Top Doctors 2014

Solving the Mysteries—and Blame Games—of Childbirth

To find out why non-human primates often have more successful births than humans do, one BCM professor is thinking small.

By Kerry H. September 1, 2014 Published in the September 2014 issue of Houstonia Magazine

Baylor College of Medicine professor Kjersti Aagaard

The “marmoset press release” needs to go out, says Baylor College of Medicine professor Kjersti Aagaard, trying to catch someone from the PR department before she can slip out the door. “We have cute marmoset pictures!” 

We’re in her office, a warm, book-lined haven from the attached fluorescent-lit lab, and while we have not come to discuss the marmoset study in particular, Dr. Aagaard is tackling so many projects it can be hard to keep up. In many ways, she is the right person at the right time. She is both a scientist and a practicing obstetrician, which means she is well placed to try and answer some of the most stubborn questions about the still-mysterious realm of human pregnancy, such as what actually prompts the onset of labor, and why so many otherwise healthy women suffer from preterm labor and stillbirth.

She is also interested in the human microbiome, that constellation of fungi, bacteria, and viruses that live within the human body, and she’s not the only one (witness all that talk about “good bacteria” lately). The surge of interest in the microbiome, and the attendant availability of grants to study its role in our health, have consequences for us all. One consequence for Aagaard was that she met her husband, James Versalovic, now head of pathology at Texas Children’s Hospital. Not only did the pair become acquainted through the National Microbiome Project, an NIH initiative, Versalovic proposed to Aagaard on the very day a microbiome-related paper by the couple was published in the journal Nature. For doctors obsessed with gut bacteria, this counts as romance.

Aagaard is particularly interested in the way primate birth differs from that of other animals. “I’ve been working with nonhuman primates since before I could drink,” she says. Among those nonhuman primates are the aforementioned marmosets, who interest Aagaard because they always carry twins or triplets, and do it, in her words, “so extraordinarily well.” Whereas human twins often emerge from the womb too early, marmosets usually carry their multiples to term, and Aagaard is investigating a possible genomic basis for these successful deliveries.

She is also the kind of person who reminds you, not infrequently, that you too are a primate. Cigarette smoking, for instance, one cause of preterm birth, is for Aagaard “something we do with our opposable thumbs.” 

Since 2007, she has been studying pregnancy within her own Baylor lab, which is staffed by over a dozen scientists and has a conspicuous tendency to make headlines. Most recently, Aagaard gained attention for a study showing that 300 different kinds of bacteria live in the placenta, an organ once thought to be sterile. Her work on pregnancy in obese mothers has also made news. There, Aagaard demonstrated, courtesy her research into other primates, that the higher rate of premature births in obese mothers was due not to obesity per se but a high-fat diet.

Amidst all of this, Aagaard is a practicing physician at Ben Taub Hospital; contact with actual patients is what drives her to keep researching. “Over the years,” she says, “I have had a series of women who have struggled with either recurrent stillbirths or recurrent preterm births. That’s one of the ongoing motivators…these women that just want their children to be healthy.” She pauses. “It’s really unfair, at the end of the day.”

Even in wealthy countries like the US, the genomic and environmental causes of most premature births and stillbirths remain unknown, which is not to say that Aagaard’s work isn’t already making a difference. Her placenta studies, for instance, imply that C-sections aren’t as dangerous for babies as previously thought, because first exposure to the microbiome actually occurs inside the womb. And her work with obese mothers suggests that such women might deliver healthy babies more often simply by modifying what they eat during pregnancy.

“You feel like something you have done maybe has helped in part,” says Aagaard, “because it takes the blame off of a condition that we provide a stigma to in our society right now…. Realistically, a pregnant woman can’t go from being obese to non-obese. But we can work with her to change her diet. And some of what we are trying to do is say, how do we take some of that blame off moms?”

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