“The opportunity to study the origin of this leukemia arose from the case of a 5-month-old baby diagnosed with acute myeloid leukemia at the Hospital Niño Jesús in Madrid,” explains Pablo Menéndez, ICREA professor at the University of Barcelona and the Josep Carreras Institute. “The parents, who had preserved the umbilical cord blood, opened a line of research that until now had not been possible to address.”
Using precision medicine techniques, researchers analyzed the complete genome of the tumor. Unlike tumors in adults, where thousands of mutations are detected, only two chromosomal alterations were identified in this leukemia.
“Genome analysis allowed us to design a personalized diagnostic method to monitor the disease,” says Xose S. Puente, Professor of Biochemistry at the University of Barcelona. Puente, Professor of Biochemistry and Molecular Biology at the University of Oviedo. “But these data raise new questions, such as when the tumor arose and in what order these mutations have appeared,” he says.
They may endanger the health of the mother, fetus or both. Many are more common in Black patients and contribute to their disproportionately high maternal mortality rate.
Severe cases may force patients and their physicians to consider abortions, but laws enacted or proposed since the Supreme Court overturned Roe v. Wade in June have limited that option.
At least 19 states with abortion restrictions allow exemptions if the mother develops a condition with severe or life-threatening health consequences, but determining whether either situation exists can be a challenging judgment call. Physicians have said they feel new abortion limits are forcing them to let patients with complications deteriorate.
Here’s a look at some of the most common pregnancy complications that could lead a doctor to recommend an abortion:
A serious high blood pressure condition that can develop suddenly in pregnancy, typically during the second half, is called preeclampsia.
It develops in about 1 in 25 pregnancies. Symptoms include swollen limbs, headaches and blurred vision.
In addition to elevated blood pressure, patients may develop kidney problems. In severe cases, fluid in the lungs, seizures or strokes may occur.
Treatment may include hospitalization, along with medicines to lower blood pressure and promote fetal lung development. Ending the pregnancy by inducing delivery or with an abortion may be recommended when the mother’s life is in danger.
Membranes in the fluid-filled amniotic sac that surrounds the fetus often rupture or break at the start of childbirth—commonly called water breaking. In at least 3% of pregnancies, the sac ruptures too early, often leading to preterm birth.
Create health education materials that will reach a wider audience
Recognize the role of the family
Involve traditional practitioners in outreach activities
The researchers believe that providing educational information is crucial for parents to make an informed decision. The team also found that many interviewees who were open to cord blood donation had experience with family members or friends who influenced their beliefs. Younger people and those in urban areas were more likely to donate, according to Elwell.
“I hope that health education for pregnant women and outreach to the tribes continues so that expecting parents can make informed decisions,” Elwell said.
Developing health education materials
The researchers commissioned Augustine Molina, a Tucson-based American Indian artist, to create the artwork for both patient educational materials and a presentation packet for community health workers.
“Molina is incredibly talented and he knew exactly what we were looking for,” Elwell said.
Project manager Sanderson hopes that American Indian parents will become more informed about the opportunity to donate cord blood and that they will have the information and time they need to make a decision that is right for them and their families.
“Understanding how American Indian belief systems intersect with the western medical perspective is very important to addressing health equity issues,” Sanderson said. “It is important to explore how American Indian people know and understand health information and options that are available to them and how those understandings shape utilization. Medical information should be presented in a way that is clear and enables people to make decisions in culturally appropriate ways.”
When cord blood is donated to a public center, the process is similar to blood donation––the donation is stored without connection to a donor name in a public cord blood bank and is listed on a registry to be used for a matching patient. Five hospitals in Arizona participate in public cord blood donation: St. Joseph’s Hospital and Medical Center, Chandler Regional Medical Center, Maricopa Integrated Health Services, Abrazo Health Care in Phoenix and Tucson Medical Center in Tucson. There is no public cord blood bank in Arizona; all cord blood donations made in the state are sent to a cord blood bank in Aurora, Colorado, within 48 hours.
The placenta of every expectant mother is located in a different place, its blood vessels are never the same, and its connection to the fetus and the umbilical cord also varies from one pregnancy to another. Moreover, the fetus is also always in a different position in each case and floating in amniotic fluid. The fetus is surrounded by highly delicate membranes that can only be perforated once so as not to risk losing the pregnancy. So, when a fetus has a life-threatening condition and requires an emergency intervention in the womb, the fetal surgeon faces a huge challenge because he/she has to decide very precisely where to enter the uterus and, once inside, has very few references to navigate safely.