Improving the health of mothers and babies motivates this Kaiser Permanente researcher
By Jan Greene
Pregnant women with depression often face a dilemma; while antidepressants are often effective, there are concerns about their impact on the developing baby. At the same time, prenatal depression left untreated raises the mother’s own risk of worsening her mood disorder, with potentially devastating consequences.
To help pregnant women make informed decisions, Division of Research (DOR) investigator Lyndsay Avalos, PhD, MPH, is leading a study to shed light on the nuances of depression treatment during pregnancy. Avalos recently received a $3 million grant from the National Institutes of Health to study the topic.
We asked Avalos about this project and her other collaborations on women’s health.
How did you get interested in studying women’s health?
I’ve always known I wanted to make a positive impact on people’s lives. While pursuing my doctorate in epidemiology at UC Berkeley, I started getting interested in women’s and children’s health, especially the prenatal period. Women are so under-represented in research, and pregnancy is such an important time, with potential long-term consequences for health of both the mother and baby. With that in mind, I started focusing on alcohol’s effect on maternal and infant health.
How have you explored women’s health since joining DOR in 2011?
My work has spanned epidemiology, health services research, and clinical and translational research as well, with a heavy focus on maternal mental health and substance use. I’ve been involved with work to understand perinatal exposures such as prenatal depression’s impact on nutrition and gestational weight gain and flu vaccination during pregnancy. These ideas spawned others, expanding my focus from exploring risk factors for poor maternal and perinatal health to testing interventions to improve outcomes. For instance, I’ve been working with DOR research scientist Ai Kubo, MPH, PhD, on a mindfulness intervention for women with perinatal depression. And I’m working with my previous postdoctoral fellow, Sylvia Badon, PhD, on a physical activity intervention for moms at increased risk of postpartum depression.
We also have some work coming out soon looking at racial and ethnic disparities in treatment of perinatal depression and identifying ways to improve treatment engagement for all pregnant and postpartum women with depression, regardless of race.
What can you tell us about your new study on depression treatment in pregnant women?
This is the grant I’ve wanted to do since starting at DOR. There is some evidence that certain antidepressants might have developmental consequences for the child, but untreated depression is harmful as well. My goal here is to provide data for clinicians and patients to make informed decisions.
We will be comparing developmental outcomes in children of women with prenatal depression, treated or untreated. We will have the advantage of access to unique data from Kaiser Permanente Northern California’s depression screening of pregnant women. For instance, we’ll have access to data on depression severity, which has not been well examined in the past. We’ll be comparing groups to learn more about risks of untreated depression, use of medication, and treatment with psychotherapy.
What other projects are you involved with?
I’m working on a study of women in a group prenatal care program called Centering Pregnancy that is comparing their maternal health outcomes and satisfaction with prenatal care to women in traditional prenatal care. I’m also working with DOR collaborators to examine maternal depression and anxiety during the COVID-19 pandemic.
Another important area is prenatal substance use; most recently DOR research scientist Kelly Young-Wolff, PhD, MPH, and I have received 3 different grants to better understand cannabis use by pregnant women. One project looks at health outcomes for both mother and baby. Another examines developmental outcomes for the children, such as risk of autism and attention deficit/hyperactivity disorder, speech and language disorders, and other outcomes. We also have a grant allowing us to assess the impact of the COVID-19 pandemic on prenatal cannabis and other substance use, and whether women who use cannabis, tobacco, or other substances before or during pregnancy are at increased risk of COVID-19 infection and illness progression.
I think it’s really important to look at prenatal cannabis use because there’s so little data right now, and women want to know whether it is safe to use during pregnancy.
How do you like to spend your free time?
I love spending time with my family — my husband, son and daughter, and dog. We love hiking, kayaking, and exploring new places to ride bikes. During COVID, we’ve also been doing a lot of puzzles and games. We’ll just put out a 500-piece puzzle and start it together, and then throughout the day the kids will just stop by and add a piece.