A cellular view of the uterine lining during a pregnancy, which forms the maternal side of the placenta(Jubal Harshaw / Shutterstock)

Placentas get kind of a bum rap.

This is possibly because of all the hoopla about the mothers who blend their placentas into smoothies and eat them, which is not a thing most women do. Even beyond the organ’s ritualistic associations, the way people talk about the placenta is implicitly dismissive.

“It is described as the ‘afterbirth,’” said Catherine Spong, an obstetrician/gynecologist and the acting director of the National Institute of Child Health and Human Development (NICHD). “Like it’s just a thing that comes out afterward. It is an underappreciated organ, and has been understudied.”

To appreciate the placenta, you have to recognize that it’s responsible for sustaining a fetus as it grows into a baby, which is tethered by the umbilical cord to the placenta embedded in a pregnant woman’s uterine wall. Through this arrangement, the placenta provides nutrients and oxygen to the fetus, eliminates waste, regulates fetal temperature, produces hormones, and performs other crucial pregnancy tasks. For one organ to perform so many jobs—duties that would otherwise be handled by separate organs—is extraordinary.

Just as remarkable is the fact that doctors and scientists know so little about the placenta, relative to its importance. For the past two years, researchers with the National Institute of Health’s Human Placenta Project—with more than $50 million in funding—have been trying to correct this oversight. One of their biggest challenges, and one that’s central to their mission, is to better understand the placenta in real time.

Most of what we do know about the placenta comes from having studied it after a pregnancy is complete. This makes sense: A placenta is easiest to examine, from a practical standpoint and from an ethical one, once it’s available for scientific study. That happens once the mom and baby aren’t using it anymore.

“But in some ways, looking at that placenta after pregnancy is looking at a tree trunk stump and trying to understand what that tree was like as a sapling,” Spong says. “Just like the fetus grows, the placenta does too. And it’s very different at 20 weeks, versus 30 weeks, versus 40 weeks.”

Over the course of a pregnancy, the placenta grows bigger over time, and develops folds and crevices. It’s not just the structure that changes, but the function, too. In early pregnancy, placental cells are dedicated to invading the uterine lining—setting up shop, essentially. As the weeks go by, the placenta removes waste like the kidneys and liver; it provides oxygenation like the lungs; and it handles circulation. That is, if the placenta is working the way it ought to. Grave outcomes in a pregnancy are often believed to be related to problems with the placenta, but given the limitations of what’s known about the organ, it’s often impossible to determine what went wrong.

Even when researchers are able to study a younger placenta—say, when a woman gives birth prematurely—there are inherent limitations to what they can learn. Because preterm birth is not a normal outcome in a healthy pregnancy, a placenta from a woman who gives birth prematurely is not necessarily normal either.

“A lot of complications that a woman has—hypertension or even growth restriction in a baby—we think it might originate from a problem with the oxygenation [of the placenta],” said Afrouz Anderson, a post-doctoral fellow at the NICHD. “So there’s sort of a mystery we’re trying to solve there. The problem is that nobody knows what the standard placenta oxygenation [should be] to begin with, in a normal pregnancy.”

To find out, Anderson and a colleague have developed a handheld imaging device that can be placed on a pregnant woman’s abdomen. The portable device works by shining near-infrared light in the direction of the placenta, then measuring the wavelengths of reflected light to detect placental oxygenation. (Pregnant women are already accustomed to imaging technologies as a routine part of prenatal care; ultrasounds use high-frequency sound waves to produce pictures of a developing fetus.) Once researchers understand optimal oxygenation levels, such a device might be used to track placental oxygenation levels in women with high-risk pregnancies. One colleague at the NICHD compares this real-time tracking to a Fitbit—only one that you shine on your placenta, rather than wear on your wrist.

That analogy probably isn’t quite right—an exercise tracker counts steps while the placenta tracker measures oxygenation—but both devices promise useful data without being invasive to the person using them. “Any interventional measurement can maybe harm the baby,” said Amir Gandjbakhche, the chief of Analytical and Functional Biophotonics at the NICHD, and one of the device’s developers. “The good thing about ours is the amount of light we are sending in is like a flashlight. It’s portable. It’s wireless. It’s extremely safe.”

Gandjbakhche and Anderson have two such devices in the works that they hope will be approved by for broader use. If that happens, they’re hopeful that researchers will soon better understand one of the placenta’s most essential roles, and that doctors will be able to detect dangerous conditions like preeclampsia and problems with fetal growth before they pose serious health risks.

In the meantime, the Human Placenta Project is pushing forward with its mission to understand the placenta in vivo, rather than merely in vitro. “It’s the only organ you grow and discard and grow again,” Spong says. “And it allows these two genetically distinct entities to coexist and thrive. It’s a really, really important organ.”

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