BackgroundThe intergenerational transmission of obesity-related traits could propagate an accelerating cycle of obesity, if parental adiposity causally influences offspring adiposity. The extent to which intergenerational obesity associations are due to such causal effects, as opposed to genetic confounding (inheritance), is unclear. We aimed to establish whether associations between parental peri-pregnancy body mass index (BMI) and offspring birth weight (BW), BMI until 8 years of age, and 8-year-old eating behaviour are due to genetic confounding.Methods and findingsData were from the Norwegian Mother, Father and Child Cohort Study, a prospective population-based birth cohort born between 1999 and 2009 at 50 out of 52 hospital maternity units in Norway. We compared the strength of the associations of maternal pre-pregnancy BMI versus paternal BMI during pregnancy, with offspring outcomes including birth weight and BMI assessed between age 6 months and 8 years of age, and appetite-related eating behaviour traits assessed at age 8 years via the Child Eating Behaviour Questionnaire (CEBQ), adjusting for potential confounders including parity, parental/grandparental language group and parental age, smoking, education and income). We then used an extended children of twins structural equation model (SEM) to quantify the extent to which associations were due to genetic confounding. Up to 85,866 children (51.3% male) were included in linear regression models, whereas SEM models included up to 50,999 children. Maternal BMI was more strongly associated than paternal BMI with offspring BW, but the maternal-paternal difference decreased for offspring BMI after birth. Greater parental BMI was associated with obesity-related offspring eating behaviours. SEM results indicated that genetic confounding did not explain the association between parental BMI and offspring BW, but explained the majority of the association with offspring BMI from 6 months onwards. For 8-year BMI, genetic confounding explained 79% (95% CI [62, 95]; p = 1.9 × 10−12) of the covariance with maternal BMI and 94% (95% CI [72, 113]; p = 2.7 × 10−14) of the covariance with paternal BMI. Limitations of this study include selective recruitment and attrition, potential bias due to parental assortative mating, and that findings may not generalise beyond high-income country settings with high obesity prevalence.ConclusionsWe found strong evidence that parent–child BMI associations may primarily be due to genetic confounding. When considered alongside prior evidence, this finding may argue against a strong causal effect of maternal or paternal adiposity on childhood adiposity via intrauterine or periconceptional mechanisms.

Adult height and body mass index (BMI) are among the fundamental somatic characteristics of humans and are shaped by the interplay of biological, familial, and environmental factors. An increasing body of research indicates the long-term importance of early-life conditions for traits observed in adulthood. This study aimed to assess the contribution of selected biological and family-related environmental determinants to variation in adult height and BMI among physical education students. An additional exploratory aim was to analyse potential correlates of age at menarche in women. The study included 267 physical education students (180 men and 87 women). Body height and body mass were measured, and data on birth parameters and family characteristics were collected, with the data obtained at the beginning of the 2025/2026 academic year. Statistical analyses were performed using descriptive statistics and multiple linear regression models. Adult height was significantly associated with the stature of both parents as well as with birth length and birth weight, with the high proportion of explained variance being partly attributable to the inclusion of sex in the models. BMI was associated with sex, birth weight, and maternal educational level, with a moderate degree of explained variance. No significant associations were found between age at menarche and the predictors included in the analysis. The findings highlight the importance of familial and early-life determinants for adult height in young adults, as well as the limited role of socioeconomic environmental factors in the population studied. Interpretation of the results for BMI requires consideration of the specific characteristics of a physically active population.

High-risk fertility behaviors remain a persistent public health challenge in sub-Saharan Africa, where maternal mortality and fertility rates are high. Women's empowerment is an essential factor in understanding and addressing high-risk fertility behaviors. However, previous studies have often focused on singular aspects of empowerment, such as education or decision-making authority. This study adopts a multidimensional approach to examine the association between women's empowerment and high-risk fertility behaviors across sub-Saharan Africa. We used Demographic and Health Survey data from 29 sub-Saharan African countries collected between 2011 and 2022 (n = 179,430). Women's empowerment was measured using principal component analysis to derive three dimensions of empowerment (decision-making, attitudes toward violence, and social independence). High-risk fertility behaviors were assessed based on childbirth before age 18, short birth intervals (< 24 months), and high birth parity (≥ 4 births). We used multilevel regressions to examine the association between empowerment dimensions and high-risk fertility behaviors while accounting for country-specific effects and controlling for potential determinants and risk factors. Across the study population, substantial variation in women's empowerment dimensions was observed across countries and population subgroups. Multilevel analyses showed significant associations between each empowerment dimension and reduced probabilities of engaging in high-risk fertility behaviors. For example, a one standard deviation increase in social independence was associated with lower odds of early childbirth (OR = 0.534; CI = 0.502-0.567), short birth intervals (OR = 0.796; CI = 0.761-0.832), and high birth parity (OR = 0.560; CI = 0.532-0.590). Similar negative associations were observed for the decision-making and attitudinal dimensions. These associations appeared strongest for high-risk behaviors occurring earlier in women's reproductive lives. The findings highlight the importance of women's empowerment in reducing high-risk fertility behaviors across multiple dimensions and life stages, providing insights for potential policy interventions targeted at gender-based factors contributing to high-risk fertility behaviors to improve the region's maternal and child health outcomes.

Birth occurs during a sensitive period in brain development wherein hormones facilitate the dramatic shift in physiology that accomplishes the transition to extrauterine homeostasis. The surge in birth signaling hormones is abridged in cases of delivery by cesarean section (CS), which accounts for 32% of all births in the U.S. Epidemiological studies have associated birth via CS with increased risk of obesity in later life. Here, we sought to investigate this association using an experimental preclinical animal model, the prairie vole. Subjects were delivered either via vaginal delivery (VD) or CS and then cross-fostered. CS delivery led to increased body weight across development, which could be prevented with "hormone rescue" of oxytocin (OXT) and arginine vasopressin (AVP), delivered to neonates immediately after CS. This weight gain could not be attributed to differences in birth weight, parenting, food consumption, or thermoregulation; however, CS subjects moved slower than VD subjects, which hormone rescue reversed. Hormone rescue also reduced adiposity in adulthood among CS subjects. The dopamine system was dysregulated in the caudate/putamen of CS offspring, suggesting a neural mechanism for the decreased locomotion. Hormone rescue of CS neonates restored dopamine synthesis in the caudate/putamen and increased spontaneous locomotor activity. These findings suggest CS can lead to increased weight gain in part through a reduction of locomotion driven by long-lasting changes in striatal dopamine regulation, all of which can be prevented by treating CS neonates with a single peripheral administration of two birth-signaling hormones, OXT and AVP.

The Early Growth and Development Study (EGDS) began in 2002 as a longitudinal prospective adoption study of birth parents, adoptive parents, and adopted children (n = 361 adoptees). It expanded in 2007 to include a second cohort of adoptees (n = 200), and a third cohort of siblings (siblings reared by the birth mother at age 7 [n = 217 siblings in 2013] and additional siblings in both birth and adoptive family homes [n = 881 siblings in 2016]). Data are available in a national repository within the Environmental influences on Child Health Outcomes (ECHO) study and have been integrated into analyses with national and international cohorts. Birth and adoptive families were originally enrolled through a systematic recruitment approach that began with efforts to partner with all domestic adoption agencies in specific regions of the United States following the birth of a child. Longitudinal assessments are ongoing and occurred in 9-month intervals until the adoptees turned 3 years of age, and in 1- to 2-year intervals thereafter to age 21. Data collection includes child temperament, cognition, behavior, and physical health; birth and adoptive parent personality, mental and physical health, context, parenting, and marital relations; the prenatal environment; genetic, hormonal, and cardiovascular data; and geocoding. A unique aspect of the adoption-sibling design is its ability to detect environmental influences on development and test complex interactions and correlations between genetic, prenatal, and postnatal environmental influences on a range of outcomes. The sample and procedures are described, followed by an overview of multicohort findings and opportunities for integration with other registries.

As global aging intensifies, elucidating reproductive health's epigenetic aging associations is crucial. However, the impact of reproductive history on multi-generational DNA methylation (DNAm) clocks remains insufficiently characterized, representing a significant gap in understanding biological vs. chronological aging divergence. This study analyzed 1117 U.S. women aged 50 or older from NHANES 1999-2002 to examine associations between reproductive history and 12 DNA methylation (DNAm) algorithms. Multivariable linear/logistic regression models assessed associations between reproductive indicators and DNAm age acceleration, adjusting for sociodemographic/biological confounders. The β coefficients represent the change in DNAm age acceleration in years. Pregnancy frequency (per additional pregnancy) showed positive associations with PhenoAgeacc (β = 0.14, 95%CI:0.01-0.27) and GrimAge2Mortacc (β = 0.10, 0.03-0.18). Categorical analyses revealed that high pregnancy parity (≥5) significantly increased the odds of GrimAge2Mortacc (OR = 2.34, 95% CI: 1.15-4.71), while high live birth parity (≥5) was associated with increased odds of HannumAgeacc (OR = 2.57, 95% CI: 1.01-6.92). Most primary associations involving second-generation clocks remained robust after false discovery rate correction. While menarche timing showed no significant associations, later menopause and a longer reproductive lifespan were significantly associated with decelerated biological aging after multiple testing correction. These findings suggest that parity and reproductive timing are associated with biological aging trajectories through methylation mechanisms, advancing our understanding of sex-specific aging drivers.

The postpartum period is a critical time when women need information and support for both their own health and newborn care. Mobile health applications can significantly improve access to information during the postpartum period. However, the effectiveness of such applications depends on understanding postpartum women's usage preferences and expectations. Existing evidence on postpartum mobile health applications is largely derived from studies conducted in South Asian and East African contexts, highlighting the need for context-specific data from Türkiye. This study aimed to determine the usage preferences and expectations of postpartum women regarding mobile applications developed for the postpartum period. This descriptive study was conducted with 385 postpartum women in Istanbul, Türkiye. Data were collected between October 2024 and February 2025 using a structured Descriptive Information Form prepared by the researchers. The form included items related to sociodemographic characteristics, obstetric characteristics, and opinions regarding the use of mobile applications during the postpartum period. Data were analyzed using descriptive statistics, chi-square and multivariate logistic regression analysis. Willingness to use mobile applications was significantly associated with age, educational level, income status, parity, and mode of birth. The most frequently requested application content included newborn care (45.5%), common newborn problems and their management (42.9%), and emergency situations related to maternal and newborn health (40.5%). Participants also emphasized the importance of applications providing reliable, clear, and up-to-date information. Postpartum women have specific preferences and expectations regarding mobile health applications designed for the postpartum period. Developing user-centered mobile applications that prioritize newborn care and emergency-related content may support postpartum health services and enhance maternal and newborn health outcomes.

Universal administration of hepatitis B (HepB) vaccine at birth is a cornerstone for hepatitis B virus (HBV) elimination efforts in the US. In 2025, the Advisory Committee on Immunization Practices (ACIP) recommended delaying HepB vaccine initiation among infants born to birth parents who tested negative for hepatitis B surface antigen (HBsAg). To evaluate the health and economic impact of delaying HepB vaccination among US infants. A Markov model of HBV infections was acquired among a cohort infants, born in 2025, up to age 18 years. The model incorporated HBsAg prevalence among birthing parents, HBsAg testing during pregnancy or delivery, vertical or perinatal and household or community HBV transmission among children, and sequalae from chronic infection. This study was conducted in the US. Eight scenarios in which the first HepB dose was delayed at intervals between 2 months and 12 years, applied either only to infants born to birth parents who tested negative for HBsAg or to parents who either tested negative for HBsAg or had unknown HBsAg status. All delayed vaccination scenarios were compared with administering first HepB dose at birth. Scenarios were modeled with perfect and imperfect adherence to recommendations. Outcomes included acute and chronic HBV infections acquired until age 18 years, additional associated lifetime HBV-related morbidity and mortality, and health care costs (2025 US dollars). The health and economic outcomes of 3 628 934 infants were modeled in this analysis. All delayed vaccination scenarios resulted in more infections, worse health outcomes, and higher costs than administering first HepB dose at birth. Under perfect adherence, delaying HepB vaccination by 2 months for infants of parents negative for HBsAg led to an additional 90 acute infections (range, 16-107), 76 chronic infections (range, 14-97), 29 HBV-related deaths (range, 6-53), with $16.4 million in added costs for infants born during 1 year. Delaying to 12 years resulted in an additional 190 acute infections (range, 61-233), 50 deaths (range, 15-83), and nearly $30 million in added costs. Delaying HepB vaccination among infants of parents with unknown HBsAg status or imperfect adherence to the vaccination schedule amplified all negative outcomes. Results of this economic evaluation quantified the potential impact of changing ACIP recommendations. Even brief delays in HepB vaccine initiation were associated with a substantial increase in HBV infections, adverse health outcomes, and health care costs.

Understanding the Relationship Between Birth and Foster Parents: A Systematic Review

Association between maternal urinary phthalate metabolites in early and late pregnancy and neonatal birth outcomes: A cohort analysis.

The purpose of this study was to determine the prevalence of Early Childhood Caries (ECC) and Severe Early Childhood Caries (S-ECC) in the Tunis region, and to identify the associated risk factors. Although primarily epidemiological, the findings may support the development of evidence-based preventive and educational strategies in pediatric oral health at the national level. A cross-sectional observational study was conducted in kindergartens in the Tunis and Ariana regions between January and May 2023. The study involved 359 children aged 3 to 5years. Data collection included dental examinations to determine the prevalence of ECC and S-ECC, as well as structured questionnaires specifically developed for the children's parents or legal guardians. These questionnaires gathered detailed information on demographic and socio-economic factors (such as parental education level and birth weight), children's oral hygiene and dietary habits, and medical history. The collected data were then analysed to identify potential associations with dental caries. The prevalence of ECC was 28.7%, whilst the prevalence of S-ECC was 14.2%. The mean dmft (decayed, missing, and filled teeth) score was 3.89. Statistically significant associations with caries were observed for parental education level and birth weight. The prevalence of Early Childhood Caries (ECC) in the Tunis region was found to be 28.7%, while Severe Early Childhood Caries (S-ECC) affected 14.2% of children aged 3 to 5years. This prevalence is higher than the 20% reported in Monastir in 2022 (Chouchene et al., Front Public Health 10: 821128, 2022), but lower than the 45% reported in the Sousse region in 2020 (Chamli et al., J Paediatr Dent 6: 39, 2020). These findings highlight regional disparities in ECC burden across Tunisia and underscore the need for region-specific preventive and educational strategies. The significant prevalence of ECC and S-ECC observed in this study emphasizes the importance of early intervention and enhanced parental education to improve oral health outcomes in children.

Shared parenting experiences in kinship care: The role of family demographics, adverse childhood experiences, birth parent involvement, and attitudes toward shared parenting

India is currently experiencing population momentum, and studying the determinants of having more children needs to be explored in depth so that the Government’s Family Welfare strategies can be revisited according to the current real needs. Despite efforts to reduce higher-order births, they continue to occur in some districts of Tamil Nadu. It’s essential to understand the factors that influence families to have more children in a state that has achieved the replacement level of fertility. To explore the attitudes of mothers has more than or equal to 3 children in a low HOB district, to explore the attitudes of mothers who have less than or equal to 2 children in a high HOB district, to explore the attitudes of Husbands and Mothers in-laws about having less than or equal to 2 children and more children. In-depth interviews were conducted among low-order- higher-order birth mothers and Husbands from the low- and high-HOB districts of Tamil Nadu. A grounded theory approach was adopted to generate the themes. Seven themes emerged from the In-depth interviews, namely, Providence, Proclivity, Social norms, Transgression, Social connectedness, Forlorn events, and lacking knowledge on contraception leading to higher-order births. Fiscal Prospects, Congenital defects, providing security to girl children, providing quality education, fulfilling social customs, and poor knowledge of available contraception were evident factors determining the higher order births.

Migrants are often diagnosed with cancer at more advanced stages than the background population, resulting in poorer prognosis. The route to cancer diagnosis is associated with the prognosis, but little is known about the diagnostic pathways for migrants. This study aimed to describe the routes to diagnosis (RtD) for migrants in Denmark and compare these with the RtD for patients of Danish origin. We conducted a nationwide cohort study based on Danish registry data, including patients aged ≥ 18 years who were diagnosed with incident cancer between 2014 and 2018 (n = 154,647, including 8066 migrants). Using the UN M49 Standard, we categorised the study population into 15 groups based on country or region of origin (defined according to parental birth country or citizenship), including 14 migrant groups and a reference group of Danish origin. Each patient was assigned to one of six specified RtD. Using multinomial logistic regression models, we assessed associations between migrant groups and RtD. A total of 44.5% of all cancer patients were diagnosed through a primary care cancer patient pathway (CPP), with variations across migrant groups. Compared with patients of Danish origin, a higher risk of diagnosis via an unplanned hospital admission relative to a CPP from primary care was seen for migrants from the former Yugoslavia (relative risk ratio (RRR) 1.30, 95% CI 1.06–1.60), Germany (RRR 1.34, 95% CI 1.12–1.59), Western Asia (RRR 1.61, 95% CI 1.28–2.02), Türkiye (RRR 1.67, 95% CI 1.29–2.15) and Africa (2.02, 95% CI 1.58–2.60). Some migrant groups experienced higher diagnosis rates via unplanned hospital admission compared with patients of Danish origin, which could impact their prognosis. The results underline the importance of strengthening cancer diagnostic pathways for migrant populations.

Maternal and perinatal quality collaboratives (M/PQCs) across nearly all U.S. states focus on improving health care and outcomes for birth parents and their infants. In the context of increases in maternal morbidity (MM) and severe maternal mortality (SMM) in the USA, M/PQCs increasingly focus on addressing maternal care and disparities in care that are partly driving observed increases in SMM and MM. To date, quality care or safety bundles and other programming from state-based M/PQCs have been implemented by hospitals and other collaborating partners, while various studies have assessed their impact. However, no extant reviews synthesize the findings of this literature. The aim of this review is to synthesize the current evidence on implementation approaches of M/PQCs at the health system level in the USA and their impact on maternal health outcomes. We will conduct a scoping review of the literature of studies or reports that qualitatively and/or quantitatively assess the implementation of "toolkits" or "bundles" through state M/PQCs. We will include studies and reports on the implementation of state M/PQC initiatives in health systems/birth facilities or the impact of these on births, maternal and infant health outcomes and clinical care in the USA published after January 1, 2000. We will exclude studies that examine single-site quality improvement initiatives or initiatives outside of state M/PQCs, or studies that do not report on implementation, births, maternal and infant health, nor care outcomes. The information sources will include MEDLINE, Embase, CINAHL, and the Maternity and Infant Care Database, as well as a targeted search using Google Advanced for grey literature to capture information produced outside of academic publishing channels such as government and academics. Each record will be assessed independently by two reviewers at the title/abstract level and then at the full-text level. Included records will be subject to single reviewer data abstraction. We will assess study quality using the Mixed Methods Appraisal Tool (MMAT). Findings will be reported in the form of a narrative review and mapping outcomes in tabular form. This review will identify where additional evidence is needed to understand the relationship between M/PQCs and maternal health care and outcomes, as well as understanding key implementation processes. We will note key limitations of the included studies and general implications for the broader findings. Open Science Framework-Embargoed/anonymized until August 30, 2025 https://osf.io/bnmpk/?view_only=9e1f754cc2d947cba6ea889e5ae58f19 .

ABSTRACT Purpose As our awareness of the prevalence and impact of trauma increases, so has the need for trauma-informed practices and interventions. Within child welfare, parent training is an important mechanism for supporting children and families. The purpose of this scoping review was to explore the ways in which trauma-informed parent training programs were used in the child welfare system. Materials and Methods The search included studies written in English, could be representative of interventions delivered globally, identified using trauma-informed approaches, served caregivers/parents involved with child welfare. Results Twenty-four studies were identified and included for review. The majority of studies were designed for foster or resource parents with a focus on helping the child’s trauma symptoms. Four studies were designed for birth parents and addressed parent own trauma and how that influences their parenting. Discussion Findings across all studies indicated that there were significant improvements in study variables for both children and parents. Group format was the most prominent intervention delivery method. A description of trauma content covered in each intervention and unique trauma-informed components of interventions were identified. Conclusion Based on the review, it is clear that trauma-informed parent training is a growing area with most studies being completed within the last 5–7 years. Information in this review can be used by interventions interested in supporting children and families in child welfare through a trauma-informed lens, of which this scoping review shows promise of incorporating.

Child maltreatment and disruptions in attachment relationships have been linked to higher levels of dissociation. This study explored the influences of birth parent-child attachment, caregiver-child attachment, and placement duration on dissociative symptoms among youth living in out-of-home care. Youth with histories of maltreatment who were recently placed in out-of-home care (N=310; Mage=10.25; 48.9% female). A moderated mediation analysis was employed to examine the effects of birth parent-child attachment on dissociation, and to examine age-conditional indirect effects through caregiver-child attachment and placement duration. Birth parent-child attachment directly influenced dissociative symptoms (B=-3.88, p=0.004) and was partially mediated by caregiver-child attachment and placement duration. The indirect effects through caregiver-child attachment were negative and significant at younger ages (at age 9.36, B=-1.34, 95% CI [-3.41, -0.22]; at age 10.25, B=-0.51, 95% CI [-1.24, -0.07]), and nonsignificant by age 11.14. The indirect effects through placement duration with their caregivers were negative and significant among the older youth (became significant at 10.25, B=-0.69, 95% CI [-1.66, -0.08], and was strongest by age 11.14, B=-1.90, 95% CI [-4.12, -0.45]). Relational pathways linking parent-child attachment to dissociation are context-dependent. Findings emphasize the need for interventions and programs that help youth navigate relationships with their birth parents and caregivers, encourage emotional and relational safety along with placement stability, and are developmentally sensitive, adapting to changing needs over time.

The purpose of this study was to explore the ways in which cascading disasters (i.e., disruptions to the environment that generate unexpected secondary events of strong impact) shape perceptions of perinatal wellbeing and breastfeeding/formula-feeding practices in south Alabama. Ethnographic research was conducted with perinatal healthcare providers (n = 10) and birth parents (n = 10) in south Alabama during the COVID-19 pandemic and in the aftermath of multiple hurricanes in 2020. Results reveal that concerns related to cascading disasters were exacerbated or eclipsed by system-level challenges that shaped breastfeeding and formula-feeding practices. Specifically, the absence of paid parental leave and community-based breastfeeding support was perceived as profoundly stressful for participants. Birth parents often had to negotiate between breastfeeding/formula-feeding decisions and their own needs. We argue that robust federal and state-level support systems are needed if birth parents and perinatal healthcare providers are to follow guidelines for breastfeeding before, during, and after cascading disasters.

Previous studies have investigated various factors influencing postpartum posttraumatic stress disorder (PP-PTSD). However, limited understanding exists regarding the network structure and interconnections among symptoms of PP-PTSD. This study aims to explore the complex relationship by applying network analysis among postpartum women in Shanghai, China. A total of 2,552 postpartum women completed the online questionnaire using the 14-item Chinese version of the Perinatal Posttraumatic Stress Disorder Questionnaire. For network analysis, 671 individuals were meticulously chosen from the upper quartile of the Perinatal Posttraumatic Stress Disorder Questionnaire scores, representing the top 25% (cutoff score ≥ 9). Subsequently, Walktrap cluster detection, a method for identifying clusters in networks, was performed on the estimated networks. Additionally, Network Comparison Tests were conducted to examine the variations among individuals based on parity and mode of birth. The symptoms "distant" (Item 8, felt isolated and disconnected from others) and "numb" (Item 9, had difficulty showing tenderness or love toward others) were found to be the most central and exhibited the strongest correlation (r partial = 0.373). This study identified three symptom clusters: "reexperiencing and avoidance" symptom cluster, "negative alterations in cognitions and mood and arousal" symptom cluster, and "hyper and guilt" symptom cluster. To mitigate PP-PTSD among postpartum women, effective strategies targeting the central symptoms of "distant" and "numb" are crucial. Prioritizing interventions that address these key symptoms can enhance overall treatment and support effectiveness for individuals with PP-PTSD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Prior work conducted within U.S. civilian graduate medical education (GME) programs has uncovered negative perceptions of parenthood related to trainee wellness and performance. However, this subject remains understudied within U.S. military GME which affords trainees 12-18 weeks of paid parental leave. We disseminated a web-based survey to trainees, faculty physicians and program directors (PDs) at U.S. military GME programs querying participants on the impact of parenthood and parental leave on trainee wellness and performance. Applicable statistical analyses were utilized to assess differences between groups. Content analysis was used to identify themes within participant open-ended responses. The survey was completed by 211 respondents from 24 different medical or surgical specialties across the Military Health System. A majority of participants reported that their program's parental leave policy either somewhat or significantly decreased the stress of trainee parents (trainee 50.5% vs. faculty 60.6% vs. PDs 61.9%). Participants reported no impact of parental leave on trainee dedication to patient care, clinical performance, scholarly activities or standardized test scores. Participants reported a somewhat negative impact of training interruptions on the training experience of peers, with no significant difference in how they rated birth and non-birth parents (birth parent 2.44 vs. non-birth parent 2.48, P = .10, d = -0.11). Technical skills and procedural volume were both rated lower for birth parents versus non-birth parents (technical skills: birth parent 2.50 vs. non-birth parent 2.60, P ≤ .001; d = -0.25, procedural volume: birth parent 2.32 vs. non-birth parent 2.41, P <. 001; d = -0.23). Content analysis uncovered themes consistent with the survey data but also revealed persistent stigma surrounding use of full parental leave benefits within certain GME programs. The current parental leave policy within U.S. military GME is perceived to decrease parental stress and can have a positive impact on trainee wellness. While this policy has been effectively implemented with limited perceived impact on trainee performance, work remains to be done to promote full acceptance of parental leave within military GME.