Maternal-Fetal Medicine Research: Advancing High-risk Pregnancy Care Video & Transcript
Louise Wilkins-Haug, MD, PhD
Division Director, Maternal-Fetal Medicine, Brigham and Women’s Hospital
Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School
Improving High-risk Pregnancy Outcomes
The research that the Maternal-Fetal Medicine Division is involved with spans a broad arena from clinical research to more basic translational research. In the clinical realm there has been interest in looking at outcomes. The cardiovascular program with Dr. Economy has looked at the outcomes from the women who deliver with repaired cardiac anomalies. Dr. Smith with her work in psychiatry is looking at interventions and depression outcomes. Dr. Zera is looking at interventions for diabetes and the best management for gestational diabetes.
Placental Conditions and Pregnancy Outcomes
Concerns that we're seeing more commonly, which are tied to the increased Cesarean section rate, are placentas that are too adherent to the uterus and don't separate well. This is often driven by the increased numbers of cesarean sections that women have. That's not the only risk factor. Certainly women who are older when they deliver are at an increased risk for this complication, known as placenta accreta. Studies that have come out of our unit also show that women who undergo IVF and in particular, frozen cycle IVF, are at an increased risk as well. Prior uterine surgeries also put women at increased risk for this.
Recently, there was NIH-directed support for initiatives looking at the role of the placenta in pregnancy outcomes. There is now an ongoing study in collaboration with Boston Children's Hospital and one of our investigators, Dr. Robinson, looking at the role of newer imaging studies of the placenta and its ability to predict the outcome of pregnancies.
Prenatal Diagnosis and Maternal Health
We're finding, as prenatal diagnostic techniques are advancing, that the testing modality is so sensitive that DNA samples from the maternal circulation are actually revealing more about the condition of the fetus in the placenta and more about the mother's health than we expected. We were contributing cases to a recent case series where the new prenatal diagnostic testing was able to identify cancers within the mother during pregnancy.
One of the ongoing research projects that Dr. McElrath and Dr. Cantonwine are lead investigators on has been a multi-year study in which women have consented to have blood samples and, in some cases, urine and placental samples, which are stored in a LIFECODES Biobank. From this we developed several studies that have been able to look at pregnancy outcomes and various correlates such as environmental exposures or pregnancy factors that may affect either biomarkers or their pregnancy outcomes.