Labour Gains

A team of sci­en­tists is learn­ing from a long-over­looked or­gan, the pla­centa

The Walrus - - CONTENTS - By Sarah Giles

A team of sci­en­tists is learn­ing from a long-over­looked or­gan, the pla­centa

It typ­i­cally starts with the ring of a phone, in­di­cat­ing a new baby is about to en­ter the world. For the two re­searchers on call, there is lit­tle time to shower or eat. Nurses and mid­wives are sup­posed to phone when the mother is ad­mit­ted, but ba­bies aren’t known for be­ing pre­dictable. It isn’t ba­bies that the Univer­sity of Ot­tawa’s Pla­centa Squad wants.

The two team mem­bers grab their lab cloth­ing and home­made Pla­centa Re­search Team badges and rush to the univer­sity. They assem­ble their mo­bile lab — cooler, tools, gloves, masks, scalpels, and a spe­cially vented bag con­tain­ing a can­is­ter of liq­uid ni­tro­gen — and load it into a car. The Pla­centa Squad has been trained in the trans­porta­tion of dan­ger­ous goods. The team then nav­i­gates through the dark streets of Ot­tawa to the hos­pi­tal. A fend­er­ben­der, a speed­ing ticket, or a sim­ple wrong turn could spell dis­as­ter. But they must hurry: when a pla­centa has been de­liv­ered af­ter a baby, there’s only a pre­cious half hour to col­lect sam­ples be­fore the chance to un­lock med­i­cal an­swers from the body’s least un­der­stood or­gan will be lost.

For decades, pla­cen­tas, or “af­ter­birth,” as they were once known, were an af­ter­thought for re­searchers. Sci­en­tists have long rec­og­nized that the or­gan is im­por­tant for oxy­gen and waste trans­fer be­tween mother and fe­tus. Like an air­plane’s black box, the pla­centa may also hold the se­crets of what hap­pens to a fe­tus dur­ing preg­nancy and why. What we know comes largely from un­healthy pla­cen­tas — those that have been ex­posed to di­a­betes and hyper­ten­sion, for ex­am­ple — from mice. Far less is known about healthy hu­man pla­cen­tas.

The Pla­centa Squad, formed in 2016 by Kristi Adamo, a pro­fes­sor at the Univer­sity of Ot­tawa, con­sists of eight stu­dents; a re­search co­or­di­na­tor; and sev­eral re­search as­so­ci­ates who are ex­perts in preg­nancy, nu­tri­ent trans­port, and fe­tal growth. Its re­searchers come from four hos­pi­tals and three univer­si­ties, and there is no other group like it in the world. This work hasn’t been done be­fore, ac­cord­ing to Adamo, be­cause it’s hard, ex­pen­sive, ex­haust­ing, and time-con­sum­ing.

Adamo sums up the goals of her re­search: “My past men­tor, Dr. An­drée Gruslin, used to say, ‘You could have a Wal­mart pla­centa— low cost and works okay — or you could have the Holt Ren­frew pla­centa — made with the best bits, high func­tion­ing, looks mag­nif­i­cent, and lasts.’” Adamo wants to one day be able to rec­om­mend the op­ti­mal diet and ex­er­cise plan women should fol­low dur­ing preg­nancy to achieve a top-of-the­line pla­centa.

Adamo be­lieves in the de­vel­op­men­tal ori­gins of health and dis­ease — the idea that a per­son’s health can be traced back to their de­vel­op­ment in the uterus and in early child­hood. While sci­en­tists know the pla­centa is the life-sup­port sys­tem of fe­tuses, ques­tions re­main about the ef­fects of nu­tri­ents, such as glu­cose, fatty acids, and amino acids, that are trans­ferred from mother to child. An un­der­stand­ing of pla­cen­tal func­tion and how it dif­fers be­tween mothers with var­i­ous diet and ex­er­cise rou­tines could help ex­plain why some ba­bies go on to de­velop child­hood obe­sity and high blood su­gar, for ex­am­ple, while oth­ers do not. It could even ex­plain why some ba­bies are born dan­ger­ously big or small; if such health is­sues can be un­der­stood, doc­tors could de­crease the like­li­hood of birth com­pli­ca­tions.

Sec­ond-year mas­ter’s of science stu­dent at the Univer­sity of Ot­tawa Jon Rankin — known on the squad as “Pla­centa Jon,” or PJ for short — joined the team dur­ing the sum­mer of 2016. He stud­ies pla­cen­tal mi­to­chon­dria and their re­s­pi­ra­tory rate, which can be used as a marker of pla­cen­tal ef­fi­ciency. Pla­cen­tas with the most-ef­fi­cient mi­to­chon­dria han­dle bi­o­log­i­cal stress best. While most of PJ’S pla­centa pick­ups have been at the four par­tic­i­pat­ing Ot­tawa hos­pi­tals, he once did a pickup at a home birth

with a lively at­mos­phere: “The neigh­bours were over. It was like a big party,” he re­mem­bers. The fam­ily al­lowed the team to set up its sam­pling equip­ment on the kitchen counter. “All the while, there’s din­ner go­ing on to our im­me­di­ate left.”

Adamo es­ti­mates the team will need twenty do­nated pla­cen­tas per year for the next four years to ad­e­quately power their stud­ies. But re­cruit­ing women for the re­search has been a chal­lenge. Not every­body is open to the idea. (One mem­ber learned not to ask his child’s preg­nant high-school teacher dur­ing par­ent-teacher night if she was will­ing to do­nate her pla­centa. It didn’t go over well.) The ques­tion of do­na­tion al­ways raises eye­brows. “Most of the time, peo­ple are highly in­trigued be­cause it’s so novel,” says Alysha Har­vey, a for­mer clin­i­cal re­search as­so­ciate at the lab. “Ei­ther that or they are dis­gusted.” But the preg­nant women who do par­tic­i­pate in the lab’s stud­ies, she says, are highly in­vested in their pla­cen­tas in a way other women are not; they feel as though they are con­tribut­ing to science and, pos­si­bly, the health of chil­dren in the fu­ture. And the re­quire­ments for par­tic­i­pat­ing are fairly sim­ple: they in­clude giv­ing blood sam­ples while preg­nant, do­ing a sim­ple walk­ing test, wear­ing a pe­dome­ter, and keep­ing a food jour­nal for three days of each trimester of preg­nancy.

Some women are fine with their pla­cen­tas be­ing sam­pled but don’t want to give away the whole thing. While the vast ma­jor­ity of pla­cen­tas end up in hos­pi­tal in­cin­er­a­tors — a fact the Pla­centa Squad finds hard to bear — some mothers take their pla­cen­tas home. In the 1970s, the trend of eat­ing one’s pla­centa emerged. Some women fry their pla­cen­tas, claim­ing they are a good source of iron; some com­pa­nies of­fer to turn pla­cen­tas into easyto-swal­low cap­sules. Other women bury their pla­cen­tas in the yard with seeds so that a tree will grow in uni­son with their child. Artis­tic types have been known to make a “tree of life” print by stamp­ing their pla­cen­tas onto pa­per — the veins of the pla­centa look like branches and the um­bil­i­cal cord like a trunk — to cre­ate a rep­re­sen­ta­tion of the mother-child bond that can be hung on a wall. In 2008, Bri­tish de­signer Alex Green cre­ated the “Twin Teddy Kit,” a how-to guide for turn­ing your pla­centa into a teddy bear.

The squad re­as­sures mothers that it only needs ap­prox­i­mately 5 per­cent of a pla­centa. “I would never want to sti­fle any­one’s cre­ativ­ity,” says re­search as­so­ciate Zach Fer­raro. “They can do both — con­trib­ute to science, a more thor­ough un­der­stand­ing of how to pre­vent many chronic dis­eases in the fu­ture, but also make pla­centa art.”

Though women liv­ing out­side of Ot­tawa cur­rently can­not do­nate to the Pla­centa Squad’s re­search, Har­vey thinks oth­ers in­ter­ested in help­ing science won’t have to wait for long. “I do be­lieve there will be quite a few re­searchers that will hop on the band­wagon and will likely en­gage in re­search spe­cially re­lated to the pla­centa,” she says.

The typ­i­cal day con­tin­ues in a birthing unit of the hos­pi­tal where the baby is born. The re­searchers set up their equip­ment in the “dirty util­ity room,” where used laun­dry and waste are stored. Af­ter fol­low­ing its re­search par­tic­i­pants for up to six months, the squad fi­nally reaches the cul­mi­na­tion of hun­dreds of hours of work. Fi­nally, a nurse opens the de­liv­ery-room door and hands the squad mem­bers — decked out in gog­gles, masks, lab coats, and gloves — a metal basin hold­ing a squishy, warm, red pla­centa.

On one side, the pla­centa looks like raw liver; the other side has a mem­brane cov­ered in vis­i­ble blood ves­sels. Out­side of amother’s body, as the min­utes slip by, the pla­centa’s cells and their mi­to­chon­dria start to die. Us­ing sur­gi­cal in­stru­ments, the team dis­sects nine sets of tis­sue sam­ples and places them into liq­uid ni­tro­gen or spe­cial so­lu­tions.

As the new baby is doted over, the re­searchers re­turn the pla­centa to a nurse. Though the sam­pling is fin­ished, the night’s work has just be­gun. The squad heads to its re­search fa­cil­ity to run PJ’S mi­to­chon­drial ex­per­i­ments. They use a hand-held drill to grind small pieces of pla­centa in a su­gar solution that’s placed in a high-fre­quency cen­trifuge to spin un­til the mi­to­chon­dria sep­a­rate out from the fluid. Adding chem­i­cals to a cham­ber that sim­u­lates the in­side of a body, the team tests the func­tion of the mi­to­chon­dria.

With tis­sues safely pre­served and PJ’S ex­per­i­ments done, the Pla­centa Squad re­turns to the main lab to place the sam­ples in a neg­a­tive-eighty-de­gree freezer. Be­fore they leave, the squad mem­bers clean their equip­ment and re­stock the de­liv­ery bag. An­other call could come at any time.

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