Prenatal Opioid Exposure: Birth, health, socioeconomic, and educational outcomes of mothers and their children
My Roles: PI with Lawrence Berger
The rapid rise in prenatal exposure to prescription and other opioids over the last decade mirrors dramatic trends in opioid use across the general population of the US. In some states nearly one in four pregnancies are exposed to prescription opioids; 60-80% of affected pregnancies are Medicaid-covered. Moreover, the rise in maternal opioid use disorder (OUD), prenatal opioid exposure, and neonatal abstinence syndrome (NAS) appears to be driving a substantial increase child protective services (CPS) involvement. However, the impact of prenatal opioid exposure on pregnancy and child outcomes, independent of co-occurring factors, remains unclear. To address this gap, we have assembled a multi-source longitudinal administrative birth cohort that links data for all ~800,000 live births across Wisconsin, including ~350,000 Medicaid-covered births, from 2007 to 2018. By linking data at the individual level, and updating each source of data annually, we can identify and track subsequent births (siblings) and follow a growing cohort of mothers and their children as their lives unfold over more than a decade. Our unique data support multilevel examination of individual factors, and the influence of health care and community characteristics, that is needed to better understand and address the effects of the opioid epidemic on women and their children. We will use regression-based and quasi-experimental methods, and geospatially informed analyses, to examine outcomes and factors which may influence outcomes.
Our specific aims are: 1) Estimate the bounded annual prevalence of prenatal opioid exposure, including OUD and infant NAS, among all Medicaid-covered births in Wisconsin from 2007-2018, and describe the characteristics of affected women, families, and their communities, and changes therein over time; 2) Examine associations of prenatal opioid exposure, including OUD and NAS, with behaviors and outcomes including a) adverse pregnancy and birth outcomes; b) child maltreatment reports, substantiated reports, and foster care entries; and c) reproductive, health, social, educational, and economic outcomes for mothers and children, spanning the prenatal period through the first 8 years of the child’s life; 3) Investigate individual and community-level factors associated with maternal participation in addiction treatment during the prenatal and postpartum periods, including type(s) of treatment and treatment retention; and 4) Estimate plausibly causal effects of addiction treatment participation on maternal and child wellbeing spanning the child’s birth through age 8 using a quasi-experimental design. This research addresses the HHS 5-Point Strategy to Combat the Opioid Crisis, with a call for Better Data and Better Research, and complements the research into the biological pathways and treatment strategies enabled by the Trans NIH effort Helping to End Addiction Long-termSM (HEAL) Initiative.
Expanding the evidence-base for prevention strategies to improve the health of women, infants, and families
Sponsor(s): US Centers for Disease Control and Prevention
My Roles: Principal Investigator
The major goal of this project is to improve the health of low-income women, infants and families through the conduct of high-quality applied health promotion and disease prevention research with a focus on achieving health equity. This grant provides funding for the University of Wisconsin-Madison Prevention Research Center.
Building a Public Health Reserve with Community Health Workers
Sponsor(s): UW Institute for Clinical and Translational Research
My Roles: Principal Investigator
The overarching goal of this study is to design, and pilot test a sophisticated, culturally appropriate strategy to support the rapid scale-up of COVID-19 testing, contact tracing, and ultimately vaccination. This will be accomplished with the already existing infrastructure of community-based programs supporting families with young children who face higher rates of poverty.
Health Disparities Research Scholar (T32) Postdoctoral Training Program
Sponsor(s): National Institutes of Health (NICHD)
My Roles: Principal Investigator
This T32 training grant from the Population Dynamics Branch of the NICHD supports five postdoctoral scholars in interdisciplinary research that addresses disparities in health status and health outcomes among minority populations with an emphasis on maternal/child, adolescent and families, as well as to enhance recruitment of underrepresented minorities into academic research careers.
Conception Failure and Pregnancy Loss in the US
My Roles: Co-Investigator with PI Jenna Nobles
Conception failure and miscarriage affect millions of U.S. couples each year. This research uses new georeferenced data on pre-pregnancy and early pregnancy for 4 million U.S. women to provide the first evidence on individual, family, ecological, and policy factors that reduce the risk of early pregnancy failure.
Building a Transformational Data Resource to Support Housing Research
Sponsor(s): University of Wisconsin-Madison
My Roles: Co-Investigator with PI Katherine Magnuson
The project will bring together faculty from across campus to identify strategic data resources needed to advance the field, complete two proof-of-concept research projects investigating links between housing assistance and children's health and education outcomes, and seek extramural funding to support new research. IRP will leverage existing relationships with local, state and national policymakers to acquire data, and IRP’s programmers, with decades of experience linking administrative data, will create the resource.
Sponsor(s): NIH, CDC, WPP
Our lab conducts life course epidemiology and applied social sciences research designed to understand and improve the health of women, infants and families, with a focus on achieving health equity. Our research focuses on three intersecting areas of women’s and children’s health, where health disparities are of fundamental importance: perinatal health and health care, child health, and women’s cardiovascular disease. We explore the association of women’s health, health care, and community factors with perinatal outcomes to inform clinical and policy questions on the national agenda.
Antony, Ehrenthal, Hoppe, Stewart published in WMJ Smoking in Pregnancy issue
UW Ob-Gyn faculty co-authored two articles in the latest issue of the Wisconsin Medical Journal.
Katie Antony, MD, and Kathy Stewart, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, co-authored the article “Travel During Pregnancy: A Study of Postpartum Women in Madison, Wisconsin,” a survey-based study examining trends in domestic and international travel by pregnant women.
Among other conclusions, they found that in the majority of cases, health care providers initiated conversations about traveling while pregnant, underscoring the need to make discussing travel risks a more common part of practice.
MFM physician Kara Hoppe, DO co-authored an article with Division of Reproductive and Population Health Director Deborah Ehrenthal, MD, MPH. “Progesterone Supplementation for the Prevention of Preterm Birth: Provider Practice in Wisconsin” assessed provider practices on prescribing progesterone to prevent preterm birth.
Their study found that obstetric providers are more likely than family practice or midwifery providers to use progesterone, and more likely to prescribe 17a-hydroxyprogesterone caproate as well.
Prevention Research Center launched on December 12
Campus and community partners gathered on December 12 to celebrate the newly-launched UW-Madison Prevention Research Center! Speakers including UW SMPH Dean Robert Golden, MD, UW Ob-Gyn Department Chair Laurel Rice, MD, Prevention Research Center Director Deborah Ehrenthal, MD, and more introduced different aspects of the center, which will be focused on improving the health of low-income women, infants and families in Wisconsin.
UW-Madison is one of just 25 academic institutions across the country to receive five-year funding from the CDC to establish a Prevention Research Center. The center reflects a partnership between the UW School of Medicine and Public Health, Institute on Poverty, and the School of Human Ecology. In addition to campus partners, the PRC will work closely with a community advisory board made up of state and local health departments, non-profit organizations, and “family circle” members – individuals representing communities experiencing maternal, infant or child health inequity, and providers connected to the core research project.
UW Population Health Institute Director Sheri Johnson, PhD, introduced two members of the Community Advisory Board to speak about why they’re partnering with the PRC: Dalvery Blackwell, executive director of the African American Breastfeeding Network Inc., and Walter Orzechowski, executive director of the Southwestern Wisconsin Community Action Program, Inc.
The principal investigators of the PRC’s core project also outlined their research goals. Roseanne Clark, PhD, of the UW SMPH Department of Psychiatry, and Jane Mahoney, MD, of the UW SMPH Department of Medicine, introduced the research project “Addressing Postpartum Depression in WI Home Visiting Programs.” The project will be a randomized trial of a two-generation, preventive intervention to:
- Ameliorate mother’s depressive symptoms
- Address relational trauma history
- Support the mother-infant relationship
- Support infant psychosocial and developmental outcomes
The project will work with community and translational partners to culturally adapt the Mother-Infant Therapy Group model for implementation in home visiting programs in urban, rural and Tribal communities across Wisconsin.
Mahoney also spoke about the PRC’s implementation and dissemination goals, noting that the center’s projects will be designed with dissemination in mind.
Learn more about the UW-Madison Prevention Research Center’s goals, faculty and staff, community partners, and opportunities for funding!
Hartenbach, Antony, Ehrenthal, Greene publish interdisciplinary research in Green Journal
Ellen Hartenbach, MD, of the UW Ob-Gyn Division of Gynecologic Oncology, will publish an article in the March edition of Obstetrics and Gynecology.
“Peripartum Blood Transfusion Among Rural Women inthe United States” is an excellent example of cross-divisional research – the article was co-authored by Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, Division of Reproductive and Population Health Director Deborah Ehrenthal, MD, and Division of Population Health members Madelyne Greene, PhD RN, Emily Schrider, PhD, and Daphne Kuo, PhD.
The study came out of a work group formed by Hartenbach and others to look at rural maternal outcomes. Before being published in the Green Journal, it was presented as an abstract at the 2019 ACOG national meeting.
The population-based retrospective cohort study evaluated peripartum transfusion rates for rural women compared with urban women in the United States. The study found that:
“The odds of blood transfusion were higher for women in rural areas. The results indicate that the rurality of the county where the birth occurred was associated with more transfusion. This may reflect differences in maternity and blood banking services in rural hospitals and warrants further study to identify opportunities for intervention.”
Read the whole paper here. Congratulations to Dr. Hartenbach and the entire publication team!
Ehrenthal promoted to Professor
Congratulations to UW Ob-Gyn Division of Reproductive and Population Health Director Deborah Ehrenthal, MD! The SMPH Tenure Track Promotions Committee voted to promote Ehrenthal to the rank of tenured Professor.
Well done, Dr. Ehrenthal!
Ehrenthal co-investigator on “Building a transformational data resource to support housing research” grant
A new project funded by the UW2020: WARF Discovery Initiative will increase the quality and amount of housing-related data available to the Wisconsin Administrative Data Core, a unique data resource at the Institute for Research on Poverty (IRP). UW Ob-Gyn Division of Reproductive and Population Health Director Deborah Ehrenthal, MD will serve as a co-investigator on the grant
“Building a transformational data resource to support housing research.
Despite the importance of stable and affordable housing and of housing benefits for low-income families, the extent to which current assistance programs affect family well-being is under-researched. There is little existing data about families’ experiences with housing instability, what works to produce housing stability, and the effectiveness of public programs that address housing.
The project will enable researchers to partner with policymakers and practitioners to develop actionable results that can be used to improve the lives of low-income families and individuals, and ameliorate impacts of the housing crisis.
Investigators on the project come from across campus, including the School of Social Work, Institute for Research on Poverty, School of Human Ecology, and more. Congratulations to Dr. Ehrenthal, and the whole investigator team!
Ehrenthal receives NIH funding for opioid research project
Congratulations to UW Ob-Gyn Division of Reproductive and Population Health Director and UW-Madison Prevention Research Center Director Deborah Ehrenthal, MD! She received five years of funding from the NIH - Eunice Kennedy Shriver National Institute of Child Health and Human Development for the project “Prenatal Opioid Exposure: Birth, health, socioeconomic, and educational outcomes of mothers and their children."
This study will evaluate the relationships between maternal opioid use and use disorder during the prenatal and postnatal periods with mother, child and family health and well-being and resource utilization using the existing, state-level “large data” from numerous sources, linked together on an individual-client level.
Ehrenthal is principal investigator on the study, along with Lawrence Berger, PhD, director of the UW-Madison Institute for Research on Poverty.
Incredible work, Dr. Ehrenthal!
Ehrenthal co-authors article on noncontraceptive benefits of birth control
In the article, Ehrenthal and co-authors in the UW SMPH Department of Family Medicine and Community Health used a comprehensive literature search to summarize the available data documenting how hormonal contraceptives can prevent ovarian and uterine cancer and be used to treat women with a variety of gynecological and nongynecological conditions such as endometriosis, uterine fibroids, heavy menstrual bleeding, polycystic ovary syndrome, acne, and migraines.
Read the whole article here!
Posters, presentations and abstracts from 2020 ACOG conference in Green Journal
While the 2020 American College of Obstetricians and Gynecologists annual meeting, scheduled for late April this year, was canceled, many people in our department had research accepted to present. Their abstracts were published in a supplement to the May 2020 issue of the journal Obstetrics and Gynecology. A few of the amazing abstracts include:
Examining Joint Effect of Race and Neighborhood Socioeconomic Disadvantage on Adverse Obstetric Outcomes – authors Kara Hoppe, DO; Felicity Harl, MD; Alexa Lowry, MD; Linnea Evans, PhD
Physician Attitudes Toward Reproductive Justice: Results From an Institution-Wide Survey – authors Cynthie Wautlet, MD, MPH; Nicholas Schmuhl, PhD; Jenny Higgins, PhD, MPH; Helen Zukin; Laurel Rice, MD
Rural Women in the United States Burdened by High Maternal Transfer Rates – authors Laura McDowell, MD; Ellen Hartenbach, MD; Hsiang-Hui Daphne Kuo, PhD; Deborah Ehrenthal, MD, MPH
Pregnancy-Related Weight and Postpartum Depressive Symptoms: Do the Relationships Differ by Race/Ethnicity? – author Tiffany Green, PhD
Is Sleep Deprivation Associated With Adverse Pregnancy Outcomes? – author Katie Antony, MD
Congratulations to all!
Ehrenthal published in Pediatrics
UW Ob-Gyn Division of Reproductive and Population Health and UW-Madison Prevention Research Center Director Deborah Ehrenthal, MD, MPH, published a new study in the journal Pediatrics.
“Infant Mortality in Rural and Nonrural Counties in the United States”, co-authored by Hsiang-Hui Daphne Kuo and Russell S. Kirby, uses a social-ecological framework to explain infant mortality disparities across the rural-urban continuum:
“Current research suggests the association of place with health is in part a reflection of high-level structural factors, including access to health care, socioeconomic factors, and racial segregation, rather than due to individual-level characteristics such as health behaviors. A social-ecological approach provides a framework for considering differences in health of populations that go beyond individual health behaviors and can guide analytic strategies to disentangle these multiple effects. However, few contemporary studies have considered the importance of these factors on infant mortality across the rural-urban continuum.”
The article inspired a commentary in response (read it here). Incredible work, Dr. Ehrenthal and co-authors!
Grand Rounds: Badger Bytes on opioids and women’s health
On Thursday, January 7, a multidisciplinary group presented Badger Bytes Grand Rounds lectures as part of the presentation “The Multiple Dimensions of Opioid Use for Women’s Health.” The session was moderated by UW Ob-Gyn Division of Reproductive and Population Health Director Deborah Ehrenthal, MD, MPH.
Erin Nacev, MD/MPH student in the UW SMPH started off with “Prenatal Opioid Use Disorder and Birth Outcomes in Wisconsin". In her presentation, Nacev examined the prevalence of prenatal opioid use disorder and uptake of medication-assisted treatment among Medicaid-covered births in Wisconsin, and discussed future directions for research on OUD and pregnancy.
Next, UW Ob-Gyn resident Emily Buttigieg, MD, PGY-4 presented "Gynecologic Surgery Postoperative Narcotic Use". In the presentation, Buttigieg examined prescribing patterns for opioids after gynecologic surgery at a large academic medical center, and estimated ideal prescription size to reduce unused opioids after procedures.
Lisa Barroilhet, MD, of the UW Ob-Gyn Division of Gynecologic Oncology presented the last lecture “Opioids, Cancer and the Immune System: Untangling a Complicated Relationship". Barroilhet outlined some ways opioids affect cancer treatments, options for pain control while limiting opioids, and areas for further study.
Watch the whole Badger Bytes presentation here!