key: cord-0881754-vrtkggnl
authors: Bonney, Elizabeth A.; Elovitz, Michal A.; Mysorekar, Indira U.
title: Diversity is essential for good science and Reproductive science is no different: A Response to the recent formulation of the Burroughs Welcome Fund Pregnancy Think-Tank.
date: 2020-08-10
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.08.012
sha: 75b44f6f742b92f542a259858aea4c015cb3ea0f
doc_id: 881754
cord_uid: vrtkggnl

nan

We are at a critical junction in our journey towards improving the health of women's lives, particularly during their reproductive years. However, the COVID-19 pandemic has revealed an inconvenient truth we have recognized in women's health for decades: not all women have benefitted equally from these advancements. Over the last 30 years, our progress in the critical arenas of maternal mortality and birth outcomes, has been largely incremental. If we are going to continue to advance science and medicine, we must recognize and acknowledge the profound toll that societal and structural racism has had on not just the output of science and medicine but on those who are the future of science and medicine. In light of this, we were greatly disappointed in the makeup of the Burroughs Welcome Fund Pregnancy Think-Tank: a group of personally and professionally affiliated white scientists (16/17); of whom 13/17 were men and included only one practicing obstetrician; and its proposed agenda 1 . Why are we disappointed? We offer three reasons.

First, pregnancy is complex. Except for rare circumstances, poor pregnancy outcomes are not attributable to a single disease, single physiologic pathway, or a discrete set of genes. The developing fetal brain, maternal immune system, and reproductive and metabolic physiology are increasingly recognized as being particularly vulnerable to poor nutrition and stressful environments. These and other early developmental perturbations are directly linked to subsequent childhood behavioral disorders and the risk and occurrence of common non-communicable diseases, such as diabetes, cardiovascular disease, obesity, and the obstetrics syndromes of preeclampsia and preterm birth. Thus, not only systems but also environments are critical drivers of outcomes. What is missing or dissected away from current mechanistic discourse about the biology of these processes is the larger environment in which a person exists and their response to it. Known factors that influence pregnancy include socioeconomic status, experience of institutional racism, underlying health conditions; access to health care, nutrition, environmental toxins, early adverse life experiences and/or exposure to violence/trauma, and psychological support. The ever-deepening dive into "omics" 1 absent a scientific incorporation of J o u r n a l P r e -p r o o f these other factors and their biological effects 2 has not and will not solve the problems of adverse pregnancy outcomes.

How did we get so deep in the weeds of this situation with a nearly exclusive focus on the genetics of preterm birth and adverse pregnancy outcomes? 1 We propose that this occurred due to the relative absence of essential perspectives, especially from women affected by these variables. The woman's contribution is literally absent from the Word-cloud of themes that emerged from the Think-Tank discussion 1 . Women bear the brunt of pregnancy's burden, but they may not see pregnancy as Finally, the impact of adversity during pregnancy affects the next generation. While the intentions of the respected Think-Tank members may well have been positive, it is the impact that is critical both now and in the future. Decisions made by those who make up this group will affect generations of scholars who will determine the mechanistic basis for critical gene-system-environment interactions, and practitioners who are more likely to be female, LGBTQIA, or BIPOC. The time is now to open up seats at the table and allow them to become critical participants in developing the strategic research plan to tackle the problems of adverse pregnancy with and in the name of meaningful science. This is not an opportunity to be missed to build a deep bench of scholars and leaders for the future.

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