Quirky coincidence: Shares the same name and middle initial as ARRMC anesthesiologist Daniel A. Kahn, MD.
Research focus: Immune regulation during pregnancy
Awards: Oppenheimer Award, UCLA Scholars in Translational Medicine Program; Joint Center for Translational Medicine
Medical education: MD and PhD (biomedical sciences), University of California, San Diego; OB/GYN residency and maternal-fetal medicine fellowship, University of California, Los Angeles; postdoctoral fellowship, California Institute of Technology
What are we learning about the immune system and high-risk pregnancies?
One of the mysteries about pregnancy has been why the mother’s immune system fails to mount an attack on her fetus despite the fact that the fetus carries different antigens inherited from the father. We also understand that the fetus is capable of making robust immune responses of its own, so why doesn’t the fetus attack the mother?
In recent years we have finally begun to understand the molecular mechanisms at play during this important process. Further, we’re beginning to learn that when this process of immune tolerance fails during pregnancy, diseases such as preeclampsia and fetal growth restriction are the result. This understanding is allowing researchers to develop novel therapies for these perplexing conditions of pregnancy and may offer hope for millions of mothers and their unborn children.
What medical advances/techniques have emerged in the past few years?
One that has gotten a lot of attention is the new approach to detecting fetal genetic conditions through a maternal blood sample. This approach takes advantage of increasingly efficient whole genome sequencing. Maternal blood carries free-floating DNA, a fraction of which is coming from the fetus. By sequencing the entire free DNA in the blood sample and reassembling the codes using advanced computation, the fetal and maternal genomes are largely determined.
Since it’s possible to quantify the represented genes, we can get an accurate determination of the number of chromosomes. In pregnancy, we can use this tool to screen for several genetic syndromes, including Down syndrome, with detection rates approaching 99 percent with 0.1 percent false-positive results.
How are these advances affecting outcomes?
In many ways, the advent of cell free DNA testing has allowed us to screen more effectively for common fetal genetic disorders and to target our invasive testing (e.g., amniocentesis) to only those pregnancies at highest risk for fetal genetic disorders. By and large, the greatest benefit has been to put many couple’s minds at ease without the risk of an invasive test.
How is medical education changing for maternal-fetal medicine specialists?
There’s now a greater emphasis on care for the mother with medical complications. For a long time, there was an emphasis (bordering on obsession) with the fetus, but MFM training in the past five years has begun to rebalance the focus.
This is important because with an aging maternal population, medical conditions such as hypertension, history of cancer, autoimmunity, etc., are becoming a more common part of routine obstetrical care. Also, we’re beginning to recognize that pregnancy complications can have lifelong impacts on maternal cardiovascular health. So, appropriate care of the mother can be very important beyond the joy of birth.
Who taught you the most, and why?
I have been blessed with many really terrific teachers, but I’ve grown the most as a person through the education provided by my children.
You like to repair cars. What kind and, more important, why?
Like many in surgical fields, I really enjoy working with my hands. In fact, my favorite part of being a bench researcher was executing experiments. Working on our family’s cars provides me with the same tactile satisfaction. That, and it allows me to fulfill another deeply held passion: saving money.
Why did you decide to join Asante Physician Partners?
After trying to find a balance between medicine and research and family for nearly 20 years, I needed to make a change. My short list of priorities was to be involved in my family’s life and to provide excellent care to my patients. Of all the options I considered, APP provided the best combination of those “must haves.” Also, Asante’s dynamic growth and its mission to improve the health of the people of Southern Oregon is irresistible.
Finish this sentence: A perfect day would be …
A bagel breakfast with my wife (a pathologist), our two daughters, and two sons. That would be followed by involvement with a beautiful birth and concluding with a hike in these wonderful hills around the Rogue Valley.