Assiamira M. Ferrara, MD, PhD

assiamira.ferrara@kp.org

Assiamira Ferrara, MD, PhD is a Senior Research Scientist at the Kaiser Permanente Northern California Division of Research. Dr. Ferrara is internationally recognized for her expertise in gestational diabetes (GDM) and obesity during pregnancy, and her research interests focus on preventing the adverse effects of these conditions on women’s and children’s health.

Her primary focus has been the epidemiology of and translational research related to diabetes and GDM. Dr. Ferrara and colleagues have adapted the National Diabetes Prevention Program to be delivered by telehealth in women with GDM as well as pregnant women with overweight or obesity during the prenatal and postpartum periods to achieve weight management and reduce the risk of type 2 diabetes. Dr. Ferrara also conducts cohort studies of pregnant women and their offspring to identify early risk factors for diabetes and obesity. She is the contact principal investigator at Kaiser Permanente of the Environmental influences on Child Health Outcomes (ECHO) program, a National Institutes of Health initiative. Dr. Ferrara’s life course approach to diabetes and obesity prevention is aimed in reducing the risk factors for these chronic conditions early in life. In recognition of her research on these topics, Dr. Ferrara was presented the 2019 American Diabetes Association’s Norbert Freinkel Lecture.

She has also led the establishment and maintenance of the KPNC Gestational Diabetes and Pregnancy Glucose Tolerance Registry since its inception in 1997. Dr. Ferrara collaborated with researchers across the nation to further the understanding of sex disparities in the quality of health care for people with diabetes in an attempt to explain the higher risk of cardiovascular mortality in women with diabetes relative to men. She has also worked to determine the safety of diabetes medications in regards to cancer risks.

Current Positions

Research Scientist III, Division of Research, Kaiser Permanente Northern California
Affiliate Professor, Department of Epidemiology, University of Washington, 2002-present

Section Affiliations

Primary Research Interests

Epidemiology of Diabetes and Gestational Diabetes
Diabetes and Obesity Prevention
Translational Research
Cardiovascular disease
Endocrinology
Menopause

Studies

UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Program

The University of California, San Francisco-Kaiser Permanente Northern California Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Program offers mentored training to scholars to advance US women’s health through the study of sex and gender influences in health and disease. The program strengthens interdisciplinary research skills and trains researchers in women’s health for successful careers in team science focused on topics of public health importance, with the ultimate goal of improving women’s health.

Investigator: Ferrara, Assiamira

Funder: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Gestational Diabetes Screening: Are Changes in Recommended Timing Associated with Perinatal Outcomes?

Optimal screening practices for gestational diabetes in those with risk factors for gestational diabetes are unknown. Some experts recommend early (under 20 weeks gestation) screening plus repeat screening at the standard 24-28 week timeframe if not diagnosed via early screening. More recent data has called this recommendation into question, citing more costs than benefits of early screening. Kaiser Permanente Northern California initiated a recommendation against early screening in April 2020, the effects of which have yet to be studied. The goals of this study are to determine whether the decrease in the proportion of women screened for gestational diabetes before 24 weeks of gestation was safe in relation to maternal and newborn health outcomes that are common gestational diabetes-related complications. This evaluation will inform whether this practice change is safe enough to evolve into a permanent care delivery strategy. We also will compare resource utilization with this new practice compared to the historic strategy.

Investigator: Ferrara, Assiamira

Funder: TPMG Delivery Science Projects Program

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

This is a 7-year renewal of our current ECHO Cohort Study Site Early Life Exposures and Child Growth, Adiposity, and Neurodevelopment. We plan to extend the capacity of the ECHO Cohort to further investigate the roles of endocrine disruptor chemicals and health behaviors on child growth, adiposity and neurodevelopment and to follow our 2,000 children and their mothers currently enrolled in our ECHO Cohort and implement the ECHO Cohort Protocol.

Investigator: Ferrara, Assiamira; Croen, Lisa; Hedderson, Monique

Funder: National Institutes of Health

Center for upstream prevention of adiposity and diabetes mellitus

The UPSTREAM Center conducts research on the upstream prevention of adiposity and diabetes by identifying risk factors and conducting interventions early in the life to prevent the onset of these conditions. Our focus is on training the next generation of researchers, collaborating with TPMG clinicians to conduct delivery science research, translating findings into clinical care, and interacting with Community Health at Kaiser Permanente to inform health policies.

Investigator: Ferrara, Assiamira

Funder: Northern California Community Benefit Programs

Understanding facilitators and barriers to achieving glycemic control among a diverse population with gestational diabetes

The SUNRISE project capitalizes on our previous qualitative research that demonstrated our ability to identify facilitators and barriers that contribute to health engagement among patients with gestational diabetes. The proposed supplement widens the potential impact of the parent project beyond the postpartum period. Information gained about gestational diabetes engagement during pregnancy will shed important light on the lived experiences of diverse populations most affected by both suboptimal glycemic control and suboptimal postpartum screening for overt diabetes.

Investigator: Ferrara, Assiamira

Funder: Northern California Community Benefit Programs

Motivational Determinants of Postpartum Lifestyle Behaviors, Weight Retention, and Metabolic Syndrome

The proposed study aims to identify affective influences on key lifestyle behaviors (healthy eating and objectively measured self-weighing and physical activity) associated with postpartum weight retention and cardiometabolic profile (e.g., metabolic syndrome). We propose a longitudinal study design within a theory-driven framework that leverages PETALS, an existing population-based cohort. The ultimate objectives of this research are to identify novel, modifiable targets for interventions to improve postpartum weight trajectory and cardiometabolic outcomes among diverse women at risk for cardiovascular health disparities.

Investigator: Ferrara, Assiamira

Funder: National Heart, Lung, and Blood Institute

Optimizing a Scalable Intervention to Maximize Guideline-Recommended Diabetes Testing after GDM

We will leverage the multiphase optimization strategy (MOST) to efficiently identify, in a single experiment, which of four components of an outreach intervention motivate women with gestational diabetes to complete a recommended oral glucose tolerance test by 12 weeks and join a health system- or community-based lifestyle program for diabetes prevention.

Investigator: Ferrara, Assiamira

Funder: National Institute of Diabetes and Digestive and Kidney Diseases

COVID-19 Related Changes in Health Care Delivery and Health Outcomes Among Pregnant Women and Their Newborns

This study will examine the impacts that COVID-19 pandemic related changes in health care delivery had on health outcomes among pregnant women and their newborns in Kaiser Permanente Northern California. The study will also evaluate the clinical course of COVID-19 during pregnancy and its impact on health outcomes.

Investigator: Ferrara, Assiamira

Funder: TPMG Delivery Science Projects Program

ECHO Coordinating Center: Opportunities and Infrastructure Fund Component

The overall goal of this project is to demonstrate that the newly FDA-approved Airwave Oscillometry System (tremoFlo c-100, Thorasys) can be used to reliably and easily obtain lung function measurements in ECHO cohorts and that these oscillometry measures of respiratory resistance and compliance are important outcomes in relating pre-, peri-, and postnatal exposures to respiratory health throughout childhood.

Investigator: Ferrara, Assiamira

Funder: National Institutes of Health, Office of the Director

Comparative Effectiveness of Diabetes Prevention Strategies in Women with Gestational Diabetes Mellitus

It is a cluster randomized lifestyle intervention trial that assesses the effect of an organizational-level intervention on weight management in GDM patients. Randomization will occur at the medical center level; 44 medical centers of Kaiser Permanente Northern California (KP) will participate and data will be collected for more than 2,400 pregnant women with GDM. The intervention will be compared to usual care.

Investigator: Ferrara, Assiamira

Funder: Agency for Healthcare Research and Quality

New Opportunities to Prevent Diabetes in the Workplace

The study seeks to compare weight loss outcomes and patient engagement in two interventions derived from Diabetes Prevention Programs.

Investigator: Ferrara, Assiamira

Funder: Kaiser Foundation Hospitals

Study to Assess the Incidence of Type 1 Diabetes in Young Adults

This project with multiple principal investigators will address the following aims: 1) Develop and implement a case ascertainment strategy for the rapid, timely and complete identification of new onset diabetes cases among young adults; 2) Develop and implement procedures for the measurement of diabetes autoantibodies; 3) Establish a diverse, population-based registry of incident cases of diabetes among young adults; 4) Determine the incidence of type 1 diabetes.

Investigator: Ferrara, Assiamira

Funder: Centers for Disease Control and Prevention

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

We hypothesize that in-utero exposures to commonly used endocrine disrupting chemicals, such as PFCs and PBDEs, individually and/or in combination, have adverse effects on child obesity and neurodevelopment through possible common pathways. Our aims are:
Aim 1. To evaluate whether in-utero exposures to maternal PFCs and PBDEs, individually and/or in combination, are associated with infant growth, adiposity and neurodevelopment.
Aim 2. To evaluate whether in-utero PFCs and PBDEs exposures are associated with metabolic determinants of obesity and neurodevelopment .
Aim 3. To explore whether in-utero PFCs and PBDEs exposures are associated with infant patterns of DNA methylation.
Aim 4. To identify infant, maternal and paternal factors that modify the association of exposure to in-utero PFCs and PBDEs exposures and with infant growth, adiposity and neurodevelopment.

Investigator: Ferrara, Assiamira; Croen, Lisa

Funder: National Institutes of Health

Appropriate Gestational Weight Gain in Overweight/Obese Women

Among overweight/obese pregnant women, we propose to develop and evaluate a randomized diet and physical activity intervention tailored to mothers and feasible in a health plan setting, with the goal of ameliorating inappropriate gestational weight gain.

Investigator: Ferrara, Assiamira

Funder: National Institute of Child Health and Human Development

Prenatal Bisphenol A Exposure and Risk of Gestational Diabetes

This study will enroll 3,350 pregnant women during their first trimester, among whom a prospective nested case-control study of 300 gestational diabetes cases and 600 controls will be conducted to examine the association between early pregnancy levels of bisphenol-A (BPA) and the risk of GDM in the second trimester, as well as the association between BPA and high levels of metabolic markers of insulin resistance and liver enzymes, and the risk of having a large for gestational age (LGA) infant.

Investigator: Ferrara, Assiamira

Funder: National Institute of Environmental Health Sciences

Cohort Study of Pioglitazone and Bladder Cancer in Patients with Diabetes

This cohort study examines the possible association of pioglitazone use with the incidence of new bladder cancer in the Kaiser Permanente Northern California Diabetes Registry .

Investigator: Ferrara, Assiamira

Funder: Takeda Pharmaceuticals North America

Cohort Study of Pioglitazone and Cancer Incidence in Patients with Diabetes Mellitus

The objective of this study is to conduct exploratory analysis of the potential association between treatment with pioglitazone and risk of cancer at sites other than bladder using information available from a variety of KPNC electronic data sources.

Investigator: Ferrara, Assiamira

Funder: Takeda Pharmaceuticals North America

Translational Diabetes Prevention in GDM

This is a lifestyle intervention project tailored to pregnant and postpartum women with gestational diabetes (GDM) and designed to reduce risk factors for type 2 diabetes. The intervention will start during pregnancy soon after GDM diagnosis and will continue postpartum. It will be delivered by individual telephone counseling contacts and brief in-person counseling sessions. Patients will be randomly assigned to a lifestyle intervention or usual medical care. Among GDM patients we propose to implement and evaluate an intervention of diet and physical activity tailored to be practical in health plan settings and for postpartum mothers, with the primary goals of: a) reaching pre-pregnancy weight if women had normal pre-pregnancy weight; or b) reaching a 5% reduction from pre-pregnancy weight if overweight or obese prior to pregnancy.

Investigator: Ferrara, Assiamira

Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Publications

Do small effects matter more in vulnerable populations? an investigation using Environmental influences on Child Health Outcomes (ECHO) cohorts

Authors: Peacock, Janet L;Ferrara, Assiamira;Croen, Lisa A;Alexeeff, Stacey;Program Collaborators for Environmental influences on Child Health Outcomes,;et al.

BMC Public Health. 2024 Sep 28;24(1):2655. Epub 2024-09-28.

Assiamira M. Ferrara, MD, PhD

Current Positions

Section Affiliations

Primary Research Interests

Studies

UCSF-Kaiser Department of Research Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Program

Gestational Diabetes Screening: Are Changes in Recommended Timing Associated with Perinatal Outcomes?

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

Center for upstream prevention of adiposity and diabetes mellitus

Understanding facilitators and barriers to achieving glycemic control among a diverse population with gestational diabetes

Motivational Determinants of Postpartum Lifestyle Behaviors, Weight Retention, and Metabolic Syndrome

Optimizing a Scalable Intervention to Maximize Guideline-Recommended Diabetes Testing after GDM

COVID-19 Related Changes in Health Care Delivery and Health Outcomes Among Pregnant Women and Their Newborns

ECHO Coordinating Center: Opportunities and Infrastructure Fund Component

Comparative Effectiveness of Diabetes Prevention Strategies in Women with Gestational Diabetes Mellitus

New Opportunities to Prevent Diabetes in the Workplace

Study to Assess the Incidence of Type 1 Diabetes in Young Adults

Early Life Exposure to Endocrine Disrupting Chemicals and Child Growth, Adiposity, and Neurodevelopment

Appropriate Gestational Weight Gain in Overweight/Obese Women

Prenatal Bisphenol A Exposure and Risk of Gestational Diabetes

Cohort Study of Pioglitazone and Bladder Cancer in Patients with Diabetes

Cohort Study of Pioglitazone and Cancer Incidence in Patients with Diabetes Mellitus

Translational Diabetes Prevention in GDM

Publications

Do small effects matter more in vulnerable populations? an investigation using Environmental influences on Child Health Outcomes (ECHO) cohorts

Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity

Association of maternal fish consumption and ω-3 supplement use during pregnancy with child autism-related outcomes: results from a cohort consortium analysis

Digital health outreach to promote postpartum screening after gestational diabetes: A randomized factorial pilot study

Racial, Ethnic, and Geographic Differences in Vaginal Birth After Cesarean Delivery in the US, 2011-2021

Bridging Differences in Cohort Analyses of the Relationship between Secondhand Smoke Exposure during Pregnancy and Birth Weight: The Transportability Framework in the ECHO Program

Birth outcomes in relation to neighborhood food access and individual food insecurity during pregnancy in the Environmental Influences on Child Health Outcomes (ECHO)-wide cohort study

Measurement bias in caregiver-report of early childhood behavior problems across demographic factors in an ECHO-wide diverse sample

Behavior reallocations within 24-h movement profiles and change in cardiometabolic biomarkers during pregnancy

Maternal education prospectively predicts child neurocognitive function: An environmental influences on child health outcomes study

Association Between Neighborhood Deprivation in Early Pregnancy and Gestational Diabetes Mellitus

Maternal Pre-Pregnancy BMI, Breastfeeding, and Child BMI

Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression

Associations of Organophosphate Ester Flame Retardant Exposures during Pregnancy with Gestational Duration and Fetal Growth: The Environmental influences on Child Health Outcomes (ECHO) Program

Associations between COVID-19-related family hardships/distress and children’s Adverse Childhood Experiences during the pandemic: The Environmental influences on Child Health Outcomes (ECHO) program

Intrinsic motivation for physical activity, healthy eating, and self-weighing in association with corresponding behaviors in early pregnancy

PFAS concentrations in early and mid-pregnancy and risk of gestational diabetes mellitus in a nested case-control study within the ethnically and racially diverse PETALS cohort

Prenatal depression and risk of child autism-related traits among participants in the Environmental influences on Child Health Outcomes program

Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children

Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States

Associations between area-level arsenic exposure and adverse birth outcomes: An Echo-wide cohort analysis

Prenatal Health Care Outcomes Before and During the COVID-19 Pandemic Among Pregnant Individuals and Their Newborns in an Integrated US Health System

Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts

Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes

Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm

Changes in Body Mass Index Among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010

In utero metabolomic signatures of refined grains intake and risk of gestational diabetes: A metabolome-wide association study

Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program

The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort

Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the COVID-19 pandemic

Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program

Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study

Perinatal Outcomes During vs. Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program

Dietary Quality Indices in Early Pregnancy and Rate of Gestational Weight Gain among a Prospective Multi-Racial and Ethnic Cohort

Trends in Screen Time Use Among Children During the COVID-19 Pandemic, July 2019 Through August 2021

Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study

Effects of COVID-19 Financial and Social Hardships on Infants’ and Toddlers’ Development in the ECHO Program

Opportunities for understanding the COVID-19 pandemic and child health in the United States: the Environmental influences on Child Health Outcomes (ECHO) program

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts

Associations of Neighborhood Opportunity and Social Vulnerability With Trajectories of Childhood Body Mass Index and Obesity Among US Children

Changes in 24-Hour Movement Behaviors From Early to Late Pregnancy in Individuals With Prepregnancy Overweight or Obesity

Urinary Phenols in Early to Mid-Pregnancy and Risk of Gestational Diabetes: A Longitudinal Study in a Multiracial Cohort

Development and validation of prediction models for gestational diabetes treatment modality using supervised machine learning: a population-based cohort study

Glycemic Control Trajectories and Risk of Perinatal Complications Among Individuals With Gestational Diabetes

Changes in BMI During the COVID-19 Pandemic

Predictive Metabolomic Markers in Early to Mid-Pregnancy for Gestational Diabetes: A Prospective Test and Validation Study

Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children

Cardiometabolic Pregnancy Complications in Association with Autism-Related Traits as Measured by the Social Responsiveness Scale in ECHO

Sociodemographic Variation in Children’s Health Behaviors During the COVID-19 Pandemic

Reach, acceptability, and perceived success of a telehealth diabetes prevention program among racially and ethnically diverse patients with gestational diabetes: the GEM cluster-randomized trial

Coping strategies for COVID-19 pandemic-related stress and mental health during pregnancy

Impaired fasting glucose in pregnancy: improved perinatal outcomes with active glycemic management

A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial

Uptake of guideline-recommended postpartum diabetes screening among diverse women with gestational diabetes: associations with patient factors in an integrated health system in USA

Perspectives on Postpartum Diabetes Screening among Patients with Gestational Diabetes in an Integrated Healthcare System

Perinatal Complications in Individuals in California With or Without SARS-CoV-2 Infection During Pregnancy