Ayesha Sujan, PhD, is a postdoctoral scholar in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Before joining Stanford University, she completed a year-long postdoctoral fellowship in the Kaiser Permanente Division of Research, her doctoral training in the Department of Psychological and Brian Sciences at Indiana University – Bloomington, her clinical internship at the Medical University of South Carolina, her master’s degree in Human Development from Cornell University, and her bachelor’s degree from Tulane University. Though her training has focused on psychological science, her training spans multiple disciplines, including epidemiology and pharmacology.
Broadly speaking, she conducts translational research focused on preventing early exposure to risk factors from having adverse consequences on child development. Her research initially focused on early-life adversities, particularly abuse and neglect, and then expanded to include the prenatal period. Though she studies the consequences of a number of pregnancy-related risk factors, her work mainly focuses on prenatal exposure to psychoactive substances (e.g., opioids and antidepressants) and risk for adverse birth outcomes (e.g., preterm birth) and neurodevelopmental problems (e.g., autism spectrum disorder and attention-deficit/hyperactivity disorder). She uses real-world health care data because women cannot be randomly assigned to use psychoactive substances during pregnancy due to ethical concerns about exposing developing offspring to potentially harmful substances. Given that people who use psychoactive substances during pregnancy differ from those who do not, she uses innovative methods that help account for these differences and seeks converging evidence across multiple methods. For example, one method she uses compares children who were exposed during pregnancy to their own siblings who were not exposed. This method accounts for all genetic and environmental factors shared by the siblings and, thus, provides a strong test of the consequences of substance exposure during pregnancy. Her research has important clinical implications. For example, a paper she published in JAMA suggests that adverse outcomes associated with prenatal exposure to antidepressants are largely due to background factors rather than medication exposure itself. This finding could provide reassurance to people considering antidepressant use during pregnancy. Her hope is that her research will inform policies and practices and will, thereby, help improve the health and wellbeing of mothers and their children.
Honors & Awards
Presidential Scholar Award, Tulane University (2008 to 2012)
Dean's List, Tulane University (2008-2012)
Mortar Board, Tulane University (2012)
Phi Beta Kappa, Tulane University (2012)
Anne M. McPherson Undergraduate Research Award, Tulane University (2012)
Travel award, Marce of North America Perinatal Mental Health Conference (2019)
J.R. Kantor Graduate Award for distinction in research, Indiana University – Bloomington (2020)
Master of Arts, Cornell University (2014)
Bachelor of Science, Tulane University of Louisiana (2012)
Doctor of Philosophy, Indiana University (2021)
BS, Tulane University, Psychology and Studio Art (double major) (2012)
MA, Cornell University, Ithaca, NY, Human Development (2014)
PhD, Indiana University - Bloomington, Bloomington, IN, Clinical Psychology (2021)
Brian Bateman, Postdoctoral Faculty Sponsor
Racial and ethnic differences in perinatal depression and anxiety.
Journal of affective disorders
Findings on racial and ethnic differences in perinatal depression/anxiety are mixed.We assessed racial and ethnic differences in depression, anxiety, and comorbid depression/anxiety diagnoses in the year before, during, and the year after pregnancy (n = 116,449) and depression severity during (n = 72,475) and in the year after (n = 71,243) pregnancy among patients in a large, integrated healthcare delivery system.Compared to Non-Hispanic White individuals, Asian individuals had lower risk of perinatal depression and anxiety (e.g., depression during pregnancy relative risk [RR] = 0.35, 95 % confidence interval [CI]:0.33-0.38) and postpartum moderate/severe (RR = 0.63, 95 % CI:0.60-0.67) and severe (RR = 0.66, 95 CI:0.61-0.71) depression but higher risk of moderate/severe depression during pregnancy (RR = 1.18, 95 % CI:1.11-1.25). Non-Hispanic Black individuals had higher risk of perinatal depression, comorbid depression/anxiety, and moderate/severe and severe depression (e.g., depression diagnoses during pregnancy RR = 1.35, 95 % CI:1.26-1.44). Hispanic individuals had lower risk of depression during pregnancy and perinatal anxiety (e.g., depression during pregnancy RR = 0.86, 95 % CI:0.82-0.90) but higher risk of postpartum depression (RR = 1.14, 95 % CI:1.09-1.20) and moderate/severe and severe depression during and after pregnancy (e.g., severe depression during pregnancy RR = 1.59, 95 % CI:1.45-1.75).Information on depression severity was unavailable for some pregnancies. Findings may not generalize to individuals without insurance or outside of Northern California.Non-Hispanic Black individuals of reproductive age should be targeted with prevention and intervention efforts aimed at reducing and treating depression and anxiety. Asian and Hispanic individuals of reproductive age should be targeted with campaigns to destigmatize mental health disorders and demystify treatments and systematically screened for depression/anxiety.
View details for DOI 10.1016/j.jad.2023.04.123
View details for PubMedID 37156281
Patterns of Substance Use During Early Pregnancy and Associations With Behavioral Health Characteristics.
Journal of addiction medicine
OBJECTIVES: The aims of the study are to identify patterns of early pregnancy substance use and to examine how these patterns relate to behavioral health conditions measured in early pregnancy.METHODS: We conducted a retrospective observational study (N= 265,274 pregnancies) screened for alcohol, cannabis, nicotine, pharmaceutical opioids, and stimulants during the first trimester via self-report and urine toxicology tests in Kaiser Permanente Northern California from January 1, 2012, to December 31, 2019. To identify patterns of prenatal substance use, we conducted latent class analysis. We then calculated the prevalence of depression, anxiety, intimate partner violence, and family drug use history for each prenatal substance use group and compared the prevalences by estimating prevalence ratios using modified Poisson regression, adjusting for sociodemographic characteristics.RESULTS: We identified the following 4 latent groups with different patterns of substance use: (a) predominantly alcohol and no other substances (9.30%), (b) predominantly cannabis and no other substances (4.88%), (c) predominantly nicotine and some pharmaceutical opioids (1.09%), and (d) high-polysubstance (alcohol, cannabis, nicotine, and stimulants; 0.36%); these pregnancies were compared with (e) no prenatal substance use (84.37%). The prevalence of all behavioral health conditions was elevated in all prenatal substance use groups compared with the no substance use group. Furthermore, the prevalence of depressive and anxiety disorders, intimate partner violence and family drug use history were greater in the high-polysubstance cluster than the alcohol and cannabis clusters.CONCLUSIONS: Results highlight the importance of screening and interventions for all types of substance use during early pregnancy and suggest a particularly high need to prioritize targeting early interventions to pregnant and reproductive age individuals with polysubstance use.
View details for DOI 10.1097/ADM.0000000000001090
View details for PubMedID 36255108
In-utero cannabis exposure and long-term psychiatric and neurodevelopmental outcomes: The limitations of existing literature and recommendations for future research
BIRTH DEFECTS RESEARCH
2022; 114 (13): 689-713
Given increases in cannabis use in pregnancy and animal model research showing effects of in-utero cannabis exposure, high-quality information on long-term consequences of in-utero cannabis exposure in humans is needed. While reviews have summarized findings from observational studies with humans, reviews have not focused on limitations of these studies and recommendations for future research. Therefore, we critically reviewed observational research on in-utero cannabis exposure and psychiatric and neurodevelopmental outcomes measured at or after age 3 and provided recommendations for future research. We used Web of Science, Google Scholar, and work cited from relevant identified publications to identify 46 papers to include in our review. Our review includes two main sections. The first section highlights the extensive limitations of the existing research, which include small and nongeneralizable samples, reliance on self-reported data, lack of detail on timing and amount of exposure, inclusion of older exposure data only, not accounting for important confounders, inclusion of potential mediators as covariates, not including outcome severity measures, and not assessing for offspring sex differences. The second section provides recommendations for future research regarding exposure and outcome measures, sample selection, confounder adjustment, and other methodological considerations. For example, with regard to exposure definition, we recommend that studies quantify the amount of cannabis exposure, evaluate the influence of timing of exposure, and incorporate biological measures (e.g., urine toxicology measures). Given that high-quality information on long-term consequences of in-utero cannabis exposure in humans does not yet exit, it is crucial for future research to address the limitations we have identified.
View details for DOI 10.1002/bdr2.2060
View details for Web of Science ID 000811526600001
View details for PubMedID 35708102
View details for PubMedCentralID PMC9357094
Listening to women and pregnant and postpartum people: Qualitative research to inform opioid use disorder treatment for pregnant and postpartum people.
Drug and alcohol dependence reports
2022; 3: 100064
Background: The diagnosis of Opioid Use Disorder (OUD) during pregnancy has increased 2-to-5-fold over the past decade and barriers to treatment are significant. Technology-based solutions have the potential to overcome these barriers and deliver evidence-based treatment. However, these interventions need to be informed by end-users. The goal of this study is to gain feedback from peripartum people with OUD and obstetric providers about a web-based OUD treatment program.Methods: Qualitative interviews were conducted with peripartum people with OUD (n=18) and focus groups were conducted with obstetric providers (n=19). Feedback from these interviews informed the development of text message-based screening, brief phone-based intervention and referral to treatment program, called Listening to Women and Pregnant and Postpartum People (LTWP). Once developed, further qualitative interviews with peripartum people with OUD (n=12) and obstetric providers (n=21) were conducted to gather feedback about the LTWP program.Results: Patients reported that a relationship with a trusted provider is paramount for treatment engagement. Providers reported that time constraints and complex patient needs prohibit them from treating OUD and that evidence-based Screening, Brief Intervention and Referral to Treatment (SBIRT) are not implemented effectively in routine prenatal care. Neither patients nor providers were enthusiastic about our web-based intervention for OUD; thus, results were used to guide the development of LTWP to improve implementation of SBIRT during prenatal care.Conclusions: End-user informed, technology-enhanced SBIRT has the potential to improve the implementation of SBIRT during routine prenatal care, and in turn, improve maternal and child health.
View details for DOI 10.1016/j.dadr.2022.100064
View details for PubMedID 36845990
Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults
2022; 149 (3)
Opioids are involved in an increasing proportion of suicide deaths. This study examined the association between opioid analgesic prescription initiation and suicidal behavior among young people.We analyzed Swedish population-register data on 1 895 984 individuals ages 9 to 29 years without prior recorded opioid prescriptions. We identified prescriptions dispensed from January 2007 onward and diagnosed self-injurious behavior and death by suicide through December 2013. We first compared initiators with demographically matched noninitiators. To account for confounding, we applied an active comparator design, which examined suicidal behavior among opioid initiators relative to prescription nonsteroidal antiinflammatory drug (NSAID) initiators while inverse-probability-of-treatment weighting with individual and familial covariates.Among the cohort, 201 433 individuals initiated opioid prescription. Relative to demographically matched noninitiators, initiators (N = 180 808) had more than doubled risk of incident suicidal behavior (hazard ratio = 2.64; 95% confidence interval [CI], 2.47-2.81). However, in the active comparator design, opioid initiators (N = 86 635) had only 19% relatively greater risk of suicidal behavior compared with NSAID initiators (N = 255 096; hazard ratio = 1.19; 95% CI,: 1.11-1.28), corresponding to a weighted 5-year cumulative incidence of 2.2% (95% CI, 2.1-2.4) for opioid and 1.9% (95% CI, 1.9-2.0) for NSAID initiators. Most sensitivity analyses produced comparable results.Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management. In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern.
View details for DOI 10.1542/peds.2020-049750
View details for Web of Science ID 000918191300002
View details for PubMedID 35128560
View details for PubMedCentralID PMC9624202
A nation-wide Swedish study of opioid analgesic prescribing patterns during pregnancy and associated preexisting mental health conditions
JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
2022; 35 (25): 5161-5167
Research has consistently shown individuals with mental health conditions are more likely to be prescribed opioid analgesic medications and to engage in heavier utilization. However, it is unclear whether these findings apply to pregnant women.We explored opioid analgesic prescription in 689,400 pregnancies occurring in Sweden between 2007 and 2013. We investigated prescription patterns across time and type of source clinic for any opioid analgesic and for strong and weak opioid analgesics. We further evaluated the extent to which receipt of opioid analgesic medications was associated with previous mental health diagnoses and prescriptions of other psychoactive medications.The prevalence of pregnant women who filled prescriptions for opioid analgesics (4.5%) was relatively stable across the assessed years. However, among pregnant women who filled opioid analgesic prescriptions, there was a large increase in strong opioid analgesic prescriptions-from 6.1% in 2007 to 17.1% in 2013. The main source of opioid analgesic prescriptions were primary care and obstetrics and gynecology clinics-38.7% of all filled prescriptions originated from primary care providers and 25.3% from obstetrics and gynecology practitioners. Compared to pregnant women who did not fill any opioid analgesic prescriptions, those who did were more likely to have a wide range of preexisting mental health diagnoses (e.g. anxiety disorder odds ratio [OR] = 3.13, 95% confidence interval [CI]:2.98,3.29) and to utilize a wide range of other psychoactive medications (e.g. benzodiazepines OR = 4.26, 95% CI:4.10,4.43). Similarly, those who received strong opioids were more likely to have a wide range of mental health diagnoses and be prescribed a wide range of psychoactive medications compared to those who received weak opioids.These results highlight the need for physicians treating pregnant women and women of childbearing age for painful conditions to obtain detailed histories of mental health problems, screen for symptoms of mental health problems, and facilitate integrated care and evidence-based mental health interventions if needed.
View details for DOI 10.1080/14767058.2021.1875436
View details for Web of Science ID 000627618700001
View details for PubMedID 33441038