Method Tuuli, MD, MPH, MBA

I am incredibly humbled to be elected to the National Academy of Medicine. It feels surreal to part of this esteemed group. Indebted to my mentors, colleagues, teams, family and all who took a chance on me. @BrownObGyn @womenandinfants @carenewengland @EmoryGynOb @WashU_OBGYN

So proud to see expansion of this impacful work led by truly outstanding MFM Physician-Scientist @AKLewkowitz Program to keep hypertensive postpartum women out of emergency room expands @womenandinfants @carenewengland @Advance_CTR @BrownObGyn turnto10.com/features/healt…

Exceptional opportunity to lead midwifery at one of the nation's finest OBGYN Departments and Maternity Hospital.#job" target="_blank" rel="nofollow noopener">carenewengland.hrmdirect.com/employment/job… @BrownObGyn @womenandinfants @EmilySMillerMD @

Happened this past weekend. Honored to be inducted into the National Academy of Medicine. I am grateful to family, colleagues, and institutions who took a chance on me. I am grateful. Forward and onward!

@ColumbiaOBGYN @UmaMReddyMD Congratulations, Uma. Well deserved.

Congratulations to @UmaMReddyMD, Vice Chair of Research, for her election to the National Academy of Medicine. Learn more about Dr. Reddy's background as an international expert on stillbirth and her groundbreaking research: cuimc.columbia.edu/news/columbias…

Honored, thankful, grateful. @Advance_CTR @BrownMedicine @BrownObGyn @womenandinfants

@FrolovaToni Great idea.

WashU Medicine to offer reproductive sciences master’s program source.washu.edu/2024/09/washu-…

@jchenkelly @NIDAnews @WashU_OBGYN @UMMC @BaumannAna Congratulations!

Thrilled to receive this @NIDAnews NOA for an R61/33 to design and implement #ContigencyManagement at @WashU_OBGYN and @UMMC, and study its interplay on #SocialDetermiantsofHealth and impact on outcomes in pregnant people with substance use disorders! With co-PI @BaumannAna

Humbled to receive this on behalf of the clinicians and staff doing the difficult work to advance perinatal health equity. Grateful to @womenandinfants and @carenewengland for the commitment and investment. Forward and onward, destination health equity.@BrownMedicine @BrownObGyn

We are thrilled to announce the appointment of Dr. William A. Grobman, MD, MBA, as Editor-In-Chief of #Pregnancy. Dr. Grobman will lead the launch of the journal in early 2025. Learn more at smfm.org/journal

@DrKLindley Congratulations, Kathryn. Very much deserved!

I just received my NOA for my first R01. A day I thought would never come. I took a non-traditional path to research. I study pregnant people. THANK YOU to those who believed in this work and helped make this happen. Let’s go improve women’s health. #cardioobstetrics

Check out our editorial on a really cool study on the role of AI-enabled US in pregnancy dating. If leveraged thoughtfully, AI can revolutionize healthcare in ways many wayss. @AhizechukwuEke @LunaCasey1718 @AKLewkowitz @BrownMedicine @BrownObGyn jamanetwork.com/journals/jama/…

Grateful to CVS Foundation for their support! Excited about the work ahead to advance perinatal health equity in our community. Learn more: cvshealth.com/news/community…

Our Perinatal Health Equity Program is expanding, and we are hiring! We are searching for an additional NP to help us advance equitable perinatal health outcomes and experiences. Please apply at: #job" target="_blank" rel="nofollow noopener">carenewengland.hrmdirect.com/employment/job…

@JaimePretellEsq @BrownMedicine I don't know if you are from a minority group or are in medicine, but I tell you, both implicit and explicit racism abound today, even for people like me who have nothing to do with victimhood or dependency.

@MethodTuuli @BrownMedicine Historical structural racism. Not current. It will take a few generations for that residual effect to correct itself. Of course over correction and teaching victimization can lead to dependency and a failure to correct.

Prof. @MethodTuuli highlights Black women's 2-3x higher risk of pregnancy-related mortality vs. white women due to structural racism, limited access to quality maternity care, & healthcare biases. He supports diverse approaches to tackle this. ow.ly/F2hc50RgrC2 #BMHW2024

@JaimePretellEsq @BrownMedicine Thank you. Everything you just outlined is in the causal pathway from historical and current structural racism to maternal mortality. Tell me: Why do black mothers have higher rates of poverty? Why are they more stressed? What caused the epigenetic changes?

Black women do not have higher mortality rates due to structural racism. Let’s look at the much more likely causes of the higher Maternal Mortality rates in Black women than White women. Poverty: The higher poverty rate among Black women compared to White women is a significant contributing factor to the disparity in maternal health outcomes. In fact, Poverty rate and Maternal Mortality rate disparity numbers are remarkably similar. Poverty can lead to reduced access to quality healthcare, nutrition, and safe living conditions, all of which can contribute to poorer maternal health outcomes. Poverty can restrict access to prenatal care and specialists who can manage chronic conditions. Additionally, financial strain and other poverty related stressors can cause chronic stress, which is linked to a variety of negative health outcomes. Poverty can mean living in areas with higher pollution levels or limited access to safe green spaces, both of which can contribute to health problems. Factors like poor housing, environmental toxins, and limited access to healthy food can contribute to the development of chronic conditions. Limited access to healthy food options can lead to poor nutrition, which can impact both mother and baby's health. Limited resources and chronic stress can make it harder to prioritize healthy behaviors like exercise and sleep, which are important for overall health. Higher rates of stress and limited opportunities can contribute to higher rates of substance abuse in some communities, which can negatively affect pregnancy outcomes. Poverty Lifestyles: Even when individuals move out of poverty, they may retain some unhealthy habits or behaviors that can negatively impact health. If these habits are shared within a community, they can contribute to health disparities. Poverty lifestyles, even after acquiring new wealth, can persist due to cultural and community influences. Unhealthy habits related to behavior, diet, unhealthy eating patterns, and exercise, or lack thereof may persist, affecting maternal health. Comorbidities: Due to poverty and poverty lifestyles, even after leaving poverty, Black women are more likely to have certain comorbidities such as obesity, diabetes, and hypertension, which can complicate pregnancy and increase the risk of maternal mortality. Furthermore, chronic conditions may persist after leaving poverty. Self-fulfilling reality: While individual racism definitely still exists, it is not rampant, nor is there systemic racism in place. But the belief of that rampant racism ends up having self-fulfilling effects. Perception and Stress: The perception of racism, even in the absence of actual racism, can lead to chronic stress, which can have negative health effects. The constant assumption, right or wrong, of being judged or receiving lower quality care due to perceived racism can increase stress hormones and negatively impact health. This stress can further exacerbate existing health conditions and make it more difficult for Black women to have healthy pregnancies. Even if no explicit racism occurs, a perception of being treated differently or having concerns dismissed can lead to stress and anxiety, impacting health outcomes. Black women and other minorities are being taught to believe in the concept of microaggressions. There is a potential downside to the concept of microaggressions. A heightened perception and alertness for microaggressions can make someone overly sensitive to everyday interactions. Comments or actions that aren't intended to be offensive might be perceived as microaggressions, leading to unnecessary conflict or stress. The belief in microaggressions can influence how individuals perceive and interpret actions that may not be intentionally aggressive or antagonistic. Actions that might otherwise be innocuous can be perceived as microaggressions due to heightened awareness and attribution bias will occur. Attribution bias occurs when we attribute negative intent to someone’s behavior, even if it was unintentional. Believing in microaggressions can lead to attributing negative motives to actions that may have been neutral. Preconceptions of racism lead to stress and defensive behavior: When someone enters a situation expecting racial bias, they may feel stressed, anxious, or even angry. This can lead them to be more combative, aggressive, or passive-aggressive during interactions. Chilling effect on communication by the providers: Fear of being perceived as making a microaggression could lead people to avoid certain topics or interactions altogether. This can hinder open communication and understanding. Defensive behavior can be misinterpreted as confirmation bias: Healthcare providers, already under pressure, might misinterpret the defensive behavior as hostility or non-compliance. This can confirm or create implicit biases about the patient group. Implicit bias can lead to unequal treatment: Unconscious biases can influence how healthcare providers interact with patients, potentially leading to less time spent listening to concerns, less thorough examinations, or less empathy. Providers may unintentionally treat future patients based on these biases, affecting care quality. Negative interactions reinforce bad behavior: If a patient feels unheard or disrespected, they may become more defensive or withdraw further, perpetuating the cycle. This cycle disproportionately impacts Black patients: Research suggests that Black patients are more likely to perceive racial bias in healthcare settings. This perception can lead to the defensive behaviors I mentioned, potentially reinforcing negative interactions and implicit biases. Feeling that they are unheard or disrespected by medical professionals, whether true or not, can lead women to be less likely to seek help when they need i and to poor communication about symptoms and concerns, hindering proper care. Finally, there is one other factor that might play a role, Epigenetic Carryover: Epigenetics refers to changes in gene expression that can be passed down from generation to generation without changing the underlying DNA sequence. In short lived biologic forms, I have seen multi, generational epigenetic effects, but not in long lived forms like humans. That doesn’t mean it can’t carry one generation over. Exposure to stress and poor health conditions in the womb can have lasting effects on offspring, even if they grow up in better circumstances. If a mother experiences significant stress or poor health due to poverty or past racism, these experiences could potentially be passed down to her children, impacting their health outcomes as well. Black women experience poverty rates roughly three times higher than White women, but their parents experienced rates that were exponentially higher, added with the Jim Crow era of oppression. Black women who are not currently poor may still carry over health consequences from their parents’ experiences during Jim Crow, and earlier poverty rates. It may take another generation to remove that epigenetic effect.

@WashU_OBGYN Well deserved, Deb.

Debbie Frank was awarded the 2024 Research Support Award! Read more here: obgyn.wustl.edu/debbie-frank-w…

@Advance_CTR @carenewengland Congratulations, Jill.

👏 Applause to Dr. Jill Maron of @carenewengland, whose research paper was honored as one of the top 10 at #ACTS2024, representing excellence in advancing clinical & translational science! Check out this impactful work: bit.ly/3VS8b56 #ResearchExcellence

@paimadhu @placresearch I could not agree more.