Into the Unknown

Yalda Afshar illustration

Among the many questions raised by the pandemic has been how COVID-19 affects pregnant women. To learn more, Dr. Yalda Afshar and colleagues at UC San Francisco studied nearly 600 COVID-19-positive pregnant women, and they found that the effects can be prolonged. “Despite the potential risks of COVID-19 for pregnant people and their newborns, there are large gaps in our knowledge on the course of the disease and the overall prognosis,” Dr. Afshar says. “Our results can help pregnant women and their clinicians better understand what to expect with COVID-19 infection.” Dr. Afshar steps into the U Magazine spotlight.

When did you start to think about science?

Wherever we lived while I was growing up, I spent a lot of time outside, and I always imagined myself being Jane Goodall meets Indiana Jones — a visionary explorer driven by the thirst for discovery. Really, that’s how I pictured it. And that was inspired by spending a lot of my childhood outdoors. Regardless of where we lived, the outdoors was the common theme. I loved that sense of freedom in the outdoors, to explore and ask questions, and I think that is what drove me to science

What was your first experiment?

I’m a little embarrassed to share this, but I had heard that people eat insects, and I wanted to see if they were edible. We had a lot of roly-poly bugs around our home, so I had my younger brother eat roly-poly bugs to assess if they were edible. I have since apologized to him for this, and I’m very thankful today for IRBs and ethical research protocols.

What sparked the idea for your current research into pregnancy and COVID-19?

The lack of research up to this point and the negative impact that lack of research was having on the patients I was seeing. It was quite an organic inspiration, because we didn’t know what to tell our patients about COVID-19. When you are in a data-free zone as a physician or as a scientist, that’s when it’s just a call to arms to get some questions answered.

What has been the greatest challenge in that work?

What has been the greatest challenge also has been the greatest inspiration: There’s no data. We are dealing with a new disease, and there has been no expert in COVID-19 and pregnancy. Generally, the kind of registry study that we undertook is something that is thought out over months, and funding to support it is established. But we just pushed forward without that infrastructure. Normally, you don’t dive into just answering the question immediately, but in this case, for a public health emergency, that’s what had to be done. We were collecting data within moments of seeing our first patient who had tested positive for COVID-19. We didn’t know what were the data points that we needed or the exact questions that we needed to answer. So, I think that the greatest challenge was also the greatest inspiration — that lack of knowledge. I felt like we were flying a plane while we were building the plane. There was no stability, and it was 24/7.

Who has been your greatest collaborator in the work that you’ve currently been doing?

I’d say both Dr. Deborah Krakow, my chair and mentor, as well as Dr. Stephanie Gaw, my colleague from UC San Francisco and a dear friend. The quality of a great collaborator is that you come to it with only one intention, to answer questions. It is not about who will be first author, who’s going to write up the work first and get it published. It’s working together toward the same goal, sharing information, sharing data, communicating well and being honest. That is what makes a great collaborator.

Where are you happiest?

Being around family and loved ones and feeling free — free to think, free to ask questions, free to share opinions without judgment. And being outside, and if we can get an ocean or a mountain view, that’s great, too.

Where does your inspiration come from?

Being raised in an environment and a safe space that allowed me to be vulnerable, to ask questions, to doubt myself, to experiment having that freedom was inspiring. And, on a daily basis, patients inspire me. Whenever I am with a patient and they ask me a question about something that I can’t counsel them on with the best available data, that’s inspiring. That makes me want to push forward and to be innovative.

What are the qualities of a great scientist or physician?

It’s really simple: You have to care, be kind, be collegial and really persistent. Sure, we need to be smart and organized and resourceful, but science is a team sport, one that is filled with failure and disappointments. If you’re not persistent and move towards your goal, which is getting the best available data to answer clinically relevant questions, it doesn’t mean anything. It’s persistence topped off with passion and zeal.

What has been your biggest “aha!” moment?

I don’t think I have had a single “aha!” moment. I think my “aha!” moments come in my visceral reaction to discovery. The cool thing about the scientific method is that you have a hypothesis and then you continuously try to prove yourself wrong. That’s the backbone of the scientific method. And so small discoveries are “aha!” moments that eventually culminate in something larger.

What characteristic makes you particularly well suited for the work that you do?

I love collaborating and being with people who are smarter than me in different ways and are coming together for a common cause. Being able to work with other people, being able to be proven wrong and let that inspire you to be flexible, to change your hypothesis, is exciting. Being collaborative and collegial are probably the characteristics that make me well-suited for this.

If not a scientist, what would you be?

An archeologist, that Jane Goodall-meets-Indiana Jones idea. I’d be, maybe, a seasonal archeologist; in the off-season, I’d have a coffee shop with a co-op flower shop on the side.

What is your most treasured possession?

Maybe I’m going to go philosophical on this one and say it is community.

What keeps you up at night?

I have an eight-week-old, and I’m an obstetrician. I don’t sleep at night

What is your greatest satisfaction?

It’s definitely the success of my mentees and those that I have the absolute privilege to train in any way.

What’s your greatest disappointment?

There are so many personal ones, professional ones. Things don’t go as planned really, really often. The experiment I was doing today was a disappointment. You can’t take it personally. It is how you use your disappointments to push forward that matters

What’s the best moment in your day?

Waking up with the morning and getting to snuggle with my baby and have a cup of coffee and think about what the day ahead is going to hold for me and what awesome things I will get to do

What is your definition of happiness?

Safety, freedom of thought, freedom to love, freedom of opinion. That, and time, and having the ability to do what you want with your time

What is your definition of misery?

Suppression of thought, suppression of freedom.

What music do you listen to?

I like to have “Eclectic 24” from KCRW playing in the background. I don’t get to choose what I am going to hear, and I like to be surprised by an awesome song or something new. If I listen to Illustration: John Jay Cabuay my own music, I love folk.