UNT researcher expanding knowledge of women’s maternal health

UNT researcher expanding knowledge of women’s maternal health

UNT Diving Eagle
April 3, 2024
Photo of UNT professor Julia Heck
Julia Heck, associate dean for research in the UNT College of Health and Public Service. (Photo by Pete Comparoni / UNT)


At UNT, research is expanding understanding of significant health matters and encouraging individuals to take charge of their wellbeing.

Julia Heck, associate dean for research in the College of Health and Public Service, studies critical realms of women's health. She earned a doctorate in epidemiology from Columbia University and completed a postdoctoral fellowship at the International Agency for Research on Cancer, an agency of the World Health Organization.

Some of her recent research projects include investigating the impacts of per- and polyfluoroalkyl substances (PFAS) exposure on eye cancer risk in children and exploring the correlation between Alpha-1 Antitrypsin Deficiency (AATD) and pregnancy complications. Heck’s research sheds light on the effects of environmental toxins and genetic conditions on maternal and child health, advocating for heightened awareness and proactive measures to safeguard women's wellbeing during pregnancy and beyond.

‘Forever chemicals’ and the risk for retinoblastoma

One of those environmental toxin groups included in her research are PFAS. PFAS are chemicals that resist grease, oil, water and heat. They were first used in the 1940s and are now in hundreds of products. The gradual buildup of PFAS in the body can lead to multiple health issues, including immune system disruption, cancer risks and thyroid hormone interference.

“PFAS are in a lot of things around us, and they’re of concern because they’re known as ‘forever chemicals,’” Heck says. “They take a long time to break down in the environment and accumulate in our bodies over time. Common sources of exposure include fast food wrappers, frying pans and drinking water. To limit PFAS exposure, you can avoid certain products, choose PFAS-free alternatives, use water filtration and dispose of items responsibly.”

Heck and her external research collaborators — Yixin Chen, Kimberly Paul, Douglas Walker, Dean Jones, Xuexia Wang, and Beate Ritz — studied medical data from 501 children with retinoblastoma and 899 children without retinoblastoma born from 1983 to 2011 to 755 U.S.-born and 366 Mexico-born mothers in California.

Perfluorooctanesulfonic acid (PFOS), perflurooctanoic acid (PFOA) and perfluorononanoic acid (PFNA) were identified from neonatal blood samples collected through the California newborn Genetic Disease Screening Program. Using logistic regression, the team assessed whether an increase of PFAS levels or having above-average levels of PFAS in blood affects retinoblastoma risk overall.

Among all children, above-average PFOS levels at birth increased the odds of retinoblastoma overall by 29% and unilateral retinoblastoma, cancer of only one eye, by 42%. For children of Mexico-born mothers, the team estimated the highest odds of retinoblastoma overall and bilateral retinoblastoma, cancer of both eyes, with above-average PFOS levels. Among children of U.S.-born mothers, higher PFOS levels increased the odds of unilateral retinoblastoma by 15% and by 71% among children with above-average PFOS levels. In addition, for children of U.S.-born mothers, PFOA increased the odds of retinoblastoma overall.

“These results suggest that PFOS and PFOA might contribute to retinoblastoma risk in children born in California,” Heck says.

Alpha-1 Antitrypsin Deficiency and pregnancy complications

Heck’s other research on genetic conditions focuses on what impact AATD and Alpha-1 Antitrypsin deficiencies in pregnancy can have on birth outcomes. AATD is a condition caused by not having enough of a protein called alpha-1 antitrypsin. This protein normally helps keep the lungs healthy by protecting them from damage caused by certain enzymes released by white blood cells. Without enough of this protein, conditions may develop such as chronic obstructive pulmonary disease and emphysema. Additionally, AATD can affect the liver, causing liver disease in some individuals.

“AATD is linked to lung and liver diseases, but its impact on pregnancy and birth outcomes lacks large-scale studies,” Heck says. “Symptoms like wheezing often lead to misdiagnosis as asthma, emphasizing the need for early detection.”

Heck investigated the risk of pregnancy complications and adverse birth outcomes in mothers and children with AATD. Using a cohort of 305 Danish mothers and 254 children with AATD from 1973 to 2013, the team conducted a Poisson regression data analysis model to examine associations between alpha-1 antitrypsin deficiency, adverse birth outcomes and pregnancy complications in the mothers and children.

Heck’s research, supported by a grant from the Alpha-1 Foundation, indicates that pregnancy in women with AATD contributes to low birth weight of their babies, cesarean-section delivery, preterm birth and preeclampsia. These findings underscore the importance of close monitoring during pregnancy for women with AATD, suggesting routine screening for better management, despite its inherited nature. Routine screening for alpha-1 antitrypsin in pregnancy may be considered among mothers with a pulmonary and liver disease history.

“It was in the process of studying childhood cancer that the importance of healthy pregnancies became apparent,” Heck says. “Challenges in my own pregnancies also were a motivator to study birth outcomes.”