Advertisement

Giants in Obstetrics and Gynecology Series: A profile of Jennifer Niebyl, MD

      Click Supplemental Materials under article title in Contents at ajog.org
      Jennifer R. Niebyl, MD, Professor of Obstetrics and Gynecology at the University of Iowa Carver College of Medicine and former Chair of the Department for 21 years, has made major contributions to the understanding of drugs in pregnancy and lactation, especially in the study of indomethacin as a tocolytic agent; published influential books; been a mentor to leaders in our field; and helped to open doors for women in medicine in our field; therefore, Jennifer is being recognized as a “Giant in Obstetrics and Gynecology.”

      Early life: born into a research project in obstetrics

      Jennifer was born in Montreal, Canada, and credits her mother’s obstetrician as responsible for her being born alive. Her mother had suffered three miscarriages and two stillbirths, and was told she would never give birth to a live baby. Not satisfied with that answer, she found a research study at McGill University, in which women with high-risk pregnancies were monitored with 24-hour urinary pregnanediol levels (the precursor to estriol levels as a marker of placental function). She enrolled in the study, and Jennifer’s father brought the 24-hour urine collections to the hospital every day during the third trimester. When the levels suddenly fell, Jennifer was born via cesarean delivery at 35 weeks, weighing 4 pounds, 4 ounces. She considers that she is the “product of a research protocol” and one of 10 babies who lived after their mothers were delivered due to falling pregnanediol levels. She also likes to relate that the day of her planned discharge from the hospital was one of the coldest days on record in Montreal, and in order to ensure that she would be kept warm on the way home, her father borrowed a car with a reliable heater – which happened to be a hearse. Jennifer said that it was her mother’s obstetrician, a woman, who inspired her to choose obstetrics and gynecology as a career.

      Professional career

      Jennifer first attended nursing school because her parents advised that medicine may not be suitable for the lifestyle of a woman at the time. Her husband encouraged her to switch to medical school. Jennifer and her younger sister, Eleanor, are now prominent professionals: Eleanor became a lawyer, and is now a judge in Toronto.
      After spending the first two years of medical school at McGill in Montreal, Jennifer transferred to Yale School of Medicine for family reasons. Her medical school thesis was based on work done with world-renowned epidemiologist Alvan Feinstein, resulting in her first publication, focusing on the changes in diagnostic processes during 40 years of clinicopathological conferences, and was published in the Archives of Internal Medicine.
      • Feinstein A.R.
      • Niebyl J.R.
      Changes in the diagnostic process during 40 years of clinicopathologic conferences.
      Jennifer applied for residency positions in New York at a time when many institutions did not accept women for training in obstetrics and gynecology. The Chairman of Obstetrics and Gynecology at Cornell, Fritz Fuchs, recognized Jennifer’s talent and offered her a position on the spot.
      Jennifer loved her residency at Cornell—Richard Berkowitz
      • Romero R.
      A profile of Richard L. Berkowitz,.
      and Joe Leigh Simpson were classmates and Steven Gabbe
      • Romero R.
      A celebration of Steven Gabbe's contributions and accomplishments: Associate Editor, American Journal of Obstetrics and Gynecology, 1990 through 2010.
      was a medical student – and she remembers them alternating every other night/weekend call. Frank Zlatnik was a year ahead of Jennifer and Richard, and Joe a year behind. Jennifer became pregnant during her second year, at a time when a standard postpartum leave was not typically granted – she worked up until the day she delivered and took only four weeks off before returning to work. Because salaries were low and hospital care was expensive, when she went into labor she walked around the hospital lobby until midnight, when the daily room charge began, in order to avoid paying for a whole extra day, and arrived just in time to deliver her son. Jennifer completed one year of internal medicine and two years of obstetrics and gynecology at Cornell before moving to Baltimore and completing a residency at Johns Hopkins Hospital.

      Fellowship in Maternal Fetal Medicine

      There were no Fellowships available at Johns Hopkins when Jennifer finished her residency, so she spent two years on the faculty before becoming a Fellow in Maternal-Fetal Medicine. Jennifer became interested in drugs in pregnancy while working with pharmacologist David Blake. She conducted pioneering work on the role of aspirin, which blocks prostaglandin production. She published a seminal paper about the efficacy of indomethacin in arresting an episode of preterm labor in the American Journal of Obstetrics and Gynecology – this work continues to influence the practice of obstetrics (Figure 1).
      • Niebyl J.R.
      • Blake D.A.
      • White R.D.
      • et al.
      The inhibition of premature labor with indomethacin.
      Jennifer conducted a placebo-controlled randomized trial which showed that indomethacin could delay delivery in cases of preterm labor, and was safe if administered for only 24 hours (Figure 2).
      • Besinger R.E.
      • Niebyl J.R.
      • Keyes W.G.
      • Johnson T.R.
      Randomized comparative trial of indomethacin and ritodrine for the long-term treatment of preterm labor.
      • Niebyl J.R.
      • Witter F.R.
      Neonatal outcome after indomethacin treatment for preterm labor.
      Figure thumbnail gr2
      Figure 1Niebyl JR, Blake DA, White RD, Kumor KM, Dubin NH, Robinson JC, et al. The inhibition of premature labor with indomethacin. Am J Obstet Gynecol 1980;136:1014-9.
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail gr3
      Figure 2Besinger RE, Niebyl JR, Keyes WG, Johnson TR. Randomized comparative trial of indomethacin and ritodrine for the long-term treatment of preterm labor. Am J Obstet Gynecol 1991;164:981-6; discussion 86-8.
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Jennifer developed an interest in teratology through Bendectin®, a drug used for the treatment of nausea and vomiting during pregnancy. The drug was alleged to be linked to birth defects and eventually taken off the market following a torrent of lawsuits against the manufacturer, even though there was no scientific evidence for the claims that it was a teratogen. Through this experience, Jennifer became an expert in nausea and vomiting during pregnancy, as well as hyperemesis gravidarum, and her contributions to the management of these common pregnancy complications have been substantial.
      • Niebyl J.R.
      Clinical practice. Nausea and vomiting in pregnancy.
      • Sahakian V.
      • Rouse D.
      • Sipes S.
      • Rose N.
      • Niebyl J.
      Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.
      She collaborated with T. Murphy Goodwin of the University of Southern California on studying the management of this important condition of pregnancy
      • Niebyl J.R.
      • Goodwin T.M.
      Overview of nausea and vomiting of pregnancy with an emphasis on vitamins and ginger.
      Jennifer was also a Guest Editor of a special issue of the American Journal of Obstetrics and Gynecology devoted to nausea and vomiting during pregnancy published in 2002 (Figure 3), which resulted from a conference sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
      Figure thumbnail gr4
      Figure 3Supplement: Understanding and treating nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002;186:5. S181-S266.
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Jennifer was successful in obtaining funding to study cleft lip, and showed that there was a genetic predisposition to cleft lip with or without a cleft palate.
      • Niebyl J.R.
      • Blake D.A.
      • Rocco L.E.
      • Baumgardner R.
      • Mellits E.D.
      Lack of maternal metabolic, endocrine, and environmental influences in the etiology of cleft lip with or without cleft palate.
      She also conducted a randomized trial that showed that a common practice at the time – postpartum estrogen administration – was ineffective in suppressing lactation, but decreased anti-thrombin III levels, therefore increasing the mother’s risk of thrombo-embolic disease.

      Principal Investigator in Randomized Clinical Trials

      At Johns Hopkins, Jennifer was appointed Director of Maternal-Fetal Medicine, and under her leadership, Hopkins became one of the seven original sites of NICHD’s Maternal-Fetal Medicine Network, with Jennifer as the Principal Investigator. Other investigators included Mortimer Rosen (Columbia University), Steven Caritis (University of Pittsburgh), Richard Paul (University of Southern California), Baha Sibai (University of Tennessee - Memphis), and Richard Depp (Thomas Jefferson University), and me (Yale University). The founding members of the Network developed the conceptual framework for the operations of multi-institutional randomized clinical trials in obstetrics in the United States, and undertook studies comparing induction of labor and expectant management in patients with prolonged gestations, aspirin administration in primigravid women to prevent preeclampsia in those at high risk, and the use of antibiotics in patients with an episode of preterm labor. Jennifer played an active role in the initial meetings of the Network. The Project Officer of the Network was Dr. Donald McNellis and the Branch Chief was Dr. Charlotte Catz, who worked closely with Dr. Sumner Yaffe, Director of the Center for Mothers and Children, all of NICHD.

      Chair at Iowa

      After her tenure at Hopkins, and her success as a division leader, clinician, investigator, and teacher, Jennifer began to consider positions as Chair of Departments of Obstetrics and Gynecology. Frank Zlatnik, who had been a Resident with Jennifer at Cornell and had moved to Iowa at the end of his training, encouraged Jennifer to apply for the Chair at Iowa: Dr. Roy Pitkin, who had been the Chair as well as Editor-in-Chief of Obstetrics and Gynecology, was headed to UCLA. The Department of Obstetrics and Gynecology at the University of Iowa had four women on the faculty, but had never had a female Chair. Jennifer had also considered the position of Chair at Ohio State University, but thought that Iowa was a better fit, and accepted the position in 1988: she was only the fourth woman in the country to chair a Department of Obstetrics and Gynecology, and remained in the post for 21 years.
      As Chair, Jennifer completely revamped the Department. She oversaw the building of a new facility, merged the many individual obstetrics and gynecology practices that, along with the implementation of in-house call, improved Resident training. A major structural change that greatly enhanced her Department occurred when Jennifer was able to move obstetrical ultrasound from the Department of Radiology to Obstetrics. In addition, there were no active Fellowships when she arrived in Iowa – Jennifer established Fellowships in all three obstetrics and gynecology subspecialties, and increased the volume of research and publications in her Department.
      In 1993, she started the nurse-midwife program at the University Hospital, hiring Anne Peacock and Nicollet Markovetz. Today, the program includes seven nurse-midwives. Jennifer was succeeded as Department Head in 2009 by Dr. Kimberly Leslie.
      A particular source of pride from her time as Chair in Iowa is the role that she played in enhancing the careers of faculty and trainees. Jennifer recalled hiring a star pelvic surgeon, Dr. Ingrid Nygaard, who is now a Professor of Obstetrics and Gynecology at the University of Utah, and Editor-in-Chief for Gynecology of the American Journal of Obstetrics and Gynecology. Jennifer also mentioned Dr. Catherine Bradley, who joined the Department in Iowa from the University of Pennsylvania. Catherine is now Professor of Obstetrics and Gynecology and Urology; Division Director of Urogynecology and Reconstructive Pelvic Surgery; and Director of the Fellowship. Catherine is also an Editor of AJOG. Drs. Nygaard and Bradley spoke highly of Jennifer's investments on scholarly pursuits, academic training, and her support.
      Jennifer trained many Fellows who have gone on to have great careers, including Katharine Wenstrom,
      • Wenstrom K.D.
      • Weiner C.P.
      • Merrill D.
      • Niebyl J.
      A placebo-controlled randomized trial of the terbutaline pump for prevention of preterm delivery.
      who she supported in completing a genetics fellowship at the University of Iowa at a time when most geneticists were pediatricians, is a past president of SMFM and now the Division Director of Maternal-Fetal Medicine at Women & Infants Hospital Brown University. Katharine recalls fondly that Jennifer was a champion of the female faculty at a time when few women stayed in academic medicine or reached the rank of Professor. She inspired camaraderie among the women in the department, from residents to faculty, and regularly attended meetings of the Women of Obstetrics group, who met monthly to have a few drinks and to support each other. Dwight Rouse, another Fellow in Maternal-Fetal Medicine
      • Sahakian V.
      • Rouse D.
      • Sipes S.
      • Rose N.
      • Niebyl J.
      Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.
      was an Associate Editor of Obstetrics and Gynecology; Timothy R.B. Johnson, who worked with Jennifer at Hopkins,
      • Besinger R.E.
      • Niebyl J.R.
      • Keyes W.G.
      • Johnson T.R.
      Randomized comparative trial of indomethacin and ritodrine for the long-term treatment of preterm labor.
      • Johnson J.W.
      • Daikoku N.H.
      • Niebyl J.R.
      • Johnson Jr., T.R.
      • Khouzami V.A.
      • Witter F.R.
      Premature rupture of the membranes and prolonged latency.
      became Chair at the University of Michigan and Editor-in-Chief of the International Journal of Obstetrics and Gynecology, the official journal of FIGO. Jennifer also warmly remembers Frank Witter,
      • Witter F.R.
      • Niebyl J.R.
      Marijuana use in pregnancy and pregnancy outcome.
      • Witter F.R.
      • Niebyl J.R.
      Inhibition of arachidonic acid metabolism in the perinatal period: pharmacology, clinical application, and potential adverse effects.
      • Witter F.R.
      • King T.M.
      • Blake D.A.
      Adverse effects of cardiovascular drug therapy on the fetus and neonate.
      • Witter F.R.
      Clinical pharmacokinetics in the treatment of rheumatoid arthritis in pregnancy.
      an exceptional academician who has had a major role in obstetrics at Johns Hopkins University, and who shared with Jennifer an interest in drugs in pregnancy. Academic obstetrics offers opportunities to develop close collaborative partnerships.

      Books

      Jennifer coauthored her first book on drugs in pregnancy with Frederick Zuspan while still at Hopkins.
      Drug Use in Pregnancy.
      In addition, she credits Fred Zuspan as having a major influence on her professional career, along with Howard and Georgeanna Jones and Donald Woodruff.
      Aside from her original peer-reviewed publications, Jennifer has edited seven editions of Obstetrics: Normal and Problem Pregnancies, a project that began with her Cornell colleagues Steven Gabbe and Joe Leigh Simpson, and was first published in 1986.

      Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal & Problem Pregnancies. London: Churchill-Livingstone; 2016.

      The book has been an extraordinary success, and the latest edition–the 7th–is co-edited by Mark Landon, Henry Galan, Eric Jauniaux, Deborah Driscoll, Vincenzo Berghella, and William Grobman.

      Gabbe SG, Niebyl JR, Simpson JL, et al. Obstetrics: Normal and Problem Pregnancies. Philadelphia, PA: Elsevier; 2016.

      Positions of Leadership in Obstetrics and Gynecology

      An active member of the Society for Gynecologic Investigation (now Society for Reproductive Investigation), Jennifer also served as President from 2000-2001. In her Presidential Address, she recounted the story of her mother’s pregnancies, and recognized her mentors, family, and trainees.
      In addition, Jennifer served as President of the prestigious American Gynecological and Obstetrical Society in 2008. Her Presidential Address, entitled “Pharmaceutical Industry: Friend or Foe”, provided a framework to regulate the relationships between the corporate world and universities.
      • Niebyl J.R.
      The pharmaceutical industry: friend or foe?.
      Her stature and unshakeable integrity have been recognized, and she is now the physician for the University of Iowa’s Conflict of Interest in Research Office.
      Jennifer is also an elected member of the National Academy of Medicine of the National Academies of Sciences, Engineering, and Medicine of the United States.

      Current Life and Interests

      In Iowa, Jennifer also met Mr. Allan Poots, a builder and developer. They have been married nearly 25 years. Since stepping down as Chair in 2009, Jennifer spends more time in her second home in Venice, Florida, but continues to be active in the Department of Obstetrics and Gynecology in Iowa, serving as a Vice Chair for Obstetrics and seeing patients regularly in the High Risk Pregnancy Clinic. She attends national meetings, and is still a source of inspiration and support to all her past residents and fellows, many of whom are in academic medicine.
      Jennifer’s son Peter, born during her second year of residency at Cornell, is a lawyer with an MBA, and works for the Federal Reserve in Washington, D.C.
      Her favorite poem is “If” by Rudyard Kipling, and her favorite films are “The King and I” and “The Sound of Music.”

      Honoring Dr. Niebyl

      Jennifer has made long-standing contributions as an investigator, clinician, teacher, mentor, author, editor, and leader in our specialty. By her example, relentless commitment to excellence, aplomb, academic strength, and grace, Jennifer has opened doors for women in obstetrics and gynecology and medicine, and thus, AJOG recognizes Jennifer Niebyl as a “Giant” in our field.

      Appendix

      Figure thumbnail fx1
      Figure S1L to R: Eleanor (sister), Maud (mother), and Jennifer
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail fx2
      Figure S2Dr. Donald Woodruff and Dr. Niebyl
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail fx3
      Figure S3Dr. Niebyl with Dr. Emily Haller, her partner in obstetrics at Johns Hopkins, and Dr. Alex Haller, a pediatric surgeon
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail fx4
      Figure S4Dr. Niebyl (seated, 4th from left) as Chair of the Department of Obstetrics and Gynecology at the University of Iowa with faculty and residents, 1989
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail fx5
      Figure S5Dr. Niebyl with Dr. Steve Gabbe in the 1990s
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail fx6
      Figure S6Dr. Niebyl with Dr. Frank Witter in the 1990s
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail fx7
      Figure S7A caricature presented by the University of Southern California to Dr. Niebyl after a speaking engagement on campus
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.
      Figure thumbnail fx8
      Figure S8Dr. Niebyl with first-year residents in 2016 at the University of Iowa
      Romero. Profile of Jennifer Niebyl, MD. Am J Obstet Gynecol 2017.

      References

        • Feinstein A.R.
        • Niebyl J.R.
        Changes in the diagnostic process during 40 years of clinicopathologic conferences.
        Arch Intern Med. 1971; 128: 774-780
        • Romero R.
        A profile of Richard L. Berkowitz,.
        MD. Am J Obstet Gynecol. 2016; 215: 265-266
        • Romero R.
        A celebration of Steven Gabbe's contributions and accomplishments: Associate Editor, American Journal of Obstetrics and Gynecology, 1990 through 2010.
        Am J Obstet Gynecol. 2011; 205: 1-4
        • Niebyl J.R.
        • Blake D.A.
        • White R.D.
        • et al.
        The inhibition of premature labor with indomethacin.
        Am J Obstet Gynecol. 1980; 136: 1014-1019
        • Besinger R.E.
        • Niebyl J.R.
        • Keyes W.G.
        • Johnson T.R.
        Randomized comparative trial of indomethacin and ritodrine for the long-term treatment of preterm labor.
        Am J Obstet Gynecol. 1991; 164 (discussion 86-8): 981-986
        • Niebyl J.R.
        • Witter F.R.
        Neonatal outcome after indomethacin treatment for preterm labor.
        Am J Obstet Gynecol. 1986; 155: 747-749
        • Niebyl J.R.
        Clinical practice. Nausea and vomiting in pregnancy.
        N Engl J Med. 2010; 363: 1544-1550
        • Sahakian V.
        • Rouse D.
        • Sipes S.
        • Rose N.
        • Niebyl J.
        Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.
        Obstet Gynecol. 1991; 78: 33-36
        • Niebyl J.R.
        • Goodwin T.M.
        Overview of nausea and vomiting of pregnancy with an emphasis on vitamins and ginger.
        Am J Obstet Gynecol. 2002; 186: S253-S255
        • Niebyl J.R.
        • Blake D.A.
        • Rocco L.E.
        • Baumgardner R.
        • Mellits E.D.
        Lack of maternal metabolic, endocrine, and environmental influences in the etiology of cleft lip with or without cleft palate.
        Cleft Palate J. 1985; 22: 20-28
        • Wenstrom K.D.
        • Weiner C.P.
        • Merrill D.
        • Niebyl J.
        A placebo-controlled randomized trial of the terbutaline pump for prevention of preterm delivery.
        Am J Perinatol. 1997; 14: 87-91
        • Johnson J.W.
        • Daikoku N.H.
        • Niebyl J.R.
        • Johnson Jr., T.R.
        • Khouzami V.A.
        • Witter F.R.
        Premature rupture of the membranes and prolonged latency.
        Obstet Gynecol. 1981; 57: 547-556
        • Witter F.R.
        • Niebyl J.R.
        Marijuana use in pregnancy and pregnancy outcome.
        Am J Perinatol. 1990; 7: 36-38
        • Witter F.R.
        • Niebyl J.R.
        Inhibition of arachidonic acid metabolism in the perinatal period: pharmacology, clinical application, and potential adverse effects.
        Semin Perinatol. 1986; 10: 316-333
        • Witter F.R.
        • King T.M.
        • Blake D.A.
        Adverse effects of cardiovascular drug therapy on the fetus and neonate.
        Obstet Gynecol. 1981; 58: 100S-105S
        • Witter F.R.
        Clinical pharmacokinetics in the treatment of rheumatoid arthritis in pregnancy.
        Clin Pharmacokinet. 1993; 25: 444-449
      1. Drug Use in Pregnancy.
        in: Niebyl J.R. Zuspan F.P. Current Concepts in Obstetrics and Gynecology. Lea and Febiger, Philadelphia, PA1982
      2. Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal & Problem Pregnancies. London: Churchill-Livingstone; 2016.

      3. Gabbe SG, Niebyl JR, Simpson JL, et al. Obstetrics: Normal and Problem Pregnancies. Philadelphia, PA: Elsevier; 2016.

        • Niebyl J.R.
        The pharmaceutical industry: friend or foe?.
        Am J Obstet Gynecol. 2008; 198: 435-439