First-author projects

First Trimester MMP-9 is Associated with Maternal Depression History and Treatment
Lily Woods, MA, LAC; Erin George, PhD, CNM; Elise Erickson, PhD, CNM; Julienne Rutherford, PhD

Matrix metalloproteinase-9 (MMP-9) is an extracellular protease that regulates tissue remodeling and inflammation. Psychological research has linked MMP-9 to the pathophysiology of depression. In obstetrics, MMP-9 facilitates placental invasion—an inflammatory process essential for placental attachment to the uterine wall. Dysregulated MMP-9 contributes to maternal morbidity, including preeclampsia and postpartum hemorrhage. Despite its dual relevance to neural and placental biology, the relationship between MMP-9 and maternal depression is largely unexplored. We conducted a secondary analysis of pregnant participants in the Perinatal Research Repository. Maternal blood was collected between 8–38 weeks’ gestation. MMP-9 was measured by ELISA and log-transformed. Exclusions included multifetal gestation, IVF, fetal anomaly, and placenta previa/abruption. Associations between MMP-9 and depression history or pharmacologic treatment during pregnancy were examined using regression models adjusted for maternal age. The final sample (n=461) was 61% Black/African American and 90% publicly insured. We analyzed 111, 385, and 235 samples in the first, second and third trimesters respectively; n=227 contributed >1 measure. 41% reported a history of depression and 18% received pharmacologic treatment during pregnancy. First-trimester MMP-9 was higher among participants with a depression history (β = 0.32; 95% CI: 0.00–0.63; p = .048) and those receiving treatment (β = 0.46; 95% CI: 0.02–0.90; p = .043). Second-trimester MMP-9 showed similar but weaker associations, and no differences were observed in the third trimester. Elevated MMP-9 concentrations in early pregnancy were associated with both a history of depression and pharmacologic treatment during gestation. These findings point to a potential link between maternal psychological health and biological processes of pregnancy. Larger studies are needed to further investigate these relationships and evaluate their clinical implications.

Maternal Influences on Placental Angiogenesis in a Clinical Population
​Lily Woods, MA, LAC; Erin George, PhD, CNM; Elise Erickson, PhD, CNM; Julienne Rutherford, PhD

Angiogenesis supports the development of uteroplacental vascular networks during pregnancy. Imbalances between pro-angiogenic (Placental Growth Factor, PlGF) and anti-angiogenic (soluble fms-like tyrosine kinase-1, sFlt-1) factors have been linked to maladaptive placentation and pregnancy complications such as preeclampsia. Maternal age and body mass index (BMI), as well as cigarette use, have been associated with these outcomes, yet their mechanistic relationships to angiogenic pathways are less understood. This exploratory analysis examined whether maternal characteristics and behaviors were associated with variation in angiogenic profiles across gestation. We hypothesized that these exposures would be associated with altered angiogenic balance. This secondary analysis included mothers in the Perinatal Research Repository. Maternal blood was collected between 8-38 weeks’ gestation. ELISAs measured sFlt-1 and PlGF. Clinical data was abstracted from medical records. Singleton, non-anomalous pregnancies >24 weeks were included; IVF and placenta previa/abruption were excluded. Biomarker concentrations were log-transformed. Spearman’s correlations and t-tests were used to evaluate relationships between angiogenic biomarkers and maternal characteristics (BMI, age, gravida, parity, anemia) and behavioral exposures (average number of cigarettes smoked per day). The final sample included n=455; 61% Black/African American; 90% publicly insured. We examined 109, 383, and 234 samples in the first, second and third trimesters respectively; n=224 had >1 measure. Higher BMI was associated with lower second-trimester sFlt-1 (rho=-0.21, p=0.003) and PlGF (rho=-0.27, p=0.0002). Across all trimesters, maternal age was negatively correlated with sFlt-1 (1st, rho=-0.23, p=0.01; 2nd, rho=-0.15 p=0.003; 3rd, rho=-0.14, p=0.04). Gravida was inversely associated with sFlt-1 levels across gestation (1st, rho=-0.21, p=0.03; 2nd, rho=-0.13, p=0.01; 3rd, rho=-.20, p=0.002), and parity was significant in the third trimester (rho=-0.16, p=0.01). Second trimester PlGF was elevated among those with anemia (Δ = 0.31 ± 0.10 log units, p = 0.0016, two-tailed) and trended higher in the third (p=0.05). Cigarette use was inversely correlated with first-trimester sFlt-1 (rho=-0.38, p=0.01). Maternal clinical and behavioral factors were associated with variation in angiogenic biomarkers across gestation, suggesting that biological and environmental exposures may distinctly shape placental vascular development and should be considered when interpreting angiogenic markers in pregnancy research.

Grief and loss during the COVID-19 pandemic: Exploring perceived physical health as a predictor for rumination
Lily Merritt, BA, Sydney Friedman, BS, Morgann West, Mary-Frances O'Connor, PhD

Ruminative thought predicts complicated grief and hinders the adjustment to loss by acting as a cognitive avoidance strategy. Not only is the process linked to psychological issues, rumination is also associated with negative health consequences, such as poor sleep quality, impaired immune functioning, and cardiovascular disease. Self-reported physical health has been shown to be indicative of documented physical health. Arizonans who experienced the death of a partner, child, sibling, parent, grandparent, other family member, non-biological family, or close friend in the past year were recruited for a semi-structured phone interview, during which they reported their grief severity, depressive symptoms, grief-specific rumination, and perceived physical health. In the present study (n=51), we tested whether perceived physical health acts as a predictor for grief-specific rumination in bereaved individuals who experienced the death of a loved one during the COVID-19 pandemic. Analyses showed that self-reported physical health predicted grief rumination outcomes  (F = 4.0, p = 0.005).  Notably, self-reported physical health also predicted grief severity (F = 4.0, p < 0.005) and depression (F = 5.2, p < 0.001). These results are consistent with previous findings that engagement in ruminative thought is associated with poorer health. Using self-report measures to assess physical health may offer accessible insights related to psychological health outcomes—especially in a time of social distancing.

Adjusting to Loss: How Beliefs About the Helpfulness of Others for Emotion Regulation Shape Grief Responses
Lily Merritt, BA, Eva-Maria Stelzer, PhD, Mary-Frances O'Connor, PhD

​​Bereaved people experience a myriad of intense emotions while grieving; given this fact, it is essential that researchers understand the connection between social support and emotion regulation in this population. The present study (n=156, 85.9% female) explored whether beliefs about the helpfulness of others for emotion regulation impacted psychological health outcomes in recent widows and widowers. Participants completed a two-week long daily diary, during which they reported their mental well-being, grief, and any emotion regulation strategies they received from both their network members and their deceased partner. Analyses found negative associations between beliefs about the helpfulness of others for interpersonal emotion regulation and depression and grief symptoms. The findings of this research have implications for the use of emotion suppression as a mediator in associations between emotion regulation beliefs and psychological outcomes.
Art by ​Roger Dean
Disclaimer: Please note that while I am both a therapist and a research coordinator, these roles remain entirely separate and within their respective scopes of practice. I do not offer therapy to research participants nor do I engage clients in any form of research. The information regarding my research work showcased on this website serves the sole purpose of providing prospective clients with a comprehensive understanding of my professional activities and expertise. It is not intended to solicit or involve clients in research studies. Should you have any questions or require clarification regarding this distinction between therapy and research activities, please do not hesitate to contact me directly.