Commemorating the monkey bars, catalyst of debate at the intersection of human evolutionary biology and public health.

Play is an essential part of childhood, and growing attention has focused on the potential health benefits of 'risky' or 'thrill-seeking' play. Such play behavior is readily observed on any playground, where it can sometimes lead to injuries--most often from fall impacts--that require medical attention. Monkey bars account for ~7% of childhood arm fractures in the USA, an alarming statistic that raises difficult questions over its costs and benefits. Many authors view monkey bars as a public health hazard, but it is plausible that our childhood impulse toward thrill-seeking play is a result of selective pressures throughout our primate evolutionary history. Indeed, emerging evidence suggests that the developmental benefits of thrill-seeking play extend into adulthood, outweighing the occasional costs of injury. Disparate and consequential, these dueling perspectives have fueled debate among health professionals and policymakers, but with little attention to the work of biological anthropologists. Here we call attention to the hominin fossil record and play behaviors of non-human primates, providing a novel perspective that bolsters arguments for the adaptive significance of thrill-seeking play. The moment for such a review is timely, for it commemorates the centennial anniversaries of two playground icons: the jungle gym and monkey bars.

Toddler hair cortisol levels are associated with maternal prenatal depression.

OBJECTIVES: Cortisol is an important metabolic hormone that regulates multiple physiologic systems. Cortisol metabolism is sensitive to early life environments, including that experienced prenatally. Limited research has evaluated factors that predict variation in maternal and offspring toddler hair cortisol, which is important since hair cortisol represents different dynamics of hypothalamic pituitary adrenal (HPA)-axis function than more common salivary or serum measures. METHODS: To address this gap, we longitudinally evaluated whether maternal depression measured in pregnancy and 1 month postnatal was associated with maternal and offspring hair cortisol levels approximately 15 months after birth (n = 46 mothers, 40 toddlers; mean 15.6 months postnatal, SD = 2.9 months). RESULTS: Mean depression symptoms were highest during the prenatal period. Prenatal, but not postnatal, maternal depression was associated with offspring hair cortisol levels (B = 0.095, p = .01). Maternal hair cortisol was not associated with depression measured at either time point. CONCLUSIONS: These findings indicate that offspring hair cortisol more than a year after birth is associated with maternal prenatal depression, consistent with previous research in salivary cortisol, suggesting that long-term offspring stress physiology may be influenced by conditions experienced in utero. These findings highlight the potential for hair cortisol-a minimally invasive and easy-to-collect measure- to index toddler HPA-axis dynamics.

Association between maternal depression symptoms and child telomere length.

The biological mechanisms that explain how adverse early life events influence adult disease risk are poorly understood. One proposed mechanism is via the induction of accelerated biological aging, for which telomere length is considered a biomarker. We aimed to determine if maternal depression pre- and post-partum was associated with telomere length in children at 4 years of age (n = 4299). Mothers completed structured questionnaires assessing depression during pregnancy (Edinburgh Depression Scale), at 9 months (Edinburgh Depression Scale), and at 54 months postpartum (Patient Health Questionnaire 9). Regression methods were used to investigate the relationship between telomere length (DNA from saliva) and maternal depression score recorded at each stage. Significant covariates included in the final model were: maternal age at pregnancy; child sex; child ethnicity; gestational age group, and rurality group. Child telomere length was found to be longer if their mother had a higher depression score at both postpartum time points tested (9 months of age; coefficient 0.003, SE = 0.001, P = 0.01, 54 months of age; coefficient 0.003, SE = 0.002, P = 0.02). Although these findings seem paradoxical, increased telomere length may be an adaptive response to early life stressors. We propose several testable hypotheses for these results and to determine if the positive association between depression and telomere length is a developmental adaptation or an indirect consequence of environmental factors.

A longitudinal study of how women's prenatal and postnatal concerns related to the COVID-19 pandemic predicts their infants' social-emotional development.

Infant social-emotional development may be impacted by the COVID-19 pandemic. This study investigated associations between maternal pre- and postnatal pandemic-related concerns and social-emotional developmental risk. Data, collected in 2020-2021, came from 220 mothers (87% white, 6% Hispanic, 1% Black, 3% Asian, 1% American Indian, Mage = 32.46 years), and infants (53.18% male, Mage = 12.98 months) in the United States. Maternal postnatal pandemic-related concerns were associated with total risk scores (B = 6.09, p-value <.001) and offspring risk of scoring positive for problems related to inflexibility (B = 4.07, p-value = .006). The total score association was moderated by self-reported social support. Infants may be detrimentally impacted by the pandemic via maternal pandemic-related concerns. Maternal social support may buffer infants.

Associations between duration of first trimester intrauterine exposure to genocide against the Tutsi and health outcomes in adulthood.

OBJECTIVES: Hundreds of thousands of Rwandans were conceived during the 1994 genocide against the Tutsi, including thousands conceived by genocidal rape. We explore whether the duration of first trimester exposure to the genocide is associated with variation in adult mental health outcomes in individuals exposed to varying degrees of genocide-related stress in utero. MATERIALS AND METHODS: We recruited 30 Rwandans conceived via genocidal rape, 31 Rwandans conceived by genocide survivors not raped, and 30 individuals of Rwandan-descent who were conceived outside of Rwanda at the time of the genocide (control group). Individuals were age- and sex-matched across groups. Adult mental health was assessed through standardized questionnaires for vitality, anxiety, and depression. RESULTS: Among the genocide only group, a longer duration of first trimester prenatal exposure was associated with higher anxiety scores and lower vitality (both p < 0.010), and higher depression scores (p = 0.051). Duration of first trimester exposure was not associated with any measures of mental health among the genocidal rape or control group. DISCUSSION: Duration of exposure to genocide in the first trimester of gestation was associated with variation in adult mental health among the genocide only group. The lack of association between duration of first trimester exposure to genocide and adult mental health in the genocidal rape group may reflect the fact that stress associated with conception through rape persisted beyond the genocide period itself, encompassing all of gestation and likely beyond. Geopolitical and community interventions are needed in the context of extreme events during pregnancy to mitigate adverse intergenerational outcomes.

Global Public Health Nursing.

BACKGROUND: An often under addressed and tragic legacy of genocide is the conception of children from rape. While the experience has been documented from their mothers' perspective, the perspectives and needs of individuals born of genocidal rape has been under-studied. METHODS: We conducted an integrative review of all peer-reviewed articles that reported on studies conducted among individuals born of genocidal rape published through 2020. We used an inductive process to identify and describe the themes from those studies. RESULTS: Twelve studies met the inclusion criteria. Ten articles reported on youth born of genocidal rape in Rwanda aged between 16 and 21 years, and two articles represented the perspective of adolescents in the former Yugoslavia aged 1416 years. Four themes were indentified: (1) birth origin stories associated with the crime of the father, (2) fractured sense of belonging to the victim-mother, perpetrator-father, their families, and the community at large, (3) intergenerational legacy of trauma and family identity, and (4) strategies to move forward including knowing the truth about one's origin, mental health, and peer support. CONCLUSION: These findings suggest that understanding increased risk of adverse health outcomes of youth born of genocidal rape could inform the design of evidence-based interventions for these and similar populations.

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers.

BACKGROUND: The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores. METHODS: This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey. RESULTS: Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05). CONCLUSIONS: The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.

COVID-19-Related Changes to Pregnant People's Work-Plans Increase Prenatal Depression.

The COVID-19 pandemic has caused unprecedented rates of unemployment in the United States. Pregnant workers may be especially affected as they are over-represented in low-wage service and hospitality industries impacted by the pandemic. We surveyed an online convenience sample of currently working pregnant people living in the U.S. (n = 1,417) to determine whether COVID-19-related changes to how long individuals planned to work during their pregnancy, and uncertainty about these changes, were associated with prenatal depression. As hypothesized, both COVID-19-related work-plan changes (OR = 1.81, 95% CI 1.36-2.42, p < 0.001) and uncertainty about the precise nature of these changes (OR = 2.62, 95% CI 1.14-6.0, p = 0.022) were associated with significantly higher odds of a clinically-significant depression score. These effects appeared to be even greater among individuals who continued working outside the home during the pandemic. Since the U.S. is one of the few countries in the world that does not guarantee paid parental leave, pregnant people may be forced to choose between keeping their jobs and risking infection during the COVID-19 pandemic. Our results demonstrate a need for immediate suspension of the eligibility requirements for the Family and Medical Leave Act and/or universal access to both paid family leave and prenatal depression screening. This would help to alleviate these concerns and provide pregnant people with more options while preserving their employment status and financial security.

Protective resources that promote wellbeing among New Zealand moms with young children facing socioeconomic disadvantage.

Poor maternal mental health and well-being during early stages of parenting impact child developmental outcomes. The primary objective of this study was to explore protective resources that may confer resilience among mothers living in low resourced neighborhoods in New Zealand. A purposive, non-probabilistic sampling method was used to recruit an ethnically representative sample of mothers with children under the age of five living in high deprivation neighborhoods in Auckland, New Zealand (n = 74). Data was collected via focus groups and interviews. Analyses consisted of both a deductive, theory-driven approach, and an inductive, data-driven approach. The most frequently mentioned resources that supported positive mental health and well-being included: 1) social support, and specifically family and instrumental support; 2) neighborhood cohesion, including collective efficacy and neighborhood permanence; and 3) alignment with social and cultural norms, though tensions surrounding cultural identity were also identified as sources of stress by some mothers. These findings highlight how the socioecological context impacts subjective perceptions of environmental demands and modifiable factors that may be promoted to improve maternal mental health and well-being and subsequent child health and development outcomes.

Maternity Care Preferences for Future Pregnancies Among United States Childbearers: The Impacts of COVID-19.

The COVID-19 pandemic has impacted maternity care decisions, including plans to change providers or delivery location due to pandemic-related restrictions and fears. A relatively unexplored question, however, is how the pandemic may shape future maternity care preferences post-pandemic. Here, we use data collected from an online convenience survey of 980 women living in the United States to evaluate how and why the pandemic has affected women's future care preferences. We hypothesize that while the majority of women will express a continued interest in hospital birth and OB/GYN care due to perceived safety of medicalized birth, a subset of women will express a new interest in out-of-hospital or "community" care in future pregnancies. However, factors such as local provider and facility availability, insurance coverage, and out-of-pocket cost could limit access to such future preferred care options. Among our predominately white, educated, and high-income sample, a total of 58 participants (5.9% of the sample) reported a novel preference for community care during future pregnancies. While the pandemic prompted the exploration of non-hospital options, the reasons women preferred community care were mostly consistent with factors described in pre-pandemic studies, (e.g. a preference for a natural birth model and a desire for more person-centered care). However, a relatively high percentage (34.5%) of participants with novel preference for community care indicated that they expected limitations in their ability to access these services. These findings highlight how the pandemic has potentially influenced maternity care preferences, with implications for how providers and policy makers should anticipate and respond to future care needs.

Double Jeopardy: Young adult mental and physical health outcomes following conception via genocidal rape during the 1994 genocide against the Tutsi in Rwanda.

Rwandans conceived by rape during the 1994 genocide against the Tutsi have endured a violent beginning and a troubled childhood. Given compelling evidence of the influence of prenatal environments and adverse childhood experiences (ACEs) on future health, these individuals are at high risk of poor mental and physical health outcomes. The purpose of the study was to characterize mental and physical health outcomes in young adults who were exposed prenatally to maternal stress due to the genocide in general and those conceived by genocidal rape, and to determine whether ACEs compound these effects. Ninety-one 24-year-old Rwandans - 30 conceived by genocidal rape, 31 born of genocide survivors not raped, and a control group of 30 born of women with neither exposure - completed the Adverse Childhood Experiences International Questionnaire and measures of multiple physical and mental health characteristics. Data were collected from March 7 to April 6, 2019. Findings demonstrated that 1) individuals conceived during the genocide had poorer mental function (p = 0.002) and higher scores in post-traumatic stress disorder (PTSD), anxiety, depression, physical function, pain intensity, and sleep disturbance compared to young adults who were not exposed to genocide (all p < 0.033); 2) individuals conceived by genocidal rape reported more depression, PTSD, and pain interference compared to those prenatally exposed to maternal genocide stress only (all p < 0.008); and 3) among the group conceived via genocidal rape, the effects of prenatal exposures on depression, physical function, pain intensity and pain interference were exacerbated by ACEs (all p < 0.041). Being conceived during genocide, especially through genocidal rape, is associated with poor adult physical and mental health. The role of ACEs in exacerbating prenatal genocide exposure highlights opportunities for interventions to reduce these effects.

A transdisciplinary approach to understand the epigenetic basis of race/ethnicity health disparities.

Health disparities correspond to differences in disease burden and mortality among socially defined population groups. Such disparities may emerge according to race/ethnicity, socioeconomic status and a variety of other social contexts, and are documented for a wide range of diseases. Here, we provide a transdisciplinary perspective on the contribution of epigenetics to the understanding of health disparities, with a special emphasis on disparities across socially defined racial/ethnic groups. Scientists in the fields of biological anthropology, bioinformatics and molecular epidemiology provide a summary of theoretical, statistical and practical considerations for conducting epigenetic health disparities research, and provide examples of successful applications from cancer research using this approach.

Prenatal Stress and Early Childhood Body Mass Index: A Path Analysis Approach.

OBJECTIVES: Stress experienced by mothers during the prenatal period can have negative impacts on offspring development. Elevated BMI in childhood in response to early stress experience is a particularly critical outcome of interest since high BMI in childhood is associated with diabetes, heart disease and stroke in later life. The primary objective of this study was to analyze pathways between prenatal stress and early childhood BMI at 54-months of age and to begin to explore ethnic variations in these pathways. METHODS: This study used the Growing Up in New Zealand (GUiNZ) dataset, which is a longitudinal, representative birth cohort study that began with recruiting pregnant women in 2009 and 2010 in Auckland, New Zealand. Path analysis modeling was used to explore risk and protective pathways between prenatal maternal stress and early childhood body mass index (BMI) at 54-months of age and differences by ethnicity (n = 5510). RESULTS: Prenatal stress was positively associated with early childhood BMI at 54-months and maternal nutrition behaviors and length of exclusive breastfeeding mediated this direct relationship (χ2 (1) = 0.83, p = 0.36; AIC = 50,496). Mediation and moderation paths varied by ethnicity. CONCLUSIONS FOR PRACTICE: These findings contribute to the understanding of the intergenerational transmission of stress with respect to early childhood obesity. Reducing early stress exposure and/or addressing mediating and moderating factors linking stress experience with obesity development may prove to be more effective than attempting to alter health behaviors and trajectories in adulthood.

COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States.

OBJECTIVES: The COVID-19 pandemic has led to unprecedented levels of unemployment and financial strain for many Americans. Among the individuals impacted by financial strain are pregnant women, for whom added financial stress may be particularly impactful due to the costs associated with prenatal care and providing for a newborn. Financial stress has been previously associated with elevated depression symptoms among pregnant women, which could have significant impacts on birth outcomes and long-term offspring health. However, the impacts of COVID-19-associated financial stress on maternal depression in pregnancy has not been investigated. METHODS: Here, we evaluated whether COVID-19-associated financial stress was associated with increased likelihood of a clinically significant depression score (Edinburgh Postnatal Depression Score ≥ 15) among pregnant women living in the United States during the COVID-19 pandemic. Data come from an online survey administered to a convenience sample in April 2020 (N = 2099). RESULTS: Forty-three percent of participants reported experiencing financial stress as a result of the pandemic, while 24% of participants had a clinically significant depression score. COVID-19-related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjustment for covariates including participant education and income (adjusted Odds Ratio: 2.23, 95% CI = 1.80, 2.77, P < .001). CONCLUSIONS: Financial stress caused by the COVID-19 pandemic is associated with more than two times the likelihood of depression during pregnancy, which could impact birth outcomes and long-term offspring health.

Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States.

BACKGROUND: The COVID-19 pandemic has negatively affected physical and mental health worldwide. Pregnant women already exhibit an elevated risk for depression compared to the general public, a pattern expected to be exacerbated by the pandemic. Certain lifestyle factors, including moderate exercise, may help support mental health during pregnancy, but it is unclear how the pandemic may impact these associations across different locations. Here, we test whether: (i) reported exercise routine alterations during the pandemic are associated with depression scores; and, (ii) the likelihood of reporting pandemic-related exercise changes varies between women living in metro areas and those in non-metro areas. METHODS: This cross-sectional study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant women in the United States. Participants were recruited April-June 2020 (n = 1,856). Linear regression analyses assessed whether reported COVID-19-related exercise change was associated with depression score as measured by the Edinburgh Postnatal Depression Survey. Logistic regression analyses tested whether a participant's Rural-Urban Continuum Code classification of "metro" was linked with higher odds of reporting exercise changes compared to a "non-metro" classification. RESULTS: Women who reported exercise changes during the pandemic exhibited significantly higher depression scores compared to those reporting no changes. Moreover, individuals living in metro areas of all sizes were significantly more likely to report exercise changes compared to women living in non-metro areas. CONCLUSIONS: These results suggest that the ability to maintain an exercise routine during the pandemic may help support maternal mental health. It may therefore be prudent for providers to explicitly ask patients how the pandemic has impacted their exercise routines and consider altered exercise routines a potential risk factor for depression. An effort should also be made to recommend exercises that are tailored to individual space restrictions and physical health.

The influence of experiential knowledge and societal perceptions on decision-making regarding non-invasive prenatal testing (NIPT).

BACKGROUND: Non-invasive prenatal testing (NIPT) allows women to access genetic information about their fetuses without the physical risk inherent to prior testing methods. The advent of NIPT technology has led to concerns regarding the quality and process of informed consent, as a view of NIPT as "routine" could impair women's considered approach when choosing to undergo testing. Prior studies evaluating NIPT decision-making have focused on the clinical encounter as the primary environment for acquisition of biomedical information and decision formation. While important, this conceptualization fails to consider how additional sources of knowledge, including embodied and empathetic experiential knowledge, shape perceptions of risk and the societal use of NIPT. METHODS: In order to address this issue, qualitative, semi-structured interviews with 25 women who had been offered NIPT were performed. Participants came from a well-resourced, rural setting near a major academic medical center in the US. Women were categorized by NIPT use/non-use as well as whether their described decision-making process was perceived as making a significant decision requiring contemplation ("significant") versus a rapid or immediate decision ("routinized"). A constructivist general inductive approach was used to explore themes in the data, develop a framework of NIPT decision-making, and compare the perceptions of women with differential decision-making processes and outcomes. RESULTS: A framework for decision-making regarding NIPT was developed based on three emergent factors: perceptions of the societal use of NIPT, expected emotional impact of genetic information, and perceived utility of genetic information. Analysis revealed that perceptions of widespread use of NIPT, pervasive societal narratives of NIPT use as "forward-thinking," and a perception of information as anxiety-relieving contributed to routinized uptake of NIPT. In contrast, women who displayed a lack of routinization expressed fewer stereotypes regarding the audience for NIPT and relied on communication with their social networks to consider how they might use the information provided by NIPT. CONCLUSIONS: The findings of this study reveal the societal narratives and perceptions that shape differential decision-making regarding NIPT in the U.S. CONTEXT: Understanding and addressing these perceptions that influence NIPT decision-making, especially routinized uptake of NIPT, is important as the use and scope of this technology increases.

The Maternal Nutritional Buffering Model: an evolutionary framework for pregnancy nutritional intervention.

Evidence that fetal nutrition influences adult health has heightened interest in nutritional interventions targeting pregnancy. However, as is true for other placental mammals, human females have evolved mechanisms that help buffer the fetus against short-term fluctuations in maternal diet and energy status. In this review, we first discuss the evolution of increasingly elaborate vertebrate strategies of buffering offspring from environmental fluctuations during development, including the important innovation of the eutherian placenta. We then present the Maternal Nutritional Buffering Model, which argues that, in contrast to many micronutrients that must be derived from dietary sources, the effects of short-term changes in maternal macronutrient intake during pregnancy, whether due to a deficit or supplementation, will be minimized by internal buffering mechanisms that work to ensure a stable supply of essential resources. In contrast to the minimal effects of brief macronutrient supplementation, there is growing evidence that sustained improvements in early life and adult pre-pregnancy nutrition could improve birth outcomes in offspring. Building on these and other observations, we propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself. Our model leads to the prediction that birth weight will be more strongly influenced by the mother's chronic pre-pregnancy nutrition than by pregnancy diet, and highlights the need for policy solutions aimed at optimizing future, intergenerational health outcomes. Lay summary: We propose that strategies to improve fetal macronutrient delivery will be most effective if they modify the pregnancy metabolism of mothers by targeting nutrition prior to conception and even during early development, as a complement to the conventional focus on bolstering macronutrient intake during pregnancy itself.