Epidemiology PhD Student Examines Risk of Medications Taken to Improve Sleep During Pregnancy

ALBANY, N.Y. (May 5, 2023) – Meredith Howley, a PhD student in the Department of Epidemiology and Biostatistics, is most interested in reproductive epidemiology and pharmacoepidemiology, and recently defended her PhD research on medication use during pregnancy and birth defects.

Howley has been working as an epidemiologist since 2009. In 2014, she joined the New York State Department of Health (NYSDOH), where she studies medication use in pregnancy. In 2019, she started the PhD in Epidemiology program at UAlbany while continuing her full-time employment as a research scientist at the Birth Defects Research Section of NYSDOH.

“Some of my past research has focused on medication use in pregnancy so I was excited to be able to build on my experience with the PhD program and research new types of medications while employing methods to address potential biases,” says Howley.

Under the supervision of Marilyn Browne, Howley’s dissertation looked at the risk of medications taken to improve sleep in pregnancy and whether there were any concerns about fetal safety. She looked at sleep aid use overall, along with risks associated with the use of zolpidem, a particular sleep medicine.

“Given that I was relying on self-reported data, I wanted to first understand how self-reported use of medications compared to information on medication use available in medical records. This would allow us to adjust our estimates of risk to account for bias from medication use mismeasurement,” Howley explains.

Howley’s research found that agreement between self-reported and medical record information on medication use differed depending on the type of medication. There was better agreement between the two sources for medications used on more of a routine basis compared to medications that were used infrequently. Knowing this, Howley and colleagues were able to adjust for this potential bias in their estimates of risk associated with sleep aid medication use.

Using data from the National Birth Defects Prevention Study (NBDPS) and the Birth Defects Study (BDS), Howley next studied whether use of zolpidem in early pregnancy was related to having a baby with a birth defect. Preliminary findings suggested that there was not a relationship for most of the defects examined. Elevated risks were, however, observed for four specific birth defects— cleft palate, anorectal atresia, gastroschisis, and tetralogy of Fallot.

Howley also used data from the Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS) to explore whether use of sleep aid medications more generally was linked to birth defects. Overall, the research team found largely null results in the main analysis for sleep aid medications as a group. However, analyses of BD-STEPS is ongoing, so these preliminary results might change when additional years of data are included in the future prior to publication.

“Pregnancy can be a stressful time for some women, especially for those with a chronic disease who are uncertain about how to continue to take care of themselves while balancing the desire to ensure a healthy future for their baby,” Howley says. “I find it rewarding to know that my research will help provide women and their healthcare providers with important information they need to feel comfortable making decisions surrounding the treatment of their disease(s) during pregnancy.”

Howley will graduate from the PhD program this May and will continue her work investigating modifiable risk factors for birth defects within the Birth Defects Research Section at NYSDOH.