What motivated you to work on nutrition-based maternal health, especially preeclampsia?
After my PhD at Agharkar Research University, I began my post-doctoral fellowship under Chittaranjan Yajnik at KEM hospital, Pune. The work I undertook was funded by the Wellcome Trust and was carried out in collaboration with David Barker and Caroline Fall from the University of Southampton, UK. The “Developmental Origins of Health and Disease” hypothesis, (also called “Fetal Origins of Adult Disease” or “Barker hypothesis”) postulates that exposure to certain environmental influences during critical periods of development and growth may have significant consequences on an individual’s short- and long-term health.
This suggests that maternal nutrition not only influences pregnancy outcome and birth weight of the baby but also contributes to the risk of the baby having cardiovascular diseases or diabetes in adulthood.
I thought this was a wonderful concept — that maternal diet can have an effect on a baby’s health even 40 years later. This held my interest for very long and soon I became part of the Pune Maternal Nutrition study which demonstrated that maternal nutrition, especially micronutrients in the mother’s diet, have a big impact on pregnancy outcome.
Then I moved to Bharati Vidyapeeth University and collaborated with clinicians from Bharati hospital where I came to know that preeclampsia (high blood pressure during pregnancy) is a very common disorder, with over 10% of pregnant women in Pune hospitals suffering from it. I wondered if babies born to mothers with preeclampsia have a chance of developing cardiovascular disease later in life and if this can be fixed by making changes to maternal nutrition early in pregnancy. We recruited and started monitoring nearly 3500 women at the end of their pregnancy to see how maternal diet influences biomarkers.
What, according to you, have been some of the most significant findings from thislong-term study?
Initially, we had recruited 3500 women at the end of their pregnancy, but we hadn’t determined the cause and effect of preeclampsia. We did a small preliminary study, where we followed pregnant women from the first trimester of pregnancy until the birth of the child. In these studies, we found certain biomarkers in the blood whose ratios, when compared to women with normal blood pressure during pregnancy, were high. This suggested that these could be useful in predicting the risk of preeclampsia.
We even combined this with animal studies in our department where we supplemented pregnant rats with omega-three fatty acid along with vitamin B12. These studies showed that an adequate diet not only has a positive impact on the mother but on the eventual development of the brain and nervous system of the fetus as well. As we know, the Indian diet is typically vegetarian that can often lack such micronutrients (mainly found in fish), unless supplemented.
We have even followed up with our earlier cohort to look at the children up to five years of age who were born to women with preeclampsia. We found that even at the age of five, they have higher blood pressure than children born to women without preeclampsia.
It has become quite clear from studies conducted by our group that epigenetic, as well as biochemical factors are also playing a role here. Three years back, we obtained a grant from the Centre of Advanced Research with Indian Council of Medical Research (ICMR) to conduct a huge study where we follow up with pregnant woman from early pregnancy (11th week of gestation) through birth and until the child is 2 years old.
Now we are trying to identify early signs of preeclampsia and monitor kids born to mothers with preeclampsia for signs of developmental cognitive issues. That is the overall larger goal of the study we are doing here.
You are working in collaboration with hospitals investigating the effect of nutritional history of pregnant women of different socio-economic backgrounds. What has that process been like?
We needed to have a different approach when we spoke to and surveyed women from higher socio-economic groups versus lower socio-economic groups. The women from the higher socio-economic groups were well-read and already had questions regarding adding supplements like omega-three fatty acids to their diet. On the other hand, the marginalized groups depended on us for their information. The nutrition intake and physical activity of the two populations are vastly different as well which, in turn, affects the biochemical factors that play a role in maternal health.
Apart from that, keeping the women a consistent part of the study was a challenge too. This was mainly because Indian women tend to go to their maternal homes for an extended period of time during pregnancy or for postnatal care. We had to convince them to stay back for the larger goal of the study, which was to take care of maternal health better in the future.
Compliance of patients also plays a big part in getting together a study of this scale as non-compliance tends to minimize any difference between the groups. Since following up with subjects constitutes a significant challenge to researchers, our team has put a lot of efforts into optimizing this process. Furthermore, we need to make sure that the women under study understand the importance and implications of a study like this.
Almost all your projects have now involved a juxtaposition of nutritional science along with social science and biochemistry. How has the experience of working in such an interdisciplinary field been for you?
I am a biochemist and have always been interested in nutrition as well. I knew, for the whole picture to become clear, we would need to look at not only social aspects but also epigenetic and molecular factors. We involve people from all walks of life, like data entry specialists, social workers, doctors, biochemists, nutritionists, mathematicians etc.
We need good and novel questions with a lot of funds to carry out these studies. I am so glad that the Indian Government, especially ICMR, saw the value of this study and gave us nearly Rs 7.5 crores to carry out this work. We have even received isolated grants from the Department of Biotechnology (DBT) and Department of Science and Technology (DST) that have kept our studies going.
Eventually, the goal is to translate the information obtained from urban areas and carry it forward to rural and tribal areas in order to monitor women’s maternal health. Once we are able to collaborate with rural health workers, we can even relay this nutrition-based information to tribal areas which don’t have access to this kind of information.Sadhana Joshi with her team
As a researcher, do you have any advice for women scientists in India?
I feel there is a huge scope in health-related research, especially maternal and child health. It’s important to remember that India is one of the signatories of the millennial development goals of the United Nations Development Programme (UNDP). I believe that women have a significant role to play in this and our group includes nearly forty women including scientists, PhD students, project assistants, data analysts, nutritionists, psychologists and social workers, which I am so proud of. It’s also easier for pregnant women to relate when a female scientist talks to them about the importance of the study and maternal health in general.
Note: Sadhana Joshi’s current project involves an in-depth study of diets of pregnant women from different social and economic backgrounds in order to identify what needs to be changed for better maternal health. This project — The REVAMP study: research exploring various aspects and mechanisms in preeclampsia has received funding from the Indian Council of Medical Research — Centre for Advanced Research (ICMR-CAR). This is a proposed comprehensive basic science, translational and public health-oriented collaborative research plan between basic scientists and clinicians that will help understand the origin of preeclampsia in the mother and its metabolic consequences in their offspring. It aims to identify biomarkers like growth factors in the plasma for the early prediction of risk for developing preeclampsia.
This is a companion discussion topic for the original entry at https://indiabioscience.org/columns/conversations/how-early-life-influences-adult-health-in-conversation-with-sadhana-joshi