Elise Erickson

Interests

Teaching

Reproductive/female-oriented healthcare. Midwifery care and management of physiologic birth and postpartum care. Human development: ovarian and uterine function, perinatal physiology, physiology of parturition including postpartum and lactation. Oxytocin function throughout the body. Development of research questions, methods and analysis.

Research

I have been a Certified Nurse Midwife since 2005 and earned a PhD in 2018 at Oregon Health and Science University where I served as a faculty midwife from 2014-2022. My research lab, "Mechanisms Underpinning Maternal Health" (MUMH), is broadly focused on understanding variation in the physiology governing labor and birth to improve individualization of care practices and promote healthy transitions to motherhood/parenthood. At the University of Arizona, I conduct research on epigenetic and genetic variation in oxytocin function for improving the use of oxytocin during the birth process and addressing postpartum hemorrhage specifically.In addition, my work includes the role of epigenetic aging (biological aging) in maternal health and maternal morbidity. Through this line of study, Social Determinants of Health (SDoH) and social environmental factors (adversity/ support) are considered for their role in contributing to epigenetic age acceleration. In addition, I am conducting studies using wearable devices for monitoring maternal autonomic/ hormonal physiology during pregnancy with the objective of understanding signals leading up to pregnancy complications or events for enhanced prediction of labor or pregnancy-related complications. I specialize in latent mixture modeling for understanding phenotypes within heterogeneous and complex phenomenon. Currently I am accepting doctoral and post-doctoral trainees.

Courses

Scholarly Contributions

Chapters

• Erickson, E., & Carlson, N. S. (2024). Role of Physiologic and Pharmacologic Oxytocin in Labor Progress.. In The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia, 5th Edition(pp 82-100). Hoboken NJ: John Wiley & Sons Ltd.

Journals/Publications

• Basavaraj, C., Grant, A. D., Aras, S. G., & Erickson, E. N. (2024). Deep Learning Model Using Continuous Skin Temperature Data Predicts Labor Onset. medRxiv : the preprint server for health sciences.
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  Changes in body temperature anticipate labor onset in numerous mammals, yet this concept has not been explored in humans.
• Basavaraj, C., Grant, A. D., Aras, S. G., & Erickson, E. N. (2024). Deep learning model using continuous skin temperature data predicts labor onset. BMC pregnancy and childbirth, 24(1), 777.
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  Changes in body temperature anticipate labor onset in numerous mammals, yet this concept has not been explored in humans. We investigated if continuous body temperature exhibits similar changes in women and whether these changes may be linked to hormonal status. Finally, we developed a deep learning model using temperature patterning to provide a daily forecast of time to labor onset.
• Danoff, J. S., Lillard, T. S., Myatt, L., Connelly, J. J., & Erickson, E. N. (2024). A Common OXTR Risk Variant Alters Regulation of Gene Expression by DNA Hydroxymethylation in Pregnant Human Myometrium. Reproductive sciences (Thousand Oaks, Calif.), 31(10), 3132-3138.
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  Postpartum hemorrhage, or excessive bleeding after birth, is a leading cause of maternal morbidity. A major cause of postpartum hemorrhage is uterine atony, tiring of the uterus which leads to ineffective contractions. Uterine contractions depend on oxytocin signaling in the myometrium, which in turn depends on expression of the oxytocin receptor (OXTR). Both genetic and epigenetic factors related to the oxytocin receptor are associated with risk of postpartum hemorrhage, but a mechanism relating these factors to oxytocin receptor activity in myometrium remains unclear. We report a genetic by epigenetic interaction whereby the relationship between DNA hydroxymethylation and OXTR gene expression depends on a common OXTR gene variant (rs53576). We also provide evidence that a similar genetic by epigenetic interaction using blood-derived DNA methylation is associated with relevant clinical outcomes: quantity of oxytocin administration and odds for postpartum hemorrhage. These results provide new avenues for predicting how women will respond to pharmacological agents in the prevention and treatment of postpartum hemorrhage.
• Erickson, E. (2024). Predictive Analytics and Bias in Pregnancy, Birth, and Postpartum Nursing Care.. MCN: The American Journal of Maternal/Child Nursing..
• Erickson, E. N., Hersh, S. R., Wharton, M. R., Bovbjerg, M. L., & Tilden, E. L. (2024). The Role of Passive Descent and Epidural Analgesia in Outcomes Associated With Prolonged Pushing Among Nulliparous Individuals in Midwifery Care. Journal of midwifery & women's health, 69(4), 499-513.
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  Efforts to reduce primary cesarean birth may include supporting longer second stages of labor. Although midwifery-led care is associated with lower cesarean use, little has been published on associated outcomes of prolonged second stage (≥3 hours of pushing) for nulliparous individuals in US hospital-based midwifery care. Epidural analgesia and the role of passive descent in midwifery-led care are also underexplored in relation to the second stage. In this study, we report the incidence of prolonged second stage stratified by epidural analgesia and/or passive descent. Secondary aims included calculating the odds of cesarean birth, obstetric anal sphincter injury (OASI), postpartum hemorrhage (PPH), and neonatal complications.
• Erickson, E., Penner, S. B., Mercado, N., Bernstein, S., DuBois, M. A., & Dreisbach, C. (2024). Fostering Informed Consent and Shared Decision-Making in Obstetric Nursing with the Advancement of Artificial Intelligence. . MCN: The American Journal of Maternal/Child Nursing..
• Kanjanakaew, A., Song, M., Driessnack, M., & Erickson, E. N. (2024). Examining Cesarean Among Individuals of Advanced Maternal Age in Nurse-Midwifery Care. Journal of midwifery & women's health, 69(5), 735-745.
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  Cesarean rates are rising, especially for individuals of advanced maternal age (AMA), defined as aged 35 or older. The Robson 10-Group Classification System (TGCS) facilitates assessment and comparison of cesarean rates among individuals in different settings. In midwifery-led care, in which pregnant people are typically healthier and seek a vaginal birth, it is unknown whether individuals of AMA have different antecedents leading to cesarean compared with younger counterparts. This study aimed to examine antecedents contributing to cesarean using Robson TGCS for individuals across age groups in midwifery care.
• Kissler, K., Erickson, E. N., Darmanjian, S., Penders, J., Holmes, L. B., & Tilden, E. L. (2024). 782 Phenotyping Labor Dystocia: A Pilot Study Triangulating Cytokines and Uterine EMG Parameters. American Journal of Obstetrics & Gynecology. doi:10.1016/j.ajog.2023.11.807
• Kissler, K., Phillippi, J. C., Erickson, E., Holmes, L., & Tilden, E. (2024). Collecting Real-Time Patient-Reported Outcome Data During Latent Labor: Feasibility Study of the MyCap Mobile App in Prospective Person-Centered Research. JMIR formative research, 8, e59155.
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  The growing emphasis on patient experience in medical research has increased the focus on patient-reported outcomes and symptom measures. However, patient-reported outcomes data are subject to recall bias, limiting reliability. Patient-reported data are most valid when reported by patients in real time; however, this type of data is difficult to collect from patients experiencing acute health events such as labor. Mobile technologies such as the MyCap app, integrated with the REDCap (Research Electronic Data Capture) platform, have emerged as tools for collecting patient-generated health data in real time offering potential improvements in data quality and relevance.
• Tilden, E. L., Kissler, K., Myatt, L., Lundborg, L., Turney, M., Bovbjerg, M. L., & Erickson, E. N. (2024). More than the passage of time: neonatal health and active labor duration, the mediating role of chorioamnionitis. American journal of obstetrics and gynecology.
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  Labor intervention is intended to prevent perinatal morbidity and mortality. Labor durations traditionally defined as 'dystocia' drive primary cesarean birth rates, yet there is mixed evidence about the association between labor duration and poor neonatal outcomes. Using latent class analysis to study unknown patterns of neonatal health can refine understanding of these relationships and effect of labor duration on newborn outcomes.
• Carlson, N. S., Carlson, M. S., Erickson, E. N., Higgins, M., Britt, A. J., & Amore, A. D. (2023). Disparities by race/ethnicity in unplanned cesarean birth among healthy nulliparas: a secondary analysis of the nuMoM2b dataset. BMC pregnancy and childbirth, 23(1), 342.
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  Racial disparities exist in maternal morbidity and mortality, with most of these events occurring in healthy pregnant people. A known driver of these outcomes is unplanned cesarean birth. Less understood is to what extent maternal presenting race/ethnicity is associated with unplanned cesarean birth in healthy laboring people, and if there are differences by race/ethnicity in intrapartum decision-making prior to cesarean birth.
• Erickson, E. N. (2023). A prolonged latent phase: An early career in oxytocin during birth. Comprehensive psychoneuroendocrinology, 15, 100190.
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  •The author, a nurse-midwife scientist, shares her path to the study of the causes and consequences of clinical oxytocin use.•This paper highlights mentors and key research that informed new thinking about the role of oxytocin during parturition.•Future directions for improving maternal care during childbirth are presented, including genetic and epigenetic perspectives.
• Erickson, E. N., Gotlieb, N., Pereira, L. M., Myatt, L., Mosquera-Lopez, C., & Jacobs, P. G. (2023). Predicting labor onset relative to the estimated date of delivery using smart ring physiological data. NPJ digital medicine, 6(1), 153.
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  The transition from pregnancy into parturition is physiologically directed by maternal, fetal and placental tissues. We hypothesize that these processes may be reflected in maternal physiological metrics. We enrolled pregnant participants in the third-trimester (n = 118) to study continuously worn smart ring devices monitoring heart rate, heart rate variability, skin temperature, sleep and physical activity from negative temperature coefficient, 3-D accelerometer and infrared photoplethysmography sensors. Weekly surveys assessed labor symptoms, pain, fatigue and mood. We estimated the association between each metric, gestational age, and the likelihood of a participant's labor beginning prior to (versus after) the clinical estimated delivery date (EDD) of 40.0 weeks with mixed effects regression. A boosted random forest was trained on the physiological metrics to predict pregnancies that naturally passed the EDD versus undergoing onset of labor prior to the EDD. Here we report that many raw sleep, activity, pain, fatigue and labor symptom metrics are correlated with gestational age. As gestational age advances, pregnant individuals have lower resting heart rate 0.357 beats/minute/week, 0.84 higher heart rate variability (milliseconds) and shorter durations of physical activity and sleep. Further, random forest predictions determine pregnancies that would pass the EDD with accuracy of 0.71 (area under the receiver operating curve). Self-reported symptoms of labor correlate with increased gestational age and not with the timing of labor (relative to EDD) or onset of spontaneous labor. The use of maternal smart ring-derived physiological data in the third-trimester may improve prediction of the natural duration of pregnancy relative to the EDD.
• Erickson, E. N., Myatt, L., Danoff, J. S., Krol, K. M., & Connelly, J. J. (2023). Oxytocin receptor DNA methylation is associated with exogenous oxytocin needs during parturition and postpartum hemorrhage. Communications medicine, 3(1), 11.
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  The oxytocin receptor gene (OXTR) is regulated, in part, by DNA methylation. This mechanism has implications for uterine contractility during labor and for prevention or treatment of postpartum hemorrhage, an important contributor to global maternal morbidity and mortality.
• Kissler, K., Erickson, E. N., & Canty, L. (2023). Contextualizing disparities in NTSV cesarean rates with county-level data. Journal of Midwifery and Women's Health. doi:10.1016/j.ajog.2022.11.1128
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  The rate of cesarean births among nulliparous women with a term singleton fetus in vertex presentation (NTSV) is a quality indicator for perinatal care. Black women are disproportionately affected by high rates of unplanned cesarean birth and are at increased risk for the associated complications. We sought to describe disparities in the county-level NTSV cesarean birth rate in the United States to understand how cesarean disparities vary by place.
• Weinstein, S. R., Erickson, E. N., Molina, R., & Bell, A. F. (2023). Maternal outcomes related to Genetic and epigenetic Variation in the oxytocin system: A scoping review. Comprehensive psychoneuroendocrinology, 16, 100209.
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  In this scoping review, we synthesize the literature on oxytocin and oxytocin receptor genetic and epigenetic variation in relationship to breastfeeding, maternal caregiving behavior, and maternal mental health.
• Bell, A. F., Erickson, E. N., & Carter, C. S. (2014). Beyond labor: the role of natural and synthetic oxytocin in the transition to motherhood. Journal of midwifery & women's health, 59(1), 35-42: quiz 108.
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  Emerging research raises questions that synthetic oxytocin during childbirth may alter the endogenous oxytocin system and influence maternal stress, mood, and behavior. Endogenous oxytocin is a key component in the transition to motherhood, affecting molecular pathways that buffer stress reactivity, support positive mood, and regulate healthy mothering behaviors (including lactation). Synthetic oxytocin is widely used throughout labor and postpartum care in modern birth. Yet research on the implications beyond labor of maternal exposure to perinatal synthetic oxytocin is rare. In this article, we review oxytocin-related biologic pathways and behaviors associated with the transition to motherhood and evidence supporting the need for further research on potential effects of intrapartum oxytocin beyond labor. We include a primer on oxytocin at the molecular level.
• Erickson, E. N., & Carlson, N. S. (2022). Maternal Morbidity Predicted by an Intersectional Social Determinants of Health Phenotype: A Secondary Analysis of the NuMoM2b Dataset. Reproductive sciences (Thousand Oaks, Calif.).
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  Maternal race, ethnicity and socio-economic position are known to be associated with increased risk for a range of poor pregnancy outcomes, including maternal morbidity and mortality. Previously, researchers seeking to identify the contributing factors focused on maternal behaviors and pregnancy complications. Less understood is the contribution of the social determinants of health (SDoH) in observed differences by race/ethnicity in these key outcomes. In this secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset, latent mixture modeling was used to construct groups of healthy, nulliparous participants with a non-anomalous fetus in a cephalic presentation having a trial of labor (N = 5763) based on SDoH variables. The primary outcome was a composite score of postpartum maternal morbidity. A postpartum maternal morbidity event was experienced by 350 individuals (6.1%). Latent class analysis using SDoH variables revealed six groups of participants, with postpartum maternal morbidity rates ranging from 8.7% to 4.5% across groups (p < 0.001). Two SDoH groups had the highest odds for maternal morbidity. These higher-risk groups were comprised of participants with the lowest income and highest stress and those who had lived in the USA for the shortest periods of time. SDoH phenotype predicted MM outcomes and identified two important, yet distinct groups of pregnant people who were the most likely have a maternal morbidity event.
• Erickson, E. N., Knight, A. K., Smith, A. K., & Myatt, L. (2022). Advancing understanding of maternal age: correlating epigenetic clocks in blood and myometrium. Epigenetics communications, 2.
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  Advanced maternal age is currently a term defined by chronological age. However, a group of biomarkers known as epigenetic clocks, which can predict morbidity and mortality, has been used to estimate measures of biological aging. Uterine myometrial function during the process of parturition may be influenced by aging, as labor dystocia, unplanned intrapartum cesarean birth, and postpartum hemorrhage are more common in older individuals. The purpose of this study was to evaluate the use of epigenetic clocks in maternal myometrium and blood for predicting age and to evaluate the correlation of epigenetic age between the tissues.
• Erickson, E. N., Krol, K. M., Perkeybile, A. M., Connelly, J. J., & Myatt, L. (2022). Oxytocin receptor single nucleotide polymorphism predicts atony-related postpartum hemorrhage. BMC pregnancy and childbirth, 22(1), 884.
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  Postpartum hemorrhage remains a key contributor to overall maternal morbidity in the United States. Current clinical assessment methods used to predict postpartum hemorrhage are unable to prospectively identify about 40% of hemorrhage cases. Oxytocin is a first-line pharmaceutical for preventing and treating postpartum hemorrhage, which acts through oxytocin receptors on uterine myocytes. Existing research indicates that oxytocin function is subject to variation, influenced in part by differences in the DNA sequence within the oxytocin receptor gene. One variant, rs53576, has been shown to be associated with variable responses to exogenous oxytocin when administered during psychological research studies. How this variant may influence myometrial oxytocin response in the setting of third stage labor has not been studied. We tested for differences in the frequency of the oxytocin receptor genotype at rs53576 in relationship to the severity of blood loss among a sample of individuals who experienced vaginal birth.
• Grant, A. D., & Erickson, E. N. (2022). Birth, love, and fear: Physiological networks from pregnancy to parenthood. Comprehensive psychoneuroendocrinology, 11, 100138.
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  Pregnancy and childbirth are among the most dramatic physiological and emotional transformations of a lifetime. Despite their central importance to human survival, many gaps remain in our understanding of the temporal progression of and mechanisms underlying the transition to new parenthood. The goal of this paper is to outline the physiological and emotional development of the maternal-infant dyad from late pregnancy to the postpartum period, and to provide a framework to investigate this development using non-invasive timeseries. We focus on the interaction among neuroendocrine, emotional, and autonomic outputs in the context of late pregnancy, parturition, and post-partum. We then propose that coupled dynamics in these outputs can be leveraged to map both physiologic and pathologic pregnancy, parturition, and parenthood. This approach could address gaps in our knowledge and enable early detection or prediction of problems, with both personalized depth and broad population scale.
• Kissler, K., Breman, R. B., Carlson, N., Tilden, E., Erickson, E., & Phillippi, J. (2022). Innovations in Prospective Perinatal Research as a Result Of the COVID-19 Pandemic. Journal of midwifery and women's health, 67(2), 264-269.
• Erickson, E. N., Bailey, J. M., Colo, S. D., Carlson, N. S., & Tilden, E. L. (2021). Induction of labor or expectant management? Birth outcomes for nulliparous individuals choosing midwifery care. Birth (Berkeley, Calif.), 48(4), 501-513.
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  Induction of labor (IOL) has been studied as a strategy to reduce rates of cesarean birth (CB). Midwifery care models are also associated with lower CB rates, even considering that midwives perform fewer IOLs. In this study, we examined childbirth outcomes among individuals undergoing IOL in certified nurse-midwifery (CNM) care as compared to two categories of expectant management (EM).
• Denfeld, Q., Erickson, E., Valent, A., Villasana, L., Zhang, Z., Myatt, L., & Guise, J. (2020). COVID-19: Challenges and Lessons Learned from Early Career Investigators.
• Erickson, E. N., & Carlson, N. S. (2020). Predicting Postpartum Hemorrhage After Low-Risk Vaginal Birth by Labor Characteristics and Oxytocin Administration. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 49(6), 549-563.
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  To determine the odds of postpartum hemorrhage (PPH) in low-risk women who gave birth vaginally and were exposed to different durations and dosages of oxytocin across a range of labor durations during spontaneous or induced labor.
• Erickson, E. N., Bovbjerg, M. L., & Cheyney, M. J. (2020). Factors affecting third-stage management and postpartum hemorrhage in planned midwife-led home and birth center births in the United States. Birth (Berkeley, Calif.), 47(4), 397-408.
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  Postpartum hemorrhage (PPH) is a potential childbirth complication. Little is known about how third-stage labor is managed by midwives in the United States, including use of uterotonic medication during community birth. Access to uterotonic medication may vary based on credentials of the midwife or state regulations governing midwifery.
• Erickson, E. N., Carter, C. S., & Emeis, C. L. (2020). Oxytocin, Vasopressin and Prolactin in New Breastfeeding Mothers: Relationship to Clinical Characteristics and Infant Weight Loss. Journal of human lactation : official journal of International Lactation Consultant Association, 36(1), 136-145.
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  Maternal milk production requires the neuropeptide oxytocin. Individual variation in oxytocin function is a compelling target for understanding low milk production, a leading cause of breastfeeding attrition. Complicating the understanding of oxytocin pathways is that vasopressin may interact with oxytocin receptors, yet little is known about the role of vasopressin in lactation.
• Erickson, E. N., Lee, C. S., & Carlson, N. S. (2020). Predicting Postpartum Hemorrhage After Vaginal Birth by Labor Phenotype. Journal of midwifery & women's health, 65(5), 609-620.
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  Postpartum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Predicting which laboring women are likely to have a PPH is an active area of research and a component of quality improvement bundles. The purpose of this study was to identify phenotypes of labor processes (ie, labors that have similar features, such as duration and type of interventions) in a cohort of women who had vaginal births, estimate the likelihood of PPH by phenotype, and analyze how maternal and fetal characteristics relate to PPH risk by phenotype.
• Erickson, E. N., Lee, C. S., Grose, E., & Emeis, C. (2019). Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage. Birth (Berkeley, Calif.), 46(1), 69-79.
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  Postpartum hemorrhage (PPH) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (AMTSL) for preventing PPH. However, trials of AMTSL include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications. Counseling women about their risk for PPH and AMTSL is difficult as many women who appear low-risk can still have PPH.
• Thiele, D. K., Erickson, E. N., & Snowden, J. M. (2019). High Prevalence of Maternal Serum 25-Hydroxyvitamin D Deficiency Is Not Associated With Poor Birth Outcomes Among Healthy White Women in the Pacific Northwest. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 48(2), 163-175.
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  To quantify vitamin D status among pregnant women in the Pacific Northwest (Portland, OR, and Seattle, WA) and examine pregnancy and newborn outcomes in relationship to maternal serum blood samples obtained during pregnancy.
• Erickson, E. N., & Emeis, C. L. (2017). Breastfeeding Outcomes After Oxytocin Use During Childbirth: An Integrative Review. Journal of midwifery & women's health, 62(4), 397-417.
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  Despite widespread use of exogenous synthetic oxytocin during the birth process, few studies have examined the effect of this drug on breastfeeding. Based on neuroscience research, endogenous oxytocin may be altered or manipulated by exogenous administration or by blocking normal function of the hormone or receptor. Women commonly cite insufficient milk production as their reason for early supplementation, jeopardizing breastfeeding goals. Researchers need to consider the role of birth-related medications and interventions on the production of milk. This article examines the literature on the role of exogenous oxytocin on breastfeeding in humans.
• Erickson, E. N., Lee, C. S., & Emeis, C. L. (2017). Role of Prophylactic Oxytocin in the Third Stage of Labor: Physiologic Versus Pharmacologically Influenced Labor and Birth. Journal of midwifery & women's health, 62(4), 418-424.
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  Maternity care providers administer oxytocin prophylactically to prevent postpartum hemorrhage (PPH). Prophylactic oxytocin is generally considered effective and safe and is promoted by national organizations for standardized use. In this article, the evidence supporting prophylactic oxytocin administration for women undergoing spontaneous labor and birth compared with women whose labors included administration of exogenous oxytocin for induction or augmentation is explored.

Presentations

• Erickson, E. (2024). Our Sphere of Influence: Assessing & Addressing Social Determinants of Perinatal Health.. Arizona Perinatal Trust Annual Conference. Flagstaff, AZ: Arizona Perinatal Trust.
• Erickson, E. (2024, March). Deep Learning Model Using Continuous Skin Temperature Data Predicts Labor Onset.. Midwifery Research & Quality Exchange. Virtual: American College of Nurse-Midwives Division of Research.
• Erickson, E. (2024, March). Has Our Assumption that Labor Duration Drives Neonatal Risk Blinded us to the Influence of Other Factors?. Midwifery Research & Quality ExchangeAmerican College of Nurse-Midwives Division of Research.
• Erickson, E. (2024, Sept). Predicting Adequate Response to Oxytocin.. National Association of Certified Professional Midwives Webinar.. Virtual: National Association of Certified Professional Midwives.
• Erickson, E. (2024, September). Predicting Adequate Response to Oxytocin.. OB/GYN Department Grand Rounds. Phoenix AZ: College of Medicine-Phoenix, University of Arizona.
• Erickson, E., & McMahon, E. (2024, April). A Layered Approach to Protecting Maternal Mental Health: More than Diagnosis & Referral.. Arizona Perinatal Improvement Summit. Phoenix, AZ: University of Arizona College of Medicine- Phoenix / OB/GYN Department..

Others

• Erickson, E., George, E. K., & Rutherford, J. N. (2024, December). Placental biomarkers in second trimester maternal serum are associated with postpartum hemorrhage: a secondary analysis of the NuMoM2b dataset. MedRxiv. https://www.medrxiv.org/content/10.1101/2024.12.30.24319779v2
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  Non-peer-reviewed preprint at MedRxiv; submitted 12/30/2024, first posted on 12/31/2024, revision posted on 1/2/2025.MedRxiv is a preprint service that provides dissemination of original work prior to peer review.