Computational modeling in pregnancy biomechanics research

Major obstetrical syndromes related to preterm birth-including preterm pre-labor rupture of membranes, fetal growth restriction and pre-eclampsia-affect 10-15% of all pregnancies worldwide, resulting in substantial financial and human costs. Human pregnancy comprises a set of complex physiological processes, which involve most organ systems within the maternal body. There has been rapid recent growth of computational biomechanical approaches to the study of problems in pregnancy. These are particularly attractive for research that is logistically difficult and ethically challenging to execute in humans. Here, we present the history and current state-of-the-art in pregnancy bioengineering research, focusing on three case studies in which computational approaches have been used to explore the maternal-fetal dyad. First, fracture models are used to examine preterm pre-labor rupture of the fetal membranes, which is responsible for one-third of premature births. Next, models of the utero-placental interface are considered, focused on the trophoblast-the layer of fetal cells that directly contact the maternal uterus and thus form the immunological interface between two genetically different individuals. Finally, maternal cardiovascular function in pregnancy is examined in a multiscale framework considering interactions between hormonal and mechanical cues leading to heart growth. These three examples demonstrate the substantial potential for engineering approaches to pregnancy research, in which 'experiments' in silico can be deployed to examine complex systems that are otherwise not available for targeted research. (225 words).