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Mary Anne Armstrong, MA

Mary Anne Armstrong, MA, is a biostatistician and research scientist at the Kaiser Permanente Northern California Division of Research, as well as managing director of special projects. Ms. Armstrong earned her master’s degree in statistics from the University of California, Berkeley. She has been with the Division of Research since 1980, where she has worked in a wide variety of research areas, including alcohol and health, perinatal substance abuse, and neonatology.

Ms. Armstrong is the chair of the Division of Research Local Research Committee, a member of the Northern California Central Research Committee. She is director of the Division of Research Biostatistical Consulting Unit, and provides statistical consultation to members of The Permanente Medical Group in Northern California. Ms. Armstrong has authored or co-authored more than 85 peer-reviewed scientific publications on a wide-variety of topics, including the relation of alcohol use to blood pressure, coronary disease, and stroke; utilization of health services before and after alcohol abuse treatment; neonatal assisted ventilation; and women’s health.

Current Positions

  • Biostatistician and Managing Director of Special Projects, Kaiser Permanente Division of Research
  • Director, Division of Research Biostatistical Consulting Unit
  • Vice Chair, KPNC Central Research Committee
  • Local Research Chair, Kaiser Permanente Division of Research

Section Affiliations

Primary Research Interests

  • Biostatistics
  • Substance abuse and pregnancy
  • Fetal Alcohol Syndrome
  • Women’s health
  • Perinatal health services research


Understanding the risk of ectopic pregnancies among people seeking abortion: a retrospective case control study

This study aims to assess the incidence of ectopic pregnancy among people wanting pregnancy compared to people seeking abortion. The specific research questions are: Are people seeking abortion at lower risk of experiencing an ectopic pregnancy compared to people not seeking abortion? What are the unique risk factors for experiencing an ectopic pregnancy among people seeking abortion? How do people seeking abortion who are eventually diagnosed with ectopic pregnancies initially present for care? We will conduct a case-control study using a retrospective review of electronic health records of approximately 2,200 randomly chosen cases of ectopic pregnancies and a comparison group of 1,100 randomly chosen intrauterine pregnancies.

Investigator: Armstrong, Mary Anne

Funder: Fidelity Charitable

Study on the Association of Uterine Perforation and IUD expulsion With Breastfeeding Status at the Time of IUD insertion and Postpartum Timing of IUD Insertion in Electronic Medical Record Databases – A Post-marketing Requirement for Mirena

The Food and Drug Administration (FDA) has required Bayer AG to conduct a post-marketing study in the U.S. to determine the incidence of uterine perforation and IUD expulsion by type of intrauterine device (IUD) used. The goal of this study is to quantify the risk of uterine perforation and IUD expulsion by: (1) breastfeeding status at the time of IUD insertion, (2) time periods postpartum when the IUD was inserted (e.g., 6 weeks or less, after 6 weeks and up to 14 weeks, more than 14 weeks and up to 52 weeks, or more than 52 weeks), and (3) type of IUD.

Investigator: Armstrong, Mary Anne

Funder: Bayer AG

Risk of Uterine Perforation among Women Using different types of IUDs and the Association with Timing of Insertion and Breastfeeding

The goal of the study is to compare the incidence of uterine perforation within 12 months after IUD insertion between: (1) postpartum insertions within 12 months of delivery (with breastfeeding status), (2) post abortion or pregnancy loss IUD insertions and (3) interval IUD insertions not associated with a pregnancy, and to determine if IUD insertion immediately postpartum and/or breastfeeding are associated with an increased risk of perforation.

Investigator: Armstrong, Mary Anne

Funder: Bayer AG


Association of Pregnancy Intentions With Substance Use During Early Pregnancy

Authors: Young-Wolff, Kelly C; Slama, Natalie; Sarovar, Varada; Conway, Amy; Tucker, Lue-Yen; Goler, Nancy; Terplan, Mishka; Ansley, Deborah; Adams, Sara R; Armstrong, Mary Anne

J Addict Med. 2022 Jan-Feb 01;16(1):118-121.

PubMed abstract

Ectopic Pregnancy Prevention: Further Evidence of Benefits of Prescription Contraceptives

Authors: Raine-Bennett, Tina; Alexeeff, Stacey; Getahun, Darios; et al.

Contraception. 2022 01;105:19-25. Epub 2021-09-20.

PubMed abstract

Design of the Association of Uterine Perforation and Expulsion of IUD (APEX-IUD) Study: A Multisite Retrospective Cohort Study

Authors: Anthony, Mary S; Getahun, Darios; Asiimwe, Alex; et al.

Am J Obstet Gynecol. 2021 06;224(6):599.e1-599.e18. Epub 2021-01-15.

PubMed abstract

Development of a longitudinal two-biomarker algorithm for early detection of ovarian cancer in women with BRCA mutations

Authors: Lentz, Scott E; Powell, C Bethan; Kushi, Lawrence H; Skates, Steven J; et al.

Gynecol Oncol. 2020 12;159(3):804-810. Epub 2020-10-01.

PubMed abstract

Identifying Ectopic Pregnancy in a Large Integrated Health Care Delivery System: Algorithm Validation

Authors: Getahun, Darios; Alexeeff, Stacey; Raine-Bennett, Tina; et al.

JMIR Med Inform. 2020 Nov 30;8(11):e18559. Epub 2020-11-30.

PubMed abstract

Trends and correlates of self-reported alcohol and nicotine use among women before and during pregnancy, 2009-2017

Authors: Young-Wolff, Kelly C; Sarovar, Varada; Alexeeff, Stacey E; Adams, Sara R; Tucker, Lue-Yen; Conway, Amy; Ansley, Deborah; Goler, Nancy; Armstrong, Mary Anne; Weisner, Constance

Drug Alcohol Depend. 2020 09 01;214:108168. Epub 2020-07-15.

PubMed abstract

Feasibility, patient compliance and acceptability of ovarian cancer surveillance using two serum biomarkers and Risk of Ovarian Cancer Algorithm compared to standard ultrasound and CA 125 among women with BRCA mutations

Authors: Haque R; Skates SJ; Armstrong MA; Lentz SE; Anderson M; Jiang W; Alvarado MM; Chillemi G; Shaw SF; Kushi LH; Powell CB

Gynecol Oncol. 2020 05;157(2):521-528. Epub 2020-03-04.

PubMed abstract

Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations

Authors: Powell CB; Alabaster A; Le A; Stoller N; Armstrong MA; Raine-Bennett T

Psychooncology. 2020 02;29(2):331-338. Epub 2019-11-22.

PubMed abstract

Bone loss in women with BRCA1 and BRCA2 mutations

Authors: Powell CB; Alabaster A; Stoller N; Armstrong MA; Salyer C; Hamilton I; Raine-Bennett T

Gynecol Oncol. 2018 03;148(3):535-539.

PubMed abstract

Diagnosis of sessile serrated adenoma after educational training in a large, community-based, integrated healthcare setting

Authors: Li D; Corley DA; Levin TR; et al.

Gastrointest Endosc. 2018 Mar;87(3):755-765.e1. Epub 2017-08-24.

PubMed abstract

Trends in Self-reported and Biochemically Tested Marijuana Use Among Pregnant Females in California From 2009-2016

Authors: Young-Wolff KC; Tucker LY; Alexeeff S; Armstrong MA; Conway A; Weisner C; Goler N

JAMA. 2017 12 26;318(24):2490-2491.

PubMed abstract

Rates and Predictors of Vaccinations Among Inflammatory Bowel Disease Patients Receiving Anti-Tumor Necrosis Factor Agents

Authors: Pham HV; Hasan I; Udaltsova N; Pham K; Abramson O; Armstrong MA; Postlethwaite D; Li D

Dig Dis Sci. 2017 Aug 23.

PubMed abstract

Are Health Plan Design and Prior Use of Long-Acting Reversible Contraception Associated with Pregnancy Intention?

Authors: Armstrong MA; Postlethwaite DA; Darbinian JA; McCoy M; Law A

J Womens Health (Larchmt). 2017 May;26(5):450-460. Epub 2016-10-18.

PubMed abstract

Risk of cancer in Asian Americans: a Kaiser Permanente cohort study

Authors: Tran HN; Li Y; Udaltsova N; Armstrong MA; Friedman GD; Klatsky AL

Cancer Causes Control. 2016 Oct;27(10):1197-207. Epub 2016-08-25.

PubMed abstract

Experience With Opportunistic Salpingectomy in a Large, Community-Based Health System in the United States

Authors: Garcia C; Martin M; Tucker LY; Lyon L; Armstrong MA; McBride-Allen S; Littell RD; Alabaster A; Raine-Bennett T; Powell CB

Obstet Gynecol. 2016 Aug;128(2):277-83.

PubMed abstract

Alcohol Intake, Beverage Choice, and Cancer: A Cohort Study in a Large Kaiser Permanente Population

Authors: Klatsky AL; Li Y; Nicole Tran H; Baer D; Udaltsova N; Armstrong MA; Friedman GD

Perm J. 2015 Spring;19(2):28-34. Epub 2015-03-01.

PubMed abstract

Prevalence and Neonatal Factors Associated with Autism Spectrum Disorders in Preterm Infants

Authors: Kuzniewicz MW; Wi S; Qian Y; Walsh EM; Armstrong MA; Croen LA

J Pediatr. 2014 Jan;164(1):20-5. Epub 2013-10-22.

PubMed abstract

Risk of Coronary Disease in South Asian Americans

Authors: Hajra A; Li Y; Siu S; Udaltsova N; Armstrong MA; Friedman GD; Klatsky AL

J Am Coll Cardiol. 2013 Aug 13;62(7):644-5. Epub 2013 Jun 13.

PubMed abstract

The value of additional pathology comments indicating suspicion of adenocarcinoma among women diagnosed preoperatively with complex atypical endometrial hyperplasia

Authors: Suh-Burgmann E; Hung YY; Armstrong MA

Int J Gynecol Pathol. 2012 May;31(3):222-6.

PubMed abstract

Postacute care and ischemic stroke mortality: findings from an integrated health care system in northern california

Authors: Wang H; Sandel ME; Terdiman J; Armstrong MA; Klatsky A; Camicia M; Sidney S

PM R. 2011 Aug;3(8):686-94.

PubMed abstract

Coffee, caffeine, and risk of hospitalization for arrhythmias

Authors: Klatsky AL; Hasan AS; Armstrong MA; Udaltsova N; Morton C

Perm J. 2011 Summer;15(3):19-25.

PubMed abstract

Alcohol consumption and risk of hematologic malignancies

Authors: Klatsky AL; Li Y; Baer D; Armstrong MA; Udaltsova N; Friedman GD

Ann Epidemiol. 2009 Oct;19(10):746-53. Epub 2009 Apr 25.

PubMed abstract

Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage

Authors: Suh-Burgmann E; Hung YY; Armstrong MA

Obstet Gynecol. 2009 Sep;114(3):523-9.

PubMed abstract

Using drink size to talk about drinking during pregnancy: a randomized clinical trial of Early Start Plus

Authors: Armstrong MA; Kaskutas LA; Witbrodt J; Taillac CJ; Hung YY; Osejo VM; Escobar GJ

Soc Work Health Care. 2009 Jan;48(1):90-103.

PubMed abstract

Documentation of contraception and pregnancy when prescribing potentially teratogenic medications for reproductive-age women

Authors: Schwarz EB; Postlethwaite DA; Hung YY; Armstrong MA

Ann Intern Med. 2007 Sep 18;147(6):370-6.

PubMed abstract

Using drink size to talk about drinking during pregnancy: Early start plus

Authors: Witbrodt J; Armstrong MA; Diehl S; Kaskutas LA; Taillac C; Osejo VM; Escobar GJ

J Addict Nurs. 2007;18(4):199-206.

Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit

Authors: Escobar GJ; McCormick MC; Zupancic JA; Coleman-Phox K; Armstrong MA; Greene JD; Eichenwald EC; Richardson DK

Arch Dis Child Fetal Neonatal Ed. 2006 Jul;91(4):F238-44. Epub 2006 Apr 12.

PubMed abstract

Rehospitalisation after birth hospitalisation: patterns among infants of all gestations

Authors: Escobar GJ; Greene JD; Hulac P; Kincannon E; Bischoff K; Gardner MN; Armstrong MA; France EK

Arch Dis Child. 2005 Feb;90(2):125-31.

PubMed abstract

Risk of hemorrhagic stroke in Asian American ethnic groups

Authors: Klatsky AL; Friedman GD; Sidney S; Kipp H; Kubo A; Armstrong MA

Neuroepidemiology. 2005;25(1):26-31. Epub 2005 Apr 25.

PubMed abstract

Wine, liquor, beer, and mortality

Authors: Klatsky AL; Friedman GD; Armstrong MA; Kipp H

Am J Epidemiol. 2003 Sep 15;158(6):585-95.

PubMed abstract

The early repolarization normal variant electrocardiogram: correlates and consequences

Authors: Klatsky AL; Oehm R; Cooper RA; Udaltsova N; Armstrong MA

Am J Med. 2003 Aug 15;115(3):171-7.

PubMed abstract

Traits of persons who drink decaffeinated coffee

Authors: Kubo Shlonsky A; Klatsky AL; Armstrong MA

Ann Epidemiol. 2003 Apr;13(4):273-9.

PubMed abstract

The effect of coronary disease on changes in drinking in an older population

Authors: Klatsky AL; Armstrong MA; Landy C; Udaltsova N

Alcohol Res. 2003;8:211-13.

Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes

Authors: Armstrong MA; Gonzales Osejo V; Lieberman L; Carpenter DM; Pantoja PM; Escobar GJ

J Perinatol. 2003 Jan;23(1):3-9.

PubMed abstract

Alcohol drinking and risk of hemorrhagic stroke

Authors: Klatsky AL; Armstrong MA; Friedman GD; Sidney S

Neuroepidemiology. 2002 May-Jun;21(3):115-22.

PubMed abstract

Rehospitalization for neonatal dehydration: a nested case-control study

Authors: Escobar GJ; Gonzales VM; Armstrong MA; Folck BF; Xiong B; Newman TB

Arch Pediatr Adolesc Med. 2002 Feb;156(2):155-61.

PubMed abstract

Utilization of health services among patients referred to an alcohol treatment program

Authors: Armstrong MA; Midanik LT; Klatsky AL; Lazere A

Subst Use Misuse. 2001 Dec;36(13):1781-93.

PubMed abstract

Alcohol drinking and risk of hospitalization for ischemic stroke

Authors: Klatsky AL; Armstrong MA; Friedman GD; Sidney S

Am J Cardiol. 2001 Sep 15;88(6):703-6.

PubMed abstract

Early Start: an obstetric clinic-based, perinatal substance abuse intervention program

Authors: Armstrong MA; Lieberman L; Carpenter DM; Gonzales VM; Usatin MS; Newman L; Escobar GJ

Qual Manag Health Care. 2001 Winter;9(2):6-15.

PubMed abstract

Neonatal sepsis workups in infants >/=2000 grams at birth: A population-based study

Authors: Escobar GJ; Li DK; Armstrong MA; Gardner MN; Folck BF; Verdi JE; Xiong B; Bergen R

Pediatrics. 2000 Aug;106(2 Pt 1):256-63.

PubMed abstract

Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans

Authors: Klatsky AL; Armstrong MA; Poggi J

Am J Cardiol. 2000 Jun 1;85(11):1334-7.

PubMed abstract

Neonatal assisted ventilation: predictors, frequency, and duration in a mature managed care organization

Authors: Wilson A; Gardner MN; Armstrong MA; Folck BF; Escobar GJ

Pediatrics. 2000 Apr;105(4 Pt 1):822-30.

PubMed abstract

Sex-based differences in causes of hospitalization for coronary heart disease

Authors: Klatsky A; Armstrong MA

Perm J. 2000 Fall;4(4):15-20.

Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization

Authors: Newman TB; Escobar GJ; Gonzales VM; Armstrong MA; Gardner MN; Folck BF

Pediatrics. 1999 Nov;104(5 Pt 2):1198-203.

PubMed abstract

Rehospitalization for respiratory syncytial virus among premature infants

Authors: Joffe S; Escobar GJ; Black SB; Armstrong MA; Lieu TA

Pediatrics. 1999 Oct;104(4 Pt 1):894-9.

PubMed abstract

Rehospitalization in the first two weeks after discharge from the neonatal intensive care unit

Authors: Escobar GJ; Joffe S; Gardner MN; Armstrong MA; Folck BF; Carpenter DM

Pediatrics. 1999 Jul;104(1):e2.

PubMed abstract

Alcohol consumption and utilization of health services in a health maintenance organization

Authors: Armstrong MA; Midanik LT; Klatsky AL

Med Care. 1998 Nov;36(11):1599-605.

PubMed abstract

Structured review of neonatal deaths in a managed care organisation

Authors: Escobar GJ; Yanover M; Gardner MN; Golembeski D; Armstrong MA; Shum F; Kipnis P

Paediatr Perinat Epidemiol. 1998 Oct;12(4):422-36.

PubMed abstract

Cataract extraction. Risk factors in a health maintenance organization population under 60 years of age

Authors: Schwab IR; Armstrong MA; Friedman GD; Wong IG; Carpentieri AC; Dawson CR

Arch Ophthalmol. 1988 Aug;106(8):1062-5.

PubMed abstract

Precursors of essential hypertension: body weight, alcohol and salt use, and parental history of hypertension

Authors: Friedman GD; Selby JV; Quesenberry CP Jr; Armstrong MA; Klatsky AL

Prev Med. 1988 Jul;17(4):387-402.

PubMed abstract

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