Helping to prevent preterm birth

Paula Quaglietta recalls her senior kindergarten graduation through a series of laughs. As her peers revealed to attendees their hopes of becoming ballerinas and firefighters, she adamantly declared her goal of becoming a doctor. “For as long as I can remember, I’ve been fascinated by health care and medicine,” she says. She was the only child in her class to voice this dream, and it’s one to which she has held on tightly.

Quaglietta has completed her third year in chemical biology at McMaster University in Hamilton, Ont., and for the second consecutive summer is at Sunnybrook Research Institute (SRI) through the SRI Summer Student Research Program. Supervised again by Dr. Stefania Ronzoni, an associate scientist in the DAN Women & Babies Research Program at SRI, and a maternal-fetal medicine specialist at Sunnybrook, she is investigating preterm birth and the value of a standard test. Also for the second summer in a row, Quaglietta has received the University of Toronto’s Obstetrics and Gynaecology Chair’s Summer Student Award.

Two years ago, Sunnybrook started a universal screening program for pregnant women, whereby measurements of their cervixes are recorded through transvaginal ultrasounds. Why? “Short cervical length is a predictor of preterm birth,” Quaglietta explains. Premature labour occurs when a baby is born before 37 weeks of pregnancy. The test—previously done only on women considered high risk due to their history of preterm birth—is time consuming and requires a lot of resources. Quaglietta notes that it increases the duration of a woman’s ultrasound appointment, which limits the number of scans that can be done in a day; sonographers need additional training to perform transvaginal ultrasounds; and it is a more invasive probe than is a typical abdominal ultrasound.

To evaluate whether measuring the cervix of every pregnant woman is helpful, Quaglietta is comparing data from the two years before the screening was introduced to that from the two years after it began. Her primary responsibilities are data collection and analysis, and writing the study’s abstract, which she says entails preparing the findings for submission to conferences and academic journals.

“We’re checking for differences between deliveries and risks, to see if [measuring the cervix] has been beneficial or not,” she says. She adds that other U of T-affiliated hospitals have expressed interest in the results.

Quaglietta is involved in a second effort, which originated in Quebec. A research team there, led by Dr. Jean-Charles Pasquier at the University of Sherbrooke, recently launched a randomized clinical trial. The aim is to see whether progesterone, a drug that helps women with short cervixes avoid early labour, is effective in preventing premature birth once a device that supports the cervix has been surgically inserted. Her role is to collect ultrasound data from consenting women who visit the Sunnybrook clinic each week, and then send it to Quebec so a large database of results can be compiled.

Her work this summer is under the same umbrella as last year’s assignment, but takes a slightly different approach. In 2018, Quaglietta participated in a project looking at serial ultrasounds in cases of preterm prelabour rupture of membranes (PPROM). She says, “This is when the woman’s water breaks before 37 weeks of gestation, which is really problematic and can leave the baby exposed, and the baby and mom can get a lot of infections.” The research findings showed that biweekly ultrasounds don’t predict an infection called chorioamnionitis [core-ee-oh-am-nee-oh-nigh-tis], or adverse neonatal outcomes in PPROM cases, meaning it is not necessary as a therapeutic intervention in such situations.

Her research in 2018 earned her the right to present at the 2019 Canadian National Perinatal Research Meeting in Mont-Tremblant, Que. “I left the conference feeling inspired and grateful to have been surrounded by so many brilliant minds,” she says. “I was excited to return to Sunnybrook for another year of research and for my future career in medicine.” The work has been accepted for publication in Ultrasound in Obstetrics and Gynecology.

In talking with Quaglietta, it’s clear that health care is a focus; she has written the medical college admission test this summer and hopes to get into U of T’s medical school in September 2020. It’s also clear that health care isn’t her only longstanding interest. When she was a three-year-old, her parents introduced her to dance, an outlet she has since relied heavily upon to counter stress. “It’s been such a passion for me, to be able to dance and express myself creatively. It’s so drastically different from what I’m doing in the science world, where everything is very structured and logical. It’s helped me balance myself out and has given me such a sense of community,” she says.

After dancing her way through high school, Quaglietta entered university not knowing where to find her groove. During her second year, she tracked down the varsity dance team, and her thirst was quenched. “It’s been the best experience. I’ve met so many amazing people from all kinds of programs and disciplines. It helped me fill [in] what I was missing,” she says. Each year, the team dances off against other university crews at three competitions, all in March. Going into the 2019 to 2020 season, the hip-hop and jazz lover is ready to embrace the role of the team’s vice-president.

Out of the research setting and off the stage, Quaglietta enjoys yoga, baking and traveling. For one week in August, she’ll part ways with ultrasound and dance in favour of beachside sunbathing in northern Italy with her brother and parents. It’ll be her third trip to the boot-shaped paradise, but this time she’s leaving the planning to her dad. “I’ll pack, show up and relax,” she says with a smile.

Returning to her work, Quaglietta speaks sincerely. “I honestly never expected myself to be doing this kind of research. I was always geared more toward kids, but when I started last year, I was opened up to a whole new world and a whole new abundance of information that I found so interesting. I like being part of all this innovation,” she says.

Stressing the importance of her research, she draws on the scope of preterm birth. “It’s such a big issue, and it happens so often. To find ways to detect it and prevent it instead of just treating it once it has happened would be amazing.”

Paula Quaglietta received an SRI Summer Studentship Award.