Maternal Well-being Research Articles

Adverse childhood experiences predict anxiety during postpartum and early childhood parenting

Perinatal anxiety disorders (PAD) affect one in five pregnant/postpartum people and are associated with adverse maternal and child health outcomes. Effective treatment and prevention rely on early identification and management of risk factors. Our study fills a gap in literature about how maternal adverse childhood experiences (ACEs) relate to PAD during and beyond the postpartum period. Using longitudinal data from a population-based sample of mothers in Colorado, USA (N = 1116), we evaluated whether maternal ACEs predicted self-reported anxiety symptoms, measured six times between 3 and 36 months postpartum. A mixed mean model of anxiety was fit with ACEs as the predictor and maternal age, race, ethnicity, education, marital status, and parity as covariates. Controlling for sociodemographic covariates, mothers reporting four or more ACEs had significantly higher levels of anxiety than those reporting less than four ACEs (b = 0.84, 95% CI (0.53, 1.15), p<.001) over the three-year period. Mothers of younger age at time of birth (25–34 years vs. <24 years: b=-0.54, 95% CI (-1.00, −0.08), p=.02) and non-Hispanic ethnicity (b = 0.47, 95% CI (0.09, 0.85), p=.01) were also found to have higher anxiety over this period. Our findings support screening for and addressing maternal ACEs early in obstetric care and well-child visits through trauma-informed, strengths-based approaches that promote maternal, child, and intergenerational well-being.

Maternal, Fetal, and Labour Outcomes of Dupilumab Use for Atopic Dermatitis During Pregnancy: A Systematic Review.

Atopic dermatitis is a chronic complex inflammatory disease that significantly impacts maternal well-being and quality of life during pregnancy, warranting effective therapeutic interventions that prioritize maternal health and fetal safety. Dupilumab is approved for moderate-to-severe atopic dermatitis, but limited data exist regarding its safety during pregnancy. We conducted a systematic review to review and analyze maternal, fetal, and labour outcomes in patients receiving dupilumab for atopic dermatitis during pregnancy. Comprehensive searches were conducted using databases including OVID, Scopus, and Web of Science, covering studies published until May 2024. Our search yielded 285 studies, of which 13 met the eligibility criteria. These studies included 68 patients with 69 pregnancies, revealing 58 live births and 11 spontaneous abortions. Dupilumab therapy was administered continuously throughout pregnancy in 22.2% of cases, while 77.8% received intermittent treatment. Maternal atopic dermatitis outcomes showed significant improvement in disease severity. Most pregnancies (86.3%) progressed without complications. Labour-associated outcomes varied, with 82.4% of women undergoing vaginal deliveries. The majority of births occurred at full term (82.5%), with a mean gestational age of 38.4 weeks. Fetal outcomes demonstrated a normal birth weight in 92.3% of cases, with no reported congenital defects. Our review suggests that dupilumab use during pregnancy is associated with improvement of atopic dermatitis and low or minimal risk of major adverse outcomes in treated patients or their newborns. Prospective studies with long-term follow-up are warranted to confirm the safety of dupilumab in this population.

Descriptive Study on Nature of Perceived Stress of Mothers of Children with Autism Spectrum Disorder - A Qualitative Analysis

This study examines the nature and impact of parental stress specifically among mothers of children with Autism Spectrum Disorder (ASD). Parental stress is a significant concern in families raising children with ASD due to the unique challenges associated with the condition. The study aims to explore the factors contributing to maternal stress, including caregiving demands, social support, coping mechanisms, and personal resilience. Methodologically, in-depth interviews as the mono-method approach are employed, to measure stress levels with qualitative insights into mothers' experiences. Participants are recruited from diverse socio-economic backgrounds to ensure a comprehensive understanding of the phenomenon. Findings highlight the multifaceted nature of parental stress in this population, shedding light on the specific stressors and protective factors that influence maternal well-being. Implications for interventions and support services aimed at alleviating maternal stress and promoting family resilience are discussed based on the study's results.

Prenatal weight stigma can affect relationship quality and maternal health outcomes

BackgroundWeight stigma is defined as negative misconception and stereotypes associated with weight, and it is commonly experienced during pregnancy. Weight stigma during pregnancy may be sourced from trusted close relationships including family members, partners, and friends. Social support is a necessary psychosocial factor for optimal health and wellbeing throughout pregnancy, and weight stigma sourced from these integral relationships may negatively affect health outcomes. The purpose of this study was to assess the impact of weight stigma from close others on maternal health outcomes.MethodsA survey was administered via Qualtrics to pregnant women (≥ 13 weeks, residence within the United States or Canada, ≥ 18 years old, singleton pregnancy). During pregnancy, participants completed questionnaires identifying whether they had experienced weight stigma from a close relationship (i.e., family, partners, or friends), how often, and relationship quality scales for each source. At three months postpartum, they were surveyed about their pregnancy outcomes including gestational diabetes, gestational hypertension, preeclampsia, chronic pain, anxiety/depression. They also completed the Edinburgh Postpartum Depression Scale (EPDS), and a linear regression was performed with frequency of weight stigma. Logistic regressions were performed between frequency of weight stigma and health outcomes. If significant, relationship quality was tested as a potential mediator. Significance was accepted as p < 0.05.Results463 participants completed both surveys of which 86% had experienced weight stigma from close others. Frequency of weight stigma was significantly associated with chronic pain (β = 0.689, p < 0.001), and anxiety/depression (β = 0.404, p = 0.005). The relationship between frequency of weight stigma in pregnancy and chronic pain was mediated by quality of all relationships. Family relationship quality mediated between frequency of weights stigma and anxiety/depression. Frequency of weight stigma was significantly associated with depression symptom severity measured by the EPDS (β = 0.634, p < 0.001).ConclusionThese findings underscore the issue of weight stigma and show that experiencing this from trusted close others is associated with poor health outcomes like chronic pain. Advocacy efforts to mitigate weight stigma in pregnancy and strengthen close relationships to improve maternal health and wellbeing is warranted.

Association of sociodemographic, obstetric characteristics, lifestyle and food consumption with life satisfaction and optimism among overweight pregnant women.

The present study investigated the relationships between maternal characteristics and subjective well-being (life satisfaction and optimism) among overweight Brazilian adult pregnant women. A cross-sectional study utilising baseline data from a randomised controlled clinical trial was conducted. A total of 330 women were investigated. Maternal characteristics (sociodemographic, obstetric and lifestyle) were obtained through a structured questionnaire. Data on dietary intake were collected through two 24-h dietary recalls, and the usual diet was estimated using the Multiple Source Method. Life satisfaction and optimism were assessed using validated instruments. Both unadjusted and adjusted linear regression models were employed to investigate the relationship between maternal characteristics and subjective well-being. Sleep quality was found to be positively associated with life satisfaction. Miscarriage and smoking during pregnancy were negatively associated with this sentiment. Additionally, a positive association was observed between optimism and maternal characteristics such as sleep quality, desired pregnancy and alcohol consumption in the previous 30 d. Furthermore, it was found that the consumption of sugary drinks, dietary fibre and Ca were positively associated with this same feeling. The present study showed that some maternal and food consumption characteristics were associated with subjective well-being among overweight pregnant women. It is, therefore, essential to recognise predictors of maternal mental health given their relevance to the field of public health.

Social workers’ perspectives on anti-Black racism and parenting outcomes for incarcerated pregnant women with substance use histories

Summary Black women who use substances face significant barriers to accessing resources and parenting their children, largely as a result of interactions with the criminal legal, child welfare, and healthcare systems. While extensive literature has demonstrated how structural racism and punitive policy approaches underpin the operation and impact of these systems, minimal attention has been paid to how social workers approach child, maternal, and family well-being when interacting with clients who use substances and have been incarcerated. To address this gap, we conducted semi-structured qualitative interviews with 19 social workers practicing in jail/prison, community, and hospital settings across the United States. Findings Interviews identified the cyclical and intergenerational nature of harms perpetuated through criminal legal, child welfare, and healthcare systems. Participants described structural racism, inadequate resources (i.e., housing), and previous criminal legal and child welfare involvement as compounding barriers to an individual’s ability to parent and maintain recovery, particularly among Black families. Participants described the pervasiveness of structural racism but did not perceive themselves as active participants in perpetuating racist and oppressive structures. Applications Social workers engage with Black pregnant women who use substances across diverse practice settings and as such have the potential to both contribute to systemic harms and to champion interventions that target the root causes of inequity. Study findings support structural interventions that dismantle punitive systems and re-center the needs of Black communities, thereby supporting Black mothers in their fundamental right to parent their children.

Psychometric Evaluation of Women's Knowledge of Healthcare Rights and Perception of Resource Scarcity during Maternity.

Background/Objectives: Resources to cope with maternity and women's participation are essential modulators of maternal well-being. Therefore, it is relevant that the psychosocial factors of woman be monitored during maternity to promote adequate healthcare. This study involved the design and the validation of two new tools that identify women's knowledge of healthcare rights (MatCODE) and perception of resource scarcity (MatER) during pregnancy, labor and early postpartum; Methods: The content validity was carried out using the Aiken's V coefficient and the content validity index (CVI-i) based on five experts. In addition, for the face validity, the pilot cohort was considered the INFLESZ scale. Finally, the questionnaires were applied to 185 women, which allowed to assess the construct validation by factorial and Rasch analysis. The divergent validity was also studied with validated psychological questionnaires; Results: MatCODE and MatER questionnaires received CVI-i and Aiken's V > 0.80 values, and the INFLESZ demonstrated acceptable semantic understanding. The analysis confirms the unidimensionality of the questionnaires, with fit values for MatCODE of RMSEA = 0.113 [0.105; 0.122] and for MatER of RMSEA = 0.067 [0.063; 0.072]. The divergent validity showed significant and consistent correlations with the constructs assessed. For MatCODE, ω = 0.95 and α = 0.94, and for MatER, ω = 0.79 and α = 0.78; Conclusions: MatCODE and MatER are useful new tools for monitoring maternal healthcare, with adequate psychometric characteristics in the Spanish context.

Partnership quality and maternal depressive symptoms in the transition to parenthood: a prospective cohort study

BackgroundPregnancy and childbirth are critical life events which lead to significant changes in family structures and roles, thus having a substantial impact on partner relationship and maternal wellbeing. A dysfunctional partnership during this critical time of life has been associated with maternal depressiveness. However, sub-components of partnership quality and the causal relation with maternal symptoms of depression in the perinatal period have been sparsely studied so far. The current study aims to longitudinally assess the course of relationship quality and its sub-components from pregnancy to postpartum and to test a potential causal association with maternal symptoms of depression in the perinatal period.MethodsDiffering from previous studies, partnership quality and symptoms of depression have been assessed prospectively and longitudinally from an early stage of pregnancy (second trimester) until six months postpartum. Cross-lagged panel models were applied to investigate a potential causal relationship between partnership quality and maternal depressive symptoms.ResultsRelationship quality decreased significantly during the transition to parenthood (p < .05) with the steepest decline referring to tenderness (p < .001). We also found a substantial association of relationship quality and maternal depressiveness, but no indication for a clear causal direction of this association.ConclusionsOur results suggest that relationship quality and maternal depressiveness are substantially related in the perinatal period, thus pointing to the need of early prevention and intervention programs for peripartum women and their partners to prevent adverse outcome for the couple and the family.

Effects of Maternal Obesity on Oxidative Parameters in Maternal and Cord Blood Samples.

Aim The purpose of this study was to analyze oxidative stress parameters in maternal and cord blood samples from both obese and nonobese women. Methods Our study included 30 obese and 35 nonobese pregnant women aged 18-40. We analyzed and compared oxidative stress parameters, including thiol/disulfide balance markers (native thiol, total thiol, and disulfide), albumin, ischemia-modified albumin (IMA), myeloperoxidase (MPO), catalase, ceruloplasmin, and intracellular glutathione levels. Results The comparison of maternal blood oxidative stress parameters between obese and nonobese pregnant women showed significantly higher levels of disulfide, catalase (kU/L), and ceruloplasmin (U/L) in the obese group (p = 0.005, p = 0.001, p < 0.001, respectively). Similarly, in cord blood, disulfide (µmol/L), IMA, catalase (kU/L), and (U/L) levels were significantly higher in the obese group (p < 0.001, p = 0.049, p < 0.001, p = 0.023, respectively), while albumin levels were significantly higher in the nonobese group (p = 0.003). Conclusions Our results suggest a strong association between maternal obesity and increased oxidative stress in both mothers and their offspring. Elevated oxidative stress levels may contribute to adverse maternal and fetal clinical outcomes. Therefore, we conclude that maintaining healthy weight control during reproductive age is crucial for ensuring maternal and fetal well-being.

Exploring Effective Interventions for Postpartum Blues: A Review of Current Literature

Postpartum blues, or "baby blues," is a common condition affecting 50-80% of new mothers, marked by mood swings, tearfulness, anxiety, and fatigue. It typically emerges within the first two weeks postpartum and can impact mother-infant bonding and maternal well-being. Left untreated, it may escalate into more severe postpartum mood disorders. This review aims to assess the efficacy, accessibility, and feasibility of various interventions for postpartum blues, synthesizing current research to inform clinical practices and future studies. A systematic review of peer-reviewed articles from 2010 to 2024 was conducted using PubMed, CINAHL, and PsycINFO databases. Articles were selected based on relevance, methodological rigor, and focus on postpartum blues interventions. After screening, 72 articles met the inclusion criteria and were included in the final analysis. The review identified several effective interventions across different domains: Psychosocial intervention particularly peer support programs and cognitive-behavioral therapy (CBT) were most effective in reducing postpartum blues symptoms; Hormonal and pharmacological interventions, including neuroactive steroids and selective serotonin reuptake inhibitors (SSRIs), showed mixed but promising results; Nutritional interventions, particularly omega-3 supplementation, demonstrated significant preventive effects; Mind-body interventions, such as mindfulness-based therapies, were effective in improving mood stability; Technology-based interventions, including mobile health applications and AI-driven support, showed potential for scalable and accessible solutions. Psychosocial interventions provide the strongest evidence for managing postpartum blues, while emerging research on hormonal, nutritional, and technology-based interventions offers promising new directions. A personalized, multimodal approach integrating these strategies is recommended for improving maternal mental health during the postpartum period.

Comprehensive Management of Pelvic Trauma in Pregnant Patients

Pelvic fractures occur frequently due to traffic accidents and high-energy. Pregnant women are susceptible to trauma, with one in 12 pregnancies complicated by such incidents, making trauma the leading cause of non-obstetric maternal deaths during pregnancy. Pelvic fractures during pregnancy pose significant risks, potentially leading to adverse pregnancy outcomes such as preterm delivery, placental abruption, fetal distress, and even maternal or fetal death. The physiological changes that occur during pregnancy, including increased blood volume and altered cardiovascular dynamics, further complicate the management of pelvic trauma in pregnant patients. Prompt and appropriate management of pelvic trauma in pregnant patients is essential to optimize outcomes for both the mother and the fetus. Initial evaluation and stabilization of the mother take precedence, with close attention to airway, breathing, and circulation. Diagnostic imaging, including pelvic X-rays and, when feasible, body CT or MRI, aids in assessing the extent of pelvic injury and identifying associated injuries. Definitive treatment of pelvic fractures may involve a combination of surgical fixation, bed rest, traction, and pelvic slings, depending on the severity of the injury. The timing and approach to delivery in pregnant patients with pelvic fractures require careful consideration, with vaginal delivery being a viable option in many cases, provided that the pelvic architecture remains intact. Conclussions: The management of pelvic trauma in pregnant patients requires a multidisciplinary approach and careful consideration of maternal and fetal well-being. Further research is needed to establish clear treatment guidelines and preventive strategies to reduce the incidence of pelvic fractures during pregnancy and improve outcomes for both mother and fetus.

A review on the role of postpartum homecare program in identification, managing and preventing common complications

The postpartum period is a crucial phase for mothers, requiring close monitoring and care to address physical, emotional, and psychological challenges. Comprehensive support is provided to new mothers through postpartum homecare programs, which prioritise the prevention and management of problems such gestational diabetes, hypertension, and postpartum depression. These programs ensure timely interventions for conditions like infections, excessive bleeding, and mental health concerns, which are common during this time. Homecare visits provide personalized care, with healthcare professionals offering guidance on breastfeeding, infant care, and self-care practices. The program's emphasis on maternal well-being reduces hospital readmissions and ensures early detection of serious conditions like postpartum hemorrhage and hypertension, promoting quicker recovery. Moreover, postpartum homecare enhances emotional support, helping new mothers cope with stress, anxiety, and fatigue. By fostering a strong mother-infant bond and addressing the unique needs of each patient, these programs contribute to better long-term health outcomes for both mother and baby, empowering women to confidently navigate the postpartum journey.

6693 Hypopituitarism in Pregnancy

Abstract Disclosure: N.A. Mcheik: None. H. Howarth: None. Background: Hypopituitarism in pregnancy requires careful management to ensure both maternal and fetal well-being. Disruptions of the pituitary gland in pregnancy can be due to adenomas, pituitary infarction, autoimmune disease, trauma, etc. Complications of hypopituitarism in pregnancy stem from inadequate production of thyroid stimulating hormone, growth hormone, gonadotropins and cortisol. Hormone replacement therapy will be necessary in such cases. For instance, patients in late pregnancy may require an increased dose of hydrocortisone due to the rise of corticosteroid-binding globulin. Patients may need increased doses of glucocorticoid therapy during labor given the major surgical stress. Antenatal care should include close follow up with endocrinologists and obstetricians and regular assessment of maternal hormone levels and fetal growth. Case: We present a case of a 37-year-old female G3P0020 at 24 weeks who presented with complaint of constant headache for 6 days. Associated with photophobia, intermittent blurry vision, nausea, and vomiting. She was admitted and given 1 g Magnesium bolus as well as Robaxin and Tylenol for headache without relief. Given persistence of symptoms and non-focal neurologic exam, MRI brain was completed that showed an enlarged pituitary gland with blood products. MRI pituitary showed an approximately 1.3 x 1.2 x 1.8 cm hemorrhagic lesion on the right side of pituitary gland with fluid level, most in keeping with hemorrhagic pituitary apoplexy. Thyroid function studies were consistent with central hypothyroidism with a low TSH 0.05, low Ft4 0.5, and normal Ft3 2.4. Luteinizing hormone was 0.1 mIU/mL (&amp;lt;1.5 normal in pregnancy), follicle stimulating hormone was &amp;lt;0.5 mIU/mL (&amp;lt;0.1 normal in pregnancy), estradiol &amp;gt;5000 pg/mL (1278-7192 normal in pregnancy), and prolactin 254 ng/mL (80-400 normal in pregnancy). IGF-1 was normal at 148 ng/ml. Morning cortisol was low at 1.8 ug/dL and ACTH was 9 pg/mL (low normal). Cortrosyn stimulation test at 60 minutes was normal at 17.7 ug/dL, however, given clinical improvement on steroids, the clinical picture is consistent with central hypoadrenalism. For treatment, she was started on IV hydrocortisone 50 mg every 8 hours and oral levothyroxine 100 mcg daily. The patient was discharged home on oral hydrocortisone 20 mg daily in the morning and 10 mg daily in the afternoon with close follow up. Conclusion: Ultimately, the management of hypopituitarism in pregnancy requires a personalized approach to hormone replacement and obstetric care and this is done through multidisciplinary care involving endocrinologists and obstetricians to optimize outcomes for both the mother and the baby. Presentation: 6/1/2024

6693 Hypopituitarism in Pregnancy

Abstract Disclosure: N.A. Mcheik: None. H. Howarth: None. Background: Hypopituitarism in pregnancy requires careful management to ensure both maternal and fetal well-being. Disruptions of the pituitary gland in pregnancy can be due to adenomas, pituitary infarction, autoimmune disease, trauma, etc. Complications of hypopituitarism in pregnancy stem from inadequate production of thyroid stimulating hormone, growth hormone, gonadotropins and cortisol. Hormone replacement therapy will be necessary in such cases. For instance, patients in late pregnancy may require an increased dose of hydrocortisone due to the rise of corticosteroid-binding globulin. Patients may need increased doses of glucocorticoid therapy during labor given the major surgical stress. Antenatal care should include close follow up with endocrinologists and obstetricians and regular assessment of maternal hormone levels and fetal growth. Case: We present a case of a 37-year-old female G3P0020 at 24 weeks who presented with complaint of constant headache for 6 days. Associated with photophobia, intermittent blurry vision, nausea, and vomiting. She was admitted and given 1 g Magnesium bolus as well as Robaxin and Tylenol for headache without relief. Given persistence of symptoms and non-focal neurologic exam, MRI brain was completed that showed an enlarged pituitary gland with blood products. MRI pituitary showed an approximately 1.3 x 1.2 x 1.8 cm hemorrhagic lesion on the right side of pituitary gland with fluid level, most in keeping with hemorrhagic pituitary apoplexy. Thyroid function studies were consistent with central hypothyroidism with a low TSH 0.05, low Ft4 0.5, and normal Ft3 2.4. Luteinizing hormone was 0.1 mIU/mL (&amp;lt;1.5 normal in pregnancy), follicle stimulating hormone was &amp;lt;0.5 mIU/mL (&amp;lt;0.1 normal in pregnancy), estradiol &amp;gt;5000 pg/mL (1278-7192 normal in pregnancy), and prolactin 254 ng/mL (80-400 normal in pregnancy). IGF-1 was normal at 148 ng/ml. Morning cortisol was low at 1.8 ug/dL and ACTH was 9 pg/mL (low normal). Cortrosyn stimulation test at 60 minutes was normal at 17.7 ug/dL, however, given clinical improvement on steroids, the clinical picture is consistent with central hypoadrenalism. For treatment, she was started on IV hydrocortisone 50 mg every 8 hours and oral levothyroxine 100 mcg daily. The patient was discharged home on oral hydrocortisone 20 mg daily in the morning and 10 mg daily in the afternoon with close follow up. Conclusion: Ultimately, the management of hypopituitarism in pregnancy requires a personalized approach to hormone replacement and obstetric care and this is done through multidisciplinary care involving endocrinologists and obstetricians to optimize outcomes for both the mother and the baby. Presentation: 6/1/2024

Accessing Trauma- and Violence-Informed Breastfeeding Support from Primary Care Providers among Women with Histories of Intimate Partner Violence: An Exploratory Interpretive Description Study.

Intimate partner violence (IPV) is a wicked social problem affecting women of all social strata and geographical location, globally. Pregnancy may be a time of heightened risk of IPV and more deleterious outcomes. Breastfeeding - a protective factor for maternal and child well-being - may be jeopardized or more challenging for women experiencing IPV. This study explored the experiences of postpartum women with histories of IPV who sought trauma- and violence-informed breastfeeding support from primary care providers. Using interpretive description and philosophically underpinned by intersectionality, in-depth semi-structured interviews were completed at 12-weeks postpartum with five breastfeeding mothers with a history of IPV who sought breastfeeding support from a family physician clinic employing a trauma- and violence-informed (TVIC) model of care. Four themes and two sub-themes shed light onto the experience of accessing breastfeeding support for women with a history of IPV and the perceived barriers that they faced when attempting to accesses this support, including: 1) The (demoralizing) navigation of the perinatal system; 2) Fostering trust: i) "It's support, but it's also knowledge"; and ii) TVIC: feeling safe and feeling "I mattered"; 3) Informal support: partners, family, and friends; and 4) Baby in focus: overcoming challenges and building confidence. TVIC may aid in the development of trusting therapeutic relationships, in turn improving access to breastfeeding support, breastfeeding self-efficacy, and breastfeeding success for women who experience violence. Further research on the implementation and evaluation of TVIC for perinatal breastfeeding education and care among women is required.

Maternal perceived safety and parenting practices with young children: a cross-sectional analysis from 15 low-income and middle-income countries

IntroductionSocial environments can influence parents’ caregiving capacities and the quality of nurturing care provided to children. These links, in turn, can shape children’s developmental outcomes over the life course. We...

Safety of Medications Used to Treat Autoimmune Rheumatic Diseases During Pregnancy and Lactation.

Autoimmune rheumatic diseases (ARDs) often affect women during their reproductive years, and early studies of pregnancy in these patients reported high rates of adverse outcomes. Continuation or initiation of safe and effective medications in the preconception period is beneficial for maintaining or achieving disease quiescence throughout pregnancy thereby improving both maternal and pregnancy outcomes. The European Alliance of Associations for Rheumatology, the American College of Rheumatology, and the British Society for Rheumatology have published recommendations and guidelines regarding management of ARDs during pregnancy. The American College of Obstetricians and Gynecologists and the American Gastroenterological Association have also provided guidance statements with relevant recommendations. This review provides an overview of available recommendations for medication use in ARD pregnancy, with discussion of safety considerations for maternal and fetal well-being. Medications considered compatible with pregnancy include hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, tacrolimus, and TNF inhibitors. Methotrexate, mycophenolate, leflunomide, and cyclophosphamide should be avoided before and during pregnancy. Other medications, most of them newer, are largely discouraged for use in pregnancy due to inadequate data or concerns for neonatal immunosuppression, including non-TNF biologics and small molecule therapies. Further investigation is needed regarding effects of non-TNF biologics, biosimilars, and small molecules in pregnancy. Important efforts for the future will include improved methodologies to gather critical safety data, with consideration of inclusion of pregnant women in clinical trials, a complex and controversial issue. Long-term information on outcomes in offspring of treated women is lacking for many of these medications.

Different patterns of endorsement of intensive mothering beliefs: Associations with parenting guilt and parental burnout.

The unrealistic expectations rooted in intensive mothering beliefs can negatively impact maternal well-being. The present study investigates associations between intensive mothering beliefs, parenting guilt, and parental burnout using a person-centered approach. We first examined whether different profiles of mothers exist based on their endorsement of the five subbeliefs of the Intensive Parenting Attitudes Questionnaire. We then tested associations between these profiles and parenting guilt and parental burnout and whether mothers' demographic characteristics predicted profile membership. Using data from 291 mothers (61% White, 15% Black/African American) with at least one child under 6 years old, we identified four profiles of mothers. Two distinct patterns of intensive mothering endorsement emerged: mothers who exhibited consistent levels of endorsement across the five subbeliefs (i.e., high endorsement, moderate endorsement, and low endorsement) and mothers who were characterized by higher endorsement on fulfillment, stimulation, and child-centered but lower endorsement on essentialism and challenging (i.e., selective endorsement). Profile membership contributed to differences in parenting guilt and parental burnout. Parenting guilt was the highest in the profile characterized by the high levels of endorsement across all five subbeliefs (high endorsement) and was significantly higher than low endorsement. Parental burnout was the lowest in the selective endorsement and was significantly lower than in the high endorsement and moderate endorsement. These results highlight the heterogeneity of subscribing to intensive mothering beliefs and suggest that magnitude and patterns of endorsement of intensive mothering beliefs differentially contribute to parenting-related well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of Maternal Health and Stress on Steroid Hormone Profiles in Human Milk: Implications for Infant Development

Steroid hormones are biologically active factors in human milk (HM) that influence the physical and mental development of infants. Critically, maternal psychosocial stress has been associated with changes in HM steroid composition. This work aimed to characterize the steroid hormone profile of HM and pasteurized donor human milk (DHM) and assess the interplay between maternal physical and psychosocial status, the HM steroid profile, and infant outcomes.A targeted ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed to quantify sixteen steroid hormones in HM samples. HM samples from mothers of term infants (N=42) and preterm infants (N=35) were collected at (i) recovery of birth weight or achievement of complete enteral nutrition, respectively, and (ii) 6 months later as well as DHM samples (N=19) from 11 donors. The physical and psychosocial status of mothers and infant neurodevelopment and temperament were assessed through structured interviews and validated questionnaires.Fourteen steroids were detected in HM/DHM samples, with cortisol, 20β-dihydrocortisol, dehydroepiandrosterone, pregnenolone, and cortisone being present in > 48% of samples. Pregnenolone, 17α-OH-progesterone, and dehydroepiandrosterone are reported for the first time in HM. Whereas milk cortisol levels were not directly related with maternal physical and psychosocial status nor with infant development, cortisone and pregnenolone correlated positively with maternal weight gain during pregnancy and were associated to maternal well-being and infant growth. The pasteurization process may have a detrimental effect on the steroid hormone levels in HM, what might influence the development of receptors.

Implication of Exclusive Breastfeeding in Early Childhood Dental Disorders: Large Cohort Evidence, US National Survey of Children Health.

Purpose/Objective: Frequent consumption of fermented carbohydrates and bottle feeding contribute to the development of early childhood caries (ECC). There are no substantial findings on the effects of breastfeeding patterns on oral health conditions in children in the United States. We aimed to assess the nexus between exclusive breastfeeding during the first 6 months and oral health disorders, namely toothache, decayed teeth, or unfilled cavities in early childhood. Materials and Methods: Design: Cross-sectional epidemiologic design of nationally representative data collected via telephone surveys in the United States was utilized. Setting: National Survey of Children's Health, 2012 Participants: Population-based random sample of parents/guardians of 24,655 children aged 6 months to 5 years. Main Outcome and Measure: The primary outcome was the presence of oral health disorders (OHD) in children, defined as the parent-reported occurrence of one or more of the following conditions in the past 12 months: toothache, decayed teeth, or an unfilled cavity. This was assessed through a single composite question in the survey, asking parents/guardians if their child had experienced any of these specific oral health issues within the previous year with a binary (yes/no) response option. Results: Among 24,655 children aged 6 months to 5 years, 2392 (9.7%) had experienced an oral health disorder (OHD) in the previous 12 months. In unadjusted analysis, children exclusively breastfed for 6 months were 28% less likely to present with OHD compared to never-breastfed children (OR = 0.72, 95% CI, 0.52-0.98). However, after adjusting for key factors, including maternal health and race/ethnicity, this association was no longer statistically significant (aOR = 1.11, 95% CI 0.79-1.57). Significant predictors of OHD included maternal health (aOR for fair/poor vs. excellent/very good maternal health = 1.79, 95% CI 1.08-2.69) and race/ethnicity, with a higher prevalence among non-Hispanic Black (12.9%) and multi-racial children (12.6%) compared to non-Hispanic White children (7.7%). Conclusions and Relevance: While exclusive breastfeeding for the first six months of life was not found to be a significant predictor of pediatric oral health outcomes after adjustment, maternal health and race/ethnicity were significant determinants of oral health disorders. These findings underscore the importance of comprehensive healthcare approaches that consider maternal well-being and socio-demographic factors. Future research should explore interventions targeting these factors to improve pediatric oral health outcomes.