In Support of Safer, Healthier Pregnancies Globally

As an undergraduate, Dr. Jyoti Mathad spent a semester in the Himalayas with a pregnant host mother who had no access to prenatal care. Both mother and baby died of complications late in her pregnancy.

When she shared the tragic story with her grandmother in India, Dr. Mathad was shocked to learn that only seven of her grandmother’s 14 children survived childbirth. “Whether you survive your pregnancy depends largely on the luck of where you were born,” Dr. Mathad says.

The experience sparked Dr. Mathad’s passion for improving maternal health in under-resourced countries and motivated her research into the immune and metabolic changes of pregnancy and their interplay with infectious diseases such as tuberculosis (TB). Dr. Mathad directs Weill Cornell Medicine’s research program in Pune, India, where she has conducted NIH-funded clinical research trials involving pregnant women — research aimed at filling a gaping void. “There are a lot of unanswered questions on how best to diagnose, prevent and manage disease in pregnant people because they haven’t been included in most studies. For pregnant people with infectious diseases like COVID-19 or TB, treatment is often ‘at your own risk,’” she says.

She has long studied TB, a leading infectious cause of death worldwide. “Gender inequities make it difficult to treat TB during pregnancy as almost none of the many TB regimens are studied in pregnancy,” she says. So in 2022, Dr. Mathad led a clinical trial in pregnant and postpartum women that evaluated a three-month TB prevention regimen of weekly isoniazid and rifapentine (3HP); the antibiotic combination had already been shown to be safe in adults and children for preventing active infection in those with latent TB. The study found that pregnant people could achieve similar drug levels with 3HP at doses used in the regular adult population. Importantly, there were no major safety issues identified, and the authors concluded that “the data support proceeding with larger safety-focused studies of 3HP in pregnancy.” These findings led Dr. Mathad to a new clinical trial, DOLPHIN-Moms, that is powered to assess the safety of 3HP in pregnancy.

Most recently Dr. Mathad has turned her focus to gestational diabetes, building on earlier research she’s done showing that women with HIV had a much higher risk of gestational diabetes than women without HIV in the same community. Her related, ongoing work has shown that about 25% of women with gestational diabetes in India rapidly progress to type 2 diabetes within one year postpartum versus 10-15 years in the United States. Her team hypothesizes that this is due to the often nutritionally compromised diets in resource-limited areas.

Dr. Mathad hopes to improve India’s public health care system, particularly for women throughout pregnancy. She’s received pilot funding from the Joan and Sanford I. Weill Department of Medicine to conduct at-home gestational diabetes screenings in underserved communities and hopes to add post-partum diabetes screening in the future.

“There’s so much work to be done in maternal health,” she says. “I want health care to be equitable for everyone.”