) project: a coordinated effort among nearly 100 investigators in 41 countries to answer high-priority research questions about the impact of SARS-CoV-2 infection on pregnant people and newborns. The PMA gathered data for 76,000 pregnancies from national registries, health information systems, and institutional databases. The primary goal is to generate data for policymaking and clinical guidelines specific to pregnant people: a population frequently excluded from clinical trials. Initial published findings from the PMA project have been featured in the Washington Post, the Guardian, and Fortune.
Evidence-Based Answers to COVID Questions
COVID-101 is an online platform launched in March 2020 to combat rampant misinformation and provide evidence-based answers to the public’s questions about the COVID-19 pandemic. It works like this: readers submit questions via Facebook, Twitter, Instagram, or COVID-101.org, our team rapidly reviews the scientific literature, and then we post a response. Over 25 volunteers contributed to this project, including epidemiologists and infectious disease physicians from a dozen colleges and universities (George Washington University, University of Washington, Columbia University, Harvard University, Johns Hopkins University, and more).
Neonatal Vitamin A Supplementation RCT
The Neonatal Vitamin A Supplementation (NVAS) Randomized Controlled Trial is the largest neonatal vitamin A supplementation trial ever conducted in sub-Saharan Africa, involving over 32,000 neonates in Tanzania. The primary goal was to assess whether NVAS reduced the risk of infant death. We then compared findings from parallel NVAS trials conducted in India and Ghana; the three trials found conflicting results. Our resulting publication explored potential reasons for these differences and Dr. Smith participated in the WHO Technical Working Group that pooled data from all prior NVAS trials. This work informed current WHO guidelines for NVAS.
Early Breastfeeding Initiation on Infant Health
Dr. Smith has published several papers showing a link between breastfeeding initiation time and infant morbidity and mortality (Smith et al The Journal of Pediatrics 2107; Smith et al PloS one 2017; Neovita Study Group Lancet Global Health 2016). However, the mechanism through which early newborn nutrition has a long-term health impact is not known. Researchers have suggested that early breastfeeding may decrease the risk of microbial translocation, accelerate intestinal maturation, promote resistance to and epithelial recovery from infection, and protect against environmental enteric dysfunction (EED). But there is limited data to support these hypotheses. To build upon previous findings, we completed a study among a cohort of children enrolled in a Multiple Micronutrient Supplementation (MMS) iron dose trial in Tanzania. Results indicated that delayed breastfeeding initiation and prelacteal feeding were both associated with elevated biomarkers of poor gut function later in infancy. Smith Lab subsequently carried out four systematic reviews to support development of the 2020 WHO Guidelines on care and feeding of low birthweight infants.
Immunology and Epidemiology of Viral Diarrhea
Dr. Smith has worked on a number of studies related to immunology and epidemiology of norovirus and rotavirus. While at Emory University, she worked on several randomized, human-challenge trials to assess the effectiveness of new technology to inactivate norovirus. Prior to introduction of the rotavirus vaccine in Bolivia, Dr. Smith worked with Universidad Mayor de San Andrés and the Pan American Health Organization to conduct national, sentinel rotavirus surveillance. In parallel, she led costing studies to assess the cost-effectiveness of the new vaccine from both the caregiver and state perspectives.