What is so interesting about the placenta?
The human placenta is unique 鈥� it鈥檚 the only organ that you discard after it grows. And you might grow another one and discard that too. It does many jobs that other organs do. It provides nutrition to the baby, and functions as its lungs, kidneys and immune system.
Don鈥檛 we already have a reasonable understanding of the placenta?
No, the placenta develops over time just like the baby, yet most of the research is on placentas delivered at birth. That only gives you a snapshot. One of the reasons we launched the Human Placenta Project is that there have been huge advances in technology in other medical fields that have not yet been applied to pregnancy. We aim to develop tools to better understand what鈥檚 happening, in real time, throughout the process.
Can鈥檛 ultrasound tell you what you need?
As an obstetrician, I use ultrasound all the time, but that just gives us a picture of the placenta. It doesn鈥檛 tell us what鈥檚 going on with its metabolism, whether it鈥檚 providing the baby with the right nutrients and right amount of oxygen, what genes are being turned on, and so on.
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How do those things affect the pregnancy?
If the placenta develops abnormally, that will affect how the baby grows and develops. It might cause the baby to be smaller or larger, and can result in premature birth. How the placenta develops may also underlie pregnancy-specific complications in the mother, like pre-eclampsia, a condition associated with high blood pressure. Other complications include placental abruption, when the placenta separates from the wall of the uterus too early. These conditions can harm both mother and baby.
Can placental development have long-term health impacts?
Yes, it may affect the lifelong health of both baby and mother. Mothers with pre-eclampsia have a higher risk of heart disease later in life. We don鈥檛 know whether they get pre-eclampsia because they have undetected conditions that are only revealed by the 鈥渟tress test鈥� of pregnancy, or if you could prevent heart disease by stopping the placenta from developing abnormally. The placenta can even have transgenerational effects: babies born small have higher risks of complications like heart disease and cancer later in life, and that can affect the eggs or sperm of their own children.
How are you going to discover the placenta鈥檚 secrets?
One way is to use available technologies, including ultrasound and MRI scans. It will also be essential to develop new tools. Hospital patients often have a pulse oximeter put on their finger to monitor their blood鈥檚 oxygen status. Is there something similar that could be applied to the abdomen or cervix to monitor the placenta? We鈥檙e right at the beginning, so it will be exciting to see what the project comes up with.
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is an obstetrician who specialises in high-risk pregnancies. She is deputy director of the Project at the US National Institutes of Health in Bethesda, Maryland
This article appeared in print under the headline 鈥淧roject placenta鈥�
