Ecoevolutionary processes structure milk microbiomes across the mammalian tree of life.

Milk production is an ancient adaptation that unites all mammals. Milk contains a microbiome that can contribute to offspring health and microbial-immunological development. We generated a comprehensive milk microbiome dataset (16S rRNA gene) for the class Mammalia, representing 47 species from all placental superorders, to determine processes structuring milk microbiomes. We show that across Mammalia, milk exposes offspring to maternal bacterial and archaeal symbionts throughout lactation. Deterministic processes of environmental selection accounted for 20% of milk microbiome assembly processes; milk microbiomes were similar from mammals with the same host superorder (Afrotheria, Laurasiathera, Euarchontoglires, and Xenarthra: 6%), environment (marine captive, marine wild, terrestrial captive, and terrestrial wild: 6%), diet (carnivore, omnivore, herbivore, and insectivore: 5%), and milk nutrient content (sugar, fat, and protein: 3%). We found that diet directly and indirectly impacted milk microbiomes, with indirect effects being mediated by milk sugar content. Stochastic processes, such as ecological drift, accounted for 80% of milk microbiome assembly processes, which was high compared to mammalian gut and mammalian skin microbiomes (69% and 45%, respectively). Even amid high stochasticity and indirect effects, our results of direct dietary effects on milk microbiomes provide support for enteromammary trafficking, representing a mechanism by which bacteria are transferred from the mother's gut to mammary gland and then to offspring postnatally. The microbial species present in milk reflect both selective pressures and stochastic processes at the host level, exemplifying various ecological and evolutionary factors acting on milk microbiomes, which, in turn, set the stage for offspring health and development.

Local environment shapes milk microbiomes while evolutionary history constrains milk macronutrients in captive cercopithecine primates.

Milk is a complex biochemical fluid that includes macronutrients and microbiota, which, together, are known to facilitate infant growth, mediate the colonization of infant microbiomes, and promote immune development. Examining factors that shape milk microbiomes and milk-nutrient interplay across host taxa is critical to resolving the evolution of the milk environment. Using a comparative approach across four cercopithecine primate species housed at three facilities under similar management conditions, we test for the respective influences of the local environment (housing facility) and host species on milk (a) macronutrients (fat, sugar, and protein), (b) microbiomes (16S rRNA), and (c) predicted microbial functions. We found that milk macronutrients were structured according to host species, while milk microbiomes and predicted function were strongly shaped by the local environment and, to a lesser extent, host species. The milk microbiomes of rhesus macaques (Macaca mulatta) at two different facilities more closely resembled those of heterospecific facility-mates compared to conspecifics at a different facility. We found similar, facility-driven patterns of microbial functions linked to physiology and immune modulation, suggesting that milk microbiomes may influence infant health and development. These results provide novel insight into the complexity of milk and its potential impact on infants across species and environments.

Macronutrient composition of milk from captive southern pig-tailed macaques (Macaca nemestrina).

Milk composition is a fundamental aspect of mammalian reproduction. Differences in milk composition between species may reflect phylogeny, dietary ecology, lactation strategy, and infant growth patterns, but may also vary within a species due to maternal body condition. This study presents the first published data on milk macronutrient composition of southern pig-tailed macaques (Macaca nemestrina) and compares the results with data on two other Cercopithecine species. Milk samples were obtained from five dams at 10- and 14-weeks postparturition. Macronutrient composition was determined at the Smithsonian's National Zoo and Conservation Biology Institute using proven methods developed over 30 years. On average (±SEM), the milk contained 83.9 ± 0.4% water, 6.7 ± 0.4% fat, 7.6 ± 0.1% sugar, 1.8 ± 0.1% protein, and 0.22 ± 0.01% mineral content. The Ca:P ratio was 1.8; concentrations of Ca and protein were correlated. Mean gross energy was 1.02 ± 0.03 kcal/g with most of the energy coming from fat (59.6 ± 1.5%), followed by sugar (29.9 ± 1.4%) and protein (10.5 ± 0.5%). The milks at 14 weeks of infant age were higher in energy than the milks at 10 weeks, with an increase in energy from fat (p = 0.005) and decrease in energy from sugar (p = 0.018). The energy from protein did not change (p = 0.272). Compared to captive rhesus macaque (Macaca mulatta) and olive baboon (Papio anubis) milk assayed by identical methods, captive pig-tailed macaque milk was higher in energy, but after accounting for the higher milk energy there was no difference in the proportions of milk energy from protein, fat, and sugar. The captive pig-tailed dams were significantly heavier than reported values for wild pig-tailed macaques, suggesting high body condition. High body condition in captive Cercopithecines appears to result in milk higher in energy, with more energy coming from fat and less from sugar. However, variation in the proportion of milk energy from protein in captive Cercopithecine milks appears relatively constrained.

Patient Perception of Telemedicine in Maternal-Fetal Medicine.

Background: Maternal-fetal medicine (MFM) is a medical subspecialty that cares for patients with high-risk pregnancies. Methods: An IRB-approved survey was offered to patients in MFM offices of a tertiary health care system from March 2022 to May 2022. Demographics and responses to 15 statements about telemedicine were collected via a 5-point Likert scale. Exploratory factor analysis was performed to identify factors affecting patient perception of the telemedicine experience. We sought to examine perception of telemedicine in MFM, identify factors affecting perception, and identify whether specific demographics were associated with patients who view telemedicine appointments favorably. Results: Surveys were completed by 327 of 347 (94%) patients. A total of 233 (71%) patients felt that the telemedicine experience was equal in quality to in-person appointments, and 257 (79%) were open to telemedicine appointments in the future. Exploratory factor analysis yielded two factors: "physician attentiveness" and "technology comfort." Telemedicine was viewed favorably or neutrally for both factors. Education (lower) and marital status (single) were associated with a favorable perception of physician attentiveness. Ethnicity (Hispanic), employment status (employed), and prior telemedicine experience were associated with a favorable perception of technology comfort. Conclusion: Most patients felt the quality of telemedicine appointments was equal to those completed in person. Physician attentiveness and technology comfort affect telemedicine perception. Specific patient demographic characteristics were associated with differing perceptions of telemedicine in MFM. Our findings suggest that telemedicine is positively viewed for MFM and can be used for improving health care delivery efficiency in MFM.

Variation in Milk Proteins Across Lactation in Pongo pygmaeus and Gorilla gorilla.

Milk is a critical nutrition source for all neonatal mammals. In addition to nutrition, milk contains a multitude of bioactive molecules that likely affect neonatal physiology, metabolism, and immune function. We suggest that changes in the milk proteome across lactation reflect the changing need of the neonate and juvenile offspring. We used mass spectrometry to characterize the milk proteomes from a Pongo pygmaeus (12 samples) and a Gorilla gorilla (6 samples) housed at the Smithsonian's National Zoo and Conservation Biology Institute and trained to give milk samples. We found a total of 454 proteins from P. pygmaeus and 428 proteins from G. gorilla. We specifically characterized changes across lactation in 13 proteins representing multiple compartments of milk, including the milk fat globule membrane and whey. Additionally, we characterized changes in various immunoglobulin types, finding similarities to previously published studies on primate milks. Despite broad similarities between the milk proteomes of these two apes, we demonstrated that proteomes from samples from 8 to 12 months clustered by species/individual and were distinct. Samples from more individuals are required to distinguish whether our result demonstrates species differences or individual differences. This study represents a baseline study that other zoo-based milk studies can build from. All RAW data, MetaMorpheus search results, and PAW_BLAST results are available on MassIVE at ftp://massive.ucsd.edu/MSV000089723/.

Challenges of devising a milk recipe in a hand-reared hippopotamus (Hippopotamus amphibius).

In January 2017, a Nile hippopotamus (Hippopotamus amphibious) was born approximately six weeks premature at the Cincinnati Zoo & Botanical Garden. Due to the calf's weakened condition and lack of interest from the dam, management at the zoo made the decision to hand-rear the calf. Limited published information was available on hand-rearing this species of hippopotamus (hippo). To devise a nutritionally appropriate recipe, milk samples were acquired from the dam on Days 1, 3, 8, and 9 postpartum, and assayed for sugar, protein, fat, mineral, and water content using standard methods validated for multiple species of mammals at the Smithsonian National Zoo's Nutrition Science Laboratory. The sugar content stayed relatively constant (mean = 4.5%; range: 4.3%-4.7%). The fat consistently increased from 0.48% to 4.24% (mean = 2%). Excluding Day 9, the protein content gradually decreased from 9.56% to 6.39% (mean = 8%). The dry matter (DM) ranged from 14.38% to 16.72% (i.e., water content of 85.62%-83.28%), with the sum of the solids (sugar, protein, fat, and ash) averaging 98.5% of measured DM. Fat content was lower than expected but within the range of other artiodactyls. Between Days 1 and 8, the trend of decreasing protein and increasing fat was consistent with a change from colostrum to mature milk. The sharp increase in fat and protein with a decrease in sugar on Day 9 may indicate the beginning of the involution of the mammary gland due to lack of nursing stimulus. Utilizing this information, the Cincinnati Zoo was able to formulate a successful milk replacement recipe that allowed the calf to be raised through weaning to maturity.

Macronutrient composition of olive baboon (Papio anubis) milk: A comparison to rhesus macaque (Macaca mulatta) milk.

This study was designed to (1) characterize the macronutrient composition of olive baboon (Papio anubis) milk, (2) compare baboon milk composition to that of rhesus macaques (Macaca mulatta), and (3) evaluate the association between the proportion of milk energy derived from protein and relative growth rate within anthropoid primates. A single milk sample was collected from each of eight lactating olive baboons ranging between 47- and 129-days postparturition and six rhesus macaques from 15- to 92-days living at the same institution under identical management conditions. Macronutrient composition (water, fat, protein sugar, and ash) was determined using standard techniques developed at the Nutrition Laboratory at the Smithsonian National Zoological Park. Baboon milk on average contained 86.0% ± 0.6% water, 4.7% ± 0.5% fat, 1.6% ± 0.04% protein, 7.3% ± 0.07% sugar, and 0.165% ± 0.007% ash. Baboon milk gross energy (GE) averaged 0.81 ± 0.04 kcal/g with 51.9% ± 2.6% from fat, 11.8% ± 0.7% from protein, and 36.2% ± 2.0% from sugar. Baboon milk demonstrated strong similarity to milk composition of the closely phylogenetically related rhesus macaque (86.1% ± 0.3% water, 4.1% ± 0.4% fat, 1.69% ± 0.05% protein, 7.71% ± 0.08% sugar, 0.19% ± 0.01% ash, and 0.78 kcal/g). There was no statistical difference between baboon and macaque milk in the proportions of energy from fat, sugar, and protein. Baboon milk can be described as a high sugar, moderate fat, and low protein milk with moderate energy density, which is consistent with their lactation strategy characterized by frequent, on-demand nursing and relatively slow life history compared to nonprimate mammal taxa. The milk energy from protein of both baboon and macaque (12.8% ± 0.3%) milk was intermediate between the protein milk energy of platyrrhine (19.3%-23.2%) and hominoid (8.9%-12.6%) primates, consistent with their relative growth rates also being intermediate. Compared to these cercopithecid monkeys, platyrrhine primates have both higher relative growth rates and higher milk energy from protein, while apes tend to be lower in both.

Macronutrient composition of milk from two captive African elephant (Loxodonta africana) cows.

We assayed 31 milk samples collected from two African elephant cows housed at the Indianapolis Zoo across lactation (birth to calf age 973 days) for macronutrient composition (water, fat, protein, sugar, gross energy [GE], ash, calcium, and phosphorus). All assays were performed at the Smithsonian National Zoological Park Nutrition Laboratory, Washington, DC (SNZP) using standard methods developed at SNZP. Milk constituents are expressed on a weight-per-weight basis (%) and as a proportion each constituent contributes to milk energy. Calf weights were recorded, and growth rate calculated. The macronutrient composition of the African elephant milk samples was compared to previously published results for Asian elephants using analysis of covariance. African elephant milk is similar to Asian elephant milk, being moderately high in fat and energy and low in sugar. The mean values across lactation (excluding colostrum; n = 28) are 5.6 ± 0.3% crude protein, 3.1 ± 0.3% sugar, 13.0 ± 1.0% fat, and GE of 1.63 ± 0.10 kcal/g. Milk composition did not differ between cows. Milk composition significantly changed over lactation; fat and protein increased, and sugar decreased with calf age, comparable to previously reported data for African and Asian elephant milk. The proportion of milk energy from fat increased and that from sugar decreased over lactation, but the energy from protein was relatively constant. Protein contributed a higher proportion of energy to African elephant milk compared to Asian elephant milk (20.6% vs. 17.0%, p = .001). Despite this, calf growth rate was similar between the species, with the calves in this study gaining about 0.8 kg/day for the first 6 months.

Increasing the Coverage of a Mass Spectral Library of Milk Oligosaccharides Using a Hybrid-Search-Based Bootstrapping Method and Milks from a Wide Variety of Mammals.

This study significantly expands both the scope and method of identification for construction of a previously reported tandem mass spectral library of 74 human milk oligosaccharides (HMOs) derived from results of combined LC-MS/MS experiments and comprehensive structural analysis of HMOs. In the present work, a hybrid search "bootstrap" identification method was employed that substantially broadens the coverage of milk oligosaccharides and thereby increases utility use of a spectrum library-based method for the rapid tentative identification of all distinguishable glycans in milk. This involved hybrid searching of the previous library, which was itself constructed using the hybrid search of oligosaccharide spectra in the NIST 17 Tandem MS Library. The general approach appears applicable to library construction of other classes of compounds. The coverage of oligosaccharides was significantly extended using milks from a variety of mammals, including bovine, Asian buffalo, African lion, and goat. This new method led to the identification of another 145 oligosaccharides, including an additional 80 HMOs from reanalysis of human milk. The newly identified compounds were added to a freely available mass spectral reference database of 219 milk oligosaccharides. We also provide suggestions to overcome several limitations and pitfalls in the interpretation of spectra of unknown oligosaccharides.

Evaluation of vitamin D3 metabolites in Callithrix jacchus (common marmoset).

Vitamin D3 (cholecalciferol) is endogenously produced in the skin of primates when exposed to the appropriate wavelengths of ultraviolet light (UV-B). Common marmosets (Callithrix jacchus) maintained indoors require dietary provision of vitamin D3 due to lack of sunlight exposure. The minimum dietary vitamin D3 requirement and the maximum amount of vitamin D3 that can be metabolized by marmosets is unknown. Observations of metabolic bone disease and gastrointestinal malabsorption have led to wide variation in dietary vitamin D3 provision amongst research institutions, with resulting variation in circulating 25-hydroxyvitamin D3 (25(OH)D3 ), the accepted marker for vitamin D sufficiency/deficiency. Multiple studies have reported serum 25(OH)D3 in captive marmosets, but 25(OH)D3 is not the final product of vitamin D3 metabolism. In addition to serum 25(OH)D3, we measured the most physiologically active metabolite, 1,25-dihydroxyvitamin D3 (1,25(OH)2 D3 ), and the less well understood metabolite, 24,25-dihydroxyvitamin D3 (24,25(OH)2 D3 ) to characterize the marmoset's ability to metabolize dietary vitamin D3 . We present vitamin D3 metabolite and related serum chemistry value colony reference ranges in marmosets provided diets with 26,367 (Colony A, N = 113) or 8,888 (Colony B, N = 52) international units (IU) of dietary vitamin D3 per kilogram of dry matter. Colony A marmosets had higher serum 25(OH)D3 (426 ng/ml [SD 200] vs. 215 ng/ml [SD 113]) and 24,25(OH)2 D3 (53 ng/ml [SD 35] vs. 7 ng/ml [SD 5]). There was no difference in serum 1,25(OH)2 D3 between the colonies. Serum 1,25(OH)2 D3 increased and 25(OH)D3 decreased with age, but the effect was weak. Marmosets tightly regulate metabolism of dietary vitamin D3 into the active metabolite 1,25(OH)2 D3 ; excess 25(OH)D3 is metabolized into 24,25(OH)2 D3 . This ability explains the tolerance of high levels of dietary vitamin D3 by marmosets, however, our data suggest that these high dietary levels are not required.

Diversity and temporal dynamics of primate milk microbiomes.

Milk is inhabited by a community of bacteria and is one of the first postnatal sources of microbial exposure for mammalian young. Bacteria in breast milk may enhance immune development, improve intestinal health, and stimulate the gut-brain axis for infants. Variation in milk microbiome structure (e.g., operational taxonomic unit [OTU] diversity, community composition) may lead to different infant developmental outcomes. Milk microbiome structure may depend on evolutionary processes acting at the host species level and ecological processes occurring over lactation time, among others. We quantified milk microbiomes using 16S rRNA high-throughput sequencing for nine primate species and for six primate mothers sampled over lactation. Our data set included humans (Homo sapiens, Philippines and USA) and eight nonhuman primate species living in captivity (bonobo [Pan paniscus], chimpanzee [Pan troglodytes], western lowland gorilla [Gorilla gorilla gorilla], Bornean orangutan [Pongo pygmaeus], Sumatran orangutan [Pongo abelii], rhesus macaque [Macaca mulatta], owl monkey [Aotus nancymaae]) and in the wild (mantled howler monkey [Alouatta palliata]). For a subset of the data, we paired microbiome data with nutrient and hormone assay results to quantify the effect of milk chemistry on milk microbiomes. We detected a core primate milk microbiome of seven bacterial OTUs indicating a robust relationship between these bacteria and primate species. Milk microbiomes differed among primate species with rhesus macaques, humans and mantled howler monkeys having notably distinct milk microbiomes. Gross energy in milk from protein and fat explained some of the variations in microbiome composition among species. Microbiome composition changed in a predictable manner for three primate mothers over lactation time, suggesting that different bacterial communities may be selected for as the infant ages. Our results contribute to understanding ecological and evolutionary relationships between bacteria and primate hosts, which can have applied benefits for humans and endangered primates in our care.

Macronutrient composition of longitudinal milk samples from captive aardvarks (Orycteropus afer).

Hand-rearing and assisted-rearing aardvarks in captivity has become commonplace and has led to success in breeding the species. However, the macronutrient content of aardvark milk past 1 month of age is unknown. A better understanding of aardvark milk composition would enhance captive management efforts. Here, we assayed milk samples from two captive individuals from 2 to 114 days postpartum (N = 21) for dry matter, fat, crude protein, total sugar, ash (total minerals), calcium (Ca), phosphorus (P), and gross energy. The body weight of one calf was measured from birth to weaning. Milk macronutrient composition was compared to that of other Afrotherian species and Xenarthra species with similar diets. Average protein, fat, and sugar concentrations of aardvark milk across lactation were 12.3%, 13.6%, and 2.5%, respectively. Ash averaged 1.9%, with Ca (0.50%) and P (0.35%) accounting for about 45% of total minerals. All measured nutrients increased over lactation except sugar, which decreased. Aardvark milk is high in energy (2.12 kcal/g) mostly derived from fat and protein and little energy from sugar. Calf growth was linear (r2 = 0.995) with a mean gain of 159 g/day, achieving almost 30% of adult weight at weaning. Within Afrotheria, aardvark milk is higher in fat and protein and lower in sugar than elephant milk and more closely resembles the milk of its fellow insectivore, the elephant shrew. Aardvark milk is also similar in composition to milk of insectivorous Xenarthra species (nine-banded armadillo and giant anteater). Aardvark milk composition is consistent with the species' high-protein diet, fast growth, and nursing pattern.

A retrospective study of gestational weight gain in relation to the Institute of Medicine's recommendations by maternal body mass index in rural Pennsylvania from 2006 to 2015.

BACKGROUND: In 2009, the Institute of Medicine (IOM) published guidance on gestational weight gain (GWG) modified by maternal pre-pregnancy body mass index (BMI). Estimates indicate that less than half of US pregnant women have GWG within recommendations. This study examined GWG from before (2006-2009) and after (2010-2015) the release of the IOM guidance in a rural, non-Hispanic white population to assess the proportion of women with GWG outside of IOM guidance, whether GWG became more likely to be within IOM guidance after 2010, and identify potential maternal factors associated with GWG outside of recommendations. METHODS: We examined GWG in 18,217 term singleton births between 2006 and 2015 in which maternal pre-pregnancy BMI could be calculated from electronic medical records at Geisinger, PA, and a subset of 12,912 births in which weekly GWG in the third trimester could be calculated. The primary outcome was whether GWG was below, within, or above recommendations based on maternal BMI. The relationships between GWG, maternal BMI, parity, age at conception, gestation length, and maternal blood pressure were examined. RESULTS: GWG declined with increasing maternal BMI, however, more than 50% of overweight and obese women gained above IOM recommendations. About one of five women gained below recommendations (21.3%) with underweight women the most likely to gain below recommendations (33.0%). The proportion of births with usable data increased after 2010, driven by a higher probability of recording maternal weight. However, the proportion of women who gained below, within or above recommendations did not change over the ten years. GWG above recommendations was associated with higher maternal BMI, lower parity, and longer gestation. GWG below recommendations was associated with lower maternal BMI, higher parity, shorter gestation, and younger age at conception. Maternal blood pressure was higher for GWG outside recommendations. CONCLUSIONS: Despite the publication of IOM recommendations in 2009 and an apparent increase in tracking maternal weight after 2010, GWG in this population did not change between 2006 and 2015. A majority of overweight and obese women gained above recommendations. GWG below recommendations continues to occur, and is prevalent among underweight women.

Provider and Patient Knowledge and Views of Office Practices on Weight Gain and Exercise during Pregnancy.

OBJECTIVE: This study sought to assess provider and patient knowledge and beliefs on gestational weight gain (GWG) and exercise during pregnancy, outline current clinical practices and the perceived value of educational tools. STUDY DESIGN: Providers and patients at the George Washington Medical Faculty Associates Obstetricians and Gynecologists clinic were recruited for a voluntary survey. Descriptive statistics of responses were compared and chi-square analysis tested for significant associations. RESULTS: A total of 461 patient and 36 provider questionnaires were analyzed. Providers recommended GWG consistent with the Institute of Medicine guidelines for a "normal" body mass index (82.9%); however, a majority (52.8%) recommended GWG below guidelines for obese women. All providers reported counseling patients on GWG, but only 53.4% of patients reported discussing personal recommendations. About half of providers reported distributing educational materials for GWG (60.0%); however, only 30.6% of patients reported receiving them. African American patients self-reported receiving the highest rates of counseling and educational materials, though a lower rate of recommendations to exercise. Patients perceived educational tools to be more useful than did providers. CONCLUSION: Our findings suggest a gap between provider-patient perceptions regarding counseling and provision of informational materials. Future research should study whether implementing various educational tools might increase the efficacy of current practices.

Vitamin D status in wild toque macaques (Macaca sinica) in Sri Lanka.

The vitamin D receptor is found on most cells, including active immune cells, implying that vitamin D has important biological functions beyond calcium metabolism and bone health. Although captive primates should be given a dietary source of vitamin D, under free-living conditions vitamin D is not a required nutrient, but rather is produced in skin when exposed to UV-B light. The circulating level of 25 hydroxyvitamin D (25-OH-D) considered adequate for humans is a topic of current controversy. Levels of circulating 25-OH-D sufficient for good health for macaques and other Old World anthropoids are assumed to be the same as human values, but data from free-living animals are scant. This study reports values for 25-OH-D and the active vitamin D metabolite, 1,25-dihydroxyvitamin D (1,25[OH]2 D) for wild, forest-ranging toque macaques (Macaca sinica) in Sri Lanka. Plasma samples were obtained from eight adult males, seven juvenile males, six young nulliparous females, nine adult females not pregnant or lactating, eleven lactating adult females, and four pregnant females. Mean values for the complete sample were 61.3 ± 4.0 ng/ml for 25-OH-D and 155.6 ± 8.7 pg/ml for 1,25[OH]2 D. There were no significant differences for either metabolite among age and sex classes, nor between lactating and non-reproductive females. Values from the literature for circulating 25-OH-D in captive macaques are three times higher than those found in this wild population, however, 1,25[OH]2 D values in captive animals were similar to the wild values. The data from this study indicate that anthropoid primates exposed to extensive sunlight will have circulating values of 25-OH-D generally above 30 ng/ml, providing some support for the Endocrine Society recommendations for humans. Current dietary vitamin D supplementation of captive macaques likely exceeds requirement. This may affect metabolism and immune function, with possible consequences for macaque health and biomedical research results.

Immunoglobulin A and nutrients in milk from great apes throughout lactation.

Differences in macronutrients between human and ape milks appear relatively small, but variation in other components such as immunoglobulins (Ig) may be greater. This study characterized the macronutrient and secretory (sIgA) profiles in milk from gorillas and orangutans throughout lactation. Fifty-three milk samples from four gorillas and three orangutans were collected throughout 48 and 22 months postpartum (MPP), respectively. Samples were grouped in five stages of lactation (0 to 6 months, more than 6 months to 12 months, more than 12 months to 18 months, more than 18 months to 36 months, and more than 36 months to 48 months). Data were analyzed as a complete randomized design. Concentration of sIgA did not change due to species or its interaction with MPP. Crude protein, regardless of MPP, was greater for gorillas compared with orangutans (1.27 vs. 0.85%). Fat, sugar, and gross energy were affected by the interaction of species × MPP. For gorilla milk, concentrations of sIgA were 43 mg/L at 6 MPP increasing to 79 mg/L at 48 MPP. Protein was highest at 48 MPP. Sugar was lowest at 48 MPP. Values for fat and gross energy were the highest 36 MPP. For orangutan milk, concentrations of sIgA were highest at 6 MPP. Sugar decreased with MPP. Protein, dry matter, or fat were unaffected by MPP. Gross energy content was steady during the first 18 MPP but it tended to decrease by 36 MPP. The results indicate that macronutrients are similar between human, published data, and great ape milk, though gorilla milk has higher protein and human milk higher fat (published data). Concentrations of sIgA in ape milk were about 10-fold lower than human values from the literature. Differences between human and ape milk may lie more in bioactive/immune molecules than nutrients. RESEARCH HIGHLIGHTS: Milk macronutrients from great apes differed throughout lactation. Milk macronutrients but not IgA from non-human great apes and humans were quite similar. Milk protein was greater in Gorilla compared with Orangutan.

Patterns of milk macronutrients and bioactive molecules across lactation in a western lowland gorilla (Gorilla gorilla) and a Sumatran orangutan (Pongo abelii).

In addition to nutrients, milk contains signaling molecules that influence offspring development. Human milk is similar in nutrient composition to that of apes, but appears to differ in other aspects such as immune function. We examine the longitudinal patterns across lactation of macronutrients, the metabolic hormone adiponectin, the growth factors epidermal growth factor (EGF) and transforming growth factor ß2 (TGF-ß2), and two receptors for these growth factors (EGF-R and TGF-ß2-RIII) in milk samples collected between days 175 and 313 postpartum from a Sumatran orangutan (Pongo abelii) and between days 3 and 1,276 from a western lowland gorilla (Gorilla gorilla), and compare the results with human data from the literature. Milk macronutrients and hormones were measured using standard nutritional assays and commercially available enzyme immunoassay kits. Ape milk fat content was lower than human milk values, but protein and sugar were similar. Concentrations of all bioactive molecules were consistently detectable except for TGF-ß2 in orangutan milk. Concentrations of adiponectin, EGF, and TGF-ß2 in both ape milks were lower than found in human breast milk. Concentrations declined with infant age in orangutan milk; in gorilla milk concentrations were high in the first months, and then declined to stable levels until 2-3 years after birth when they increased. However, when expressed on a per energy basis milk constituent values did not differ with age for orangutan and the variation was reduced at all ages in gorilla. In orangutan milk, the ratio of EGF-R to EGF was constant, with EGF-R at 7.7% of EGF; in gorilla milk the EGF-R concentration was 4.4 ± 0.2% of the EGF concentration through 3 years and then increased. These data indicate that potent signaling molecules such as EGF and adiponectin are present in ape milk at physiological concentrations. However, human breast milk on average contains higher concentrations.

Metabolic screening in patients with polycystic ovary syndrome is largely underutilized among obstetrician-gynecologists.

Women with polycystic ovary syndrome have substantially higher rates of insulin resistance, impaired glucose tolerance, type 2 diabetes, dyslipidemia, and metabolic syndrome when compared with women without the disease. Given the high prevalence of these comorbidities, guidelines issued by the American College of Obstetricians and Gynecologists and the Endocrine Society recommend that all women with polycystic ovary syndrome undergo screening for impaired glucose tolerance and dyslipidemia with a 2 hour 75 g oral glucose tolerance test and fasting lipid profile upon diagnosis and also undergo repeat screening every 2-5 years and every 2 years, respectively. Although a hemoglobin A1C and/or fasting glucose are widely used screening tests for diabetes, both the American College of Obstetricians and Gynecologists and the Endocrine Society preferentially recommend the 2 hour oral glucose tolerance test in women with polycystic ovary syndrome as a superior indicator of impaired glucose tolerance/diabetes mellitus. However, we found that gynecologists underutilize current recommendations for metabolic screening in women with polycystic ovary syndrome. In an online survey study targeting American College of Obstetricians and Gynecologists fellows and junior fellows, 22.3% of respondents would not order any screening test at the initial visit for at least 50% of their patients with polycystic ovary syndrome. The most common tests used to screen for impaired glucose tolerance in women with polycystic ovary syndrome were hemoglobin A1C (51.0%) and fasting glucose (42.7%). Whereas 54.1% would order a fasting lipid profile in at least 50% of their polycystic ovary syndrome patients, only 7% of respondents order a 2 hour oral glucose tolerance test. We therefore call for increased efforts to encourage obstetrician-gynecologists to address metabolic abnormalities in their patients with polycystic ovary syndrome. Such efforts should include education of physicians early in their careers, at the medical student and resident level. Efforts should also include implementation of continuing medical education activities, both locally and at the national level, to improve understanding of the metabolic implications of polycystic ovary syndrome. Electronic medical record systems should be utilized to generate prompts for appropriate screening tests in patients with a diagnosis of polycystic ovary syndrome. Because obstetrician-gynecologists may be the only physicians seen by many polycystic ovary syndrome patients, particularly those in their young reproductive years, such interventions could effectively promote optimal preventative health care and early diagnosis of metabolic comorbidities in these at-risk women.

Influenza Vaccination among Pregnant Women: Patient Beliefs and Medical Provider Practices.

ACOG's research department recruited four medical centers to participate in a study on the attitudes and practices of medical providers and pregnant patients regarding influenza vaccination. Medical providers and patients were given voluntary surveys and medical record data was collected over two flu seasons, from 2013 to 2015. Discrepancies between self-reports of medical providers and patients and medical records were observed. Nearly 80% of patients self-reported accepting the influenza vaccine, but medical record data only reported 36% of patients accepting the vaccine. Similarly, all medical providers reported giving recommendations for the vaccine, but only 85% of patients reported receiving a recommendation. Age, education, a medical provider's recommendation, and educational materials were found to positively influence patient beliefs about the influenza vaccine. Accepting the vaccine was influenced by a patient's previous actions, beliefs, and a medical provider's recommendation. Patients who reported previously not accepting the vaccine and had negative feelings towards the vaccine but accepted it while pregnant reported concern for the health and safety of their baby. Future research should focus on groups that may be less likely to accept the vaccine and ways to dispel negative myths. Medical provider should continue to strongly recommend the vaccine and provide educational materials.

The energetic and nutritional yields from insectivory for Kasekela chimpanzees.

Insectivory is hypothesized to be an important source of macronutrients, minerals, and vitamins for chimpanzees (Pan troglodytes), yet nutritional data based on actual intake are lacking. Drawing on observations from 2008 to 2010 and recently published nutritional assays, we determined the energy, macronutrient and mineral yields for termite-fishing (Macrotermes), ant-dipping (Dorylus), and ant-fishing (Camponotus) by the Kasekela chimpanzees of Gombe National Park, Tanzania. We also estimated the yields from consumption of weaver ants (Oecophylla) and termite alates (Macrotermes and Pseudacanthotermes). On days when chimpanzees were observed to prey on insects, the time spent in insectivorous behavior ranged from <1 min to over 4 h. After excluding partial bouts and those of <1 min duration, ant-dipping bouts were of significantly shorter duration than the other two forms of tool-assisted insectivory but provided the highest mass intake rate. Termite-fishing bouts were of significantly longer duration than ant-dipping and had a lower mass intake rate, but provided higher mean and maximum mass yields. Ant-fishing bouts were comparable to termite-fishing bouts in duration but had significantly lower mass intake rates. Mean and maximum all-day yields from termite-fishing and ant-dipping contributed to or met estimated recommended intake (ERI) values for a broad array of minerals. The mean and maximum all-day yields of other insects consistently contributed to the ERI only for manganese. All forms of insectivory provided small but probably non-trivial amounts of fat and protein. We conclude that different forms of insectivory have the potential to address different nutritional needs for Kasekela chimpanzees. Other than honeybees, insects have received little attention as potential foods for hominins. Our results suggest that ants and (on a seasonal basis) termites would have been viable sources of fat, high-quality protein and minerals for extinct hominins employing Pan-like subsistence technology in East African woodlands.