Episode 2: Master Organ: The Placenta

Transcript

Speakers:

Host - Olivia

Guest – Prof Eric Jauniaux

00:00:04 Olivia

Hello everyone and welcome back to it all starts here. This is a podcast focusing on the education and communication of reproductive science and Women's Health. I am your host, Olivia Moir, and we are here at the Institute for Women's Health at UCL here in London. And today we are going to be diving into the topic of an organ that I think is incredibly special and underappreciated, which is the placenta. And really just talking about its critical role that it has in all of our lives and development and to discuss this, I have with me today the lovely Professor Eric Jonio, who is a researcher here at the Institute, but as well as that is an internationally established fetal medicine specialist with extensive experience in the related Bioscience, his academic work and clinical activities have been focused in placental and fetal development and the diagnosis and management of placental related complications of pregnancy. He has covered the full spectrum from the anatomy and Physiology to the diagnosis and treatment in utero of placental and fetal diseases.

00:01:18 Olivia

It is so lovely to have you here with me today. I think maybe to kick this off, it would be great to hear from you what how you started down this path and about studying the placenta and, you know, have become so invested at looking at this organ over the course of your career.

00:01:37 Eric

Thank you for the Nice introduction. I mean, like good things. It all happens so you know a bit with an accident to start with and Uhm, as a child, uhm, I remember my father telling me that he saved my life when I was a fetus in neutral because he was very much anti medicine, that he would not have a vaccination. He was not an anti vaccine really probably wouldn't, wouldn't didn't exist at the time. But my grandparents on the maternal side were doctors, so they were getting samples from the pharmaceutical industry and when she was pregnant, of course, she had a bit of headache, nausea, so her parents would give her these samples, which my father would throw in the bin immediately because he saw that homeopathy he was much better than any of these table medicine. And so I grew up with that concept that maybe medicine can harm you in utero and you know it was fascinating.

00:02:35 Eric

And then at high school I saw the commentary by an extraordinary professor of biology who was fascinated about in vitro fertilization, IVF and I was absolutely ghost like when I saw the birds of Louise Brown, then the Robert Edwards and Patrick Steptoe, who were technically, you know, medically the father of who's not biologically, of course And when I went to medical school, I went to the professor of Embryology so the sort of combination of you know, fetal malformation, how they develop in neutral and the possible role of the placenta in transferring this medicine.

00:03:22 Eric

In the first chapter of of any Embryology book or anatomy book, is actually the presenter because presenter presenta you have no pregnancy. So that's how I got into it and I've never stopped because it's such a big chapter that I've just managed to come out and become a field medicine specialist. But I know much more about the placenta than I know about the fetus.

00:03:45 Olivia

That's so that's so cool.  Yeah, I I really do relate to that kind of. I think for me it all started with the the interest about how it all begins and over the last couple of years, I've really just become so curious about the placenta. And really, just how important that in utero period is.

00:04:04 Olivia

I mean, I was doing some research that I mentioned to you back in Toronto looking at, you know, an artificial placenta.

00:04:10 Olivia

And just from that, it became clear that there is so much that you have to consider and the influences of that.

00:04:17 Olivia

So I guess thinking a little bit about the study of the placenta, I mean the evolution; You know, you touched upon how people would start to consider the influence obviously in utero and how that can impact you throughout your life course, but maybe you can talk a little bit about how the evolution of studying this organ has gone and and the different ways that we can investigate it and into today.

00:04:44 Eric

I mean, us humans have a unique presenter which is very different from all the other mammal species, except maybe the higher primate like the gorilla.

00:04:58 Eric

But because they have a different lifestyle, obviously, and they don't exclusively walk on two legs like we do, that person develops in a different way.

00:05:09 Eric

When we have a very special.

00:05:12 Eric

Development of our circulation inside the wall because we walk upright.

00:05:17 Eric

On two legs.

00:05:18 Eric

And so that changed a little bit the interaction between the placenta and the womb.

00:05:23 Eric

And so this problem actually is the source of most of the pregnancy complication because it is so complicated that, you know, the other animal species, mammals, including the.

00:05:37 Eric

You know the high primary don't have things like miscarriages as often as we do. They may have a few percent of miscarriages. We have 2025% of, you know, pregnancy, that implant, that don't make it.

00:05:52 Eric

And then you have other disease like preeclampsia, which is.

00:05:58 Eric

I mean, you can mimic this in.

00:06:00 Eric

Other laboratory animals like rodents, but it's never the same because they have a different presentation.

00:06:07 Eric

They have a different traction and immunology also the animals is is different from from ours.

00:06:13 Eric

So this is combination of this vasculature that's different and the immune interaction between the placenta and.

00:06:20 Eric

And the uterus that makes us.

00:06:22 Eric

Different so not easy and in a way I'm quite happy because I would not have liked to be involved in animal experiment anyway.

00:06:30 Eric

That here I had had an endless source of tissue for research, because nobody wants to, you know, keep placenta.

00:06:39 Eric

And so it's being thrown away.

00:06:42 Eric

At the end of the of the delivery.

00:06:44 Eric

So the research has been very interesting.

00:06:47 Eric

That's the main problems are obviously miscarriages.

00:06:49 Eric

And and this preeclampsia, which is a hypertensive disorder pregnancy, which can lead.

00:06:54 Eric

To premature delivery to very small babies because the sensor stops functioning at that stage.

00:07:00 Eric

So I mean these are probably the most important complication of of human pregnancy.

00:07:06 Olivia

Right.

00:07:07 Olivia

I mean, I think it's, it's obviously using different models to try and understand it can be.

00:07:15 Olivia

But yeah, since since being here, it's definitely been interesting to kind of be able to look at it from the human side of things.

00:07:21 Olivia

And I guess that's also something that, you know, as researchers, we're conscious of.

00:07:25 Olivia

It's useful, obviously, to use the different models, whether it's a cell line or, you know, in some cases an animal.

00:07:31 Olivia

Model it's it's helpful to understand, but it's important to recognize those differences and particularly with placenta placentation, I mean the different ways that it can occur, I guess kind of taking more of a clinical background or trying to understand you know.

00:07:52 Olivia

How that all goes, you know, in your work in clinic how, what have you found to be true?

00:07:58 Olivia

You know, over the course of your career?

00:08:02 Olivia

Solid facts, if any, about influences on placental health.

00:08:07 Olivia

What do you think is important to to know and and consider?

00:08:11 Eric

I will start with the untrue first.

00:08:14 Eric

Sounds good, it goes.

00:08:18 Eric

If you again you open these old traditional anatomy textbook, you'll see that as soon as the places, implants and the primitive placenta, the early present is transforming.

00:08:29 Eric

You have an entry of maternal blood inside the placenta.

00:08:33 Eric

You see this in those diagrams you know you have a little bit of red color coming inside the placenta.

00:08:38 Eric

And in fact this is not.

00:08:40 Eric

Because it takes time for the placental cells to adapt to.

00:08:46 Eric

Oxygen level that we're breathing, even if there is less inside the tissue than there is in the atmosphere, you don't get 21% oxygen inside the uterus.

00:08:54 Eric

You probably get 1012%, but even that is quite high for an early pregnancy, and So what happens is the placenta during its development, actually blocks the entry.

00:09:05 Eric

Of the maternal blood inside.

00:09:08 Eric

Itself to allow itself to develop properly, so that when the time comes, which is usually at the end of the first trimester, around 12 weeks, 3 months, then progressively maternal blood can get in.

00:09:20 Eric

And that is the primary mechanism of the miscarriages in all miscarriages.

00:09:25 Eric

At some point, you have a premature entry.

00:09:29 Eric

Maternal blood inside the placenta that it is due to a chromosome abnormality that it is due to an infection that it is genetic codes that you know we cannot always identify is this premature entry of maternal blood inside the first time as a percent that that creates the phenomenon of miscarriages and not surprisingly.

00:09:50 Eric

Patients who have a miscarriage most of the time present with a little bit of bleeding or a lot of bleeding to in any department.

00:09:57 Eric

It's one of the most common complication you know in in medicine in general.

00:10:02 Eric

But of course it's the most common complication in pregnancy.

00:10:05 Eric

So that's, you know, that's sent through and and I'm very proud to say that in the grace.

00:10:11 Eric

And that's Amy, the team of Grey's Anatomy have accepted this concept.

00:10:17 Eric

And then for the last three edition I have been here with a colleague in Cambridge to Graham Burton to to write the chapter on the placenta.

00:10:26 Eric

So finally this information is getting through.

00:10:29 Eric

You know, medicine and science.

00:10:33 Eric

And so it's changing a little bit the way we.

00:10:36 Eric

Look at patient with these complications.

00:10:38 Eric

The way we manage them and you know, finding treatments in those cases that don't have a chromosome abilities and maybe would benefit, you know, from.

00:10:49 Eric

Not having a miscarriage.

00:10:51 Eric

Because health codes, the other codes like immune codes and vascular codes that can be.

00:10:56 Eric

Improve with treatments that had no evidence.

00:11:01 Olivia

I mean, I think obviously.

00:11:03 Olivia

It's it can be hard to understand or to take an interest in understanding different processes related to health.

00:11:11 Olivia

If it's not kind of something that you naturally have a curiosity about so you know, with the placenta, I think generally people maybe don't.

00:11:20 Olivia

I think that's why it's so, you know, I think underappreciated.

00:11:23 Olivia

Just because unless you're pregnant.

00:11:24 Olivia

I mean, it's not something that you really care to understand and study, but I guess I'm wondering, you know, in clinic when you have moms, new moms that are coming in or, you know, they're early in pregnancy, are there certain misconceptions that you find that they or or questions that they have really about the placenta?

00:11:44 Olivia

And, you know, or their baby or an understanding that they might benefit from about the placenta.

00:11:51 Eric

In general people are not interested in the present, but they don't realize they wouldn't exist.

00:11:56 Eric

They didn't have a nice healthy placenta when they were fetuses in neutral.

00:12:01 Eric

And I can say it's almost the same in the medical establishment because fetal medicine looks at the fetus and they often forget the placenta is a fetal organ.

00:12:15 Eric

And so they really have an interest in looking at the placenta, even when.

00:12:21 Eric

So serious complications like placenta previa and percent accreta, and they tend to forget that ultrasound.

00:12:30 Eric

Actually, first used in pregnancy to locate the placenta and not to identify fetal malformation.

00:12:35 Eric

It took another 10 years we're talking about here.

00:12:37 Eric

The end of the 60s, when the first placenta previa were were identified, and it was, this was a killer, because if you didn't know the placenta was previa, which means the placenta is covering the neck of the womb.

00:12:51 Eric

You know, if you're going to labor or someone examines you and you induce a massive hemorrhage.

00:13:00 Eric

Before you had access to modern technology, it was very difficult to control and most of the patients would die.

00:13:06 Eric

So ultrasound has really had a much bigger impact in fact.

00:13:11 Eric

By identifying this kind of placenta anomalies is another one which is less well understood by the public as person previa.

00:13:18 Eric

I think everybody knows.

00:13:20 Eric

What it means, it's the model of pregnancy, the hydatidiform mole with which is sort of genetic anomaly of the placenta and basically the percentages growing madly with other fetus.

00:13:33 Eric

It can transform into a cancer.

00:13:37 Eric

And this again was not diagnosed until the.

00:13:40 Eric

Patient was presenting with heavy bleeding, abnormal blood pressure and no ultrasound can identify this from the second month and so it has saved countless lives.

00:13:54 Eric

Just identifying these two placental anomalies, previa then the nasty one.

00:14:02 Eric

Between one in 501 in 1000 and modal pregnancies, if you look at miscarriages, most of them miscarry, it's probably 1%.

00:14:13 Eric

This is far more common than all the fetal anomalies put together.

00:14:18 Eric

Of course, feature anomalies really have an impact on the mother's health.

00:14:23 Eric

These anomalies are really a killer and you know.

00:14:26 Eric

In low income countries.

00:14:28 Eric

Where there is no.

00:14:29 Eric

On examination, this is a killer every day.

00:14:34 Eric

So yes, no.

00:14:35 Eric

So they are not misconception.

00:14:38 Eric

I don't think people are really having.

00:14:41 Eric

At all, because it's not.

00:14:43 Eric

Plus, how important the organ is.

00:14:45 Olivia

Right.

00:14:46 Eric

I mean, yes, there's a lot of crazy things happening with people, and it comes in waves, you know, fashion eating their placenta.

00:14:54 Eric

And I know that now it's it's back and I.

00:14:56 Eric

Get that question?

00:14:58 Eric

But then if the other function represents apart from, you know, enabling the fetus to grow and develop normally is to prevent too many of the bad stuff to get through like pollutant.

00:15:12 Eric

We're still studying, but black carbon particles seem to get through, but you know certain medication, then it's able to stop some parasite but not others.

00:15:25 Eric

So understanding this is very important, but eating it.

00:15:29 Eric

Makes me wondering if you, you know, I tell a patient, just think about your local swimming pool and the filter, you know, that cleans the water God.

00:15:41 Eric

And basically you want me to eat that?

00:15:44 Eric

Are you serious? It has.

00:15:50 Eric

Act as a barrier for a lot of the bad stuff which have spilled up. It's if you take, for example smoking, it's still about 20% of mothers who smoke.

00:16:01 Eric

Uhm, up to five cigarettes.

00:16:03 Eric

It doesn't really have any impact on the fuel growth, probably because the placenta is capable of blocking horrible stuff like cadmium.

00:16:10 Eric

That's in your cigarette.

00:16:11

Right.

00:16:12 Eric

But then after some level is reached, if you smoke 10 cigarettes then you can see then the impact on the field growth.

00:16:21 Eric

But then all of this has piled up in the placenta.

00:16:25 Eric

And imagine everything we have in the air and the water in what we eat.

00:16:30 Eric

Piling up this, I mean.

00:16:33 Eric

I don't understand the concept because.

00:16:36 Eric

If you transform this into a pill.

00:16:39 Eric

You dehydrate the whole stuff, so the molecules like progesterone that might have an effect as an antidepressant, for example, which is one of the argument use, you know to eat your.

00:16:52 Eric

They're not biologically active.

00:16:54 Eric

They've been completely destroyed by the process of transforming this into.

00:16:59 Eric

Chips, *****, and pills.

00:17:02 Eric

So all you're left with are all these horrible, toxic, you know, you know.

00:17:11 Olivia

Yeah, speaking Speaking of which, I mean it's, I mean again another another one of the many kind of incredible talents of that organ is is the ability to act as a sort of barrier kind of filter which we don't totally understand what and and how and what gets through.

00:17:29 Olivia

But you know.

00:17:32 Olivia

Through your research, I mean something that you've.

00:17:36 Olivia

Brought up in.

00:17:36 Olivia

In courses, is this idea of and I think it's important in all of the different fields is to really take a step back and consider.

00:17:45 Olivia

Whatever it is you're studying in the context of the environment now, and that's important, that's something that we've been trying to do better in, in different fields.

00:17:53 Olivia

But you know, you've brought up this point about microplastics and different bits that can exist in the water and something that you've touched on before is, you know.

00:18:04 Olivia

Obviously we we have to continue doing work on understanding the environment and the interactions between an organ and the environment.

00:18:11 Olivia

But taking it to water, I mean you have done research and and you've talked about this.

00:18:17 Olivia

I wonder if you?

00:18:17 Olivia

Could dive into that a little bit.

00:18:21 Eric

The promise of miraculous earthing.

00:18:23 Eric

Walter Brute and, like you know, arsenic or nitrate.

00:18:26 Eric

Yeah, they do cross the placenta quite easily.

00:18:31 Eric

No, historically they didn't exist.

00:18:36 Eric

The modern age exposure to black carbon particle particulate matter, which is what you have in exhaust pipe from cars and factories, etcetera.

00:18:47 Eric

I mean, in a way, we've been exposed to this for a very long time because you're burning wood in a cave.

00:18:52 Eric

Yourself to these particles so.

00:18:56 Eric

No, I think it's.

00:18:57 Eric

We're discussing before the level of exposure, the amount which overwhelms the placental barrier function.

00:19:05 Eric

If you want.

00:19:07 Eric

So yeah, that that is really the issue that we have now.

00:19:10 Eric

So we have created the problem and we don't yet know what the long term consequences are going to be because we are the first generation.

00:19:19 Eric

Of people who are exposed to such an amount of.

00:19:22 Eric

Of pollutant and so in the first generation they're exposing the unborn generation.

00:19:29 Eric

To that amount of pollutant, because we all exposed to it.

00:19:34 Eric

You know, even if you live in the countryside, we've seen the water pollution in the countryside.

00:19:40 Eric

Is as bad, if not worse sometimes than it is.

00:19:44 Eric

Big cities because it's uncontrolled and, you know sewage is going into pristine rivers and on beaches.

00:19:51 Eric

And so yeah, I mean this is new.

00:19:53 Eric

We don't have enough data so, but I'm sure that's a question of time.

00:19:57 Eric

I mean, I saw the word buying Q and report.

00:20:01 Eric

Showing you know that half of the planet doesn't get access to clean water, it doesn't have sewages and this is so simple.

00:20:10 Eric

I mean, we had this in Roman time and it worked.

00:20:14 Eric

So, you know, stopping cars is not going to happen overnight.

00:20:18 Eric

Stopping water pollution and getting everybody access to clean water.

00:20:23 Eric

And there you know, that's where the percentage of course my interest, the person that comes in is, is, is role as a filter.

00:20:30 Eric

But how much can the presenter take?

00:20:34 Olivia

No, I think it's it's mind blowing, like you said.

00:20:38 Olivia

How you know still today access to clean water is something that not everyone has and actually an alarming amount of the population doesn't have access to.

00:20:48 Eric

And it's so cheap.

00:20:49 Eric

Of course it costs money, but nothing compared to, you know, changing all the cars into electric cars.

00:20:57 Eric

The investment is minute compared to what we spend.

00:21:01 Eric

On arms and.

00:21:03 Eric

You know, factories and they're polluting.

00:21:07 Eric

We can't create water.

00:21:09 Eric

The number of water molecules on this planet is limited.

00:21:11 Eric

There may be some more deep inside the earth, so we might get some from Mars or, but we can't create it.

00:21:19 Eric

So we have to respect it.

00:21:21 Olivia

And you know, I mean, I've seen that you've you've done obviously a lot of work internationally and you know taking this further than than the water.

00:21:31 Olivia

But you know your studies and your practice in different countries where access to healthcare.

00:21:38 Olivia

As well, is really limited, I mean.

00:21:41 Olivia

The the the one of the goals of this podcast is really to improve science communication and you have done a lot of work with the charity that you Co founded back in 2006 of medical Aid films, which you know, I'm sure you can go into more than me but is dedicated.

00:22:00 Olivia

To help medical training and education in those low income countries, and I guess I wonder, how do you find and and where did the idea of using these films to to teach as a teaching resource, where did that come from and and how do you find that that translates in different countries?

00:22:19 Eric

It comes from the BBC.

00:22:22 Eric

Which at the time was without any doubt the best television in the world and the documentaries that were being produced.

00:22:30 Eric

That you know that this, you know, White lives ministries or historical documentaries were absolutely fascinating.

00:22:36 Eric

And I was wondering, why are we not using this in school, for example, in education in general because some of them are absolutely stunning.

00:22:45 Eric

I mean you you.

00:22:47 Eric

Even even in science, you've learned when you watch them, even at my stage.

00:22:52 Eric

And so I thought, this sort of approach was probably the best one because people are not going to read anymore and you think about, you know, low income countries, mainly in in Africa.

00:23:06 Eric

The nurses or healthcare assistant, the people that really need to have access to this education, read English, French or Portuguese.

00:23:15 Eric

They may understand it.

00:23:17 Eric

But they may not read it and so access to book also is limited.

00:23:22 Eric

When we saw there were not many smartphones in Africa except, you know, in North Africa, in South Africa, but in between it was.

00:23:32 Eric

Empty in terms.

00:23:33 Eric

No. You have two smartphone per African in sub-Saharan Africa. So you know passing on this knowledge through films that you can translate easily with AI. One of the adventure of AI into all the different languages including local tribal language.

00:23:53 Eric

Is fantastic because you can really democratize access to education.

00:23:59 Eric

So obviously our films are very basic where we're talking about placenta previa, obviously, is a problem.

00:24:05 Eric

One of the major problems is placental retention.

00:24:10 Eric

So it's not the presence of previous not blocking, because otherwise the mother dies if she doesn't have access to a team that can do it as an infection is a placenta being left behind after the baby has been delivered.

00:24:25 Eric

You can't leave it inside of you just for too long because it will be responsible for bleeding, heavy, bleeding, heavier bleeding.

00:24:33 Eric

It will increase with time infection, so that needs to be removed and it affects 2 to 3% of the population is not and it's probably one of the main cause with you.

00:24:45 Eric

Was not contracting properly after delivery of metal of metal death in in the world, but obviously mainly in sub-Saharan Africa.

00:24:57 Eric

So yes, another you know important item about the PERCENTA, which obviously we've been making films about and anybody can have access to these films through YouTube.

00:25:09 Eric

Some of the more technical films are protected because we don't want, you know, the general population to start doing design sections.

00:25:17 Eric

But you know, Yep, preventing postpartum hemorrhage.

00:25:23 Eric

Basic resuscitation of the newborns, you know.

00:25:29 Eric

Malaria prevention, HIV prevention, breastfeeding.

00:25:33 Eric

You know all these important things identifying patient with high blood pressure, preeclampsia, which is much more common actually in African population.

00:25:40 Eric

All this is available online and link with equipment, for example, measured blood pressure that are very cheap.

00:25:49 Eric

Or measure the oxygenation level.

00:25:52 Eric

For new bonds.

00:25:53 Eric

You know that.

00:25:57 Eric

Nurses midwives can get through NGOs and other charity organizations, so you know, we've been teaming up also with some of these charities that are providing this sort of.

00:26:10 Eric

So you know, it's a globalization now, so and and again, it doesn't cost much money, it's it's incredible.

00:26:18 Eric

Making a film like this probably would cost.

00:26:22 Eric

Between 10:00 and $20,000.

00:26:26 Eric

And it can go a long way. Some of our films have been watched 1,000,000 * a year. Well, you know, for specialist films it is quite.

00:26:38 Eric

We need support.

00:26:39 Eric

We need more help because we need to make my dream would be to make an entire midwifery curriculum online.

00:26:46 Eric

Translates in all the possible languages we can translate into this so you know that midwife because in many countries this is not a midwives and nurse and in other parts of Africa you don't even have nerves, you have health care assists and you.

00:27:01 Eric

Both at tendon.

00:27:04 Eric

And we could give them sort of basic training through these films.

00:27:08 Olivia

Right.

00:27:09 Olivia

Yeah, I mean, and even taking it, you know, back to the to the whether it's, you know, of course teaching as a concept in in pregnancy, but for the patient too, I mean just helping to shed light, I guess on the importance of the placenta and the importance of nurturing a healthy placenta during pregnancy, I think.

00:27:29 Olivia

There's so much utility of having a kind of video.

00:27:34 Olivia

I mean, at least personally, I think I always learn better when I can.

00:27:37 Olivia

See kind of.

00:27:38 Olivia

The way that it works, rather than just reading it out of a book, so I think it would be great of course to to continue that on.

00:27:47 Olivia

UM and yeah, I mean, I think the future of of these different areas, whether it be teaching clinicians or the patient, you know there's going to be a lot that evolves in that area. And I think videos is definitely a way to do that.

00:28:06 Olivia

OK.

00:28:07 Olivia

Well, I mean, it's been so lovely having you here today to talk about the placenta.

00:28:12 Olivia

And, you know, you guys heard it here first.

00:28:15 Olivia

Maybe, maybe skip eating it after you.

00:28:17 Olivia

After you first.

00:28:20 Olivia

But it was such a pleasure.

00:28:21 Olivia

And thank you so much for.

00:28:22 Olivia

Joining me today.