1 Simple Question That Could Improve Women’s Health | Meryam Sugulle | TED

Translator: María Suárez Seijas Reviewer: traduceTED USC

How would you react if I told you that we have an underused screening tool

Como reaccionariades se vos dixese que temos

unha ferramenta de detección infrautilizada

that has the potential to improve women's health substantially?

que pode mellorar considerablemente a saúde das mulleres?

And that this tool only consists of one simple question.

E esta ferramenta é simplemente unha pregunta:

Have you had any pregnancy complications?

tiveches algunha complicación durante o embarazo?

With that simple question,

Con esa sinxela pregunta

we could identify women at increased risk for cardiovascular disease

poderiamos identificar as mulleres cun alto risco

de padecer enfermidades cardiovasculares ao longo da súa vida.

later in their lives.

That means diseases involving the heart, the brain

É dicir, enfermidades que afectan ao corazón,

ao cerebro e aos vasos sanguíneos,

and the blood vessels,

like heart attack, heart failure, stroke and high blood pressure.

coma infartos, insuficiencia cardíaca, derramos cerebrais e hipertensión.

By asking that simple question,

Facendo esa sinxela pregunta,

we could seek out the women

poderiamos localizar as mulleres

who could benefit from general health screening

que poderían beneficiarse dun exame médico xeral

already at a younger age.

a unha idade máis nova.

That means checkups of blood pressure, body weight and blood sugar.

Falo de controis de presión arterial, peso corporal e azucre en sangue.

Based on the results, we could offer personalized lifestyle advice

Baseándonos nos resultados,

ofreceriamos asesoramento personalizado sobre o estilo de vida

and suggest preventive measures.

e poderiamos suxerir medidas preventivas.

Why?

Por que?

For this is a fact:

Isto é así:

cardiovascular disease is a major cause of early death, apart from cancer,

as enfermidades cardiovasculares son a principal causa de morte prematura,

á parte do cáncer,

not only for men, but also for women.

non só en homes, senón tamén en mulleres.

I hope that all of you now got very curious

Espero que vos entrase a curiosidade por saber

about what on Earth nine months of pregnancy

que teñen que ver os nove meses de embarazo

have to do with older women getting heart attacks and strokes.

con que as mulleres máis maiores teñan infartos e derramos cerebrais.

Pregnancy is something younger people do, you might think,

Poderíase pensar que o embarazo é algo propio das persoas máis novas,

even though I would argue that 50 is the new 30.

malia que eu creo que os 50 son os novos 30.

(Laughter)

(Risos)

Pregnancy is often described by a well-used quote

O embarazo acostuma describirse cunha cita moi usada:

as a stress test for life.

“unha proba de estrés de por vida”.

A woman's health gets tested by being pregnant.

A saúde dunha muller ponse a proba cando está embarazada.

Will she tolerate pregnancy

Tolerará ben o embarazo

and all the involved physiological changes well,

e todos os cambios fisiolóxicos que implica

or will there be any complications?

ou haberá algunha complicación?

The most important organ for pregnancy

O órgano máis importante no embarazo

is the one that was once attached to the center of your belly,

é o que estivo pegado ao centro da barriga,

where your belly button is.

onde temos o embigo.

We all have a belly button, regardless of gender.

Todos temos embigo, sen importar o xénero.

You and I, King Charles, the Pope, Beyoncé.

Vós e mais eu, o rei Carlos, o papa e Beyoncé.

And where it is, we were all once connected

Todos estivemos conectados algunha vez

via a lifeline, the umbilical cord,

a través da liña da vida, do cordón umbilical,

to the most important organ in both our and our mother's life.

ao órgano máis importante da nosa vida e da de nosa nai.

Vós e mais eu, todos estamos aquí grazas á placenta.

You and I, we are all here thanks to our placenta.

We all survived the single most dangerous event in our life,

Todos sobrevivimos ao evento máis perigoso da nosa vida,

birth, that is,

é dicir, o nacemento,

due to our well-enough functioning placenta.

grazas ao bo funcionamento da nosa placenta.

We all know that the placenta was our first meal box

Todos sabemos que a placenta foi a nosa primeira fonte de alimentación

when we were growing babies inside our mother's womb.

cando eramos bebés que estaban medrando no útero de nosa nai.

Most of us also know

A maioría tamén sabemos

that the approximately nine months of growth

que os nove meses de crecemento, aproximadamente,

inside our mothers' womb

dentro do útero materno

have lifelong, lasting effects

teñen efectos duradeiros de por vida

on our health and diseases once we are outside.

na nosa saúde e nas enfermidades unha vez que estamos fóra.

But what is lesser-known is that the placenta,

Pero o que non se sabe é que a placenta,

the one we were attached to,

á que estivemos unidos,

is crucial for the future cardiovascular health of the mother

é crucial para a futura saúde cardiovascular da nai,

who lent us a room in her womb.

que nos deixou sitio no seu útero.

That means how healthy our placenta was

Iso significa que a saúde da nosa placenta

is very important for the health of our mother's heart and blood vessels.

é moi importante para a saúde do corazón e dos vasos sanguíneos da nosa nai.

How is that the case?

Como é posible?

How does our placenta

Como é que a nosa placenta

affect our mother's future cardiovascular health?

afecta á futura saúde cardiovascular da nosa nai?

In order to understand that,

Para entender iso

we must briefly talk about the makeup of a healthy placenta.

debemos falar un pouco sobre a composición dunha placenta sa.

This fascinating organ is made early on in pregnancy,

Este fascinante órgano fórmase nas primeiras etapas do embarazo,

when the fertilized egg develops into the baby

cando o óvulo fecundado se converte no bebé

and into cells that invade the layers of the womb of the mother.

e nas células que invaden as capas do útero da nai.

This happens early on in pregnancy, before the baby even looks like a baby.

Isto ocorre na primeira etapa do embarazo, antes de que o bebé pareza un bebé.

After invading the different wall layers of the mother's womb,

Tras invadir as diferentes capas da parede do útero materno,

the cells group together and form finger-shaped tissue.

as células agrúpanse e forman tecido con forma de dedo.

These tissue fingers seem to poke into the layers.

Eses dedos de tecido parecen cravarse nas capas.

Finally, the healthy placenta includes a special room

Por último, a placenta sa inclúe unha sala especial

where these tissue fingers are showered in the mother's blood.

onde estes dedos de tecido se bañan no sangue da nai.

In this shower room,

Nesta ducha, o bebé que está a medrar

the growing baby receives different life-important nutrients and signals

recibe diferentes nutrientes e sinais importantes para a vida

via different transport mechanisms.

a través de diferentes mecanismos de transporte.

In other words, it is very important

É dicir, é moi importante

that everything works well in this specialized room.

que todo funcione á perfección nesta sala especializada.

It has to be nice and tidy.

Ten que estar coidada e ordenada.

That guarantees the meal box effect of the placenta.

Iso garante que a placenta sexa unha fonte de alimentación,

The good effect.

unha boa fonte.

But just like almost every other living things,

Con todo, igual ca case todos os demais seres vivos,

cells can get stressed, and cells can get out of control.

as células poden estresarse e perder o control.

This happens, for example, in cancer.

Isto pasa, por exemplo, no cáncer.

But how can a healthy placenta become a stressed placenta?

Pero como se converte unha placenta sa nunha placenta estresada?

What happens?

Que sucede?

Placental cells can get stressed

As células placentarias poden estresarse

when the blood shower in the specialized room gets messy.

cando a chuvia de sangue na sala especializada se complica.

The placental cells then get out of control.

As células placentarias perden o control.

They grow crazy bumps on their surface.

Sáenlles protuberancias na superficie.

In fact, they seem to literally throw up stuff into the specialized room.

De feito, parece que literalmente vomitan cousas na sala especializada.

By that, the stressed placental cells send many different types of signals

Así, as células placentarias estresadas envían moitos tipos diferentes de sinais

into the specialized room.

á sala especializada.

And these stress signals then reach the mother's blood

E estes sinais de estrés chegan logo ao sangue

and the mother's blood vessels.

e aos vasos sanguíneos da nai.

And when they reach the mother's blood vessels,

E cando chegan aos vasos sanguíneos,

they can make these vessels unhealthy,

poden alterar a saúde destes vasos

and they can contribute to making the pregnant woman sick,

e contribuír a que a muller embarazada enferme

and the pregnancy gets complicated.

e o embarazo se complique.

The placenta is then not really healthy anymore.

Daquela, a placenta xa non está sa.

Maybe you've heard of or even know personally,

Se cadra oístes falar ou incluso coñecedes persoalmente

women who have had increased blood pressure

mulleres ás que lles aumentou a presión arterial

from around the middle of pregnancy,

á metade do embarazo,

who had protein in their urine or headache,

que tiñan proteínas na urina, dor de cabeza,

abdominal pain, blurred vision

dor abdominal, visión borrosa ou todo iso xunto.

or all of this.

Then they had what we call preeclampsia,

Logo tiveron o que chamamos preeclampsia,

a pregnancy complication of varied severity

unha complicación do embarazo de diversa gravidade

that occurs in three to 10 percent of all pregnant women,

que se presenta entre o 3 e o 10 % de todas as mulleres embarazadas.

the rate depending on where we live.

A taxa depende de onde vivamos.

What does preeclampsia have to do with the placenta

Que ten que ver a preeclampsia coa placenta

and with the mother's future cardiovascular health?

e coa futura saúde cardiovascular da nai?

Remember what I told you about the stressed placenta?

Lembrades o que vos dixen da placenta estresada?

According to a widely accepted theory supported by research,

Segundo unha teoría amplamente aceptada e avalada por investigacións,

in preeclampsia the stressed placental cells

na preeclampsia as células placentarias estresadas

send signals into the mother's blood.

envían sinais ao sangue da nai.

These stress signals may cause inflammation-like processes

Estes sinais de estrés poden provocar procesos similares á inflamación

na parede interior dos vasos sanguíneos da nai.

in the inner lining of the mother's blood vessels.

This then leads to disturbed vessel function

Isto leva a unha alteración do funcionamento dos vasos sanguíneos

e aos sinais de preeclampsia que mencionei antes.

and to the signs of preeclampsia that I mentioned earlier.

Preeclampsia is only one of several examples

A preeclampsia é un dos moitos exemplos

for a pregnancy complication related to a not-well-working placenta,

de complicacións no embarazo relacionados co mal funcionamento da placenta,

but I will stick to this example.

pero centrareime neste exemplo.

In a way,

En certo modo,

the placenta and the mother talk to each other.

a placenta e a nai comunícanse.

And since our earliest cells

E, dado que as nosas primeiras células

formed both us, the babies, and the placenta,

formáronnos tanto a nós, os bebés, como a placenta,

we talked to our mothers even before we could speak properly.

comunicámonos coas nosas nais antes de saber falar.

And it turns out that this may well be

E resulta que esta podería ser

one of the more important talks we had with our mothers.

unha das conversas máis importantes que tivemos coas nosas nais.

So back to the concept of pregnancy as a stress test for life

Volvamos ao concepto do embarazo como unha proba de estrés de por vida

and how stressed placental cells

e de como as células placentarias estresadas

can impact on a mother’s future cardiovascular health,

poden afectar a futura saúde cardiovascular da nai,

decades after she was pregnant and had preeclampsia.

décadas despois de quedar embarazada e ter preeclampsia.

Como sabemos que as mulleres que tiveron complicacións no embarazo

How do we know that women after pregnancy complications

are at increased risk for future cardiovascular disease?

corren un maior risco de sufrir enfermidades cardiovasculares no futuro?

In Scandinavia, we have unique access to large population-based data sets

En Escandinavia temos acceso exclusivo a grandes conxuntos de datos da poboación

containing health information.

con información sobre a saúde.

For many decades,

Durante décadas,

these databases have provided important medical knowledge.

estas bases de datos proporcionaron importantes coñecementos médicos.

They tell us that women who have had preeclampsia

Dinnos que as mulleres que tiveron preeclampsia

towards the end of pregnancy

a finais do embarazo

have a doubled risk for future cardiovascular disease,

teñen o dobre de risco de padecer enfermidades cardiovasculares

compared to women who have had uncomplicated pregnancies.

en comparación coas mulleres que tiveron embarazos sen complicacións.

I mentioned the meal box function of the placenta.

Mencionei a función da placenta como fonte de alimentación.

I explained the effect of stressed placental cells

Expliquei o efecto das células placentarias estresadas

and how they send signals to the mother.

e como envían sinais á nai.

If the placenta gets even more stressed,

Se a placenta se estresa aínda máis,

the meal box function may be affected.

a función de alimentación pode verse afectada.

That means the baby has a lower weight than it should have,

Iso significa que o bebé terá un peso inferior ao que debería

in addition to the woman developing preeclampsia.

e, ademais, a muller contraerá preeclampsia.

Some babies may even, for various reasons,

Incluso algúns bebés, por diversas razóns,

be born too early, prematurely.

poden nacer antes de tempo, de forma prematura.

For these women

No caso das mulleres

with a very, very stressed placenta,

cunha placenta moi moi estresada,

the databases tell us

as bases de datos dinnos

that the future cardiovascular disease risk is even higher,

que o risco de ter no futuro enfermidades cardiovasculares é maior,

up to four to eightfold higher compared to women with uncomplicated pregnancies.

de catro a oito veces maior en comparación con quen tivo embarazos sen complicacións.

So to sum up what we have talked about so far,

Para resumir o que dixemos ata agora,

hai bases de datos con información sobre as complicacións do embarazo

we have databases that give us information on pregnancy complications

and future cardiovascular health risks.

e os futuros riscos das enfermidades cardiovasculares.

We know that the baby and the placenta and the mother

Sabemos que o bebé, a placenta e a nai

send messages to each other, talk to each other during pregnancy,

se envían mensaxes e se comunican durante o embarazo,

but we do not know the exact mechanisms

pero non coñecemos os mecanismos concretos

by which complicated pregnancy and the placenta

polos que un embarazo con complicacións e a placenta

contribute to future health risks for women.

contribúen aos futuros riscos da saúde das mulleres.

And this is my point.

E aí é onde quero chegar.

Much research remains to be done,

Queda moito por investigar,

and the placenta is still full of secrets that need to be unveiled.

e a placenta aínda está chea de segredos que hai que descubrir.

Pero por que debería importarnos?

But why should we bother anyhow?

And how can we identify women at increased risk?

E como podemos identificar as mulleres con maior risco?

And what should we do then?

E que deberiamos facer?

As I said in the beginning.

Como dixen ao comezo:

Why? Because cardiovascular diseases

por que? Porque as enfermidades cardiovasculares

are a main cause for early death also in women.

son a principal cause de morte prematura tamén en mulleres.

Heart attacks are known to present differently in women

Os ataques cardíacos preséntanse de maneira distinta nas mulleres

compared to men,

ca nos homes,

and may be recognized too late,

e poden detectarse demasiado tarde

and that might prove fatal.

e resultar mortais.

This is also another good reason

Esta é outra boa razón

for identifying women at increased risk earlier, at a younger age.

para identificar as mulleres con maior risco a unha idade temperá.

This is because the earlier the risk factors are dealt with,

Isto débese a que, canto antes se traten os factores de risco,

the better the effect on the blood vessels and the heart.

mellor efecto terá sobre os vasos sanguíneos e o corazón.

How can we identify women at increased risk?

Como identificamos as mulleres con maior risco?

By asking the right questions about pregnancy at the right time,

Facendo as preguntas axeitadas sobre o embarazo no momento axeitado,

and whatever the exact cause and the precise mechanism

e sexa cal sexa a causa exacta e o mecanismo concreto

for the association between pregnancy complications

para asociar as complicacións do embarazo

and cardiovascular disease prove to be,

e as enfermidades cardiovasculares,

our mothers', sisters', aunts' pregnancy history

o historial de embarazo das nosas nais, irmás e tías

pode proporcionar información importante para as necesidades de saúde futuras.

may provide important information for future health needs.

And what should we do then?

E logo que facemos?

We could take action at the right time.

Podemos tomar medidas no momento axeitado.

Ás mulleres pódenlles facer un exame médico xeral a idades temperás,

Women could be offered general health screening at a younger age,

including checkups of blood pressure, body weight and blood sugar.

incluídos controis de presión arterial, peso corporal e azucre en sangue.

We could give personalized advice on lifestyle

Poderiamos dar consellos personalizados sobre o estilo de vida

and try to influence other risk factors,

e intentar influír noutros factores de risco,

such as weight gain, obesity,

como o aumento de peso, a obesidade,

smoking or type 2 diabetes.

fumar ou a diabetes de tipo 2.

This could be done even before women enter their 50s.

Isto podería facerse antes de que as mulleres fagan 50 anos.

Is this new medical knowledge?

É un coñecemento médico novo?

The answer is no.

A resposta é “non”.

Has this knowledge been acted upon?

Púxose en práctica este coñecemento?

Not really.

A verdade é que non.

Placenta-related pregnancy complications

A Asociación Estadounidense do Corazón

have officially been acknowledged

admitiu oficialmente hai 11 anos

as sex-specific risk factors for cardiovascular disease

que as complicacións no embarazo relacionadas coa placenta

by the American Heart Association

son factores de risco específicos do xénero de enfermidades cardiovasculares

11 years ago,

and other cardiological societies have followed their lead.

e outras sociedades cardiolóxicas seguiron o seu exemplo.

Many guidelines suggest or call for follow-up

Moitas pautas suxiren ou esixen un seguimento

after pregnancy complications.

tras un embarazo con complicacións.

But we are not aware of any country in the world

Con todo, non coñecemos ningún país no mundo

having a systematic cardiovascular follow-up

que teña un seguimento cardiovascular sistemático

for women after pregnancy complications

para mulleres que tiveron embarazos con complicacións

already at a younger age.

a unha idade máis nova.

We think such follow-up is of extreme importance

Cremos que este seguimento é de suma importancia

for equality in health care and society's survival,

para a igualdade na atención médica e a supervivencia da sociedade,

since women are important for society's survival.

xa que as mulleres son importantes para a supervivencia da sociedade.

We think that it should be possible to integrate

Pensamos que debería ser posible que os médicos de cabeceira

a simple cardiovascular risk factor assessment --

puidesen incorporar avaliacións sinxelas dos factores de risco cardiovasculares,

measure blood pressure, body weight and blood sugar --

medición da presión arterial, o peso corporal e o azucre en sangue,

at the general practitioners

into existing screening programs for cervical dysplasia

nos programas de detección da displasia cervical existentes

or other comparable available screening programs around the world.

ou outros programas de detección similares dispoñibles en todo o mundo.

Tomorrow, when you stand in the shower and look at your belly button,

Mañá, cando esteades na ducha e miredes o embigo,

remember the placenta.

lembrádevos da placenta.

Remember the one simple question

Lembrade a sinxela pregunta

that could improve a mother's health.

que pode mellorar a saúde materna,

The one simple question that could improve cardiovascular health.

a sinxela pregunta que podería mellorar a saúde cardiovascular:

Have you had any pregnancy complications?

tiveches algunha complicación durante o embarazo?

(Applause)

(Aplausos)