Maternal-fetal medicine: an inside look

By Eleni Kanavas

Medicine is in her blood.

“I’ve sort of grown up around hospitals because my dad is an obstetrician and I’ve always liked the environment. Getting to be a part of it made me want to get into [health sciences and research], especially the field of maternal-fetal medicine,” says Alex Pittini, who was born at Women’s College Hospital in Toronto 19 years ago.

As a soon-to-be third-year undergraduate student studying science at the University of British Columbia in Vancouver, Pittini returned to Sunnybrook Research Institute (SRI) to complete a second summer placement as part of the D+H SRI Summer Student Research Program under the supervision of Dr. Jon Barrett, director of the Women & Babies Research Program at SRI. Barrett also holds the Waks Family Chair in Maternal-Fetal Medicine Research at Sunnybrook. He specializes in high-risk and multiple pregnancies.

“I got a position last year with Dr. Barrett and I really liked the research. It’s a really interesting field with a combination of clinical and surgical practice,” she says. Her project focused on the use of cervical length as a predictor of preterm delivery. She presented her findings at an international conference hosted by the Society for Maternal-Fetal Medicine earlier this year in San Diego, Calif.

This summer, Pittini is working closely with Dr. Nir Melamed, an associate scientist in the Women & Babies Research Program. His research focuses on growth restriction and placental dysfunction during fetal development. He also uses ultrasound to assess fetal growth abnormalities and to measure cervical length in the prediction of preterm delivery.

One of the challenges in pregnancy care is the management of fetuses who are small for gestational age—fetuses with an estimated weight below the 10th percentile for gestational age. While most small fetuses are healthy, some of these cases reflect intrauterine growth restriction (IUGR), where fetal growth is inhibited by a pathological factor like placental insufficiency. This happens when the placenta is unable to deliver an adequate supply of nutrients and oxygen to the fetus.

The tools available for fetal assessment to distinguish between small healthy fetuses and IUGR fetuses are limited. This leads to many women with small fetuses undergoing unnecessary interventions like induced labour. This in turn increases the chances of a premature and caesarean delivery, which can have health consequences for the infant later on.

Pittini’s project aims to identify factors that are measured regularly during prenatal ultrasound visits such as fetal blood flow, amniotic fluid levels and body measurements to predict adverse outcomes in cases of suspected late-onset IUGR in small for gestational age fetuses.

“I’m looking at sonographic (ultrasound) measurements of blood vessels in the fetus, so the umbilical artery and the middle cerebral artery that goes to the brain. We’re looking at whether the ratio between those two measurements is a good predictor for adverse outcomes in an IUGR fetus,” says Pittini. “It’s really about what we’re doing in the clinic, which measurements we’re taking; for example, the ultrasound measurements of blood vessels, and seeing how we can best apply that to predict outcomes.”

She notes the results may help obstetricians identify fetuses that are small for gestational age because of IUGR, and that might therefore benefit from early delivery.

When asked what has been the most rewarding part of working at SRI, Pittini says working in a collaborative research environment and talking to her peers about their projects. “We talk a lot about our work. I don’t think you see girls my age at lunch talking about placentas,” she says with a laugh.

Joking aside, Pittini says she has learned a lot about research methods, including technical skills like data collection and analysis, and how to prepare a manuscript of her results for publication. She plans on completing her undergraduate degree at UBC and would like to attend the University of Toronto for medical school.

“I’ve always wanted to do clinical research as opposed to [basic] research,” she says. “I want to be able to contribute to clinical practice some day and actually change how things are done.”

Alex Pittini received a D+H Summer Studentship Award.