What got you into the research that you are doing?
If 10 years ago someone had asked me if I would be doing research, I would have said “NO WAY”. I have always loved taking care of patients and their families, from the first day I started medical school. Now I can’t imagine NOT DOING research! And actually, I think I am a better doctor by doing research, and I think I am a better researcher by being a doctor.
I became interested in pediatrics in medical school and did a pediatric rotation at Poudre Valley in Fort Collins where I took care of babies in the NICU. I loved the environment and realized that I wanted to take care of babies in the NICU. I wanted to understand more about neonatal illnesses and therapies, which ultimately led me into a Pediatrics Residency and Fellowship in Neonatology.
My first research project during Fellowship was with Dr. Bill Hay– who is my research mentor and, to this day, one of the biggest cheerleaders for the importance of research in medicine. The project was on how a fetus grows during pregnancy and how the fetus and newborn adapt to changes in nutrition. This project piqued my interest in research. I wanted to learn more about why babies sometimes don’t grow well and gain weight appropriately during either a pregnancy, or after they are born. Nutrition is so important to adult health, child health, and the health of a fetus growing during a pregnancy. So now I am a physician scientist; so I can take care of babies in the NICU, learn where there are “gaps” in our knowledge about the nutrition of babies, and focus my research on how to improve nutritional management of babies.
Why is this important?
I became more focused on a problem in pregnancy called intrauterine growth restriction, a very important problem in terms of fetal growth and nutrition. Intrauterine growth restriction occurs in 6 to 8% of all pregnancies, which equals about one in ten women who have either had this happen to them or know someone with that problem. During the pregnancy, the baby does not grow as well as he or she should, often leading to “growth failure” requiring delivery of the baby.
Many babies with intrauterine growth restriction are born preterm, or if they are born at term they are very low birth weight and their growth patterns don’t necessarily ‘fix’ themselves as they grow into childhood. Therefore their body composition is sometimes not normal – so I am interested in how lean body mass (or muscle mass) is impacted in the pregnancy. The muscle and lean mass may not grow proportionally to the growth of fat mass, so that could put the individual at higher risk for diabetes and heart disease later on in life.
The real issue is that we really don’t know how that works. If we assess body composition of an adult with less lean mass, that correlates with lower birth weight. Babies who are small at birth have increased fat mass and decreased lean mass, and that fat mass is more visceral, which puts them at higher risk for diabetes and heart disease.
The biggest reason this research is important is because there is no real intervention that we can do now during pregnancy to improve the growth of the fetus. What we can do is closely follow the pregnancy, and deliver the baby once the baby’s growth really slows down (which is determined by following blood flow measurement). By that point though, the baby might already have developed abnormalities in long term growth patterns. We want to figure out how to intervene early on to decrease the future risk of heart disease and diabetes.
What are your hopes and dreams for your research?
My 20-year dream is to find an intervention during pregnancy to improve the growth of the baby. Our research has told us so far that it’s not as simple as giving the Mom more nutrients and protein. We have to first figure out what is happening to the fetus in the uterus when he or she is not getting enough nutrients, and then figure out what we might do after the baby is born to improve growth and body composition. We need to find interventions along the way and that is what motivates my 10-year goal which is taking care of the babies once they are born and finding the right mix of nutrients to help those children grow into adult hood.
The ultimate ‘cure’ will come from understanding what triggers the problem of intrauterine growth restriction, why it happens in the uterus, and how to intervene during the pregnancy to add to lean mass and prevent the diabetes and heart disease that develops in adulthood. Then, we can avoid the problem all together.
How do we communicate this?
One idea is to have women who have had this problem in pregnancy to tell us their stories to put on the website, thus personalizing the condition and giving a human ‘face’ to why this is an important research issue. It impacts more women, families, and babies than we think.