Vision for Improving Pregnancy Health: Innovation and the Future of Pregnancy Research

Abstract

Understanding, predicting, and preventing pregnancy disorders have been a major research target. Nonetheless, the lack of progress is illustrated by research results related to preeclampsia and other hypertensive pregnancy disorders. These remain a major cause of maternal and infant mortality worldwide. There is a general consensus that the rate of progress toward understanding pregnancy disorders lags behind progress in other aspects of human health. In this presentation, we advance an explanation for this failure and suggest solutions. We propose that progress has been impeded by narrowly focused research training and limited imagination and innovation, resulting in the failure to think beyond conventional research approaches and analytical strategies. Investigations have been largely limited to hypothesis-generating approaches constrained by attempts to force poorly defined complex disorders into a single “unifying” hypothesis. Future progress could be accelerated by rethinking this approach. We advise taking advantage of innovative approaches that will generate new research strategies for investigating pregnancy abnormalities. Studies should begin before conception, assessing pregnancy longitudinally, before, during, and after pregnancy. Pregnancy disorders should be defined by pathophysiology rather than phenotype, and state of the art agnostic assessment of data should be adopted to generate new ideas. Taking advantage of new approaches mandates emphasizing innovation, inclusion of large datasets, and use of state of the art experimental and analytical techniques. A revolution in understanding pregnancy-associated disorders will depend on networks of scientists who are driven by an intense biological curiosity, a team spirit, and the tools to make new discoveries.

Inflammatory markers are elevated in early pregnancy, but not late pregnancy, in women with overweight and obesity that later develop preeclampsia

“…39 This supports the notion that cohort studies of early pregnancy and preconception care may shed light on pathologic pathways that predispose to the development of preeclampsia but also provide a target of investigation for clinical risk prediction, which allows for targeted preventive intervention. 40 While these findings are consistent with our central hypothesis that preeclampsia is marked by higher concentrations of inflammatory markers, differences in inflammatory markers were minimal among cases and controls in late pregnancy, when preeclampsia had become clinically evident. There are several potential explanations for this finding.…”

“…This aligns with the theory that preeclampsia and other pregnancy complications may be manifestations of the early pregnancy or even pre‐pregnancy state 39 . This supports the notion that cohort studies of early pregnancy and preconception care may shed light on pathologic pathways that predispose to the development of preeclampsia but also provide a target of investigation for clinical risk prediction, which allows for targeted preventive intervention 40 …”

Interdisciplinary fetal-neonatal neurology training applies neural exposome perspectives to neurology principles and practice

“…Prediction and prevention of adverse TSI effects on reproductive and pregnancy health require targeted therapeutic interventions. However, progress toward understanding pregnancy disorders affecting the MPF triad such as preeclampsia lags behind advances regarding other aspects of human health ( 210 ). Investigations have been largely limited to hypothesis-generating approaches, constrained by attempts to treat a specific disease phenotype rather than consider etiopathogenesis involving TSI that adversely affects the neural exposome.…”