Maternal Programs Research Articles

Demand for Maternal Health Inputs in Eastern States of India

Using NFHS-4 data, this study explores the determinants of maternal health care programmes for eastern states of India, which include prenatal care and hospital delivery. To reduce unobserved heterogeneity in the analysis, we employed the Full Information Likelihood Method, also known as the Joint Estimation Technique, in conjunction with individual probit models. Like other studies, we found place of residence, wealth, caste, religion and level of education as significant contributor for demand for both services. But, unlike earlier studies, we found that women’s age increases the use of prenatal care and hospital delivery, and the child’s birth order influences getting prenatal care. To increase the utilisation of maternal health care services, we recommend investing in health infrastructure, increasing the Janani Suraksha Yojana (JSY) subsidy amount and coverage of the Janani Shishu Suraksha Karyakram (JSSK) scheme, and promoting awareness about various government programmes among women through the Accredited Social Health Activists (ASHAs). JEL Codes: I140, I150, I180, O150

Promoting Coordination and Collaboration in Tribal Home Visiting Programs in the United States.

A joint statement from two federal agencies in the United States calls for coordination and collaboration between programs serving families of infants and toddlers who are at risk or developmentally delayed or disabled U.S. Department of Education and U.S. Department of Health and Human Services. Policy guidance: Joint statement on collaboration and coordination of the MIECHV and IDEA Part C programs. (2017). Individuals with Disabilities Education Act. ED/HHS Joint Guidance Document: Collaboration and Coordination of the Maternal, Infant, and Early Childhood Home Visiting Program and the Individuals with Disabilities Education Act Part C Programs. Young Native American children living on tribal lands in this country are currently eligible for two federal programs associated with these agencies which overlap in mission and implementation. This paper outlines potential strategies for creating a more seamless system of services for tribal families involving more centralized intake processes and procedures, cross training of staff to work across programs, and adopting more unifying approaches to program implementation. A streamlined system of services will result in interventions that better support family and child outcomes while reducing duplication of services, consolidating the limited number of qualified professionals available to provide services, and increasing convenience and cultural attunement of services to Native American families currently participating in both programs.

Promotion of school readiness in home visiting: creating a key driver diagram for continuous quality improvement

ABSTRACT School readiness is a topic of great interest to early childhood and maternal child health initiatives, such as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. However, there is a lack of information about best practices or strategies in home visiting and their relative effectiveness in improving school readiness, making this topic appropriate for improvement through Continuous Quality Improvement (CQI) methods. In 2022, Alabama developed a Key Driver Diagram (KDD) for improving school readiness efforts within the home visiting programme using synchronous online focus groups as a method of qualitative data collection with early childhood and home visiting experts. Findings from this study include development of a KDD that includes aims, key drivers, and secondary drivers. The KDD represents the first of many steps toward a unified theory of change. Future efforts will include development of a CQI change package and testing change ideas in the field.

Maternal nutritional programming shapes the cerebral landscape

The escalating prevalence of maternal obesity raises concerns about its influence on offspring health. Exposure to obesogenic environments during early development leads to persistent alterations in brain function contributing to neurological disorders. Nutritional programming emerges as a promising avenue to counteract the deleterious effects of maternal obesity on offspring neurodevelopment.

Antepartum Depression and Its Clinico-Social Correlates: A Cross Sectional Study in a Tertiary Hospital of North India.

Maternal depression, the second leading cause of disease burden in women worldwide is often under-diagnosed and untreated. It can have consequences for pregnancy outcomes and child health. (1) To estimate the prevalence of antepartum depression among females attending antenatal clinic of a tertiary hospital. (2) To determine its obstetric and clinico-social correlates. A cross-sectional study was conducted in antenatal clinic by consecutive sampling of 300 pregnant women. We included those in third trimester, aged 18-40years and giving informed consent and excluded those with pre-diagnosed mental disorders. Pre-tested structured questionnaire and Edinburgh postnatal depression scale used. Score ≥ 10 indicated possible antepartum depression (APD). Chi-square test and logistic regression analysis applied using IBM SPSS version 22.0. P < 0.05 was considered statistically significant. Prevalence of possible APD was 23.3%. It was higher among urban females (25.3%) than rural (17.7%) but the difference was not statistically significant. APD increased with increasing maternal age. Other socio-demographic and obstetric factors were not associated significantly with APD. History of recent stressful life event, domestic violence, marital conflict, lack of support from husband, and preference of male child were found to be the significant correlates. More than one out of five antenatal females had possible antepartum depression, but none had sought treatment for the same. Antenatal women of higher age and those afflicted with social pathologies are more at risk. Screening for APD should be included in the maternal and child health care programme to address this hidden 'iceberg' disease.

279 Maternal Programming of the Piglet Microbiome Through Supplementation with a Yeast Feed Additive

Abstract The objective of this study was to investigate effects of live yeast supplementation of sow diets during late gestation and lactation on sow reproductive performance and piglet microbiome development. Three dietary treatments were imposed on mixed-parity sows (n = 92) from three contemporary farrowing groups during late gestation and lactation. Dietary treatments were based upon the inclusion level (%) of Actisaf Sc47 in corn/soybean meal-based diets: Control (C, 0%), Low (L, 0.1%), and High (H, 0.5%). Sows were fed their assigned gestation diet (1.8 kg ∙animal-1∙day-1/) from days 85 to 110 of gestation. On day 111 of gestation, sows were fed their assigned lactation diet (3.6 kg/head/day) until parturition. Sows were allowed ad libitum access to their assigned lactation diet beginning day one postpartum until piglets were weaned. Fecal and vaginal swabs were collected from all sows on day 85 of gestation (T1-S) and the day before parturition (T2-S). Colostrum and milk samples were collected from 30 focal sows (10/treatment group), and fecal swabs were collected from 6 piglets per focal sow (n = 180) at 24 to 36 hours after birth (T1-P) and weaning (T2-P, ~19 days old). Extracted DNA from swab samples was sequenced on the MiSeq platform targeting the V4 variable region of the 16S rRNA bacterial gene, and sequence data were analyzed using DADA2 plus various packages within the R statistical software. Generalized linear mixed models were built for sow performance data using the R lme4 package, with treatment as a fixed effect, and farrowing group, parity, and sire as random effects. Piglet performance models also included sex as a fixed effect and maternal origin instead of sire as a random effect. No significant differences were observed among dietary treatment groups for gestation or lactation length, lactation feed intake, sow body weights, sow backfat depth, litter size at birth or weaning, pre-weaning piglet mortalities, or piglet growth performance. Although alpha and beta diversity did not differ among maternal dietary treatment groups in sow colostrum, milk, fecal, or vaginal samples (T1-S or T2-S), several taxa were significantly enriched or less abundant in sow samples based upon dietary yeast inclusion levels. Diversity of piglet fecal microbiomes was not different across maternal dietary treatment groups, but community composition was different at both time-points (T1-P: PERMANOVA, R2 = 0.13, P=0.02; T2-P: PERMANOVA, R2 = 0.01, P=0.048). These results indicate that yeast supplementation in sow diets in late gestation and lactation may influence development and composition of piglet gut microbiomes in early life.

280 Effects of a Yeast Feed Additive for Maternal Programming of the Postweaning Pig Microbiome

Abstract The objective of this study was to determine whether feeding live yeast to sows from day 85 of gestation and through lactation influences pig performance and microbiomes in the postweaning period. Three dietary treatments were imposed on mixed-parity sows during late gestation and lactation based on the inclusion level (%) of Actisaf Sc47 in corn/soybean meal-based diets: Control (C, 0%), Low (L, 0.1%), and High (H, 0.5%). Pigs (n = 240; 80/maternal dietary treatment group) were selected randomly at weaning (~19 days old) for further performance data collection throughout the nursery period. A subset of these pigs (n = 180; 60/maternal treatment group) were selected randomly for microbiome sampling through fecal swabs collected on days 4 (T1) and 28 (T2) postweaning. Pigs were housed in pens in a confinement nursery barn according to maternal dietary treatment group (10 pigs/pen; 0.28 m2/pig of floor space; 8 pens/treatment group). Treatment groups were kept separate from each other by maintaining one empty pen between treatment groups to prevent potential microbial cross-contamination. Pigs were balanced by litter, body weight, and sex during nursery allotment. Pigs had ad libitum access to water and a common industry-relevant diet, fed in four phases from weaning through day 42. Pigs were weighed individually at the end of each dietary phase (d4, d14, d28, d42). DNA was extracted from fecal swabs and sequenced on the MiSeq platform, targeting the V4 variable region of the 16S rRNA bacterial gene. Sequence data were analyzed using QIIME2 and DADA2, plus various packages within the R statistical software. Performance data were analyzed using repeated measures and generalized linear mixed models that included maternal treatment as a fixed effect, maternal parity as a random effect, and pen as the experimental unit. Daily weight gain was greater for L pigs (0.47 kg) compared with H pigs (0.42 kg; P &amp;lt; 0.05), while ADFI was increased for L pigs (0.57 kg) compared with both C and H pigs (0.49 and 0.47 kg, respectively; P &amp;lt; 0.05; see Table). No differences in microbiome diversity were observed at either time-point. However, microbiome composition differed based on maternal treatment group at both time-points (T1: PERMANOVA, R2 = 0.02, P=0.001; T2: PERMANOVA, R2 = 0.04, P=0.001). These results indicate that live yeast supplementation in sow diets in late gestation and lactation may have lasting effects on pig performance and microbiome composition in the post-weaning period.

Maternal thyroid hormone receptor β activation in mice sparks brown fat thermogenesis in the offspring

It is well established that maternal thyroid hormones play an important role for the developing fetus; however, the consequences of maternal hyperthyroidism for the offspring remain poorly understood. Here we show in mice that maternal 3,3’,5-triiodothyronine (T3) treatment during pregnancy leads to improved glucose tolerance in the adult male offspring and hyperactivity of brown adipose tissue (BAT) thermogenesis in both sexes starting early after birth. The activated BAT provides advantages upon cold exposure, reducing the strain on other thermogenic organs like muscle. This maternal BAT programming requires intact maternal thyroid hormone receptor β (TRβ) signaling, as offspring of mothers lacking this receptor display the opposite phenotype. On the molecular level, we identify distinct T3 induced alterations in maternal serum metabolites, including choline, a key metabolite for healthy pregnancy. Taken together, our results connect maternal TRβ activation to the fetal programming of a thermoregulatory phenotype in the offspring.

Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries.

Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.

A survey evaluating practice pattern in management of obstetric hemorrhage.

Hemorrhage anticipation and management has shifted significantly over the past decade due to evolution of data surrounding management of obstetric hemorrhage. Limited data exists which describe the practical use and clinical application of hemorrhage management. Our goal was to identify obstetric hemorrhage management patterns in a cohort of practicing Maternal Fetal Medicine physicians. We administered a survey to Maternal Fetal Medicine (MFM) fellows and faculty that addressed the management of hemorrhage including risk assessment, uterotonic use, antifibrinolytic use, cell saver use, and abnormal placentation management. An email was sent out regarding the survey to a listserv of all Maternal Fetal Medicine fellow program coordinators to disseminate to their faculty and fellows. Eighty responses were obtained. A total of 78 surveys were analyzed. Participants preferred methylergonovine as a first line agent (n = 57; 73%, n = 62; 80%). Most participants would consider using cell salvage when also activating MTP (28, 48%) or during scheduled deliveries who are high risk of hemorrhage (40, 69%). Approximately a third of providers would use TXA (tranexamic acid) prophylactically (n = 21; 28%). Only 26% of MFM fellows felt comfortable performing cesarean hysterectomy without Gynecologic Oncology. In comparison to prior reports, TXA use has increased substantially. Further, when looking at the management of abnormal placentation, the use of magnetic resonance imaging and embolization have both increased. Possibly due to the rise in centers of excellence for treatment of accreta spectrum disorders, Maternal Fetal Medicine fellows still feel largely unprepared to perform a cesarean hysterectomy without Gynecologic Oncology.

Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis.

Following the introduction of jurisdictional maternal pertussis vaccination programs in Australia, we estimated maternal vaccine effectiveness (VE) and whether maternal pertussis vaccination modified the effectiveness of the first 3 primary doses of pertussis-containing vaccines. We conducted a population-based cohort study of 279 418 mother-infant pairs using probabilistic linkage of administrative health records in 3 Australian jurisdictions. Infants were maternally vaccinated if their mother had a documented pertussis vaccination ≥14 days before birth. Jurisdictional immunization records were used to identify receipt of the first 3 infant doses of pertussis-containing vaccines. Infant pertussis infections were identified using notifiable disease records. VE was estimated using Cox proportional hazard models. Pertussis was administered during 51.7% (n = 144 429/279 418) of pregnancies, predominantly at 28-31 weeks' gestation. VE of maternal pertussis vaccination declined from 70.4% (95% confidence interval [CI], 50.5-82.3) among infants <2 months old to 43.3% (95% CI, 6.8-65.6) among infants 7-8 months old and was not significant after 8 months of age. Although we observed slightly lower VE point estimates for the third dose of infant pertussis vaccine among maternally vaccinated compared with unvaccinated infants (76.5% vs 92.9%, P = .002), we did not observe higher rates of pertussis infection (hazard ratio, 0.70; 95% CI, 0.61-3.39). Pertussis vaccination near 28 weeks' gestation was associated with lower risk of infection among infants through 8 months of age. Although there was some evidence of lower effectiveness of infant vaccination among maternally vaccinated infants, this did not appear to translate to greater risk of disease.

Maternal high-calorie diet feeding programs hepatic cholesterol metabolism and Abca1 promoter methylation in the early life of offspring

Maternal high-calorie diet feeding can dramatically increase the susceptibility of metabolic diseases in offspring. However, whether maternal high-calorie diet feeding can program hepatic cholesterol metabolism in the early life of offspring is less understood, and the epigenetic mechanisms underlying this intergenerational effect, especially during the early life of offspring, are unknown. Female C57BL/6J mice were randomly assigned to a high-calorie diet or control diet before and during gestation, and lactation. Lipid metabolism was evaluated in male offspring at weaning. Gene expressions and quantitative methylation levels of key genes associated with hepatic cholesterol metabolism were further evaluated in offspring at weaning age. We found that maternal high-calorie diet feeding resulted in higher body weight, hypercholesterolemia, elevated total cholesterol in liver homogenates, and fat deposits in the liver in offspring at weaning. For key genes that regulate cholesterol metabolism in liver, we showed lower Hmgcr and Ldlr, and higher Abca1 mRNA and protein expressions in offspring from dams fed with high-calorie diet at weaning age. We further found that maternal high-calorie diet feeding significantly decreased Abca1 methylation level in offspring, with lower methylation levels of both CpG 11 and CpG 22 sites. Interestingly, we found that Abca1 methylation level was negatively associated with hepatic Abca1 mRNA expression in offspring from dams fed with high-calorie diet and controls. However, the expressions of key genes associated with hepatic cholesterol metabolism were not significant between fetuses of dams fed with high-calorie diet and control diet. In conclusion, our results indicate that maternal high-calorie diet feeding results in aberrant lipid metabolism, including hypercholesterolemia and fat deposits in the liver of offspring as early as weaning age. Furthermore, maternal high-calorie feeding can program hepatic cholesterol metabolism and Abca1 methylation in the early life of offspring.

Co-designing a conceptual framework of home visiting implementation quality

Early childhood home visiting is a two-generation approach to promote positive health and well-being outcomes among people who are pregnant and families with infants and young children. A popular family support strategy for the past several decades, home visiting expanded exponentially in the United States when the federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) was authorized in 2010 through a provision within the Affordable Care Act. MIECHV currently funds evidence-based home visiting services in underserved and historically marginalized communities in all 50 states, 22 tribes, the District of Columbia, and five U.S. territories. It is widely accepted that achieving intended child and family outcomes through home visiting services requires “high-quality” program implementation, but the field lacks a standard definition or empirical evidence for what “quality” means in the context of home visiting. With the rapid expansion of home visiting that has accompanied MIECHV, there is increased interest from the field in having a shared understanding of home visiting implementation quality that is applicable across models and accounts for dimensions of quality across the entirety of the home visiting implementation system. This paper describes the process used to develop a conceptual framework to understand home visiting quality. We engaged MIECHV awardees and other experts from the fields of home visiting, early childhood, implementation science, and health equity in a co-design process that involved initial brainstorming, a series of iterative framework drafts, and finalization of the model. The resulting framework captures the multiple levels (i.e., the contexts, agencies, entities, and individuals) that are part of the home visiting system and the theorized key aspects of quality that are applicable across the levels of the systems. We discuss potential uses of the conceptual framework, as well as lessons learned from the co-design process.

O.5.2-10 Barriers to physical activity among parous women postpartum: a qualitative study in Denmark

Abstract Purpose Physical activity (PA) among parous women postpartum has multiple health benefits to mother and child. Knowledge of the barriers to PA among parous women postpartum is necessary to support future health-enhancing PA interventions. The purpose of this study was to explore the barriers to PA in parous women six to 10 months after giving birth. Methods In this qualitative study, we used a phenomenological–hermeneutic approach to explore barriers to PA among parous women six to 10 months postpartum. Semi-structured interviews were conducted including 16 parous women from Central Denmark Region. These women were physically active before pregnancy; had a mean age of 29 years; differed in level of education; and represented both vaginal birth and caesarian section. The women were recruited from two sources. 1) a video on Facebook, which had &amp;gt;10.000 views, and 2) the Department of Health Visitors at Aarhus Municipality. Nvivo was used for analysis. We used open and closed coding, and quotes from the interviews were used to support claims and illustrate the identified barriers. Results Three categories of barriers were identified. 1) The individual level: lack of motivation to engage in PA, insufficient self-efficacy in PA, limited economical resources, and bodily physical changes. 2) The interpersonal level: lack of a training partner, childcare, and missing community-based activities in sports clubs. 3) The structural level: lack of guidance and directions on PA from the healthcare system, lack of training facilities, the accessibility of training facilities, and the weather. Fourteen of the 16 included women felt “lack of guidance on PA from the healthcare system” as a barrier to PA postpartum. Conclusions 11 barriers to PA among parous women were identified. On a policy level, “lack of guidance and directions from the health care system” is a modifiable barrier, calling for intervention. Health-enhancing PA in parous women postpartum may be improved by addressing this barrier, when future maternity care programs are developed. Support/Funding No funding source was applied for this study.

Development programming: Stress during gestation alters offspring development in sheep.

Inappropriate management practices of domestic animals during pregnancy can be potential stressors, resulting in complex behavioural, physiological and neurological consequences in the developing offspring. Some of these consequences can last into adulthood or propagate to subsequent generations. We systematically summarized the results of different experimental patterns using artificially increased maternal glucocorticoid levels or prenatal maternal physiological stress paradigms, mediators between prenatal maternal stress (PMS)and programming effects in the offspring and the effects of PMS on offspring phenotypes in sheep. PMS can impair birthweight, regulate the development of the hypothalamic-pituitary-adrenal axis, modify behavioural patterns and cognitive abilities and alter gene expression and brain morphology in offspring. Further research should focus on the effects of programming on gene expression, immune function, gut microbiome, sex-specific effects and maternal behaviour of offspring, especially comparative studies of gestational periods when PMS is applied, continual studies of programming effects on offspring and treatment strategies that effectively reverse the detrimental programming effects of prenatal stress.

Genetic associations of ewe body condition score and lamb rearing performance in extensively managed meat sheep

Many small ruminant production systems are relatively low input and rely heavily on animals grazing pastures often in extensive and harsh environmental conditions, unsuitable for any other type of agriculture. New breeding goal traits for lifetime resilience for maternal sheep breeding programmes have been investigated, focusing on body tissue mobilisation phenotypes and their genetic relationships with maternal production traits. Performance records of 8,355 Scottish Blackface ewes, from 2 extensively reared hill sheep flocks, collected over a 20-year period, were used to quantify relationships between body condition score (BCS) and the ewe's ability to successfully rear lambs. Between 14,000 and 25,000 data records per trait were available, measured across the annual sheep reproductive cycle. The pedigree file used for the analyses included sire and dam information for 50,207 animals. Most heritability estimates for the BCS traits - measured at key time points within the annual production cycle, or considering BCS changes between time points - were low, but significantly different from zero, ranging between 0.07 and 0.17. The heritability estimate for the number of lambs at pregnancy scanning was 0.09. Heritabilities for foetal loss from pregnancy scanning to lambing, lamb loss from lambing to weaning and number of lambs weaned were 0.02, 0.02 and 0.06, respectively. These estimates indicate that genetic control over the reproductive and lamb survival traits (expressed as a trait of the dam), is lower than that for BCS (and BCS changes) over the reproductive cycle. The genetic relationships amongst the BCS of ewes at pre-mating, pregnancy scan and at pre-lambing, with litter size at pregnancy scan and number of lambs weaned, were consistent. They indicate that ewes of higher body condition score (potentially over-fat, within the range recorded in these flocks) conceive, and rear, fewer lambs, with genetic correlations ranging between -0.18 and -0.58. However, post-weaning, animals with genetic propensity for greater gain in BCS from weaning to pre-mating produce larger litters and rear more lambs. In addition, the selection of ewes that lose less condition during pregnancy will reduce foetal losses. The results from this study paint a complex picture that should be interpreted in the context of specific management practices for extensively managed hill sheep, at critical times in their reproductive cycle. The traits relating to body tissue mobilisation, as assessed using BCS, are mostly heritable and their inclusion in future breeding programmes, to aid future selection for resilience, should be considered.

Characteristics and outcomes of socioeconomically disadvantaged pregnant individuals with adult congenital heart disease presenting to a Cardio-Obstetrics Program

Outcomes of individuals with adult congenital heart disease (ACHD) who are socioeconomically disadvantaged and cared for in a cardio-obstetric programs are lacking. To describe clinical characteristics, maternal pregnancy outcomes and contraceptive uptake of individuals with ACHD in an urban cardio-obstetric program. Retrospective data were collected for individuals with ACHD seen in the Maternal Fetal Medicine-Cardiology Joint Program at Montefiore Health System between 2015-2021 and compared by modified World Health Organization (mWHO) class I,II vs. mWHO ≥II/III. Over 90% of individuals with ACHD were pregnant at the time of referral. mWHO I,II (n=77, 62.4% Black or Hispanic/Latina) had a total of 94 pregnancies and mWHO ≥II/III (n=49, 49.0% Black or Hispanic/Latina), a total of 56 pregnancies. Over 25% of individuals in each group had a body mass index ≥30 (p=0.78), as well as very low summary socioeconomic scores. mWHO ≥II/III were more likely to be anticoagulated in the first trimester than mWHO I, II (10.7% vs. 0.0%, p=0.002) and throughout pregnancy (14.3% vs 3.2% p=0.02). mWHO ≥II/III were more likely to require arterial monitoring during delivery than mWHO I, II (14.3% vs. 0.0%, p=0.001) or delivery under general anesthesia (8.9% vs. 1.1%, p=0.03), but had a comparable frequency of Cesarean delivery (35.8% vs. 41.3%, p=0.68). There were no in-hospital maternal deaths. There was no difference in the type of contraception recommended by mWHO class, however, mWHO ≥II/III were more likely to receive long acting types or permanent sterilization (35.6% vs 54.6%, p=0.045). In a socioeconomically disadvantaged cohort with ACHD from a historically marginalized community, those with mWHO ≥II/III had more complex antepartum and intrapartum needs, but similar maternal and obstetric outcomes as mWHO I,II. The multidisciplinary approach offered by a cardio-obstetrics program may contribute to successful outcomes in this high-risk cohort and these data are hypothesis generating.

Maternal and child nutrition programme of investigation within the 100 Million Brazilian Cohort: study protocol

IntroductionThere is a limited understanding of the early nutrition and pregnancy determinants of short-term and long-term maternal and child health in ethnically diverse and socioeconomically vulnerable populations within low-income and...

Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care.

Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.

Colostrum: Day 1 and beyond

As dairy farms optimize maternity facilities and early life calf management, proper handling and storage of maternal colos­trum become the single point within a dairy system where all animals must flow. The success of this program therefore has a direct impact on calf and cow performance. Research has shown the benefits of feeding high-quality maternal colostrum to new­born calves and the key role it plays in gastrointestinal tract (GIT)1 and immune system development. Further research has shown benefits of extended colostrum feeding beyond day one to provide a local protective effect in the GIT, food for GIT mi­crobiota,2 and even as part of therapy for common early life calf illnesses such as scours3,4 and bovine respiratory disease (BRD).4 Producers and veterinarians should work together to understand how each dairy can best manage their maternity and colostrum programs to optimize early life calf health and development.