Reproductive, Perinatal, and Pediatric Epidemiology Research

RPPE

What is Reproductive, Perinatal, and Pediatric Epidemiology (RPPE)?

RPPE03_229x279The health concerns faced in the field of reproductive, perinatal, and pediatric health are among the most pressing issues of our time, both from scientific and public perspectives. The ability to successfully reproduce and have a healthy child transcends other health concerns by touching on very basic human needs and desires. Whether the challenge is to understand and remedy causes of infertility, prevent prematurity or birth defects, or identify the causes of such highly visible, troubling disorders as autism or attention deficit disorder, epidemiologists have a central role that is just now being fully appreciated.

The University of North Carolina at Chapel Hill is a leader in the field of reproductive, perinatal and pediatric epidemiology. The academic departments of Epidemiology, Maternal and Child Health, Nutrition, Pediatrics, and Obstetrics and Gynecology have engaged in a variety of collaborative and individual projects to address substantive and methodological issues facing our field.

RPPE_Research

Reproductive and Perinatal Health

The Diet, Weight Change and Obesity During Pregnancy Study (DWOP) (Siega-Riz AM, Faith M, Burger K, Stuebe A, Nicholson W, Dorman K-NICHD, 10/13-9/18).  This team of UNC investigators along with Drs. Tonja Nansel and Leaha Lipksy from NICHD and Dr. Franca Barton from EMMES Corporation will be recruiting a total of 345 women from the UNC prenatal clinics from three weight status groups (normal, over and obese) to examine the role of food reward responsivity, food reward value, and behavioral control in weight change and dietary intake during pregnancy and postpartum. Women will be followed throughout pregnancy until 1 year postpartum with protocols that include the collection of blood, stool, and urine specimens, previous and current medical information, dietary intake and eating behaviors, anthropometrics, and demographic information.  Sub-studies will include: (1) a focus group study examining pregnant women’s perceptions of hedonic eating ‘triggers,’ food cravings/aversions, and food choice and alternatives, (2) a laboratory-based behavioral experiment using an innovative ‘eating in the absence of hunger’ protocol and (3) a functional magnetic resonance imaging (fMRI) of women during the postpartum period in order to obtain objective measures of food reinforcement value and food reward responsivity.
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The Pregnancy, Infection, and Nutrition Study (PIN) (Dole N, Evenson K, Herring A, Olshan A, Siega-Riz AM, Thorp J – NIH, 8/95-12/05). This team of investigators has collaborated on the decade-long PIN study to investigate the epidemiology of preterm birth, one of the major contributors to perinatal morbidity and mortality in the United States. This study’s primary goal is to identify etiologic factors for preterm delivery, including preterm premature rupture of the membranes (PROM), delivery due to early onset of labor, and related complications of pregnancy, so that public health measures can be taken to reduce this adverse pregnancy outcome and its associated health, social, and economic costs. The PIN study successfully recruited over 5000 pregnant women from central North Carolina to address physical activity, psychosocial factors, placental characteristics, postpartum weight retention, nutritional factors and food security, bacterial vaginosis and other genital tract infections, occupational physical exertion, smoking, sexual behavior during pregnancy, vaginal bleeding, genetic factors, as well as variety of health and social behaviors and community level factors.
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The PIN Postpartum Study (Siega-Riz AM, Evenson K, Herring A, Dole N, Moos M-K, Thorp J, NIH, 8/02-7/07) was added as a major extension of the PIN study in 2002. This study follows women (n=689) for the first year post-partum to identify modifiable factors related to postpartum weight retention and postpartum mental health. The study collects data in the home 3 and 12 months after delivery including: maternal height, weight, and percent body fat using bioelectrical impedance, and an interview about diet, breastfeeding status, body image, behaviors, health and work status, physical activity, and psychosocial factors.. Focus groups during pregnancy and in-depth interviews during the postpartum period were conducted among a subset of women to collect qualitative information on barriers and enhancements to physical activity, healthy eating, and weight loss during the postpartum period. Dr. Siega-Riz collaborated with Dr. Evenson, who received funding to add a detailed assessment of physical activity and neighborhood factors to this, and Dr. Daniels, received funding to follow the growth and neurodevelopment of the infants.
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North Carolina Center for Birth Defects Research and Prevention (Olshan A, Siega-Riz A, Herring A, Meyer R, CDC, 9/02-8/13). The North Carolina Center for Birth Defects Research and Prevention conducts surveillance and collaborates with Centers across the country to conduct case-control studies of risk factors for birth defects (the National Birth Defects Prevention Study). The national study now includes over 14,000 cases of birth defects and 8,000 controls. The Center is a close collaboration with the North Carolina Department of Public Health. Telephone interviews are conducted and DNA is collected by buccal cells to allow detailed evaluation of environmental, nutritional, and genetic factors that might be associated with specific birth defects. Dr. Olshan is currently evaluating trends in neural tube defects and other folic acid preventable birth defects following folic acid interventions, as well as inflammation, metabolizing enzyme, and DNA repair gene polymorphisms that may be associated with oral clefts, neural tube, and heart defects. Dr. Siega-Riz, a Center investigator, has begun evaluating nutritional factors associated with various birth defects such as gastroschisis, NTD’s, etc. Dr. Daniels mentored Cynthia Cassell, an MCH doctoral student with a minor in Epidemiology, who linked North Carolina Center for Birth Defects Research and Prevention data to state Medicaid data to conduct her dissertation research on the cost and services used by children with oral facial clefts.
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Maternal Smoking, Maternal and Fetal Genetic Variation, and Risk of Preeclampsia R01HD058008. NICHD 06/01/2008 – 05/31/2013 (Engel PI)  The goal of this project is to elucidate the influence of genetic variation in candidate genetic pathways on the development of preeclampsia among smokers and non-smokers. This study is nested within the Norwegian Mother and Child Birth Cohort (MoBa). All cases of preeclampsia in MoBa were validated by independent record review. We will select 750 cases of preeclampsia and 750 validated non-cases for genotyping. Maternal and fetal DNA will be assayed using the Affymetrics Whole Exome genoytyping array, which includes 300,000 coding SNPs including non-synonymous and synonymous SNPs as well as variants in splice and stop codons, and approximately 30,000 SNP and complex indels from draft 1 of the thousand genomes project. Additionally, a supplement of 100,000 promoter/enhancer site variants across genes in high priority pathways (inflammation, apoptosis, angiogenesis, smoking detoxification and carbon monoxide signaling) will be added.
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A Pooled Investigation of Prenatal Phthalate Exposure and Childhood Obesity. R21ES021700 NIEHS 07/01/2012 – 06/31/2014 (Engel PI). Starting in 1998, NIEHS and EPA jointly funded a network of Children’s Environmental Health and Disease Prevention Research Centers, with the mission of addressing the role of environment in children’s health. The Mount Sinai, Columbia, and Cincinnati Children’s Centers each enrolled independent prospective birth cohorts, collected third trimester urine specimens, and followed children up for growth and development. Each of these Centers has already measured maternal urinary phthalate metabolites in the third trimester. We propose to pool these data in order to efficiently examine the association between maternal phthalate concentrations and longitudinal measures of adiposity from birth through age 7 years. To our knowledge, these three birth cohorts together represent the only US studies with currently available data on phthalates and growth through age 7, and constitute a rich and unique resource to efficiently address the aims of this study while providing the foundation for future pooling efforts to address the impact of environmental chemicals on children’s health.
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Malaria and HIV in Pregnant Women in Malawi (Meshnick S NIH 8/1/12 – 07/31/14)
Genetic epidemiology of malaria in the Democratic Republic of the Congo
Malaria is very highly endemic in the Democratic Republic of the Congo (DRC). We propose to use >16,000 dried blood spots from the 2007 and 2012 Demographic and Health Surveys (DHS) in the DRC to conduct the first longitudinal, nation-wide study of malaria genetic epidemiology. Our aim is to determine the effects of malaria control efforts on the prevalence of P. falciparum and other malaria species.
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Pediatric Health

The North Carolina Center for Autism and Developmental Disabilities Epidemiology ( U50/CCU422345-04 & U10DD000184-01 – CDC 09/30/2006 – 06/29/2016 (Daniels JL, PI).
NC was one of six sites in a multi-site case-control study investigating genetic and environmental causes of autism, as well as phenotypic and behavioral correlates of autism and development.  The first phase of the study has just ended, yielding rich biologic, genetic, health, and developmental data on approximately 700 children with autism, 700 children with other disabilities, and 700 sampled from the community and their families. The second phase of the study maintains a similar protocol and enters the field this spring (May, 2012) – which will essentially double the sample size.  This project is among the largest epidemiologic studies of risk factors for autism and developmental disabilities to date.  The second phase of the study offers students opportunities to gain experience in field data collection and the administrative aspects of multi-site studies; while the first phase of the study is primed for epidemiologic investigation and analysis.  Students can generate and investigate hypotheses that will benefit from the rigorously collected data on an extensive array of genetic and environmental risk factors.  The reputable multi-site investigator group is collaborative and engaging, providing students with professional entrée into the growing field of autism epidemiology
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Assessment of Perinatal PBDE Exposure and related Child Behavioral and Cognitive Developmental Effects (Daniels J, EPA, 3/06-3/09). The primary aim of the study was to investigate children s exposure to PBDEs through breast milk, diet and their physical environment in relation to cognitive and behavioral development. This study followed a subcohort of the children born to participants of the PIN studies until they were 3 years of age. Home visits were conducted at 3, 12 and 36 months to investigate a variety of environmental exposures that may affect their health, including PBDEs, diet, and social factors, and assess the child s general health, neurodevelopment, and anthropometry. Participants of this study are children born to participants of two existing studies: the Pregnancy, Infection, and Nutrition (PIN) Study follows women through the end of pregnancy, then the PIN Postpartum Study continues to follow them through the first year postpartum. Linkage with these studies provides considerable information on the mothers during pregnancy, including diet, stress, psychosocial health, infection, weight status, physical activity, and blood samples. This study will offer students many opportunities to evaluate exposures during pregnancy and early life in relation to children’s health.
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Genetic Susceptibility Factors in the Etiology of Neuroblastoma (Olshan A, Siega-Riz AM, NIH 08/01/08 – 07/30/13). Over a five-year period, the Neuroblastoma Epidemiology in North America (NENA) study seeks to enroll approximately 600 children (living and deceased) who were diagnosed with neuroblastoma before 6 years of age. In addition, NENA is enrolling the biological mothers and biological fathers of these children. In this way, biological triads can be studied which allows NENA to explore the genetics of the disease. Children with neuroblastoma, along with their biological parents, are recruited from the US, Puerto Rico and Canada to participate in this research.
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Hispanic Community Children’s Health Study of Latino Youth- Coordinating Center RO1-HL1021301 4/1/2011-11/30/2014 (Bangdiwala, S PI, co-investigator Siega-Riz) US Latino youth are more overweight or obese than non-Hispanic white youth and are at risk for lasting cardiovascular complications into adulthood. The present study will study a wide range of cultural factors (e.g., family environment, physical, social) associated with obesity in a sample of 1,600 Latino boys and girls aged 8-14 years old from the Bronx, NY; Chicago, IL; Miami, FL and San Diego, CA. Findings from our study will inform practice and policy efforts to develop programs to prevent obesity in Latino youth and thus improve the health of future generations.
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Program Faculty

Anna Maria Siega-Riz
Program Director
Professor of Epidemiology and Nutrition
Associate Dean for Academic Affairs of Gillings School of Global Public Health

Research interests:

  • Breastfeeding
  • Maternal health
  • Reproductive health
  • Nutrition
  • Obesity

Julie Daniels
Program Co-Director
Associate Professor of Epidemiology and Maternal and Child Health

Research interests:

  • Child development
  • Environment (general)
  • Nutrition
  • Reproductive health
  • Occupational health
  • Pediatric epidemiology

Stephanie Engel
Associate Professor of Epidemiology

Research interests:

  • Child development
  • Environment (general)
  • Maternal health
  • Reproductive health
  • Occupational epidemiology

Andrew Olshan
Professor of Epidemiology
Chair of Department of Epidemiology

Research interests:

  • Cancer
  • Child development
  • Environment (general)
  • Genetic epidemiology
  • Occupational health
  • Reproductive health

Charles Poole
Associate Professor of Epidemiology

Research interests:

  • Epidemiologic Methods
  • Meta-Analysis

Whitney Ragan Robinson
Assistant Professor of Epidemiology

Research interests:

  • Obesity development
  • Health disparities
  • Epidemiologic methods

Daniel Westreich
Assistant Professor of Epidemiology

Research interests:

  • Child development
  • Maternal Health
  • Reproductive Health
  • Sexually transmitted diseases
  • Women’s Health

Collaborating Faculty

Linda Adair
Professor of Nutrition
Research Interests:

  • Nutrition,
  • Fetal programming
  • International health

Donna Baird
Adjunct Associate Professor of Epidemiology, Epidemiologist at NIEHS
Research Interests:

  • Reproductive health
  • Fertility and early pregnancy
  • Epidemiology of uterine fibroids

Nancy Dole
Adjunct Associate Professor of Epidemiology, Deputy Director of the Carolina Population Center
Research Interests:

  • Reproductive Health
  • Psychosocial Stress

Sara Ephross
Adjunct Associate Professor of Epidemiology, Director of Epidemiology at GlaxoSmithKline
Research Interests:

  • Pharmacoepidemiology
  • Reproductive health

Kelly Evenson
Research Professor of Epidemiology
Research interests:

  • Physical activity
  • Cardiovascular disease
  • Reproductive epidemiology

Penny Gordon-Larsen
Associate Professor of Nutrition
Research Interests:

  • Adolescent nutrition
  • Built environment
  • Obesity

David Grimes
Professor of Obstetrics and Gynecology
Research Interests:

  • Contraception
  • Reproductive epidemiology

Amy Herring
Professor of Biostatistics
Research Interests:

  • Child development
  • Environment (general)
  • Maternal health
  • Nutrition
  • Obesity
  • Reproductive health
  • Women’s health

Jon Hussey
Research Assistant Professor of Maternal and Child Health
Research Interests:

  • Health disparities
  • Maternal and child health
  • Neighborhood effects
  • Child abuse and neglect
  • Drug use
  • Perinatal epidemiology

Michele Jonsson-Funk
Research Assistant Professor of Epidemiology
Research Interests:

  • Reproductive health
  • Pharmacoepidemiology
  • Epidemiologic methods

Danelle Lobdell
Principal Investigator at the Environmental Protection Agency
Research Interests:

  • Reproductive health
  • Environmental epidemiology
  • Occupational epidemiology

Stephanie London
Adjunct Professor of Epidemiology, Senior Investigator at the National Institute of Environmental Health Sciences
Research Interests:

  • Asthma
  • Reproductive epidemiology
  • Environmental epidemiology

Matthew Longnecker
Adjunct Professor of Epidemiology, Senior Investigator at the National Institute of Environmental Health Sciences
Research Interests:

  • Cancer
  • Environmental epidemiology
  • Reproductive health

Stephen Marshall
Professor of Epidemiology
Research Interests:

  • Injury prevention
  • Violence prevention
  • Environmental/Occupational
  • Epidemiologic methods

Sandra Martin
Professor of Maternal and Child Health, Associate Dean for Research of Gillings School of Global Public Health
Research Interests:

  • Violence prevention
  • Women’s health

Michelle Mendez

Assistant Professor of Nutrition
Research Interests:

  • Maternal Health
  • Reproductive Health
  • Nutrition
  • Obesity

Steven Meshnick
Professor and Associate Chair, Department of Epidemiology
Professor of Microbiology and Immunology
Research Interests:

  • Prevention of malaria in pregnant women
  • Pathophysiological effects of infection on placental development
  • Genetic epidemiology of malaria

Robert Meyer
Adjuncy Professor of Maternal and Child Health, Director of the NC Birth Defects Monitoring Program at the NC Department of Health and Human Services
Research Interests:

  • Reproductive Health
  • Birth defects

Herbert Peterson
Professor and Chair of Maternal and Child Health, Professor of Obstetrics and Gynecology
Research Interests:

  • Contraception
  • Maternal and child health

Anne Steiner
Assistant Professor of Obstetrics and Gynecology
Research Interests:

  • Fertility
  • Egg donation
  • Polycystic ovarian disease
  • Fibroids
  • In vitro fertilization
  • Hysteroscopy
  • Amenorrhea

Alison Stuebe
Assistant Professor of Obstetrics and Gynecology
Research Interests:

  • Gestational diabetes
  • Obesity
  • Gestational weight gain
  • Breastfeeding
  • Mastitis
  • Perinatal depression
  • Birth outcomes
  • Women’s health

John Thorp
Professor of Maternal and Child Health, Professor of Obstetrics and Gynecology
Research Interests:

  • Preterm birth
  • Cervical insufficiency
  • Clinical trials
  • Nutrition in pregnancy
  • Health disparities

Annelies Van Rie
Associate Professor of Epidemiology
Research Interests:

  • Infectious diseases
  • Cancer
  • Disabilities
  • Environment (air)

Claire Weinberg
Adjunct Professor of Epidemiology and Biostatistics, Chief of Biostatistics Branch and the National Institute of Environmental Health Sciences
Research Interests:

  • Genetics
  • Reproductive epidemiology
  • Epidemiologic methods

Allen Wilcox
Adjunct Professor of Epidemiology, Senior Investigator at the National Institute of Environmental Health Sciences
Research Interests:

  • Fertility
  • Conception
  • Early pregnancy
  • Low birth weight
  • Environmental teratogens

Below is a listing of some of our current students associated with the RPPE program area:

 

Anna Bauer
4th year PhD student in the Department of Epidemiology

Prior degrees:

  • MPH, Maternal and Child Health
  • BS, Environmental Sciences

Research interests include:

  • Birth outcomes
  • Environmental exposures
  • Preeclampsia
  • Childhood outcomes
  • Methodological issues concerning timing and exposures during pregnancy

Why I chose UNC:
I received my MPH here from UNC, so I was already aware of the phenomenal faculty, students, and resources that the Gillings School of Global Public Health had to offer. The UNC Epidemiology department is also known for the rigor of their methods training, an area which I wanted to pursue more.


Alan Kinlaw
4th year MSPH/PhD student in the Department of Epidemiology

Prior degrees:

  • BS, Textile Engineering (Biomedical Materials), North Carolina State University
  • BA, French Language and Literature, North Carolina State University

Research interests include:

  • Perinatal nutrition
  • Environmental exposures
  • Child developmental outcomes
  • Pharmacoepidemiology
  • Epidemiologic methods
  • Health disparities

Why I chose UNC:
I chose UNC because of the large and diverse network of accessible faculty and students in our department. Their constant collaboration with scholars in epidemiology and related fields promotes a positive environment for research, teaching and learning.


Suzanne Landi
2nd year PhD Student in the Department of Epidemiology

Prior degrees:

  • MPH, Epidemiology (George Mason University)
  • BA, Linguistics (Bryn Mawr College)

Research interests include:

  • Pregnancy outcomes
  • Fertility
  • Hormonal contraceptives/family planning
  • Pharmacoepidemiology
  • Epidemiologic methods

Why I chose UNC:
I knew I wanted to gain skills in epidemiologic methods, and the UNC Department of Epidemiology is a fantastic place for that kind of training. The faculty and students are working at the cutting edge of methods, and are a great resource for teaching and mentorship. I also desired opportunities to work with other topic areas and departments in the School of Global Public Health, which is highly encouraged here.


Chantel Martin
6th year PhD Student in the Department of Epidemiology

Prior degrees:

  • MSPH, UNC Charlotte
  • BA, Finance (Minor in Economics), University of Delaware

Research interests include:

  • Maternal nutrition
  • Social and environmental factors
  • Pregnancy outcomes
  • Child weight status
  • Obesity trends
  • Epidemiologic methods

Why I chose UNC:
UNC has a strong research and faculty base, with many ongoing research projects on the cutting-edge. Students have lots of opportunities to engage in research activities to bridge their educational and research training.


Nelson Pace
2nd year PhD Student in the Department of Epidemiology

Prior degrees:

  • SM, Epidemiology, Harvard University
  • BS, Statistics, Brigham Young University

Research interests include:

  • Maternal nutrition
  • Environmental exposures (air pollution, herbicide use)
  • Birth Defects
  • Vaccine use during pregnancy
  • Causal Inference

Why I chose UNC:
UNC offers an incredible number of opportunities to be at the forefront of cutting-edge research. Faculty are very supportive of student-initiated research projects and help students make the right connections to pursue scientific questions. Coming to the Gillings School of Global Public Health gave me a chance to work with outstanding faculty that had very similar research interests as myself particularly in the area of reproductive and perinatal epidemiology. I also feel that UNC greatly values their students and their contribution to the university.


Jeanette Stignone

Mt. Sinai School of Medicine


Recent Graduates:

Elizabeth Jensen, Postdoctoral Fellow, NIEHS

Catherine Vladutiu, Postdoctoral Fellow, Cardiovascular Training Grant, UNC Dept. of Epidemiology.

Jeanette Stingone, Postdoctoral Fellow,

Kelly Strutz, Postdoctoral Fellow, Reproductive and Perinatal Training Grant, Dept. of Epidemiology, Michigan State.

Learning objectives

The RPPE program area provides students with a multidisciplinary perspective, a strong foundation in epidemiologic concepts and methods, and an understanding of the underlying biology of reproduction and childhood development and growth. The program prepares students to pursue careers in reproductive, perinatal and pediatric epidemiologic research.

Through their participation in the program, students gain an understanding of the following:

  • basic human reproduction and child development biology
  • clinical and health service aspects of reproductive and perinatal health
  • social, lifestyle, and environmental influences on reproductive and child health
  • issues in measuring and interpreting studies on fertility, pregnancy, and child health

As a part of the RPPE curriculum, students perform course work in the Departments of Epidemiology, Biostatistics, Maternal and Child Health, Nutrition and Biology; attend seminars and journal clubs regarding innovative and developing research topics; and conduct research under the guidance of experienced program faculty.

Courses

In addition to core requirements for completion of graduate degrees in the Department of Epidemiology, the RPPE program includes two required and several recommended courses which fit the diverse interests of students.

Required courses
  • EPID/MHCH 851
Reproductive and Perinatal Epidemiology
  • EPID/MCH 853
Advanced Perinatal Epidemiology
Examples of recommended courses
  • NUTR/MHCH 611
Maternal, Infant and Child Nutrition
  • MHCH 716
International Family Planning
  • MHCH/EPID 892
Seminar on Health Disparity
  • MHCH 722
Issues in International Maternal and Child Health
  • EPID 757
Epidemiology of HIV/AIDS in Developing Countries
  • EPID 743
Genetic Epidemiology: Methods and Applications
  • EPID 814
Obesity Epidemiology
  • CBIO 123
Developmental Teratology and Toxicology

RPPE Training Grant

The RPPE Training Grant offers 5 predoctoral positions that provide stipend, tuition remission, health insurance, and some travel costs. Interested students in the Departments of Maternal and Child Health, Nutrition, and Epidemiology are encouraged to apply. Application for Training Grant positions is competitive.

Graduate Student Research Assistantships

Research assistantships (RAs) offer students an opportunity to gain research-related experience, develop close working relationships with faculty, and sometimes earn CO-authorship on peer-reviewed publications. Information on the type of assistantships available and how to locate them is available from Student Services. A small number of RA positions are typically available in the RPPE program. Students interested in an assistantship should submit an application form (available from Student Services), and should discuss this interest with their advisors.

External funding

Some students in the RPPE program have secured funding through sources that are external to the Department or the University. Please click on the links below for further information about some of these external funding sources.