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Smooth delivery

By Alisa Kim  •  Jul 10, 2017

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Summer student sees first-hand how research informs obstetrical care

Morgan Yuan has always been fond of babies. An aspiring doctor, Yuan, who is an undergraduate student at McMaster University in Hamilton, Ont., says that’s why obstetrics is one of the specialties in which he is interested. “[The obstetrician is] the person you see when you’re born. They have a very big impact on the generation of the future,” says Yuan, who is going into his second year in health sciences.

Given his career goal, Yuan’s summer studentship at Sunnybrook Research Institute (SRI) is an ideal placement. His supervisor is Dr. Nir Melamed, an associate scientist in the Women & Babies Research Program at SRI, and a physician in maternal and fetal medicine at Sunnybrook. Under Melamed’s guidance, Yuan is working on a study of women with chronic kidney disease whose pregnancies were followed at Sunnybrook and Mount Sinai Hospital between 2005 and 2016.

The research has a dual focus, says Yuan. “There are two outcomes: how the kidney disease has impacted the pregnancy, both for the mother and the fetus, and how the pregnancy has [affected] the kidney disease or the diagnosis of the patient.” In studying the effect of kidney disease on pregnancy and vice-versa, the researchers are looking at indicators of maternal and fetal health. These include creatinine levels, which show how well the kidney filters out waste products in the blood, whether babies were born early and if they were born at a healthy weight.

The aim of the work is to help doctors provide a more accurate prognosis to women with kidney disease who are pregnant or thinking of conceiving. Yuan notes that research on how the conditions affect each other is scant; moreover, what few studies there are on the topic are small, with roughly 100 patients in each. “We’re working with upwards of 1,000 patients with kidney disease and pregnancy,” says Yuan. “It really gives [these] women a better gauge of what the risk of poor outcomes is for their babies and themselves by getting pregnant.”

Yuan’s role involves collecting and analyzing data, as well as doing literature reviews. His supervisor felt, however, that to get the “bigger picture” for the research Yuan should see the clinical rationale. On Fridays, he shadows a nephrologist in Sunnybrook’s Pregnancy and Kidney Disease or PreKid Clinic—an experience he says is eye opening. “This allows me to see what ‘minimal changes’ looks like in a patient, or how different conditions—like edema [swelling] in the legs, or a lot of protein in the urine—are impacting their well-being. It allows me to get a better understanding of what I’m doing and why I’m doing it,” he says.

Particularly meaningful for Yuan was seeing a woman from the study return to the clinic for follow-up care. Despite having kidney disease, she went on to have a healthy baby. He says that being able to see the impact of doctors managing the women’s kidney disease and pregnancies such that the women were able to deliver a baby has influenced how he views the data and study itself.

Yuan’s eyes are trained on a career in medicine, but he says the studentship has helped him to consider other paths, including research. He has also gained an appreciation for how research informs health care. “I find research so important in medicine because there’s always new innovations and things that need to be assessed, like how different things impact each other. So far it’s been pretty positive. I’m really enjoying myself.”

Morgan Yuan received a D+H Summer Studentship Award.