Liam Lin, MG25 (MBS), M29, spent this summer collecting saliva samples from premature babies who had been exposed to opioids in the womb. He brought those samples to the lab to test how in-utero opioid exposure might impact how much milk they drink—and therefore how much weight they put on—in their first few days of life.

“Swabbing babies’ mouths was never something I pictured doing in my life,” he says. “But it's actually easier than you would think because, for the most part, the babies are pretty compliant.”

While pursuing his master’s of biomedical science degree at Tufts University School of Medicine, Lin worked with the Woman, Mother and Baby Research Institute (WoMB), a collaboration between the School of Medicine and Tufts Medical Center. WoMB was founded in 2010 as the Mother Infant Research Institute (MIRI), focusing primarily on maternal-fetal health and disease.

In his role with WoMB, Lin worked alongside Celia Rubien, A22, M26, and Ana Leonard, M27, in the lab of Elizabeth Yen, an associate professor of pediatrics at the School of Medicine and a neonatologist at Tufts Medical Center. All three students took part in Yen’s research on in-utero opioid exposure by comparing various health metrics to those of non-exposed babies to understand and improve their long-term health outcomes.

“Our mission has really expanded to encompass the lifelong health of not just mothers and babies, but women outside of pregnancy, as well,” says Perrie O'Tierney-Ginn, executive director of WoMB and a research associate professor at the School of Medicine. “We achieve this through a multidisciplinary, collaborative approach that is central to our institute’s mission.”

In addition to being WoMB’s executive director, O’Tierney-Ginn leads the perinatal ecology lab within WoMB that studies how environmental stressors affect maternal-placental crosstalk—the communication between the mother, placenta, and fetus—and its impact on offspring cardiometabolic outcomes. Other research priorities of the WoMB Institute include the intergenerational transmission of metabolic diseases like obesity and diabetes as well as the long-term implications of in-utero opioid exposure. Researchers also investigate pre-term birth prevention and cervical cancer prevention.

“What's unique about WoMB is that we have pediatricians, neonatologists, high-risk maternal fetal medicine specialists, gynecologists, and basic scientists all working together in one physical space,” O’Tierney-Ginn says.

Exposure for Students

Training the next generation of researchers is essential to WoMB’s mission. Students like Lin, Rubien, and Leonard are involved in all aspects of research in the institute and come from all levels at the university, from undergraduate students to postdoctoral clinical fellows. Undergraduate students primarily work as summer interns to gain research experience, but many continue working with WoMB when classes resume. Graduate students may join a WOMB lab and work on long-term research studies for their theses, while medical students gain clinical research experience to enhance a career in medicine.

In her role with WoMB, Leonard worked closely with Yen to match her interests with the research goals of the lab. She says every student in Yen’s lab is encouraged to study the aspects that interest them the most and that WoMB is an environment that fosters creativity while providing plenty of resources and guidance. For example, previous students have studied changes in BMI of mothers with and without opioid use disorder during pregnancy and others have studied the effects of in-utero cannabis exposure on babies.

Lin and Rubien collected saliva samples and took biometric measurements from more than 20 preterm babies, born at 34 to 37 weeks, to study the effects of in-utero opioid exposure on hunger signaling, feeding cues, and reward signaling. When we experience something rewarding, like a baby drinking milk, the body releases dopamine, leading to feelings of pleasure that reinforce the behavior—this is known as reward signaling. The students expected that in-utero exposure to opioids would increase the rewarding signaling and alter these babies’ feeding ability. To find out, they compared the results to those of non-exposed preterm babies.

“With those two groups, there's an intersectionality,” Lin says. “It's hard to tell if the adverse health outcomes come from the opioid exposure, or from being born preterm, or both.”

This preliminary study found that the opioid-exposed babies were smaller at birth than their non-exposed counterparts, but that they had increased hunger and reward signaling and drank more milk in the first three days of life than the non-exposed preterm babies. Rubien says that for babies with neonatal abstinence syndrome, or babies who have been exposed to opioids in utero, there are already guidelines that providers follow for term babies, but not preterm babies. Her hope was to gather more information about preterm babies so a standard set of guidelines can be established for their care as well.

The NICU Influence

During her time with WoMB, Rubien honed her skills in both lab and clinical work while also volunteering in the neonatal intensive care unit (NICU) shadowing the neonatal team and doing NICU cuddling, “which is as cute as it sounds,” she says. 

NICU cuddling provides essential physical comfort to premature babies by trained volunteers. Such human contact and attention helps vulnerable newborns with development, reduces stress, and improves overall health outcomes.

“This experience exposed me to how team-based neonatology and pediatrics is and just how resilient kids are,” Rubien says. “It was really amazing to see how much fight they had in them. It makes me even more confident in my decision to go into medicine.”

While working in Yen’s lab, Leonard also spent time in the NICU, where she says the environment and type of medicine practiced was very different from anything she had seen before. The whole-body medicine of the NICU combined with addiction medicine confirmed the type of medicine and patient populations Leonard would like to focus on throughout her medical career.

“As a woman who identifies as Latina, we’re underrepresented in the medical industry,” she says. “From my experience growing up in Puerto Rico, which is itself a medically underserved place, I always knew I wanted to go to medicine and work in an underserved community with vulnerable populations. I'm very focused on social determinants of health and how they affect our communities.”

While working with WoMB, Leonard is involved in part of Yen’s study that compares MRIs of opioid-exposed and non-exposed babies’ brains. The scans are sent to a partner hospital that conducts a preliminary color-coding of different regions of the brain. The scans are then returned to Yen’s lab for Leonard to conduct manual corrections. The final image is analyzed to determine the relative volumes of each region of the brain.

Preliminary results have shown that maternal opioid use reduces offspring brain volume compared to non-exposed infants, with worsened outcomes for newborns exposed to more than one substance, such as opioid use in combination with cannabis.

“Working with WoMB has opened my eyes to different parts of medicine that has left me wondering if I'd like to continue doing research after medical school,” Leonard says. “I've now seen that there's so much more research to be done.”

Filling a Need

As director, O’Tierney-Ginn has seen many students like Lin, Rubien, and Leonard who she says have become increasingly enthusiastic about answering these research questions.

“People are digging in,” O’Tierney-Ginn says. “People are more determined than ever. They're excited to keep going in these spaces. They know there's a need.”

With recent threats to funding, 75% of which WoMB receives from federal sources, O’Tierney-Ginn believes that everyone, not just students and researchers, need to support the type of work being conducted at WoMB.

“We should all care about women's health because it impacts future generations of all genders,” she says.