About

Ellen C. Francis, PhD, is an assistant professor in the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health. She received her PhD from Clemson University's program in Applied Health Research and Evaluation and a graduate certificate in Personalized and Genomic Medicine from the University of Colorado. Her research integrates biochemical and clinical information to refine metabolic profiles during pregnancy, aiming to improve the identification of maternal-offspring pairs at risk for poor metabolic health later in life. She utilizes 'omics data generated from blood and placenta to provide a more precise understanding of the developmental origins of health and disease. Her work employs approaches from lifecourse epidemiology, systems biology, and computer science to identify modifiable targets and mechanisms leading to premature cardiovascular morbidities. Dr. Francis was a pre-doctoral fellow at NICHD and completed post-doctoral training as a Perinatal Biology and Reproductive T32 fellow at the University of Colorado Anschutz Medical Campus. In 2022, she received a K99 Transition to Independence Fellowship from NICHD and an NHLBI PRIDE Scholarship, supporting her ongoing research efforts.

Research topics

• Political Science
• Medicine
• Intensive care medicine
• Internal medicine
• Endocrinology
• Genetics
• Pathology
• Biology
• Family medicine
• Physical therapy

Selected publications

• Life’s Essential 8 in Pregnancy and Time to Incident Cardiometabolic Disease Over 7 Years Follow-Up

  medRxiv · 2026-04-16

  articleOpen access1st authorCorresponding

  Importance: Assessment of cardiovascular health (CVH) during may unmask latent metabolic vulnerability and indicate long-term disease risk. However, the prognostic value of the AHA's Life's Essential 8 (LE8) framework during pregnancy remains uncertain. Objective: To evaluate CVH during using a modified Life's Essential 8 (mLE8) score in association with time to incident cardiometabolic disease. Design: Prospective cohort study with electronic medical record (EMR) surveillance for 7 years postpartum (August 2018-March 2026). Adjusted accelerated time-to-failure models estimated mLE8 associations with incident conditions. Setting: A population-based prenatal cohort recruited from a large academic medical system in South Carolina. Participants: Singleton pregnancies in individuals aged 18 to 44 years without pre-existing diabetes or cardiovascular disease (CVD). Exposures: A 7-component mLE8 score assessed during pregnancy, incorporating hypertensive disorders of pregnancy (HDP), 50-g glucose tolerance test results, pre-pregnancy body mass index, smoking status, sleep adequacy, diet quality, and physical activity. Scores ranged from 0 to 100, with higher scores indicating more favorable CVH. Main Outcomes and Measures: Post-delivery incident cardiometabolic conditions captured through EMRs and classified as chronic hypertensive conditions, chronic metabolic conditions (e.g., dyslipidemia, impaired glucose regulation), and CVD (e.g. cardiac arrest, cardiomyopathy). Time to incident diagnosis was measured in days from delivery. Results: Among 1,225 pregnancies (mean age, 25.0 [5.3] years), 499 incident cardiometabolic events occurred over a median follow-up of 6.2 (2.8) years. Each 10-point higher mLE8 score was associated with a longer time to incident diagnosis of chronic hypertensive conditions (time ratio [TR], 1.26; 95% CI, 1.11-1.42) and chronic metabolic conditions (TR, 1.20; 95% CI, 1.11-1.29). Healthier HDP, glucose, BMI, and sleep scores were most strongly associated with longer time to diagnosis of chronic metabolic disease. Results were robust to sensitivity analyses excluding individuals who developed gestational diabetes or HDP. Conclusions and Relevance: In this racially diverse, low-income cohort study of 1,225 pregnancies, better CVH during pregnancy was associated with a longer time to incident post-delivery diagnosis of cardiometabolic conditions. Pregnancy-based CVH assessment may help identify individuals with elevated and emerging cardiometabolic risk who could benefit from early, targeted intervention and enhanced longitudinal surveillance. Key Points: : Pregnancy cardiovascular health assessment using LE8 may identify individuals with elevated risk and latent vulnerability, and support earlier intervention during a sensitive window for prevention of long-term cardiometabolic disease.

  PublisherOA PDFDOI

• Placental insulin-mTOR and stress–inflammatory signaling patterns are associated with childhood adiposity

  BMC Medicine · 2026-05-08

  articleOpen access1st authorCorresponding

  BACKGROUND: Placental signaling pathways regulate nutrient transport and fetal growth, with potential long-term consequences for offspring metabolic health. Most prior human studies have focused on individual placental markers, limiting insight into the role of coordinated activity across multiple pathways in relation to offspring outcomes. Our objective was to identify patterns across placental nutrient signaling pathways and assess whether the latent placental signaling patterns were associated with early childhood adiposity, and secondarily, explore associations of adiposity-associated patterns with metabolic biomarkers. METHODS: Among 108 mother-child pairs from the Healthy Start cohort, we quantified 33 placental signaling proteins and their phosphorylated-to-total protein ratios involved in nutrient sensing, insulin/growth factor signaling, stress/inflammation, and mitochondrial biogenesis using Simple Western assays of term placental villus tissue. We applied unsupervised methods to identify latent patterns and LASSO regression was used to select patterns associated with %fat mass at age 4. Multivariable linear regression was used to estimate associations adjusting for offspring age, sex, and maternal pre-pregnancy BMI. These same models were used in exploratory analysis of fasting levels of adiponectin, leptin, insulin, glucose, and lipids at age 4. RESULTS: We identified two placental signaling patterns associated with %fat mass. The insulin-mTOR-energy sensing pattern was associated with lower childhood %fat mass (β = -2.46, 95% CI - 4.84, - 0.09) and adiponectin, and the stress-inflammatory MAPK pattern was associated with higher %fat mass (β = 1.28, 95% CI 0.05, 2.51), leptin, and triglycerides; however, the FDR p-values ranged from 0.06 to 0.13. CONCLUSION: Two placental signaling patterns were associated with childhood %fat mass and metabolic markers. These findings indicate that capturing placental activity across several signaling pathways may yield insights into early origins of adiposity and metabolic health.

  PublisherDOI

• Abstract MP64: PREVENT 30-Year CVD Risk During Pregnancy Is Associated With Inflammatory and Vascular Placental Pathology

  Circulation · 2025-03-11

  article

  Introduction: Many adverse pregnancy outcomes (APOs) associated with long-term CVD risk, such as preeclampsia, are mediated by placental function. Notably, the vascular and inflammatory placental pathology underlying APOs are also found in 20-35% of healthy pregnancies. Thus, we aimed to investigate the link between 30-year CVD risk and placental pathology. Hypothesis: We hypothesized that higher 30-year CVD risk, as estimated based on the PREVENT equation calculated in mid-pregnancy, would be associated with greater likelihood of placental pathology, including chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM). Methods: Data are from the Stress, Pregnancy, and Health (SPAH) study, a prospective pregnancy cohort conducted from 2018-2023 in Evanston, IL. The PREVENT 30-year CVD risk estimate was calculated based on the 2 nd trimester study visit. At the study visit, blood pressure was assessed, and a blood sample was collected and used to measure cholesterol and estimate eGFR from creatinine. Participants self-reported smoking status. Age, pre-gestational diabetes diagnosis, and use of anti-hypertensive or lipid-lowering medications were abstracted from medical records. Following delivery, placentas were collected and reviewed by a perinatal pathologist and patterns of placental injury (CI, MVM, FVM) were identified based on Amsterdam consensus criteria. Logistic models were used to test associations between CVD risk in pregnancy and placental pathology, adjusted for race/ethnicity, socioeconomic position, and gestational age at the study visit. Results: The SPAH study included 605 participants, 505 of whom had placental pathology exams and complete data to estimate 30-year CVD risk during pregnancy. The mean gestational age at the study visit was 23.7 weeks (SD: 1.7) and the mean age of study participants was 33.3 years (SD: 5.6). The mean 30-year CVD risk was 7.6% (SD: 6.7) and 54% had CI, 29% had MVM, and 34% had FVM. In the adjusted model, a 1 SD increase in CVD risk was associated with 24% greater odds of having CI (95% CI: 1.01, 1.52) and 25% greater odds of having MVM (95% CI: 1.04, 1.50; Figure 1) at delivery. CVD risk was not associated with FVM. Conclusions: Results demonstrate that PREVENT 30-year CVD risk estimated in the second trimester is associated with CI and MVM in the placenta at delivery, which may provide insight into the mechanisms linking CVD risk and APOs.

  PublisherDOI

• Participant characteristics in the effectiveness of lifestyle interventions to optimize gestational weight gain: a systematic review and meta-analysis

  Communications Medicine · 2025-10-24 · 1 citations

  reviewOpen access

  Precision prevention involves tailoring interventions to the unique characteristics of a group or individual to maximize their effectiveness. In this study, we examined the role of participant characteristics in the effectiveness of lifestyle interventions to optimize gestational weight gain (GWG). We searched Medline, Embase, and PubMed, from inception up to March 2025, to identify randomized and non-randomized controlled trials of lifestyle interventions (diet, physical activity, or combined) commencing before or during pregnancy. Participant characteristics, including age, race/ethnicity, body mass index (BMI), employment status, fasting low- and high-density lipoprotein cholesterol (HDL-C) were assessed. Mean differences (MD) in GWG were pooled using the random-effect model. Meta-regression and subgroup analysis were conducted by participant characteristics (e.g., BMI). A total of 86 studies with 28,270 participants were included in this systematic review and meta-analysis. All lifestyle intervention types significantly reduced GWG. Combined lifestyle interventions initiated at first (MD −0.68; 95% confidence interval [CI]: −1.28, −0.07) and early second (13–17 weeks) trimester (MD −0.83; 95% CI: −1.46, −0.20) provide better effectiveness in optimizing GWG. Diet-only interventions significantly reduced GWG only in participants with normal BMI (MD −1.33 kg; CI: −1.75, −1.91) compared to the other BMI categories. Combined diet and physical activity interventions reduce excessive GWG in women with higher baseline HDL-C (β −0.04; 95% CI −0.06, −0.01). Lifestyle interventions reduced excessive GWG, with possible differential effects by intervention initiation time, BMI, and HDL-C. Future studies should consider physiological as well as social characteristics, in line with a holistic framework for precision medicine. A growing body of evidence underscores the pivotal role of lifestyle intervention in reducing the risk of excessive weight gain during pregnancy and associated maternal and child health complications. However, instead of a one-size-fits-all approach, further research is needed to help differentiate how to optimize the effectiveness of these interventions based on individual physiological and social determinants. This study found that lifestyle interventions reduce excessive weight gain during pregnancy, with greater benefits for certain women, including those with a normal body mass index and higher high-density lipoprotein cholesterol (good cholesterol) levels at the beginning of lifestyle interventions. Non-stratified data reporting prevented us from examining other pertinent participant characteristics, and future studies are required to inform precision intervention approaches that benefit all women. Grieger, Takele, Vesco, et al. perform a systematic review and meta-analysis of gestational weight gain interventions. Findings indicate lifestyle interventions that reduce excessive gestational weight gain provide greater benefits for women with a normal BMI and higher HDL cholesterol levels at the initiation of interventions.

  PublisherOA PDFDOI

• Abstract P1140: PREVENT 30-Year CVD Risk Associated With Greater Odds of Adverse Pregnancy Outcomes

  Circulation · 2025-03-11

  article

  Introduction: Poor pre-pregnancy cardiovascular health is associated with adverse pregnancy outcomes (APOs). We sought to investigate whether estimated 30-year CVD risk from the PREVENT equation similarly predicts APOs. Hypothesis: We hypothesized that higher 30-year CVD risk mid-pregnancy would be associated with greater risk of APOs, including preterm delivery and preeclampsia. Methods: Participants are from the Stress, Pregnancy, and Health (SPAH) study, conducted in Evanston, IL between 2018-2023. During the 2 nd trimester study visit, blood pressure was measured and participants provided a blood sample. Nuclear magnetic resonance was used to measure serum cholesterol and creatinine (used to estimate eGFR). Medication use, pre-gestational diabetes diagnosis, and APOs, including preterm delivery (<37 weeks gestation), early preterm delivery (<34 weeks) and preeclampsia, were abstracted from medical records. The PREVENT equation was used to estimate 30-year CVD risk based on 2 nd trimester measures. Logistic models were used to test associations between CVD risk in pregnancy and APOs, adjusted for race/ethnicity, as a marker of structural factors, socioeconomic position, based on household educational attainment and occupational prestige, and gestational age at the study visit. Results: SPAH included 605 participants, 524 of whom had complete data to estimate 30-year CVD risk from the 2 nd trimester study visit (mean gestational age at visit: 23.7 weeks, SD: 1.7). The mean age of participants was 33.3 years (SD: 5.5) and 18% identified as Black, 21% as Hispanic, 49% as White, and 12% as another group. The mean 30-year CVD risk during pregnancy was 7.6% (SD: 6.6), 11% delivered preterm, and 10% developed preeclampsia. In the adjusted model, a 1 SD increase in CVD risk was associated with 41% greater odds of preterm delivery (95% CI: 1.14, 1.74), 67% greater odds of early preterm delivery (95% CI: 1.27, 2.19), and 71% greater odds of developing preeclampsia (95% CI: 1.36, 2.14; Figure 1). Conclusions: Results suggest that a higher PREVENT 30-year estimated CVD risk in mid-pregnancy is associated with greater odds of delivering preterm and developing preeclampsia. These APOs are associated with long-term offspring CVD risk, also highlighting the intergenerational implications of PREVENT CVD risk estimates.

  PublisherDOI

• Unsupervised Approaches to Placental Protein Clustering: Which Best Captures Signals Linked to Childhood Metabolic Health?

  Research Square · 2025-11-14

  preprintOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Maternal Inflammation During Pregnancy and Cord Blood Metabolomic Signatures in the Context of HIV Exposure

  Metabolites · 2025-11-25 · 1 citations

  articleOpen access

  Background/Objectives: Pregnant people with HIV (PWH) are more likely to experience systemic inflammation than pregnant people without HIV (PWoH), which may contribute to adverse outcomes in HIV-exposed uninfected (HEU) infants; however, the underlying mechanisms are not well studied. This study examined associations between maternal inflammatory markers during pregnancy and cord blood inflammatory markers and metabolomic signatures. Methods: Between 2011 and 2025, pregnant PWH and PWoH were enrolled at 24–28 weeks of gestational age. Maternal plasma was analyzed for inflammatory markers [interleukin (IL)-6, high-sensitivity C-reactive protein (hsCRP), soluble TNF-α receptor 1 (sTNFR1) and 2 (sTNFR2), soluble CD163 (sCD163), soluble CD14 (sCD14)]. At delivery, cord blood was collected for measurement of IL-6, TNF-α, IFN-γ, and IL-10 and for targeted metabolomics by ultra-performance liquid chromatography–mass spectrometry. Spearman correlation, linear regression, and weighted correlation network analysis (WGCNA) were used to evaluate associations, stratified by HIV exposure. Results: This study included 22 PWH and 47 PWoH and their infants. Among HEU infants, but not HUU infants, maternal IL-6 correlated with cord blood TNFα (r = 0.443, p < 0.05) and maternal sTNFR1 correlated with both cord blood TNFα (r = 0.617, p < 0.05) and IFNγ (r = −0.517, p < 0.05). WGCNA identified five metabolomic modules. In the HEU group, naternal sCD14 was positively associated with a metabolomic module characterized by lysophosphotidylecholines in the HEU group. Conclusions: We identified distinct patterns in the relationships between maternal inflammation and infant immune–metabolic profiles by HIV exposure status. These findings suggest that HIV infection, even with viral suppression, may alter the maternal–fetal inflammatory interface and influence early metabolic programming.

  PublisherDOI

• Normalization of trophoblast mTOR signaling rescues impaired function in primary human trophoblast cells isolated from pregnancies complicated by fetal growth restriction

  Cell Death Discovery · 2025-11-07 · 2 citations

  articleOpen access1st authorCorresponding

  Fetal growth restriction (FGR) is associated with inhibition of placental mTOR signaling and amino acid transport. mTOR is a positive regulator of amino acid transport mediated by controlling the plasma membrane trafficking of SNAT2, a System A amino acid transporter isoform, and LAT1 an isoform involved in System L amino acid transport. Inhibition of mTOR complex 1 decreases SNAT2 and LAT1 plasma membrane trafficking by activating of Nedd4-2, an E3 ubiquitin ligase, and inhibition of mTOR Complex 2 decreases the protein expression of Cdc42 which limits transporter trafficking to the plasma membrane. We isolated human primary trophoblast (PHT) cells from FGR placentas and demonstrate that they maintain the in vivo FGR phenotype with increased expression of DEPTOR, an endogenous inhibitor of mTOR, reduced mTOR signaling, increased Nedd4-2 expression, lower expression of Cdc42, and decreased SNAT2 and LAT 1 protein expression in the plasma membrane, and decreased System A and L activity. We silenced DEPTOR in FGR PHT cells using siRNA and found normalized mTOR signaling, Nedd4-2 and Cdc42 protein expression, SNAT2 and LAT1 plasma membrane trafficking and System A and L amino acid transport activity. We also show that hypoxia induces DEPTOR upregulation in PHT cells. In the Healthy Start Study, a longitudinal pre-birth cohort, placental DEPTOR expression was correlated with lower birth weight percentile and with higher systolic and diastolic blood pressure in children at 4-6 years of age. Together, our studies provide mechanistic and translational insight into how placental DEPTOR may serve as potential mediator of fetal growth and long-term health risk. We identify a mechanistic link between increased trophoblast DEPTOR expression in FGR and decreased placental mTOR signaling and amino acid transport. Intervention strategies aimed at normalizing trophoblast mTOR signaling may be effective to improve trophoblast nutrient transport and fetal growth in FGR.

  PublisherOA PDFDOI

• The Camden Study—A Pregnancy Cohort Study of Pregnancy Complications and Birth Outcomes in Camden, New Jersey, USA

  Nutrients · 2024-12-19 · 1 citations

  articleOpen access

  BACKGROUND: Pregnancy is a unique stage of the life course characterized by trade-offs between the nutritional, immune, and metabolic needs of the mother and fetus. The Camden Study was originally initiated to examine nutritional status, growth, and birth outcomes in adolescent pregnancies and expanded to study dietary and molecular predictors of pregnancy complications and birth outcomes in young women. METHODS: From 1985-2006, 4765 pregnant participants aged 12 years and older were recruited from Camden, NJ, one of the poorest cities in the US. The cohort reflects a population under-represented in perinatal cohort studies (45% Hispanic, 38% non-Hispanic Black, 17% White participants; 98% using Medicaid in pregnancy). Study visits, including questionnaires, dietary assessments, and biospecimen collection, occurred in early and late pregnancy as well as at delivery. Medical records were abstracted, and a subset of mothers and infants participated in a six-week postpartum visit. RESULTS: Findings from the Camden Study have added to the understanding of adolescent and young adult maternal health and perinatal outcomes. These include associations of adolescent linear growth while pregnant with smaller neonatal birth size, low dietary zinc intake in early pregnancy with increased risk of delivery <33 gestational weeks, and higher circulating fatty acid levels with greater insulin resistance. More recent analyses have begun to unpack the biochemical pathways in pregnancy that may be shaped by race as an indicator of systemic racism. CONCLUSIONS: The Camden Study data and biorepositories are well-positioned to support future research aimed at better understanding perinatal health in under-represented women and infants. Linkages to subsequent health and administrative records and the potential for recontacting participants over 18-39 years after initial participation may provide key insights into the trajectories of maternal and child health across the life course.

  PublisherOA PDFDOI

• Maternal Obesity and Differences in Child Urine Metabolome

  Metabolites · 2024-10-25 · 3 citations

  articleOpen access1st author

  Background/objective: Approximately one-third of pregnant individuals in the U.S. are affected by obesity, which can adversely impact the in utero environment and offspring. This study aimed to investigate the differences in urine metabolomics between children exposed and unexposed to maternal obesity. Methods: In a study nested within a larger pregnancy cohort of women–offspring pairs, we measured untargeted metabolomics using liquid chromatography–mass spectrometry in urine samples from 68 children at 4–8 years of age. We compared metabolite levels between offspring exposed to maternal obesity (body mass index [BMI] ≥ 30.0 kg/m2) vs. unexposed (maternal BMI 18.5–24.9 kg/m2) and matched them on covariates, using two-sample t-tests, with additional sensitivity analyses based on children’s BMI. This study reports statistically significant results (p ≤ 0.05) and potentially noteworthy findings (fold change &gt; 1 or 0.05 &lt; p &lt; 0.15), considering compounds’ involvement in common pathways or similar biochemical families. Results: The mean (SD) maternal age at study enrollment was 28.0 (6.3) years, the mean child age was 6.6 (0.8) years, 56% of children were male, and 38% of children had a BMI in the overweight/obese range (BMI ≥ 85th percentile). Children exposed to maternal obesity had lower levels of 5-hydroxyindole sulfate and 7-hydroxyindole sulfate and higher levels of secondary bile acids. Phenylacetic acid derivatives were lower in offspring exposed to obesity and in offspring who had a current BMI in the overweight/obese range. Exposure to maternal obesity was associated with lower levels of androgenic steroid dehydroepiandrosterone sulfate (DHEA-S). Conclusions: In this preliminary study, children exposed to maternal obesity in utero had differences in microbiome-related metabolites in urine suggestive of altered microbial catabolism of tryptophan and acetylated peptides. Some of these differences were partially attributable to the offspring’s current BMI status. This study highlights the potential of urine metabolomics to identify biomarkers and pathways impacted by in utero exposure to maternal obesity.

  PublisherOA PDFDOI

Frequent coauthors

• Cuilin Zhang

  80 shared

• Wei Perng

  Colorado School of Public Health

  71 shared

• Stefanie N. Hinkle

  University of Pennsylvania Health System

  61 shared

• Mengying Li

  Jiujiang First People's Hospital

  59 shared

• Dana Dabelea

  University of Colorado Anschutz Medical Campus

  54 shared

• Norbert Stefan

  Deutsches Diabetes-Zentrum e.V.

  49 shared

• Cécile Saint‐Martin

  Assistance Publique – Hôpitaux de Paris

  48 shared

• Feifei Cheng

  Dalian Medical University

  48 shared

Education

• PhD, Public Health Sciences

  Clemson University

  2019

Awards & honors

• K99 Transition to Independence Fellowship from NICHD (2022)
• NHLBI PRIDE Scholarship