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Start Making Sense

How diet may alter the gut microbiome, maternal health, and birth outcomes

By Laura Raines

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The human microbiome—the 100-trillion-cell community of microorganisms that live on and in the human body—is the new frontier for medical research. One of the pioneers dedicated to exploring how diet alters this invisible realm, which in turn affects health, is research assistant professor Erin Poe Ferranti, an Emory nursing alumna who never expected to become a scientist. 

"I always wanted to work in academia and teach, but adding research to the mix came as a surprise," says Ferranti 96Ox 98N 01MN/MPH 13PhD. "Had I known my career would take me to this point, I’d have done a lot of things differently 17 years ago." 

Yet each step of her nursing journey led to her current research endeavor. As a new RN, Ferranti worked in acute care with kidney and liver transplant patients who had pancreatic and renal disease. "Taking care of very sick patients made me aware early on that I wanted to work on the prevention side of health care," she says. 

That awareness led to a dual master’s degree in nursing and public health and a role as assistant chief nurse with the Georgia Division of Public Health, where she managed a nursing quality improvement initiative throughout the state. "Public health is my heart and my passion," she says. "I love that so much of the focus is on maternal and child health and the prevention of chronic disease."

The lack of solid content in the nutrition field took Ferranti back to Emory to begin a PhD centering on diet and maternal health. Her reasoning: "Nurses and other practitioners need better information about what keeps people healthy and better tools to advise patients on diet."  

In reviewing the literature, she found that women with gestational diabetes (GDM) were underserved. Although these women are closely monitored during pregnancy, they often fall off the radar after delivery. 

Knowing that women with previous GDM are at risk of developing type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS), Ferranti focused her dissertation on diet quality and early postpartum cardiometabolic risk after pregnancy affected by GDM. She found that women who had higher confidence in eating healthfully were more likely to have higher diet quality. Studies with larger sample sizes showed that higher diet quality most certainly reduces the risk in women who had GDM during pregnancy.

By the time Ferranti completed her doctorate, microbiome research had exploded, and Emory nursing faculty were investigating this new frontier. She began working with mentors Anne Dunlop MD MPH and Elizabeth Corwin PhD RN FAAN on their study of the biobehavioral determinants of the microbiome and preterm birth among African American women in Atlanta.

"Preterm birth, a leading cause of infant mortality and severe health complications, is a major problem in this country," notes Ferranti. "It affects about 10 percent of all pregnant women in the U.S. and the numbers are rising."  

Until recently, researchers believed that the fetal intrauterine environment and the fetal gastrointestinal tract were sterile. But new evidence of microbes in the fetal environment suggests that the microbiome may evolve sometime during fetal development. The neonatal microbiome is further influenced by delivery type (vaginal versus C-section) and feeding type (breast versus bottle). There is growing evidence that the vaginal microbiome influences risk for preterm birth.

Other risk factors contribute as well, such as GDM, hypertension, preeclampsia, and maternal stress. One of the strongest factors is being African American. These women have a 1.5 times higher risk of preterm birth than Caucasian women. Emory is a leader in investigating this health disparity.

Given her passion for prevention, nutrition, and maternal health, Ferranti chose to study how diet quality affects the gut microbiome and cardiometabolic outcomes during pregnancy and postpartum among women involved in the Atlanta study.

"In the past, it has been hard to gather data on diet because people either over- or under-report what they eat," she explains. "But if we can look at the microbiome and link it to certain diets, then we can know how to intervene and modify the diet to reduce adverse birth complications and improve infant health."

Nutrition still lacks the attention it deserves in our health care system, Ferranti maintains. "It’s not rocket science to know that diet affects health, but new technology is allowing us to study exactly how what we eat affects the gut microbiome for better or adverse effects in pregnancy and the health of the population at large.  Microbiome research provides us with another biomarker for assessing health, and that’s super exciting."  

A couple of years ago, Ferranti and colleagues published an article playing off news about the human microbiome in mass media. The article, "20 Things You Didn’t Know About the Human Gut Microbiome" published in the Journal of Cardiovascular Nursing, provided concise and important information for clinicians.

"There is growing evidence in associations between the microbiome and cardiometabolic issues that I felt CVD nurses needed to know," says Ferranti of the article. "I believe that diet is the main contributor in altering the microbiome, which both likely affect cardiometabolic disease risk."

While the microbes she studies are invisible, the results she sees are tangible and real. "What sets nursing research apart is the close interactions between nurses and their patients," says Ferranti. "My best research days are those spent talking with the pregnant moms in our study. It’s amazing how receptive they are to letting us collect samples (oral, vaginal, fecal, and blood) and how excited they are to participate, knowing that the study might not help them individually but may help others and contribute to a greater good." 

So far, her study is confirming that a plant-based, high-fiber, unprocessed diet is healthier. "Ultimately, I hope that we’ll learn how to design effective dietary interventions that will make a big difference," she says. "Knowing that our research contributes to healthier moms is really motivating because if you can affect the behavior of the pregnant mom, you can affect the whole family."

The National Institutes of Health recently named Ferranti as a BIRCWH (Building Interdisciplinary Research Careers in Women’s Health) Scholar. BIRCWH is a career development program that connects junior and senior faculty who share an interest in women’s health and sex difference research. Anne Dunlop and Elizabeth Corwin serve as Ferranti’s mentors on her study of "Microbiome, Diet, and Persistence of Cardiometabolic Dysregulation in African American Postpartum Women," sponsored by the NIH Office of Research on Women’s Health.

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