# Leveraging psychobiologic markers of stress to reduce severe maternal morbidity in pregnant people with mental illness

> **NIH NIH K23** · STANFORD UNIVERSITY · 2024 · $165,672

## Abstract

PROJECT SUMMARY
Interventions are critically needed to address the maternal mental health crisis in the United
States, particularly since mental illness is now the leading cause of maternal mortality.
Unprecedented societal shifts, disparities in access to mental health care, stigma, reluctance to
use psychiatric medications, and inflammation associated with uncontrolled mental illness all
highlight the need for simple, scalable, and equitable solutions in pregnancy. Developing
solutions tailored to specific aspects of this problem is an essential first step. However, there is
a significant knowledge gap in how mental illness contributes to maternal morbidity and
mortality which must first be understood to direct risk reduction strategies. One approach to
doing this involves studying severe maternal morbidity (SMM), a composite of severe
complications that often precede death yet occur 70 times more frequently. In preliminary work,
Dr. Panelli found that the risk of SMM is 58% higher in people with mental illness yet the relative
contribution of other factors such as substance use and medical comorbidities to this risk
remains to be elucidated. To address these knowledge gaps and prepare for a career as an
independent clinician scientist in this field, Dr. Panelli has developed this innovative K23
proposal to reduce SMM due to mental illness through identifiable behavioral and biologic
pathways. The Specific Aims are to: 1) Identify casual pathways for increased SMM in people
with depression and anxiety – the two most common perinatal mental illnesses – using a
population-level approach with Veteran’s Health Administration (VA) data; and 2) Conduct a pilot
randomized controlled trial (RCT) of a physical activity intervention in pregnant people with
mental illness to reduce severity of depression and/or anxiety and lower stress biomarkers
(leukocyte telomere length and hair cortisol). These aims will be conducted in parallel to provide
complimentary preliminary data to inform an R01 RCT of a physical activity intervention to
reduce SMM in people with mental illness. Dr. Panelli’s training will be conducted under the
experienced mentorship of Drs. Carmichael (perinatal epidemiologist), Phibbs (health
economist), and Gotlib (clinical psychologist/neuroscientist), in conjunction with advisors in
lifestyle interventions (Dr. Pinto) and RCT design (Dr. Lyell). Support from this K23, which will
feature content training in perinatal mental illness, hands-on analysis of population-level data
with advanced epidemiologic methods, and experience with clinical trials, will advance Dr.
Panelli’s long-term goal of becoming an independent clinical researcher with expertise in the
complex physical and biological interrelationship between mental illness, pregnancy, and SMM.

## Key facts

- **NIH application ID:** 10984100
- **Project number:** 1K23HD113845-01A1
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Danielle Mari Panelli
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $165,672
- **Award type:** 1
- **Project period:** 2024-07-15 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10984100

## Citation

> US National Institutes of Health, RePORTER application 10984100, Leveraging psychobiologic markers of stress to reduce severe maternal morbidity in pregnant people with mental illness (1K23HD113845-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10984100. Licensed CC0.

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