# Oxygen for intrauterine resuscitation: Investigating the role of oxidative stress

> **NIH NIH K23** · WASHINGTON UNIVERSITY · 2022 · $151,594

## Abstract

Project Summary/Abstract
Approximately 2/3 of laboring women receive supplemental oxygen (O2) in an attempt to reverse perceived fetal
hypoxia on electronic fetal monitoring (EFM). O2 supplementation is most commonly used in patients with
Category II EFM, a class of EFM patterns designed in part to identify fetal acidemia. This liberal use of O2 in
laboring patients is concerning because hyperoxygenation in infants is associated with adverse outcomes
including retinopathy and abnormal neurodevelopment. Furthermore, excess O2 exposure is linked to free radical
generation and subsequent oxidative cell damage. This calls for a closer look at the safety of intrauterine O2
exposure. The proposed project explores potential mechanisms for harm with maternal O2 supplementation in
laboring patients with Category II EFM. Specifically, this project will determine the effect of O2, compared to room
air (RA), on umbilical cord and maternal serum levels of malondialdehyde (MDA) and 4-hydroxynonenal (4-
HNE), markers of free radical-induced oxidative stress. The study will also explore the feasibility of using urine
markers of oxidative stress as a less invasive alternative to serum markers and to establish temporal trends in
oxidative stress throughout labor. This project will employ a randomized controlled design based on a recently
completed pilot trial that demonstrated feasibility of such an approach. The expected outcome of this study is
high-quality, mechanistic, pilot data on the pathophysiology of in-utero O2 exposure. If the central hypothesis
that intrauterine exposure to O2 during labor is less safe than RA is confirmed, the findings will impact the
intrapartum management of millions of patients who labor and deliver each year in the United States. Ultimately,
this work will lead to evidence-based intrauterine resuscitation during labor that minimizes neonatal morbidity.

## Key facts

- **NIH application ID:** 10434017
- **Project number:** 5K23HD098315-03
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Nandini Raghuraman
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $151,594
- **Award type:** 5
- **Project period:** 2020-06-17 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10434017

## Citation

> US National Institutes of Health, RePORTER application 10434017, Oxygen for intrauterine resuscitation: Investigating the role of oxidative stress (5K23HD098315-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10434017. Licensed CC0.

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