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34 Issues L. & Med. 15 (2019)
The Perinatal Revolution

handle is hein.journals/ilmed34 and id is 19 raw text is: The Perinatal Revolution Colleen Malloy, M.D.,* Monique Chireau Wubbenhorst, M.D., MPH,** and Tara Sander Lee, Ph.D.*** ABSTRACT: The Perinatal Revolution is an exciting and rapidly developing field of medicine that aims to treat and possibly cure disease in the prena- tal period, and thereby to improve health across the lifespan of the child. Here we describe an overview of the perinatal field, with specific emphasis on current therapies and interventions for specific fetal problems, such as myelomeningocele and congenital diaphragmatic hernia. Advances in peri- natal medicine have resulted in increased survival rates and improvements in morbidity and mortality for premature neonates. Novel innovations in screening and genetic diagnosis, as well as future prospects in cell-based therapies, tissue engineering, gene therapy, and artificial womb are sig- nificantly expanding the field and are discussed. Ethical, regulatory and policy concerns closely linked to clinical practice and public awareness are also highlighted as the Perinatal Revolution continues to unfold through research, genetic, medical and surgical advances. Introduction Perhaps the final frontier of medicine is fetal diagnosis and therapy With advance- ments in medical diagnosis and therapy, we are now able to treat the patient within the patient - the fetus in utero. Clinicians, researchers and the public have become much more aware of the lasting impact of fetal life upon the rest of a person's life. As Chool- ani and Biswas have noted, with the unraveling of developmental origins of health and disease, we can begin to recognize pivotal trends in the way we address fetal health and disease. No longer do we accept the limited choices of prenatal diagnosis - to continue the pregnancy, or not.' Instead, medical pioneers are actively developing means and methods to treat the fetus in utero. These authors refer to this as the Third Alternative - the Perinatal Revolution the goal of which is to treat and possibly cure disease in the prenatal period, and thereby to improve human health across the lifespan. *Northwestern University Feinberg School of Medicine, Chicago, IL. **US Agency for International Development, Washington, DC. -'Charlotte Lozier Institute, Arlington, VA; formerly with the Medical College of Wisconsin and Chil- dren's Hospital of Wisconsin, Milwaukee, WI.

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