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

Preterm birth is a significant problem in the world and affects one in 10 pregnancies in the US.

Any early birth anytime before 37 weeks. Could lead to a host of negative outcomes, both for the mother and the baby.

What can be done?

Today, I talked to a researcher about his work examining how aspirin taken early in pregnancy can decrease the rate of preterm birth.

Dr. Hoffman's most recent publication about aspirin use in pregnancy: https://journals.lww.com/greenjournal/citation/2024/03000/aspirin_in_pregnancy.27.aspx

This week's episode is a continuation of my conversation about developing our skills to best use the placenta as a diary of intrauterine life. 

Dr. Parast shares more of her work about the promise of placental pathology to better understand both the pregnancy that has been completed and potentially to better predict what a future pregnancy could hold. 

We also talk about: 
* how to prepare your body for pregnancy
* what biomarkers in conjunction with new screening methods can do to help with prediction during a pregnancy
and
* how studying the placenta could yield insights on aging more generally 

The placenta is the diary of intrauterine life, so says Dr. Parast and her collegues. They are using this diary, after birth, to better understand both the trajectory of problems in birth (like IUGR and preeclampsia) as well as markers of impending morbidity for mothers (like autoimmune conditions that have not yet crossed the threshold of noticeable symptoms). Dr. Parast believes that placental pathology should be the standard of care in any birth that involved some sort of pregnancy complication, to better understand the cause of stillbirth (and potentially prevent future problems) and to guide maternal care in future pregnancies.

Check out some of the work the Parast Lab is doing here: https://pathology.ucsd.edu/research/labs/parast/index.html

Many first time mothers experience the schedule of OB visits as informative: there are few visits in the beginning of the pregnancy and many near the end and one might take that to mean that there is more going on at the end than the beginning of gestation. 

In fact, there is a tremendous amount of activity going on in the opening weeks of pregnancy, but until now, we understood very little of it, and had very limited ability to change our trajectory with any move other than delivery.

Today's guest, Dr. Carl Weiner, has mined some of the early data of the first trimester to allow him and his team to predict whether a premature birth is likely on the horizon when the pregnant person is 12 weeks pregnant. Today we'll talk about his exciting work.

To find Dr. Carl Weiner's work, see: https://pubmed.ncbi.nlm.nih.gov/?term=Carl+Weiner&sort=date

Here we are in the 21st century and we're just figuring out how uterine contractions work.

Humans have giving birth for millions of years and we are only now unpacking part of the uterine contribution to this magic trick.

For years scientists used a rodent model to interrogate how uterine contractions work, which turned out to be the wrong model; scientists used the heart as a model organ to try to elucidate how electricity moves in the uterus and makes it contract, but that too, was the wrong model.

The uterus is sui generis, it's own unique organ that, according to Dr. Roger Young, is in the last decade, becoming better understood; His company is working on making a fetal monitor to better assess when labor is in fact happening, by measuring the pressure changes in the uterus, a statistic that's critical to understanding labor progression.  Keep listening to better understand how your uterus actually works.

To see some of Dr. Young's academic work: see https://pubmed.ncbi.nlm.nih.gov/?term=roger+young+uterus

Although postpartum depression is the most common side effect of pregnancy–roughly 1 in 6 women will experience a less often studied condition that may be equally common-- post delivery post traumatic stress disorder. 

Dr. Sharon Dekel, PhD is a leading researcher in the developing field of childbirth related PTSD.  Her lab is focused on understanding, diagnosing and treating this regrettably common mental health challeng, and disentangling CB-PTSD from PPD. Diagnosis can be difficult to uncover because many women imagine themselves to be responsible for the natural challenges of labor and delivery; when the delivery doesn’t accord with their wishes, or takes a significant turn–which happens in roughly 20 to 30 percent of deliveries–women tend to blame themselves, and then fail to attend to the trauma and stress that follows them home from that experience. Dr. Dekel’s goal is to more quickly and accurately identify PTSD associated with childbirth, distinguish it from other postpartum mental health challenges, and get help for women who experience it. In our conversation today she talks about why this work is so important: not only does it address a significant source of stress on mothers, but PTSD can have dramatic impacts on the mother child bond, on the child’s development, and on the mother’s willingness to have more children.

Dr. Dekel also talks about her work training large language models to potentially identify PTSD after childbirth based on narrative based stories provided by women who’ve recently given birth.

To find Dr. Dekel's work: https://www.massgeneral.org/doctors/22372/sharon-dekel-tsvetkov

Find Dr. Dekel's Lab here: https://massgeneral.link/DekelLab

The brain fog and forgetfulness that may accompany pregnancy and postpartum is almost always described negatively as "mommy brain"--but this phenomenal brain plasticity needs a rebrand.

What's actually happening is that the brain, like almost every other organ in the body, is adapting to the dramatic state of pregnancy. Some changes are transitory in the brain, as they are in the body. Some are more permanent.

Going forward, let's be impressed by our ability to neurologically prepare for the new world we are creating with our bodies.

Today's guest has done research on this very issue: the impact of hormones during pregnancy on the brain. By combining imaging technology, neuroendocrinology and neuroscience, she examines how sex hormones impact human brain function in pregnancy.

Dr. Pritschet's paper on hormones and the brain during pregnancy:  https://www.nature.com/articles/s41593-024-01741-0

Want to participate in this work:  https://wbhi.ucsb.edu/sites/default/files/docs/Flyers/Maternal%20Brain%20Project/Maternal%20Brain%20Project%20Flyer%20.pdf

I am both hopeful and moved, AND filled with disbelief after my conversation with today's guest. 

He is an OB who has done an inordinate amount of work to make birth safer first for Californians, then for women across the country. His work, which you'll hear about and be able to use in your own pregnancy, is inspiring. 

What I can't get my head around is the state of maternity care he set out to change in 2006, some of which remains unchanged. 
Does it make sense that you don't really know the quality of care you'll get at your birth because hospitals didn't keep track of their health outcomes in a useable way? 
Does it make sense that C section rates vary widely between hospitals? 

No dear listener, it does not. 

We talk about the importance of data being collected and quickly disseminated so that hospitals actually know the quality of their maternal care and can compare their care with the care neighboring, and what should be competing hospitals, do, and you, too, as the consumer, can get a better handle on what you are walking into when you pick a hospital in which to give birth. 

Making Sense of Pregnancy is a show that seeks out answers to lots of the questions we are confronted by in this enormous transition. I'm finding and talking with experts, doing cutting edge work to better understand what we do and don't know about pregnancy and what you can do to better understand your own experience. Each week, I'll be talking to scientists, doctors, and researchers who are trying to uncover the many mysteries that still exist in reproduction. Giving you the most current evidence-based way to approach this transformative event.  I hope it  will become your go-to source for how to make your pregnancy better.