Category: show notes

Monitoring contractions in labor hasn’t changed in 50 years–the most often used tool, the tocodynamometer, uses an indirect, one dimensional view of uterine activity in labor. 

Dr. Wang talks about applying the tech used in cardiology to the uterus, to create a three dimensional way to non invasively measure electricity as it travels through the smooth muscle of the uterus, creating contractions.  His lab is working on the tech that would allow us to distinguish, and potentially arrest preterm labor, to potentially jump start arrested labor, and to create a uterine measure of labor stages (which could be used in conjunction with cervical checks). 

 Understanding how the uterus works and the wearable technology that this work promises gives a sense of how complicated the uterus is when contractions feel fierce or labor stalls.  It may also have applications that ease period cramps and monitor and potentially “turn off” endometriosis. 

Wang Lab: https://reproductivesciences.wustl.edu/laboratories/wang-lab/

Dr. Wang’s publications: https://www.ncbi.nlm.nih.gov/sites/myncbi/1Tux87w_RnEkl/bibliography/47687944/public/?sort=date&direction=ascending

You may not have given much thought to the lining of your uterus, aka your endometrium; but it is a super important workhorse when it comes to pregnancy, and one that, it turns out, has a voice. The old story used to be that the endometrium is this passive, patient group of cells waiting to give any embryo it glimpsed a warm, safe harbor to grow. Today’s guest shares the updated story: the endometrium as selective screener, interviewing the embryo–by assessing its chemical signals– accepting and investing in the embryos it thinks are viable, and rejecting the rest.

Nick Macklon’s published work can be found here: https://pubmed.ncbi.nlm.nih.gov/?term=nick+macklon&sort=date 

Uterine Selection of Human Embryos at Implantation: https://pmc.ncbi.nlm.nih.gov/articles/PMC3915549/

Dr. Macklon’s work at the London Women’s Clinic, Kind IVF

On average in the US 1 in 10 babies is born prematurely and, in many cases, the cause is unknown; although there could be many contributing factors, nearly 40% of pregnant people who deliver before 37 weeks exhibit chronic placental inflammation, which happens when the mother’s immune system attacks the placenta. 

Today’s guest is trying to decipher the conversation between the immune system and a pregnancy.  If we understood this conversation, we could look for ways to predict and potentially prevent preterm birth, and in the process we are learning more about how spontaneous term labor happens (which is, somewhat shockingly, also a mystery).

Center for Reproductive Health: Gomez-Lopez Lab

article that launches this conversation:
Deciphering Maternal-Fetal Crosstalk in the Human Placenta during parturition using single cell RNA sequencing

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

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

You can also 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