PharmSci graduate’s research provides evidence to guide maternal health care

Shenthuraan Tharmarajah’s graduation last week from the Leslie Dan Faculty of Pharmacy was particularly meaningful for him and his parents watching from the audience, as it took place in the city where his younger brother was born with congenital abnormalities and passed away at just 10 years old. His family’s experience motivated him to pursue a career in health care and research.

“It was very fitting that life took me down this journey in maternal and prenatal health research and that I could come to Toronto to study and make an impact in a field that is so important to me,” says Tharmarajah, who recently completed a PhD in pharmaceutical sciences supervised by Associate Professor’s Mina Tadrous and Sara Guilcher. “It has been so meaningful and motivating to have the opportunity to complete this work, especially here in Toronto.”

“It has been so meaningful and motivating to have the opportunity to complete this work, especially here in Toronto.”

Prior to his graduate studies in Toronto, Tharmarajah studied psychology at New York University, human nutrition at Columbia University, and medicine at Albany Medical College, all in New York State where he grew up. He then began working for a biotechnology company at the beginning of the COVID-19 pandemic. After a few years in the industry, he wanted to gain additional research skills, particularly in studying the safety and effectiveness of medical devices and drugs at the population level. This interest brought him to Tadrous, whose research uses real-world evidence to examine a range of questions related to pharmacoepidemiology.

“I’ve always enjoyed number crunching, statistical modeling, and translating complex data into clear, concise, relevant insights. Being able to analyze different data sources from a variety of fields and synthesizing them into a coherent narrative really attracted me,” says Tharmarajah. “And the beautiful thing is that the methodology and skill set you cultivate can be applied to any topic or discipline.”

PhD research provides evidence to empower decision-making in pregnancy

Tharmarajah was most interested in applying these skills to maternal and prenatal health, based on his family’s experience caring for his brother born with disabilities. His specific PhD project used large-scale databases and real-world evidence to examine whether medications called disease-modifying antirheumatic drugs (DMARDs), which are used to treat rheumatic conditions such as rheumatoid arthritis and lupus, are associated with poor health outcomes for mothers and their babies.

People with rheumatic conditions who want to become pregnant need to balance the risks and benefits of taking medication while pregnant with the risks of uncontrolled disease during pregnancy if they don’t take their medications. And because clinical trials often exclude pregnant people, there is little information to help guide these decisions.

“This is a space that deserves to be explored because these conditions affect so many individuals, and individuals with those conditions may even be apprehensive about even pursuing pregnancies,” says Tharmarajah.

“This is a space that deserves to be explored because these conditions affect so many individuals, and individuals with those conditions may even be apprehensive about even pursuing pregnancies.”

This question had not been studied in the Ontario population before, and Tharmarajah’s research generated new population-level evidence.

“This type of work is incredibly important, as we lack information to help guide clinicians and patients to make some important health care decisions,” says Tadrous. “Shenthuraan’s research with real-world evidence helps to fill a critical gap.”

Tharmarajah identified that from 2006 to 2021, use of antirheumatic therapy – particularly more targeted biologic therapies – in Ontario has risen significantly. Importantly, he also found that exposure to antirheumatic therapy before and during pregnancy was not associated with any adverse outcomes for mothers and babies, suggesting that continuing therapy and controlling the condition during pregnancy is the safest option.

“These results clearly support and strengthen existing clinical guidelines. It shows that keeping maternal disease under control can be done responsibly with drugs that are compatible with pregnancy,” says Tharmarajah. “By having proactive dialogue with the rheumatologist and OB/GYN, people with rheumatic conditions can navigate pregnancy with conviction, rather than fear and doubt. We hope that our research provides evidence to empower patients in their reproductive health choices.”

PhD program provided valuable skills for future success

As part of the PhD program, Tharmarajah was able to attend local and international conferences, which enabled him to network with other researchers, clinicians, patients, and government officials. He was also involved in student activities, including serving as co-president of the Pharmaceutical Sciences Graduate Student Association (PSGSA) and president of the U of T student chapter of the International Society for Pharmacoepidemiology.

Since completing his PhD program, Tharmarajah has returned to New York and is exploring opportunities in pharma industry and biotechnology. He is confident that his education at the Leslie Dan Faculty of Pharmacy has given him the knowledge and skills to prepare him for his career – from designing research studies and managing multiple projects to building networks and collaborating with colleagues across different fields.

“These are all important professional and life skills that I’ve developed as part of my graduate studies, and I’m looking forward to translating them in a fast-paced environment,” says Tharmarajah.

“The staff and faculty have always been very supportive of the students, and they really care about student success and building relationships in and out of the labs. That support, and the opportunities to build networks and lead impactful research, have been the highlights of my time at the Faculty.”