The RFTS Team

Who launched and partnered in RFTS?

Key Scientific Results

What have we published?

Help Share

How can you get the word out about pregnancy health?


How do we share data and partner in new studies?

Why is Right From the Start important?

Before RFTS, understanding what contributes to pregnancy well-being or increases risk for adverse outcomes, like miscarriage and preterm birth, was limited to small studies or those in settings that did not represent a typical woman in the United States planning a pregnancy. Most research missed crucial information about the time around conception and the first few weeks of pregnancy.

We are grateful to thousands of women, in eight areas of the country, who enrolled very early in pregnancy–most before their first prenatal visit, or while they were hoping to conceive. Each woman provided details about facets of her life, including personal characteristics, medical history, and daily activities, as well as habits and behaviors, at multiple times. What we have learned results from their generous gift of trust and patience in sharing their stories.

About RFTS

What does RFTS bring to understanding healthy pregnancies?*

Information from ultrasounds, medical records, and details provided by more than 8,000 participants falls in three major categories:
Good News to Reduce Worries

  • On average, women who conceived did so within 3 months, with 90% by 11 months.
  • While 27% of women have bleeding in early pregnancy, only 12% go on to have a miscarriage.
  • Nausea, with or without vomiting, is common (88%). Women who had these symptoms were 31% less likely to have a miscarriage than those without symptoms.
  • Use of common over-the-counter and prescription pain meds, like ibuprofen and acetaminophen, near conception and in the first trimester, is not associated with increased risk of miscarriage.
  • Delaying conception after a miscarriage does not reduce the risk of having another miscarriage.
  • Use of caffeine in typical amounts, from any source, does not increase the risk of miscarriage.

News to Protect Healthy Pregnancies

  • Taking a multivitamin or prenatal vitamin, including those available from grocery and drug stores, can reduce odds of miscarriage by more than 50% compared to those who don’t start early or never use them.
  • Stopping alcohol use when you are trying to get pregnant or as soon as you have a positive pregnancy test reduces odds of miscarriage.
  • If your care provider discusses surgery for fibroids to improve chances of conception and successful pregnancy, gather information to help make your decision. We have not found fibroids increase the time to get pregnant nor do they cause miscarriage or preterm birth.

News to Understand Risk Factors & Guide Study of Prevention

  • Women who describe themselves as African American have increased risk of pregnancy loss after taking into account other factors known to influence risk.
  • Using ancestry informative markers, genetic studies suggest this effect may be related to differences in inflammatory pathways that cause more robust inflammation for some African American women. 

  • Among those with changes in genes that increase immune response, women who used non-steroidal anti-inflammatory meds like Aleve, Motrin, and generic equivalents, had lower risk of miscarriage. Please note this has not been studied sufficiently to prompt genetic testing or use of these drugs within any racial or ethnic group.

How was the RFTS study conducted?

RFTS is a prospective cohort. Women from eight metropolitan and surrounding suburban and rural areas in North Carolina, Tennessee, and Texas enrolled in RFTS from 2000 to 2012 . Local businesses, community agencies, churches, conventional advertising, direct mail, and care providers who do early pregnancy testing helped distribute information about how to join the study.

Study volunteers were age 18 years or older, English- or Spanish-speaking, did not use fertility treatments, and planned to carry their pregnancy to term.

All women who contacted us and consented to be included joined prior to the end of the first trimester, at an average of 19 days after their missed period. More than a quarter of participants joined the study while planning to become pregnant; they often let us know they were pregnant right around the time of their missed period.

Participants completed an intake interview when they first contacted us, and later did an extensive telephone interview in the first trimester. This included information about their personal characteristics, medical history, reproductive history, lifestyle, and health behaviors. They also had an early ultrasound, around six weeks, to assess pregnancy well-being and to measure characteristics of the uterus, including any uterine fibroids identified.

During portions of the study we also did home visits related to tap water quality, collected biologic specimens like blood and urine, arranged for semen samples from partners, and collected DNA using saliva samples from mothers and their babies. Additional written and electronic surveys supported special projects and follow-up after pregnancy.

Who are the women who joined the RFTS study?

Around 10,000 women contacted us to volunteer to join RFTS, and  >8,000 were eligible to participate. They are the reason the research teams were able to learn more about what helps make pregnancies healthy and what may cause harm.

Multiple aspects of diversity among those who participated were crucial so that the study would reflect typical women in the US who are very early in pregnancy or still planning a pregnancy. We recruited from eight areas of three states, beginning in North Carolina and growing to Texas and Tennessee.

These women who gave their trust, time, and information, had these characteristics:

  • 18 to 45 years old, with an average age of 28
  • 70% white race (all race/ethnicity was self-reported)
  • 19% black race
  • 7% of Hispanic ethnicity separate from race
  • 89% married or living as married
  • 70% employed
  • 61% had a college degree
  • 48% in their first pregnancy
  • 22% had experienced one or more prior pregnancy loss
  • 11% had one or more uterine fibroids visible by study ultrasound
  • 95% took a prenatal vitamin or multivitamin
  • 55% consumed alcohol close to conception and early pregnancy
  • 94% of those quit drinking alcohol close to a positive pregnancy test
  • 43% used over-the-counter or prescription pain medications
  • 28% drank caffeine, an average of about 1.5 cups a day
  • 4% used antidepressants
  • 4% smoked cigarettes
  • <3% used other substances

Where can I get outreach and education materials?

Our site includes these materials:

If you, your organization, or professional group would like to actively collaborate on developing brochures, posters, handouts or other materials please contact us. More details are available when you click on the “Collaborate” icon above.

Reach Dashboard

We care about sharing results of our research with both the scientific community and with women who can be reassured or benefit from the contributions of our study volunteers. Reach describes how many journal articles have been published by the researchers, how other scientists note that those publications informed future work, and how much attention the results of the research gain online from sources like media outlets, social accounts, and video links.







Uterine fibroids unlikely to increase risk of spontaneous or induced preterm birth

About 1 in 10 women have fibroids during pregnancy. Fibroids have been reported to increase risk of preterm birth. We have previously published lack of an overall increase in risk of early births among women with fibroids. To be cautious we examined the type of preterm birth more closely separating births preceded by 1) preterm labor which is early onset of contraction and dilation, 2) preterm premature rupture of the amniotic sac, and 3) reasons of the mother’s or infant’s health that required early delivery. In this new analysis that included more than 4,600 women, we confirmed risk is not linked to preterm birth that occurs spontaneously or is induced. This study is published in BMC Pregnancy and Childbirth.


Welcome to the News Vault

We’ve rounded up media coverage and added some of our own summaries about what Right From the Start research means. Print, broadcast, and online news, original scientific articles, and finding groups that share mutual interests give us all better access to information about health around the time of conception and pregnancy health. Staying informed, checking that sources are reliable, and having details to share supports good decisions and can be helpful to discuss with your doctor or midwife.

Deeper Dive

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