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Recent revolutionary advances at the intersection of medicine, omics, data sciences, computing, epidemiology, and related technologies inspire us to ponder their impact on health. Their potential impact is particularly germane to the biology of pregnancy and perinatal medicine, where limited improvement in health outcomes for women and children has remained a global challenge. We assembled a group of experts to establish a Pregnancy Think Tank to discuss a broad spectrum of major gestational disorders and adverse pregnancy outcomes that affect maternal-infant lifelong health and should serve as targets for leveraging the many recent advances. This report reflects avenues for future effects that hold great potential in 3 major areas: developmental genomics, including the application of methodologies designed to bridge genotypes, physiology, and diseases, addressing vexing questions in early human development; gestational physiology, from immune tolerance to growth and the timing of parturition; and personalized and population medicine, focusing on amalgamating health record data and deep phenotypes to create broad knowledge that can be integrated into healthcare systems and drive discovery to address pregnancy-related disease and promote general health. We propose a series of questions reflecting development, systems biology, diseases, clinical approaches and tools, and population health, and a call for scientific action. Clearly, transdisciplinary science must advance and accelerate to address adverse pregnancy outcomes. Disciplines not traditionally involved in the reproductive sciences, such as computer science, engineering, mathematics, and pharmacology, should be engaged at the study design phase to optimize the information gathered and to identify and further evaluate potentially actionable therapeutic targets. Information sources should include noninvasive personalized sensors and monitors, alongside instructive “liquid biopsies” for noninvasive pregnancy assessment. Future research should also address the diversity of human cohorts in terms of geography, racial and ethnic distributions, and social and health disparities. Modern technologies, for both data-gathering and data-analyzing, make this possible at a scale that was previously unachievable. Finally, the psychosocial and economic environment in which pregnancy takes place must be considered to promote the health and wellness of communities worldwide.

WITH PREECLAMPSIA: THE INTERSECTION BETWEEN COAGULATION AND INFLAMMATION OFFER EREZ, SUNG-SU KIM, JUNG-SUN KIM, YEON MEE KIM, DEREK E. WILDMAN, NANDOR GABOR THAN, FRANCESCA GOTSCH, JIMMY ESPINOZA, SONIA HASSAN, CHONG JAI KIM, ROBERTO ROMERO, Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, Michigan, Wayne State University School of Medicine, Department of Pathology, Detroit, Michigan, Wayne State University, Center for Molecular Medicine & Genetics, Detroit, Michigan, Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan OBJECTIVE: Preeclampsia (PE) is characterized by excessive thrombin generation, which has been implicated in the multiple organ damage associated with the disease. Protease activated receptor-1 (PAR-1), a G-protein receptor, mediates the biological effects of thrombin on coagulation and its proinflammatory properties. The aim of this study was to determine the expression of PAR-1 in placentas from women with PE as well as from patients with preterm labor (PTL) without inflammation. STUDY DESIGN: A cross sectional study was designed including two study groups matched for gestational age at delivery: 1) preterm PE (!35 weeks gestation; n=27) and 2) PTL without inflammation (n=27). Placental tissues were immunostained for PAR-1 using a monoclonal anti-PAR-1 antibody. Placental tissue microarrays were constructed using an automated tissue arrayer and a standard 0.6 mm microarray needle. Immunoreactivity of PAR1 in the villous trophoblasts was graded as: 0, negative; 1, weakly positive; and 2, strongly positive. RESULTS: 1) Protein expression of PAR-1 was found in the cellular compartments of the placental villous tree, mainly in villous trophoblasts and stromal endothelial cells; 2) PAR-1 was detected in 92.6% (25/27) of the placentas of PE women and in 88.9% (24/27) of the placentas from the control group; and 3) The rate of strong positive PAR-1 immunostaining was significantly higher in placentas of PE patients than placentas from the control group [36% (9/25) vs. 8.3% (2/24); p=0.037, respectively]. CONCLUSION: Placentas from pregnancies complicated by preterm PE have significantly higher expression of immunoreactive PAR-1 than placentas from women with spontaneous PTL. This observation is consistent with a role for PAR-1 as a mediator of thrombin’s effect on coagulation and inflammation. We propose that the effects of thrombin in PE are due to increased thrombin generation and higher expression of the major receptor for this enzyme.