Hyperandrogenism diminishes maternal-fetal fatty acid transport by increasing FABP4-mediated placental lipid accumulation†.

Long-chain polyunsaturated fatty acids (LCPUFAs) are critical for fetal brain development. Infants born to preeclamptic mothers or those born growth restricted due to placental insufficiency have reduced LCPUFA and are at higher risk for developing neurodevelopmental disorders. Since plasma levels of testosterone (T) and fatty acid-binding protein 4 (FABP4) are elevated in preeclampsia, we hypothesized that elevated T induces the expression of FABP4 in the placenta leading to compromised transplacental transport of LCPUFAs. Increased maternal T in pregnant rats significantly decreased n-3 and n-6 LCPUFA levels in maternal and fetal circulation, but increased their placental accumulation. Dietary LCPUFAs supplementation in T dams increased LCPUFA levels in the maternal circulation and further augmented placental storage, while failing to increase fetal levels. The placenta in T dams exhibited increased FABP4 mRNA and protein levels. In vitro, T dose-dependently upregulated FABP4 transcription in trophoblasts. Testosterone stimulated androgen receptor (AR) recruitment to the androgen response element and trans-activated FABP4 promoter activity, both of which were abolished by AR antagonist. Testosterone in pregnant rats and cultured trophoblasts significantly reduced transplacental transport of C14-docosahexaenoic acid (DHA) and increased C14-DHA accumulation in the placenta. Importantly, FABP4 overexpression by itself in pregnant rats and trophoblasts increased transplacental transport of C14-DHA with no significant placental accumulation. Testosterone exposure, in contrast, inhibited this FABP4-mediated effect by promoting C14-DHA placental accumulation.

Care Coordination Services: A Description of an Alternative Service Model for At-Risk Families.

OBJECTIVE: The objective of this article is to describe a care coordination model that includes promising practices which are supported by both practice-based and research-based evidence. This model was developed to address the gaps of other models, namely an emphasis on skill teaching with parents, the flexibility to adapt to the needs of youth with a wide variety of presenting problems, and model fidelity assessment tools to help scale up the program across multiple locations with fidelity. METHOD: We discuss preliminary administrative and outcome data from 898 youth served across eight locations. RESULTS: Data suggest positive outcomes at departure from service, as well as 6 months and 12 months post case closure. CONCLUSION: Preliminary data indicate that youth with educational and behavioral health challenges can benefit from coordination of services that are both youth guided and family driven. As this program has been scaled up and has an established vehicle of dissemination, it is in a unique position to be tested via more highly controlled and rigorous efficacy trials.

Evaluation of Boys Town In-Home Family Services with Families Referred by Child Welfare.

This study evaluated the Boys Town In-Home Family Services model with families referred by child welfare for issues related to maltreatment. Participants were 135 parents (mean age = 32.15 years, SD = 9.13) who completed intake and discharge assessments. The target child ranged in age from one month to 17 years (M = 4.54, SD = 4.38). We had a high-risk sample (e.g., 57% and 41% of parents reported being victims of physical and sexual abuse, respectively; 24% of parents reported attempting suicide in their lifetimes). The intervention was implemented with a degree of fidelity consistent with model standards. Reduced levels of perceived stressors were found for several domains of functioning with the largest effects observed for family safety, parental capabilities, and environmental factors. Results serve as an important step in building the evidence base of a widely disseminated intervention.