2015 DIG Research Projects | TJ Gan DIG Award: “Obstructive Sleep Apnea in Pregnancy: Development of a Pregnancy-Specific Screening Tool”
I am a first-generation American, born to Cuban parents that immigrated to the United States as children following the Cuban Revolution. As a high school student in Ridgefield, Connecticut, I began to consider a career in medicine. I went on to attend Duke University where I graduated with a Bachelor of Arts. While I was an undergraduate, my interest in women’s health was kindled out of personal tragedy when my mother died of breast cancer at a young age. I saw the need for additional research in women’s health, and for three years prior to medical school, I worked on a clinical study in New York City at Columbia Presbyterian Medical Center in the Department of Obstetrics and Gynecology looking at the effects of anorexia nervosa on the skeletons and reproductive systems of young women.
I studied medicine at Yale School of Medicine in New Haven, Connecticut, where I helped to develop a study that used brain imaging to look for differences in neurotransmitter levels in the brains of new mothers that could potentially predispose them to postpartum depression. I received a fellowship from the Howard Hughes Medical Institute to do this work. During that time, I also earned a Masters in Health Sciences by taking additional courses in clinical research methods. During medical school, I was captivated by my rotations in anesthesiology. I loved that anesthesiology was interdisciplinary, that you could care for a diverse patient population, do procedures with your hands, alleviate pain and suffering, and provide life-saving intensive care. I stayed on at Yale School of Medicine for a residency in anesthesiology, where I received excellent training and decided to pursue further training in obstetric anesthesiology.
I completed an obstetric anesthesiology fellowship, and then became an Assistant Professor at Duke University Medical Center, where I have had the opportunity to be constantly challenged by complex patients, to see what questions remain unanswered in our field, and to design and implement my own research studies with the help of excellent mentors and collaborators that will ultimately help to improve the quality of care that we deliver to our patients.
Morbid obesity is a common health problem among reproductive-age women in the United States, and I have seen first hand how obesity complicates many aspects pregnancy and delivery. One health problem that is commonly associated with obesity is obstructive sleep apnea (OSA), a breathing disorder in which the airway narrows or collapses during sleep. Recent studies suggest that mothers with OSA are at higher risk of having complications during pregnancy such as preeclampsia, which is a leading cause of maternal morbidity and mortality, as well as premature birth.
To date, there are no valid screening tools available to screen pregnant women for obstructive sleep apnea. The DREAM Innovation Grant will allow my collaborators and myself to collect pilot data with which to develop a screening tool for OSA in pregnant women and to study the pregnancy and peripartum outcomes of women diagnosed with OSA. Earlier identification and treatment of pregnant women with OSA could have a significant impact on maternal and neonatal outcomes in this high-risk population. The next step of this line of investigation will be to validate our screening tool in pregnant women using laboratory-based, overnight sleep studies, as well to study patient outcomes following treatment for OSA. Pilot data obtained with the help of the DREAM Innovation Grant will allow us to successfully apply for both NIH and other extramural funding within the next two years in order to continue this work.
I am grateful to the donors who support the DREAM Innovation Grants for the opportunity to take the first step towards our long-term goal of improving maternal and neonatal outcomes by identifying and treating women with undiagnosed obstructive sleep apnea during pregnancy.
My husband, Dr. Hani Elwafi, and I are very fortunate to have two wonderful daughters, Salma and Camila. We met while we were Duke undergraduates many years ago, and are happy to be living in Durham again.