Erica P. Gunderson, PhD, MS, MPH

People

Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612

510-891-5917 (phone)
erica.gunderson@kp.org
Kaiser Permanente Researcher Profiles

Erica P. Gunderson, PhD, MS, MPH, RD, is a senior research scientist at Kaiser Permanente Northern California Division of Research and a professor of Health Systems Science at Kaiser Permanente Bernard J. Tyson School of Medicine. She is a reproductive life-course epidemiologist studying the lasting effects of pregnancy outcomes and lactation on future cardiometabolic health outcomes in women and children. Her prospective, longitudinal studies in women across the child-bearing years are among the first to account for antecedent risk factors, such as preconception and gestational cardiometabolic profiles to distinguish the impact of preceding adverse pregnancy outcomes (APOs) and lactation on longer-term health outcomes. Her research studies preserve the temporal sequence of these exposures, thereby strengthening the evidence basis supporting causal inferences for the lasting benefits of lactation to reduce the relative risk of progression to T2D and CVD in women during mid-life. Dr. Gunderson has collaborated on many studies to identify metabolite signatures and biomarkers linked to future development of diabetes after gestational diabetes. She has also evaluated both fetal and early postnatal infant diet, i.e., beverages and breastfeeding, influencing future cardiometabolic health in children exposed to maternal gestational diabetes. Another major research focus involves characterizing early pregnancy blood pressure patterns that more accurately predict hypertensive disorders of pregnancy, and longer-term CVD risk in women, and the role of preconception chronic hypertension during pregnancy and racial health disparities.

Dr. Gunderson leads the Study of Women, Infant Feeding and Type 2 Diabetes after Gestational Diabetes (SWIFT), a diverse, prospective cohort of 1,033 women with gestational diabetes (75% minority: Asian, Black, Hispanic) recruited during pregnancy (2008-2011) and evaluated at 3 in-person research exams, each including 2-h 75 g OGTTs from early postpartum through 2 years post-delivery to evaluate risk factors for early progression to T2D. The SWIFT research cohort has continued in ongoing follow up utilizing Kaiser Permanente electronic health records for clinical diagnoses of Type 2 diabetes in women and lifestyle behaviors in early life (e.g., breastfeeding, detailed infant diet from birth) related to obesity and cardiometabolic health in children. For two decades, Dr. Gunderson has been a co-investigator on the Coronary Artery Risk Development in Young Adults (CARDIA) Study, and Co-chair of the Pregnancy-Related Reproductive Exposures and Outcomes Working Group. She is the Principal investigator for two R01 ancillary studies to CARDIA funded by NIDDK in which she led the collection, development, and validation of the CARDIA longitudinal variable datasets across the reproductive life-course, including preconception, pregnancy and post-pregnancy periods.

In 2020-21, Dr. Gunderson was appointed a member of the Organizing Committees for the National Academy of Sciences, Engineering and Medicine, Workshop on Nutrition During Pregnancy and Lactation: Exploring New Evidence, and the Workshop on Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age. In 2022, she received the Dr. Nanette K. Wenger Research Goes Red Award for the Best Scientific Article Cardiovascular Disease and Stroke in Women from the American Heart Association in 2022. Dr. Gunderson received the Agnes Higgins Award in Maternal-Fetal Nutrition from The March of Dimes in 2023. She has authored more than 140 peer-reviewed original research papers and reviews on the preconception, pregnancy and lactation continuum and its lasting impact on longer-term cardiometabolic outcomes in women and their children. Dr. Gunderson earned her BS in Biological Sciences at Stanford University, and her MPH and MS in Public Health/Nutritional Sciences and PhD in Epidemiology at the University of California at Berkeley, with the distinction of receiving the Warren Winkelstein Award for Graduate Studies in Epidemiology.

Current Position(s):

Research Scientist III, Division of Research, Kaiser Permanente Northern California

Section Affiliations:

Primary Research Interests:

Life course epidemiology of obesity and cardiometabolic disease in women and children
Links between the pregnancy-lactation continuum and women’s health
Early prediction of adverse pregnancy outcomes for CVD risk reduction
Fetal life exposures and early postnatal behaviors for prevention of child obesity and metabolic disease
Prospective, longitudinal studies of diverse race and ethnic groups of women across the childbearing years

Related Website(s):

Studies

Biomarker of Pancreatic B-cell Loss Predicting Progression to Type 2 Diabetes After Gestational Diabetes

The goal of this study is to identify unmethylated INS DNA reflecting higher type 2 diabetes risk in women after gestational diabetes pregnancy and to evaluate unmethylated INS DNA as a potential mediator of the lactation duration and intensity association with up to 50% lower relative risk of progression to type 2 diabetes in women after gestational diabetes. The study combines the two largest collections worldwide of longitudinal biospecimens from serial annual 2-h 75 g research OGTTs and in-person research visits in 1,033 women with gestational diabetes followed prospectively since early postpartum (6-9 wks) through 2 years post-delivery, and up to 12 years via electronic health records for type 2 diabetes testing in the KPNC Study of Women, Infant Feeding and Type 2 Diabetes After Gestational Diabetes (SWIFT) funded by NICHD and NIDDK (Gunderson, PI), and women enrolled from 12 weeks to 1 year postpartum and followed through 4 years post-delivery in Tianjin GDM Observational study (TGDM-O) funded by the European Foundation for the Study of Diabetes (Hu, PI
Investigator: Gunderson, Erica
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Targeted metabolomics for early pregnancy prediction of gestational diabetes mellitus

This study will apply a targeted metabolomics approach to the prediction of gestational diabetes from a single blood sample collected in the first trimester of pregnancy and stored for the Research Program on Genes, Environment and Health pregnancy cohort study, which recruited 24,000 pregnant participants during early pregnancy through delivery within Kaiser Permanente Northern California. This large racially and ethnically diverse pregnancy cohort, with stored biospecimens, and clinical data and perinatal health outcomes from electronic health records, provides an excellent opportunity to conduct a nested case-control study among women without prior diabetes to identify a metabolite profile predicting subsequent gestational diabetes diagnosis during mid-gestation. This study will involve a specialized targeted metabolomics approach that can reveal risk of gestational diabetes significantly sooner than conventional tests.
Investigator: Gunderson, Erica
Funder: University of Toronto

Targeted metabolomics for early pregnancy prediction of gestational diabetes mellitus

This study will apply a targeted metabolomics approach to the prediction of gestational diabetes mellitus (GDM) from a single blood sample collected in the first trimester of pregnancy and stored for the Research Program on Genes, Environment and Health (RPGEH) pregnancy cohort study. This study will involve a specialized targeted metabolomics approach that can reveal risk of GDM significantly sooner than conventional tests.
Investigator: Gunderson, Erica
Funder: University of Toronto

Effect of reproductive history on longitudinal change in cardiac, vascular, and lipid parameters

The NHLBI NGHS enrolled 871 girls (50% Black and 50% white) in 1987 at age 9 or 10 and examined them up to 17 times, to age 27. This resulted in 7 echocardiogram reports from ages 20-27, multiple saved samples, and reproductive history questionnaires. We will conduct detailed lipoprotein sizing and functionality assessments from stored and new samples, cardiovascular imaging, and repeat echocardiograms at median age 46. Our aims are to determine the specific lipoprotein particle size distribution and function changes which occur from before to short- and long-term post-pregnancy; determine whether pregnancy-related cardiac adaptations result in long-term alterations in cardiac structure and function, thereby increasing CVD risk for women in their forties; and to test whether parity increases cardiovascular risk independently of socioeconomic status in Black and white women.
Investigator: Gunderson, Erica
Funder: National Heart, Lung, and Blood Institute

Fetal and Early Postnatal Influences on Child Metabolic Health After Gestational Diabetes

This 5-year RO1 study will determine the independent contribution of fetal exposures and early postnatal lifestyle factors on subsequent development of child adiposity and metabolic health among youth (ages 9 to 13 ) exposed to gestational diabetes in utero. The research study will evaluate cardiometabolic health factors and lifestyle behaviors in youth whose mothers were diagnosed with gestational diabetes and enrolled in the prospective, longitudinal SWIFT Study from 2008 to 2011. This study will conduct an in-person research exam and will coordinate the research exams in the children with 10-year follow up exams in the SWIFT women to reclassify glucose tolerance.
Investigator: Gunderson, Erica
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Metabolites Preceding Progression to Type 2 Diabetes in Women after Gestational Diabetes

This study will identify biochemical markers that predict type 2 diabetes mellitus in women after a pregnancy complicated by gestational diabetes mellitus (GDM). Ultimately, the results of this study may lead to improved testing and more effective, personalized interventions to prevent diabetes in women after GDM pregnancy.
Investigator: Gunderson, Erica
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Gestational diabetes phenotypes, glucose tolerance transitions and lifestyle behaviors related to cardiovascular risk status

The Study of Women, Infant Feeding, and Type 2 Diabetes after GDM Pregnancy (SWIFT) is a prospective, community-based cohort of mothers aged 20-45 years of age and diagnosed with gestational diabetes mellitus (GDM) who delivered a singleton pregnancy longer than 35 weeks gestation at Kaiser Permanente Northern California in 2008-2011. The new study leverages the SWIFT cohort's rich datasets, and measures blood pressure and novel biomarkers in blood samples obtained at the NIDDK funded 10-year follow up exam. The goal of this ancillary study will evaluate the relationship of GDM phenotype and subsequent transitions in glucose tolerance after GDM pregnancy to cardiovascular disease risk profiles, inflammation, and novel lipid biomarkers as well as effect modification by lifestyle behaviors.
Investigator: Gunderson, Erica
Funder: National Heart, Lung, and Blood Institute

Prenatal Blood Pressure Patterns to Predict Pregnancy-Related Hypertension and Later-Life Cardiovascular Risk

This study utilizes clinical prenatal-care blood pressure measurements and other clinical and biochemical variables to develop models for the early prediction of hypertensive disorders of pregnancy, and evaluates the relationship of pregnancy blood-pressure patterns to new onset hypertension and cardiovascular diseases in women within more than a decade later.
Investigator: Gunderson, Erica
Funder: National Heart, Lung, and Blood Institute

Pregnancy-Related Risk Factors and Glucose Intolerance in Women during Midlife

This is an ancillary study to the CARDIA Study, a multi-center longitudinal study of 5,115 black and white women and men (18-30) enrolled in 1985-1986, and followed at in-person exams serially through 2011. The study will evaluate pregnancy-related changes in cardiometabolic risk factors and their lasting effects on progression to glucose intolerance in women from the reproductive years through midlife.
Investigator: Gunderson, Erica
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Lactation and Incidence of Diabetes Mellitus in CARDIA Women

The goals of our study are to prospectively examine whether longer duration of lactation is associated with development of type 2 diabetes in women of reproductive age during the 25-year CARDIA study period (1986-2011) and assess changes in risk factors. We will identify changes in cardiometabolic risk factors and biomarkers linked to incident type 2 DM as well as lactation, and examine duration of lactation for all pregnancies in relation visceral fat levels in mid-life.
Investigator: Gunderson, Erica
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Highlighted Publications

Association of Infant Temperament With Subsequent Obesity in Young Children of Mothers With Gestational Diabetes Mellitus

Author(s): Faith MS; Hittner JB; Hurston SR; Yin J; Greenspan LC; Quesenberry CP; Gunderson EP; SWIFT Offspring Study Investigators

JAMA Pediatr. 2019 05 01;173(5):424-433.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Related Website(s):

Studies

Biomarker of Pancreatic B-cell Loss Predicting Progression to Type 2 Diabetes After Gestational Diabetes

Targeted metabolomics for early pregnancy prediction of gestational diabetes mellitus

Targeted metabolomics for early pregnancy prediction of gestational diabetes mellitus

Effect of reproductive history on longitudinal change in cardiac, vascular, and lipid parameters

Fetal and Early Postnatal Influences on Child Metabolic Health After Gestational Diabetes

Metabolites Preceding Progression to Type 2 Diabetes in Women after Gestational Diabetes

Gestational diabetes phenotypes, glucose tolerance transitions and lifestyle behaviors related to cardiovascular risk status

Prenatal Blood Pressure Patterns to Predict Pregnancy-Related Hypertension and Later-Life Cardiovascular Risk

Pregnancy-Related Risk Factors and Glucose Intolerance in Women during Midlife

Lactation and Incidence of Diabetes Mellitus in CARDIA Women

Highlighted Publications

Association of Infant Temperament With Subsequent Obesity in Young Children of Mothers With Gestational Diabetes Mellitus

Longer lactation duration is associated with decreased prevalence of non-alcoholic fatty liver disease in women

Breastfeeding and growth during infancy among offspring of mothers with gestational diabetes mellitus: a prospective cohort study

Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years: The 30-Year CARDIA Study

Pregnancy and Subsequent Glucose Intolerance in Women of Childbearing Age: Heeding the Early Warning Signs for Primary Prevention of Cardiovascular Disease in Women

Dietary variables associated with substantial postpartum weight retention at 1-year among women with GDM pregnancy

Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study

Lactation intensity and fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: The SWIFT cohort

Pregnancy during adolescence has lasting adverse effects on blood lipids: A 10-year longitudinal study of black and white females

Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes

A 20-year prospective study of childbearing and incidence of diabetes in young women, controlling for glycemia before conception: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Long-term plasma lipid changes associated with a first birth: the Coronary Artery Risk Development in Young Adults study

Publications

Contribution of social, behavioral, and contextual exposures to Black-White disparities in incident obesity: The CARDIA study

The prospective association of hyperandrogenism, oligomenorrhea and polycystic ovary syndrome with incident gestational diabetes: The coronary artery risk development in young adults women's study

Genome-wide analysis identifies genetic effects on reproductive success and ongoing natural selection at the FADS locus

A common IGF1R gene variant predicts later life breast cancer risk in women with preeclampsia

Prepregnancy Protein Source and BCAA Intake Are Associated with Gestational Diabetes Mellitus in the CARDIA Study

Adverse Pregnancy Outcomes: The Missing Link in Discovering the Role of Lactation in Cardiovascular Disease Prevention

Prolactin and maternal metabolism in women with a recent GDM pregnancy and links to future T2D: the SWIFT study

Reduced cardiovascular risks in women with endometriosis or polycystic ovary syndrome carrying a common functional IGF1R variant

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

Gestational Diabetes and Hypertensive Disorders of Pregnancy by Maternal Birthplace

Early Pregnancy Blood Pressure Patterns Identify Risk of Hypertensive Disorders of Pregnancy Among Racial and Ethnic Groups

Prepregnancy weight change associated with high gestational weight gain

Gestational Diabetes and Overweight/Obesity: Analysis of Nulliparous Women in the U.S., 2011-2019

Adverse Pregnancy Outcomes and Incident Heart Failure in the Women's Health Initiative

Intensive lactation among women with recent gestational diabetes significantly alters the early postpartum circulating lipid profile: the SWIFT study

Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019

DNA methylation GrimAge and Incident Diabetes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

The Association of Lactation Duration with Visceral and Pericardial Fat Volumes in Parous Women: the CARDIA Study

Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association

Association of infant diet with subsequent obesity at 2-5 years among children exposed to gestational diabetes: the SWIFT study

Maternal weight change from prepregnancy to 18 months postpartum and subsequent risk of hypertension and cardiovascular disease in Danish women: A cohort study

Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study

Adverse Childhood Experiences and Early and Continued Breastfeeding: Findings from an Integrated Health Care Delivery System

Cancer and Cardiovascular Risk in Women With Hypertensive Disorders of Pregnancy Carrying a Common IGF1R Variant

Diminished Sphingolipid Metabolism, a Hallmark of Future Type 2 Diabetes Pathogenesis, Is Linked to Pancreatic β Cell Dysfunction

Non-alcoholic fatty liver disease in pregnancy is associated with adverse maternal and perinatal outcomes

Life Course Changes in Cardiometabolic Risk Factors Associated With Preterm Delivery: The 30-Year CARDIA Study

Underlying dyslipidemia postpartum in women with a recent GDM pregnancy who develop type 2 diabetes

Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life-Course Analysis in CARDIA Women

Life-Course Reproductive History and Cardiovascular Risk Profile in Late Mid-Life: The CARDIA Study

Amino acid and lipid metabolism in post-gestational diabetes and progression to type 2 diabetes: A metabolic profiling study

A longitudinal study of pre-pregnancy antioxidant levels and subsequent perinatal outcomes in black and white women: The CARDIA Study

The Preconception Period analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium

Duration and stability of metabolically healthy obesity over 30 years

Links Between Childhood Obesity, Gestational Diabetes, and Infant Temperament-Reply

Fasting glucose variability in young adulthood and incident diabetes, cardiovascular disease and all-cause mortality

Association of breastfeeding and gestational diabetes mellitus with the prevalence of prediabetes and the metabolic syndrome in offspring of Hispanic mothers

Association of Infant Temperament With Subsequent Obesity in Young Children of Mothers With Gestational Diabetes Mellitus

The discovery of novel predictive biomarkers and early-stage pathophysiology for the transition from gestational diabetes to type 2 diabetes

Longer lactation duration is associated with decreased prevalence of non-alcoholic fatty liver disease in women

Pre-pregnancy kidney function and subsequent adverse pregnancy outcomes

Breastfeeding and later maternal risk of hypertension and cardiovascular disease - The role of overall and abdominal obesity

Cardiorespiratory Fitness, Exercise Hemodynamics and Birth Outcomes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Breastfeeding and growth during infancy among offspring of mothers with gestational diabetes mellitus: a prospective cohort study

Blood Pressure Patterns and Subsequent Coronary Artery Calcification in Women Who Delivered Preterm Births

Breastfeeding and Future Maternal Health-No Causal Evidence-Reply

Elevated Medium Chain-Acylcarnitines are Associated with Gestational Diabetes, and Early Progression to Type-2 Diabetes, and Induce Pancreatic β-Cell Dysfunction

Pre-pregnancy endothelial dysfunction and birth outcomes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Pre-Pregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis.

Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years: The 30-Year CARDIA Study

Association Between Gestational Diabetes and Incident Maternal CKD: The Coronary Artery Risk Development in Young Adults (CARDIA) Study