Elucidating Neighborhood- and Individual-Level Factors Associated with Pregnancy Glycemia Levels and Childhood Obesity
In this K99R00 Pathway to Independence Award conducted among a cohort of approximately a half million mother-child dyads at KPNC, this project aims to examine how neighborhood-level factors, such as the food environment and walkability, alongside individual-level factors, including diet…
Maternal Autoantibody Reactivity, Gestational Inflammation, and Child Neurodevelopment (MARGIN)
The goal is to extend the aims of the IMPaCT study to interrogate additional gestational biomarkers - maternal autoantibodies (MA) - in pregnancy blood samples collected from mothers of 600 autism spectrum disorder, 2,000 developmental delay (DD), and 2,000 general…
Develop and optimize algorithms using real-world data (RWD) to define and identify less invasive surfactant administration (LISA) in infants with respiratory distress syndrome (RDS)
The aim of this study is to develop and validate algorithms to identify less-invasive surfactant administration in real-world databases using various data sources.
Implementing vancomycin-sparing regimens in preterm infants
The goal of this study is to reduce total vancomycin use days among preterm infants during hospitalization without an increase in adverse effects, and to identify barriers and facilitators to the use of vancomycin-sparing regimens in preterm infants in participating…
Gestational Diabetes Mellitus and Subsequent Risks of Diabetes and Cardiovascular Diseases: the Life Course Perspective and Implications of Racial Disparities
Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications worldwide and the prevalence is continuously rising globally. Importantly, GDM is not an isolated complication of pregnancy. Growing evidence suggests that individuals with GDM, compared to those without…
Update to the Neonatal Early-Onset Sepsis Calculator Utilizing a Contemporary Cohort
The Kaiser Permanente Neonatal Early-Onset Sepsis (EOS) Calculator has been an effective tool for risk stratification to safely reduce newborn antibiotic exposure. The calculator was derived from data on infants born between 1993 and 2007. Since that time, US obstetric…
Longitudinal Exposure to Neighborhood Concentrated Poverty Contributes to Differences in Adiposity in Midlife Women
Background: Neighborhood poverty is associated with adiposity in women, though longitudinal designs, annually collected residential histories, objectively collected anthropometric measures, and geographically diverse samples of midlife women remain limited. Objective: To investigate whether longitudinal exposure to neighborhood concentrated poverty is…
Do small effects matter more in vulnerable populations? an investigation using Environmental influences on Child Health Outcomes (ECHO) cohorts
A major challenge in epidemiology is knowing when an exposure effect is large enough to be clinically important, in particular how to interpret a difference in mean outcome in unexposed/exposed groups. Where it can be calculated, the proportion/percentage beyond a…
Cesarean delivery, labor duration and mothers’ mortality risk over 50 years of follow-up: Cesarean delivery and maternal mortality
Pregnancy complications have been recognized as a window to future health. Though cesarean delivery is common, it is unknown whether labor duration and mode of delivery are associated with maternal long-term mortality. To examine whether labor duration and mode of…
Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity
Limited access to healthy foods, resulting from residence in neighborhoods with low food access, is a public health concern. The contribution of this exposure in early life to child obesity remains uncertain. To examine associations of neighborhood food access during…
Commonly used genomic arrays may lose information due to imperfect coverage of discovered variants for autism spectrum disorder
Common genetic variation has been shown to account for a large proportion of ASD heritability. Polygenic scores generated for autism spectrum disorder (ASD-PGS) using the most recent discovery data, however, explain less variance than expected, despite reporting significant associations with…
Diabetes and uterine fibroid diagnosis in midlife: Study of Women’s Health Across the Nation (SWAN)
Fibroids are non-cancerous uterine tumors potentially associated with cardiovascular risk factors. We examined prospectively associations of glucose, insulin, sex hormone binding globulin (SHBG), and diabetes with incidence of fibroid diagnoses in midlife. Participants in the Study of Women's Health Across…
Characterizing self-reported physical activity before and during a subsequent pregnancy among parents in a familial autism cohort
Parents of autistic children may have limited time and resources to participate in physical activity, a key aspect of health. Previous studies have been small and included mostly mothers, rather than fathers. No studies have examined physical activity in these…
Epidural Analgesia During Labor and Neonatal Hypoxic-Ischemic Encephalopathy
Epidural analgesia is used by approximately 70% of birthing persons in the US to alleviate labor pain and is a common cause of elevated temperature in the birthing parent during labor, which, in turn, is associated with adverse neonatal outcomes…
HDL-C criterion of the metabolic syndrome and future diabetes and atherosclerosis in midlife women: The SWAN Study
High-density lipoprotein cholesterol (HDL-C) is one of 5 components [high blood pressure, glucose, triglycerides, waist circumference, low HDL-C], 3 of which, needed to diagnose metabolic syndrome (MetS). Evolving research shows that higher HDL-C is not necessarily cardioprotective in midlife women,…
Racial, ethnic, and neighborhood socioeconomic disparities in local cannabis retail policy in California
Policies governing legal cannabis commerce can vary widely within a U.S. state when local control exists. Disproportionate distribution of policies allowing retail sale, protecting public health, or promoting equity in licensing may contribute to differences in health and economic outcomes…
Association of maternal fish consumption and ω-3 supplement use during pregnancy with child autism-related outcomes: results from a cohort consortium analysis
Prenatal fish intake is a key source of omega-3 (ω-3) polyunsaturated fatty acids needed for brain development, yet intake is generally low, and studies addressing associations with autism spectrum disorder (ASD) and related traits are lacking. This study aimed to…
Prenatal Cannabis Use and Maternal Pregnancy Outcomes
Many studies have evaluated whether in utero cannabis exposure is associated with fetal and neonatal outcomes, yet little is known about whether prenatal cannabis use is associated with maternal health outcomes during pregnancy. To evaluate whether prenatal cannabis use is…
Advancing Understanding of Chemical Exposures and Maternal-child Health Through the U.S. Environmental Influences on Child Health Outcomes (ECHO) Program: A Scoping Review
Environmental chemical exposures may disrupt child development, with long-lasting health impacts. To date, U.S. studies of early environmental exposures have been limited in size and diversity, hindering power and generalizability. With harmonized data from over 60,000 participants representing 69 pregnancy…
Comparative effectiveness of treating prenatal depression with counseling versus antidepressants in relation to preterm delivery
Maternal depression during pregnancy is prevalent and has been associated with increased risk of preterm delivery. However, comparative effectiveness of 2 commonly used treatment options, mental health counseling and use of antidepressants, in mitigating the risk of preterm delivery associated…
Health and Neurodevelopmental Outcomes in Infants at Risk for Neonatal Opioid Withdrawal Syndromes: (NOWSEffects of Timing and Duration of Prenatal Opioid Exposure (POE) & Postnatal Management with Eat-Sleep-Console (ESC)
In alignment with the objectives of the FDA to apply regulatory science to ensure optimal drug safety in pediatric populations, this study will address the critical public health consequences of prenatal opioid exposure during the ongoing opioid epidemic in the…
Standardized Postpartum Management for Hypertensive Disorders of Pregnancy: Impact on Readmission Rate
This study will evaluate whether the 2022 regional postpartum Hypertensive Disorders of Pregnancy (HDP) management initiative reduced readmission rates and was safe in relation to maternal morbidities associated with HDP. We will also assess whether the impact of the initiative…
Hallenbeck, Bethany R.
Research interests include gestational diabetes, childhood obesity, and activity monitoring.
Digital health outreach to promote postpartum screening after gestational diabetes: A randomized factorial pilot study
We examined the acceptability and feasibility of a multi-component digital health outreach intervention to promote uptake of guideline-recommended postpartum screening for type 2 diabetes among patients with gestational diabetes (GDM). We conducted a 24 randomized factorial experiment as part of…
Exposure to heavy metals in utero and autism spectrum disorder at age 3: a meta-analysis of two longitudinal cohorts of siblings of children with autism
Autism spectrum disorder (ASD) is a prevalent and heterogeneous neurodevelopmental disorder. Risk is attributed to genetic and prenatal environmental factors, though the environmental agents are incompletely characterized. In Early Autism Risk Longitudinal Investigation (EARLI) and Markers of Autism Risk in…
The association between prenatal oxidative stress levels measured by isoprostanes and offspring neurodevelopmental outcomes at 36 months
Oxidative stress during pregnancy has been a mechanistic pathway implicated in autism development, yet few studies have examined this association directly. Here, we examined the association of prenatal levels of 8-iso-PGF2α, a widely used measure of oxidative stress, and several…
The Effect of City-Level Sugar-Sweetened Beverage Taxes on Longitudinal HbA1c and Incident Diabetes in Adults With Prediabetes
Prediabetes, which is a condition characterized by higher-than-normal blood glucose levels that are under the threshold for diabetes, impacts over one-third of U.S. adults. Excise taxes on sugar-sweetened beverages (SSBs) are a proposed policy intervention to lower population consumption of…
Depressive symptoms and activity engagement in autistic adolescents and those with other developmental disabilities
Autistic adults and those with other developmental disabilities (DD) have increased depressive symptoms and decreased activity engagement when compared to those with no DD. Few studies explore activities related to depressive symptoms in autistic people and those with other DD…
City-Level Sugar-Sweetened Beverage Taxes and Youth Body Mass Index Percentile
Levying excise taxes on sugar-sweetened beverage (SSB) distributors, which are subsequently passed on to consumers, is a policy implemented to reduce the high prevalence of cardiometabolic disease and generate public health funding. Taxes are associated with lower SSB purchases and…
Hydroxychloroquine and Preeclampsia in a Diverse Cohort of Women with SLE
Patients with systemic lupus erythematosus (SLE) are at risk for pregnancy complications such as preeclampsia and eclampsia. These clinically important complications are associated with maternal morbidity, mortality and postpartum cardiovascular disease. Some studies suggest that hydroxychloroquine (HCQ) may reduce preeclampsia…
Construction of a comprehensive fetal monitoring database for the study of perinatal hypoxic ischemic encephalopathy
This article describes the methods used to build a large-scale database of more than 250,000 electronic fetal monitoring (EFM) records linked to a comprehensive set of clinical information about the infant, the mother, the pregnancy, labor, and outcome. The database…
Reproducibility between preschool and school-age Social Responsiveness Scale forms in the Environmental influences on Child Health Outcomes program
Evidence suggests core autism trait consistency in older children, but development of these traits is variable in early childhood. The Social Responsiveness Scale (SRS) measures autism-related traits and broader autism phenotype, with two age-dependent forms in childhood (preschool, 2.5-4.5 years; school…
The effect of occupational therapy services on hospital readmission for patients with cancer in acute care settings: a retrospective data analysis
This study examined how the use of occupational therapy services affected the likelihood of hospital readmission within 30 days for patients with cancer diagnoses. This was a retrospective observational study. Patient medical records were analyzed from a National Cancer Institute…
Intrapartum exposure to synthetic oxytocin, maternal BMI, and neurodevelopmental outcomes in children within the ECHO consortium
Synthetic oxytocin (sOT) is frequently administered during parturition. Studies have raised concerns that fetal exposure to sOT may be associated with altered brain development and risk of neurodevelopmental disorders. In a large and diverse sample of children with data about…
Kaiser Permanente Autism Family Biobank
Kaiser Permanente Autism Family Biobank This project involves sending 3,751 DNA samples from the KP Autism Family Biobank to Mount Sinai School of Medicine to perform whole exome and whole genome sequencing. Funder: Mount Sinai School of Medicine
Comparing the effects of pharmacological treatment for gestational diabetes on long-term maternal and child health outcomes
Comparing the effects of pharmacological treatment for gestational diabetes on long-term maternal and child health outcomes This study will use real-world clinical data on pregnancies with gestational diabetes requiring pharmacological treatment to compare the risk of long-term maternal and child…
The Relationship between Racial Residential Segregation and Prenatal Depression among US-born and non-US born Pregnant Individuals
Research supports that racial residential segregation is associated with depression, yet findings are inconsistent, sparse (among pregnant individuals), and differ by race, ethnicity, and nativity. The study seeks to explore the relationship between racial residential segregation and risk of prenatal…
A retrospective real-world study of treatment patterns and outcomes in pre-term infants 32-37 weeks gestational age with respiratory distress syndrome
A retrospective real-world study of treatment patterns and outcomes in pre-term infants 32-37 weeks gestational age with respiratory distress syndrome To characterize treatment patterns and outcomes in infants 32-37 weeks with respiratory distress, short term outcomes will include modality of…
Developing Data Collection Methods to Understand Race-Related Factors Influencing Genital Herpes Infection Reporting and Acceptance of Prescribed Treatments: Uncovering Other Factors Impacting Treatment Effectiveness to Reduce Racial Disparities
Data Collection Methods to Understand Race-Related Factors Influencing Genital Herpes Infection Reporting and Acceptance of Prescribed Treatments The study seeks to develop data collection methods to determine whether potential race-related factors impacting reporting of genital herpes infection, and acceptance of…
Differences in mid-gestational and early postnatal neonatal cytokines and chemokines are associated with patterns of maternal autoantibodies in the context of autism
Associations between maternal immune dysregulation (including autoimmunity and skewed cytokine/chemokine profiles) and offspring neurodevelopmental disorders such as autism have been reported. In maternal autoantibody-related autism, specific maternally derived autoantibodies can access the fetal compartment to target eight proteins critical for…
Association of Adverse Childhood Experiences and Resilience With Depression and Anxiety During Pregnancy
This was a retrospective cohort study of pregnant individuals in the Kaiser Permanente Northern California system who were screened for adverse childhood experiences and resilience as part of standard prenatal care at about 16 weeks of gestation. Overall, 14,625 pregnancies…
Long-Term Risk of Reintervention After Surgical Leiomyoma Treatment in an Integrated Health Care System
To compare long-term risk of reintervention across four uterus-preserving surgical treatments for leiomyomas and to assess effect modification by sociodemographic factors in a prospective cohort study in an integrated health care delivery system. We studied a cohort of 10,324 patients…
Racial, Ethnic, and Geographic Differences in Vaginal Birth After Cesarean Delivery in the US, 2011-2021
This cross-sectional study examines racial, ethnic, and geographic differences in vaginal birth after cesarean delivery in the US, from 2011 to 2021.
Pubertal Timing Across Asian American, Native Hawaiian, and Pacific Islander Subgroups
Earlier puberty is associated with adverse health outcomes, such as mental health issues in adolescence and cardiometabolic diseases in adulthood. Despite rapid growth of the Asian American, Native Hawaiian, and Pacific Islander populations in the US, limited research exists on…
Bridging Differences in Cohort Analyses of the Relationship between Secondhand Smoke Exposure during Pregnancy and Birth Weight: The Transportability Framework in the ECHO Program
Estimates for the effects of environmental exposures on health outcomes, including secondhand smoke (SHS) exposure, often present considerable variability across studies. Knowledge of the reasons behind these differences can aid our understanding of effects in specific populations as well as…
Group Multimodal Prenatal Care and Postpartum Outcomes
An increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However, research is needed to evaluate outcomes of group multimodal prenatal care (GMPC), with groups delivered virtually in…
Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study
Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage…
Antimicrobial exposure during infancy in a longitudinal California cohort
To describe temporal and sociodemographic patterns of antimicrobial exposure during the first year of life in a large US cohort. Singleton infants born 1998-2014 enrolled in Kaiser Permanente Northern California integrated health system (n = 345,550) were followed longitudinally via comprehensive electronic…
Health Care for Autistic Children: A Public Health Perspective
Autism has been the subject of large-scale public health investment. These investments are increasingly shifting toward mitigating the lifelong disability and impairment associated with autism. Key efforts include bolstering screening schedules, accelerating the path to diagnosis and early entry into…
Pregnancy outcomes in a diverse US Lupus Cohort
Although the population of patients with systemic lupus erythematosus (SLE) is racially and ethnically diverse, many study populations are homogeneous. Further, data are often lacking on critical factors, such as antiphospholipid antibodies (aPLs). We investigated live birth rates in patients…
Longitudinal Changes in Sex Hormone Binding Globulin (SHBG) and Risk of Incident Diabetes: The Study of Women’s Health Across the Nation (SWAN)
To investigate the associations of longitudinal changes in sex hormone binding globulin (SHBG) and testosterone (T) over the menopause transition with the risk of diabetes. We followed 2,952 participants in the Study of Women's Health Across the Nation (SWAN) who…
Gestational thyroid hormones and autism-related traits in the EARLI and HOME studies
Thyroid hormones are essential for neurodevelopment. Few studies have considered associations with quantitatively measured autism spectrum disorder (ASD)-related traits, which may help elucidate associations for a broader population. Participants were drawn from two prospective pregnancy cohorts: the Early Autism Risk…
Hypertension, Cardiovascular Risk Factors, and Uterine Fibroid Diagnosis in Midlife
Fibroids are benign neoplasms associated with severe gynecologic morbidity. There are no strategies to prevent fibroid development. To examine associations of hypertension, antihypertensive treatment, anthropometry, and blood biomarkers with incidence of reported fibroid diagnosis in midlife. The Study of Women's…
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
Limited access to healthy foods, resulting from residence in neighborhoods with low-food access or from household food insecurity, is a public health concern. Contributions of these measures during pregnancy to birth outcomes remain understudied. We examined associations between neighborhood food…
Measurement bias in caregiver-report of early childhood behavior problems across demographic factors in an ECHO-wide diverse sample
Research and clinical practice rely heavily on caregiver-report measures, such as the Child Behavior Checklist 1.5-5 (CBCL/1.5-5), to gather information about early childhood behavior problems and to screen for child psychopathology. While studies have shown that demographic variables influence caregiver…
Behavior reallocations within 24-h movement profiles and change in cardiometabolic biomarkers during pregnancy
The goal of this study was to investigate associations of reallocations within 24-h movement profiles and changes in cardiometabolic biomarkers from early to late pregnancy. In 137 individuals with prepregnancy overweight/obesity, waking movement was measured using wrist-worn accelerometers, sleep was…
History of multifetal gestation and long-term maternal mortality
Multifetal gestation could be associated with higher long-term maternal mortality because it increases the risk of pregnancy complications such as preeclampsia and preterm birth, which are in turn linked to postpartum cardiovascular risk. We examined whether spontaneously conceived multifetal versus…
Prevalence of maternal hyperglycemic subtypes by race/ethnicity and associations between these subtypes with adverse pregnancy outcomes: Findings from a large retrospective multi-ethnic cohort in the United States
With the two-step gestational diabetes mellitus (GDM) screening approach, hyperglycemic subtypes can be identified. We aimed to investigate racial/ethnic differences in the prevalence of hyperglycemic subtypes and to examine the associations between these subtypes and adverse pregnancy outcomes. In this…
Maternal education prospectively predicts child neurocognitive function: An environmental influences on child health outcomes study
A large body of research has established a relation between maternal education and children's neurocognitive functions, such as executive function and language. However, most studies have focused on early childhood and relatively few studies have examined associations with changes in…
Mobile app activity engagement by cancer patients and their caregivers informs remote monitoring
Mobile phone applications ("apps") are potentially an effective, low-burden method to collect patient-reported outcomes outside the clinical setting. Using such apps consistently and in a timely way is critical for complete and accurate data capture, but no studies of concurrent…
Association Between Neighborhood Deprivation in Early Pregnancy and Gestational Diabetes Mellitus
To evaluate whether having a pregnancy in a deprived neighborhood was associated with an increased risk of gestational diabetes mellitus (GDM) compared with having a pregnancy in the least-deprived neighborhoods. This was a retrospective observational cohort study of pregnant individuals…
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…
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…
Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging — Extension Study
This study is an extension of the Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging (RIC). Our aims are to evaluate patterns of medical imaging and associated radiation exposure in children and adults and to determine the risk…
Characterizing uterine fibroid diagnosis and treatment in Asian and Pacific Islander patients
This study will characterize fibroid diagnosis rate, and treatment rate within 5 years of diagnosis, by racial/ethnic group (Asian/Pacific Islander, Black, White, Hispanic, Other) and Asian subgroups (Chinese, Japanese, Filipino, other Southeast Asian, South Asian, Pacific Islander, other/unspecified Asian). The…
Determining the modifying role of prenatal depression on the association between gestational diabetes mellitus and early childhood obesity
This study will explore the potential modifying (i.e., synergistic) impact of prenatal depression on the association between gestational diabetes mellitus (GDM) and childhood weight trajectories, as well as the risk of childhood obesity across various life stages. We hypothesize that…
Elucidating the High and Heterogenous Risk of Gestational Diabetes among Asian Americans: An Integrative Approach of Metabolomics, Lifestyles and Social Determinants
This study will leverage the California Alpha-fetoprotein Screening Program (CA-AFSP) and the Pregnancy Environment and Lifestyle Study (PETALS) to identify metabolites and pathways among Asian American racial/ethnic subpopulations with gestational diabetes in the CA-AFSP discovery set; validate the shared and…
Risk of postpartum readmission after hypertensive disorder of pregnancy and variation by discharge antihypertensive medication prescription
Patients with hypertensive disorders of pregnancy have a high rate of postpartum readmission. We evaluated whether type of antihypertensive medication prescribed at discharge was associated with postpartum readmission after a hypertensive disorder of pregnancy. A retrospective cohort of 57,254 pregnancies…
Metabolomic data presents challenges for epidemiological meta-analysis: a case study of childhood body mass index from the ECHO consortium
Meta-analyses across diverse independent studies provide improved confidence in results. However, within the context of metabolomic epidemiology, meta-analysis investigations are complicated by differences in study design, data acquisition, and other factors that may impact reproducibility. The objective of this study…
Barriers to Healthcare for Latinx Autistic Children and Adolescents
To understand the ways in which autistic Latinx children experience disparities in diagnosis, healthcare, and receipt of specialty services. 417 individuals who identified as Latinx caregivers of autistic children who were members of the same integrated healthcare system in Northern…
Reproductive Health Care in Adolescents with Autism and Other Developmental Disabilities
Adults with developmental disabilities often have less access to reproductive health services than adults without these disabilities. However, little is known about how adolescents with developmental disabilities, including autism, access reproductive health care. We aimed to characterize the utilization of…
Maternal Pre-Pregnancy BMI, Breastfeeding, and Child BMI
Breastfeeding practices may protect against offspring obesity, but this relationship is understudied among women with obesity. We describe the associations between breastfeeding practices and child BMI for age z-score (BMIz), stratified by maternal BMI. We analyzed 8134 dyads from 21…
Inflammatory Conditions During Pregnancy and Risk of Autism and Other Neurodevelopmental Disorders
Maternal inflammation can result from immune dysregulation and metabolic perturbations during pregnancy. Whether conditions associated with inflammation during pregnancy increase the likelihood of autism spectrum disorder (ASD) or other neurodevelopmental disorders (DDs) is not well understood. We conducted a case-control…
Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression
Postpartum depression (PPD) affects up to 20% of childbearing individuals, and a significant limitation in reducing its morbidity is the difficulty in modifying established risk factors. Exposure to synthetic environmental chemicals found in plastics and personal care products, such as…
A mixture of urinary phthalate metabolite concentrations during pregnancy and offspring Social Responsiveness Scale (SRS) scores
Phthalates are a group of chemicals with ubiquitous exposure worldwide. Exposures to phthalates during pregnancy may play a role in autism spectrum disorder (ASD) etiology by disrupting hormone levels or directly impacting fetal neurodevelopment. However, there is little research quantifying…
Mixture of air pollution, brominated flame retardants, polychlorinated biphenyls, per- and polyfluoroalkyl substances, and organochlorine pesticides in relation to vitamin D concentrations in pregnancy
Over two-thirds of pregnant women in the U.S. have insufficient 25(OH)D (Vitamin D) concentrations, which can adversely impact fetal health. Several pollutants have been associated with 25(OH)D, but have not been considered in the context of chemical co-exposures. We aimed…
Training the next generation of delivery science researchers: 10-year experience of a post-doctoral research fellowship program within an integrated care system
Learning health systems require a workforce of researchers trained in the methods of identifying and overcoming barriers to effective, evidence-based care. Most existing postdoctoral training programs, such as NIH-funded postdoctoral T32 awards, support basic and epidemiological science with very limited…
Agreement Between Self-reports and Urine Toxicology Measures of Illicit Methamphetamine and Cocaine Use During Early Pregnancy
This study aimed to assess agreement between self-report and urine toxicology measures assessing use of 2 illicit simulants (methamphetamine and cocaine) during early pregnancy. This cross-sectional study of 203,053 pregnancies from 169,709 individuals receiving prenatal care at Kaiser Permanente Northern…
Gestational diabetes mellitus and risk of neurodevelopmental disorders in young offspring: does the risk differ by race and ethnicity?
Previous studies examined the associations of gestational diabetes mellitus with autism spectrum disorder and attention deficit hyperactivity disorder. However, the associations between gestational diabetes mellitus and other neurodevelopmental disorders, such as the common speech/language disorder and developmental coordination disorder, are…
Associations of Organophosphate Ester Flame Retardant Exposures during Pregnancy with Gestational Duration and Fetal Growth: The Environmental influences on Child Health Outcomes (ECHO) Program
Widespread exposure to organophosphate ester (OPE) flame retardants with potential reproductive toxicity raises concern regarding the impacts of gestational exposure on birth outcomes. Previous studies of prenatal OPE exposure and birth outcomes had limited sample sizes, with inconclusive results. We…
Altered cytokine and chemokine profile linked to autoantibody and pathogen reactivity in mothers of autistic children
Maternal autoimmunity, and more specifically, the production of specific maternal autoantibodies, has been associated with altered offspring neurodevelopment. Maternal autoantibody-related (MAR) autism is a subtype of autism that is linked to gestational exposure to certain combinations of autoantibodies to proteins…
Exposure to air pollution is associated with DNA methylation changes in sperm
Exposure to air pollutants has been associated with adverse health outcomes in adults and children who were prenatally exposed. In addition to reducing exposure to air pollutants, it is important to identify their biologic targets in order to mitigate the…
Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis
Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. Systematic literature searches were…
Maternal obesity and childhood asthma risk: Exploring mediating pathways
Growing evidence for the effect of maternal obesity on childhood asthma motivates investigation of mediating pathways. To investigate if childhood body mass index (BMI), gestational weight gain (GWG) and preterm birth mediate the association of maternal obesity on childhood asthma…
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
Economic hardships imposed by the pandemic could have implications for children's experiences of adversity in the home, or Adverse Childhood Experiences (ACEs). This observational cohort study examined associations between COVID-19-related hardships and distress (e.g., job loss, caregiver stress) and the…
Longitudinal lipidomic profiles during pregnancy and associations with neonatal anthropometry: findings from a multiracial cohort
Maternal lipidomic profiling offers promise for characterizing lipid metabolites during pregnancy, but longitudinal data are limited. This study aimed to examine associations of longitudinal lipidomic profiles during pregnancy with multiple neonatal anthropometry using data from a multiracial cohort. We measured…
Intrinsic motivation for physical activity, healthy eating, and self-weighing in association with corresponding behaviors in early pregnancy
Healthy lifestyle behaviors influence maternal cardiovascular health, but motivation for them in pregnancy is poorly understood. We examined whether intrinsic motivation (assessed on 5-point scales for each behavior) is associated with three lifestyle behaviors in early pregnancy: physical activity, by…
Perinatal Hypoxic-Ischemic Encephalopathy: Incidence Over Time Within a Modern US Birth Cohort
Recent studies suggest that the incidence of perinatal hypoxic-ischemic encephalopathy (HIE) may be increasing in developed countries. However, this observed increase may be due to increased ascertainment and increased treatment with therapeutic hypothermia rather than an increase in disease burden…
Neonatal Outcomes Associated with In Utero Cannabis Exposure: A Population-Based Retrospective Cohort Study
The full spectrum of associations between in utero cannabis exposure and adverse neonatal outcomes is still unclear. This study evaluates associations between in utero cannabis exposure and neonatal outcomes. This population-based retrospective cohort study of singleton births among Kaiser Permanente…
Weight loss, stability and low weight gain during pregnancy among individuals with obesity: associations with adverse perinatal outcomes: an observational study
The safety of weight loss and low weight gain during pregnancy remains unclear. To determine how different patterns of gestational weight gain (GWG), including weight loss, stability and low GWG relate to perinatal outcomes by prepregnancy obesity class. The study…
Development and psychometric validation of the Pandemic-Related Traumatic Stress Scale for children and adults
To assess the public health impact of the COVID-19 pandemic on mental health, investigators from the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) research program developed the Pandemic-Related Traumatic Stress Scale (PTSS). Based on the Diagnostic…
Effectiveness of COVID-19 vaccination during pregnancy by circulating viral variant
SARS-CoV-2 infection in pregnancy can result in a spectrum of asymptomatic to critical COVID-19 outcomes, including hospitalization, admission to the intensive care unit, or death. This study aimed to investigate the effectiveness of messenger RNA COVID-19 vaccination during pregnancy against…
Neighborhood Disadvantage, Race and Ethnicity, and Postpartum Depression
Postpartum depression (PPD) is a debilitating condition with higher rates among Black individuals. Increasingly, neighborhood disadvantage is being recognized as a contributor to poor health and may be associated with adverse postpartum mental health; however, associations between neighborhood disadvantage, race…
Opportunities for Examining Child Health Impacts of Early-Life Nutrition in the ECHO Program: Maternal and Child Dietary Intake Data from Pregnancy to Adolescence
Longitudinal measures of diet spanning pregnancy through adolescence are needed from a large, diverse sample to advance research on the effect of early-life nutrition on child health. The Environmental influences on Child Health Outcomes (ECHO) Program, which includes 69 cohorts,…
Grosvenor, Luke P.
Research interests include autism spectrum disorder and perinatal health conditions.
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…
Preconception and Prenatal Health Impacting Factors and Child Health
The study will recruit a diverse cohort of 1,800 pregnant individuals, the conceiving partner, their resulting child, and will follow all of them at multiple visits after the child is born to contribute to the Environmental influences on Child Health…
Management of Paxlovid eVisits by Pharmacists and Primary Care Physicians
This study will compare pharmacist management of e-visit requests for Paxlovid for COVID-19 with usual care management by primary care physicians regarding costs, time, clinical outcomes, and patient and clinician satisfaction.
Independent Impact of Eat, Sleep, Console Assessment on Neonatal Opioid Withdrawal Syndrome
Compared with the Finnegan Neonatal Abstinence Scoring System (FNASS), the Eat, Sleep, Console (ESC) approach reduces pharmacotherapy and length of stay (LOS) for neonatal opioid withdrawal syndrome (NOWS) infants. The independent outcome contribution of ESC is unknown as the approach…
Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine
Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop…
Association between maternal prenatal cannabis use and missed child preventive care visits in an integrated health care delivery system in Northern California
The periodicity of well-child visits recommended by the American Academy of Pediatrics emphasizes the importance of continuity of care in health management. Exposure to cannabis in utero has been associated with adverse development, and adherence to well-child visits is critical…
Accounting for Nulliparity in the Prediction of Hypoxic-Ischemic Encephalopathy Using Cardiotocography
Nulliparous pregnancies, those where the mother has not previously given birth, are associated with longer labors and hence expose the fetus to more contractions and other adverse intrapartum conditions such as chorioamnionitis. The objective of the present study was to…
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
Per- and polyfluoroalkyl substances (PFAS) are persistent synthetic chemicals and are commonly found in everyday items. PFAS have been linked to disrupting glucose homeostasis, however, whether they are associated with gestational diabetes mellitus (GDM) risk remains inconclusive. We examined prospective…
Kelly-Taylor, Kendria
Research interests include reproductive health inequities among Black populations.
Individual and neighborhood factors associated with being unvaccinated against COVID-19 among pregnant persons
We investigated whether unvaccinated pregnant persons cluster geographically and determined factors associated with being unvaccinated using spatial and multivariate logistic regression analyses. Pregnant persons with deliveries from December 15, 2020, through September 30, 2022, at Kaiser Permanente Northern California were…
Updates to the Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda
Autistic individuals, now representing one in 36 individuals in the U.S., experience disproportionate physical health challenges relative to non-autistic individuals. The Health Resources and Services Administration's (HRSA) Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multi-center Research…
Long-term adverse health outcomes for women and children following SARS-CoV-2 infection during pregnancy
The study will assemble a longitudinal cohort of more than 195,000 pregnant women (>22,000 women with SARS-CoV-2 infection during pregnancy and approximately >173,000 without) between March 2020 and December 2022. We will use our comprehensive EHR to follow women and…
Moderna Cytomegalovirus Child Hearing and Autism Study (MOCCHA)
Human cytomegalovirus (CMV) is the most common infection acquired before birth. In the US, about 1 of every 150 to 200 infants (0.5%-0.67%) are born with congenital CMV (cCMV). About 1 in 5 infants with cCMV infection will experience long-term…
Prenatal Weight Change Trajectories and Perinatal Outcomes among Twin Gestations
Despite an increase in twin pregnancies in recent decades, the Institute of Medicine twin weight gain recommendations remain provisional and provide no guidance for the pattern or timing of weight change. We sought to characterize gestational weight change trajectory patterns…
Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort
Tools for assessing multiple exposures across several domains (e.g., physical, chemical, and social) are of growing importance in social and environmental epidemiology because of their value in uncovering disparities and their impact on health outcomes. Here we describe work done…
Timely Detection of Infants at Risk of Intrapartum Acidosis and Hypoxic-Ischemic Encephalopathy Using Cardiotocography
This work aims to improve the intrapartum detection of fetuses with an increased risk of developing fetal acidosis or hypoxic-ischemic encephalopathy (HIE) using fetal heart rate (FHR) and uterine pressure (UP) signals. Our study population comprised 40,831 term births divided…
Novel approaches to examining weight changes in pregnancies affected by obesity
Current gestational weight change (GWC) recommendations for obese individuals were established with limited evidence of the pattern and timing of weight change across pregnancy. Similarly, the recommendation of 5-9 kg does not differentiate by the severity of obesity. We sought…
Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes
Epidemiologic evidence linking prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with altered neurodevelopment is inconclusive, and few large studies have focused on autism-related outcomes. We investigated whether blood concentrations of PFAS in pregnancy are associated with child autism-related outcomes…
Prepregnancy Body Mass Index and Risk of Childhood Asthma
Growing evidence suggests that maternal obesity may affect the intrauterine environment and increase a child's risk of developing asthma. We aim to investigate the relationship between prepregnancy obesity and childhood asthma risk. Cohorts of children enrolled in Kaiser Permanente Northern…
Opportunities for Inclusion and Engagement in the Transition of Autistic Youth from Pediatric to Adult Healthcare: A Qualitative Study
Transitioning autistic youth from pediatric to adult healthcare requires coordination of multiple stakeholders, including youth, caregivers, and pediatric and adult care providers, whose interests at times overlap but often differ. To understand barriers and facilitators to inclusive transition experiences, we…
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…
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…
GEARs Combining advances in Genomics and Environmental science to accelerate Actionable Research and practice in ASD
The Autism Centers of Excellence (ACE) program is a trans-NIH initiative that supports large-scale studies on autism spectrum disorder. A priority area for the ACE program is work that will advance our understanding of the biologic mechanisms underlying gene-environment interplay…
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
In this 28-year prospective study of 455 women (mean age: 26 years), polycystic ovary syndrome (PCOS) was associated with a 2.6-fold elevated risk of gestational diabetes (GDM). However, hyperandrogenism or oligomenorrhea in the absence of PCOS was not associated with GDM.
NICU Versus Mother/Baby Unit Admission for Low-Acuity Infants Born at 35 Weeks’ Gestation
To estimate the effect of NICU admission of low-acuity infants born at 35 weeks' gestation versus care in a mother/baby unit, on inpatient and outpatient medical outcomes. This retrospective cohort study included 5929 low-acuity infants born at 350/7 to 356/7…
Changes in Body Mass Index Among School-Aged Youths Following Implementation of the Healthy, Hunger-Free Kids Act of 2010
The prevalence of obesity among youths 2 to 19 years of age in the US from 2017 to 2018 was 19.3%; previous studies suggested that school lunch consumption was associated with increased obesity. 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
Epidemiologic evidence has linked refined grain intake to a higher risk of gestational diabetes (GDM), but the biological underpinnings remain unclear. We aimed to identify and validate refined grain-related metabolomic biomarkers for GDM risk. In a metabolome-wide association study of…
Incidence Rates of Medically Attended COVID-19 in Infants Less Than 6 Months of Age
Studies suggest infants may be at increased risk of severe coronavirus disease 2019 (COVID-19) relative to older children, but few data exist regarding the incidence of COVID-19 episodes and associated risk factors. We estimate incidence rates and describe characteristics associated…
Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study
Prenatal antidepressant exposure has been associated with increased risk for neurodevelopmental disorders in childhood, including autism spectrum disorder (ASD). The current study utilized multi-cohort data from the Environmental influences on Child Health Outcomes (ECHO) program (N = 3129) to test for this…
Racial-Ethnic Differences in Treatment Initiation for New Diagnoses of Perinatal Depression
The adverse consequences of untreated perinatal depression highlight the need to identify populations to target in order to increase treatment rates. The authors sought to evaluate treatment initiation for a new diagnosis of depression during pregnancy or postpartum and to…
Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program
Descriptive epidemiological data on incidence rates (IRs) of asthma with recurrent exacerbations (ARE) are sparse. We hypothesized that IRs for ARE would vary by time, geography, age, race and ethnicity, irrespective of parental asthma history. We leveraged data from 17246…
The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort
The Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States…
Modifying the social responsiveness scale for adaptive administration
The social responsiveness scale (SRS) is frequently used to quantify the autism-related phenotype and is gaining use in health outcomes research. However, it has a high respondent burden (65 items) for large-scale studies. Further, most evaluations of it have focused…
A framework for measuring the cost to families of caring for children’s health: the design, methodology, and study population of the r-Kids study
All families experience financial and time costs related to caring for their children's health. Understanding the economic burden faced by families of children with chronic health conditions (CHC) is crucial for designing effective policies to support families. In this prospective…
Rates of malignancies among patients with moderate to severe atopic dermatitis: a retrospective cohort study
Patients with atopic dermatitis (AD), also known as eczema, may be at an increased risk for malignancies compared with patients without AD; however, incidence rates (IRs) of malignancies in patients with moderate to severe AD are largely unknown. The objective…
Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the COVID-19 pandemic
Abstract. Studies have reported mixed findings regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women and birth outcomes. This study used a quasi-experimental design to account for potential confounding by sociodemographic characteristics. Data were drawn from…
Using Peer Support to Prevent Diabetes: Results of a Pragmatic RCT
High-contact structured diabetes prevention programs are effective in lowering weight and HbA1cs, yet their intensity level can create barriers to participation. Peer support programs improve clinical outcomes among adults with Type 2 diabetes, but their effectiveness in diabetes prevention is…
Associations between antidepressant use patterns during pregnancy and birth outcomes among periconception antidepressant users
Little is known about antidepressant medication use patterns during pregnancy among periconception (before and immediately following conception) users. Additionally, the associations between these patterns and birth outcomes is unclear, after taking into account underlying depression severity. This study describes patterns…
Evaluation of the EmbrACE Intervention for Pregnant Adults with a History of Adverse Childhood Experiences
Feasibility study of a 6-week virtual intervention for pregnant women with high adverse childhood experience (ACE) exposure and moderate to moderate-severe depression to reduce perinatal depression symptoms. Study will enroll and randomize participants to the 6-week virtual EmbrACE program or…
Wellness coaching during pregnancy and maternal weight outcomes
Study to determine if individuals who participated in Wellness Coaching have lower risk of high gestational weight gain and postpartum weight retention compared with individuals who did not participate in Wellness Coaching. Electronic health record data will be used to…
Associations between Glycemic Control Trajectories among Individuals with Gestational Diabetes and Obesity Risk and Growth Trajectories in the Offspring
The study will examine the association between glycemic control trajectories among individuals with gestational diabetes (GDM) included in the GDM registry and the risk of childhood obesity and growth trajectories in the offspring. Glycemic control trajectories provide unique insights into…
Evaluating patient engagement in “KP Connected Pregnancy Care” and its association with utilization, perinatal outcomes and patient satisfaction.
This cohort study evaluates a new prenatal care delivery pathway, KP Connected Pregnancy Care (KPCPC). KPCPC is an opt-in hybrid in-person and virtual care model using digital tools to expand remote patient monitoring and virtual visits for low-risk prenatal care…
Prenatal medication exposure in autism, birth complications and developmental disabilities
Systematically investigate the effects of maternal medication use in pregnancy on offspring autism spectrum disorder (ASD) risk. Test the mechanisms underlying the associations between maternal medication use and ASD. Establish the specificity and generalizability of maternal medication effects on ASD.
Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental Influences on Child Health Outcomes (ECHO) Program
Per- and polyfluoroalkyl substances (PFAS) are persistent and ubiquitous chemicals associated with risk of adverse birth outcomes. Results of previous studies have been inconsistent. Associations between PFAS and birth outcomes may be affected by psychosocial stress. We estimated risk of…
Perinatal Outcomes After Bariatric Surgery Compared With a Matched Control Group
To evaluate perinatal outcomes associated with pregnancy after bariatric surgery within a large integrated health care system using propensity score matching. We conducted a retrospective cohort study that evaluated perinatal outcomes in pregnant patients after bariatric surgery from January 2012…
Metabolomic biomarkers of the mediterranean diet in pregnant individuals: A prospective study
Metabolomic profiling is a systematic approach to identifying biomarkers for dietary patterns. Yet, metabolomic markers for dietary patterns in pregnant individuals have not been investigated. The aim of this study was to identify plasma metabolomic markers and metabolite panels that…
Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study
Childhood maltreatment is associated with adverse health outcomes and this risk can be transmitted to the next generation. We aimed to investigate the association between exposure to maternal childhood maltreatment and common childhood physical and mental health problems, neurodevelopmental disorders,…
The impact of autism spectrum disorder on parent employment: Results from the r-Kids study
Parents of children with autism spectrum disorder (ASD) and other chronic health conditions often face exceptional caregiving demands that can lead to challenges related to maintaining and succeeding in employment. Detailed information on the specific ways in which these health…
Accuracy of diagnostic codes for prenatal opioid exposure and neonatal opioid withdrawal syndrome
Determine the accuracy of diagnostic codes in identifying Prenatal Opioid Exposure (POE) and Neonatal Opioid Withdrawal Syndrome (NOWS). A cross-sectional study of 374,222 mother-infant dyads with delivery from 01/01/2010 to 12/31/2019. We ascertained maternal diagnostic codes for opioid use during…
Healthcare transition outcomes among autistic youth at KPNC
The study follows a cohort of autistic and non-autistic youth longitudinally to examine several transition indicators measurable in the EHR including: continuation of medications and other treatments during the transition years; length of time elapsed between last pediatric appointment and…
Maternal and neonatal outcomes associated with treating hypertension in pregnancy at different thresholds
In the United States, there has been controversy over whether treatment of mild-to-moderate hypertension during pregnancy conveys more benefit than risk. The objective of the study was to compare risks and benefits of treatment of mild-to-moderate hypertension during pregnancy. This…
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
We sought to evaluate the impact of the COVID-19 pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic. Data dyads…
SARS-CoV-2 testing and detection during peripartum hospitalizations among a multi-center cohort of pregnant persons, March 2020-February 2021
Identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections during peripartum hospitalizations is important to guide care, implement prevention measures, and understand infection burden. This cross-sectional analysis used electronic health record data from hospitalizations during which pregnancies ended (peripartum hospitalizations)…
Dietary Quality Indices in Early Pregnancy and Rate of Gestational Weight Gain among a Prospective Multi-Racial and Ethnic Cohort
Meeting the Institute of Medicine (IOM) gestational weight gain (GWG) guidelines is associated with a reduced risk of adverse perinatal outcomes. Overall diet quality comprehensively assesses dietary components and accounts for interactions between them. While GWG is influenced by maternal…
Association of the COVID-19 Pandemic With Unstable and/or Unsafe Living Situations and Intimate Partner Violence Among Pregnant Individuals
The social, behavioral, and economic consequences of the COVID-19 pandemic may be associated with unstable and/or unsafe living situations and intimate partner violence (IPV) among pregnant individuals. To investigate trends in unstable and/or unsafe living situations and IPV among pregnant…
Trends in Screen Time Use Among Children During the COVID-19 Pandemic, July 2019 Through August 2021
The COVID-19 pandemic led to widespread lockdowns and school closures that may have affected screen time among children. Although restrictions were strongest early in the pandemic, it is unclear how screen time changed as the pandemic progressed. To evaluate change…
Daytime napping and nighttime sleep in pregnant individuals with insomnia disorder
Examine bidirectional associations between daytime napping and nighttime sleep among pregnant individuals with insomnia disorder. We used baseline data from a randomized controlled trial of insomnia treatment during pregnancy (n = 116). Participants in their second or third trimester of…
Association of cannabis use during pregnancy with severe acute respiratory syndrome coronavirus 2 infection: a retrospective cohort study
Cannabis use is increasingly common among pregnant individuals and might be a risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to test whether prenatal cannabis use is associated with increased risk of SARS-CoV-2 infection during…
Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study
Sleep in childhood is affected by behavioral, environmental, and parental factors. We propose that these factors were altered during the COVID-19 pandemic. This study investigates sleep habit changes during the pandemic in 528 children 4-12 years old in the US,…
Placental Histopathologic Findings of a Large Cohort of Patients With SARS-CoV-2 Infection During Pregnancy
Pregnant individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at a higher risk for adverse pregnancy outcomes. Previous small cohort studies have shown increased frequency of placental lesions associated with maternal vascular malperfusion, fetal vascular malperfusion, and inflammation…
Ambient air pollutants are associated with morning serum cortisol in overweight and obese Latino youth in Los Angeles.
BACKGROUND: Hypothalamic-pituitary-adrenal (HPA)-axis dysfunction has been associated with a variety of mental health and cardio-metabolic disorders. While causal models of HPA-axis dysregulation have been largely focused on either pre-existing health conditions or psychosocial stress factors, recent evidence suggests a possible…
Prenatal Maternal Cortisol Levels and Infant Birth Weight in a Predominately Low-Income Hispanic Cohort.
Infant birth weight influences numerous health outcomes throughout the life course including childhood obesity and metabolic morbidities. Maternal experience of stress, both before and during pregnancy, has been hypothesized to influence fetal growth and birth outcomes. However, these associations currently…
Third trimester cortisol is positively associated with gestational weight gain in pregnant women with class one obesity.
BACKGROUND/OBJECTIVE: Prevalence of pre-pregnancy obesity and excessive gestational weight gain (GWG) are higher among women of color with low SES. Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and its end-product, cortisol, during pregnancy is hypothesized to be associated with excessive GWG…
Effects of COVID-19 Financial and Social Hardships on Infants’ and Toddlers’ Development in the ECHO Program
The financial hardships and social isolation experienced during the COVID-19 pandemic have been found to adversely affect children's developmental outcomes. While many studies thus far have focused on school-aged children and the pandemic-related impacts on their academic skills and behavior…
Indoor and outdoor air pollution and couple fecundability: a systematic review
Air pollution is both a sensory blight and a threat to human health. Inhaled environmental pollutants can be naturally occurring or human-made, and include traffic-related air pollution (TRAP), ozone, particulate matter (PM) and volatile organic compounds, among other substances, including…
Pregnancy post-bariatric surgery: Improved outcomes with telephonic nutritional management program
Pregnancies post-bariatric surgery are increasingly common. It is important to understand how to manage prenatal care in this high-risk population to optimize perinatal outcomes. To determine among pregnancies post-bariatric surgery whether participation in a telephonic nutritional management program was associated…
Prenatal Opioid Exposure and Neurodevelopmental Outcomes
The opioid epidemic in the United States has resulted in a significant increase in opioid use disorder among pregnant women and a concomitant increase in the incidence of neonatal opioid withdrawal syndrome. The long-term consequences of prenatal opioid exposure on…
Perinatal Anesthesia Exposure and Autism Spectrum Disorders
Epidural analgesia is frequently used during labor among pregnant people in the United States. Different factors have been associated with the development of autism spectrum disorder in the epidemiological literature: maternal health, infectious and pharmacological etiologies, social factors, and environmental…
Method for Activity Sleep Harmonization (MASH): a novel method for harmonizing data from two wearable devices to estimate 24-h sleep-wake cycles
Daily 24-h sleep-wake cycles have important implications for health, however researcher preferences in choice and location of wearable devices for behavior measurement can make 24-h cycles difficult to estimate. Further, missing data due to device malfunction, improper initialization, and/or the…
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
In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects…
Changes in COVID-19 Vaccine Intent Among a Diverse Population of Older Adults, June 2021-February 2022
Introduction COVID-19 vaccination rates remain suboptimal in the United States. Clinicians and policymakers need to better understand how likely vaccine-hesitant individuals are to ultimately accept vaccination and what is associated with such changes. This study's aims were to 1) describe…
Habitual coffee consumption and subsequent risk of type 2 diabetes in individuals with a history of gestational diabetes – a prospective study
Females with a history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes mellitus (T2D) later in life. This study prospectively examined whether greater habitual coffee consumption was related to a lower risk of T2D…
Physical activity and individual plasma phospholipid saturated fatty acids in pregnancy, a longitudinal study among a multiracial/multiethnic cohort in the United States
Circulating individual SFAs in pregnant females are critical for maternal and fetal health. However, research on identifying their modifiable factors is limited. We aimed to examine the associations of total physical activity (PA) and types of PA with circulating individual…
Examining shortened versions of the Social Responsiveness Scale for use in autism spectrum disorder prediction and as a quantitative trait measure: Results from a validation study of 3-5 year old children
The Social Responsiveness Scale (SRS) is a 65-item measure yielding a continuous score capturing autism-related traits. Scores based on SRS item subsets have been analytically examined but administration of shortened versions has not been evaluated prospectively. The goal of this…
Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults
Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the…
Associations of Neighborhood Opportunity and Social Vulnerability With Trajectories of Childhood Body Mass Index and Obesity Among US Children
Physical and social neighborhood attributes may have implications for children's growth and development patterns. The extent to which these attributes are associated with body mass index (BMI) trajectories and obesity risk from childhood to adolescence remains understudied. To examine associations…
COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US
The primary outcomes of the COVID-19 pandemic on the mental health of women with children remain largely unknown. To identify and describe clusters of mothers of children participating in the Environmental influences on Child Health Outcomes (ECHO) Program that characterize…
Changes in 24-Hour Movement Behaviors From Early to Late Pregnancy in Individuals With Prepregnancy Overweight or Obesity
Understanding how sleep, sedentary behavior (SED), and physical activity (PA) (24-h movement profile) changes across pregnancy in individuals with prepregnancy overweight or obesity and how parity (previous births) impacts these changes can help inform interventions. In 155 participants, movement was…
Plasma Phospholipids Monounsaturated Fatty Acids and Gestational Diabetes Mellitus: a Longitudinal Study in the NICHD Fetal Growth Studies-Singleton Cohort
Fatty acids (FAs) have been implicated in the development of gestational diabetes mellitus (GDM), but the role of monounsaturated FAs (MUFAs) remains understudied. We investigated the associations of plasma phospholipid MUFAs in early to mid-pregnancy with cardiometabolic biomarkers and GDM…
Associations between accelerated parental biologic age, autism spectrum disorder, social traits, and developmental and cognitive outcomes in their children
Parental age is a known risk factor for autism spectrum disorder (ASD), however, studies to identify the biologic changes underpinning this association are limited. In recent years, "epigenetic clock" algorithms have been developed to estimate biologic age and to evaluate…
Urinary Phenols in Early to Mid-Pregnancy and Risk of Gestational Diabetes: A Longitudinal Study in a Multiracial Cohort
Environmental phenols are ubiquitous endocrine disruptors and putatively diabetogenic. However, data during pregnancy are scant. We investigated the prospective associations between pregnancy phenol concentrations and gestational diabetes mellitus (GDM) risk. In a nested matched case-control study of 111 individuals with…
The clinical burden of extremely preterm birth in a large medical records database in the United States: complications, medication use, and healthcare resource utilization
Approximately 5% of global preterm births are extremely premature (EP), defined as occurring at less than 28?weeks gestational age. Advances in care have led to an increase in the survival of EP infants during the neonatal period. However, EP infants…
Efficacious lifestyle interventions for appropriate gestational weight gain in women with overweight or obesity set in the health care system: a scoping review
Purpose: Health care systems offer opportunities to scale up interventions for appropriate gestational weight gain (GWG); however, GWG interventions in the health care setting remain largely unavailable to women with overweight or obesity. To inform the translation of efficacious lifestyle…
Antepartum and intrapartum stillbirth rates across gestation: a cross-sectional study using the revised foetal death reporting system in the U.S
There is a renewed call to address preventable foetal deaths in high-income countries, especially where progress has been slow. The Centers for Disease Control and Prevention released publicly, for the first time, the initiating cause and estimated timing of foetal…
Sujan, Ayesha
Ayesha Sujan, PhD, is a postdoctoral research fellow in the Kaiser Permanente Division of Research specializing in maternal mental health and substance use. She completed her doctoral training in the Department of Psychological and Brian Sciences at Indiana University –…
Chehab, Rana
Research interests include maternal and child health and health across the life course.
Mitro, Susanna
Research interests include women’s cardiometabolic health and environmental chemical exposures.
Badon, Sylvia
Research interests include perinatal epidemiology, specializing in maternal lifestyle during pregnancy.
Brown, Susan
Research interests include behavioral interventions for weight management, physical activity, and dietary change.
Kuzniewicz, Michael W
Research interests include perinatal health services research and perinatal clinical epidemiology
Lieu, Tracy A.
Research interest include child health services research; effectiveness and delivery of primary care; and decision sciences, including decision analysis
Croen, Lisa A.
Research interests include the epidemiology of autism and other neurodevelopmental disorders.
Ehrlich, Samantha F.
Research interests include epidemiology of gestational diabetes, diabetes and obesity prevention exercise and women's health
Ferrara, Assiamira
Research interests include the epidemiology of diabetes and gestational diabetes.
Association between Quality of Maternal Prenatal Food Source and Preparation and Breastfeeding Duration in the Environmental Influences on Child Health Outcome (ECHO) Program
This study examined the relationship between maternal food source and preparation during pregnancy and the duration of breastfeeding among 751 mother-child dyads in the United States. The data collected from the Environmental influences on Child Health Outcomes (ECHO) Program included…
Association of serum folate levels during pregnancy and prenatal depression
To evaluate the association between serum folate levels during pregnancy and prenatal depression and the extent to which obesity may modify this relationship. This secondary data analysis leveraged data from a previous study of pregnant Kaiser Permanente Northern California participants…
SEED Follow-Up Study
SEED is a case-control study comparing children aged 2-5 years with autism spectrum disorder to children with other developmental disabilities. The SEED Follow-up Study is a longitudinal study designed to improve understanding of risk factors and expression of autism spectrum…
Medically Attended Influenza During Pregnancy in the 2019-2020 and 2020-2021 Influenza Seasons
Influenza testing and case-confirmation rates in pregnant populations have not been reported during the coronavirus disease 2019 (COVID-19) pandemic. Using electronic medical record data from a cohort of nearly 20,000 pregnancies in the United States, this retrospective cohort study examines…
Geographic Accessibility of Retail Cannabis in Northern California and Prenatal Cannabis Use During the COVID-19 Pandemic
Prenatal cannabis use is associated with health risks for mothers and their children. Prior research suggests that rates of prenatal cannabis use in Northern California increased during the COVID-19 pandemic, but it is unknown whether increases varied with the local…
Time to positivity of blood cultures in neonatal late-onset bacteraemia
To determine the time to positivity (TTP) of blood cultures among infants with late-onset bacteraemia and predictors of TTP >36 hours. Retrospective cohort study. 16 birth centres in two healthcare systems. Infants with positive blood cultures obtained >72 hours after birth. The…
Peri-Pregnancy Cannabis Use and Autism Spectrum Disorder in the Offspring: Findings from the Study to Explore Early Development
The association of autism spectrum disorder (ASD) with self-reported maternal cannabis use from 3 months pre-conception to delivery ("peri-pregnancy") was assessed in children aged 30-68 months, born 2003 to 2011. Children with ASD (N = 1428) were compared to children with other developmental delays/disorders…
Patterns of Substance Use During Early Pregnancy and Associations With Behavioral Health Characteristics
The aims of the study are to identify patterns of early pregnancy substance use and to examine how these patterns relate to behavioral health conditions measured in early pregnancy. We conducted a retrospective observational study (N= 265,274 pregnancies) screened for…
Reconciling Between Medication Orders and Medication Fills for Lupus in Pregnancy
Most studies consider either medications ordered or filled, but not both. Medication underuse based on filling data cannot necessarily be ascribed to patient nonadherence. Using both data sources, we quantified primary medication adherence in a cohort of prevalent systemic lupus…
Gestational diabetes mellitus, prenatal maternal depression, and risk for postpartum depression: an Environmental influences on Child Health Outcomes (ECHO) Study
Prior research has demonstrated bidirectional associations between gestational diabetes mellitus (GDM) and perinatal maternal depression. However, the association between GDM, prenatal depression, and postpartum depression (PPD) has not been examined in a prospective cohort longitudinally. Participants in the current analysis…
Development and validation of prediction models for gestational diabetes treatment modality using supervised machine learning: a population-based cohort study
Gestational diabetes (GDM) is prevalent and benefits from timely and effective treatment, given the short window to impact glycemic control. Clinicians face major barriers to choosing effectively among treatment modalities [medical nutrition therapy (MNT) with or without pharmacologic treatment (antidiabetic…
Strategies Facilitating Video Visit Implementation by a Medical Group Serving a Diverse Population
IntroductionVideo visits have created new opportunities to enhance access to care, but limited information exists on strategies medical groups can employ to facilitate video visit use by higher-risk patients. Our objective was to identify generalizable strategies to facilitate successful delivery…
Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study
In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse…
Glycemic Control Trajectories and Risk of Perinatal Complications Among Individuals With Gestational Diabetes
Glycemic control is the cornerstone of gestational diabetes management. Glycemic control trajectories account for differences in longitudinal patterns throughout pregnancy; however, studies on glycemic control trajectories are scarce. To examine whether glycemic control trajectories from gestational diabetes diagnosis to delivery…
Changes in BMI During the COVID-19 Pandemic
Experts hypothesized increased weight gain in children associated with the coronavirus disease 2019 (COVID-19) pandemic. Our objective was to evaluate whether the rate of change of child body mass index (BMI) increased during the COVID-19 pandemic compared with prepandemic years…
Maternal autoantibody profiles as biomarkers for ASD and ASD with co-occurring intellectual disability
Maternal autoantibody-related ASD (MAR ASD) is a subtype of autism in which pathogenic maternal autoantibodies (IgG) cross the placenta, access the developing brain, and cause neurodevelopmental alterations and behaviors associated with autism in the exposed offspring. We previously reported maternal…
Ovarian Cystadenomas: Growth Rate and Reliability of Imaging Measurements
To evaluate the growth rate of benign ovarian cystadenomas and the degree of variability in ultrasound measurements. Two independent retrospective cohorts of women found to have benign cystadenomas at surgery were identified. To assess growth rate, ultrasounds on women in…
Adverse short- and long-term outcomes among infants with mild neonatal encephalopathy
Studies in newborns with mild neonatal encephalopathy (mNE) demonstrated normal outcomes, but recent literature suggests otherwise. This retrospective cohort study examined inborn infants between 2014 and 2017. Biochemical and clinical characteristics determined the presence of NE and an encephalopathy score…
Examining the Factors for the Rapid Rise of Colorectal Cancer in Young Adults: Does Increased Medical Use of Radiation and Imaging Technology Contribute to the Rise?
This study is examining whether the secular increase in use of medical radiation therapy and diagnostic imaging technology is associated with the corresponding secular increase in the risk of colorectal cancer among young adults age 50 and under.
Prenatal vitamin intake in first month of pregnancy and DNA methylation in cord blood and placenta in two prospective cohorts
Prenatal vitamin use is recommended before and during pregnancies for normal fetal development. Prenatal vitamins do not have a standard formulation, but many contain calcium, folic acid, iodine, iron, omega-3 fatty acids, zinc, and vitamins A, B6, B12, and D,…
In-utero cannabis exposure and long-term psychiatric and neurodevelopmental outcomes: The limitations of existing literature and recommendations for future research
Given increases in cannabis use in pregnancy and animal model research showing effects of in-utero cannabis exposure, high-quality information on long-term consequences of in-utero cannabis exposure in humans is needed. While reviews have summarized findings from observational studies with humans,…
The clinical burden of extremely preterm birth in a large medical records database in the United States: Mortality and survival associated with selected complications
Preterm birth is a leading cause of infant mortality, particularly for those born extremely prematurely (EP;
Predictive Metabolomic Markers in Early to Mid-Pregnancy for Gestational Diabetes: A Prospective Test and Validation Study
Gestational diabetes mellitus (GDM) predisposes pregnant individuals to perinatal complications and long-term diabetes and cardiovascular diseases. We developed and validated metabolomic markers for GDM in a prospective test-validation study. In a case-control sample within the PETALS cohort (GDM n =…
Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children
This longitudinal study compared children's health behaviors before the COVID-19 pandemic versus during the pandemic. This analysis examined the association between individual-level characteristics and health behavior change. Four prospective cohort studies in the Environmental influences on Child Health Outcomes (ECHO)…
Cardiometabolic Pregnancy Complications in Association with Autism-Related Traits as Measured by the Social Responsiveness Scale in ECHO
Prior work has examined associations between cardiometabolic pregnancy complications and autism spectrum disorder (ASD) but not how these complications may relate to social communication traits more broadly. We addressed this question within the Environmental Influences on Child Health Outcomes program,…
Sociodemographic Variation in Children’s Health Behaviors During the COVID-19 Pandemic
Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping…
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
Patients with gestational diabetes mellitus and from racial/ethnic minority groups face disproportionate risk for type 2 diabetes. Lifestyle interventions, if accessible and acceptable to diverse patients, could advance diabetes prevention and mitigate racial/ethnic disparities. Here we describe overall and race/ethnicity-specific…
Coping strategies for COVID-19 pandemic-related stress and mental health during pregnancy
Increased stress has likely contributed to the observed high prevalence of depression and anxiety in pregnant individuals during the COVID-19 pandemic. The objective of this study was to assess the prevalence of coping strategies for COVID-19 pandemic-related stress and associations…
Multi-Chain Semi-Markov Analysis of Intrapartum Cardiotocography
Visual assessment of the evolution of fetal heart rate (FHR) and uterine pressure (UP) patterns is the standard of care in the intrapartum period. Unfortunately, this assessment has high levels of intra- and inter-observer variability. This study processed and analyzed…
Associations between combined exposure to environmental hazards and social stressors at the neighborhood level and individual perinatal outcomes in the ECHO-wide cohort
Limited studies examine how prenatal environmental and social exposures jointly impact perinatal health. Here we investigated relationships between a neighborhood-level combined exposure (CE) index assessed during pregnancy and perinatal outcomes, including birthweight, gestational age, and preterm birth. Across all participants,…
Association Between Prenatal Cannabis Use and Psychotropic Medication Use in Pregnant Patients With Depression and Anxiety
This cross-sectional study examined associations between prenatal cannabis use and prescribed psychotropic medication use among pregnant patients with depression or anxiety in a large, integrated healthcare system. Study patients had a confirmed pregnancy and a depressive or anxiety disorder defined…
Prevalence of Depression and Anxiety Disorders Following Mild Traumatic Brain Injury
Previous studies have identified an association between traumatic brain injuries and the development of psychiatric disorders in general. However, these studies were subject to limitations that demonstrate the need for a study of a large, clearly defined mild traumatic brain…