Making Sense of Pregnancy: What Experts Want you To Know About Your Body

One of the big unknowns in pregnancy, and there are many, is what initiates labor. Researchers point to many different possible triggers, and likely it is some combination of signals from the placenta, the fetus and the mother that kick off productive contractions. 

This is a highly sought after bit of information in part because if we knew what initiated labor, maybe, just maybe we could turn it off in teh case of preterm labor. preterm labor is a significant issue in the US. 1 in 10 births are premature. And presently we don't have a successful approach to turning labor off once it's started--which is why my conversation with a researcher today, whose group has identified one of the switches that turns contractions on, is so exciting and inspiring.

To read more about Dr. Lishko's work, you can find her here: https://cellbiology.wustl.edu/people/polina-lishko-phd/

Today we are all about fetal programming. It's also known as the Barker Hypothesis or Fetal Origins of Health and Disease. This theory suggests that the uterine environment can impact not just immediate health for the baby, but long-term health as well.

The theory suggests that the nine month window of pregnancy is a particularly critical time in the body's development. It is when all organs are being formed and any physical or mental health issue for the mother that affects this sensitive environment of the uterus, leaves its mark on organ and system formation in the fetus.

For a pregnant woman, I feel like this theory might spark ambivalence. There's something hopeful in it because it suggests some indirect control over something as important as long-term health, and you're not entirely beholden to the genetics you're passing on. But at the same time, this theory also comes with a lot of responsibility for the pregnant person.

You may think I've already given up alcohol and sushi and cheese, and whatever your long list is while I'm sharing my body for nine months, not counting breastfeeding. Now, I'm also responsible for the baby's lifelong health. Let's dive into this topic and see what the state of the research is today.

Episode with Dr. Alison Paquette testing Barker Hypothesis issues: https://podcasts.apple.com/us/podcast/the-connection-between-the-womb-and/id1779600854?i=1000697820556

It should not ALSO be a mother's job to catch her own depression after delivery.

In pregnancy care in the future, imagine if you walked into your OBs office in your third trimester and you got a blood test that could predict how likely you are to run into postpartum depression? 

Among all your other novel and challenging responsibilites as the caretaker of a newborn, it would not be your responsibility while operating on very little sleep to also be carefully monitoring and analyzing your emotional state so that you can reach out to a doctor if anything seems awry--and that's making the sometimes large leap in imagining that amidst all the change and newness you'd be able to tell whether the change you may be feeling is typical or one that requires help. Today's guest will talk about this future.

You can find Dr. Payne's work here, at the Reproductive Psychiatry Research Program: https://med.virginia.edu/psychiatry/research/reproductive-psychiatry-research-program/

 This week's episode is kind of a how to episode. It's how do you grow a placenta, an entirely new organ, and quickly. Probably a more accurate title would be how do we think we might grow a placenta? How does a placenta develop? Maybe because in truth we have by no means worked out all of the details about how this critical life-giving organ is formed.

Having said that, let's run through some of what we think we know today.

Growing the placenta is kind of like establishing a fetal embassy inside the united organs of you. It's subject to the laws and customs of the mother country expressed through her chemistry and the condition of her body. But the embassy has ways to get what it needs. Today, I'll highlight what we think is going on and the ways in which we're able to track this progress while it's going on, and what we can do if we run into trouble.

I admit that I love a cross over event, especially when it comes to pregnancy and birth research. Today's crossover involves the use of sports medicine to think about issues that come up in delivery. In particular, we'll talk to both the CEO and one of the co-founders of a company making a device to predict postpartum hemorrhage before it happens. Something like 40% of cases happen to women who are considered low risk, so a tool that helps to flag these people could be significant.

Find more about vasowatch here: https://www.vasowatch.com/

Find more about Dr. Weimer's internet-of-medical-things lab here: https://jamesweimer.net/

The human placenta is a superhero of organs. It's a master regulator of hormones, a negotiator with the maternal immune system, and capable of adapting structurally and metabolically--in real time--to changes in it's environment to cater to the fetus. But it also has a lot of black box features, in part because it is a difficult organ to study. 

My guest today talks about an amazing paradigm shift in the way we can examine the placenta, using organ on a chip technology that frees us from the petri dish, and takes advantage of organ on a chip technology to create a 3-D proto placenta that responds to mechanical pressure and allows for investigation of the interaction between multiple cell types grown from induced human pluripotent stem cells. This kind of model will allow us to ask lots of important questions about how the placenta interacts with different drugs and maybe too what factors influence how the developing placenta invades the mother's body, providing more clues about preeclampsia, among other things.

You can find more about Dr. Colin Murdoch's work here: https://www.dundee.ac.uk/people/colin-murdoch

Last week we talked about the magic of peering into your brain, looking for clues about what issues might visit in pregnancy by using the non invasive retinal scan. Today we add more possibilities to that list of things to look for in the second half of my conversation with Dr. Li. she's an Assistant Professor in the Department of Obstetrics and Gynaecology at the National University of Singapore (NUS). She is also the Assistant Director of Public Affairs at the Global Centre for Asian Women's Health (GloW).

In today's episode we talk about how long it takes for systemic changes to be reflected in these scans, for the use of these scans to measure things like small for gestation age as well as depression in pregnancy.

To learn more about Dr. Li and her work, you can find her here: https://medicine.nus.edu.sg/obgyn/research/our-researchers/Queenie-Li-Ling-Jun.html#:~:text=Queenie%20Li%20Ling%20Jun%20%7C%20Department%20of%20Obstetrics%20&%20Gynaecology

 In today's episode, I'll share some research conducted by doctors in Singapore that gives you a sense of how close we are to using non invasive scans to predict conditions in pregnancy and fertility before clinical symptoms arise.

What these research physicians are doing is making use of a retinal scan--taking pictures of the tiny vessels at the back of your eye and measuring changes in these vessels to predict a number of significant issues in fertility and pregnancy. 

Through the lucky marriage of improvements in imaging tech and the harvesting and analysis of big data scientists have birthed a field, maybe yet to be fully named, but what I saw called oculomics--(sounds a little too much like a bond villian) which is using biomarkers from pictures of the eye to predict systemic disease. What makes this particularly useful is that often issues show up in the microvasculature, these tiny vessels, before it shows up in more obvious clinical symptoms, giving us something like an advance warning, and potentially time to react.

Dr. Li's 2024 paper: https://pmc.ncbi.nlm.nih.gov/articles/PMC8677435/

​There are many routes to depression, in  pregnancy and postpartum, and one route that we focus on today is that of immune dysregulation. Pregnancy is a time of real immune disruption as your body shifts its resources to protect the baby from the mother's body, and the mother's body from infectious agents in the environment. Researchers think that how these shifts play out can contribute to the risk of developing depression after pregnancy. Today I talk to one of those researchers, in the hunt for a blood test to predict postpartum depression.

To follow more of Dr. Osborne's work, you can find her here: https://pippilab.weill.cornell.edu/team/lauren-m-osborne-md

 This week's episode is a bit of a prequel focused on the making of the egg, which will make the embryo. Sorry guys. The sperm is an NPC in this one.  Why do we care? Because we might not even think about how eggs are made. Until circumstances require it often in the form of a miscarriage, miscarriage rates on average are pretty high.

Something like one in four suspected,  and that's just of the embryos that actually get implanted. An estimated 60% of embryos never make it past. The sensors in the uterine lining. Miscarriages tend to congregate around the first trimester. Something like 80% of them happen then. And the largest fraction of those is seemingly related to aneuploidy.

When cells that make up the embryo have the wrong number of chromosomes. So the question is. How does it work, when it works, and what happens when it goes wrong?