RESEARCH

To advance the understanding of the impact of air pollutant mixture and the built environment on pregnancy complications (gestational diabetes, gestational hypertension, and pre-eclampsia/eclampsia) and outcomes by leveraging prospectively- recorded and high-quality maternal clinical data from the electronic health record and address data with state-of-the-art spatiotemporal air pollution modeling and novel statistical methods that examine both individual and composite exposure profiles.

The goal of the Boostrix study is to examine pre-specified pregnancy-related adverse events in a cohort of women vaccinated with Boostrix at 27 weeks gestation or beyond compared to a matched historical unvaccinated control group.

Mindfulness Based Cognitive Therapy (MBCT) an 8-session in-person intervention using mindfulness meditation and cognitive-behavioral strategies, has shown effectiveness in reducing residual depressive symptoms and risk for recurrence among pregnant women with histories of depression. A digital adaptation of MBCT for pregnant women, Mindful Mood Balance for Moms (MMBFM), was recently developed to overcome access barriers to in-person groups and increase potential for scale-up in OB care settings. We will address the following aims for this study: 1) Compare the clinical effectiveness (i.e. engagement and symptom reduction) of MMBFM supported by clinician vs. peer coaches among women with a history of prior depressive episodes; 2) examine specific mechanisms of action for MMBFM participants receiving clinician vs. peer coaching; 3) examine the effects of specific implementation strategies on reach of the MMBFM program; and 4) estimate the cost-effectiveness of MMBFM supported by clinician vs. peer coaches. We hypothesize that MMBFM will be more cost-effective when supported by peer vs. clinician coaches.

In 2008, 23% of births in the United States (nearly 1 million) were initiated by induction. Many inductions are elective, that is, performed without a medical or obstetric indication, typically for the woman’s comfort or convenience. In prior studies, this proportion has ranged from 13 to 49% of inductions. This suggests that 130,000 to 490,000 births in the U.S. each year are initiated by elective induction. As a pilot study, we examined the prevalence of induction from 2001-8 using linked electronic health data and birth certificate data at two integrated health care delivery systems, Kaiser Permanente Southern California (KPSC) and Group Health (GH). The prevalence of induction rose from 24% to 30%. Among all births, the prevalence of induction with no documented indication rose from 4.7% to 8.4%. At KPSC, we examined trends by race and ethnicity. Induction with no documented indication was more common in whites than any other group, but similar increases were seen in all groups.

Polybrominated diphenyl ether(s) (PBDEs) have been in widespread use in home construction, furniture, clothing and electronic appliances for decades. PBDEs save lives by giving occupants valuable time to extinguish or escape from a spreading fire, however, with time, they leach into the environment and have become one of the most prevalent of the persistent organic pollutants (POPs). Concentrations of PBDEs have been increasing in human tissues since their introduction into consumer products. Breast-milk and plasma concentrations of PBDEs are 10 to 100-fold higher in the United States than other countries. Studies of pregnancy tissues indicate that PBDEs are present in amniotic fluid, umbilical cord plasma, umbilical cord tissue, placenta, and fetal membranes. The role of these flame retardants on adverse pregnancy outcomes is understudied, however, some recent reports have shown significant effects on birth weight. PBDEs may affect human health as endocrine disruptors. Overt and subclinical hypothyroidism increases the risk for preterm birth through an unknown mechanism. Furthermore, T4 reduced the production of proinflammatory cytokines, reduced inflammation, improved bacterial clearance and survival in animal models of sepsis. We hypothesize that exposure of pregnant women to PBDEs may reduce bioactivity of the T3 and T4 leading to a proinflammatory environment and increasing their risk for preterm birth.

The overall goal of this study is to identify the associations of the in-utero cardio-metabolic milieu with young adult cardiovascular health and subclinical cardiovascular disease in offspring, and to investigate whether DNA methylation mediates these associations.

Aims: 1. Determine maternal preconception weight trajectories associated with (a) recommended GWG (total and trimester-specific) and (b) lowest PPWR at 4-6 weeks and 12 months postpartum. 2. Determine maternal preconception weight trajectories associated with the lowest risk of adverse pregnancy outcomes: gestational diabetes, gestational hypertension/preeclampsia, and cesarean section. 3. Determine maternal preconception weight trajectories associated with the lowest risk of adverse child outcomes: preterm birth, size for gestational age at birth (small [SGA], appropriate, large [LGA]), infant growth trajectory, and BMI at 3 years of age.

The objective of the Menveo Pregnancy Registry is to evaluate pregnancy outcomes among women immunized with the Menveo vaccine within 28 days prior to conception or at any time during pregnancy. The primary outcomes of interest include major congenital malformation, preterm birth, and low birth weight. Other pregnancy outcomes will be collected, including spontaneous abortions and stillbirths.

Evaluating the effect of treating mild-to-moderate hypertension in pregnancy, compare the risks of clinically important outcomes with different medications, and determine whether the benefits and risks vary by maternal race/ethnicity or obesity status.

The goal of this study is to examine the potential relationship between antibiotic use during pregnancy and pediatric weight problems. Particular focus is given to infants exposed to intrapartum Group B streptococcus prophylaxis and its impact on a child’s body weight.

The goal of this study it to evaluate patterns of medical imaging associated with cumulative exposure to radiation (CT, nuclear medicine, fluoroscopy, angiography, and radiography), and subsequent risk of childhood cancers.