Laura Jelliffe-Pawlowski

Faculty

Jelliffe-Pawlowski Headsot

Laura Jelliffe-Pawlowski

MS PhD

1 212 998 9020

433 First Ave
New York, NY 10010
United States

Laura Jelliffe-Pawlowski, PhD, MS, is a Professor. Prof. Jelliffe-Pawlowski’s research interests focus on understanding and addressing the drivers and consequences of adverse pregnancy outcomes with a special emphasis on preterm birth and associated racial/ethnic and socioeconomic inequities. Her work is highly transdisciplinary and looks at the interplay of biomolecular, social, and policy factors in observed patterns and outcomes. Her teaching and mentorship activities reflect this transdisciplinary approach with an emphasis on motivating the translation of research findings into action.

 

Prof. Jelliffe-Pawlowski leads a number of statewide, national, and international research efforts funded by the National Institutes of Health, the Bill and Melinda Gates Foundation, the March of Dimes, the State of California, and other entities. These includes, notably, the “Healthy Outcomes of Pregnancy for Everyone (HOPE)” consortium and study which focuses on understanding the experience of pregnant people and their infants pre- and post-COVID 19 pandemic. HOPE examines how biomolecular, social, and community factors affect the well-being and outcomes of mothers and infants and includes enrollment during pregnancy with outcome follow-up to 18-months after birth. Other ongoing projects include, for example, the NIH funded “Prediction Of Maturity, Morbidity, and Mortality in PreTerm Infants (PROMPT)”, study which focuses on examining the metabolic profiles of newborns with early preterm birth and associated outcomes, the “Transforming Health and Reducing PerInatal Anxiety through Virtual Engagement (THRIVE)”, randomized control trial (RCT), funded by the State of California which examines whether digital cognitive behavior therapy delivered by mobile app can assist in reducing anxiety symptoms in pregnant people and also examines participant acceptability of the application. Ongoing efforts also include leading the “California Prediction of Poor Outcomes of Pregnancy (CPPOP)” cohort study which focuses on investigating multi-omic drivers of preterm birth. The study interrogates biomolecular signals associated with preterm birth and includes full genome sequencing and mid-pregnancy biomolecular signaling related to metabolic, immune, stress, and placental function in hundreds of pregnancies with and without preterm birth. 

 

Prior to her joining NYU Meyers, Prof. Jelliffe-Pawlowski was a Professor of Epidemiology & Biostatistics, Chief of the Division of Lifecourse Epidemiology, a Professor in the Institute of Global Health Sciences, and Director of Discovery and Precision Health for the UCSF California Preterm Birth Initiative in the University of California San Francisco (UCSF) School of Medicine. She has a lifetime appointment as an Emeritus Professor of Epidemiology & Biostatistics in the UCSF School of Medicine and continues to work closely with the new Center for Birth Equity at UCSF. Prior to her appointment at UCSF, she was a leader at the Genetic Disease Screening Program within the California Department of Public Health. 

 

Prof. Jelliffe-Pawlowski efforts have been highlighted in numerous academic and lay articles including in the New York Times, in WIRED Magazine, in the Atlantic, on CNN, and on MSNBC. In 2023, she was recognized by Forbes Magazine as one of the top 50 over 50 Innovators in the United States. She is also a Phase I and Phase II Bill and Melinda Gates Foundation Grand Challenges awardee for her work in the United States and Uganda which focused on the development and validation of newborn metabolic profile as a novel measure of gestational age in infants.

BA, Psychology, University of California Los Angeles
MS, Child Development, University of California Davis
PhD, Human Development, University of California Davis

Preterm Birth

Forbes 50 over 50 awardee in Innovation (2023)
Delegate, African Academy of Sciences (2016)
Governor Brown Appointee for the California Department of Public Health, Interagency Coordinating Council on Early Intervention
Awardee, Bill and Melinda Bates Foundation, Gates Grand Challenges Phase I and II

Risk of preterm birth among women using drugs during pregnancy with elevated α-fetoprotein

Baer, R. J., Chambers, C. D., Ryckman, K. K., Oltman, S. P., Norton, M. E., & Jelliffe-Pawlowski, L. L. (2017). Journal of Perinatology, 37(3), 220-225. 10.1038/jp.2016.224
Abstract
Abstract
Objective:Examine the risk of preterm birth (PTB) among women who use drugs during pregnancy and have elevated-fetoprotein (AFP).Study Design:The sample included California singleton live births in 2005 to 2010 contained within a hospital discharge database linked to the Prenatal Screening Program. A selection of mothers who did not use drugs was selected at a ratio of 4:1. Risk of PTB was calculated using adjusted odds ratios and 95% confidence intervals (CIs) for women who did or did not use drugs by their AFP percentile.Results:We identified 7190 women who used drugs and selected 28 760 women who did not. Of women using cocaine with AFP ≥95th percentile, 43.8% delivered prematurely. Women using drugs with AFP ≥95th percentile were 11 to 35 times as likely to deliver <32 weeks.Conclusion:The combination of drug use and elevated AFP results in high rates of PTB. This combination results in an additive risk.

Risk of recurrent preterm birth among women according to change in partner

Baer, R. J., Yang, J., Chambers, C. D., Ryckman, K. K., Saftlas, A. F., Berghella, V., Schetter, C. D., Shaw, G. M., Stevenson, D. K., & Jelliffe-Pawlowski, L. L. (2017). Journal of Perinatal Medicine, 45(1), 63-70. 10.1515/jpm-2016-0207
Abstract
Abstract
There is well-established literature indicating change in partner as a risk for preeclampsia, yet the research on the risk of preterm birth after a change in partners has been sparse and inconsistent. Using a population of California live born singletons, we aimed to determine the risk of preterm birth after a change in partner between the first and second pregnancies. The risk of preterm and early term delivery in the second pregnancy was calculated for mothers who did or did not change partners between births with the referent group as women who delivered both pregnancies at term and did not change partners. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Relative to women who delivered at 39 weeks or later in the second pregnancy and did not change partners, preterm birth risks were somewhat lower for women who changed partners between the first and second pregnancies compared to those women who did not change partners. For example, 10.6% of women who did not change partners and delivered their second pregnancy before 34 weeks also delivered their first pregnancy before 34 weeks, while 8.5% of women who changed partners delivered before 34 weeks. Findings suggest partner change may alter the risk of preterm birth.

Sleep Disorder Diagnosis during Pregnancy and Risk of Preterm Birth

Felder, J. N., Baer, R. J., Rand, L., Jelliffe-Pawlowski, L. L., & Prather, A. A. (2017). Obstetrics and Gynecology, 130(3), 573-581. 10.1097/AOG.0000000000002132
Abstract
Abstract
OBJECTIVE: To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other). METHODS: In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated). RESULTS: Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, P<.001, 15.5%) for sleep apnea. Risk varied by gestational age and preterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders. CONCLUSION: Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.

Alpha-fetoprotein and poor pregnancy outcomes

Jelliffe-Pawlowski, L. L., & Baer, R. J. (2016). In Alpha-Fetoprotein: Observed patterns, pathophysiology, and clinical utility (1–, pp. 175-192). Nova Science Publishers, Inc.
Abstract
Abstract
During pregnancy, maternal serum alpha-fetoprotein (MSAFP) is commonly used as a second trimester prenatal screening biomarker for chromosomal and structural birth defects. In the absence of birth defects, abnormal levels of mid-pregnancy MSAFP are associated with adverse pregnancy outcomes including fetal demise and preterm birth. Pregnancies ending in fetal demise or preterm birth often have unusually lower or higher mid-pregnancy MSAFP levels than pregnancies that do not. The same is true for pregnancies with specific conditions that are closely related to fetal demise and preterm birth including preeclampsia, conditions of abnormal placentation (e.g., previa, abruption, accreta), and pregnancies carrying a fetus with intrauterine growth restriction. In this chapter, we review specific studies looking at the relationship between MSAFP and fetal demise or preterm birth. In addition, we will review associations between MSAFP and conditions with close links to fetal demise and preterm birth including preeclampsia, placenta previa, placental abruption, placenta accreta, and intrauterine growth restriction. We also provide a brief review of the pathophysiological literature that underscores these relationships and we suggest next steps with respect to research and clinical use of MSAFP data.

Cell-free DNA vs sequential screening for the detection of fetal chromosomal abnormalities Presented at the Society for Maternal-Fetal Medicine 34th Annual Meeting, San Diego, CA, Feb. 5-7, 2015.

Norton, M. E., Baer, R. J., Wapner, R. J., Kuppermann, M., Jelliffe-Pawlowski, L. L., & Currier, R. J. (2016). American Journal of Obstetrics and Gynecology, 214(6), 727.e1-727.e6. 10.1016/j.ajog.2015.12.018
Abstract
Abstract
Background Sequential and cell-free DNA (cfDNA) screening are both tests for the common aneuploidies. Although cfDNA has a greater detection rate (DR) for trisomy 21, sequential screening also can identify risk for other aneuploidies. The comparative DR for all chromosomal abnormalities is unknown. Objective To compare sequential and cfDNA screening for detection of fetal chromosomal abnormalities in a general prenatal cohort. Study Design The performance of sequential screening for the detection of chromosome abnormalities in a cohort of patients screened through the California Prenatal Screening Program with estimated due dates between August 2009 and December 2012 was compared with the estimated DRs and false-positive rates (FPRs) of cfDNA screening if used as primary screening in this same cohort. DR and FPR for cfDNA screening were abstracted from the published literature, as were the rates of "no results" in euploid and aneuploid cases. Chromosome abnormalities in the entire cohort were categorized as detectable (trisomies 13, 18, and 21, and sex chromosome aneuploidy), or not detectable (other chromosome abnormalities) by cfDNA screening. DR and FPR were compared for individual and all chromosome abnormalities. DR and FPR for the cohort were compared if "no results" cases were considered "screen negative" or "screen positive" for aneuploidy. DR and FPR rates were compared by use of the Fisher exact test. Results Of 452,901 women who underwent sequential screening during the time period of the study, 2575 (0.57%) had a fetal chromosomal abnormality; 2101 were detected for a DR of 81.6%, and 19,929 euploid fetuses had positive sequential screening for an FPR rate of 4.5%. If no results cases were presumed normal, cfDNA screening would have detected 1820 chromosome abnormalities (70.7%) with an FPR of 0.7%. If no results cases were considered screen positive, 1985 (77.1%) cases would be detected at a total screen positive rate of 3.7%. In either case, the detection rate of sequential screening for all aneuploidies in the cohort was greater than cfDNA (P<.0001). Conclusion For primary population screening, cfDNA provides lower DR than sequential screening if considering detection of all chromosomal abnormalities. Assuming that no results cfDNA cases are high-risk improves cfDNA detection but with a greater FPR. cfDNA should not be adopted as primary screening without further evaluation of the implications for detection of all chromosomal abnormalities and how to best evaluate no results cases.

Copy-number variant analysis of classic heterotaxy highlights the importance of body patterning pathways

Hagen, E. M., Sicko, R. J., Kay, D. M., Rigler, S. L., Dimopoulos, A., Ahmad, S., Doleman, M. H., Fan, R., Romitti, P. A., Browne, M. L., Caggana, M., Brody, L. C., Shaw, G. M., Jelliffe-Pawlowski, L. L., & Mills, J. L. (2016). Human Genetics, 135(12), 1355-1364. 10.1007/s00439-016-1727-x
Abstract
Abstract
Classic heterotaxy consists of congenital heart defects with abnormally positioned thoracic and abdominal organs. We aimed to uncover novel, genomic copy-number variants (CNVs) in classic heterotaxy cases. A microarray containing 2.5 million single-nucleotide polymorphisms (SNPs) was used to genotype 69 infants (cases) with classic heterotaxy identified from California live births from 1998 to 2009. CNVs were identified using the PennCNV software. We identified 56 rare CNVs encompassing genes in the NODAL (NIPBL, TBX6), BMP (PPP4C), and WNT (FZD3) signaling pathways, not previously linked to classic heterotaxy. We also identified a CNV involving FGF12, a gene previously noted in a classic heterotaxy case. CNVs involving RBFOX1 and near MIR302F were detected in multiple cases. Our findings illustrate the importance of body patterning pathways for cardiac development and left/right axes determination. FGF12, RBFOX1, and MIR302F could be important in human heterotaxy, because they were noted in multiple cases. Further investigation into genes involved in the NODAL, BMP, and WNT body patterning pathways and into the dosage effects of FGF12, RBFOX1, and MIR302F is warranted.

First trimester pregnancy-associated plasma protein-A and birth weight

Baer, R. J., Lyell, D. J., Norton, M. E., Currier, R. J., & Jelliffe-Pawlowski, L. L. (2016). European Journal of Obstetrics and Gynecology and Reproductive Biology, 198, 1-6. 10.1016/j.ejogrb.2015.12.019
Abstract
Abstract
Objective To evaluate first trimester pregnancy-associated plasma protein-A (PAPP-A) and birth weight percentile. Study design Included were women who underwent first trimester prenatal screening through the California Prenatal Screening Program with expected dates of delivery between August 2009 and December 2010, linked birth certificate and hospital discharge records, known birth weight, and no chromosomal abnormality (n = 134.105). PAPP-A results were reported as multiples of the median. The frequency of small or large for gestational age (SGA, ≤10%; LGA, ≥90%) versus appropriately grown for gestational age birth was examined by PAPP-A percentile. Patterns were studied by gestational age at delivery. Relative risks (RRs) and their 95% confidence intervals were adjusted for race/ethnicity. Results Women with PAPP-A ≤10th percentile and an infant born after 32 weeks were increasingly more likely to have an SGA infant ( adj RRs 1.5-4.6) as the PAPP-A percentile declined, and were increasingly less like to have an LGA infant born at term ( adj RRs 0.5-0.7) compared to women with PAPP-A measurement >10th to <90th percentile. PAPP-A ≥90th percentile was protective for SGA among infants born after 32 weeks gestation ( adj RRs 0.3-0.7) and was associated with LGA among infants born at term ( adj RRs 1.2-8.2). Conclusion Women with PAPP-A ≤10th percentile are more likely to have an SGA infant at all gestational ages. PAPP-A ≥90th percentile is protective against SGA and is associated with an increased risk of LGA for infants born after 32 weeks gestation.

Gestational dating by metabolic profile at birth: A California cohort study

Jelliffe-Pawlowski, L. L., Norton, M. E., Baer, R. J., Santos, N., & Rutherford, G. W. (2016). American Journal of Obstetrics and Gynecology, 214(4), 511.e1-511.e13. 10.1016/j.ajog.2015.11.029
Abstract
Abstract
Background Accurate gestational dating is a critical component of obstetric and newborn care. In the absence of early ultrasound, many clinicians rely on less accurate measures, such as last menstrual period or symphysis-fundal height during pregnancy, or Dubowitz scoring or the Ballard (or New Ballard) method at birth. These measures often underestimate or overestimate gestational age and can lead to misclassification of babies as born preterm, which has both short- and long-term clinical care and public health implications. Objective We sought to evaluate whether metabolic markers in newborns measured as part of routine screening for treatable inborn errors of metabolism can be used to develop a population-level metabolic gestational dating algorithm that is robust despite intrauterine growth restriction and can be used when fetal ultrasound dating is not available. We focused specifically on the ability of these markers to differentiate preterm births (PTBs) (<37 weeks) from term births and to assign a specific gestational age in the PTB group. Study Design We evaluated a cohort of 729,503 singleton newborns with a California birth in 2005 through 2011 who had routine newborn metabolic screening and fetal ultrasound dating at 11-20 weeks' gestation. Using training and testing subsets (divided in a ratio of 3:1) we evaluated the association among PTB, target newborn characteristics, acylcarnitines, amino acids, thyroid-stimulating hormone, 17-hydroxyprogesterone, and galactose-1-phosphate-uridyl-transferase. We used multivariate backward stepwise regression to test for associations and linear discriminate analyses to create a linear function for PTB and to assign a specific week of gestation. We used sensitivity, specificity, and positive predictive value to evaluate the performance of linear functions. Results Along with birthweight and infant age at test, we included 35 of the 51 metabolic markers measured in the final multivariate model comparing PTBs and term births. Using a linear discriminate analyses-derived linear function, we were able to sort PTBs and term births accurately with sensitivities and specificities of ≥95% in both the training and testing subsets. Assignment of a specific week of gestation in those identified as PTBs resulted in the correct assignment of week ±2 weeks in 89.8% of all newborns in the training and 91.7% of those in the testing subset. When PTB rates were modeled using the metabolic dating algorithm compared to fetal ultrasound, PTB rates were 7.15% vs 6.11% in the training subset and 7.31% vs 6.25% in the testing subset. Conclusion When considered in combination with birthweight and hours of age at test, metabolic profile evaluated within 8 days of birth appears to be a useful measure of PTB and, among those born preterm, of specific week of gestation ±2 weeks. Dating by metabolic profile may be useful in instances where there is no fetal ultrasound due to lack of availability or late entry into care.

Inflammatory biomarkers and spontaneous preterm birth among obese women

Wallenstein, M. B., Jelliffe-Pawlowski, L. L., Yang, W., Carmichael, S. L., Stevenson, D. K., Ryckman, K. K., & Shaw, G. M. (2016). Journal of Maternal-Fetal and Neonatal Medicine, 29(20), 3317-3322. 10.3109/14767058.2015.1124083
Abstract
Abstract
Objective: To identify associations between second-trimester serum inflammatory biomarkers and preterm birth among obese women. Methods: In this nested case-control study, we compared 65 serum inflammatory biomarkers in obese women whose pregnancies resulted in early spontaneous preterm birth (<32 weeks gestation, n = 34) to obese women whose pregnancies resulted in term birth (n = 34). These women were selected from a larger population-based California cohort. Random forest and classification and regression tree techniques were employed to identify biomarkers of importance, and adjusted odds ratios (aORs) and 95% confidence intervals (CI) were estimated using logistic regression. Results: Random forest and classification and regression tree techniques found that soluble vascular endothelial growth factor receptor-3 (sVEGFR3), soluble interleukin-2 receptor alpha-chain (sIL-2RA) and soluble tumor necrosis factor receptor-1 (sTNFR1) were related to preterm birth. Using multivariable logistic regression to compare preterm cases and term controls, decreased serum levels of sVEGFR3 and increased serum levels of sIL-2RA and sTNFR1 were associated with increased risk of preterm birth among obese women, aOR = 3.2 (95% CI: 1.0–9.9), aOR = 2.8 (95% CI: 0.9–9.0), and aOR = 4.1 (95% CI: 1.2–14.1), respectively. Conclusions: In this pilot study, we identified three serum biomarkers indicative of inflammation to be associated with spontaneous preterm birth among obese women: sVEGFR3, sIL-2RA and sTNFR1.

Population-based risks of mortality and preterm morbidity by gestational age and birth weight

Baer, R. J., Rogers, E. E., Partridge, J. C., Anderson, J. G., Morris, M., Kuppermann, M., Franck, L. S., Rand, L., & Jelliffe-Pawlowski, L. L. (2016). Journal of Perinatology, 36(11), 1008-1013. 10.1038/jp.2016.118
Abstract
Abstract
Objective: The objective of this study is to examine the effect of small or large for gestational age (SGA/LGA) status on mortality and morbidity by gestational age. Study design: Logistic binomial regression was used to calculate relative risks (RRs) and 95% confidence intervals for infant mortality and preterm morbidities for SGA or LGA compared with appropriately grown (AGA) deliveries stratified by gestational age group. Results: Compared with AGA infants of similar gestational age, SGA infants were at increased risk for infant mortality. Mortality risk was decreased for LGA infants born between 25 and 27 weeks (RR: 0.6) but increased for LGA infants born between 28 and 31 weeks (RR: 1.9). Risk of preterm morbidity was increased for SGA infants born between 28 and 38 weeks, but decreased for LGA infants born before 37 weeks. Conclusion: This study demonstrates the importance of considering birth weight for gestational age when evaluating morbidity and mortality risks.