Lectures

Human Placenta, Birth Cohorts, and the Production of Epigenetic Knowledge

Precious Material

Over the past decade, the Canadian university-based Epigenetics Lab has become increasingly central to the production of knowledge about human health and development.[1] During my first visit there, Daniel, one of three technicians in the lab, is visibly stressed. He apologizes for not being more relaxed. He has been up all night worried about a shipment of biological samples sent to the lab by one of their collaborators in the United States. The shipment arrived in Canada yesterday, but is stuck at the airport. “I’ve already called Customs multiple times,” he tells me. “We’re just going to have to drive there and get it ourselves.” Within two hours, one of the other technicians returns from the airport with a small white box containing twenty-five samples of human placental tissue. The shipment is smaller than I imagined and I am initially surprised that it caused so much concern, but Daniel is noticeably relieved.

The placenta samples are part of a birth cohort study that their collaborator has been conducting for the past year. These samples will serve as a critical resource in answering questions about whether and how particular experiences and exposures during pregnancy influence children’s later health and development.

Daniel swiftly and carefully opens the box to check the samples and, when he sees they are still frozen and intact, he lets out an audible sigh of relief. “Okay,” he says, “I think everything is going to be okay.” Later he explains that “it’s a huge responsibility on our end to make sure everything goes right… some samples you can only collect once. If it’s gone, it’s gone. It’s irreplaceable. So, each one is just so precious.”

Precious. The term strikes me as meaningful, especially when thinking about human placenta.

Long ignored in the biosciences and often labeled as waste and discarded following birth in medical settings, interest in the placenta has seen a dramatic shift in biomedicine and beyond in recent years (Benirschke, 1991; Martin and Holloway, 2013). In 2014, the National Institute of Child Health and Development (NICHD) launched the first ever Human Placenta Project (HPP) with the goal of “understanding placental structure, development, and function in real time” (Guttmacher et al., 2015, p. 303). With more than $46 million in funding to date, the project aims to improve maternal and child health through explicitly studying the placenta, marking a significant shift in research priorities associated with the organ. This is in part because, “from womb to tomb,” medical professionals and scientists have come to characterize the placenta as a “window into the future health of both mom and baby,” and a key biological resource in shifting understandings of health and development today (Nelson 2015, p. S12; Cleal and Lewis, 2016; Clark, 2017; Gluckman and Hanson, 2006; Wild, 2012).

Our own research engages with human placenta samples and the birth cohort studies that collect them as one part of a larger multi-sited ethnographic study exploring the production and translation of epigenetic knowledge related to children’s health across laboratories, communities, and clinics in the United States and Canada. Environmental epigenetics focuses broadly on how social forces including pollution, nutrition, stress, trauma, and care can become molecularly embodied, alter gene expression without changing DNA sequence, and influence the health of individuals, their offspring, and even future generations (Landecker and Panofsky, 2013). Scientific publications and popular news stories often describe epigenetics as the science of how “experience gets under the skin,” providing a powerful narrative of how social life can become biologically embedded (Aristizabal et al., 2019; Heindel et al., 2016; Liboiron et al., 2018). Longitudinal birth cohort studies and the biological materials they collect provide a growing resource for understanding these molecular processes (Gibbon and Pentecost, 2019).

Here, we focus on changing meanings of the placenta within dominant scientific and medical discourse as a window into its current importance in developmental origins and epigenetic research. We then draw on our ongoing study to consider how the meanings of the placenta are stabilized through birth cohort research, and their effects for biosocial and postgenomic knowledge production today.

Changing Meanings of the Placenta

Conceptualizations of how the human placenta develops and functions have changed considerably over the course of the late 20th century. In western biomedicine, a view of the placenta as a protective barrier between the pregnant person and their offspring dramatically shifted by the 1970s (Almond and Currie, 2011). In its place, a more porous understanding of the placenta came into view, one that has become central to contemporary research. According to Martin and Holloway (2013), however, the placenta’s porosity and limited ability to protect a fetus from harmful exposures was already documented by the early 20th century. Thus, the placenta’s ‘rise and fall’ as a protective barrier, they argue, is better understood as mapping onto changing “norms regulating women’s conduct during pregnancy” over the first half of the 20th century (pp. 300-301). Nevertheless, it also took the medical and social tragedies associated with diethylstilbestrol (to reduce miscarriage) and thalidomide (to counter morning sickness) in the mid-20th century to finally overturn entrenched medical views about the placenta as barrier, and, much later, to establish drug-related policies as they relate to pregnancy (Bell, 2009). During this same era, British epidemiologist David Barker and colleagues began charting correlations between poor maternal nutrition associated with WWII wartime rations during gestation and ‘programmed’ long-term health outcomes for affected children, including increased risks of cardiovascular disease and early mortality (Barker, 1995; Barker and Osmond, 1986; Gluckman et al., 2008; Waggoner, 2017).

These events collectively shifted conceptualizations of the placenta and its connections to fetal development, pregnant peoples’ lived experiences, and later child development in meaningful ways. First, these shifts helped inform what are now considered basic “tenets” (Burggren and Mueller, 2015) of developmental biology and morphology, namely the “critical” and “sensitive” “windows of development” (McCance and Widdowson, 1974). Links between events experienced in utero and possible long-term programming effects on children’s later health also led to the establishment of new empirical fields of investigation, including the “Developmental Origins of Health and Disease” (DOHaD) (Barker, 2007). Second, the finding that chemical teratogens like diethylstilbestrol and thalidomide could cross the placental barrier and harm fetuses influenced the “endocrine disruptor hypothesis” in the 1990s, and efforts to understand how chemicals cross the maternal-fetal ‘barrier’ (Bell 2009; Christensen and Casper, 2000; Kim and Scialli, 2011). Finally, through these shifting understandings, the placenta itself has become an environmental object of growing biomedical interest. This is because new conceptualizations position the placenta’s development and functions as uniquely connected to, nested within, and dependent on multiple milieu, including the pregnant person’s environment. The idea of the placenta as an impressionable but regulatory organ has thus positioned placentas and the bodies they connect as subject to – and potentially embodying – the social in influential ways.

By focusing on the origins of health and disease during prenatal timeframes and extending their potential impacts across the life course, however, DOHaD and epigenetic findings have been critiqued for reinscribing familiar tropes of self-surveillance and anticipatory carework, particularly for expectant mothers (Maher, Fraser and Wright, 2010; Pentecost and Ross, 2019; Rapp, 1999; Richardson, 2015; Richardson et al., 2014). Medical anthropologists, sociologists, and other scholars have reflected on how medical and social surveillance of the pregnant body occurs around food and nutrition (Armstrong, 2003), vitamin supplements (Al-Gailani, 2014), exercise (Dworkin and Wachs, 2004), and even the admonition to avoid pollutants, pesticides, and plastics (MacKendrick, 2014; MacKendrick and Cairns, 2018). It is within this context that social stressors that are unequally experienced, including racial discrimination (Davis, 2019; Kuzawa and Sweet, 2008), poverty (Link and Phelan, 1995), and natural disasters (Currie and Rossin-Slater, 2012) are often individualized (Pentecost and Meloni, 2018).

Basic science examining both the porosity of bodily materials like the placenta and the embodiment of in utero events can therefore reinforce the imperative of intervention and individual responsibilities, especially during early life. This is the case even as placenta research and epigenetics more broadly challenge medical and cultural concepts of bodily autonomy (Lappé, 2016; Lappé, Hein and Landecker, 2019). Rather than seeing the “mother, fetus, and placenta” as “essentially discrete,” research on the placenta positions them as intimately constituting one another (Yoshizawa, 2016, p. 83; Fannin, 2014; Maher, 2002), something the scientists we spoke with reiterated time and time again. Through placenta research, notions of immunity (immunological responses), integrity (chimerism), individual inheritance (sedimented and inscribed exposures), and even genomic stability have been thrown into flux (Blackman, 2010; Gammeltoft, 2014; Lappé and Landecker 2015; Martin, 2010; Stotz, 2008). Placenta research has thus heightened interest in the prenatal period as a window onto the future and a site of growing social and individual attention, while simultaneously attending to the complex connections between bodies and environments over time. Here, anticipatory labor for the future nevertheless remains connected to gendered responsibilities for care, even as health and development are increasingly conceptualized as contingent, relational, and biosocial phenomenon.

Today, in addition to its role in biomedical research, human placental tissue has gained prominent attention as a so-called “natural resource” in commercial markets and regenerative medicine as well (Annas 1999, p1521; Santoro, 2011). Feminist scholars have remarked on the increasing production of “biovalue” associated with the placental tissue (Waldby and Cooper, 2010). In therapeutic and regenerative medicine, placental derivatives and those from cord blood (Haw, 2015) are extracted and utilized in a wide variety of applications including blood transfusions, transplants, and wound healing (Andrews and Nelkin, 1998; Brown and Kraft, 2006; Cooper, 2006; Copeman, 2009; Franklin and Lock, 2003; Santoro, 2011). In commercial markets, including private umbilical cord blood and placenta banks, pharmaceutical companies, and the cosmetics industry, placental stem cell reserves are cryo-preserved in anticipation of potential therapies and future products (Waldby, 2006). Through these efforts, feminist scholars have noted how the afterbirth, in the form of tissue and cells, gains a newfound social and medical “mobility” as its materiality is transformed and made to traverse bodies and “multiple temporalities” across lifespans (Colls and Fannin, 2013, p.1093-1094). Thus, in both commercial and scientific instances, instantiations of biovalue in the form of products and knowledge are gendered enterprises – based on reproductive labor that produces the material substrate on which the very creation of such value depends, and on research participation and forms of care that are overwhelming performed by women (Dickenson 2007; Kent 2008; Mitchell and Waldby, 2010; Cooper and Waldby, 2014).

For epigenetic scientists, this labor also generates research materials. However, the potential to locate the effects of experiences and exposures in placental tissue, and chart the potentially lasting influences of these early events on future lives, requires study designs that extend far beyond the womb. This is one way that birth cohorts have become central technologies of postgenomic knowledge production today.

Stabilizing Epistemic Claims

To stabilize postgenomic claims about the health effects of in utero exposures and experiences through human placenta research, scientists we worked with positioned birth cohort studies as critical resources. Researchers told us these study designs were costly but important because the data gathered over time could provide a “postnatal package” of biological and social information that would help anchor epigenetic findings found in the placenta. Data collected before, during, and after birth could then be analyzed alongside placenta samples to provide evidence of whether and when experiences and exposures are biologically embodied, and their lasting influences over time.

The temporal and material dimensions of building epistemic claims through placenta samples therefore required other bodily specimens including urine, blood, saliva, and breastmilk, as well as surveys, psychosocial and demographic data, and environmental information collected during birth cohort studies. As children grew, this data provided our interlocutors clues about the relevance of epigenetic phenomena identified in placental tissues. Thus, for scientists and the clinicians who might later use their results, understanding the relevance of the placenta required seeing it in relationship toother data over time. The scientists we worked with therefore saw birth cohort studies as an opportunity to stabilize claims about the importance of both the placenta and epigenetic knowledge gained from it. But patience was critical in these efforts.

As one scientist explained, conducting epigenetic research related to health and development is a “lesson in patience” because researchers must often wait to establish meaningful relationships between early exposures and their effects. She said, “a lot of what we do, truthfully, is collect samples and bank them… because if you have to build a study each time you want to know something, it’s incredibly inefficient and wildly expensive.” Banked samples, including placental tissue, therefore provide epigenetic scientists ways back in time and into bodies, allowing researchers to mine the pastfor information about the future (Radin, 2017). Here, we see how the ongoing collection of data across the life course becomes not only an effort to trace the complex effects of embodied experiences over time, but a mode of stabilizing claims about human placenta and the sciences used to study it as well.

Conclusion

Over the past several years, the placenta has become a resource for identifying how experiences and exposures become biologically embedded. The scientists we study describe it as simultaneously providing a retrospective window into the womb, and as a biological reference point for deciphering the impacts of early life on long-term health. The placenta has thus become endowed with new status as a central, relational organ situated at the critical interface of past and future health and development. It is both prophetic and a cypher, providing clues about the future while embodying the past.

This potential, however, relies on research infrastructures that can themselves extend into the future, providing ongoing biosamples and social context that are then marshalled as a way of knowing placentas differently too. As such, longitudinal birth cohort studies provide increasingly important sites in the production of knowledge about bodies and their experiences in the world (Lamoreaux, 2020; Roberts, 2019).

As birth cohorts become central to the production of epigenetic and biosocial knowledge, the connections they make possible between early-life experiences and later-life health point to the importance of tracing their practices thoughtfully. Ethnography is critical to this project. Here we have explored the human placenta and its relationship to both birth cohorts and postgenomic knowledge production. We described how placentas are imagined and enacted as not only a connection between bodies, but as a means of understanding relationships between lives, environments, and time. The possibilities of placenta research are therefore also about the politics of embodiment – how research materials can be made to stand in for complex and deeply social processes that are unequally felt and experienced, while they sit, often frozen in time, waiting – at airports or in labs – for lives to unfold and other biological materials to substantiate them as meaningful glimpses into both the past and future.

Notes

[1] Epigenetics Lab is a pseudonym.

Funding Statement

Research reported in this publication was supported by NHGRI grant number R00HG009154. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Martine Lappé is an Assistant Professor of Sociology and Science, Technology, and Society in the Department of Social Sciences at California Polytechnic State University, San Luis Obispo. She is a medical sociologist and feminist science and technology studies scholar. Her research focuses on lived experiences of health, science, and medicine. She is a member of the international Biosocial Birth Cohort Research (BCCR) network and the Principal Investigator of the NHGRI-funded K99/R00 study “Behavioral Epigenetics in Children: Exploring the Social and Ethical Implications of Translation” (R00HG009154).

Robbin Jeffries Hein has a PhD in Sociology from University of California, Los Angeles. She studies the intersections of science, medicine and technology, sociology, and feminist theory. She specializes in research on the environmental and reproductive politics of health, developmental origins of disease, and environmental epigenetics. She is a member of the Behavioral Epigenetics in Children study and the BCCR network. Her current work focuses on the social and political implications of placenta epigenetics for women and children’s health.


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