Current research
All Publications
Placenta Accreta Spectrum
The Afshar Lab focuses on normal and abnormal placentation in pregnancy. We’re interested in the placenta as a transient support organ in fetal development, in cardiac development, as well as abnormal placentation, specifically placenta accreta spectrum (PAS) disorders, a high-risk obstetrical complication associated with significant maternal morbidity. We utilize our lab’s UCLA Perinatal Biorepository as well as the UCLA Pathology Laboratory to understand clinical and histological features that define PAS as well as focusing on improving current diagnostic techniques. The goal of our work in PAS is to ultimately lead to improvements in both maternal and neonatal health. Understanding the etiology of PAS has translation implications for a high-risk patient population that we have identified.
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Maternal cardiovascular
disease and pregnancy
Congenital heart defects (CHDs) are the most common cause of congenital anomaly, occurring in ~1% of newborns. The etiology(ies) of CHD remain elusive making intervention purely mechanical. To understand and target the mechanisms underlying the vascular phenotype, we aim to integrate data through the life course -- the prenatal and postnatal sequalae. We couple prenatal maternal-fetal imaging, underlying genetic predispositions, and developmental endothelial flow dynamics. Ultimately, this may improve treatment that arisesfrom loss of vascular integrity. Despite being born with a morbid CHD, we have a chance to understand downstream complications and interventions that can improve quality of life in these patients with lifelong sequelae related to an abnormal endothelial cell and vascular phenotype.
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Afshar Y, Ma F, Quach A, Jeong A, Sunshine HL, Freitas V, Jami-Alahmadi Y, Helaers R, Li X, Pellegrini M, Wohlschlegel JA, Romanoski CE, Vikkula M, Iruela-Arispe ML. Transcriptional drifts associated with environmental changes in endothelial cells. Elife. 2023 Mar 27;12:e81370. PMID: 36971339; PMCID: PMC10168696.
Desmond A, Imany-Shakibai H, Wong D, Kwan L, Satou G, Sklansky M, Afshar Y. Prenatal Congenital Heart Disease and Placental Phenotypes: Preserved Neonatal Weight Despite Small Placentas. JACC Adv. 2023 Jun 30;2(4):100383. doi: 10.1016/j.jacadv.2023.100383. PMID: 38938228; PMCID: PMC11198356.
Afshar Y, Hogan WJ, Conturie C, Sunderji S, Duffy JY, Peyvandi S, Boe NM, Melber D, Fajardo VM, Tandel MD, Holliman K, Kwan L, Satou G, Moon-Grady AJ. Multi-Institutional Practice-Patterns in Fetal Congenital Heart Disease Following Implementation of a Standardized Clinical Assessment and Management Plan. J Am Heart Assoc. 2021 Aug 3;10(15):e021598. Epub 2021 Jul 28. PMID: 34315235; PMCID: PMC8475692.
Desmond A, Nguyen KL, Watterson CT, Sklansky M, Satou GM, Prosper AE, Garg M, Van Arsdell GS, Finn JP, Afshar Y. Integration of Prenatal Cardiovascular Magnetic Resonance Imaging in Congenital Heart Disease. J Am Heart Assoc. 2023 Nov 21;12(22):e030640. doi: 10.1161/JAHA.123.030640. Epub 2023 Nov 20. PMID: 37982254; PMCID: PMC10727279.
Imany-Shakibai H, Yin O, Russell MR, Sklansky M, Satou G, Afshar Y. Discordant congenital heart defects in monochorionic twins: Risk factors and proposed pathophysiology. PLoS One. 2021 May 6;16(5):e0251160. PMID: 33956871. PMCID: PMC8101911
Fetal cardiovascular
disease and pregnancy
Significant advancements in medical care have allowed pregnant people with cardiovascular disease, specifically congenital heart disease (CHD), to survive to childbearing age, resulting in an increased prevalence of cardiovascular disease in pregnancy. Although pregnancy and its associated hemodynamic changes may be well tolerated in some, pregnancy may increase the risk of volume overload, development of arrhythmias, and progressive cardiac dysfunction in others. The presence of maternal CHD is also a major determinant for neonatal morbidity. Overall, pregnancies complicated by maternal CHD are at an increased risk for adverse maternal and neonatal outcomes compared to the general obstetric population. Our translational team focuses on optimizing both delivery coordination and planning for this high-risk population as well as understanding molecular mechanisms that underlie normal and abnormal physiological changes of the cardiovascular system in pregnancy.
Mok T, Woods A, Small A, Canobbio MM, Tandel MD, Kwan L, Lluri G, Reardon L, Aboulhosn J, Lin J, Afshar Y. Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term. J Am Heart Assoc. 2022 Aug 16;11(16):e025791. Epub 2022 Aug 9. PMID: 35943056; PMCID: PMC9496287.
Williamson CG, Altendahl M, Martinez G, Ng A, Lin JP, Benharash P, Afshar Y. Cardiovascular Disease in Pregnancy: Clinical Outcomes and Cost-Associated Burdens From a National Cohort at Delivery. JACC Adv. 2024 Jul 2;3(8):101071. doi: 10.1016/j.jacadv.2024.101071. PMID: 39050813; PMCID: PMC11268102.
Ng AP, Verma A, Sanaiha Y, Williamson CG, Afshar Y, Benharash P. Maternal and Fetal Outcomes in Pregnant Patients With Mechanical and Bioprosthetic Heart Valves. J Am Heart Assoc. 2023 May 16;12(10):e028653. Epub 2023 May 15. PMID: 37183876; PMCID: PMC10227312.
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Altendahl M, Mok T, Adimkpayah E, Goldstein J, Lin J, Afshar Y. Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk. Sci Rep. 2023 Jan 25;13(1):1439. PMID: 36697426; PMCID: PMC9876959.
Nobakht N, Afshar Y, Vaseghi M, Li Z, Donangelo I, Lavretsky H, Mok T, Han CS, Nicholas SB. Hypertension Management in Women With a Multidisciplinary Approach. Mayo Clin Proc. 2024 Dec 29:S0025-6196(24)00520-2. doi: 10.1016/j.mayocp.2024.10.005. Epub ahead of print. PMID: 39736047.
Mei JY, Afshar Y Hypertensive complications of pregnancy: Hepatic consequences of preeclampsia through HELLP syndrome. Clin Liver Dis (Hoboken). 2023 Dec 8;22(6):195-199. doi: 10.1097/CLD.0000000000000088. PMID: 38143815; PMCID: PMC10745250.
The Fetal Allograft
Recipients of solid organ transplants who become pregnant represent an obstetrically high-risk population. Preconception planning and effective contraception tailored to the individual patient are critical in this group. Planned pregnancies improve both maternal and neonatal outcomes and provide a window of opportunity to mitigate risk and improve lifelong health. Optimal management of these pregnancies is not well defined. Common pregnancy complications after transplantation include hypertension, preterm birth, infection, and metabolic disease. Multidisciplinary preconception and prepartum management, and counseling decrease complications and benefit the maternal-neonatal dyad. We focus on understanding the fetal allograft in the setting of solid-organ transplantation and pregnancy.
Yin O, Kallapur A, Coscia L, Constantinescu S, Moritz M, Afshar Y. Differentiating Acute Rejection From Preeclampsia After Kidney Transplantation. Obstet Gynecol. 2021 Jun 1;137(6):1023-1031. PMID: 33957644; PMCID: PMC8141043.
Yin O, Kallapur A, Coscia L, Kwan L, Tandel M, Constantinescu SA, Moritz MJ, Afshar Y. Mode of Obstetric Delivery in Kidney and Liver Transplant Recipients and Associated Maternal, Neonatal, and Graft Morbidity During 5 Decades of Clinical Practice. JAMA Netw Open. 2021 Oct 1;4(10):e2127378. PMID: 34605918. PMCID: PMC8491100
Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73(1):318-365. Epub 2021 Jan 3. PMID: 32946672.
Yin O, Coscia L, Constantinescu S, Moritz MJ, Afshar Y, Irani RA. Pregnancy after deceased donor vs living donor kidney transplant: associated obstetric and graft outcomes. Am J Obstet Gynecol. 2023 Aug 16:S0002-9378(23)00543-4. Epub ahead of print. PMID: 37595824.
Walia A, Yin O, Coscia L, Afshar Y, Irani R, Constantinescu S, Moritz M, Sarkar M. Clinical outcomes in patients with unintended pregnancy after liver transplantation: A multicenter registry cohort study. Liver Transpl. 2024 Oct 28. doi: 10.1097/LVT.0000000000000524. Epub ahead of print. PMID: 39451110.
Pithia N, Yin O, Coscia LA, Constantinescu S, Moritz MJ, Afshar Y. Differences in neonatal sepsis among immunosuppression regimens in pregnancies of transplant recipients. Am J Obstet Gynecol MFM. 2024 Nov;6(11):101482. doi: 10.1016/j.ajogmf.2024.101482. Epub 2024 Sep 10. PMID: 39260770.