COVID-19 Evaluation and Testing Strategies in a Federally Qualified Health Center.

Federally Qualified Health Centers (FQHCs) are organizations that provide primary care services to our nation's most vulnerable communities. This nurse practitioner-led intervention sought to double the number of available COVID-19 evaluation and testing appointments within an FQHC. Results showed a significant increase in the availability of respiratory clinic appointments, the number of completed appointments, and the number of tests completed. This demonstrates nurse practitioners' ability to work with organizations to develop innovative systems that can be adapted for future use. (Am J Public Health. 2022;112(S3):S284-S287. https://doi.org/10.2105/AJPH.2022.306827).

Developmental Origins of Health and Disease: A Challenge for Nurses.

Prevention of disease is a cornerstone of nursing care. Through our endeavors in research, teaching, and clinical care, nurses consistently seek to change the trajectory of disease development. The theoretical framework known as the Developmental Origins of Health and Disease (DOHaD) offers a new lens that shifts the current disease prevention paradigm upstream, encouraging intensified care of pregnant girls/women, neonates, and infants. This new focus parallels other emerging ecobiodevelopmental, life-course theories, which identify the long-term impact of early environments and stressors on the later risk of chronic adult diseases. Nurses have the potential to influence the health of multiple generations by incorporating DOHaD perspectives and interventions into their research and patient care.

High Prevalence of Maternal Serum 25-Hydroxyvitamin D Deficiency Is Not Associated With Poor Birth Outcomes Among Healthy White Women in the Pacific Northwest.

OBJECTIVE: To quantify vitamin D status among pregnant women in the Pacific Northwest (Portland, OR, and Seattle, WA) and examine pregnancy and newborn outcomes in relationship to maternal serum blood samples obtained during pregnancy. DESIGN: A retrospective cohort design. SETTING: Data from 2009 to 2013 were abstracted from the health records of two out-of-hospital midwifery practices in the Pacific Northwest. PARTICIPANTS: Women with recorded serum blood samples for vitamin D during pregnancy were included. We reviewed health records of 663 women, and 357 met criteria. METHODS: We extracted demographic, biometric, and pregnancy outcome data from participants' records and analyzed them using regression models. RESULTS: Mean serum 25-hydroxy vitamin D (25[OH]D) was 29.96 ± 10.9 ng/ml; 45.5% of participants were sufficient (≥30 ng/ml), and 55.5% were insufficient or deficient (<29 ng/ml). Lower vitamin D levels were predicted by Seattle location, greater prepregnancy body mass index, and blood samples drawn during the winter. Vitamin D status was not a predictor of spontaneous abortion, glucose tolerance test result, cesarean birth, infant birth weight, or any other outcome investigated. CONCLUSION: Although there is a high prevalence of vitamin D insufficiency and deficiency in pregnant women in the Pacific Northwest, adverse health effects were not observed. This may be attributable to the overall healthy profile of the women in our sample. Further research on maternal vitamin D status should focus on identification of optimal vitamin D levels in pregnancy and long-term outcomes among offspring of women who are vitamin D deficient, particularly those from high-risk, vulnerable populations.

Effects of Maternal Vitamin D Supplementation on the Maternal and Infant Epigenome.

INTRODUCTION: Mothers and infants are at high risk for inadequate vitamin D status. Mechanisms by which vitamin D may affect maternal and infant DNA methylation are poorly understood. OBJECTIVE: This study quantified the effects of vitamin D3 supplementation on DNA methylation in pregnant and lactating women and their breastfed infants. MATERIALS AND METHODS: In this randomized controlled pilot study, pregnant women received vitamin D3 400 international units (IU) (n = 6; control) or 3,800 IU (n = 7; intervention) daily from late second trimester through 4-6 weeks postpartum. Epigenome-wide DNA methylation was quantified in leukocytes collected from mothers at birth and mother-infant dyads at 4-6 weeks postpartum. RESULTS: At birth, intervention group mothers showed DNA methylation gain and loss at 76 and 89 cytosine-guanine (CpG) dinucleotides, respectively, compared to controls. Postpartum, methylation gain was noted at 200 and loss at 102 CpGs. Associated gene clusters showed strongest biologic relevance for cell migration/motility and cellular membrane function at birth and cadherin signaling and immune function at postpartum. Breastfed 4-6-week-old infants of intervention mothers showed DNA methylation gain and loss in 217 and 213 CpGs, respectively, compared to controls. Genes showing differential methylation mapped most strongly to collagen metabolic processes and regulation of apoptosis. CONCLUSIONS: Maternal vitamin D supplementation during pregnancy and lactation alters DNA methylation in mothers and breastfed infants. Additional work is needed to fully elucidate the short- and long-term biologic effects of vitamin D supplementation at varying doses, which could hold important implications for establishing clinical recommendations for prenatal and offspring health promotion.

Vitamin D3 Supplementation During Pregnancy and Lactation Improves Vitamin D Status of the Mother-Infant Dyad.

OBJECTIVE: To identify the combined effect of prenatal and postnatal vitamin D3 supplementation on the vitamin D status of pregnant and lactating women and their exclusively breastfed infants. DESIGN: Double-blind, randomized controlled trial. SETTING: Upper Midwestern U.S., hospital-based obstetric practice. PARTICIPANTS: Pregnant women (N = 13) planning to exclusively breastfeed were randomized at 24 to 28 weeks gestation to receive vitamin D3 at a dosage of 400 IU (control group, n = 6) or 3,800 IU (intervention group, n = 7) daily through 4 to 6 weeks postpartum. Vitamin D status was determined at enrollment and in mother-infant dyads at 24 to 72 hours after birth and 4 to 6 weeks postpartum. METHODS: Serum 25-hydroxyvitamin D levels were measured to determine the effect of vitamin D3 supplementation on the vitamin D status of mothers and infants. Analysis of covariance was used to compare differences in 25-hydroxyvitamin D levels between the control and intervention groups. RESULTS: The mothers' vitamin D levels were significantly higher in the intervention group than in the control group at birth (p = .044) and at 4 to 6 weeks postpartum (p = .002). Infants in the intervention group had significantly higher vitamin D levels at birth (p = .021) and nonsignificant, clinically relevant increases at 4 to 6 weeks of age (p = .256). No differences were found between maternal groups in serum calcium or parathyroid hormone levels. CONCLUSION: Prenatal to postpartum vitamin D3 supplementation is an effective intervention to increase a mother's vitamin D status and to promote optimal vitamin D status in newborns and exclusively breastfed infants.

Maternal vitamin D supplementation to meet the needs of the breastfed infant: a systematic review.

Maternal vitamin D insufficiency during lactation, related to lack of sun exposure and minimal intake of vitamin D from the diet, contributes to low breast milk vitamin D content and, therefore, infant vitamin D deficiency. The objective of this review was to examine the literature regarding evidence for achieving maternal vitamin D status that promotes sufficient vitamin D transfer from mother to infant exclusively from breast milk. PubMed and CINAHL databases were searched using the terms lactation or breastfeeding or milk, human and vitamin D. The resulting articles were further limited to those written in English, published within the last 10 years, and involving clinical or randomized controlled trials of humans. The search yielded 13 studies, 3 of which provide evidence for maternal intake of vitamin D and the correlation with exclusively breastfed infants' serum 25-hydroxyvitamin D level. A strong positive correlation exists between maternal vitamin D intake during exclusive breastfeeding and infant serum 25-hydroxyvitamin D levels. There is support to conclude that when maternal vitamin D intake is sufficient, vitamin D transfer via breast milk is adequate to meet infant needs. In the reviewed studies, doses up to 10 times the current recommended daily intake of vitamin D were needed to produce sufficient transfer from mother to breastfed infant. Further research is needed to refine the dose and gestational timing of maternal vitamin D supplementation. Due to the high rates of vitamin D deficiency during lactation and the correlations between vitamin D deficiency and multiple diseases, providers should consider monitoring lactating mothers' vitamin D status.

Maternal vitamin D status as a critical determinant in gestational diabetes.

OBJECTIVE: To synthesize published research to determine the evidence for the association between maternal vitamin D status during pregnancy and the development of gestational diabetes mellitus (GDM). DATA SOURCES: Literature searches were conducted for data based articles that examined maternal vitamin D during pregnancy, GDM, glucose tolerance, and insulin resistance using the PubMed, CINAHL, and SCOPUS data bases and reference lists from reviewed papers. STUDY SELECTION: Primary research studies published in the English language between 1999 and 2011 reporting findings regarding the association of vitamin D with glucose homeostasis during pregnancy and GDM. DATA EXTRACTION: Study characteristics and findings related to vitamin D status determinants, gestational timing, and measures of glucose homeostasis and insulin resistance. DATA SYNTHESIS: Six data based articles met the criteria for study inclusion. Study findings comprised solely Level-2 evidence for the association of maternal vitamin D deficiency and risk of GDM. The majority of studies (66%) were conducted between 24 and 30 weeks gestation. Five (83%) studies reported an inverse relationship between circulating vitamin D levels and markers of glucose homeostasis associated with gestational diabetes or an increased risk for GDM associated with reduced maternal levels of vitamin D. In one study, researchers did not identify an association between vitamin D and GDM but did identify an association between higher vitamin D levels and lower fasting glucose and insulin levels. CONCLUSION: Maternal vitamin D deficiency and insufficiency is prevalent among gravid women and is associated with markers of altered glucose homeostasis. These findings underscore the need for mechanistic and clinical studies to determine optimal vitamin D status in pregnancy for reduction in the risk for GDM with implications for vitamin D supplementation as a potential target for GDM prevention.