Embedded in the Kaiser Permanente Northern California health plan, DOR investigators conduct studies that can rapidly translate results into changes in clinical practice to improve women's health and health care. DOR investigators utilize high-quality pregnancy and diabetes patient registries, historical electronic health data, and real-time electronic health records to conduct high-quality, high-impact research. Prime examples are a large study of the diagnostic criteria for gestational diabetes and pregnancy outcomes (which led the health plan to adopt lower thresholds for diagnosing and treating gestational diabetes to reduce pregnancy complications) and a large epidemiological study of pregravid risk factors for gestational and postpartum diabetes using health screening clinical exams performed by the Kaiser Permanente Northern California health plan years before conception. Other studies are evaluating the impact of pregancy complications and preconception health status on the future risk of obesity, diabetes, and heart disease in women.
More recently the GEM (Gestational Diabetes' Effects on Moms) study, a cluster randomized controlled trail, evaluated the effects of a lifestyle diabetes prevention program delivered at the health system level to reduce postpartum weight retention among women with a recent history of gestational diabetes. Additional research programs focus on implementation science, such as testing novel outreach strategies to promote patient engagement in health system-based preventive lifestyle programs with the goal of reducing health disparities. A recent large epidemiological study has shown that 6 months or more of lactation was associated with a 50 percent lower risk of progression to type 2 diabetes in women with gestational diabetes two years postpartum.
Pregnancy: Investigators have participated in a wide array of women's health research, including prospective and retrospective studies in etiology and prevention. Our work in this area includes etiologic studies of pre-pregnancy and pregnancy risk factors for gestational diabetes and excessive gestational weight gain, as well as studies of the impact of obesity, gestational diabetes, gestational weight gain, and other environmental exposures on pregnancy and postpartum outcomes. Additional research programs include randomized controlled trials to understand how to help women to achieve appropriate gestational weight gain. Current research includes intervention studies on weight management during and after pregnancy to improve perinatal and postpartum outcomes. DOR investigators have also participated in large studies of the effects of medication use on pregnancy outcomes, depression during pregnancy and its impact on preterm birth, and the impact of common environment exposures, such as bisphenol-A, on pregnancy outcomes.
Reproductive health: Investigators are also evaluating women's reproductive health, with the goal of improving maternity care and insuring that women are able to plan their families with appropriate timing and optimized preconception health. As a result DOR investigators focus research on contraceptive use and preventing unintended pregnancy. DOR investigators also have close collaborations with the National Cancer Institute to examine cervical cancer screening processes and outcomes. Collaborative work with NCI also includes the creation of a biorepository to study biological markers of human papilloma virus (HPV) Infection and cervical cancer.
Depression: Investigators at DOR are conducting a wide-range of health services, clinical, and epidemiological research focused on depression during pregnancy and postpartum. Epidemiologic research includes assessing genetic and nutritional risk factors for depression, while health research includes evaluation of the effectiveness of a universal peripartum depression screening program for improving detection and treatment of depression. Clinical research includes comparing the effectiveness of treatment options for antepartum depression on reducing the risk of postpartum depression.
