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

Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes

Bandoli, G., Jelliffe-Pawlowski, L., Schumacher, B., Baer, R. J., Felder, J. N., Fuchs, J. D., Oltman, S. P., Steurer, M. A., & Marienfeld, C. (2021). Drug and Alcohol Dependence, 225. 10.1016/j.drugalcdep.2021.108757
Abstract
Abstract
Background: Cannabis use and cannabis use disorders are increasing in prevalence, including among pregnant women. The objective was to evaluate the association of a cannabis-related diagnosis (CRD) in pregnancy and adverse maternal and infant outcomes. Methods: We queried an administrative birth cohort of singleton deliveries in California between 2011–2017 linked to maternal and infant hospital discharge records. We classified pregnancies with CRD from International Classification of Disease codes. We identified nicotine and other substance-related diagnoses (SRD) in the same manner. Outcomes of interest included maternal (hypertensive disorders) and infant (prematurity, small for gestational age, NICU admission, major structural malformations) adverse outcomes. Results: From 3,067,069 pregnancies resulting in live births, 29,112 (1.0 %) had a CRD. CRD was associated with an increased risk of all outcomes studied; the strongest risks observed were for very preterm birth (aRR 1.4, 95 % CI 1.3, 1.6) and small for gestational age (aRR 1.4, 95 % CI 1.3, 1.4). When analyzed with or without co-exposure diagnoses, CRD alone conferred increased risk for all outcomes compared to no use. The strongest effects were seen for CRD with other SRD (preterm birth aRR 2.3, 95 % CI 2.2, 2.5; very preterm birth aRR 2.6, 95 % CI 2.3, 3.0; gastrointestinal malformations aRR 2.0, 95 % CI 1.6, 2.6). The findings were generally robust to unmeasured confounding and misclassification analyses. Conclusions: CRD in pregnancy was associated with increased risk of adverse maternal and infant outcomes. Providing education and effective treatment for women with a CRD during prenatal care may improve maternal and infant health.

Gestational age dating using newborn metabolic screening: A validation study in Busia, Uganda

Oltman, S. P., Jasper, E. A., Kajubi, R., Ochieng, T., Kakuru, A., Adrama, H., Okitwi, M., Olwoch, P., Kamya, M., Bedell, B., McCarthy, M., Dagle, J., Jagannathan, P., Clark, T. D., Dorsey, G., Rand, L., Ruel, T., Rogers, E. E., Ryckman, K. K., & Jelliffe-Pawlowski, L. L. (2021). Journal of Global Health, 11, 1-9. 10.7189/jogh.11.04012
Abstract
Abstract
Background Limited ultrasound capacity in low-resource settings makes correct gestational age (GA) dating difficult. Previous work demonstrated that newborn metabolic profiles can accurately determine gestational age, but this relationship has not been evaluated in low-income countries. The objective of this study was to validate and adapt a metabolic GA dating model developed using newborn blood spots for use in a low-resource setting in rural Uganda. Methods A cohort of pregnant women was followed prospectively and heel stick blood spots were collected from 666 newborns in Busia, Uganda at the time of delivery. They were dried, frozen, and shipped to the US where they were tested for 47 metabolites. Metabolic model performance was assessed using early ultrasound determined GA as the standard. Models tested included previously built multivariable models and models specifically adapted to the Busia population. Results The previously built model successfully dated 81.2% of newborns within two weeks of their ultrasound GA. Only 4.8% of GAs were off by greater than three weeks. In the model adapted to the local population, 89.2% of GAs matched their corresponding ultrasound to within two weeks. The model-derived preterm birth rate was 7.2% compared to 5.9% by ultrasound. Conclusions These results suggest that metabolic dating is a reliable method to determine GA in a low-income setting. Metabolic dating offers the potential to better elucidate preterm birth rates in low-resource settings, which is important for assessing population-level patterns, tailoring clinical care, and understanding the developmental trajectories of preterm infants.

Maternal nativity and risk of adverse perinatal outcomes among Black women residing in California, 2011–2017

McKenzie-Sampson, S., Baer, R. J., Blebu, B. E., Karasek, D., Oltman, S. P., Pantell, M. S., Rand, L., Rogers, E. E., Torres, J. M., Jelliffe-Pawlowski, L. L., Scott, K. A., & Chambers, B. D. (2021). Journal of Perinatology, 41(12), 2736-2741. 10.1038/s41372-021-01149-9
Abstract
Abstract
Objective: Examine the risk of adverse perinatal outcomes among the United States (US)-born and foreign-born Black women in California. Study design: The study comprised all singleton live births to Black women in California between 2011 and 2017. We defined maternal nativity as US-born or foreign-born. Using Poisson regression, we computed risk ratios (RR) and 95% confidence intervals (CI) for three adverse perinatal outcomes: preterm birth, small for gestational age deliveries, and infant mortality. Results: Rates of adverse perinatal outcomes were significantly higher among US-born Black women. In adjusted models, US-born Black women experienced an increased risk of preterm birth (RR 1.51, 95% CI 1.39, 1.65) and small for gestational age deliveries (RR 1.52, 95% CI 1.41, 1.64), compared to foreign-born Black women. Conclusions: Future studies should consider experiences of racism across the life course when exploring heterogeneity in the risk of adverse perinatal outcomes by nativity among Black women in the US.

Mortality and Major Neonatal Morbidity in Preterm Infants with Serious Congenital Heart Disease

Steurer, M. A., Baer, R. J., Chambers, C. D., Costello, J., Franck, L. S., McKenzie-Sampson, S., Pacheco-Werner, T. L., Rajagopal, S., Rogers, E. E., Rand, L., Jelliffe-Pawlowski, L. L., & Peyvandi, S. (2021). Journal of Pediatrics, 239, 110-116.e3. 10.1016/j.jpeds.2021.08.039
Abstract
Abstract
Objective: To investigate the trends of 1-year mortality and neonatal morbidities in preterm infants with serious congenital heart disease (CHD). Study design: This cohort study used a population-based administrative dataset of all liveborn infants of 26-36 weeks gestational age with serious CHD born in California between 2011 and 2017. We assessed 1-year mortality and major neonatal morbidities (ie, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade >2, and periventricular leukomalacia) across the study period and compared these outcomes with those in infants without CHD. Results: We identified 1921 preterm infants with serious CHD. The relative risk (RR) of death decreased by 10.6% for each year of the study period (RR, 0.89; 95% CI, 0.84-0.95), and the RR of major neonatal morbidity increased by 8.3% for each year (RR, 1.08; 95% CI, 1.02-1.15). Compared with preterm neonates without any CHD (n = 234 522), the adjusted risk difference (ARD) for mortality was highest at 32 weeks of gestational age (9.7%; 95% CI, 8.3%-11.2%), that for major neonatal morbidity was highest at 28 weeks (21.9%; 95% CI, 17.0%-26.9%), and that for the combined outcome was highest at 30 weeks (26.7%; 95% CI, 23.3%-30.1%). Conclusions: Mortality in preterm neonates with serious CHD decreased over the last decade, whereas major neonatal morbidities increased. Preterm infants with a gestational age of 28-32 weeks have the highest mortality or morbidity compared with their peers without CHD. These results support the need for specialized and focused medical neonatal care in preterm neonates with serious CHD.

Newborn metabolic vulnerability profile identifies preterm infants at risk for mortality and morbidity

Oltman, S. P., Rogers, E. E., Baer, R. J., Jasper, E. A., Anderson, J. G., Steurer, M. A., Pantell, M. S., Petersen, M. A., Partridge, J. C., Karasek, D., Ross, K. M., Feuer, S. K., Franck, L. S., Rand, L., Dagle, J. M., Ryckman, K. K., & Jelliffe-Pawlowski, L. L. (2021). Pediatric Research, 89(6), 1405-1413. 10.1038/s41390-020-01148-0
Abstract
Abstract
Background: Identifying preterm infants at risk for mortality or major morbidity traditionally relies on gestational age, birth weight, and other clinical characteristics that offer underwhelming utility. We sought to determine whether a newborn metabolic vulnerability profile at birth can be used to evaluate risk for neonatal mortality and major morbidity in preterm infants. Methods: This was a population-based retrospective cohort study of preterm infants born between 2005 and 2011 in California. We created a newborn metabolic vulnerability profile wherein maternal/infant characteristics along with routine newborn screening metabolites were evaluated for their association with neonatal mortality or major morbidity. Results: Nine thousand six hundred and thirty-nine (9.2%) preterm infants experienced mortality or at least one complication. Six characteristics and 19 metabolites were included in the final metabolic vulnerability model. The model demonstrated exceptional performance for the composite outcome of mortality or any major morbidity (AUC 0.923 (95% CI: 0.917–0.929). Performance was maintained across mortality and morbidity subgroups (AUCs 0.893–0.979). Conclusions: Metabolites measured as part of routine newborn screening can be used to create a metabolic vulnerability profile. These findings lay the foundation for targeted clinical monitoring and further investigation of biological pathways that may increase the risk of neonatal death or major complications in infants born preterm. Impact: We built a newborn metabolic vulnerability profile that could identify preterm infants at risk for major morbidity and mortality.Identifying high-risk infants by this method is novel to the field and outperforms models currently in use that rely primarily on infant characteristics.Utilizing the newborn metabolic vulnerability profile for precision clinical monitoring and targeted investigation of etiologic pathways could lead to reductions in the incidence and severity of major morbidities associated with preterm birth.

Pregnancy after bariatric surgery in women with rheumatic diseases and association with adverse birth outcomes

Singh, N., Baer, R. J., Swaminathan, M., Saurabh, S., Sparks, J. A., Bandoli, G., Flowers, E., Jelliffe-Pawlowski, L. L., & Ryckman, K. K. (2021). Surgery for Obesity and Related Diseases, 17(2), 406-413. 10.1016/j.soard.2020.09.016
Abstract
Abstract
Background: Autoimmune rheumatic diseases (ARDs) and bariatric surgery are each risk factors for adverse birth outcomes. To date, no study has investigated their combined impact on birth outcomes. Objectives: The objective of this study was to evaluate the impact of bariatric surgery on pregnancy outcomes in women with an ARD. As a secondary comparison, we assessed the risk of bariatric surgery on the same outcomes in women without an ARD. Setting: Records maintained by the California Office of Statewide Health Planning and Development. Methods: This cohort study included infants born between 20–44 weeks of gestation in California between 2011–2018. Risks of adverse pregnancy outcomes were evaluated for women with a history of bariatric surgery as compared to women without a history of bariatric surgery, stratified by ARD, using log-linear regression with a Poisson distribution. Results: The study included 3,574,165 infants, of whom 10,823 (0.3%) were born to women who had an ARD and 13,529 (0.38%) to women with a history of bariatric surgery. There were 155 infants born to women (0.0043%) with both an ARD and a history of bariatric surgery. In women with an ARD and without bariatric surgery, the prevalence of preterm births was 18%, compared to 17.4% in women with both ARD and bariatric surgery; in women without ARD but with prior bariatric surgery, the prevalence of preterm births was 13.7%, compared to 8.2% in women without bariatric surgery. Except for neonatal intensive care unit (NICU) admissions, women with an ARD and history of bariatric surgery were not at a statistically increased risk of having other adverse pregnancy outcomes as compared to women with an ARD and no history of bariatric surgery. Conclusion: Our study shows that women with ARD already have a high occurrence of several adverse birth outcomes, and this was not further increased by a history of bariatric surgery. The infants born to women with a history of ARD and bariatric surgery were admitted to the NICU significantly more than the infants born to women with an ARD and no history of bariatric surgery.

Racial Disparities in the Rates of and Indications for Cesarean Delivery in California: Are They Changing over Time?

Teal, E. N., Anudokem, K., Baer, R. J., Jelliffe-Pawlowski, L., & Mengesha, B. (2021). American Journal of Perinatology, 41(1), 31-38. 10.1055/s-0041-1740071
Abstract
Abstract
Objective  The aim of this study was to assess whether racial disparities in rates of and indications for cesarean delivery (CD) between non-Hispanic Black and non-Hispanic White birthing people in California changed from 2011 to 2017. Methods  This was a retrospective cohort study using a database of birth certificates linked to discharge records. Singleton term live births in nulliparous Black and White birthing people in California between 2011 and 2017 were included. Those with noncephalic presentation, placenta previa, and placenta accreta were excluded. CD rate and indication were obtained from birth certificate variables and International Classification of Diseases codes. Differences in CD rate and indication were calculated for Black versus White individuals using univariable and multivariable logistic regression and adjusted for potential confounders. Results  A total of 348,144 birthing people were included, 46,361 Black and 301,783 White. Overall, 30.9% of Black birthing people underwent CD compared with 25.3% of White (adjusted relative risk [aRR]: 1.2, 95% confidence interval [CI]: 1.2-1.3). From 2011 to 2017, the CD rate fell 11% (26.4-23.7%, p < 0.0001) for White birthing people and 1% for Black birthing people (30.4-30.1%, p = 0.037). Over the study period, Black birthing people had a persistent 1.2- to 1.3-fold higher risk of CD and were persistently more likely to undergo CD for fetal intolerance (aRR: 1.1, 95% CI: 1.1-1.2) and less likely for active phase arrest or arrest of descent (aRRs: 0.9 and 0.4; 95% CIs: 0.9-0.9 and 0.3-0.5). Conclusion  The CD rate decreased substantially for White birthing people and minimally for Black birthing people in our cohort over the study period. Meanwhile, disparities in CD rate and indications between the two groups persisted, despite controlling for confounders. Although care bundles for reducing CD may be effective among White birthing people, they are not associated with reduction in CD rates among Black birthing people nor improvements in racial disparities between Black and White birthing people. Precis  Despite increasing attention to racial inequities in obstetric outcomes, there were no changes in disparities in CD rates or indications in California from 2011 to 2017. Key Points Black birthing people are more likely to undergo CD than White despite controlling for confounders. There are unexplained differences in CD indication among Black and White birthing people. These disparities persisted from 2011 to 2017 despite increasing efforts to decrease CD rates in CA.

Racial and ethnic disparities in outcomes through 1 year of life in infants born prematurely: a population based study in California

Karvonen, K. L., Baer, R. J., Rogers, E. E., Steurer, M. A., Ryckman, K. K., Feuer, S. K., Anderson, J. G., Franck, L. S., Gano, D., Petersen, M. A., Oltman, S. P., Chambers, B. D., Neuhaus, J., Rand, L., Jelliffe-Pawlowski, L. L., & Pantell, M. S. (2021). Journal of Perinatology, 41(2), 220-231. 10.1038/s41372-021-00919-9
Abstract
Abstract
Objectives: To investigate racial/ethnic differences in rehospitalization and mortality rates among premature infants over the first year of life. Study design: A retrospective cohort study of infants born in California from 2011 to 2017 (n = 3,448,707) abstracted from a California Office of Statewide Health Planning and Development database. Unadjusted Kaplan–Meier tables and logistic regression controlling for health and sociodemographic characteristics were used to predict outcomes by race/ethnicity. Results: Compared to White infants, Hispanic and Black early preterm infants were more likely to be readmitted; Black late/moderate preterm (LMPT) infants were more likely to be readmitted and to die after discharge; Hispanic and Black early preterm infants with BPD were more likely to be readmitted; Black LMPT infants with RDS were more likely to be readmitted and die after discharge. Conclusions: Racial/ethnic disparities in readmission and mortality rates exist for premature infants across several co-morbidities. Future studies are needed to improve equitability of outcomes.

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study

Baer, R. J., Nidey, N., Bandoli, G., Chambers, B. D., Chambers, C. D., Feuer, S., Karasek, D., Oltman, S. P., Rand, L., Ryckman, K. K., & Jelliffe-Pawlowski, L. L. (2021). AJP Reports, 11(1), E5-E14. 10.1055/s-0040-1721668
Abstract
Abstract
Objective The aim of the study is to evaluate the risk of preterm birth (PTB, <37 weeks) and early term (37 and 38 weeks) birth among women with an emergency department (ED) visit or hospitalization with a urinary tract infection (UTI) by trimester of pregnancy. Methods The primary sample was selected from births in California between 2011 and 2017. UTIs were identified from the ED or hospital discharge records. Risk of PTB, by subtype, and early term birth were evaluated by trimester of pregnancy and by type of visit using log-linear regression. Risk ratios were adjusted for maternal factors. Antibiotic usage was examined in a population of privately insured women from Iowa. Results Women with a UTI during pregnancy were at elevated risk of a birth <32 weeks, 32 to 36 weeks, and 37 to 38 weeks (adjusted risk ratios [aRRs] 1.1-1.4). Of the women with a diagnostic code for multiple bacterial species, 28.8% had a PTB. A UTI diagnosis elevated risk of PTB regardless of antibiotic treatment (aRR 1.4 for treated, aRR 1.5 for untreated). Conclusion UTIs are associated with early birth. This association is present regardless of the trimester of pregnancy, type of PTB, and antibiotic treatment.

Risk and Protective Factors for Preterm Birth Among Black Women in Oakland, California

McLemore, M. R., Berkowitz, R. L., Oltman, S. P., Baer, R. J., Franck, L., Fuchs, J., Karasek, D. A., Kuppermann, M., McKenzie-Sampson, S., Melbourne, D., Taylor, B., Williams, S., Rand, L., Chambers, B. D., Scott, K., & Jelliffe-Pawlowski, L. L. (2021). Journal of Racial and Ethnic Health Disparities, 8(5), 1273-1280. 10.1007/s40615-020-00889-2
Abstract
Abstract
This project examines risk and protective factors for preterm birth (PTB) among Black women in Oakland, California. Women with singleton births in 2011–2017 (n = 6199) were included. Risk and protective factors for PTB and independent risk groups were identified using logistic regression and recursive partitioning. Having less than 3 prenatal care visits was associated with highest PTB risk. Hypertension (preexisting, gestational), previous PTB, and unknown Women, Infant, Children (WIC) program participation were associated with a two-fold increased risk for PTB. Maternal birth outside of the USA and participation in WIC were protective. Broad differences in rates, risks, and protective factors for PTB were observed.