Nurse holding baby after birth
June Cho

Professor June Cho

Jun. 9, 2022

By Joseph Gaccione (UNLV School of Nursing Associate Director of Communications)

Dr. June Cho is an associate professor at UNLV School of Nursing. Her research foci consist of neonatal health and mother-infant interactions, but those are the umbrella topics that hold more specific studies that could unlock better ways to treat infants, especially those in more challenging socioeconomic conditions. Through her years of research, she has found better ways to study infant risks from pregnancy through the first few months of their lives, but also relay the importance of mother-infant connections. 

Q: Can you describe your research more specifically?

A: My research contributions are in three primary areas: 

  • Gender differences theory-based approach for examining male vulnerability in very-low-birthweight (VLBW, BW < 1,500 gm) infant health and developmental (cognitive/motor/language/social-emotional) outcomes from the perinatal period to the infancy. 
  • Generating new knowledge about the associations between biological factors – testosterone and cortisol levels – and adverse birth outcomes, infant health and development, and maternal mental health issues.
  • Developing new methods for assessing and screening infants' behavioral and developmental issues such as autistic spectrum disorders regarding the male vulnerability, hormonal biomarkers, and quality of mother-infant interactions.

My research examines the associations between the levels of testosterone and cortisol and infant health and growth, mother-infant interactions, and infant cognitive/motor/language/socio-emotional development in VLBW infants over the first 2 years after birth. 

Q: Where did this topic come from?

A: This line of research is an outgrowth of years of clinical experience with male vulnerability in infant mortality and morbidity; mother-VLBW infant interactions; and infant motor and language development that attempts to answer questions of clinical significance and relevance. My initial studies described gender differences in the interactions between mothers and their medically at-risk infants until 3 years old. More recently, my research has focused on examining the associations between hormonal biomarkers and their relationships to health disparities based on a bio-psychosocial model.

Q: Why focus on preterm infants?

A: I always wanted to help babies because newborn babies are innocent. Sometimes they are just born unhealthy. Since VLBW newborns are very sick, the parents and society need to have them be healthy and have a nice life. Therefore, I started with VLBW preterm babies because they have multiple health and development issues. 

Q: How significant is the mother-infant interaction? 

A: The quality of mother-infant interactions is very important for infant health and development. If mothers provide more positive interactive behaviors including positive stimulation, smiling, and talking, their babies learn more and have better cognitive and language development. Sometimes, economically disadvantaged mothers and mothers with mental health issues show fewer interactions because of the extra burden of childcare and financial support. 

Q: Talk about your research resources and how your work has evolved.

A: I used my research funding primarily to assess VLBW infant health and development progress. I worked together with a neonatologist, pediatrician, pediatric endocrinologist, pediatric psychologist, and occupational/physical therapist. I provided necessary services for infant developmental assessment and maternal mental health assessment for mother-VLBW infant dyads between birth and 24 months corrected age for prematurity. 

When I was in the PhD program, I was interested in infant health and development as well as mother-infant interaction based on male vulnerability. When babies are born as boys and VLBW preterm, they tend to have more health and development issues compared to their counterparts. As the prevalence of preterm birth is 2 to 2.5 times higher in a Black population than White population, Black boys were even more likely to be at risk. 

After I completed my PhD program, I found a gender differences theory, which said if a baby has a high level of testosterone from the womb, they have more health and developmental issues. I started to measure testosterone and cortisol levels concurrently from the baby’s saliva and found that if a male baby had a higher level of testosterone and a lower level of cortisol, they had more adverse birth outcomes. Then I thought, ‘What about the mother?’ Sure enough, a mother has a similar situation. If a mother has a high level of testosterone, they have more mental health issues including depressive symptoms, anxiety, and parenting stress. I measured healthy lifestyle behaviors and found that they were also related to the levels of testosterone and cortisol such that mothers with higher testosterone and lower cortisol levels had fewer healthy behaviors. Also, we found that Black mothers had fewer healthy behaviors than White mothers. 

Recently, I examined social determinants of postpartum health in mothers of VLBW infants. In this topic, I have found that health insurance either private or federal-assistant programs such as the WIC program is the most predictable factor for maternal mental health, whereas maternal married status is the most predictable factor for infant birth outcomes. Since I have found important associations between socio-demographic and biological factors in maternal and infant health, I plan to conduct a multi-site study. 

Q: Why is there such a disparity between races? 

A: I think the most important thing is socioeconomic status. The race itself cannot apply to everything about Black mothers and preterm birth because if their surroundings and social demographic are better, their mental health issues and health behavior issues are better. Low-income pregnant women without health insurance usually do not visit the prenatal clinic. Without prenatal care, mothers could have more medical complications during pregnancy, childbirth, and postpartum periods. That's why I want to see why Black mothers are in less favorable situations, although that is only one of the socio-demographic factors. 

Another important thing in our society, especially in the United States, is that Black mothers have experienced discrimination including structural, institutional, and systematic racism. Those discriminations could well affect them significantly before and after pregnancy and childbirth.

Q: Something as small as saliva seems to uncover so much information. Why are biomarkers so critical for research?

A: Biomarkers provide objective information. Objective information is required in research to serve as measurable markers for reducing symptoms and problems related to health and treatment. Also, the development of intervention requires measurable markers to serve as the assessment of intervention effects. Recently, we have measured testosterone and cortisol levels as novel factors related to health disparities since they are involved in stress regulation and birth outcomes. For example, testosterone and cortisol levels before and after any interventions could be used to assess the intervention effects.

Q: When will your research be finished? What would be the endgame for your work, to be satisfied and accomplished?

A: Good research ended up with more questions. That means my research will be continued with new questions and ideas. 

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