Meaningful Engagement in Depression and Anxiety Collaborative Care: Associations With Systematic Case Review.

BACKGROUND: Collaborative care (CC) is an evidence-based model of care for treating behavioral health conditions in primary care settings. The CC team consists of a primary care provider, behavioral health care manager (CM), and a consultant psychiatrist who collaborate to create treatment plans. To date, there is limited data on factors associated with meaningful engagement in CC programs. OBJECTIVE: To identify the proportion of patients who were meaningfully engaged and to investigate the factors associated with meaningful engagement in a CC program. METHODS: Data was collected from a CC program implemented across 27 adult primary care clinics in a Midwestern, U.S. academic medical system. Logistic regression (n = 5218) was used to estimate the odds of receiving meaningful engagement. RESULTS: Data was collected from 6437 individuals with 68% being female and a mean age of 45 years old (standard deviation 17.6). Overall, 57% of patients were meaningfully engaged; however, this proportion differed based on demographic and clinical factors. Among modifiable clinical factors, systematic case reviews between the CM and psychiatrist (odds ratio: 10.2, 95% confidence interval: 8.6-12.1) and warm handoffs (odds ratio: 1.3, 95% confidence interval: 1.1-1.5) were associated with a higher likelihood of receiving meaningful engagement. CONCLUSIONS: The presence of systematic case reviews between the behavioral health CM and the consultant psychiatrist was highly associated with meaningful engagement. When implementing such programs, high fidelity to the core principles including regularly scheduled systematic case reviews should be pursued.

Neonatal AVPR1a Methylation and In-Utero Exposure to Maternal Smoking.

(1) Introduction: Epigenetic changes have been proposed as a biologic link between in-utero exposure to maternal smoking and health outcomes. Therefore, we examined if in-utero exposure to maternal smoking was associated with infant DNA methylation (DNAm) of cytosine-phosphate-guanine dinucleotides (CpG sites) in the arginine vasopressin receptor 1A AVPR1a gene. The AVPR1a gene encodes a receptor that interacts with the arginine vasopressin hormone and may influence physiological stress regulation, blood pressure, and child development. (2) Methods: Fifty-two infants were included in this cohort study. Multivariable linear models were used to examine the effect of in-utero exposure to maternal smoking on the mean DNAm of CpG sites located at AVPR1a. (3) Results: After adjusting the model for substance use, infants with in-utero exposure to maternal smoking had a reduction in DNAm at AVPR1a CpG sites by -0.02 (95% CI -0.03, -0.01) at one month of age. In conclusion, in-utero exposure to tobacco smoke can lead to differential patterns of DNAm of AVPR1a among infants. Conclusions: Future studies are needed to identify how gene expression in response to early environmental exposures contributes to health outcomes.

Assessment of US Federal Funding of Incarceration-Related Research, 1985 to 2022.

Importance: The US leads the world in the raw number of incarcerated persons as well as the rate of incarceration, with detrimental effects on individual-, family-, community-, and population-level health; as such, federal research has a critical role in documenting and addressing the health-related impacts of the US criminal legal system. How often incarceration-related research is funded at the National Institutes of Health (NIH), National Science Foundation (NSF), and US Department of Justice (DOJ) levels has a direct association with the public attention given to mass incarceration as well as the efficacy of strategies to mitigate negative effects and poor health related to incarceration. Objective: To understand how many incarceration-related projects have been funded at the NIH, NSF, and DOJ. Design, Setting, and Participants: This cross-sectional study used public historical project archives to search for relevant incarceration-related keywords (eg, incarceration, prison, parole) since January 1, 1985 (NIH and NSF), and since January 1, 2008 (DOJ). Quotations and Boolean operator logic were used. All searches and counts were conducted and double verified by 2 coauthors between December 12 and 17, 2022. Main Outcomes and Measures: Number and prevalence of funded projects related to incarceration and prison keywords. Results: The term incarceration resulted in 3540 of 3 234 159 total project awards (0.11%) and prisoner-related terms resulted in 11 455 total project awards (0.35%) across the 3 federal agencies since 1985. Nearly a tenth of all projects funded at NIH since 1985 related to education (256 584 [9.62%]) compared with only 3373 projects (0.13%) that related to criminal legal or criminal justice or correctional system and 18 projects (0.0007%) that related to incarcerated parents. Only 1857 (0.07%) of all NIH-funded projects have been funded related to racism since 1985. Conclusions and Relevance: This cross-sectional study found that a very low number of projects about incarceration have historically been funded at the NIH, DOJ, and NSF. These findings reflect a dearth of federally funded studies investigating the effects of mass incarceration or intervention strategies to mitigate adverse effects. Given the consequences of the criminal legal system, it is undoubtedly time for researchers, and our nation, to invest more resources into studying whether this system should be maintained, the intergenerational effects of mass incarceration, and strategies to best mitigate its impact on public health.

A Quality Improvement Network for Interdisciplinary Training in Developmental Disabilities.

Children with developmental disabilities (DD), such as autism spectrum disorder (ASD), have complex health and developmental needs that require multiple service systems and interactions with various professionals across disciplines. The growing number of children and youth identified with ASD or DD, including anxiety and depression, has increased demand for services and need for highly qualified pediatric providers. Federally funded Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs across the United States address today's health care shortages by providing comprehensive, interdisciplinary training to providers from multiple pediatric disciplines who screen, diagnose, and treat those with ASD and DD. Each LEND program develops training methods independently, including quality improvement efforts. In 2014, LEND programs began designing and validating common measures to evaluate LEND training. The LEND Program Quality Improvement (LPQI) Network was established in 2016. Participating LEND programs in the LPQI Network administer validated trainee self-report and faculty-observation measures that address skills in key competency domains of Interdisciplinary or Interprofessional Team Building, Family-Professional Partnerships, and Policy. This study reports data from faculty and trainees from 22 LEND programs that participated in the LPQI Network across the 5-year data collection period. The main outcome of this study was the change in trainee knowledge, skills, and attitudes scores in key competency domains across programs. Overall, trainees made significant knowledge, skills, and attitude gains based on both self-report and faculty observation scores for all 3 competency domains. Data demonstrate the value of LEND programs and feasibility of a national quality improvement approach to evaluate interdisciplinary training and systems-level improvement.

Racial Inequities in Breastfeeding Counseling Among Pregnant People Who Use Cannabis.

We examined how breastfeeding advice in the context of cannabis use differed by race and ethnicity. Data from the 2017-2018 PRAMS (Pregnancy Risk Assessment Monitoring System) survey were used to assess differences in breastfeeding guidance related to cannabis use among 1,213 individuals who self-reported cannabis use 3 months before or during pregnancy. A multivariable logistic regression model was specified to examine the extent to which the odds of receiving prenatal advice against breastfeeding if using cannabis differed by self-reported race and ethnicity. We found that non-Hispanic Black people were four times more likely than non-Hispanic White people to be advised against breastfeeding if using cannabis (adjusted odds ratio 4.1, 95% CI 2.1-8.2). Pregnant non-Hispanic Black people were disproportionately advised not to breastfeed if using cannabis.

The Deferred Action for Childhood Arrivals program and birth outcomes in California: a quasi-experimental study.

BACKGROUND: The Deferred Action for Childhood Arrivals (DACA) program provides temporary relief from deportation and work permits for previously undocumented immigrants who arrived as children. DACA faced direct threats under the Trump administration. There is select evidence of the short-term impacts of DACA on population health, including on birth outcomes, but limited understanding of the long-term impacts. METHODS: We evaluated the association between DACA program and birth outcomes using California birth certificate data (2009-2018) and a difference-in-differences approach to compare post-DACA birth outcomes for likely DACA-eligible mothers to birth outcomes for demographically similar DACA-ineligible mothers. We also separately compared birth outcomes by DACA eligibility status in the first 3 years after DACA passage (2012-2015) and in the subsequent 3 years (2015-2018) - a period characterized by direct threats to the DACA program - as compared to outcomes in the years prior to DACA passage. RESULTS: In the 7 years after its passage, DACA was associated with a lower risk of small-for-gestational age (- 0.018, 95% CI: - 0.035, - 0.002) and greater birthweight (45.8 g, 95% CI: 11.9, 79.7) for births to Mexican-origin individuals that were billed to Medicaid. Estimates were consistent but of smaller magnitude for other subgroups. Associations between DACA and birth outcomes were attenuated to the null in the period that began with the announcement of the Trump U.S. Presidential campaign (2015-2018), although confidence intervals overlapped with estimates from the immediate post-DACA period. CONCLUSIONS: These findings suggest weak to modest initial benefits of DACA for select birthweight outcomes during the period immediately following DACA passage for Mexican-born individuals whose births were billed to Medicaid; any benefits were subsequently attenuated to the null. The benefits of DACA for population health may not have been sufficient to counteract the impacts of threats to the program's future and heightened immigration enforcement occurring in parallel over time.

Breastfeeding Initiation and Continuation Among Women with Substance and Tobacco Use During Pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System 2016-2018.

Background and Aims: Substance and tobacco use is associated with poor maternal and child health outcomes. Although these have each been linked to lower breastfeeding rates when examined separately, studies have yet to examine how the combination of tobacco and other substance use influences breastfeeding initiation and continuation. The aim of this study was to examine how the combination of smoking tobacco and use of illicit substances influences the odds of breastfeeding initiation and continuation. Materials and Methods: This retrospective cohort study (n = 15,634) used survey data from the 2016-2018 Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System from eight US states to examine the association of tobacco and illicit substance use with breastfeeding initiation and continuation (≥6 weeks). The odds of breastfeeding initiation and continuation for individuals with and without prenatal tobacco and illicit substance use, adjusting for maternal and infant characteristics, were estimated using weighted, multivariable logistic regression models. Results: The combination of prenatal tobacco and illicit substance use was associated with a 42% reduction in the odds of initiating breastfeeding (adjusted odds ratio [aOR] 0.58 [95% confidence interval, CI 0.39-0.87]) and a 39% reduction in the odds of breastfeeding for at least 6 weeks (aOR 0.61 [95% CI 0.41-0.92]) when compared with those without tobacco and substance use. Conclusion: The odds of breastfeeding initiation and continuation are significantly lower among individuals with both prenatal tobacco and illicit substance use. Future studies are needed to identify barriers to breastfeeding within this population, to inform patient-centered interventions aimed at overcoming these barriers.

Factors Associated With Bullying Victimization and Bullying Perpetration in Children and Adolescents With ADHD: 2016 to 2017 National Survey of Children's Health.

OBJECTIVE: To identify characteristics associated with bullying involvement in pediatric ADHD. METHODS: Data from the 2016 to 2017 National Survey of Children's Health for children aged 6 to 17 years with ADHD were evaluated to assess the association between parent-reported bullying victimization or perpetration and the following potential predictors: demographic characteristics, family factors, school factors, and child conditions/behaviors. RESULTS: Among children with ADHD, 46.9% were bullying victims and 16.2% were perpetrators. Factors associated with victimization included having family financial strain, developmental delay or intellectual disability, friendship difficulties, and school reports about problems. Factors linked to perpetration included being male, receiving government assistance, lack of school engagement, school reports about problems, and having difficulties with friendships, staying calm, and arguing. CONCLUSIONS: Children with ADHD frequently were bullying victims and sometimes bullying perpetrators. Factors related to family financial strain, developmental disabilities, emotional regulation, peer relationships, and school functioning may help to identify risk for bullying and opportunities for anti-bullying interventions.

Home Visiting as an Equitable Intervention for Perinatal Depression: A Scoping Review.

Objective: Maternal mental health disorders are a leading complication of childbirth. While few systems are adequately able to identify and treat depression, people experiencing perinatal depression may benefit from the intervention of home visiting. The intent of home visiting interventions is to alleviate stressors of parenthood for people facing additional risk factors. The aim of this scoping review is to investigate the effect of home visiting on perinatal depression grounded in published studies. Methods: We conducted a scoping review of the existing literature of studies relevant to perinatal depression and home visiting. We entered keywords in five search databases: MEDLINE, PsycInfo, CINAHL, Social Work Abstracts, and Google Scholar. All relevant literature published between January 1999-December 2019 was reviewed. Duplicates, books, and errata were excluded from the study. As a scoping review, we included all studies published in English describing the inclusion of maternal depression in home visits. We hypothesize birthing people with perinatal depression will benefit from home visiting interventions. Results: The results from the scoping review and describe the use of home visiting to improve perinatal mental health. An initial 12,652 records were identified in the search. After duplicates were removed, the titles of 2,140 articles were assessed for applicability, however 29 identified for full-text eligibility and were included in this analysis. The majority of the studies included in this review were quantitative (n = 23), followed by qualitative (n = 3), and mixed methods (n = 3). Nearly all studies (n = 28) using validated instruments such as the Edinburgh Postnatal Depression Scale to determine depressive symptoms. Discussion: This review offers preliminary qualitative insights on the efficacy of home visiting for administrating perinatal depression care. Studies show that home visiting programs can provide treatment for perinatal depression and reduce the effects of depression for birthing people. Our review suggests that the efficacy of home visiting programs beginning in the postpartum period are less predictable than prenatal home visiting intervention among various populations, including people experiencing both high-risk and low-risk situations.

Association Between Maternal Adverse Childhood Experiences and Neonatal SCG5 DNA Methylation-Effect Modification by Prenatal Home Visiting.

Maternal childhood adversity and trauma may elicit biological changes that impact the next generation through epigenetic responses measured in DNA methylation (DNAm). These epigenetic associations could be modified by the early postnatal environment through protective factors, such as early childhood home visiting (HV) programs that aim to mitigate deleterious intergenerational effects of adversity. In a cohort of 53 mother-child pairs recruited in 2015-2016 for the Pregnancy and Infant Development Study (Cincinnati, Ohio), we examined the association between maternal adverse childhood experiences (ACEs) and neonatal DNAm in the secretogranin V gene (SCG5), which is important in neuroendocrine function. We examined prenatal HV as an effect modifier. Mothers completed a questionnaire on ACEs during pregnancy, and infant buccal samples were collected 1 month postpartum. Multivariable linear regression was used to examine the association between maternal ACEs and neonatal DNAm expressed as M-values averaged across 4 cytosine-phosphate-guanine dinucleotide sites. A higher number of maternal ACEs (>3) was associated with a 5.79-percentage-point lower offspring DNAm (95% confidence interval: -10.44, -1.14), and the association was modified by the number of home visits received during pregnancy. In a population of at-risk mother-child dyads, preliminary evidence suggests that maternal ACEs have a relationship with offspring SCG5 DNAm that differs by the amount of prenatal HV.

Substance Use and Utilization of Prenatal and Postpartum Care.

OBJECTIVES: Prenatal and postpartum care for women with substance use is important due to increased risk of poor health outcomes. The influence of substance use on perinatal care utilization is not well characterized, especially postpartum care. The objective of this study was to examine the effect of substance use during pregnancy on prenatal and postpartum care utilization in a nationally representative sample and to identify maternal characteristics associated with inadequate prenatal and postpartum care among women with substance use. METHODS: Pregnancy Risk Assessment Monitoring System data (2016-2018) from 8 states were used for this study. Logistic regression models adjusted for complex survey weights and confounder variables were used to estimate the odds of not receiving adequate prenatal care and postpartum care. Weighted Rao-Scott chi-square tests were used to examine maternal characteristics associated with care utilization among women who reported substance use during pregnancy. RESULTS: The study included 15,131 women, with 5.3% who reported illicit substance use during pregnancy. In multivariable models, substance use was associated with an increase in the odds of not receiving adequate prenatal care (OR 1.69, CI 1.32, 2.17) and not receiving postpartum care (OR: 1.47, CI 1.10, 1.95). Among women who reported substance use, depression and smoking status were associated with not receiving adequate prenatal or postpartum care. CONCLUSIONS: Substance use during pregnancy is independently associated with disparities in prenatal and postpartum care access. Future studies are needed to identify how barriers lead to care inequalities and importantly, to identify strategies to improve care utilization.

Meta-Analysis Of Antenatal Depression And Adverse Birth Outcomes In US Populations, 2010-20.

Untreated depression presents a distinct set of risks for pregnancy complications. Past studies have connected antenatal depression with adverse birth outcomes. The purpose of this study was to conduct an updated systematic review and meta-analysis examining the relationship between depression during pregnancy and associated adverse birth outcomes in US populations during the period 2010-20. As a trend, disparities in adverse pregnancy outcomes and maternal morbidities for Black pregnant people compared with those for White pregnant people continue to rise. Addressing mental health conditions during pregnancy has the potential to ameliorate a large and excessive burden on adverse birth outcomes among childbearing people and their offspring. Policy solutions to encourage, mandate, and reimburse universal depression screening during pregnancy are warranted.

Pregnancy and Infant Development (PRIDE)-a preliminary observational study of maternal adversity and infant development.

BACKGROUND: Children from socioeconomically disadvantaged families have a markedly elevated risk for impaired cognitive and social-emotional development. Children in poverty experience have a high risk for developmental delays. Poverty engenders disproportionate exposure to psychological adversity which may contribute to impaired offspring development; however the effect may be mitigated by social support and other aspects of resilience. Our objective was to determine the association between maternal stress, adversity and social support and early infant neurobehavior and child behavior at two and three years. METHODS: We conducted a longitudinal mother-infant cohort study nested within a regional home visiting program in Cincinnati, Ohio. Four home study visits were completed to collect measures of maternal stress, adversity and social support and infant and child behavior. A measure of infant neurobehavior ('high-arousal' infant) was derived from the NICU Network Neurobehavioral Scale (NNNS) at 1 month and externalizing and internalizing symptoms were measured by the Child Behavior Checklist (CBCL) at 24 and 36 months. Linear and logistic regression identified associations between maternal risk/protective factors and infant and child behavioral measures. We used stratification and multiplicative interaction terms to examine potential interactions. RESULTS: We enrolled n = 55 pregnant mothers and follow 53 mother-offspring dyads at 1 month, 40 dyads at 24 months and 27 dyads at 36 months. Maternal adversity and protective factors were not associated with neurobehavior at one month. However, maternal depression and measures of distress in pregnancy were significantly associated with internalizing and externalizing symptoms at 24 and 36 months. CONCLUSIONS: This pilot study established the feasibility of conducting longitudinal research within a community intervention program. In addition, although there were no statistically significant associations between maternal psychosocial factors in pregnancy and infant neurobehavior, there were several associations at 24 months, primarily internalizing symptoms, which persisted through 36 months. Future work will replicate findings within a larger study as well as explore mediators and modifiers of these associations.

Striving for Structure and Stability in Cincinnati's Family Homeless Shelters: A Community-Based Participatory Research Approach.

Experiencing homelessness negatively impacts child health, development, and emotional-behavioral functioning, but there is limited knowledge regarding specific service priorities, as articulated by families themselves, to prevent or address these adverse sequelae. Thus, to elicit the service needs perspective of families in shelter and to translate these findings into real-world action, we undertook a community-based participatory research effort using Group-Level Assessment, a focus group methodology. An action-based participatory needs assessment called a Group-Level Assessment (GLA) was conducted in collaboration with parents currently experiencing homelessness. A total of 53 parents from 3 Cincinnati homeless shelters participated by responding to 17 to 20 open-ended prompts regarding their child's medical, developmental, learning, social, and behavioral needs. Using GLA methodology, we found that the needs expressed by families residing in shelters coalesced around the following themes: job and housing stability, education and skill development, emotional support, and improving shelter life. The GLA findings were then shared with shelter and community leaders, leading to a number of policy and practice enhancements in the shelters. This study demonstrates the power of the GLA approach to affect community action as a direct result of priorities generated by families experiencing homelessness.

Association between perinatal depression and risk of attention deficit hyperactivity disorder among children: a retrospective cohort study.

PURPOSE: Perinatal depression has previously been identified as a risk factor for attention deficit hyperactivity disorder (ADHD) in the offspring. Population-based studies utilizing diagnosis data are needed to better understand the relationship between these two variables. The objective of this study was to examine the association between perinatal depression and the risk of ADHD among children born during a 5 or-more-year follow-up period. METHODS: The sample was drawn from a population-based cohort of privately insured mother-child pairs within the state of Iowa. Hazard ratios for risk of ADHD by exposure to perinatal depression were estimated using adjusted Cox proportional-hazard models. RESULTS: Among the 5,635 mother-child pairs, 484 mothers were diagnosed with depression during the perinatal period, and 269 children were diagnosed with ADHD. After adjustment for confounders, children born to mothers with perinatal depression were over three times more likely to be diagnosed with ADHD (HR 3.16 (95% CI 2.35, 4.23)). CONCLUSIONS: Children born to mothers with perinatal depression were found to be at increased risk of ADHD. This finding suggests that ADHD and its adverse sequelae could be mitigated by increasing maternal depression intervention efforts as well as ADHD screening and treatment efforts targeted to this vulnerable population.

Regional comparison of self-reported late pregnancy cigarette smoking to mass spectrometry analysis.

OBJECTIVE: To report a more accurate prevalence estimate of late pregnancy nicotine exposures. STUDY DESIGN: A cross-sectional study during a 2-month period in 2019. Participants were women delivering in any of the six county maternity hospitals who consented to universal drug testing at the time of delivery as part of routine hospital admission. RESULTS: Of 2531 tested samples, 18.7% tested positive for high levels of cotinine indicating primary smoking or other primary use of tobacco products. Together, 33.0% of the study population tested positive for nicotine exposure during late pregnancy compared to vital records which reported 8.2% cigarette smoking during the third trimester of pregnancy and 10.5% cigarette smoking at any time during pregnancy through maternal self-report. CONCLUSION: Captured vital birth smoking measures vastly underreport actual primary exposures to nicotine products. Vital birth data also fail to capture secondhand exposures which constitute a significant proportion of the population.

Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study.

Objective The aim of the study is to evaluate the risk of preterm birth (PTB, <37 weeks) and early term (37 and 38 weeks) birth among women with an emergency department (ED) visit or hospitalization with a urinary tract infection (UTI) by trimester of pregnancy. Methods The primary sample was selected from births in California between 2011 and 2017. UTIs were identified from the ED or hospital discharge records. Risk of PTB, by subtype, and early term birth were evaluated by trimester of pregnancy and by type of visit using log-linear regression. Risk ratios were adjusted for maternal factors. Antibiotic usage was examined in a population of privately insured women from Iowa. Results Women with a UTI during pregnancy were at elevated risk of a birth <32 weeks, 32 to 36 weeks, and 37 to 38 weeks (adjusted risk ratios [aRRs] 1.1-1.4). Of the women with a diagnostic code for multiple bacterial species, 28.8% had a PTB. A UTI diagnosis elevated risk of PTB regardless of antibiotic treatment (aRR 1.4 for treated, aRR 1.5 for untreated). Conclusion UTIs are associated with early birth. This association is present regardless of the trimester of pregnancy, type of PTB, and antibiotic treatment.

Combinations of adverse childhood events and risk of postpartum depression among mothers enrolled in a home visiting program.

PURPOSE: The purpose of this study was to examine how combinations of adverse childhood events (ACEs) contribute to the risk of postpartum depression and the mediating role of prenatal social support. METHODS: The Adverse Childhood Experiences Scale Questionnaire and the Edinburgh Postnatal Depression Scale Questionnaire were used to measure the study's exposure and outcome. Among a cohort of 419 mothers enrolled in a home visiting (HV) program, latent class analyses were used to identify classes of ACEs exposure. General linear models assessed the risk of postpartum depression, and prenatal social support was examined as a mediator. RESULTS: Four distinct classes of ACE exposure were identified. On the Edinburgh Postnatal Depression scale, mothers who were classified in Classes 1-3 scored higher by 2.6-4.4 points compared with women in Class 0. ACE class was found to be indirectly associated with postpartum depression scores through prenatal social support. CONCLUSIONS: Identifying combinations of ACEs in an HV program has the potential to improve the characterization of ACEs among low-income perinatal women in the United States. Elucidating how these combinations contribute to the risk of postpartum depression has the potential to identify women at increased risk, which can help HV programs prioritize prevention efforts.

Association of Mood and Anxiety Disorders and Opioid Prescription Patterns Among Postpartum Women.

BACKGROUND AND OBJECTIVES: Postpartum women represent a large population with opioid exposure who also have an increased risk of experiencing mood and anxiety disorders. However, the effect that mood and anxiety disorders have on opioid use postpartum has received little attention in the literature. Therefore, the objective of this study was to examine the association of mood and anxiety disorders with filling opioid prescriptions within the first 3 months postpartum. METHODS: A retrospective cohort study (n = 25 279) was completed using claims data for a sample of privately insured women who gave birth in the state of Iowa. The interactive effects of mood and anxiety disorders and delivery mode on filling at least one and two or more opioid prescriptions were examined in logistic regression models. RESULTS: The presence of mood and anxiety disorders among women who delivered vaginally increased their odds of filling at least one opioid fill by nearly 50% (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.35-1.63) and by 20% (OR: 1.20, 95% CI: 1.00-1.43) among women with cesarean delivery. DISCUSSION AND CONCLUSION: Postpartum women with mood and anxiety disorders were more likely to fill opioid prescriptions postpartum compared to women without these conditions. SCIENTIFIC SIGNIFICANCE: This study extends prior research by examining the intersection of risk of mood and anxiety disorders and opioid use postpartum. Findings from this study support the need for future research to identify the drivers of increased opioid use among postpartum women with mood and anxiety disorders. (Am J Addict 2020;29:463-470).

Gestational vitamin D and offspring risk of multiple sclerosis: a systematic review and meta-analysis.

PURPOSE: Our objective was to systematically review and meta-analyze studies that assessed the association between gestational vitamin D levels and risk of multiple sclerosis (MS) in offspring. METHODS: Embase and Pubmed databases were searched from inception to May 2018. Original, observational studies that investigated both clinically defined MS (in offspring) and vitamin D levels in utero or shortly after birth were included. Two reviewers independently abstracted data and assessed the quality of studies using the Newcastle-Ottawa Quality Assessment Scale. Summary effect estimates and 95% confidence intervals were calculated with random effects models using inverse variance weighting. Determinants of heterogeneity were evaluated. RESULTS: Four case-control studies of moderate to low risk of bias were included. Summary effect estimates of the effect of higher levels of gestational vitamin D on risk of offspring MS demonstrated a significant protective effect in random effects (OR: 0.63, 95% CI: 0.47, 0.84) models and in a stratified analysis based on study quality. Factors identified as determinants of heterogeneity were the definitions of vitamin D deficiency, the characteristics of study participants, and the quality of the study. CONCLUSIONS: Sufficient levels of vitamin D during pregnancy may be protective against offspring's development of multiple sclerosis later in life.