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,…
Kuzniewicz, Michael W
Croen, Lisa A.
Ferrara, Assiamira
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…
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,…
Motivational Determinants of Postpartum Lifestyle Behaviors, Weight Retention, and Metabolic Syndrome
The proposed study aims to identify affective influences on key lifestyle behaviors (healthy eating and objectively measured self-weighing and physical activity) associated with postpartum weight retention and cardiometabolic profile (e.g., metabolic syndrome). We propose a longitudinal study design within a…
Comparative Effectiveness of Treating Genital Herpes Infection to Reduce Racial Disparities in the Risk of Severe Maternal Morbidity (SMM)
The goals of the study are to determine whether treating GHSV infection in pregnancy, especially earlier in pregnancy, is effective in mitigating the racial disparities in SMM, and GHSV infection, if untreated, contribute to racial disparities in the risk of…
Maternal blood metal concentrations and whole blood DNA methylation during pregnancy in the Early Autism Risk Longitudinal Investigation (EARLI)
The maternal epigenome may be responsive to prenatal metals exposures. We tested whether metals are associated with concurrent differential maternal whole blood DNA methylation. In the Early Autism Risk Longitudinal Investigation cohort, we measured first or second trimester maternal blood…
Understanding the risk of ectopic pregnancies among people seeking abortion: a retrospective case control study
This study aims to assess the incidence of ectopic pregnancy among people wanting pregnancy compared to people seeking abortion. The specific research questions are: Are people seeking abortion at lower risk of experiencing an ectopic pregnancy compared to people not…
Associations of COVID-19-Related Health, Healthcare and Economic Factors With Prenatal Depression and Anxiety
Objective: This study evaluated whether COVID-19 pandemic-related health, healthcare and economic factors during pregnancy are associated with prenatal depression and anxiety. Methods: We conducted a cross-sectional study of 6,628 pregnant members of Kaiser Permanente Northern California who responded to a…
Association of Pregnancy Intentions With Substance Use During Early Pregnancy
The goal of this study was to evaluate the association between pregnancy intentions and substance use in early pregnancy among pregnant women receiving prenatal care in a large, integrated healthcare system. The sample comprised 29,787 Kaiser Permanente Northern California pregnant…
Treatment Initiation for New Episodes of Depression in Pregnant Women
This study will use rigorous methods and rich health care data from a diverse, multi-site study population to study psychotherapy and antidepressant treatments for new episodes of depression during pregnancy. Analyses will include examination of infant outcomes and breastfeeding.
Healthy preconception and early-pregnancy lifestyle and risk of preterm birth: a prospective cohort study
Preterm birth (PTB) remains a leading cause of neonatal mortality and long-term morbidity. Individual factors have been linked to PTB risk. The impact of a healthy lifestyle, with multiple modifiable prenatal factors, remains unknown. We aimed to examine the associations…
mHealth Mindfulness Intervention for Pregnant Black and Latina Women at Risk of Postpartum Depression
This randomized controlled trial of an mHealth mindfulness intervention designed for Black and Latinx pregnant women at risk of developing postpartum depression will compare outcomes (depression, stress, sleep) of participants in the intervention with those in the control arm.
Mediating Effects of Cardiometabolic Risk Factors on the Association Between Maternal Race-Ethnicity and Cesarean Delivery Among Low-Risk Women
Background: While racial-ethnic disparities in cesarean delivery rates among nulliparous women delivering a term singleton in the vertex position (NTSV) exist, it remains unclear the extent to which potentially modifiable maternal cardiometabolic risk factors (obesity, maternal hyperglycemia and hypertensive disorders)…
Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association
This statement summarizes evidence that adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, preterm delivery, gestational diabetes, small-for-gestational-age delivery, placental abruption, and pregnancy loss increase a woman's risk of developing cardiovascular disease (CVD) risk factors and of developing…
The Epidemiology of SARS-CoV-2 in Pregnancy and Infancy (ESPI) Network: ESPI-Electronic Cohort
Multisite study to describe the incidence, clinical presentation, treatment, clinical course, and outcomes of COVID-19 among pregnant women and up to six months postpartum, and estimate the incidence of COVID-19 hospitalizations and medically attended ambulatory care visits (including telehealth) during…
Blood Pressure, Obesity, and Diabetes in Relation to Perinatal and Postpartum Complications
By leveraging the KPNC Gestational diabetes and Glucose Tolerance Registry, which includes rich data on blood glucose levels, obesity, gestational weight gain, we will add blood pressure levels for the earliest years to evaluate the individual and joint impact of…
Can hydroxychloroquine prevent preeclampsia and preterm delivery in lupus pregnancy?
Pregnant women with lupus are at high risk to develop preeclampsia and preterm delivery. This work leverages three large population-based databases with detailed prescription and clinical data to determine whether use of hydroxychloroquine during pregnancy among women with lupus reduces…
Maternal Health in Pregnancy and Autism Risk – Genetic and Non-genetic Mechanisms
This study will systematically identify maternal diagnoses in pregnancy associated with autism spectrum disorder (ASD) in offspring; test if the association between maternal diagnoses and ASD is due to shared genetic factors using family data; and test the association between…
Prenatal Air Pollution Exposure and Neurodevelopment: A Review and Blueprint for a Harmonized Approach within ECHO
Air pollution exposure is ubiquitous with demonstrated effects on morbidity and mortality. A growing literature suggests that prenatal air pollution exposure impacts neurodevelopment. We posit that the Environmental influences on Child Health Outcomes (ECHO) program will provide unique opportunities to…
Association of Inadvertent 9-Valent Human Papillomavirus Vaccine in Pregnancy With Spontaneous Abortion and Adverse Birth Outcomes
The 9-valent human papillomavirus (9vHPV) vaccine is recommended for individuals through age 26 years and may be administered to women up to age 45 years. Data on 9vHPV vaccine exposures during pregnancy are limited. To evaluate the associations between 9vHPV…
Maternal weight change from prepregnancy to 18 months postpartum and subsequent risk of hypertension and cardiovascular disease in Danish women: A cohort study
One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD). We conducted a cohort study of 47,966 women with…
Maternal health around pregnancy and autism risk: a diagnosis-wide, population-based study
Many studies have reported an increased risk of autism spectrum disorder (ASD) associated with some maternal diagnoses in pregnancy. However, such associations have not been studied systematically, accounting for comorbidity between maternal disorders. Therefore our aim was to comprehensively test…
mHealth Mindfulness Intervention for Women with Moderate-to-Moderately-Severe Antenatal Depressive Symptoms: a Pilot Study Within an Integrated Health Care System
Traditional mindfulness-based interventions have been shown to reduce depression symptoms in pregnant women, although in-person classes may pose significant accessibility barriers, particularly during the COVID-19 pandemic. Mobile technology offers greater convenience, but little is known regarding the efficacy of self-paced,…
Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study
Gestational diabetes (GD) leads to earlier onset and heightened risk of type 2 diabetes, a strong risk factor for cardiovascular disease (CVD). However, it is unclear whether attaining normoglycemia can ameliorate the excess CVD risk associated with GD history. This…
Plasma lipidomics profile in pregnancy and gestational diabetes risk: a prospective study in a multiracial/ethnic cohort
Disruption of lipid metabolism is implicated in gestational diabetes (GDM). However, prospective studies on lipidomics and GDM risk in race/ethnically diverse populations are sparse. Here, we aimed to (1) identify lipid networks in early pregnancy to mid-pregnancy that are associated…
Adverse Childhood Experiences and Pregnancy Intentions among Pregnant Women Seeking Prenatal Care
This study examined whether adverse childhood experiences (ACEs) are associated with increased risk of having an unwanted or mistimed pregnancy. Women in two medical centers within an integrated health system were screened for ACEs during standard prenatal care (N = 745). Multinomial…
Prenatal Exposure to Mixtures of Phthalates, Parabens, and Other Phenols and Obesity in Five-Year-Olds in the CHAMACOS Cohort
Exposures to phthalates, parabens, and other phenols are often correlated due to their ubiquitous use in personal care products and plastics. Examining these compounds as a complex mixture may clarify inconsistent relationships between individual chemicals and childhood adiposity. Using data…
COVID-19 Related Changes in Health Care Delivery and Health Outcomes Among Pregnant Women and Their Newborns
This study will examine the impacts that COVID-19 pandemic related changes in health care delivery had on health outcomes among pregnant women and their newborns in Kaiser Permanente Northern California. The study will also evaluate the clinical course of COVID-19…
PREDICTION OF OBSTETRIC AND FETAL COMPLICATIONS USING AUTOMATED ELECTRONIC HEALTH RECORD DATA
An increasing number of delivering women experience major morbidity and mortality. Limited work has been done on automated predictive models that could be used for prevention. Using only routinely collected obstetrical data, this study aimed to develop a predictive model…
Gestational Exposure to Phthalates and Social Responsiveness Scores in Children Using Quantile Regression: The EARLI and HOME Studies
Linear regression is often used to estimate associations between chemical exposures and neurodevelopment at the mean of the outcome. However, the potential effect of chemicals may be greater among individuals at the 'tails' of outcome distributions. Here, we investigated distributional…
Association between self-reported caffeine intake during pregnancy and social responsiveness scores in childhood: The EARLI and HOME studies
Maternal nutrition during gestation has been investigated for its role in child neurodevelopment. However, little is known about the potential impact of gestational caffeine exposure on child autistic behaviors. Here, we assess the relation between maternal caffeine intake during pregnancy…
Impact of nulliparity, hypertensive disorders of pregnancy, and gestational diabetes on vasomotor symptoms in midlife women
To determine whether women with a history of nulliparity, hypertensive disorders of pregnancy (HDP), or gestational diabetes mellitus (GDM) have a higher odds of reporting vasomotor symptoms (VMS) at midlife. A longitudinal analysis was performed with 2,249 women with pregnancy…
Individual and Neighborhood Factors Associated with Failure to Vaccinate against Influenza during Pregnancy
Uptake of influenza vaccine among pregnant women remains low. We investigated whether unvaccinated pregnant women were clustered geographically and determined factors associated with failure to vaccinate using spatial and multivariate logistic regression analyses. Pregnant women who were members of Kaiser…
Translating Research on Diabetes and Obesity in Pregnancy Into Prevention: The 2019 Norbert Freinkel Award Lecture
Epidemiological studies on the intergenerational transmission of hyperglycemia and obesity via in utero exposure have established the scientific foundation for the vicious cycle of diabetes and obesity. The findings compel us to address an urgent public health question: how do…
Using a 24-Hour Movement Framework to Improve Pregnancy Outcomes
The goal of this K99/R00 Pathway to Independence Award is to better understand associations of 24-hour movement profiles during pregnancy (consisting of physical activity, sedentary behavior, and sleep) and maternal and infant outcomes. This Award includes training in the analysis…
Comparing the Effects of Prenatal Depression and its Treatment on Developmental Outcomes of the Offspring
This study will test the hypothesis that the underlying prenatal depression and use of SSRIs are independent risk factors for adverse neurodevelopmental outcomes. The aims of this study are: 1) evaluate the effect of untreated prenatal depression, compared to no…
Cord blood DNA methylome in newborns later diagnosed with autism spectrum disorder reflects early dysregulation of neurodevelopmental and X-linked genes
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with complex heritability and higher prevalence in males. The neonatal epigenome has the potential to reflect past interactions between genetic and environmental factors during early development and influence future health outcomes. We…
Gestational weight gain, birthweight and early-childhood obesity: between- and within-family comparisons
Associations of excessive gestational weight gain (GWG) with greater birthweight and childhood obesity may be confounded by shared familial environment or genetics. Sibling comparisons can minimize variation in these confounders because siblings grow up in similar environments and share the…
SARS-CoV-2 Infection Among Hospitalized Pregnant Women: Reasons for Admission and Pregnancy Characteristics – Eight U.S. Health Care Centers, March 1-May 30, 2020
Pregnant women might be at increased risk for severe coronavirus disease 2019 (COVID-19), possibly related to changes in their immune system and respiratory physiology* (1). Further, adverse birth outcomes, such as preterm delivery and stillbirth, might be more common among…
Trends and correlates of self-reported alcohol and nicotine use among women before and during pregnancy, 2009-2017
To examine trends and correlates of frequency of self-reported alcohol and nicotine use among pregnant women. Cross-sectional study of 363,240 pregnancies from 2009 to 2017 screened for self-reported substance use at their first prenatal visit in Kaiser Permanente Northern California.…
Racial/Ethnic Disparities in Perinatal Depression Treatment Utilization
The study will characterize racial/ethnic differences in perinatal depression treatment utilization, treatment engagement, and continued care by assembling a retrospective cohort of KPNC members entering prenatal care between 2012-2016. The study will also identify barriers to and facilitators of treatment…
Understanding racial-ethnic disparities in preterm birth sub-types and prenatal care utilization
The study will examine racial-ethnic disparities in the risk of preterm birth overall and by preterm birth sub-types. It will also study whether the racial-ethnic disparities in preterm births and preterm birth sub-types are modified by the level of prenatal…
Underlying dyslipidemia postpartum in women with a recent GDM pregnancy who develop type 2 diabetes
Approximately, 35% of women with Gestational Diabetes (GDM) progress to Type 2 Diabetes (T2D) within 10 years. However, links between GDM and T2D are not well understood. We used a well-characterised GDM prospective cohort of 1035 women following up to…
Life Course Changes in Cardiometabolic Risk Factors Associated With Preterm Delivery: The 30-Year CARDIA Study
Background Women who deliver preterm infants (
Changes in Cardiometabolic Risk Factors Before and After Gestational Diabetes: A Prospective Life-Course Analysis in CARDIA Women
This study hypothesized that both preconception and postchildbearing patterns of cardiometabolic risk factors may be different for women with gestational diabetes mellitus (GDM) compared with women without GDM. Among 1,302 (51% black) women in the Coronary Artery Risk Development in…
Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study (COVID-19 Revision)
As of March 26, 2020, there have been more than 80,000 cases and 1,000 deaths in the US due to COVID-19. Because it attacks the lungs, COVID-19 could be an especially serious threat to those who smoke or vape tobacco…
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…
Impact of In Utero Marijuana Exposure on Neurodevelopment, Behavior and Mental Health: A Longitudinal Birth Cohort Study
This study will investigate whether maternal prenatal marijuana use increases the risk of impairments in a child's executive functioning and mental health, after accounting for other factors such as tobacco, alcohol, and other drug use; socioeconomic status, and maternal mental…
Adipokines in early and mid-pregnancy and subsequent risk of gestational diabetes: a longitudinal study in a multiracial cohort
Several adipokines are implicated in the pathophysiology of gestational diabetes mellitus (GDM), however, longitudinal data in early pregnancy on many adipokines are lacking. We prospectively investigated the association of a panel of adipokines in early and mid-pregnancy with GDM risk.…
Prenatal Depression and Diet Quality During Pregnancy
Maternal nutrition during pregnancy has a significant effect on the health of the offspring and mother, highlighting the need for identifying factors that may affect diet during pregnancy. Research in nonpregnant and pregnant populations suggest depression may play a role.…
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…
MAESTRA: Maternal Antecedents of Encephalopathy in Term Infants
This study tests the hypothesis that established NICHD-approved electronic fetal monitoring (EFM) features used as standard care in the U.S. and other developed countries can exhibit improved sensitivity and specificity for predicting HIE when they are combined with novel EFM features…
Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort
To determine whether women with multiple sclerosis (MS) diagnosed according to current criteria are at an increased risk of postpartum relapses and to assess whether this risk is modified by breastfeeding or MS disease-modifying therapies (DMTs), we examined the electronic…
Does Centering Pregnancy impact patient satisfaction with prenatal care and maternal health and behavioral outcomes?
This longitudinal study of 350 women seeking prenatal care in Kaiser Permanente Northern California will compare patient satisfaction with prenatal care, maternal health and behavioral outcomes between women in group prenatal care (Centering Pregnancy) and traditional prenatal care
Epidemiology and clinical outcomes of hospitalizations for acute respiratory or febrile illness and laboratory-confirmed influenza among pregnant women during six influenza seasons, 2010-2016
Pregnant women are at increased risk of seasonal influenza hospitalizations, but data about the epidemiology of severe influenza among pregnant women remain largely limited to pandemics. To describe the epidemiology of hospitalizations for acute respiratory infection or febrile illness (ARFI)…
Maternal infection and antibiotic use in pregnancy and the risk of childhood obesity in offspring: a birth cohort study
The reported association between maternal antibiotic use and childhood obesity, if true, could change obstetric practice. However, it is unclear whether the reported association was due to antibiotics, or underlying infection or both. To examine the independent contributions of maternal…
Neonatal Thyroid Stimulating Hormone and Subsequent Diagnosis of Autism Spectrum Disorders and Intellectual Disability
Hypothyroid conditions in early life, if left untreated, are associated with adverse neurodevelopmental outcomes, including intellectual disability (ID). However, evidence addressing the role of neonatal thyroid hormone insufficiencies in the altered neurobiology underlying autism spectrum disorders (ASD), particularly among its…
Trivalent inactivated influenza vaccine (IIV3) during pregnancy and six-month infant development
Despite recommendations by professional organizations that all pregnant women receive inactivated influenza vaccine, safety concerns remain a barrier. Our objective was to assess the effect of trivalent influenza vaccines (IIV3) during pregnancy on parent report 6-month infant development. We conducted…
Exercise During the First Trimester and Infant Size at Birth: Targeted Maximum Likelihood Estimation of the Causal Risk Difference
This cohort study sought to estimate the differences in risk of delivering infants who were small or large for gestational age (SGA or LGA, respectively) according to exercise during the first trimester of pregnancy (vs. no exercise) among 2,286 women…
Survey of influenza vaccine knowledge, attitudes, and beliefs among pregnant women in the 2016-17 season
Influenza vaccination coverage among pregnant women in the United States is suboptimal. We surveyed women who were pregnant during the 2016-17 influenza season to assess knowledge and attitudes regarding influenza vaccination. We identified and sampled pregnant women to include approximately…
The Effect of Gestational Weight Gain Across Reproductive History on Maternal Body Mass Index in Midlife: The Study of Women’s Health Across the Nation
Background: Excessive weight gain during pregnancy is common and has been shown to be associated with increased long-term maternal weight. However, less is known on whether there is a cumulative effect of excessive gestational weight gain (GWG) over multiple pregnancies.…
Management of Cannabis Use in Breastfeeding Women: The Untapped Potential of Certified Lactation Consultants
Recent increases in maternal cannabis use, in combination with rapidly changing cannabis policies in the United States, pose a unique threat to maternal and child health. To date, 33 states and the District of Columbia (D.C.) have legalized medicinal cannabis,…
ECHO Coordinating Center: Opportunities and Infrastructure Fund Component
The overall goal of this project is to demonstrate that the newly FDA-approved Airwave Oscillometry System (tremoFlo c-100, Thorasys) can be used to reliably and easily obtain lung function measurements in ECHO cohorts and that these oscillometry measures of respiratory…
Exogenous surfactant utilization for respiratory failure in late and moderately preterm infants: impact on short- and long-term outcomes
The goal is to define and refine the current epidemiology, clinical characteristics, and treatment practices in respiratory failure in late and moderately preterm Infants. Specific aims include determining the incidence and epidemiology of respiratory failure in the neonates born at…
Preventing Postpartum Depression: Exercise as Medicine
This intervention study will randomize 200 postpartum women at increased risk of postpartum depression to an eHealth physical activity intervention and assess the efficacy of the intervention on increasing physical activity and decreasing postpartum depressive symptoms. Additionally, this study will…
Background rates of maternal, fetal, neonatal, and infant outcomes and events of interest to inform maternal immunization clinical trials
GlaxoSmithKline Vaccines is currently preparing for clinical trials that evaluate the safety/reactogenicity and immunogenicity of a respiratory syncytial virus maternal vaccine candidate in pregnant women. Robust epidemiological data is needed to support the interpretation of maternal and neonatal outcomes in…
Leisure Time Physical Activity, Sedentary Time in Pregnancy, and Infant Weight at Approximately 12 Months
Background: Maternal leisure time physical activity (LTPA) and sedentary time during pregnancy may influence programming of infant growth in a sex-specific manner. Materials and Methods: Participants (N = 35,212) from the Danish National Birth Cohort reported moderate/vigorous LTPA (hours/week) in early (conception…
Identifying hypertension in pregnancy using electronic medical records: The importance of blood pressure values
To incorporate blood pressure (BP), diagnoses codes, and medication fills from electronic medical records (EMR) to identify pregnant women with hypertension. A retrospective cohort study of singleton pregnancies at three US integrated health delivery systems during 2005-2014. Women were considered…
Routes of cannabis administration among females in the year before and during pregnancy: Results from a pilot project
Use of cannabis during pregnancy is on the rise, yet little is known about how women administer cannabis during the perinatal period. This study examined self-reported modes of cannabis administration among women in the year before and during pregnancy, and…
Early Life Exposure to Air Pollution and Autism Spectrum Disorder: Findings from a Multisite Case-Control Study
Epidemiologic studies have reported associations between prenatal and early postnatal air pollution exposure and autism spectrum disorder (ASD); however, findings differ by pollutant and developmental window. We examined associations between early life exposure to particulate matter ≤2.5 µm in diameter…
Prenatal Depression and Antidepressant Exposure: Effects on Child Speech and Language Disorders
The aims of this study are to 1) Assess the relationship between untreated prenatal depression and the risk of speech and language disorders of offspring; 2) Compare the effectiveness of treatment of prenatal depression on speech and language disorders of…
Validity of Self-reported Cannabis Use Among Pregnant Females in Northern California
Most clinical and epidemiologic estimates of prenatal cannabis use are based on self-report, and the validity of self-reported cannabis use has not been examined in a large, representative population of pregnant women. We determined the validity of self-reported prenatal cannabis…
Maternal cortisol during pregnancy and offspring schizophrenia: Influence of fetal sex and timing of exposure
Maternal stress during pregnancy has been repeatedly linked to increased risk for schizophrenia; however, no study has examined maternal cortisol during pregnancy and risk for the disorder. Study aims were to determine whether prenatal cortisol was associated with risk for…
A Prospective Study of Leukocyte Telomere Length and Risk of Gestational Diabetes in a Multiracial Cohort
Short telomere length (TL), an indicator of cellular aging and oxidative stress, has been implicated in glucose homeostasis. Additionally, studies have illustrated that the association of TL with health outcomes may vary by age. Yet, data on the association between…
Uptake and safety of hepatitis A vaccination during pregnancy: A Vaccine Safety Datalink study
Infection with hepatitis A virus (HAV) during pregnancy, although uncommon, is associated with gestational complications and pre-term labor. Hepatitis A vaccine (HepA) is recommended for anyone at increased risk for contracting hepatitis A, including women at risk who are also…
Inactivated influenza vaccine and spontaneous abortion in the Vaccine Safety Datalink in 2012-13, 2013-14, and 2014-15
A recent study reported an association between inactivated influenza vaccine (IIV) and spontaneous abortion (SAB), but only among women who had also been vaccinated in the previous influenza season. We sought to estimate the association between IIV administered in three…
Infection and Fever in Pregnancy and Autism Spectrum Disorders: Findings from the Study to Explore Early Development
Maternal infection and fever during pregnancy have been implicated in the etiology of autism spectrum disorder (ASD); however, studies have not been able to separate the effects of fever itself from the impact of a specific infectious organism on the…
Fetal Programming of Growth and Obesity: A Metabolomics Approach
This proposal uses a novel holistic framework that leverages both targeted and untargeted metabolomics approach, electronic health records data, and bioinformatics analytics to investigate the mechanisms by which the in-utero environment may infer risk of fetal growth extremes and altered…
Cluster-randomized Trial of a Mobile Health Intervention to Achieve Appropriate Gestational Weight Gain in Overweight and Obese Women
This randomized trial will test whether the implementation of an mHealth tool in the health-plan setting increases the proportion of overweight and obese women with appropriate total gestational weight gain, according to Institute of Medicine (IOM) guidelines in comparison to…
Investigation of Prevalence of and Barriers to Achieving Optimal Glycemic Control among Women with Gestational Diabetes
This project aims to demonstrate that sufficient, high quality glycemic control data are available for investigating the determinants of and barriers to glycemic control among women with gestational diabetes in a cohort of 30,000 women at Kaiser Permanente Northern California…
Risk Prediction of Gestational Diabetes Treatment Modalities Utilizing Clinical and Laboratory Data in the EHR
This study aims to utilize data from the Kaiser Permanente Northern California Gestational Diabetes and Pregnancy Glucose Tolerance Registry for a cohort of 25,000 women diagnosed with gestational diabetes. The goal is to determine whether clinical and laboratory factors can…
Walking for health during pregnancy: A literature review and considerations for future research
Walking is the most commonly chosen type of physical activity (PA) during pregnancy and provides several health benefits to both mother and child. National initiatives have promoted the importance of walking in general, but little emphasis is directed toward pregnant…
Prenatal Opioid Exposure: Neurodevelopmental Consequences and Future Research Priorities
Neonatal opioid withdrawal syndrome (NOWS) has risen in prevalence from 1.2 per 1000 births in 2000 to 5.8 per 1000 births in 2012. Symptoms in neonates may include high-pitched cry, tremors, feeding difficulty, hypertonia, watery stools, and breathing problems. However,…
Pre- and Early Pregnancy Onset Depression and Subsequent Rate of Gestational Weight Gain
Background:Depression is associated with weight change outside of pregnancy. We assessed associations of prepregnancy or early pregnancy onset depression with gestational weight gain (GWG) rate overall and according to Institute of Medicine (IOM) recommendations. Materials and Methods:Depression from 6 months…
Trends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016
The use of medical imaging has sharply increased over the last 2 decades. Imaging rates during pregnancy have not been quantified in a large, multisite study setting. To evaluate patterns of medical imaging during pregnancy. A retrospective cohort study was…
Self-reported Daily, Weekly, and Monthly Cannabis Use Among Women Before and During Pregnancy
As the overall prevalence of prenatal cannabis use rises, it is vital to also monitor trends in the frequency of cannabis use in the period leading up to and during pregnancy because more frequent use may confer greater health risks…
Understanding periviable birth: A microeconomic alternative to the dysregulation narrative
Periviable infants (i.e., those born in the 20th through 26th weeks of gestation) suffer much morbidity and approximately half die in the first year of life. Attempts to explain and predict these births disproportionately invoke a "dysregulation" narrative. Research inspired…
Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study
The goal of this application is to examine the association between maternal marijuana use during pregnancy and adverse obstetrical and neonatal outcomes. We aim to: 1) Examine trends in prenatal marijuana use following the legalization of marijuana for recreational purposes…
Risk factors for low birth weight among rural and urban Malaysian women
Low birth weight prevalence in Malaysia remains high. Socioeconomic background may lead to differences in physical activity and maternal nutritional status, which may play an important role in birth outcomes. This prospective cross-sectional study aimed to identify rural-urban differences in…
Association of Blood Donor Sex and Prior Pregnancy With Mortality Among Red Blood Cell Transfusion Recipients
Evidence regarding associations of blood donor sex with mortality among red blood cell transfusion recipients is conflicting. To study associations of donor sex and prior pregnancy with mortality of transfusion recipients. Data from 3 retrospective cohorts of transfusion recipients (the…
Associations of pre-pregnancy body mass index, middle-upper arm circumference, and gestational weight gain
An optimal gestational weight gain is essential for maternal health and to reduce adverse birth outcomes. Current guidelines to monitor gestational weight gain are based on pre-pregnancy body mass index (BMI). However, middle-upper arm circumference (MUAC) is increasingly used as…
Maternal diabetes and hypertensive disorders in association with autism spectrum disorder
Previous studies have shown complications of pregnancy, often examined in aggregate, to be associated with autism spectrum disorder (ASD). Results for specific complications, such as maternal diabetes and hypertension, have not been uniformly consistent and should be investigated independently in…
Newborn vitamin D levels in relation to autism spectrum disorders and intellectual disability: A case-control study in california
Vitamin D deficiency has been increasing concurrently with prevalence of autism spectrum disorders (ASD), and emerging evidence suggests vitamin D is involved in brain development. Most prior studies of ASD examined vitamin D levels in children already diagnosed, but a…
Factors associated with recruitment, surveillance participation, and retention in an observational study of pregnant women and influenza
This report describes the results of recruitment efforts and the subsequent participation of pregnant women in study activities in a 2010-2012 observational study focused on influenza illness and vaccination in California and Oregon, USA. Socio-demographic and health characteristics extracted from…
Epigenetic marks of prenatal air pollution exposure found in multiple tissues relevant for child health
Prenatal air pollution exposure has been linked to many adverse health conditions in the offspring. However, little is known about the mechanisms underlying these associations. Epigenetics may be one plausible biologic link. Here, we sought to identify site-specific and global…
Gestational weight gain and optimal wellness (GLOW): rationale and methods for a randomized controlled trial of a lifestyle intervention among pregnant women with overweight or obesity
Excess gestational weight gain (GWG) is common among women with overweight or obesity, increasing their risks for pregnancy complications, delivering a large infant, and postpartum weight retention. To date, only intensive interventions have had success and few interventions have been…
Influenza Vaccine Effectiveness in Preventing Influenza-associated Hospitalizations During Pregnancy: A Multi-country Retrospective Test Negative Design Study, 2010-2016
To date, no study has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy. The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) consisted of public health or healthcare systems with integrated laboratory, medical, and vaccination records in Australia, Canada…
Meta-analysis of epigenome-wide association studies in neonates reveals widespread differential DNA methylation associated with birthweight
Birthweight is associated with health outcomes across the life course, DNA methylation may be an underlying mechanism. In this meta-analysis of epigenome-wide association studies of 8,825 neonates from 24 birth cohorts in the Pregnancy And Childhood Epigenetics Consortium, we find…
The discovery of novel predictive biomarkers and early-stage pathophysiology for the transition from gestational diabetes to type 2 diabetes
Gestational diabetes mellitus (GDM) affects up to 20% of pregnancies, and almost half of the women affected progress to type 2 diabetes later in life, making GDM the most significant risk factor for the development of future type 2 diabetes.…
Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: a prospective multi-racial/ethnic cohort study
Nutritional perturbations during pregnancy may impact fetal and long-term childhood growth, although there are limited data on overall diet quality. We investigated whether diet quality, measured by the Healthy Eating Index-2010 (HEI-2010), during pregnancy was related to birthweight z-score (BWZ)…
Adverse Childhood Experiences and Mental and Behavioral Health Conditions During Pregnancy: The Role of Resilience
Little is known about how exposure to adverse childhood experiences (ACEs) and protective factors, such as resilience, influence prenatal mental and behavioral health. This study examined associations between exposure to ACEs and mental and behavioral health during pregnancy overall and…
Shared Antecedents to Preterm Birth and Cardiovascular Disease in Women
This study will conduct a secondary data analysis of CARDIA women that leverages existing data to evaluate the relation of pre-pregnancy inflammation to the occurrence of pre-term birth and to determine whether the inflammatory profile is exacerbated following pregnancy, perhaps…
Maternal Gestational Weight Gain, Obesity, and the Timing of Pubertal Onset in Daughters
Early puberty is associated with adverse health outcomes, but little is known regarding early life determinants influencing pubertal timing. We examined the associations between maternal gestational weight gain (GWG) and the timing of the onset of breast development (thelarche) and…
Trends in marijuana use among pregnant women with and without nausea and vomiting in pregnancy, 2009-2016
Cross-sectional studies indicate an elevated prevalence of prenatal marijuana use in women with nausea and vomiting in pregnancy (NVP). However, it is unknown whether differences in marijuana use by NVP status have persisted over time as marijuana becomes more acceptable…
Pregnancy-Associated Cancer: A U.S. Population-Based Study
The incidence of pregnancy-associated cancer (PAC) is expected to increase as more women delay childbearing until later ages. However, information on frequency and incidence of PAC is scarce in the United States. We identified pregnancies among women aged 10-54 years…
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…
Automated Early Detection of Obstetric Complications: Theoretical and Methodological Considerations
Compared to adults admitted to general medical-surgical wards, women admitted to labor and delivery services are at much lower risk of experiencing unexpected critical illness. Nonetheless, critical illness and other complications that put either the mother or fetus at risk…
Estimating Vaccine Effectiveness Against Hospitalized Influenza During Pregnancy: Multicountry Protocol for a Retrospective Cohort Study
Although pregnant women are believed to have elevated risks of severe influenza infection and are targeted for influenza vaccination, no study to date has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy, primarily because this outcome poses…
Motivational Determinants of Postpartum Lifestyle Behaviors, Weight Retention, and Metabolic Syndrome – DUPLICATED DO NOT ACTIVATE
The Pregnancy Environment and Lifestyle Study-2 (PETALS-2) aims to identify psychosocial influences on healthy lifestyle behaviors — such as healthy eating, self-weighing, and physical activity — and examine their relation to weight retention and cardiometabolic profile in the transition from…
Prenatal exposure to extremely low frequency magnetic field and its impact on fetal growth
Studies on the effect of prenatal exposure to magnetic field (MF) on fetal growth is inconclusive and subject to some methodological limitations, particularly in measurement of MF exposure. The present study aimed to examine the association between maternal extremely low…
A meta-analysis of two high-risk prospective cohort studies reveals autism-specific transcriptional changes to chromatin, autoimmune, and environmental response genes in umbilical cord blood
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects more than 1% of children in the USA. ASD risk is thought to arise from both genetic and environmental factors, with the perinatal period as a critical window. Understanding early…
Diagnostic thresholds for pregnancy hyperglycemia, maternal weight status and the risk of childhood obesity in a diverse Northern California cohort using health care delivery system data
To estimate the risk of childhood obesity associated with the various criteria proposed for diagnosis of gestational diabetes (GDM), and the joint effects with maternal BMI. Cohort study of 46,396 women delivering at the Kaiser Permanente Northern California health care…
Pre-pregnancy kidney function and subsequent adverse pregnancy outcomes
Renal insufficiency is associated with pregnancy complications including fetal growth restriction, preterm birth (PTB), and pre-eclampsia. To determine the effect of preconception kidney function within the normal range on pregnancy outcome. 1043 (50% black, 50% white) women who participated in…
The Association of Polycystic Ovary Syndrome and Gestational Hypertensive Disorders in a Diverse Community-Based Cohort
To examine the association of polycystic ovary syndrome (PCOS) and pregnancy-induced hypertension (PIH) within a large population of pregnant women in an integrated healthcare system. This retrospective study utilized a source cohort of 1023 women with PCOS and 1023 women…
Lead exposure during childhood and subsequent anthropometry through adolescence in girls
Cross-sectional studies suggest that postnatal blood lead (PbB) concentrations are negatively associated with child growth. Few studies prospectively examined this association in populations with lower PbB concentrations. We investigated longitudinal associations of childhood PbB concentrations and subsequent anthropometric measurements in…
Brief Report: Maternal Opioid Prescription from Preconception Through Pregnancy and the Odds of Autism Spectrum Disorder and Autism Features in Children
Opioid use during pregnancy is associated with suboptimal pregnancy outcomes. Little is known about child neurodevelopmental outcomes. We examined associations between maternal opioid prescriptions preconception to delivery (peri-pregnancy) and child's risk of ASD, developmental delay/disorder (DD) with no ASD features,…
Expansion of Division of Research Perinatal Research Unit (EXPPRU)
Dedicated quantitative analytic support for obstetrics has not been available in Kaiser Permanente Northern California. An unusual opportunity has appeared: as a result of a project to develop a predictive model for obstetric complications, considerable development work has been conducted…
Optimizing a Scalable Intervention to Maximize Guideline-recommended Diabetes Testing after Gestational Diabetes Mellitus
Guideline-recommended postpartum screening is a critical step toward diabetes prevention after a diagnosis of gestational diabetes mellitus (GDM). However, patient uptake of postpartum screening remains suboptimal and uneven across racial/ethnic groups. This creates a missed opportunity for diabetes prevention or…
Antenatal and Intrapartum Risk Factors for Hypoxic-Ischemic Encephalopathy in a US Birth Cohort
To identify risk factors for hypoxic-ischemic encephalopathy (HIE) within a recent US birth cohort. In a retrospective cohort study of 44 572 singleton infants ?36 weeks of gestation born at Kaiser Permanente Northern California in 2008-2015, we identified all infants…
Maternal exposure to bisphenol A and anogenital distance throughout infancy: A longitudinal study from Shanghai, China
Bisphenol A (BPA) is one of the most common endocrine-disrupting compounds (EDCs) with a ubiquitous presence. Both animal and human studies have reported the association between maternal exposure to BPA and anogenital distance (AGD) in offspring. However, the results are…
Respiratory Syncytial Virus Hospitalization during Pregnancy in Four High-income Countries, 2010-2016
Few studies have addressed respiratory syncytial virus (RSV) infection during pregnancy. Among 846 pregnant women hospitalized with respiratory illness and tested for RSV, 21 (2%) were RSV positive, of whom 8 (38%) were diagnosed with pneumonia. Despite study limitations, these…
Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance
This study examined the associations of central obesity measures, waist to hip ratio (WHR) and waist circumference (WC), in early pregnancy with subsequent risk of gestational diabetes mellitus (GDM) and evaluated the potential mediating role of insulin resistance markers. Within…
Longitudinal Maternal Vitamin D Status during Pregnancy Is Associated with Neonatal Anthropometric Measures
Findings on maternal 25-hydroxyvitamin D (25[OH]D) and neonatal anthropometry are inconsistent, and may at least be partly due to variations in gestational week (GW) of 25(OH)D measurement and the lack of longitudinal 25(OH)D measurements across gestation. The aim of the…
Maternal Inflammation during Pregnancy and Neurodevelopmental Disorders
This study will utilize the Pregnancy Cohort from the Kaiser Permanente Northern California Research Program on Genes, Environment and Health to characterize the maternal immune profile over pregnancy and evaluate whether there are specific longitudinal patterns that are associated with…
A Pre-Pregnancy Biomarker Risk Score Improves Prediction of Future Gestational Diabetes
Previous studies have not examined the ability of multiple preconception biomarkers, considered together, to improve prediction of gestational diabetes mellitus (GDM). To develop a preconception biomarker risk score and assess its association with subsequent GDM. A nested case-control study among…
Uptake and safety of Hepatitis B vaccination during pregnancy: A Vaccine Safety Datalink study
Hepatitis B virus (HBV) infection acquired during pregnancy can pose a risk to the infant at birth that can lead to significant and lifelong morbidity. Hepatitis B vaccine (HepB) is recommended for anyone at increased risk for contracting HBV infection,…
Breastfeeding and later maternal risk of hypertension and cardiovascular disease – The role of overall and abdominal obesity
In this study, we examined how any, full, and partial breastfeeding durations were associated with maternal risk of hypertension and cardiovascular disease (CVD), and how prepregnancy body mass index (BMI) and waist circumference 7 years postpartum influenced these associations. A total…
Use of non-steroidal anti-inflammatory drugs during pregnancy and the risk of miscarriage
Nonsteroidal antiinflammatory drugs are among the medications most widely used by pregnant women, and previous studies have reported an increased risk of miscarriage that is associated with nonsteroidal antiinflammatory drug use during pregnancy. Although the findings have not always been…
Placental gross shape differences in a high autism risk cohort and the general population
A growing body of evidence suggests that prenatal environment is important in Autism Spectrum Disorder (ASD) etiology. In this study, we compare placental shape features in younger siblings of children with ASD, who themselves are at high ASD risk, to…
Cross-genetic determination of maternal and neonatal immune mediators during pregnancy
The immune system plays a fundamental role in development during pregnancy and early life. Alterations in circulating maternal and neonatal immune mediators have been associated with pregnancy complications as well as susceptibility to autoimmune and neurodevelopmental conditions in later life.…
Association of Nausea and Vomiting in Pregnancy With Prenatal Marijuana Use
Use of marijuana, an antiemetic, is increasing among pregnant women,1,2 and data from 2 small surveys3,4 indicate that women self-report using marijuana to alleviate nausea and vomiting in pregnancy (NVP). To date, only 1 epidemiologic study5 has examined whether women…
AHR gene-dioxin interactions and birthweight in the Seveso Second Generation Health Study.
Background: 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD) is proposed to interfere with fetal growth via altered activity of the aryl hydrocarbon receptor (protein: AHR; gene: AHR) pathway which regulates diverse biological and developmental processes including xenobiotic metabolism. Genetic variation in AHR…
Research Gaps in Gestational Diabetes Mellitus: Executive Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop
The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop on research gaps in gestational diabetes mellitus (GDM) with a focus on 1) early pregnancy diagnosis and treatment and 2) pharmacologic treatment strategies. This article summarizes the…
Breastfeeding and growth during infancy among offspring of mothers with gestational diabetes mellitus: a prospective cohort study
Breastfeeding (BF) may protect against obesity and type 2 diabetes mellitus in children exposed to maternal diabetes in utero, but its effects on infant growth among this high-risk group have rarely been evaluated. The objective of this study was to…
Health Care Utilization in the First Month after Birth and Its Relationship to Newborn Weight Loss and Method of Feeding
Guidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated…
Cardiorespiratory Fitness, Exercise Hemodynamics and Birth Outcomes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Determine associations of cardiorespiratory fitness, exercise systolic blood pressure (SBP) and heart rate recovery (HRR) following a maximal exercise test performed years preceding pregnancy with odds of preterm birth (PTB;
Effect of Maternal Influenza Vaccination during Pregnancy on Risk of Infant Influenza
This project has three major aims: 1) to examine whether influenza vaccination during pregnancy prevents influenza and other respiratory infections in infants aged 0 to 12 months, with a sub-aim to examine the effect of vaccine timing during pregnancy on…
Comparison of Collaborative Versus Single-Site Quality Improvement to Reduce NICU Length of Stay
There is unexplained variation in length of stay (LOS) across NICUs, suggesting that there may be practices that can optimize LOS. Three groups of NICUs in the California Perinatal Quality Care Collaborative were followed: (1) collaborative centers participating in an…
Blood Pressure Patterns and Subsequent Coronary Artery Calcification in Women Who Delivered Preterm Births
Women who delivered preterm infants have excess cardiovascular disease, but vascular pathways linking these conditions are not understood. We considered that higher blood pressure over 25 years among women with preterm delivery may be associated with coronary artery calcification (CAC).…
Associations Between Maternal Obesity and Pregnancy Hyperglycemia and Timing of Pubertal Onset in Adolescent Girls: A Population-Based Study
Early puberty is associated with adverse health outcomes. We investigated whether in utero exposure to maternal obesity is associated with daughters' pubertal timing using 15,267 racially/ethnically diverse Kaiser Permanente Northern California members aged 6-11 years with pediatrician-assessed Tanner staging (2003-2017).…
Maternal sedentary behavior during pre-pregnancy and early pregnancy and mean offspring birth size: a cohort study
Sedentary behavior is associated with adverse health outcomes in the general population. Whether sedentary behavior during pregnancy is associated with newborn outcomes, such as birth size, is not established, and previous studies have been inconsistent. While previous research suggests that…
A Longitudinal Study of Thyroid Markers across Pregnancy and the Risk of Gestational Diabetes
Triiodothyronine (T3) is the biologically-active thyroid hormone involved in glucose metabolism. fT3:fT4 ratio, a marker indicating conversion of free thyroxine (fT4) to free T3 (fT3), is also implicated in glucose homeostasis. To examine associations of fT3 and fT3:fT4 ratio with…
Birth outcomes following immunization of pregnant women with pandemic H1N1 influenza vaccine 2009-2010
Following the H1N1 influenza pandemic in 2009, pregnant women were recommended to receive both seasonal (TIV) and H1N1 influenza vaccines. This study presents incidence of adverse birth and pregnancy outcomes among a population of pregnant women immunized with TIV and…
Improving Post-Discharge Bilirubin Management in Newborns
There is variation and overuse in bilirubin testing among newborns. Multiple repeat testing occurs despite most newborns being at low risk for reaching bilirubin levels that would require phototherapy. Among the Kaiser Permanente birth population, 45 percent have two or…
Efficacy of Subthreshold Newborn Phototherapy During the Birth Hospitalization in Preventing Readmission for Phototherapy
Treatment of jaundiced newborns with subthreshold phototherapy (phototherapy given to newborns with bilirubin levels below those recommended in American Academy of Pediatrics [AAP] guidelines) is common. However, the use of subthreshold phototherapy may have risks and increase costs, and, to…
Pre-pregnancy endothelial dysfunction and birth outcomes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Endothelial dysfunction is a form of subclinical cardiovascular disease that may be involved in preterm birth and small-for-gestational-age deliveries. However, concentrations of biomarkers of endothelial dysfunction before pregnancy have rarely been measured. We hypothesized that higher levels of biomarkers of…
Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery
Determining the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes for postpartum hemorrhage (PPH) is vital for reaching valid conclusions about the epidemiology of PPH. Our primary objectives were to assess the performance characteristics of ICD-9…
Association between paternal alcohol consumption before conception and anogenital distance of offspring
There are limited studies on the effects of paternal alcohol consumption, before conception, on the reproductive development of offspring. Anogenital distance (AGD), the distance from the center of the anus to the genitals, is a sensitive biomarker of reproductive hormone…
Extremely Premature Births Cohort Study
The goal of this study is to understand the incidence of extremely preterm birth and associated adverse health conditions and growth abnormality.
mHealth Mindfulness Intervention for Women with Perinatal Depression: A Feasibility Study
The primary goal of this project is to assess the feasibility of conducting a mobile-health mindfulness intervention (mHealth) study among pregnant and postpartum women with depressive symptoms. Perinatal depression has numerous adverse health consequences, including preterm delivery, negative maternal-infant interaction,…
Risk Prediction of Gestational Diabetes Treatment Modalities Utilizing Clinical and Laboratory Data in the EHR – DUPLICATED DO NOT ACTIVATE
This study will utilize data from the Kaiser Permanente Northern California Gestational Diabetes and Pregnancy Glucose Tolerance Registry for a cohort of 25,000 women diagnosed with gestational diabetes. The goal is to determine whether clinical and laboratory factors can be…
Pre-Pregnancy Fitness and Risk of Gestational Diabetes: A Longitudinal Analysis.
PURPOSE: To assess the associations of pre-pregnancy cardiorespiratory fitness, moderate-to vigorous-intensity physical activity (MVPA), and time spent watching television with subsequent development of gestational diabetes mellitus (GDM).METHODS: Participants were 1,333 women enrolled in the Coronary Artery Risk Development in Young…
Association Between Estimated Cumulative Vaccine Antigen Exposure Through the First 23 Months of Life and Non-Vaccine-Targeted Infections From 24 Through 47 Months of Age
Some parents are concerned that multiple vaccines in early childhood could weaken their child's immune system. Biological data suggest that increased vaccine antigen exposure could increase the risk for infections not targeted by vaccines. To examine estimated cumulative vaccine antigen…
Infant Hospitalizations and Mortality After Maternal Vaccination
The Advisory Committee on Immunization Practices currently recommends pregnant women receive influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. There are limited studies of the long-term safety in infants for vaccines administered during pregnancy. We evaluate…
Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years: The 30-Year CARDIA Study
Lactation duration has shown weak protective associations with incident diabetes (3%-15% lower incidence per year of lactation) in older women based solely on self-report of diabetes, studies initiated beyond the reproductive period are vulnerable to unmeasured confounding or reverse causation…
Acute Associations between Outdoor Temperature and Premature Rupture of Membranes
Extreme ambient temperatures have been linked to preterm birth. Preterm premature rupture of membranes is a common precursor to preterm birth but is rarely studied in relation to temperature. We linked 15,381 singleton pregnancies with premature rupture of membranes from…
Glyburide Versus Insulin for the Treatment of Women with Gestational Diabetes in Kaiser Permanente Northern California
We aim to compare the effectiveness and safety of glyburide and insulin at improving neonatal and maternal outcomes among women with gestational diabetes mellitus (GDM) requiring medication therapy in Kaiser Permanente Northern California from 2007 to 2016. We will use…
Development and Testing of a Mobile-Health (m-health) Intervention tool to Help Obese Women Achieve Appropriate Gestational Weight Gain
To determine whether a mobile-health (m-health) tool (accessible via smartphone or website) intervention for obese pregnant improves patient satisfaction with their gestational weight gain, quality of life, stress and depression during pregnancy. Provider satisfaction with discussing gestational weight gain among…
Feasibility and Acceptability of Screening for Adverse Childhood Experiences in Prenatal Care
Adverse childhood experiences (ACEs) are common among pregnant women and contribute to increased risk for negative perinatal outcomes, yet few clinicians screen prenatal patients for ACEs. The purpose of this study was to evaluate the feasibility and acceptability of screening…
Early Detection of Obstetric Complications: Development of Predictive Models Suitable for Real-Time Surveillance During Labor, Delivery, and the Postpartum Period
This is a feasibility study to determine whether data from Kaiser Permanente HealthConnect® can be harnessed to predict obstetric complications in real time. The long-term goal is to develop algorithms that could be instantiated in the electronic record to provide…
Prenatal Maternal Serum Concentrations of Per- and Polyfluoroalkyl Substances in Association with Autism Spectrum Disorder and Intellectual Disability
Emerging work has examined neurodevelopmental outcomes following prenatal exposure to per- and polyfluoroalkyl substances (PFAS), but few studies have assessed associations with autism spectrum disorder (ASD). Our objective was to estimate associations of maternal prenatal PFAS concentrations with ASD and…
Liver Enzymes in Early to Mid-pregnancy, Insulin Resistance, and Gestational Diabetes Risk: A Longitudinal Analysis
Background: Liver enzymes may be implicated in glucose homeostasis; liver enzymes progressively change during pregnancy but longitudinal data during pregnancy in relation to insulin resistance and gestational diabetes (GDM) risk are lacking. We investigated longitudinal associations of γ-glutamyl transferase (GGT)…
A cohort study of maternal cardiometabolic risk factors and primary cesarean delivery in an integrated health system
Maternal cardiometabolic risk factors (i.e., hyperglycemia, pre-existing hypertension and high body mass index) impact fetal growth and risk of having a cesarean delivery. However, the independent and joint contribution of maternal cardiometabolic risk factors to primary cesarean section is unclear.…
Cord blood buffy coat DNA methylation is comparable to whole cord blood methylation
Cord blood DNA methylation is associated with numerous health outcomes and environmental exposures. Whole cord blood DNA reflects all nucleated blood cell types, while centrifuging whole blood separates red blood cells, generating a white blood cell buffy coat. Both sample…
Characteristics of drug use among pregnant women in the United States: Opioid and non-opioid illegal drug use.
BACKGROUND: The opioid epidemic in the US is affecting pregnant women and their offspring, with rising numbers of maternal and neonatal treatment episodes. The aim of this study was to characterize pregnant drug users in order to inform intervention strategies…
Exposure to Magnetic Field Non-Ionizing Radiation and the Risk of Miscarriage: A Prospective Cohort Study
Magnetic field (MF) non-ionizing radiation is widespread and everyone is exposed to some degree. This prospective cohort study of 913 pregnant women examined the association between high MF exposure and miscarriage risk. Cox (proportional hazards) regression was used to examine…
Autism risk classification using placental chorionic surface vascular network features
Autism Spectrum Disorder (ASD) is one of the fastest-growing developmental disorders in the United States. It was hypothesized that variations in the placental chorionic surface vascular network (PCSVN) structure may reflect both the overall effects of genetic and environmentally regulated…
Maternal BMI at the start of pregnancy and offspring epigenome-wide DNA methylation: findings from the pregnancy and childhood epigenetics (PACE) consortium
Pre-pregnancy maternal obesity is associated with adverse offspring outcomes at birth and later in life. Individual studies have shown that epigenetic modifications such as DNA methylation could contribute. Within the Pregnancy and Childhood Epigenetics (PACE) Consortium, we meta-analysed the association…
Scaling of the surface vasculature on the human placenta
The networks of veins and arteries on the chorionic plate of the human placenta are analyzed in terms of Voronoi cells derived from these networks. Two groups of placentas from the United States are studied: a population cohort with no…
Spontaneous and indicated preterm delivery risk is increased among overweight and obese women without prepregnancy chronic disease
To investigate the independent impact of prepregnancy obesity on preterm delivery among women without chronic diseases by gestational age, preterm category and parity. A retrospective cohort study. Data from the Consortium on Safe Labor (CSL) in the USA (2002-08). Singleton…
Prenatal Alcohol Exposure in Relation to Autism Spectrum Disorder: Findings from the Study to Explore Early Development (SEED)
Prenatal alcohol exposure can affect neurodevelopment, but few studies have examined associations with autism spectrum disorder (ASD). We assessed the association between maternal alcohol use and ASD in the Study to Explore Early Development, a multi-site case-control study of children…
Prenatal Serum Concentrations of Brominated Flame Retardants and Autism Spectrum Disorder and Intellectual Disability in the Early Markers of Autism Study: A Population-Based Case-Control Study in California
Prior studies suggest neurodevelopmental impacts of polybrominated diphenyl ethers (PBDEs), but few have examined diagnosed developmental disorders. Our aim was to determine whether prenatal exposure to brominated flame retardants (BFRs) is associated with autism spectrum disorder (ASD) or intellectual disability…
Chronic and Acute Ozone Exposure in the Week Prior to Delivery Is Associated with the Risk of Stillbirth
Chronic and acute air pollution has been studied in relation to stillbirth with inconsistent findings. We examined stillbirth risk in a retrospective cohort of 223,375 singleton deliveries from 12 clinical sites across the United States. Average criteria air pollutant exposure…
Pathogenesis of Gestational Diabetes
To investigate the etiology for gestational diabetes mellitus and adverse birth outcomes using pathway-driven biomarkers and metabolites in the NICHD Fetal Growth Study.
Maternal perchlorate exposure in pregnancy and altered birth outcomes
At high medicinal doses perchlorate is known to decrease the production of thyroid hormone, a critical factor for fetal development. In a large and uniquely exposed cohort of pregnant women, we recently identified associations between environmental perchlorate exposures and decreased…
Ambient temperature and air quality in relation to small for gestational age and term low birthweight.
BACKGROUND: Exposures to extreme ambient temperature and air pollution are linked to adverse birth outcomes, but the associations with small for gestational age (SGA) and term low birthweight (tLBW) are unclear. We aimed to investigate exposures to site-specific temperature extremes…
The Pregnancy Environment and Lifestyle Study (PETALS): a population-based longitudinal multi-racial birth cohort
Increasing recognition has been received regarding the proven and suggested links between multi-level environmental exposures on a broad scale (e.g., chemical, clinical, behavioral, physical and social) and health deficits originated from the critical window of development. However, such prospective human…
Maternal healthy lifestyle during early pregnancy and offspring birthweight: differences by offspring sex
PURPOSE: Individual maternal lifestyle factors during pregnancy have been associated with offspring birthweight; however, associations of combined lifestyle factors with birthweight and potential differences by offspring sex have not been examined. MATERIALS AND METHODS: Participants (N = 2924) were identified from a…
Outcomes of Admissions for Preterm Labor
Objective This study aims to quantitate the incidence of preterm labor (PTL) admissions and determine the frequency and predictors of preterm delivery (PTD) during these admissions. Study Design Retrospective cohort of singleton pregnancies within Kaiser Permanente Northern California, 2001 to…
A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis
Current algorithms for management of neonatal early-onset sepsis (EOS) result in medical intervention for large numbers of uninfected infants. We developed multivariable prediction models for estimating the risk of EOS among late preterm and term infants based on objective data…
Ambient Temperature and Early Delivery of Singleton Pregnancies.
BACKGROUND: Extreme temperature is associated with adverse birth outcomes but it is unclear whether it increases early delivery risk.OBJECTIVES: We aimed to determine the association between ambient temperature and early delivery.METHODS: Medical records from 223,375 singleton deliveries from 12 U.S.…
Racial/ethnic differences in preterm perinatal outcomes.
BACKGROUND: Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at
A Clinical Prediction Rule for Rebound Hyperbilirubinemia Following Inpatient Phototherapy
The American Academy of Pediatrics provides little guidance on when to discontinue phototherapy in newborns treated for hyperbilirubinemia. We sought to develop a prediction rule to estimate the probability of rebound hyperbilirubinemia after inpatient phototherapy. Subjects for this retrospective cohort…
Independent Maternal and Fetal Genetic Effects on Mid-gestational Circulating Levels of Environmental Pollutants
Maternal exposure to environmental pollutants could affect fetal brain development and increase autism spectrum disorder (ASD) risk in conjunction with differential genetic susceptibility. Organohalogen congeners measured in maternal midpregnancy blood samples have recently shown significant, but negative associations with offspring…
The impact of preterm birth <37 weeks on parents and families: a cross-sectional study in the 2 years after discharge from the neonatal intensive care unit
Little is known about the quality of life of parents and families of preterm infants after discharge from the neonatal intensive care unit (NICU). Our aims were (1) to describe the impact of preterm birth on parents and families and…
The impact of high apparent temperature on spontaneous preterm delivery: a case-crossover study
The impact of high apparent temperature on spontaneous preterm delivery: a case-crossover studyBACKGROUND: Despite the prediction that temperatures are expected to increase in the future, little is known about the health effects of increasing temperatures on pregnant women. The objective…
Newborn Weight Loss During Birth Hospitalization and Breastfeeding Outcomes Through Age 1 Month
Weight loss is universal for exclusively breastfed newborns in the first few days after birth. Many newborns exclusively breastfed during birth hospitalization receive formula in the first month after discharge and thus cease exclusive breastfeeding. However, the relationship between early…
Prenatal Depression: Registry, Treatment Effectiveness to Reduce Preterm Delivery
The goal of this study is to develop a perinatal depression registry to assess the relationship between prenatal depression and preterm delivery, and whether these relationships differ by race or ethnicity. Additionally, we will evaluate whether treatment for prenatal depression…
Carnitine palmitoyltransferase 1A P479L and infant death: policy implications of emerging data.
Carnitine palmitoyltransferase 1 isoform A (CPT1A) is a crucial enzyme for the transport of long-chain fatty acids into the mitochondria. The CPT1A p.P479L variant is found in high frequencies among indigenous populations residing on the west and north coasts of…
The impact of maternal factors on the association between temperature and preterm delivery
Few studies have examined maternal modifiers of temperature and adverse birth outcomes because of lack of data. We assessed the relationship between apparent temperature, preterm delivery (PTD) and maternal demographics, medical and mental health conditions, and behaviors. A time-stratified case-crossover…
Patterns and predictors of severe postpartum anemia after Cesarean section
Postpartum anemia is associated with maternal and perinatal morbidity. Population-level data may inform guideline development for postpartum anemia screening. Our objectives were to evaluate the associations between potential predictors (predelivery anemia and postpartum hemorrhage [PPH]) with severe postpartum anemia after…
Placental genetic variations in vitamin D metabolism and birthweight
INTRODUCTION: Vitamin D has pleiotropic functions that regulate fetal growth and development. We investigated associations of common placental genetic variations in vitamin D metabolism with birthweight. METHODS: The study was conducted among participants (506 maternal-infant pairs) of a pregnancy cohort…
Weight Change Nomograms for the First Month After Birth
Clinicians expect newborns to surpass birth weight by age 10 to 14 days, yet few studies have examined the natural history of weight change in the weeks after birth. We sought to determine the distribution of weight loss and subsequent…
The Kaiser Permanente Northern California research program on genes, environment, and health (RPGEH) pregnancy cohort: study design, methodology and baseline characteristics
Exposures during the prenatal period may have lasting effects on maternal and child health outcomes. To better understand the effects of the in utero environment on children's short- and long-term health, large representative pregnancy cohorts with comprehensive information on a…
Differences in testosterone and its precursors by sex of the offspring in meconium
Prenatal metabolism exerts profound effects on development. The first stool of the newborn, meconium, provides a window into the prenatal metabolic environment. The objective of this study was to examine the feasibility of meconium as a novel matrix to quantify…
Phototherapy and Risk of Type 1 Diabetes
Increases in both phototherapy use and the incidence of type 1 diabetes mellitus (DM-1) have been reported. One large study has suggested a strong association between them. Our objective was to quantify any association between neonatal phototherapy and DM-1 in…
Effects of maternal folic acid supplementation on gene methylation and being small for gestational age
Being small for gestational age (SGA), a foetal growth abnormality, has a long-lasting impact on childhood health. Its aetiology and underlying mechanisms are not well understood. Underlying epigenetic changes of imprinted genes have emerged as a potential pathological pathway because…
Maternal T. gondii, offspring bipolar disorder and neurocognition
Prenatal exposure to maternal Toxoplasma gondii (T. gondii) IgG antibody titer has been associated previously with an increased risk of offspring schizophrenia (SZ) and cognitive impairment. We examined maternal T. gondii, offspring bipolar disorder (BP) and childhood cognition using a…
Risk of Preterm or Small-for-Gestational-Age Birth After Influenza Vaccination During Pregnancy: Caveats When Conducting Retrospective Observational Studies
Vaccines are increasingly targeted toward women of reproductive age, and vaccines to prevent influenza and pertussis are recommended during pregnancy. Prelicensure clinical trials typically have not included pregnant women, and when they are included, trials cannot detect rare events. Thus,…
Obstetric and Neonatal Risks Among Obese Women Without Chronic Disease.
OBJECTIVE: To investigate whether prepregnancy obesity is associated with adverse pregnancy outcomes among women without chronic disease. METHODS: Singleton deliveries (N=112,309) among mothers without chronic diseases in the Consortium on Safe Labor, a retrospective U.S. cohort, were analyzed using Poisson…
Exposure to Ambient Air Pollution and Premature Rupture of Membranes.
Premature rupture of membranes (PROM) is a major factor that predisposes women to preterm delivery. Results from previous studies have suggested that there are associations between exposure to air pollution and preterm birth, but evidence of a relationship with PROM…
Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke
To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke. We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian…
Development of a Brief Questionnaire to Assess Contraceptive Intent
We sought to develop and validate an instrument that can enable providers to identify young women who may be at risk of contraceptive non-adherence. Item response theory based methods were used to evaluate the psychometric properties of the Contraceptive Intent…
Improved Perinatal Depression Screening, Treatment, and Outcomes With a Universal Obstetric Program
To evaluate whether universal prenatal and early postnatal screening for depression leads to increased detection, subsequent intervention, and improved depressive symptom outcomes. We conducted a population-based retrospective cohort study of 97,678 pregnant Kaiser Permanente Northern California members during three phases…
Trimethoprim-sulfonamide use during the first trimester of pregnancy and the risk of congenital anomalies
Sulfonamide antibacterials are widely used in pregnancy, but evidence about their safety is mixed. The objective of this study was to assess the association between first-trimester sulfonamide exposure and risk of specific congenital malformations. Mother-infant pairs were selected from a…
Maternal Leisure Time Physical Activity and Infant Birth Size
BACKGROUND: Associations of maternal leisure time physical activity with birth size are inconsistent. Roles of infant sex and maternal prepregnancy body mass index (BMI) in these associations have not been studied. METHODS: Participants (N = 3,310) in the Omega study,…
Altered Gut Microbiota Composition Associated with Eczema in Infants
Eczema is frequently the first manifestation of an atopic diathesis and alteration in the diversity of gut microbiota has been reported in infants with eczema. To identify specific bacterial communities associated with eczema, we conducted a case-control study of 50…
Trimester-Specific Gestational Weight Gain and Infant Size for Gestational Age
Gestational weight gain is known to influence fetal growth. However, it is unclear whether the associations between gestational weight gain and fetal growth vary by trimester. In a diverse cohort of 8,977 women who delivered a singleton between 2011 and…
Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study
Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. Prospective, observational cohort of women with recent…
Associations of Early and Late Gestational Weight Gain with Infant Birth Size
OBJECTIVES: Associations of gestational weight gain (GWG) during specific periods of pregnancy with infant birth size have been inconsistent. Infant sex-specific differences in these associations are unknown METHODS: Information on GWG (kg) [total, early (
Thyroid Hormones and Moderate Exposure to Perchlorate during Pregnancy in Women in Southern California
Findings from national surveys suggest that everyone in the US is exposed to perchlorate. At high doses, perchlorate, thiocyanate, and nitrate inhibit iodide uptake into the thyroid and decrease thyroid hormone production. Small changes in thyroid hormones during pregnancy, including…
Maternal prepregnancy waist circumference and BMI in relation to gestational weight gain and breastfeeding behavior: the CARDIA study
Studies suggest that gestational weight gain (GWG) and breastfeeding behavior may influence long-term maternal abdominal fat mass. However, this could be confounded by abdominal fat mass before pregnancy because it is unknown whether abdominal fat mass, independently of body size,…
Maternal ambient air pollution exposure preconception and during early gestation and offspring congenital orofacial defects.
BACKGROUND: Maternal air pollution exposure has been related to orofacial clefts but the literature is equivocal. Potential chronic preconception effects have not been studied. OBJECTIVES: Criteria air pollutant exposure during three months preconception and gestational weeks 3-8 was studied in…
The Association Between Influenza Vaccination and Other Preventative Health Behaviors in a Cohort of Pregnant Women
Although pregnant women are a high-priority group for seasonal influenza vaccination, vaccination rates in this population remain below target levels. Previous studies have identified sociodemographic predictors of vaccine choice, but relationships between preconception heath behaviors and seasonal influenza vaccination are…
Results of a Pilot Study using Self-Collected Mid-Turbinate Nasal Swabs for Detection of Influenza Virus Infection among Pregnant Women
We evaluated the feasibility of asking pregnant women to self-collect and ship respiratory specimens. In a preliminary laboratory study, we compared the RT-PCR cycle threshold (CT) values of influenza A and B viruses incubated at 4 storage temperatures (from 4…
Maternal caffeine intake during pregnancy and risk of obesity in offspring: a prospective cohort study
In-utero exposures through adverse fetal programming are emerging as an important contributing factor to the epidemic of childhood obesity. This study examines the impact of in-utero exposure to caffeine on the risk of childhood obesity in offspring. A prospective study…
Topiramate use during pregnancy and major congenital malformations in multiple populations
We measured birth prevalence of major congenital malformations (MCMs) after topiramate use during pregnancy to screen for a possible signal of increased risk. Using four healthcare databases, we identified three cohorts of pregnant women: cohort 1, used topiramate during the…
Breastfeeding Versus Formula-Feeding and Girls’ Pubertal Development
To examine the association of breastfeeding or its duration with timing of girls' pubertal onset, and the role of BMI as a mediator in these associations. A population of 1,237 socio-economically and ethnically diverse girls, ages 6-8 years, was recruited…
Does adopting a prenatal substance use protocol reduce racial disparities in CPS reporting related to maternal drug use? A California case study
This study examined whether adopting a standardized prenatal substance use protocol (protocol) in a hospital labor and delivery unit reduced racial disparities in reporting to child protective services (CPS) related to maternal drug use during pregnancy. This study used an…
Severity of influenza and non-influenza acute respiratory illness among pregnant women, 2010-12
The objective of the study was to identify characteristics of influenza illness contrasted with noninfluenza acute respiratory illness (ARI) in pregnant women. ARI among pregnant women was identified through daily surveillance during 2 influenza seasons (2010-2012). Within 8 days of…
Antidepressant medication use, depression, and the risk of preeclampsia
To assess the effects of depression and antidepressant medication use during pregnancy on the risk of preeclampsia. We conducted a retrospective, population-based cohort study that linked automated clinical and pharmacy databases including comprehensive electronic medical records of 21,589 pregnant Kaiser…
Genital herpes and its treatment in relation to preterm delivery
To examine the risks of genital herpes and antiherpes treatment during pregnancy in relation to preterm delivery (PTD), we conducted a multicenter, member-based cohort study within 4 Kaiser Permanente regions: northern and southern California, Colorado, and Georgia. The study included…
Trends in Elective Labor Induction for Six United States Health Plans, 2001-2007
To describe trends in labor induction, including elective induction, from 2001 to 2007 for six U.S. health plans and to examine the validity of induction measures derived from birth certificate and health plan data. This retrospective cohort study included 339,123…
Topiramate use in pregnancy and the birth prevalence of oral clefts
First marketed in the USA in 1996, topiramate (TPM) is an antiepileptic drug later approved for migraine prophylaxis, and in 2012 for weight loss in combination with phentermine. Some studies indicate an elevated prevalence of oral cleft (OC) in infants…
Maternal gestational weight gain and offspring risk for childhood overweight or obesity
The objective of the study was to evaluate the association between gestational weight gain, per the 2009 Institute of Medicine (IOM) recommendations, and offspring overweight/obesity at 2-5 years of age. This was a prospective cohort study of 4145 women who…
Genetic risk score for prediction of newborn adiposity and large-for-gestational-age birth
CONTEXT: Macrosomic infants are at increased risk for adverse metabolic outcomes. Improving prediction of large-for-gestational-age (LGA) birth may help prevent these outcomes. OBJECTIVE: This study sought to determine whether genes associated with obesity-related traits in adults are associated with newborn…
Combining Immature and Total Neutrophil Counts to Predict Early Onset Sepsis in Term and Late Preterm Newborns: Use of the I/T2
The absolute neutrophil count and the immature/total neutrophil ratio (I/T) provide information about the risk of early onset sepsis in newborns. However, it is not clear how to combine their potentially overlapping information into a single likelihood ratio. We obtained…
Maternal Acculturation and the Prenatal Care Experience
Acculturation may influence women's perceptions of health care experiences and may explain the epidemiologic paradox, whereby foreign-born women have lower rates of adverse birth outcomes than United States (US)-born women. We evaluated the relationship between maternal acculturation and specific dimensions…
Characteristics and quality of life of opioid-dependent pregnant women in Austria.
This study investigated pregnant opioid-dependent women undergoing maintenance therapy, applying a multidisciplinary, case-management approach at the Addiction Clinic of the Medical University of Vienna, Austria. It aimed at characterizing the patients' basic demographic and clinical parameters and evaluating their overall…
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
Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates…
Risk of Cardiovascular Disease Among Postmenopausal Women with Prior Pregnancy Loss: The Women’s Health Initiative
Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort…
Pregravid Liver Enzyme Levels and Risk of Gestational Diabetes During a Subsequent Pregnancy
Liver enzymes are independent predictors of type 2 diabetes. Although liver fat content correlates with features of insulin resistance, a risk factor for developing gestational diabetes mellitus (GDM), the relationship between liver enzymes and GDM is unclear. The objective of…
Safety of influenza vaccination during pregnancy: A review of subsequent maternal obstetric events and findings from two recent cohort studies
Pregnant women and their infants are vulnerable to severe disease and secondary complications from influenza infection. For this reason, annual influenza vaccination is recommended for all pregnant women in the United States. Women frequently cite concerns about vaccine safety as…
Does antidepressant exposure in pregnancy affect maternal serum markers for aneuploidy?
The objective of this study was to examine the effect of maternal antidepressant exposure on first- and second-trimester maternal serum markers for aneuploidy. We conducted a 10-year retrospective cohort study within a large health care organization. Pregnant women diagnosed with…
Gestational weight gain and neonatal adiposity in the Hyperglycemia and Adverse Pregnancy Outcome study-North American region
OBJECTIVE: To examine the associations between gestational weight gain (GWG) exceeding Institute of Medicine (IOM) guidelines and neonatal adiposity in the five North American field centers of the Hyperglycemia and Adverse Pregnancy Outcome study.METHODS: GWG was categorized as less than,…
Vaccinations given during pregnancy, 2002-2009: a descriptive study
A number of studies have described influenza vaccination coverage during pregnancy but few publications have described rates of other vaccinations. To describe vaccination rates during pregnancy in the Vaccine Safety Datalink (VSD), with particular focus on vaccinations contraindicated during pregnancy.…
Brief report: risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy
To assess the risk of adverse fetal outcomes following exposure to individual immunosuppressive drugs in pregnant women with chronic immune-mediated diseases. Health plan data were obtained from the Tennessee Medicaid and Kaiser Permanente Northern California and Southern California claims databases,…
Correlation between Exposure to Magnetic Fields and Embryonic Development in the First Trimester
To explore the correlation between maternal magnetic field (MF) exposure in daily life and embryonic development. A cross-sectional study was conducted among 149 pregnant women who were seeking induced abortion of unwanted pregnancies. Participating women were asked to wear an…
Prepregnancy SHBG Concentrations and Risk for Subsequently Developing Gestational Diabetes Mellitus
Lower levels of sex hormone-binding globulin (SHBG) have been associated with increased risk of diabetes among postmenopausal women; however, it is unclear whether they are associated with glucose intolerance in younger women. We examined whether SHBG concentrations, measured before pregnancy,…
Stratification of Risk of Early-Onset Sepsis in Newborns >=34 Weeks’ Gestation
To define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ? 34 weeks' gestation. We conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth…
The Prevalence and Trends of Antiviral Medication Use During Pregnancy in the US: A Population-Based Study of 664,297 Deliveries in 2001-2007
To evaluate the prevalence, trends, timing and duration of exposure to antiviral medications during pregnancy within a US cohort of pregnant women and to evaluate the proportion of deliveries with a viral infection diagnosis among women given antiviral medication during…
Levels of Cotinine in Dried Blood Specimens from Newborns as a Biomarker of Maternal Smoking Close to the Time of Delivery
The precise quantitation of smoking during pregnancy is difficult in retrospective studies. Routinely collected blood specimens from newborns, stored as dried blood spots, may provide a low-cost method to objectively measure maternal smoking close to the time of delivery. This…
Hospital readmissions and emergency department visits in moderate preterm, late preterm, and early term infants
The increased vulnerability of late preterm infants is no longer a novel concept in neonatology, with many studies documenting excess morbidity and mortality in these infants during the birth hospitalization. Because outcomes related to gestational age constitute a continuum, it…
Medication Exposure in Pregnancy Risk Evaluation Program: The Prevalence of Asthma Medication Use During Pregnancy
Asthma is one of the most common chronic diseases in women of reproductive age, occurring in up to 8 % of pregnancies. The objective of this study is to assess the prevalence of asthma medication use during pregnancy in a large…
Childbirth and female sexual function later in life
To examine relationships among parity, mode of delivery, and other parturition-related factors with women's sexual function later in life. Self-administered questionnaires examined sexual desire, activity, satisfaction, and problems in a multiethnic cohort of women aged 40 years and older with…
Adherence to Immunoprophylaxis Regimens for Respiratory Syncytial Virus Infection in Insured and Medicaid Populations
Immunoprophylaxis is the only pharmaceutical intervention for mitigating respiratory syncytial virus (RSV) infection. Patient level data on adherence to American Academy of Pediatrics (AAP) immunoprophylaxis recommendations are limited. This study characterizes adherence to AAP guidelines in privately insured and Medicaid…
Early-onset sepsis: a predictive model based on maternal risk factors
PURPOSE OF REVIEW: Neonatal early-onset sepsis (EOS) is a very low-incidence, but potentially fatal condition among term and late preterm newborns. EOS algorithms based on risk-factor threshold values result in evaluation and empiric antibiotic treatment of large numbers of uninfected…
Genetic risk factors for perinatal arterial ischemic stroke
The cause of perinatal arterial ischemic stroke is unknown in most cases. We explored whether genetic polymorphisms modify the risk of perinatal arterial ischemic stroke. In a population-based case-control study of 1997-2002 births at Kaiser Permanente Northern California, we identified…
Trends in the Use of Antiepileptic Drugs among Pregnant Women in the US, 2001-2007: A Medication Exposure in Pregnancy Risk Evaluation Program Study
BACKGROUND: Little is known about the extent of antiepileptic drug (AED) use in pregnancy, particularly for newer agents. Our objective was to assess whether AED use has increased among pregnant women in the US, 2001-2007. METHODS: We analysed data from…
A Large, Population-Based Study of 2009 Pandemic Influenza A Virus Subtype H1N1 Infection Diagnosis During Pregnancy and Outcomes for Mothers and Neonates
BACKGROUND: Pregnant women were at increased risk for serious outcomes of 2009 pandemic influenza A virus subtype H1N1 (influenza A[H1N1]pdm09) infection, but little is known about the overall impact of the pandemic on neonatal and maternal outcomes. METHODS: We identified…
Risk of preterm delivery in non-diabetic women with polycystic ovarian syndrome
OBJECTIVE: To examine the risk and etiology of preterm delivery in women with polycystic ovary syndrome (PCOS). STUDY DESIGN: Retrospective cohort study comparing preterm delivery rate among non-diabetic PCOS and non-PCOS women with singleton pregnancy. Multivariable logistic regression was used…
Prevalence of cervical insufficiency in polycystic ovarian syndrome
BACKGROUND: Pregnant women with polycystic ovarian syndrome (PCOS) experience a greater rate of adverse obstetrical outcomes compared with non-PCOS women. We examined the prevalence and incidence of cervical insufficiency (CI) in a community cohort of pregnant women with and without…
Underimmunization at discharge from the neonatal intensive care unit
OBJECTIVE: The objectives of this study are to determine immunization rates at discharge from the neonatal intensive care unit (NICU) among infants 2 months of age and above and to evaluate risk factors for underimmunization. STUDY DESIGN: A retrospective cohort…
Prenatal and Perinatal Characteristics Associated with Pediatric-Onset Inflammatory Bowel Disease
BACKGROUND: The majority of studies that report early life risk factors for pediatric-onset inflammatory bowel disease (IBD) do not account for potential confounding, which can lead to spurious associations and incorrect inferences. AIMS: To assess the relationship between prenatal and…
Prepregnancy cardiometabolic and inflammatory risk factors and subsequent risk of hypertensive disorders of pregnancy
OBJECTIVE: The purpose of this study was to examine prepregnancy cardiometabolic and inflammatory markers and the subsequent risk of hypertensive disorders of pregnancy. STUDY DESIGN: This was a retrospective cohort study of 3380 women who took part in a comprehensive…
The impact of maternal characteristics on the moderately premature infant: an antenatal maternal transport clinical prediction rule
OBJECTIVE: Moderately premature infants, defined here as those born between 30(0)/(7) and 34(6)/(7) weeks gestation, comprise 3.9% of all births in the United States and 32% of all preterm births. Although long-term outcomes for these infants are better than for…
Racial and ethnic differences in the prevalence of placenta previa
OBJECTIVE: The objective of this study is to determine the prevalence of placenta previa among different racial and ethnic groups. STUDY DESIGN: We conducted a retrospective cohort study to examine the prevalence of placenta previa among five major racial and…
Interpersonal Processes of Care and Cesarean Delivery in Two Health Care Settings
OBJECTIVES: We examined whether interpersonal processes of care (IPC) were associated with cesarean delivery. METHODS: We performed a cross-sectional study of 1308 postpartum women at Kaiser Permanente Medical Center in Walnut Creek, CA (KP-WC), and San Francisco General Hospital (SFGH)…
Frequency, duration and predictors of bronchiolitis episodes of care among infants [greater than or equal to]32 weeks gestation in a large integrated healthcare system: a retrospective cohort study
BACKGROUND: Bronchiolitis is common in the first two years of life and is the most frequent cause of hospitalization in this age group. No previous studies have used an episode-of-care analysis to describe the frequency, duration, and predictors of bronchiolitis…
Total Serum Bilirubin Exceeding Exchange Transfusion Thresholds in the Setting of Universal Screening
OBJECTIVE: To describe the incidence and predictors of total serum bilirubin (TSB) levels that meet or exceed American Academy of Pediatrics (AAP) exchange transfusion (ET) thresholds in the setting of universal screening. STUDY DESIGN: We conducted a retrospective cohort analysis…
California Very Preterm Birth Study: design and characteristics of the population- and biospecimen bank-based nested case-control study
Very preterm birth (VPTB) is a leading cause of infant mortality, morbidity and racial disparity in the US. The underlying causes of VPTB are multiple and poorly understood. The California Very Preterm Birth Study was conducted to discover maternal and…
Early start: a cost-beneficial perinatal substance abuse program
OBJECTIVE: To conduct a cost-benefit analysis of Early Start, an integrated prenatal intervention program for stopping substance use in pregnancy. METHODS: A retrospective cohort study was conducted of 49,261 women who had completed prenatal substance abuse screening questionnaires at obstetric…
A Prospective Study of In-utero Exposure to Magnetic Fields and the Risk of Childhood Obesity
We conducted a prospective study to examine whether in-utero exposure to magnetic fields (MFs) increases the risk of childhood obesity. Participating women carried a meter measuring MF levels during pregnancy and 733 of their children were followed up to 13…
The impact of the iPLEDGE program on isotretinoin fetal exposure in an integrated health care system
BACKGROUND: Preventing fetal exposure to isotretinoin is widely acknowledged as an important safety issue. The iPLEDGE program is the latest in a series of Food and Drug Administration-mandated risk management programs designed to prevent pregnancies in female patients of childbearing…
Parturition events and risk of urinary incontinence in later life
AIMS: To examine the association between specific events during vaginal deliveries and urinary incontinence later in life. METHODS: A retrospective cohort study of 1,521 middle-aged and older women with at least one vaginal delivery who were long-term members of an…
Does Lack of Multinutrient Supplementation During Early Pregnancy Increase Vulnerability to Alcohol-Related Preterm or Small-for-Gestational-Age Births?
The objective of this study was to assess whether women who do not take multinutrient supplements during early pregnancy are more susceptible to the effects of low-to-moderate alcohol consumption on preterm birth and small-for-gestational-age birth (SGA) compared to women who…
Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors
OBJECTIVE: To develop a quantitative model to estimate the probability of neonatal early-onset bacterial infection on the basis of maternal intrapartum risk factors. METHODS: This was a nested case-control study of infants born at >/=34 weeks' gestation at 14 California…
In utero exposure to bisphenol-A and anogenital distance of male offspring
BACKGROUND: Bisphenol-A (BPA) is an endocrine disruptor with widespread human exposure. The effect of in utero BPA exposure on human offspring remains largely unknown. METHODS: Anogenital distance (AGD) of sons of workers who did or did not have occupational BPA…
Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes
OBJECTIVES: To estimate the incidence, describe the mortality, and identify independent predictors of peripartum cardiomyopathy, a very serious cardiovascular complication of pregnancy associated with maternal morbidity and mortality among otherwise healthy women without prior heart disease. METHODS: We identified all…
First-trimester fetal heart rate in mothers with opioid addiction.
AIM: To investigate the difference in fetal heart rate of opioid-dependent mothers compared to non-dependent mothers in the first trimester of pregnancy.DESIGN: The data of 74 consecutive singleton pregnancies of mothers enrolled in a maintenance programme for opioid-dependent women was…
Epidemiology of apnea and bradycardia resolution in premature infants
BACKGROUND: There is little epidemiologic evidence to assess the maturation of respiratory control in premature infants. OBJECTIVE: To measure the success rate or the percentage of infants who have no additional events of various apnea- or bradycardia-free intervals after correcting…
Pregravid cardiometabolic risk profile and risk for gestational diabetes mellitus
OBJECTIVE: The purpose of this study was to examine pregravid cardiometabolic profile and subsequent risk of gestational diabetes mellitus (GDM). STUDY DESIGN: GDM cases (n = 199) and control subjects (n = 381) were selected from a cohort of women…
In utero exposure to bisphenol-A and its effect on birth weight of offspring
To examine the effect of in utero BPA exposure on the birth weight of offspring, a total of 587 children from families in which parent(s) did or did not have occupational exposure to BPA were examined. Their birth weights were…
The Pregnancy and Influenza Project: design of an observational case-cohort study to evaluate influenza burden and vaccine effectiveness among pregnant women and their infants
The US Centers for Disease Control and Prevention is conducting an observational study of 300-500 women infected with influenza during pregnancy. Women are being recruited from members of the Kaiser Permanente health plan in 2 metropolitan areas before and during…
Interpreting conjugated bilirubin levels in newborns
OBJECTIVE: To examine the clinical significance of elevated conjugated bilirubin (CB) levels in newborns. STUDY DESIGN: This retrospective study evaluated a birth cohort of 271 186 full-term newborns born within a Northern California hospital network from 1995 to 2004. All…
Vitamin D, pregnancy, breastfeeding, and postpartum multiple sclerosis relapses
OBJECTIVE: To determine whether low levels of 25-hydroxyvitamin D (25[OH]D) contribute to the increased risk of postpartum multiple sclerosis (MS) relapses. DESIGN: Prospective cohort study. SETTING: Outpatients identified through membership records of Kaiser Permanente Northern California or Stanford University outpatient…