Cristina Paules, gynecologist at the Zaragoza Clinical Hospital and member of the Placental Physiopathology and Fetal Programming group at the IIS Aragón

«If we can better understand the causes and consequences of prematurity, there will come a day when we will be able to prevent it.«

Cristina Paules Tejero (Zaragoza, 1985) studied Medicine in the Aragonese capital and did her residency at the Lozano Blesa Clinical Hospital in the specialty of obstetrics and gynecology. After completing a subspecialization in maternal-fetal medicine through a Río Hortega contract at the Hospital Clínic of Barcelona, ​​a reference center in her field of work, she returned to Zaragoza and currently enjoys a Juan Rodés contract at the Hospital Clínico Lozano Blesa. She completed her doctoral thesis on 'Biomarkers in preterm birth for the prediction of medium-term neurological development', co-directed by the University of Zaragoza and Johns Hopkins University in Baltimore (United States). She received an extraordinary doctorate award from the University of Zaragoza and the Royal Academy of Medicine.

When did you know you wanted to study Medicine and the specialty you wanted to work in?

It comes from my family. My father was a doctor and it is a profession that I lived at home since I was little. I don't remember ever wanting to be anything other than a doctor. As for the specialty, at first I was more attracted to oncology, but the first internships I did in gynecology and maternal-fetal medicine completely focused my attention. During my degree I loved the subject of embryology. I find it fascinating how a person ends up forming from two tiny cells. When monitoring a pregnancy you see how the organs develop, how a human being is formed... That is why I specialized in fetal medicine.

And why are you dedicated to research?

It had always caught my attention. If something made me hesitate about studying Medicine, it was some laboratory courses more related to research, such as cell biology or biochemistry. It is true that at the university they did not talk to us about research as a professional option, but when I started the residency I met Daniel Orós, assistant Obstetrician at the Hospital Clínico and principal investigator of the Placental Physiopathology and Fetal Programming group at the IIS Aragón. For me, Daniel has been a reference for his clinical-research career and he is the person through whom I got started in research. Subsequently, I moved to the Hospital Clinic of Barcelona, ​​one of the best centers in its field worldwide, to expand my training in research in maternal-fetal medicine.

There in Barcelona she was the principal investigator of the IMPACT BCN clinical trial. What did she consist of?

It was a clinical trial that aimed to reduce the percentage of low-weight newborns with non-pharmacological interventions, but by improving maternal lifestyle and eating habits with a Mediterranean diet and reducing stress through techniques such as mindfulness. The interaction with the patients, whom we selected at week 20 of gestation, was very beautiful and enriching. We worked with a multidisciplinary team that included everything from nutritionists to psychiatrists. The study proved to be very effective, especially the part of the Mediterranean diet, and was published in one of the magazines with the greatest impact worldwide, JAMA magazine.

What has having Río Hortega and Juan Rodés contracts meant for you?

I consider it very important that health professionals can go to train at national and international reference centers and then import the knowledge or new techniques to the hospitals in our community. The Rio Hortega contract allowed me to carry out this super-specialized training in a world-renowned center, and the Juan Rodés has made it easier for me to put this training into practice in the center where I began my specialization, the Lozano Blesa Clinical Hospital in Zaragoza. It is crucial that this type of contracts be promoted and that, subsequently, the reintegration of the professional into the National Health System in highly specialized positions is facilitated.

She was responsible for the first international publication of results on the impact of a threat of premature birth on the neurodevelopment of a child. What conclusions did she reach?

The study consisted of recruiting pregnant women when they were admitted due to a threat of premature birth, and after two years the children underwent a neurodevelopmental assessment. The results were very striking, since they showed that the neurodevelopment of children who had been born full term after suffering this event during pregnancy was more similar to that of premature children than to controls. With this conclusion there would be a new hypothesis worldwide, postulating that the weeks of gestation at which one is born is not as important as the insults that occur during gestation.

What has this meant in your career?

It is the job that, without a doubt, I will always remember most fondly. Although we are a group that has grown exponentially in recent years and currently have many relevant publications, that article was special. It was the first of my doctoral thesis and had a great impact on our field due to its publication in the American Journal and the editorial that the magazine dedicated to us. That meant that Roberto Romero, the world's leading expert on prematurity, contacted us and even came to Zaragoza to meet us. In short, he put us on the map of this specialty worldwide.

What are you currently working on?

We have two projects related to the threat of premature birth. On the one hand, 'Superkids study' has as protagonists those same children, who are now between 6 and 9 years old, and we are doing a comprehensive assessment, which includes neurodevelopment, visual development, body composition, physical condition and cardiovascular health. On the other hand, we are creating a new cohort of pregnant women who suffer a threat of premature birth to study the possible cardiac remodeling of these fetuses inside the uterus as a consequence of this insult.

What result do you dream of achieving in your professional career?

Demonstrate how to prevent premature birth. If we can better understand the causes and consequences of prematurity, there will come a day when we will be able to prevent it. In our research group, which includes biologists, biochemists, obstetricians and pediatricians, we will continue working to, one day, be able to prove it.