March of Dimes researches recurrent pregnancy loss

Contemporary OB/GYN:

Hi, I'm Celeste Krewson with Contemporary OB/GYN and I'm here with Dr. Seli to discuss March of Dimes’ recent announcement on recurrent pregnancy loss. Would you like to introduce yourself?

Emre Seli, MD:

Yes, my name is Emre Seli. I'm the chief Scientific officer of the March of Dimes, and I'm also a faculty at Yale School of Medicine.

Contemporary OB/GYN:

So, to get started, can you talk a bit about the announcement from March of Dimes on recurrent pregnancy loss?

Seli:

Yes. First of all, thank you for having us here. We want to reach out to as many constituents as possible, as many stakeholders as possible, and obviously, Contemporary OB/GYN is a very good resource for this. As many of you might know, March of Dimes has a long-standing commitment to research and has spared a large budget for research over the past decades, actually, for the past 85 years. And, you know, played a key role in the discovery of the polio vaccine, and so on and so forth. For the past few decades, we've been very much invested in researching preterm birth and complications related to pregnancy as well as congenital abnormalities. An organic extension of that question, obviously, is, is pregnancy loss, which is a major problem. And this research theme is now being initiated in 2 locations where 2 separate groups of scientists will be investigating different aspects of recurrent pregnancy loss. One will be in the Imperial College of London, professors field Bennett and McCarthy will be working on the potential role of the microbiome, the microbes in the genitalia, as well as the environmental pollutants, because the essential aspect of this research is not just recurrent pregnancy loss, but how environmental factors and pollution may be affecting pregnancy losses. So that will be their focus. And the second group will be in the University of California, San Francisco, where they will be working on large database analysis using machine learning to see clinical predictors of recurrent loss as well as a genetic approach to see whether any of these groups of patients have changes in the genetics of the embryo or their own, that may be causing repetitive pregnancy losses.

Contemporary OB/GYN:

Those are really interesting topics. Is there any other research you hope to conduct on recurrent pregnancy loss?

Seli:

There are many. And I would like to also point out that this was started by a generous donation from a family who really is supporting the first year of this work, and they will continue to hopefully support it in the coming years. But what we hope is that like many other things we do, this becomes a core around which other donors and other stakeholders become aligned. And we hope to grow this part of the research into a more prospective analysis where we can collect more and more data on the environmental factors, we are exposing each one of us in a sense, of course, we'll be focusing on people who are, you know, either pregnant or planning to get pregnant and then associating the expo zones, which is what they call and the adverse pregnancy outcomes such as recurrent pregnancy loss. And there will be I think, a lot of, you know, additional projects that will be derived from the bases that I just mentioned.

Contemporary OB/GYN:

And why is March of Dimes conducting this research on recurrent pregnancy loss?

Seli:

Well, because pregnancy loss is a major problem. There are approximately 1 million losses every year in the United States and recurrent loss and its definition, as you know, change over the years we used to we used to require 3 losses to call something recurrent brings us on now we only required 2 losses, and the prevalence of is around 2%. And a lot of people that are affected by it, a lot of reproductive age people are affected by it. So, when we look at the financial commitment from the NIH to this subject, we see that it's been very limited according to an ACOG publication since 2003, the current investments of around $9 million for 20 years, which is not a large sum of money if you want to address such an important issue. So, we thought, with the with, with the help of our donors and families who have been affected by this, we thought that March of Dimes could play a kind of a leadership role, bring people together, and bring attention to this matter with the help of others, such as yourself, and then hopefully increase public and, and private funding to the subject. We think it's a worthwhile topic to investigate, people who are affected by this are affected on many levels, both physical and emotional. It's a devastating experience to have multiple losses. I think the progress in this field has not been what we hoped it would be in the past decades, we really didn't learn too much yet, or we didn't learn enough, I would say, and 50% of people who are having recurrent losses are finding out are unable to identify a real cause for it. This means that we are unable to identify it's not that there is no cause. So, I think it is a worthy path of research for March of Dimes and for others.

Contemporary OB/GYN:

And what would you say is the ultimate goal of this research? What impact do you hope it'll have on recurrent pregnancy loss?

Seli:

That’s a good question. It is so many. There are so many things to be accomplished. From a descriptive perspective, and some people call it like the D word like you don't want to do descriptive research. It's too simple like, but actually descriptive research should play a major role in this in this subject, we would really like to know the extent of recurrent pregnancy loss when you remove the most common cause of loss, which is abnormal number of chromosomes. So, in euploid embryos that result in a pregnancy, what are the prevalence of different etiologic factors? What are the causes of loss in these people? And then we want to know how those causes are affected by environmental factors. And of course, then we want to see what changes we can make to those environmental factors and to decrease losses and whether our hypotheses regarding the effective changes are true or not. So, it is a long road. There's a lot to learn.