Elevated cord levels of ustekinumab following its use in the treatment of Crohn's disease in pregnancy.

Ustekinumab (USK) was used in the treatment of two pregnant patients with Crohn's disease. It was given in the third trimester and restarted postnatally for both women. One woman remained on USK and in remission throughout pregnancy. The second woman, took a treatment break, flared, and then had remission induced with reintroduction of USK. Both women delivered healthy term infants. The interval from last dose to birth was 11 and 8 weeks respectively. Interestingly, USK levels in cord blood was observed in higher concentrations than in the maternal serum taken in third trimester. While no adverse effect in infants has been observed, clinicians should remain aware of fetal transfer when using USK in pregnancy. An evaluation of risk and benefit may favour continuing USK in pregnancy in patients with refractory disease.

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.

Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF's Welcome Service.

Psychosocial challenges impact patients' ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement: 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs' understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.

Cloud technology and capsule endoscopy: A single-center users' experience of remote online video analysis and reporting.

Background and study aims Telemedicine has progressed significantly in recent years, with newer, more integrated information technology systems improving healthcare delivery. The development of the world's first cloud-based capsule platform could allow safe and timely virtual analysis of videos from a network of linked hospital centers. We aimed to assess the efficacy of Medtronic's PillCam Remote Reader System. Methods PillCam remote reader technical data were collected from the capsule endoscopy (CE) database over 8 months. User-reported performance was collect using an online survey. Outcomes included overall procedure success, video-upload/report-download rates and speeds, encryption/decryption rates, and user/reader satisfaction. Results Data from 377 studies encompassing seven different readers was collected (318 small bowel capsules, 59 colon capsules). Overall procedure success was 100% (all videos reported). Two upload delays occurred (< 24 hours). There were no encryption/decryption errors. Seven of seven respondents felt it easy to access and use vs one of seve for the old system. Six of seven respondents felt department efficiency increased. Benefits included off-site reading and multisite-conferences. Issues included offsite difficulty accessing other hospital systems. Conclusions PillCam remote reader is a reliable, secure, and effective capsule analysis platform and should be incorporated into any CE service development plan.

The Influence of Using Novel Predictive Technologies on Judgments of Stigma, Empathy, and Compassion among Healthcare Professionals.

BACKGROUND: Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals' judgments of stigma, empathy, and compassion. METHODS: We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, empathy, and compassion. RESULTS: Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists. CONCLUSIONS: The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others.

How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study.

Clinical tools for use in practice-such as medicine reconciliation charts, diagnosis support tools and track-and-trigger charts-are endemic in healthcare, but relatively little attention is given to how to optimise their design. User-centred design approaches and co-design principles offer potential for improving usability and acceptability of clinical tools, but limited practical guidance is currently available. We propose a framework (FRamework for co-dESign of Clinical practice tOols or 'FRESCO') offering practical guidance based on user-centred methods and co-design principles, organised in five steps: (1) establish a multidisciplinary advisory group; (2) develop initial drafts of the prototype; (3) conduct think-aloud usability evaluations; (4) test in clinical simulations; (5) generate a final prototype informed by workshops. We applied the framework in a case study to support co-design of a prototype track-and-trigger chart for detecting and responding to possible fetal deterioration during labour. This started with establishing an advisory group of 22 members with varied expertise. Two initial draft prototypes were developed-one based on a version produced by national bodies, and the other with similar content but designed using human factors principles. Think-aloud usability evaluations of these prototypes were conducted with 15 professionals, and the findings used to inform co-design of an improved draft prototype. This was tested with 52 maternity professionals from five maternity units through clinical simulations. Analysis of these simulations and six workshops were used to co-design the final prototype to the point of readiness for large-scale testing. By codifying existing methods and principles into a single framework, FRESCO supported mobilisation of the expertise and ingenuity of diverse stakeholders to co-design a prototype track-and-trigger chart in an area of pressing service need. Subject to further evaluation, the framework has potential for application beyond the area of clinical practice in which it was applied.

Prophylactic HPV vaccines in patients with HPV-associated diseases and cancer.

Individuals with human papillomavirus (HPV)-related disease remain at risk for subsequent HPV infection and related disease after treatment of specific lesions. Prophylactic HPV vaccines have shown benefits in preventing subsequent HPV-related disease when administered before or soon after treatment. Based on our understanding of the HPV life cycle and vaccine mechanism of action, prophylactic HPV vaccination is not expected to clear active persistent HPV infection or unresected HPV-associated dysplastic tissue remaining after surgery. However, vaccination may reasonably be expected to prevent new HPV infections caused by a different HPV type as well as re-infection with the same HPV type, whether from a new exposure to an infected partner or through autoinoculation from an adjacent or distant productively infected site. In this review, we describe the evidence for using prophylactic HPV vaccines in patients with HPV-associated disease before, during, or after treatment and discuss potential mechanisms by which individuals with HPV-associated disease may or may not benefit from prophylactic vaccines. We also consider how precise terminology relating to the use of prophylactic vaccines in this population is critical to avoid the incorrect implication that prophylactic vaccines have direct therapeutic potential, which would be counter to the vaccine's mechanism of action, as well as considered off-label. In other words, the observed effects occur through the known mechanism of action of prophylactic HPV vaccines, namely by preventing virus of the same or a different HPV type from infecting the patient after the procedure.

Patency testing improves capsule retention rates but at what cost? A retrospective look at patency testing.

Capsule retention is one of the major complications of capsule endoscopy, which range from 2.1 to 8.2% depending on the indication. Over the last few years, reported rates of retention have fallen due to better patient selection due to the recognition of risk factors for capsule retention as well as the introduction of the patency capsule. The patency capsule is a dissolvable capsule with the same dimensions as the functional capsule. It breaks down in the GI tract after approximately 30 h, reducing the risk of symptomatic retention. Failure to pass this patency capsule out of the small bowel results in the patient being excluded from capsule endoscopy. We performed a retrospective analysis of the patency capsules performed in our unit over a 12-month period. A total of 166 (14.7%) of 1,127 patients referred for capsule endoscopy were deemed to require patency assessment (45.8% men, mean age 48 years). Of those who passed the patency assessment and underwent capsule endoscopy, no capsule retention was seen. Indication for patency assessment was found to be appropriate in 87.0% (n = 147). Overall, the failure rate at the patency assessment was 43.1%. The patency capsule remains an imperfect but useful tool in examining functional patency of the GI tract prior to capsule endoscopy.

Maternal racism experience and cultural identity in relation to offspring telomere length.

Racism is a determinant of individual and offspring health. Accelerated telomere shortening, an indicator of cellular aging, is a potential mechanism through which parental experience of racism could affect offspring. Here we longitudinally evaluated the relationship between maternal lifetime experience of an ethnically-motivated verbal or physical attack, as reported in pregnancy, with offspring telomere length in 4.5-year-old children. We also explored the potential association between positive feelings about one's culture and offspring telomere length. Data come from a nationally representative, multi-ethnic birth cohort in Aotearoa New Zealand (NZ) (Maori N = 417, Pacific N = 364, Asian N = 381). In models adjusting for covariates, including socioeconomic status and health status, Maori mothers who experienced an ethnically-motivated physical attack had children with significantly shorter telomere length than children of Maori mothers who did not report an attack (B = - 0.20, p = 0.01). Conversely, Maori mothers who had positive feelings about their culture had offspring with significantly longer telomeres (B = 0.25, p = 0.02). Our results suggest that ethnicity-based health inequities are shaped by racism, with impacts for clinical care and policy. Future research should also evaluate the potential protective effects of positive cultural identity.

Behavioural outcomes of children exposed to antidepressants and unmedicated depression during pregnancy.

BACKGROUND: Antenatal exposure to both antidepressants and maternal depression has been associated with child behavioural difficulties. However, previous research has not adequately distinguished between the effects of the antidepressants and the underlying maternal depression. METHODS: Child behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire at 2-, 4.5-, and 8-years of age by mothers in the Growing Up in New Zealand study (N = 6233 at 2-years; N = 6066 at 4.5-years; N = 4632 at 8-years). Mothers were classified as either on antidepressants, unmedicated depression, or neither based on self-reported antidepressant intake during pregnancy and the Edinburgh Postnatal Depression Scale. Hierarchical multiple logistic regressions were used to examine whether antenatal exposure to antidepressants and unmedicated depression had a differential association with child behavioural outcomes relative to no exposure. RESULTS: When later life depression in the mother and a range of birth and sociodemographic variables were accounted for, neither antenatal exposure to unmedicated depression or antidepressants remained associated with an increased risk of behavioural difficulties at the ages investigated. However, maternal later life depression was associated with behavioural difficulties in the fully adjusted analyses at all three ages investigated. LIMITATIONS: The current study relied on mother-report of child behaviour which may be susceptible to bias due to maternal mental health problems. CONCLUSIONS: Adjusted results did not show an adverse association between antenatal antidepressant exposure or unmedicated depression in relation to child behaviour. Findings also suggest that efforts to improve child behaviour need to include more family-based approaches that support maternal wellbeing.

High diagnostic yield despite a lower completion rates for inpatient versus outpatient colon and pan-intestinal capsule endoscopy: a nested case-control study.

BACKGROUND: Increased familiarity with capsule endoscopy (CE) has been associated with a growing demand for urgent inpatient procedures. Limited data exists comparing the effect of admission status on colon capsule (CCE) and pan-intestinal capsule (PIC) performance. We aimed to compare the quality of inpatient versus outpatient CCE and PIC studies. METHODS: A retrospective nested case-control study. Patients were identified from a CE database. PillCam Colon 2 Capsules with standard bowel preparation and booster regimen were used in all studies. Basic demographics and key outcome measures were documented from procedure reports and hospital patient records, and compared between groups. RESULTS: 105 subjects were included, 35 cases and 70 controls. Cases were older, were more frequently referred with active bleeding and had more PICs. The diagnostic yield was high at 77% and was similar in both groups. Completion rates were significantly better for outpatients, 43% (n = 15) v's 71% (n = 50), OR 3, NN3. Neither gender nor age affected completion rates. Completion rates and preparation quality were similar for CCE and PIC inpatient procedures. CONCLUSION: Inpatient CCE and PIC have a clinical role. There is an increased risk of incomplete transit in inpatients, and strategies to mitigate against this are needed.

What it takes to get it right: A qualitative study exploring optimal handover of health programmes in Tonkolili District, Sierra Leone.

Since 2015 Médecins Sans Frontières (MSF) has been supporting the Ministry of Health (MoH) in Tonkolili district, Sierra Leone, with an integrated health care approach at the community, primary health centre (PHC), and hospital level. This programme is planned to be handed over to MoH. To prepare for this handover, a qualitative study exploring elements of a successful handover was undertaken in 2019. Focus group discussions (FGD) with the community members (n-48) and in-depth interviews (IDI) with MSF staff, community leaders, and MoH staff in Sierra Leone (n-15) were conducted. Data were audio-recorded, transcribed verbatim from English, Creole, and Themne, coded, and thematically analysed. Participants expressed that an optimal project handover and exit strategy should be a continuous, long-term, the staggered process included from the inception of the programme design. It requires clear communication and relationship building by all relevant stakeholders and demands efficient resources and management capacity. Associated policy implications are applicable across humanitarian settings on the handover of programmes where the government is functional and willing to accept responsibilities.

Control of cell surface expression of GABAA receptors by a conserved region at the end of the N-terminal extracellular domain of receptor subunits.

Type A γ-aminobutyric acid receptors (GABAARs) represent a family of pentameric GABA-gated Cl-/HCO3- ion channels which mediate inhibitory transmission in the central nervous system. Cell surface expression of GABAARs, a prerequisite for their function, is dependent on the appropriate assembly of the receptor subunits and their transient interactions with molecular chaperones within the endoplasmic reticulum (ER) and Golgi apparatus. Here, we describe a highly conserved amino acid sequence within the extracellular N-terminal domain of the receptor subunits adjoining the first transmembrane domain as a region important for GABAAR processing within the ER. Modifications of this region in the α1, ß3, and γ2 subunits using insertion or site-directed mutagenesis impaired GABAAR trafficking to the cell surface in heterologous cell systems although they had no effect on the subunit assembly. We found that mutated receptors accumulated in the ER where they were shown to associate with chaperones calnexin, BiP, and Grp94. However, their surface expression was increased when ER-associated degradation or proteosome function was inhibited, while modulation of ER calcium stores had little effect. When compared to the wt, mutated receptors showed decreased interaction with calnexin, similar binding to BiP, and increased association with Grp94. Structural modeling of calnexin interaction with the wt or mutated GABAAR revealed that disruption in structure caused by mutations in the conserved region adjoining the first transmembrane domain may impair calnexin binding. Thus, this previously uncharacterized region plays an important role in intracellular processing of GABAARs at least in part by stabilizing their interaction with calnexin.

Sociodemographic differences in 24-hour time-use behaviours in New Zealand children.

BACKGROUND: The time that children spend in physical activity, sedentary behaviour, and sleep each day (i.e., 24-h time-use behaviours), is related to physical and mental health outcomes. Currently, there is no comprehensive evidence on New Zealand school-aged children's 24-h time-use behaviours, adherence to the New Zealand 24-h Movement Guidelines, and how these vary among different sociodemographic groups. METHODS: This study utilises data from the 8-year wave of the Growing Up in New Zealand longitudinal study. Using two Axivity AX3 accelerometers, children's 24-h time-use behaviours were described from two perspectives: activity intensity and activity type. Compositional data analysis techniques were used to explore the differences in 24-h time-use compositions across various sociodemographic groups. RESULTS: Children spent on average, 31.1%, 22.3%, 6.8%, and 39.8% of their time in sedentary, light physical activity, moderate-to-vigorous physical activity, and sleep, respectively. However, the daily distribution of time in different activity types was 33.2% sitting, 10.8% standing, 7.3% walking, 0.4% running, and 48.2% lying. Both the activity intensity and activity type compositions varied across groups of child ethnicity, gender, and household income or deprivation. The proportion of children meeting each of the guidelines was 90% for physical activity, 62.5% for sleep, 16% for screen time, and 10.6% for the combined guidelines. Both gender and residence location (i.e., urban vs. rural) were associated with meeting the physical activity guideline, whereas child ethnicity, mother's education and residence location were associated with meeting the screen time guideline. Child ethnicity and mother's education were also significantly associated with the adherence to the combined 24-h Movement Guidelines. CONCLUSIONS: This study provided comprehensive evidence on how New Zealand children engage in 24-h time-use behaviours, adherence to the New Zealand 24-h Movement Guidelines, and how these behaviours differ across key sociodemographic groups. These findings should be considered in designing future interventions for promoting healthy time-use patterns in New Zealand children.

Association of Assisted Reproductive Technology With Offspring Growth and Adiposity From Infancy to Early Adulthood.

Importance: People conceived using assisted reproductive technology (ART) make up an increasing proportion of the world's population. Objective: To investigate the association of ART conception with offspring growth and adiposity from infancy to early adulthood in a large multicohort study. Design, Setting, and Participants: This cohort study used a prespecified coordinated analysis across 26 European, Asia-Pacific, and North American population-based cohort studies that included people born between 1984 and 2018, with mean ages at assessment of growth and adiposity outcomes from 0.6 months to 27.4 years. Data were analyzed between November 2019 and February 2022. Exposures: Conception by ART (mostly in vitro fertilization, intracytoplasmic sperm injection, and embryo transfer) vs natural conception (NC; without any medically assisted reproduction). Main Outcomes and Measures: The main outcomes were length / height, weight, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). Each cohort was analyzed separately with adjustment for maternal BMI, age, smoking, education, parity, and ethnicity and offspring sex and age. Results were combined in random effects meta-analysis for 13 age groups. Results: Up to 158 066 offspring (4329 conceived by ART) were included in each age-group meta-analysis, with between 47.6% to 60.6% females in each cohort. Compared with offspring who were NC, offspring conceived via ART were shorter, lighter, and thinner from infancy to early adolescence, with differences largest at the youngest ages and attenuating with older child age. For example, adjusted mean differences in offspring weight were -0.27 (95% CI, -0.39 to -0.16) SD units at age younger than 3 months, -0.16 (95% CI, -0.22 to -0.09) SD units at age 17 to 23 months, -0.07 (95% CI, -0.10 to -0.04) SD units at age 6 to 9 years, and -0.02 (95% CI, -0.15 to 0.12) SD units at age 14 to 17 years. Smaller offspring size was limited to individuals conceived by fresh but not frozen embryo transfer compared with those who were NC (eg, difference in weight at age 4 to 5 years was -0.14 [95% CI, -0.20 to -0.07] SD units for fresh embryo transfer vs NC and 0.00 [95% CI, -0.15 to 0.15] SD units for frozen embryo transfer vs NC). More marked differences were seen for body fat measurements, and there was imprecise evidence that offspring conceived by ART developed greater adiposity by early adulthood (eg, ART vs NC difference in fat mass index at age older than 17 years: 0.23 [95% CI, -0.04 to 0.50] SD units). Conclusions and Relevance: These findings suggest that people conceiving or conceived by ART can be reassured that differences in early growth and adiposity are small and no longer evident by late adolescence.

Creating Interactive Three-Dimensional Applications to Visualise Novel Stent Grafts That Aid in the Treatment of Aortic Aneurysms.

Three-Dimensional (3D) medical animations incorporated into applications are highly beneficial for clinical outreach and medical communication purposes that work towards educating the clinician and patient. Aortic aneurysms are a clinically important area to communicate with multiple audiences about various treatment options; both abdominal and thoracic aortic aneurysms were selected to create 3D animations and applications to educate medical professionals and patients regarding treatment options. Fenestrated endovascular aortic repair (FEVAR) and thoracic endovascular aortic repair (TEVAR) are both tried and tested minimally invasive surgical methods for treating thoracic aortic aneurysms respectively. The Terumo Aortic Custom Relay Proximal Scalloped stent graft and Fenestrated Anaconda stent graft were both designed specifically for these procedures; however, it can be difficult to visually communicate to clinicians and patients in a straightforward way how these devices work. Therefore, we have developed two interactive applications that use 3D visualisation techniques to demonstrate how these aortic devices function and are implemented. The objective of these applications is to engage both clinicians and patients, therefore demonstrating that the addition of anatomically accurate 3D visualisations within an interactive interface would have a positive impact on public engagement while also ensuring that clinicians will have the best possible understanding of the potential uses of both devices, enabling them to exploit their key features to effectively broaden the treatable patient population.Detailed anatomical modelling and animation was used to generate realistic and accurate rendered videos showcasing both products. These videos were integrated into an interactive application within a modern, professional graphic interface that allowed the user to explore all aspects of the stent device. The resulting applications were broken down into three modules: deployment, clinical performance and features. Following application development, these applications were evaluated by professionals in the field. Overall, positive feedback was received regarding the user-friendly nature of the applications and highly effective animations to showcase the products. The clinical applications and feature modules were particularly successful, while the deployment modules had a neutral response. Biomedical applications such as these show great potential for communicating the key features of medical devices and promoting discussion between clinicians and patients; further testing would need to be conducted on a larger group of participants in order to validate the learning effectiveness of the applications.

Fostering Resilience Among Mothers Early (FRAME): using growth mixture modeling to identify resources that mitigate perinatal depression.

The primary objective of this study was to delineate classes of individuals based on depression trajectories from the antenatal period through 54-month postpartum and internal and external resources that are associated with low depression risk. Participants came from the Growing Up in New Zealand (GUiNZ) study (n = 5664), which is a pregnancy cohort study and is nationally representative of the ethnic and socioeconomic diversity of contemporary New Zealand births. Growth curve mixture modeling was used to identify distinct subgroups based on depression scores from the antenatal period through 54-month postpartum. Logistic regression models were run to investigate socioeconomic factors and internal and external resources that were associated with depression class membership. A two-class model, "low risk" and "high risk," resulted in the best model fit. Most of the sample (n = 5110, 90%) fell into the "low-risk" class defined by no-to-mild depression symptoms during pregnancy and decreasing depressive symptoms over time (bintercept = - .05, bslope = - .05). Approximately 10% of the sample fell into the "high-risk" class (n = 554, 10%) defined by mild-to-moderate depressive symptoms during pregnancy and increasing depressive symptomology over time (bintercept = .39, bslope = .57). More positive parenting-related attitudes, better pre-pregnancy self-reported health, informal social supports, and community belonging were significantly associated with greater odds of being in the "low-risk" class, after controlling for socioeconomic factors. These findings suggest that targeting internal and external resources for individuals across the perinatal and early childhood periods is important to mitigating maternal depression.

Prenatal determinants of depressive symptoms in childhood: Evidence from Growing Up in New Zealand.

BACKGROUND: Young people who experience depression are at an increased risk of adverse psychosocial and developmental outcomes that can persist over the lifecourse. Identifying maternal prenatal risk factors that may contribute to childhood depressive symptoms can be useful when considering mental health intervention. METHODS: The current study included 3,925 children from the Growing Up in New Zealand (GUiNZ) study who had complete data for self-reported depressive symptoms and mothers' antenatal information. Depressive symptoms were measured at age 8 using the Centre for Epidemiological Studies Depression Scale for Children (CESD-10) short form questionnaire. Hierarchical linear regression was used to determine the relationship between prenatal factors and depressive symptoms at age 8. RESULTS: When controlling for sociodemographic characteristics, our hierarchical linear regression revealed that the most significant maternal prenatal predictors of high depressive symptoms at age 8 were maternal perceived stress, smoking during pregnancy, body mass index (BMI) in the overweight/obese range, and paracetamol intake. LIMITATIONS: One limitation with the current study was a reduction in the sample due to attrition. This may have affected our statistical power, reflected in our modest effect sizes. The sample remained both socioeconomically and ethnically diverse, however our results should be interpreted with respect to the sample and not the whole New Zealand population. CONCLUSIONS: A combination of maternal mental health and lifestyle factors contribute to depressive symptoms for children, possibly through foetal programming. Our results emphasise the importance of mental and physical health support for expectant mothers.

A regional survey evaluating patient experience seeking trial of labor after cesarean.

OBJECTIVE: To evaluate access to trial of labor after cesarean (TOLAC) in a large metropolitan city. STUDY DESIGN: In 2012, a public tertiary care hospital in Houston, TX promoted its TOLAC services on social media, resulting in a surge of self-referrals. In 2018, an electronic survey was distributed by email to 200 women who had previously contacted the hospital regarding TOLAC and posted on 2 local social media TOLAC sites. Women were asked to participate if they ever sought TOLAC in the Houston area. Data were analyzed for trends in patient experience seeking TOLAC and comparisons were made based on number of prior cesarean deliveries (CD) and race/ethnicity. RESULTS: The survey was open for responses for 1 month, with 128 completed surveys by the end of the study time period. Of the respondents, most (64%) had 1 prior CD and identified as White (63%). Most (60%) of all women reported contacting ≥3 providers before finding one that offered TOLAC, with no difference reported for women with 1 vs 2 prior CD (p = .2). Over half (52%) reported their experience seeking TOLAC to be difficult with more difficulty noted by those with 2 vs 1 prior CD, (61.8% vs 42.7%,) but not statistically significant (p = .06). White women were more likely to report an easier experience seeking TOLAC compared to Black women (55.6% vs 30%, p = .04).Overall, 37% attempted TOLAC at the reference hospital. Black (50%) and Hispanic (68.2%) women were significantly more likely to have delivered at the reference hospital than White women (24%) (p < .05). CONCLUSION: Our results suggest that women seeking TOLAC have difficulty finding providers who offer the service. This may be especially true for Black and Hispanic women and women with >1 prior CD. Women may utilize social media forums for resources and recommendations and such platforms may represent an underutilized opportunity to identify regional TOLAC services.

Maternal depression trajectories and child BMI in a multi-ethnic sample: a latent growth modeling analysis.

BACKGROUND: Perinatal (antenatal and postpartum) depression impacts approximately 12% of mothers. Perinatal depression can impact everyday functioning for mothers, and the relationship with, and development of, their children. The purpose of this study was to investigate depression trajectories from the antenatal period through 54-months postpartum and associations with child body mass index at 54-months postpartum. METHODS: This study applied latent growth modeling to the Growing Up in New Zealand study, which is a longitudinal pregnancy cohort study that provides nationally representative-level data, to investigate associations between depression at three time points (antenatal, 9-months postpartum, 54-months postpartum) and child body mass index at 54-months (n=4897). RESULTS: The average slope of depression for this sample is low and decreases over time. When child BMI was added to the model as an outcome variable, both antenatal depression (B=.25, p<.01), and the rate of change of depression across the perinatal and postpartum periods (B=.09, p<.01) were associated with child BMI at 54-months postpartum. After controlling for sociodemographic characteristics, antenatal depression, but not the slope of depression, remained significantly associated with child BMI (B=.05, p<.05). When controlling for maternal pre-pregnancy BMI the effect of antenatal depression on child BMI at 54-months was entirely attenuated (χ2 (9) = 39.60, p < .05, SRMR = 0.01, CFI = .99, RMSEA = 0.03, BIC=53213). CONCLUSIONS: Our findings align with the Developmental Origins of Health and Disease theory and imply that both the physical and mental health of mothers during pregnancy may be important indicators of child growth and development outcomes. Early intervention directed towards women who have even mild depression scores during pregnancy may promote healthy child development outcomes. Additionally, given the heterogeneity of depressive symptoms over time seen in this study, multiple assessment periods across the postpartum period may be valuable to adequately address and support maternal mental health.