#410 ‒ The biology of pregnancy: physiologic adaptation, gestational diabetes, preeclampsia, childbirth, and long-term maternal health | Kathryn Gray, M.D., Ph.D.

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In this episode, Peter sits down with Dr. Kathryn (Katie) Gray, a physician-scientist, high-risk obstetrician, and maternal-fetal medicine specialist at the University of Washington School of Medicine. Katie begins by explaining the remarkable physiologic changes that occur during pregnancy and how the cardiovascular, metabolic, and hormonal systems adapt to support both mother and developing fetus. From there, the conversation turns to some of the most important complications that can arise. Katie explains how gestational diabetes is screened for and treated, and what a diagnosis may mean for the long-term health of both mother and child. She then walks through the biology of preeclampsia, including who is at risk and how the condition is managed. She also discusses HELLP syndrome and postpartum depression. Peter and Katie explore the realities of labor and delivery, including breech presentation, the role of midwives, and the trade-offs between vaginal and cesarean delivery. The conversation also covers stillbirth and the growing role of cell-free DNA in prenatal genetic screening. Other topics include prenatal nutrition and folate, breastfeeding, and exercise during pregnancy. Throughout the episode, Peter and Katie return to a larger question: What can pregnancy reveal about a woman's long-term health? They discuss how complications during pregnancy can provide important clues about future health risks. Finally, Katie highlights some of the major questions that remain unanswered in maternal health and why greater investment in research is needed to improve outcomes for mothers and their children.

Disclaimer: The views expressed on this podcast are solely those of Dr. Kathryn Gray and do not represent the University of Washington or any of its affiliated units. Dr. Gray speaks solely in a personal capacity, and nothing here should be construed as an official position or endorsement from the University of Washington.

We discuss:

• What drew Katie to obstetrics and gynecology, and fundamental questions in the field that remain unanswered [3:15];
• Pregnancy as a cardiovascular and metabolic stress test; the first symptoms and early changes [6:30];
• Early hormonal changes, prenatal nutrition, and neural tube defects [16:00];
• Fetal development and the physiology of gestational diabetes [23:45];
• Diagnosing and treating gestational diabetes [30:00];
• Preeclampsia: diagnosis, biology, acute risk, and how it's managed [37:00];
• HELLP syndrome, what genetic studies reveal about preeclampsia, and the antihypertensive medications used to treat it [49:00];
• What pregnancy reveals about long-term cardiometabolic health [54:45];
• Cesarean delivery, breech presentation, and stillbirth [1:01:15];
• The onset of labor, cervical dilation, and membrane rupture [1:14:15];
• Vaginal delivery and breastfeeding: benefits versus myths [1:23:15];
• Exercise during pregnancy, sleep position in the third trimester, and postpartum depression [1:27:00];
• Prenatal genetic screening: the growing role of cell-free DNA and the gap between what is technologically possible and what gets deployed in the clinic [1:33:00];
• Midwifery and the realities of childbirth [1:39:00];
• Maternal health in the United States and the need for research investment [1:48:30]; and
• More.

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