Dr. Ruth Landau

Virginia Apgar Professor of Anesthesiology

Research Description

As a clinician-scientist dedicated to helping women better endure labor pain and childbirth and improve neonatal outcomes, Dr. Landau has concentrated her efforts on investigating the influence of genetics on pregnancy-related disorders, such as preterm labor & delivery, endothelial dysfunction & preeclampsia, as well as labor pain and its relief, and the ability to predict one’s individual susceptibility to develop post-operative and chronic pain.

Dr. Landau is currently the Director of the Division of Obstetric Anesthesia at Columbia and leads the Center for Precision Medicine Research within the Department of Anesthesiology.

Dr. Landau is the President-Elect of the Society for Obstetric Anesthesia & Perinatology (SOAP) and is the Scientific Program Chair of the upcoming annual SOAP meeting in Halifax (May 13-17 2020).

Dr. Landau has always been passionate about teaching, providing clinical care, and researching ways to improve patients’ experiences and care, and is currently invested in identifying clinical, genomic and epigenetic factors to predict and help prevent adverse peri-operative outcomes in all age groups.

Clinical research within the Division of Obstetric Anesthesia involves RCTs aiming to improve provision of neuraxial labor analgesia and anesthesia for obstetric procedures (Dr. Allison Lee, Dr. Richard Smiley), as well as outcome studies in the field of high-risk obstetric patients using institutional databases (Dr. Elena Reitman, Dr. Laurence Ring, Dr. Richard Smiley) and national databases (Dr. Jean Guglielminotti).

Dr. Landau is also leading the Columbia/NYPH Enhanced Recovery after Cesarean Delivery (ERACeD) program in collaboration with the Department of Obstetrics & Gynecology (Dr. Janice Aubey), investigating ways to promote judicious opioid prescription after cesarean delivery and raise awareness about risks associated with excessive opioid use postpartum. 

Dr. Landau has received NIH funding to investigate the epigenetic impact of in utero opioid exposure on Generation Z. The alarming rise in opioids prescriptions nationwide including during pregnancy has resulted in an increasing number of neonatal drug withdrawals. Evidence that Neonatal Abstinence Syndrome (NAS) babies are more likely to become ‘addicted’ later in life has emerged. This study explores the hypothesis that in utero opioid exposure results in epigenetic processes with potentially long-term consequences for the fetus/child such as an increased vulnerability to develop an opioid (mis)use disorder.

Current Precision Medicine Initiatives with the Institute of Genomic Medicine are evaluating:

  • Post-cesarean pain – a multicenter project aiming at predicting acute pain and analgesic intake, as well as persistent and chronic pain, with psychophysical tests and genetic markers, in collaboration with Santa Joana Hospital, Sao Paolo Brazil, Stanford University, and Haifa University.
  • Local anesthesia insensitivity – a project aiming to phenotype individuals’ response to local anesthesia (Dr. Bridget Ferguson; College of Dental Medicine and Department of Oral & Maxillofacial Surgery) and evaluate genetic markers associated with resistance or insensitivity to local anesthetics.
  • Uterine contractility - a project aiming at evaluating extreme phenotypes such as idiopathic preterm labor and non-contractility of the term uterus and to identify genetic markers (with Dr. Richard Smiley)
  • Preeclampsia – several observational studies in an attempt to bridge the gap between obstetric health and long-term cardiovascular outcomes in women diagnosed with preeclampsia, assessing biomarkers, vascular reactivity and endothelial function with non-invasive measures (EndoPAT) in the postpartum period, in middle-aged women undergoing gynecological procedures, and later in life when requiring cardiovascular surgery (Dr. Andrea Miltiades).
  • Post-operative delirium - a project aiming to identify genetic markers associated with post-operative delirium among elderly patients.
  • Respiratory muscle paralysis after polymyxin B – a project aiming to identify genetic markers associated with this rare phenotype among ICU patients (Dr. Vivek Moitra).

Dr. Landau is collaborating with Dr. Kirsten Cleary (MFM Obstetrics), Dr. Eliza Miller (Neurology), Dr. Natalie Bello (Cardiology) in a Precision Medicine Pilot Award funded project (April 2018) evaluating maternal health after preeclampsia. Investigations include maternal cardiac, cerebral, and vascular monitoring for up to 12 months postpartum.

Other collaborations include:

1) a CTSA Pilot Award working with the Department of Epidemiology (Prof. Silvia Martins) to develop tools guiding individualized opioid prescriptions (January 2020)

2) an NIH grant funding the MFM-U Network to study an intervention individualizing opioid prescriptions with shared decision making after cesarean delivery - the Prescription After Cesarean Trial (PACT) in collaboration with Department of Obstetrics & Gynecology (Prof. Cynthia Gyamfi).

 

Learn More

For more information, please contact Dr. Landau at rl262@cumc.columbia.edu.

Members

  • Richard Smiley

    Dr. Richard Smiley (Obstetric anesthesia) is the Chief of the Division of Obstetric Anesthesia and oversees clinical research and outcome studies, and participates in the Precision Medicine Initiative evaluating extreme phenotypes of uterine contractility.

  • Vivek Moitra

    Dr. Vivek Moitra (Critical Care) is the Chief of the Division of Critical Care in the Department of Anesthesiology, and participates in the Precision Medicine Initiative evaluating extreme phenotypes in the context of anesthesia and critical care.

  • Andrea Miltiades

    Dr. Andrea Miltiades (Cardiothoracic anesthesia) is conducting research evaluating biomarkers and endothelial function in women diagnosed with preeclampsia.

  • Elena Reitman

    Dr. Elena Reitman (Obstetric Anesthesia) is in charge of the Education Curriculum in Obstetric Anesthesia. Dr. Reitman is conducting outcomes research in patients with abnormal placentation (accreta).

Select Publications

You can view a complete list of Dr. Landau's publications here