About

Heather Herson Burris, MD, MPH, is an Associate Professor of Pediatrics specializing in Neonatology and Newborn Services at the Children's Hospital of Philadelphia. She is an attending physician in the Division of Neonatology and a member of the Center for Pediatric Clinical Effectiveness at the same hospital. Additionally, she is affiliated with the Center for Excellence in Environmental Health at the University of Pennsylvania and is a faculty member in the Epidemiology and Biostatistics Graduate Group at the University of Pennsylvania School of Medicine. Her research expertise focuses on social and environmental contributions to racial disparities in birth outcomes. Burris has a background in anthropology, having earned her BA from the University of Pennsylvania, and completed her MD at Temple University School of Medicine. She further obtained an MPH in Clinical Effectiveness from Harvard University School of Public Health. Her work includes studying the spatial patterning of preterm birth, the role of neighborhood deprivation in the cervicovaginal microbiota, and factors influencing continuity of midwifery care in Philadelphia.

Research topics

• Demography
• Internal medicine
• Bioinformatics
• Medicine
• Biology
• Genetics

Selected publications

• Looking Beyond the Individual: The Impact of Neighbourhood on Gestational Diabetes

  Paediatric and Perinatal Epidemiology · 2025-05-01 · 1 citations

  articleOpen accessSenior author

  Gestational diabetes mellitus (GDM), characterised by insulin resistance during pregnancy, is one of the most common pregnancy complications, with its incidence increasing [1]. GDM is a well-established risk factor for adverse pregnancy outcomes, including hypertensive disorders of pregnancy, macrosomia, operative delivery, neonatal metabolic disturbances, and long-term cardiometabolic complications in both birthing people and their offspring [1]. While studies have demonstrated racial and ethnic disparities in the prevalence of GDM, the specific factors contributing to these health disparities remain poorly understood. Social determinants of health are non-medical, broader societal factors that shape health outcomes, including the conditions in which individuals are born, grow, work, live, play, and age [2]. Traditionally, investigations and interventions to improve health and health equity have focused on individual risk factors. However, a growing body of evidence highlights the critical role of neighbourhood-level exposures—such as housing quality, violence, access to healthy food, and poverty—in contributing to adverse health outcomes [3]. In this issue of Paediatric and Perinatal Epidemiology, Parra and colleagues [4] explore the relationship between neighbourhood deprivation and the risk of developing GDM. Outside of pregnancy, neighbourhood deprivation has been associated with poorer control of diabetes, but there is limited data on the pregnant population [5]. They conducted a population-based retrospective cohort study using data from the Arizona Prenatal Environmental and Reproductive Outcomes Study (AzPEARS), which merges birth certificate data with area-level exposure data from the US Census. For this analysis, data from over 480,000 births were merged with the Neighbourhood Deprivation Index (NDI), a composite measure that quantifies overall neighbourhood socioeconomic status. The NDI is scored on a scale from 0 to 1, with higher scores indicating greater deprivation. A multivariable log-binomial regression model calculated the risk of GDM across NDI quartiles, adjusting for maternal age, education, race/ethnicity, parity, rurality, and birth year. Additionally, a sensitivity analysis was conducted to account for body mass index, a known covariate, but one that may be on the causal pathway. The authors found that the overall incidence of GDM was consistent with existing literature, at 7.8%. However, there was considerable geographical variation, with incidence as high as 12% in communities with a high proportion of patients identifying as Native American/American Indian. Residents in the most deprived quartile were younger, less educated, had a higher prevalence of obesity, had smaller infants, and were more likely to have public insurance. The authors found a dose-dependent increase in GDM incidence with greater exposure to neighbourhood deprivation, which persisted in adjusted analyses. This finding is consistent with other literature demonstrating a dose-dependent relationship between developing GDM and increasing exposure to neighbourhood deprivation [6]. The authors utilised a large dataset that included almost half a million births, of which 37,636 were affected by GDM. The investigators used robust statistical methods to explore the association between neighbourhood deprivation and GDM. However, the study is limited by the absence of data on pregnancy outcomes beyond the incidence of GDM. Additional information regarding the impact of neighbourhood deprivation on glycaemic control, the need for pharmacologic treatment, hypertensive disorders, mode of delivery, and other neonatal complications would have provided a more comprehensive understanding of the broader impact of neighbourhood deprivation on maternal and neonatal health outcomes. This study found a high incidence of GDM in patients identifying as Native American/American Indian (almost 18%), which is more than double the overall incidence. This finding highlights the need for further work focusing on this population, which is vulnerable to healthcare disparities, to understand the factors contributing to this higher incidence of GDM and develop targeted interventions to address this disparity. Neighbourhoods can influence metabolic health through multiple pathways. The neighbourhood deprivation used by Parra et al. includes multiple area-level socioeconomic indicators. It may serve as a proxy for other neighbourhood characteristics such as access to greenspace, walkability, violent crime, and access to nutritious food and healthcare. Studies of the built environment and diabetes in non-pregnant adults have found that higher neighbourhood walkability and more greenspace are associated with a lower prevalence of diabetes [7]. In pregnancy, lower levels of neighbourhood greenness have been associated with increased odds of developing a hypertensive disorder [8]. Greenspace improves air quality while encouraging physical and social activities, which can lead to positive health outcomes. The food environment within a neighbourhood, including access, availability, and affordability of nutritious foods, impacts metabolic health. Access to neighbourhood healthcare resources may influence the utilisation of prenatal care. Perceptions of neighbourhood safety may increase stress, decrease physical activity, and affect the ability to consume a healthy diet, all of which can have adverse metabolic consequences. While a growing body of research has focused on understanding social determinants of health, it is equally essential for clinical practice to recognise the social factors that influence patient health. The first step toward meaningful improvements in care is recognising and acknowledging the social barriers our patients face. As part of patient-centred care, all individuals should be screened for social determinants of health, including food insecurity, stable housing, transportation needs, exposure to violence, and health literacy, at least once during pregnancy [9]. Implementing standardised screening programmes and referral mechanisms to social services is essential to addressing these needs. This study contributes to our understanding of the role neighbourhood-level factors play in the risk of developing GDM. To improve pregnancy outcomes, healthcare professionals and policymakers must look beyond individual factors and address the root cause of community, neighbourhood, and societal factors that are contributing to pregnancy health inequities. Identifying and investing in high-risk communities and neighbourhoods, as well as place-based health interventions that support access to nutritious food, physical activity, and healthcare, and mitigate environmental stressors could help reduce the prevalence of GDM and ultimately decrease healthcare disparities. CDD was invited to write the commentary. CDD wrote the first draft of the article with input from HHB The authors declare no conflicts of interest.

  PublisherOA PDFDOI

• Associations of Early Life Ambient PM _2.5 Exposure With Asthma Risk in a Cohort of Preterm Infants With Bronchopulmonary Dysplasia

  Pediatric Pulmonology · 2025-12-01

  articleOpen access

  ABSTRACT Objective To examine whether exposure to fine particulate matter (PM 2.5 ) during the first year after neonatal intensive care unit (NICU) discharge is associated with asthma by age 5 among infants with bronchopulmonary dysplasia (BPD). Methods We conducted a retrospective cohort study of 337 infants with BPD, born between 2010 and 2019, who survived to discharge with clinical follow‐up in the Children's Hospital of Philadelphia Care Network through age 5. Daily residential census block group PM 2.5 exposures were estimated using a spatiotemporal machine‐learning model and averaged over the first year after NICU discharge. Modified Poisson regression models with robust standard errors quantified associations of PM2.5 with asthma by age 5, adjusting for neonatal clinical factors, insurance, neighborhood deprivation, and race/ethnicity. Results By age 5 years, 169 (50.1%) infants had an asthma diagnosis. Mean annual PM 2.5 exposure was 8.8 µg/m 3 (SD 1.1). Each 1 µg/m 3 increment of PM 2.5 was associated with higher asthma risk (unadjusted RR 1.14, 95% CI: 1.03–1.25; fully adjusted aRR 1.19, 95% CI: 1.03–1.37). Compared to the lowest exposure tertile (mean 7.6 µg/m 3 ), adjusted rates of asthma tended to be higher as exposure increased: Tertile 2 (mean 8.7 µg/m 3 , aRR 1.31; 95% CI: 0.98–1.74), Tertile 3 (mean 10.0 µg/m 3 , aRR 1.68, 95% CI: 1.17–2.4). Conclusions Exposure to higher ambient PM 2.5 in the year after NICU discharge was associated with asthma by age 5 among children with BPD. These findings highlight early‐life air quality as a modifiable determinant of long‐term respiratory outcomes in infants with BPD.

  PublisherOA PDFDOI

• Postpartum care in the neonatal intensive care unit, PeliCaN: a randomized controlled trial

  American Journal of Obstetrics & Gynecology MFM · 2025-05-06 · 12 citations

  article1st authorCorresponding
  PublisherDOI

• Facilitating postpartum care with a doula and certified nurse midwife in the neonatal intensive care unit: A qualitative analysis of maternal experiences

  Pregnancy · 2025-11-01 · 1 citations

  articleOpen accessSenior author

  Introduction: Mothers of infants in the Neonatal Intensive Care Unit (NICU) are at higher risk of postpartum complications than mothers of well infants. The Postpartum Care in the NICU (PeliCaN) study was an unblinded, randomized controlled trial of doula-supported, certified nurse midwife-delivered postpartum care for NICU mothers that reduced time to postpartum care for intervention participants. To establish acceptability and identify the most valuable core components of this care model, we conducted a qualitative study to understand the following: 1) the perspective and experience of NICU mothers in the intervention and control groups; 2) their receipt of and associated facilitators and barriers to postpartum care; and 3) the relative contributions of the doula and certified nurse midwife in accessing postpartum care. Methods: Semi-structured interviews were completed with 20 participants (10 intervention and 10 control) who were NICU mothers of infants born <34 weeks' gestation, admitted to the NICU, and <2 weeks old. We utilized template analysis, a form of thematic analysis, and an inductive approach to examine, interpret, and identify themes in the data. Results: We identified seven primary themes capturing the positive influence and care facilitated by the doula and certified nurse midwife. Four themes were specific to the doula: care coordination; prioritization of NICU mothers' own postpartum care; resource coordination; and guidance by the doula. Three themes were specific to the certified nurse midwife: efficient, timely care at the bedside; removing travel and scheduling barriers; and personalized care from the midwife. Conclusions: We identified a variety of ways in which embedding a doula and certified nurse midwife in the NICU to support postpartum care contributed to timely access to postpartum care and improved the postpartum experience for these high-risk obstetric patients. The synergy of doula-facilitated care, resource coordination, emotional support, and guidance with personalized certified nurse midwife-delivered essential bedside care that minimized logistical barriers was well received and appreciated by intervention participants. These maternal perspectives support embedding postpartum care in NICUs via policies and integrated healthcare delivery models.

  PublisherOA PDFDOI

• Postpartum care receipt among parents of infants admitted to a freestanding children’s hospital neonatal intensive care unit (NICU)

  Journal of Perinatology · 2025-11-17

  articleSenior author
  PublisherDOI

• Evidence for missed cases of postpartum depression based on paediatric clinical care screenings

  The British Journal of Psychiatry · 2025-06-01 · 2 citations

  articleOpen access
  PublisherOA PDFDOI

• Postpartum care receipt among parents of preterm infants admitted to the neonatal intensive care unit

  American Journal of Obstetrics & Gynecology MFM · 2025-03-01 · 10 citations

  letterOpen accessSenior author
  PublisherOA PDFDOI

• Conditional-longitudinal brain growth charts detect MRI changes with birth weight and psychopathology

  bioRxiv (Cold Spring Harbor Laboratory) · 2025-12-26

  articleOpen access

  Abstract Importance Brain maturation varies between individuals, particularly during dynamic developmental periods like adolescence. Directly assessing differences in longitudinal trajectories can reveal deviations from normative patterns. Objective We present novel conditional-longitudinal normative models that characterize variability in brain maturation. We utilize these models to examine whether differences in longitudinal trajectories are associated with birth weight (BW), gestational age (GA), and longitudinal psychopathology derived from behavioral assessments. Design Cross-sectional and conditional-longitudinal normative models were developed for brain volumes derived from the first two neuroimaging timepoints from the Adolescent Brain Cognitive Development (ABCD) Study. Conditional-longitudinal models index an individual’s expected brain volume at follow-up conditioned on their baseline measurement. Models were fit with split-half cross-validation on demographically matched samples. Setting The ABCD Study is a multi-site, population-based study Participants Participants were excluded based on imaging quality flags and missing data, leaving 10,830 at baseline and 7,262 at follow-up. Exposures BW and GA were derived from parent-report questionnaires. General psychopathology scores were calculated using a bifactor model. Main Outcomes and Measures We calculated cross-sectional and conditional-longitudinal centiles, respectively quantifying individual deviations in size and change between timepoints. Sensitivity analyses included covariates for parental income and education as well as current weight and height. Results The sample was 10,830 at baseline (48.2% F,age 9-10y) and 7,262 at follow-up (46.6% F,age 11-13y). Conditional-longitudinal centiles were sensitive to individual differences in brain change between timepoints. Lower BW was associated with lower conditional-longitudinal centiles, suggesting larger decreases in brain volumes over time (27 regions p fdr &lt;0.05, β max =0.08). Lower conditional-longitudinal centiles were associated with greater increases in psychopathology scores, suggesting with increased psychopathology brain volumes show greater decrease (37 regions p fdr &lt;0.05, β max =0.06). Notably, changes in psychopathology were not related to brain size at either timepoint, indexed by cross-sectional centiles. Conclusions and Relevance Models that capture individual-level deviations from expected growth trajectories, rather than static positions on a growth curve, are particularly informative for assessing developmental change. Novel conditional-longitudinal models address this gap in lifespan brain imaging. Using this framework, we demonstrate robust associations between individual trajectory deviations, perinatal adversity, and longitudinally assessed mental health symptoms. Condition-longitudinal models hold promise for applications across psychiatric neuroscience, from development to aging. Key Points Question How do differences in brain maturation trajectories, quantified by novel conditional-longitudinal models, relate to perinatal factors and mental health in adolescence? Findings In this longitudinal analysis of neuroimaging data from the Adolescent Brain Cognitive Development (ABCD) Study, conditional-longitudinal normative models revealed that trajectories of brain maturation in adolescence are associated with birth weight, and with longitudinal changes in mental health. Meaning Conditional longitudinal models detect inter-individual variability in brain maturation, which is related to both perinatal factors and concurrent changes in psychopathology.

  PublisherDOI

• Exposure to violence and socioeconomic deprivation in susceptibility to nitrogen dioxide on term infant birthweight in New York City

  Environmental Health · 2025-05-31

  articleOpen access

  Abstract Introduction Air pollution has been associated with adverse birth outcomes, with variation by socioeconomic position (SEP). However, it remains unknown which aspects of lower SEP – comprised of myriad physical and psychosocial stressors – may best explain observed pollution susceptibilities. Building upon previous studies that estimated joint associations of air pollution and socioeconomic deprivation on term birth weight in New York City (NYC), this study seeks to identify specific social stressors underlying that relationship. Methods We examined records for 243,853 term births in NYC from 2007–2010. Residence-specific pregnancy-average NO 2 was estimated using NYC Community Air Survey (NYCCAS) and EPA regulatory data. Twenty-six community social stressor indicators were tested as modifiers of NO 2 -birthweight associations in linear mixed-effects models, adjusting for particulate matter (PM 2.5 ), individual-level maternal characteristics, and other covariates. In sensitivity analyses, we also examined non-linear interactions between continuous NO 2 and census-tract level violence and deprivation terms. Results Consistent with previous work, a 1-IQR (6.2 ppb) increase in average prenatal NO 2 exposure was associated with a 12.6 (SE = 2.7)-gram decrease in term birthweight.We observed similar values in independent models for most stressors related to violent crime or SEP and significantly lower birthweights with higher stressor exposures. In models of effect modification, however, we found that – despite lower average birthweights in high-stressor communities – NO 2 -birthweight associations were weaker in higher-stressor communities, particularly for violence-related stressors. For example, in the highest-quartile communities for assault, a 1-IQR increase in NO 2 exhibited a decrement of only 7.3 g, on average, compared to 16.9 g in the lowest-assault quartile ( p = .01 trend across quartiles). Exposures to non-violent stressors were not significantly associated with lower birthweights, nor modified observed NO 2 -birthweight associations. Conclusions We found significantly lower term-infant birthweights with higher NO 2 or community stressors. Counter to hypotheses, however, in communities with very high stressor exposures (esp. violent crimes), despite lower overall birthweights, associations for NO 2 were weaker than in low-stressor communities. Our results suggest a possible saturation effect in stress-pollution interactions, wherein very high stressor exposures appear to overwhelm any effects of pollution. In addition, we observed stronger effects for violent crimes, in relation to other social stressors.

  PublisherOA PDFDOI

• Associations of NICU-Specific Stressors with Postpartum Depression in a Freestanding Children's Hospital NICU

  American Journal of Perinatology · 2025-07-24 · 1 citations

  articleSenior author

  This study aimed to measure associations of neonatal intensive care unit (NICU)-related stressors with postpartum depression (PPD) among birthing parents of infants in a large, quaternary care, urban, U.S. children's hospital NICU.We performed a cross-sectional study of parents of infants continuously hospitalized for at least the first 6 weeks of life. Participants completed the Parental Stressor Scale: NICU and Edinburgh Postnatal Depression Scale (EPDS). An EPDS score of ≥ 10 indicated a positive PPD screen. The Multidimensional Scale of Perceived Social Support assessed emotional, practical, and informational support from family, friends, and significant others. Modified Poisson regression models calculated risk ratios of PPD per interquartile range (IQR) increment of NICU stressor scores adjusted for social support, history of anxiety or depression, infant gestational age at birth, and infant age at survey completion. We also explored whether social support modified these associations.Of the 83 participants, 34 (41%) screened positive for PPD. Per IQR increment, overall NICU stressors (adjusted risk ratio [aRR]: 1.39; 95% confidence interval [CI]: 1.01-1.92) and parental role stress (aRR: 1.78; 95% CI: 1.18-2.68) were associated with higher risk of PPD in adjusted models. Social support did not modify associations of NICU stressors with PPD.PPD was common in this population of postpartum parents of infants with long hospitalizations. PPD was associated with overall NICU stressors and loss of parental role. Given the importance of maternal mental health for family wellbeing, universal PPD screening and capacity to treat PPD in freestanding children's hospital NICUs may improve maternal and child outcomes. · Postpartum NICU parents are at high risk of PPD.. · Overall, NICU and parental role stress increased PPD risk.. · Social support did not modify observed associations.. · NICUs should implement repeated PPD screening.. · Improved mental healthcare for NICU parents is crucial..

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Recent grants

• NIH Grant K23ES02224204

  NIH · $158k · 2017

• The Role of Neighborhood Greenspace in reducing Risk of Hypertensive Disorders of Pregnancy, Chronic Hypertension, and Racial Disparities in Maternal Morbidity

  NIH · $4.1M · 2022–2026

• NIH Grant K23ES022242

  NIH · $632k · 2018

Frequent coauthors

• Andrea Baccarelli

  Columbia University

  136 shared

• Emily Oken

  85 shared

• Michele R. Hacker

  Beth Israel Deaconess Medical Center

  85 shared

• Sheryl L. Rifas–Shiman

  Harvard University

  83 shared

• Carlos A. Camargo

  Harvard University

  81 shared

• Augusto A. Litonjua

  Golisano Children's Hospital

  80 shared

• Matthew W. Gillman

  Office of the Director

  77 shared

• Scott A. Lorch

  76 shared

Education

• MPH

  Harvard School of Public Health

  2009

• MD

  Temple University School of Medicine

  2003

• BA

  University of Pennsylvania

  1997