#410 ‒ The biology of pregnancy: physiologic adaptation, gestational diabetes, preeclampsia, childbirth, and long-term maternal health | Kathryn Gray, M.D., Ph.D.

Peter Attia (0:11)

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My guest this week is Dr. Katie Gray, a physician scientist and maternal fetal medicine specialist at the University of Washington School of Medicine where she serves as division chief of maternal fetal medicine and the director of research in MFM.

Katie's clinical work and research focuses on high-risk pregnancy and pregnancy complications with particular expertise in preeclampsia and stillbirth. I wanted to have Katie on because pregnancy is one of the most remarkable physiologic challenges the human body undergoes. And yet I realized there's a lot about this that I certainly don't understand. So we start with the basic physiology of pregnancy and work our way through many of the complications that can arise from gestational diabetes and preeclampsia to stillbirth and actual complications of delivery. Through this conversation, we talk about many things like how pregnancy changes a woman's cardiovascular system, metabolic system, and hormone physiology. Talk about nutrition during pregnancy, fetal development, and the importance of nutrients such as folate. Talk about gestational diabetes, why it develops, how it's diagnosed and treated, and what it can mean for both mother and child later on. Talk about preeclampsia, including the role of the placenta, why it can become so dangerous and how it's managed. Talk about help syndrome and other severe complications of pregnancy. We discuss stillbirth and its potential causes and why so many cases remain unexplained even after extensive testing. We discuss the trade-offs between C-sections, vaginal delivery, and how clinicians think about the risk and trade-offs of each, and how pregnancy complications can affect a woman's health well beyond pregnancy, including her future risk of metabolic, cardiovascular, and kidney disease. It's this last issue in particular that has me curious, as I've been reading more and more literature about what occurs in a woman's pregnancy can be a window into her health later in life. Without further delay, please enjoy my conversation with Dr. Katie Gray.

Katie, thank you so much for coming out. It's awesome to meet you and I'm super excited about what we're here to talk about.

Kathryn Gray (3:17)

Yeah, me too.

Peter Attia (3:18)

Give folks just a little bit of a background in your, maybe what you're doing today, but also kind of the trajectory that got you here. You're a physician scientist at an MD, PhD, what led you to this field?

Kathryn Gray (3:29)

I guess that's a good question. But I think I've always been interested in science and I was an undergrad, and I really liked all my classes and all the science classes, and I was thinking of just going to medical school.

Then I had this one advisory meeting that was required at the University of Wisconsin where in this one meeting, this professor sat down and said, well, my daughter went to medical school and she really enjoyed it, but I thought she would have been so much happier if she also did a PhD. Have you ever heard of that? I was like, no, I've never heard of that. But because of that one conversation, I investigated that further and I thought that that was fascinating and super interesting, that was the beginning of me pursuing all the rest of the steps that happened after that.

Peter Attia (4:19)

And so just briefly, what did you focus on during your PhD?

Kathryn Gray (4:23)

Yeah. So I technically have a PhD in immunology, but what we really did was take this benzodiazepine that was found from a drug screen. And it had been shown by a previous student in the lab to help treat autoimmune lupus, disease in mysolupus. But they didn't know how it was working. So my PhD was focused on understanding the molecular mechanism of this novel benzodiazepine and where it bound and how it actually induced apoptosis in cells. And so basically I took a lot of cow hearts and isolated mitochondria and did a lot of biochemical assays to show that it acted on the mitochondrial ATPase. So that is what I spent my time doing.