Perinatal & Pediatric Epidemiology




faculty-icon  Dr. Claudia Holzman


The Pregnancy Outcomes and Community Health (POUCH) Study


The POUCH Study was motivated by the relatively high rates of adverse pregnancy outcomes in the US and the persistent race and social class disparities within those rates. Our goals are to uncover social and biological factors that influence the risks of preterm delivery and poor fetal growth, thereby informing strategies for primary prevention, prediction and intervention. The NIH-funded POUCH pregnancy cohort, assembled between 1998-2004 from 52 clinics in 5 Michigan communities, includes 3,019 pregnant women who were followed through delivery. Data from maternal interviews, abstracted medical records, placental examinations and stored biological samples collected at mid-pregnancy continue to be analyzed and already have generated over 70 publications. We welcome collaborators who seek to work with existing data or use stored biologic samples to probe new hypotheses. (PI, Dr. Claudia Holzman)



faculty-icon  Dr. Jean Kerver


Microbiota and Allergic Asthma Precision Prevention (MAAP2)

The microbial community colonizing a newborn’s gastrointestinal (GI) tract is very important for the ongoing development of that community, which has a strong impact on the optimal development of the baby’s immune system, leading to better child and adult health and specifically the prevention of allergy and allergic asthma. This collection of projects will identify relationships between factors influencing a mother’s GI and vaginal microbes during pregnancy, and how these factors and the mother’s microbes affect her newborn’s GI microbial community and immune system development from birth through the first years of life in both human and mouse studies. Taken together, these advances in understanding have the potential to lay the foundation for a strategy for the primary prevention of allergies and asthma. This project is led by Dr. Johnson and Dr. Ownby at HFHS; Dr. Jean Kerver serves as a co-investigator, leading the diet assessment and nutritional components.  


Mitigating the Impact of Implicit Bias on Maternal Morbidity and Mortality for African American Women

In the US, illness and death around the time of childbirth are much higher in African American women than white women, partly because of bias and racism experienced in the health care setting. In this study, we will ask questions and listen to answers about respectful health care practices from groups of African American mothers and their health care providers. The result will be the development of a toolkit of specific strategies for mothers to counter negative interactions and obtain patient centered, respectful care.  This project is co-led by Dr. Jean Kerver and Dr. Gwendolyn Norman of Wayne State University.


NOURISH (Grant Title: Food as Medicine for High-Risk Pregnant and Postpartum Women)

This project, led by Dr. Jean Kerver, will address the negative health impacts for two generations (Mom + Baby) that result from food insecurity, substance use disorder, or other challenges to eating healthy foods during and after pregnancy. High-risk pregnant women at Grand Traverse Women’s Clinic and primary caregivers of babies in the NICU at Munson Medical Center will receive weekly food pick-up or delivery for 12 weeks. Pre-post assessment of fruit and vegetable intake will be assessed in multiple ways including noninvasive skin carotenoid assessment with reflection spectroscopy and gut microbiome composition assessed from stool samples.


Understanding Breastfeeding Practices Before and During/After the COVID-19 Pandemic

Although many women intend to breastfeed, individual problems like overweight/obesity or public health problems including the COVID-19 pandemic may keep them from being able to reach their goals. This project will explore the impact of the COVID-19 pandemic on women’s breastfeeding practices and experiences. Dr. Gayle Shipp is a post-doctoral researcher leading this project with funding from a Diversity Supplement and a mentoring team led by Dr. Jean Kerver.




faculty-icon  Dr. Zhehui Luo


Causal inference using observational data

Many real-world interventions are not randomly assigned. Even in randomized controlled trials, intercurrent events may prevent valid inference of efficacy. Non-compliance and non-random drop-out may lead to selection bias and comprise the interval validity of a study. Dr. Zhehui Luo collaborates with epidemiologists, sociologists, clinicians and other scientists to find appropriate methods dealing with complications of causal inference using observational data. Currently she is exploring different impacts of non-compliance in placebo-controlled versus active-controlled trials and examining the potential of using spatial-temporal data to mimic randomized trials. The applications apply to trials for reproductive health and birth outcomes.


Health Services Research

Using large administrative claims data in research has advantages and disadvantages, which demands thorough understanding of the structure and limitations of such databases. Working closely with experts in generating, modifying and storing these data and utilizing her expertise in causal inference, Dr. Zhehui Luo provides insights in the design, analysis and interpretation of several program evaluation studies that have policy implications for improving population health. Currently she is investigating the impact of extending Medicaid benefit to persons affected by the Flint water crisis on health service utilization and implementing community health worker home visiting programs on birth outcomes. Dr. Zhehui Luo



faculty-icon  Dr. Claire Margerison


Policy Change and Women’s Health

Our research team is assessing the impact of the Affordable Care Act (ACA) on reproductive health behaviors, preconception preventive health, pregnancy health, and postpartum health. We are particularly interested in whether and how the ACA impacted racial/ethnic and socioeconomic disparities in women’s health. The project is led by Dr. Claire Margerison and funded by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01095951, R01095951-02S1, and F31103404).



 faculty-icon  Dr. Dawn Misra


Baltimore Preterm Birth Study (Grant Title: How Social Factors Influence the Risk of Preterm Delivery)

This was an NIH R01 study funded from 2000 through 2006. We collected data on 842 women, African-American Baltimore City residents seeking care either at a Johns Hopkins prenatal clinic or delivering at Johns Hopkins Hospital. Approximately half of the cohort was recruited prenatally and half recruited at delivery. A wide range of social and psychosocial factors were examined. The prenatally recruited cohort was also enrolled in collection of vaginal smear slides and limited saliva measures for cortisol assessment. Current residential address data was also collected. This design was intended to capture women receiving late or no prenatal care who would be missed by longitudinal (prenatal) designs. Consistent with the high-risk study population, our preterm birth rate was approximately 17 percent. We have published several manuscripts but there are still many excellent questions that remain to be examined with these data. Dr. Dawn Misra is the principal investigator.


Biosocial Impacts on Black Births (BIBB)

BIBBBIBB is a prospective longitudinal study of Black women that focuses on how social (at the individual and neighborhood levels) relate to risk of preterm birth. We are recruiting Black women in early to mid pregnancy with data collected at 2 to 3 prenatal time points (depending on entry into the study). Data include self administered questionnaires (social and behavioral factors, including life course measures), blood (to measure the lipidome and cytokines, with banked extra specimens), saliva (to measure telomere length), and medical record abstraction (maternal health, birth outcomes). For a subset of women, we have collected postpartum questionnaires to assess prenatal care quality and a few additional measures. We are currently recruiting women at 2 prenatal care sites: St. John Hospital, Detroit MI; Ohio State University Health System, Columbus OH. As of October 2021, we have enrolled about 950 pregnant women and had 750 deliveries. Dr. Dawn Misra is a co-investigator.

Supplemental funding has been provided by NIH to further study: 1) maternal morbidity; 2) COVID-19.

Fathers Matter

Fathers MatterThe objective of Fathers Matter is to assess whether and how fathers may have an effect on successful birth outcomes using an integrated conceptual framework by Misra et al. that considers maternal as well as paternal social, psychological, and biomedical factors. This study complements the NIH R01 Biosocial Impacts on Black Births in that fathers of the babies (to be born) of pregnant Black women in that study will be recruited for the proposed study. Using a prospective design, we will enroll 400 mother-father dyads. Both fathers and mothers will be interviewed during the prenatal period and within the first week after birth. Both fathers and mothers will provide a saliva specimen to assess telomere length. Prenatal maternal questionnaire and biomarker data and birth outcomes from BIBB will complement data from this study. Thus, multiple sources of data will be available to provide a more comprehensive assessment of fathers as part of the social environment in which Black women experience pregnancies. Fathers Matter is recruiting the father of the baby (fetus) of women enrolled in the BIBB study (see above). Most fathers are recruited during the pregnancy and complete a prenatal and postpartum questionnaire as well as providing a saliva sample (telomere length). We are also recruiting fathers only at delivery. As of January 2021, we have enrolled about 120 fathers. Dr. Dawn Misra is the principal investigator.  BIBB/Fathers Matter Team 

GROW Study (Grant Title: Gestational Regulators of Weight)

Dr. Vinod Misra is the PI and Dr. Dawn Misra is a co-investigator. The research was undertaken at the University of Michigan where Dr. Misra used his K award coupled with a Doris Duke Clinical Foundation Award he obtained to examine how maternal overweight and obesity influenced pregnancy. This was a longitudinal study of pregnant women who presented for early prenatal care at the University of Michigan Health System. Women were enrolled between 6 and 10 weeks gestation. Women were eligible for inclusion if they were between 18 and 45 years of age, had a singleton pregnancy, and intended to deliver at the study hospital. Participants were seen for four additional study visits at 10-14, 16-20, 22-26, and 32-36 weeks gestation. At each of the five study visits, questionnaire data, anthropometric measurements (maternal weight and fetal ultrasound, including measures of maternal and fetal fat on half the sample), and biological samples were collected. Baseline maternal characteristics were obtained by questionnaire and medical record review. Data were collected, over two phases, on 286 pregnancies. The sample was well educated, relatively high income, and primarily of white ethnicity. However, there was heterogeneity with regard to weight with approximately half of the cohort classified as normal weight and half as overweight/obese. We have published several manuscripts with more in development. Again, the data set is very rich and there are many opportunities that remain.

LIFE Study (Grant Title: Impact of Racism on Risk of Preterm Birth in Black Women)

Life StudyThis is an NIH R01 study funded from 2008 through 2014. We collected data on 1410 African-American/Black women delivering at Providence Hospital in Southfield Michigan. Our preterm birth rate was approximately 15 percent. This grant collected information on a wide range of social and psychosocial factors as well as measures of women’s exposures and experiences over the life course. It included interviews with approximately half of the mothers of women in the study to better examine life course measures. Addresses, both current and childhood, have been geocoded. We have published several manuscripts. However, the data set is very rich and many opportunities remain.  


LIFE-2 Study (Grant Title: Looking Back to Look Forward: Social Environment Across the Life Course, Epigenetics, and Birth Outcomes in Black Families)

LIFE-2This is an active NIH R01 study funded from September 30 2021 through 2026. We will collect data on 1,000 African-American/Black women delivering at Providence Hospital in Southfield Michigan. This award aims to investigate the social environment over the maternal life course to influences the maternal epigenetic profile (methylation and telomere length) from her own birth to the delivery of her offspring and the perinatal outcomes of the women’s offspring. It will also supplement the LIFE study conducted 2000-2006 by using many of the same measures and outcomes.



faculty-icon  Dr. Nigel Paneth 



Conductive Education Evaluation Project (CEEP) is a randomized clinical trial to compare the effectiveness of routine care for cerebral palsy (CP) with conductive education at the Conductive Learning Center (CLC) of Grand Rapids.  Funded by State of Michigan, the trial enrolled children aged 2-6 in four week sessions of conductive education, a movement therapy featuring daily group sessions led by specially trained teachers, rhythmic intention, peer motivation and specialized equipment. PIs: Madeleine Lenski and Nigel Paneth. Research Coordinator: Deborah Weiland.



ELGANExtremely Low Gestational Age Newborns (ELGAN) began in the early 2000s as a multisite NIH-funded study of antecedents of brain injury after premature birth.  Over 1,500 newborns and their parents were enrolled at 14 hospitals in the Lake Michigan area, New England, and North Carolina. Developmental assessments were obtained in infancy and for over 85% of children at 24 months, with further neurodevelopmental follow-up around age 10.   The third follow-up phase, led by Dr Michael O'Shea at University of North Carolina, is part of the national NIH ECHO (Environmental Influences on Child Health Outcomes) initiative, examining environmental exposures and high school age outcomes, and their relationship to earlier biomarkers.  MSU team: PIs Madeleine Lenski and Nigel Paneth, and Research Coordinator Deborah Weiland.


Prenatal Exposures and Child Health Outcomes: A Statewide Study

This project, joint with four other Michigan partners, is part of the national ECHO program (Environmental influences on Child Health Outcomes) to support studies of potential environmental causes of adverse pregnancy outcomes, obesity, asthma and neurodevelopmental disorders. We are creating a statewide study in Michigan, adding to our extant pregnancy cohorts. Women are interviewed during pregnancy; blood, urine, and placenta are collected and archived. We will later assess the child’s health and development in relation to factors assessed during pregnancy. This project is led by Dr. Nigel Paneth in close collaboration with Dr. Jean Kerver as a departmental co-principal investigator. Other co-principal investigators include Dr. Charles Barone (HFHS), Dr. Michael Elliott (UM), Dr. Patricia McKane (MDHHS), and Dr. Douglas Ruden (WSU).

  • Category: Perinatal/Pediatric; Developmental
  • NIH-OD, UG3/UH3OD023285




 faculty-icon  Dr. Nicole Talge


Early Hearing Study

Early Hearing Study

In the Early Hearing Study, we use click-evoked auditory brainstem responses (ABRs) to investigate how infants process sound early in life. Knowledge gained through this project may advance our understanding of brain development among children with and without neurodevelopmental disorders. This project is supported by a R21 award from the National Institute on Deafness & Communication Disorders to Nicole Talge. Our project manager is Melanie Adkins, MPH, and our collaborative team includes investigators from Michigan State University, the University of Michigan, UCLA, and the local community (Sparrow Health System; Hearing Health Center).


MichBabies Study  Michigan Babies

The MichBabies Study links administrative health records maintained by the Michigan Department of Health and Human Services to address questions with public health relevance for children and their families. This project is funded through R01 award to Nicole Talge from the National Institute on Deafness & Other Communication Disorders (NIDCD).  Our project manager is Melanie Adkins, MPH and our collaborative team involves investigators from MDHHS, the MSU Institute for Health Policy, and the University of Michigan.