Q&A: George Saade, M.D.
In January 2023, George Saade, M.D., a world authority in maternal-fetal medicine and highly accomplished researcher and clinician, was appointed EVMS Foundation chair in women's health and associate dean for women’s health.
Dr. Saade is considered a giant in the world of maternal-fetal medicine research. His research focuses on preeclampsia, preterm labor and fetal physiology and therapy. He is principal investigator on a broad range of research, including six current studies funded by the NIH. He is widely published and a reviewer for 49 journals, including some of the leading publications in obstetrics and in medicine.
Here, Dr. Saade discusses his work.
Why are pregnancy and childbirth so fraught with dangers?
I prefer not to say they are fraught with dangers. The vast majority of pregnancies and childbirth do not have dangers. However, given that pregnancy is typically straightforward, complicated pregnancies stand out more. The perception is really influenced by the expectation. No one speaks of brain surgery as fraught with dangers even though it is associated with much more morbidity than pregnancy. Having said that, pregnancy nowadays is not as simple as 50 years ago. While the expectations have not changed, reality has.
How has pregnancy changed over the last half century?
There are many ways it has changed. But let me give you one major change. More pregnant women are now older and heavier than before. The age is not the issue as much as someone who is older is more likely to have more co-morbidities (other conditions that impact their health like hypertension, diabetes), or be closer to such co-morbidities (pre-hypertension, pre-diabetes). All of these conditions increase the risk of pregnancy complications. We also have more patients with medical conditions like cystic fibrosis or heart abnormalities who 50 years ago were told not to get pregnant, or were not living long enough to get pregnant.
What’s behind the stark racial discrepancies in pregnancy outcomes?
Where should I start? It is inequality in many things, including socio-economic factors, access to care, different care, etc. Unfortunately, care is not the same for everyone. There are certain things we can do to address this, but a drastic change to health policy is really needed. What we are doing at EVMS is making sure we include the community in our discussion, we highlight equity and inclusion, and we develop programs that improve access to care and follow up, such as patient navigators and community health workers.
From your perspective, what is the most important unanswered question surrounding pregnancy?
The most important unanswered question is what causes the complications of pregnancy like preeclampsia, preterm birth and stillbirth. Until we know the causes, it is going to be difficult to prevent them. Until we find the causes, the most important intervention we can think of to improve pregnancy outcomes would be to get patients to optimal health — including blood pressure, metabolic, nutrition and weight control — before they become pregnant.
What drew you to research in general and particularly maternal-fetal medicine?
To research in general is the hope to improve care and decrease suffering for more than one person, or family, at a time. When we find a better way to care for patients, we can impact a lot of people for a long time, even some we have never met. What drew me to maternal-fetal medicine in particular relates to the intricate physiology of pregnancy and fetal development. There is nothing in biology that is more elegant than what happens to maintain a pregnancy and have a healthy mother and baby. The pathways and mechanisms involve the entire body and every biologic principle we know of. From a pathologic process, it is one area that we know very little about. To me, the mother and baby are the last frontier in medicine, which makes this field ripe for discovery. Finally, anything that impacts two individuals very early in their life is bound to have a much bigger impact than whatever we can do for one individual late in their life.
What are your major areas of research?
My overall area of research is to make pregnancy safer, either through developing novel treatments or strategies for managing pregnancy or developing health systems to support patients. Another area of research for me is what I call “pregnancy as a window to future health.” Pregnancy impacts the future health for both mother and baby, and appropriate follow up and management after delivery for both is important to optimize long-term health. The ultimate goal of every physician should be to decrease suffering, both physical and emotional, direct and indirect. How this is done can be different, but all of what we do should have this same goal.
What attracted you to EVMS?
It is a community-focused, nimble institution with a can-do attitude, and an institution that punches above its weight. EVMS is the only referral institution for complex conditions in obstetrics and gynecology. Despite the limited health care resources provided, EVMS has been able to maintain high-quality care for the underserved patients.
A generation from now, how will maternal-fetal care be different than today? What advances do you expect to see in the next 10-20 years?
There is the social and the scientific answer. The social would be that every pregnant person will have the same access to high-level care. The scientific is that we will have individualized and personalized approaches to management of pregnancy.
What is something people may not know about you?
From a serious side, I get lost in my own thoughts. I love to spend time inside my mind doing thought experiments, finding solutions or answers to questions, sometimes silly ones. On the fun side, I am a big fan of Napolitan pizza, opera and English Premier League soccer. I am a big Liverpool supporter. Their official anthem, “You'll Never Walk Alone,” always gives me goosebumps when I hear it.
Watch a video of Dr. Saade discussing the importance of medical care during pregnancy.