Advancing Human Health in the Decade Ahead: Pregnancy as a Key Window for Discovery A Burroughs Wellcome Fund Pregnancy Think-Tank.
- Yoel Sadovsky, MD
- Sam Mesiano, PhD
- Graham J. Burton, PhD
- Michelle Lampl, PhD, MD
- Jeffrey C. Murray, MD
- Rachel M. Freathy, PhD
- Anita Mahadevan-Jansen, PhD
- Ashley Moffett, MD
- Nathan D. Price, PhD
- Paul H. Wise, MD, MPH
- Derek E. Wildman, PhD
- Ralph Snyderman, MD
- Nigel Paneth, MD, MPH
- John Anthony Capra, PhD
- Marcelo A. Nobrega, MD, PhD
- Yaacov Barak, PhD
- Louis J. Muglia, MD, PhD
Abstract
Recent revolutionary advances at the intersection of medicine, omics, data sciences, computing, epidemiology and related technologies inspire us to ponder their impact on health. Their potential impact is particularly germane to the biology of pregnancy and perinatal medicine, where limited improvement in health outcomes for women and children has remained a global challenge. We assembled a group of experts to establish a Pregnancy Think Tank to discuss a broad spectrum of major gestational disorders and adverse pregnancy outcomes that impact maternal-infant lifelong health and that should serve as targets for leveraging the many recent advances. This report reflects avenues for future impact that hold great potential in three major areas: developmental genomics, including the application of methodologies designed to bridge genotypes, physiology and diseases addressing vexing questions in early human development; gestational physiology, from immune tolerance to growth and the timing of parturition; and personalized and population medicine, focusing on amalgamating health record data and deep phenotypes to create broad knowledge that can be integrated into health care systems and drive discovery to address pregnancy related disease and promote general health. We propose a series of questions reflecting development, systems biology, diseases, clinical approaches and tools, and population health and a call for scientific action. Clearly, transdisciplinary science must advance and accelerate in order to address adverse pregnancy outcomes. Disciplines not traditionally involved in the reproductive sciences, including computer science, engineering, mathematics, and pharmacology should be engaged at the study design phase to optimize the information gathered as well as to identify and further evaluate potentially actionable therapeutic targets. Information sources should include non-invasive, personalized sensors and monitors, alongside instructive “liquid biopsies” for non-invasive pregnancy assessment. Future research should also address the diversity of human cohorts in terms of geography, racial and ethnic distributions, as well as social and health disparities. Modern technologies, both for data-gathering and for data-analyzing, make this possible at a scale that was previously unachievable. Finally, the psychosocial and economic environment in which pregnancy takes place must be considered to promote the health and wellness of communities worldwide.