Earlier this year, officials at the National Institutes of Health launched the Human Placenta Project with the aim of better understanding how this organ functions and what role it plays in adverse pregnancy outcomes from preeclampsia to preterm birth.
One of the main goals of the project is to develop new technologies for the real-time assessment of placental development, allowing for the study of placental function in normal versus abnormal pregnancies. NIH officials also seek to develop noninvasive markers to predict adverse pregnancy outcomes and better understand how the placenta affects long-term health. In late September, the agency took a step toward those goals by awarding $46 million to researchers around the country.
What does this mean for obstetrics care? In an interview, Dr. Catherine Y. Spong, a maternal-fetal medicine specialist and deputy director of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Md., explained how this initiative is different from studying the placenta after birth, as well as when this research could yield clinically meaningful results.
Question: Through the project, you’re setting out to study the human placenta in real time. What will that tell us that looking at the placenta at birth alone does not?
Dr. Spong: Just as the fetus develops and changes across pregnancy, the placenta does as well. Early on, the placenta invades into the uterine decidua, invades the spiral arteries, and replaces the endothelium to make the vessels large bore, for easy flow of blood to the fetus. If this does not happen, preeclampsia may develop and the fetus may not grow appropriately.
Using current methods of evaluating the placenta after delivery does not help us determine how the placenta is working or functioning early or in mid-gestation. It is akin to doing an autopsy at the end of life and trying to figure out how the person developed and acted during their youth and midlife.
Our hope is that by monitoring the placenta in action, we will gain a much richer understanding of normal placental function – and of placental problems that can lead to common pregnancy complications.
Question: What could this research potentially tell us about hard-to-prevent conditions such as preterm birth and other adverse pregnancy outcomes?
Dr. Spong: Preterm birth and adverse pregnancy outcomes have as one component abnormal placental function. If the placenta cannot support the pregnancy, the baby may not grow well and may develop growth restriction. The placenta, if not formed appropriately, also may result in preeclampsia (toxemia), stillbirth, or preterm birth. If we could better understand how the placenta develops and functions in healthy pregnancies, we may be able to spot potential problems earlier on and test interventions to see if they improve outcome.
Question: How will environmental impacts on pregnancy be monitored through the placenta?
Dr. Spong: It is clear that environmental influences affect outcomes. One of the initiatives we are supporting will help to evaluate how these influences affect outcome. Investigators will study factors such as smoking or obesity, thus including women who do and who do not have these influences, and determine how they affect placental development.
Question: The NIH is investing more than $40 million in this project. How will the money be spent?
Dr. Spong: Our funds will support development of novel approaches for placental assessment, research on environmental influences that affect placental structure and function, and interdisciplinary collaborations, including investigators new to placental research who bring important expertise in bioimaging and biotechnology.
We have been impressed by the proposals we have received, both in their quality and breadth. Investigators are focusing on a range of imaging technologies, including MRIs and ultrasound, as well as techniques to identify biomarkers of placental function in maternal blood samples. Investigators also are interested in many different environmental factors, from nutrition to air pollution.
This initial investment in the Human Placenta Project should lead to new approaches to safe, noninvasive, real-time monitoring of placental development and function across pregnancy, and yield important insights into environmental influences on placental health.
Question: It takes a while for research findings to translate into clinical practice. How long before ob.gyns. can see practice-changing recommendations as a result of this project?
Dr. Spong: This is an important question, as not only do we need the evidence to determine what is important for normal placental development and function, but we also need to learn what additional steps to take to optimize pregnancy outcome. The timing for this – both identifying the development, structure, and function of the placenta across human gestation and determining how best to intervene and optimize outcome – may take some time. However, we believe that this work will be time well spent. It is clear that pregnancy affects the lifelong health of both the mom and the fetus. If we could optimize pregnancy outcome, we could improve the health of the nation.