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Everett BG, Philbin MM, Homan P. Structural heteropatriarchy and maternal cardiovascular morbidities. Soc Sci Med 2024; 351 Suppl 1:116434. [PMID: 38825374 PMCID: PMC11149902 DOI: 10.1016/j.socscimed.2023.116434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 06/04/2024]
Abstract
The United States has some of the poorest maternal health outcomes of any developed nation. Existing research on maternal cardiovascular morbidities has focused predominantly on individual- and clinic-level drivers, but we know little about community- and structural-level factors that shape these outcomes. We use a composite measure of "structural heteropatriarchy" which includes measures of structural sexism and structural LGB-stigma to examine the relationship between structural heteropatriarchy and three cardiovascular-related maternal morbidities using the National Longitudinal Study of Adolescent to Adult Health (n = 3928). Results using multivariate regressions show that structural heteropatriarchy is associated with increased risk of reporting maternal morbidities. Our findings provide further evidence that sexuality- and gender-based stigma operate together to shape health disparities, including maternal health.
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Affiliation(s)
| | - Morgan M Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California at San Francisco, United States
| | - Patricia Homan
- Department of Sociology, Florida State University, United States
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2
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Pathirana MM, Andraweera PH, Leemaqz S, Aldridge E, Arstall MA, Dekker GA, Roberts CT. Anxiety and Depression in Early Gestation and the Association with Subsequent Gestational Diabetes Mellitus in a Disadvantaged Population. Matern Child Health J 2023; 27:2185-2193. [PMID: 37823988 PMCID: PMC10618298 DOI: 10.1007/s10995-023-03778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Evaluate the association between poor mental health and risk of developing gestational diabetes mellitus (GDM) in a cohort of women from a socioeconomically disadvantaged community. METHODS A total of 1363 nulliparous women with singleton pregnancies recruited to the Screening Tests to Predict Poor Outcomes of Pregnancy study in Adelaide, Australia. Women were assessed for mental health in the first trimester, including likelihood of depression, high functioning anxiety, perceived stress and risk of developing a mental health disorder. GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria. Socioeconomic status was measured using the New Zealand Socioeconomic Index (NZSEI). RESULTS Complete mental health data was available for 1281 participants. There was no statistically significant difference in SEI, depression, risk of mental health issues, high functioning anxiety and perceived stress between women who developed GDM and those who did not. There was no difference in history of depression nor risk of developing a high mental health disorder in first trimester after adjusting for SEI, BMI in first trimester, smoking status in first trimester and maternal age between women with a GDM pregnancy and those who did not. CONCLUSIONS FOR PRACTICE There was no difference in markers of poor mental health in early pregnancy between women who subsequently did or did not develop GDM. Cohort participants were socioeconomically disadvantaged, potentially contributing to the lack of apparent differences in depression observed between groups. Socioeconomically disadvantaged women should be targeted in pre-conception planning to reduce risk of GDM.
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia.
| | - Prabha H Andraweera
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Shalem Leemaqz
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Emily Aldridge
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Margaret A Arstall
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Gustaaf A Dekker
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Division of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Claire T Roberts
- Adelaide Medical School, The University of Adelaide, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Mínguez-Alarcón L, Chagnon O, Tanaka A, Williams PL, James-Todd T, Ford JB, Souter I, Rexrode KM, Hauser R, Chavarro JE. Preconception Stress and Pregnancy Serum Glucose Levels Among Women Attending a Fertility Center. J Endocr Soc 2023; 8:bvad152. [PMID: 38178907 PMCID: PMC10766068 DOI: 10.1210/jendso/bvad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 01/06/2024] Open
Abstract
Context The association between women's stress and pregnancy glucose levels remain unclear, specifically when considering the preconception period as a sensitive window of exposure. Objective We investigated whether preconception perceived stress was associated with glucose levels during pregnancy among women attending a fertility center (2004-2019). Methods Before conception, women completed a psychological stress survey using the short version of the validated Perceived Stress Scale 4 (PSS-4), and blood glucose was measured using a 50-gram glucose load test during late pregnancy as a part of screening for gestational diabetes. Linear and log-binomial regression models were used to assess associations of total PSS-4 scores with mean glucose levels and abnormal glucose levels ( ≥ 140 mg/dL), adjusting for age, body mass index, race, smoking, education, physical activity, primary infertility diagnosis, number of babies, and mode of conception. Results Psychological stress was positively associated with mean abnormal glucose levels. The adjusted marginal means (95% CI) of mean glucose levels for women in the first, second, and third tertiles of psychological stress were 115 (110, 119), 119 (115, 123), and 124 (119, 128), and mg/dL, respectively (P for trend = .007). Also, women in the second and third tertiles of psychological stress had 4% and 13% higher probabilities of having abnormal glucose compared with women in the first tertile of psychological stress (P trend = .01). Conclusion These results highlight the importance of considering preconception when evaluating the relationship between women's stress and pregnancy glucose levels.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston 02115, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Olivia Chagnon
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Aya Tanaka
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Irene Souter
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston 02115, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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Erbetta K, Almeida J, Thomas KA. Racial/Ethnic and Nativity Inequalities in Gestational Diabetes Mellitus: The Role of Psychosocial Stressors. Womens Health Issues 2023; 33:600-609. [PMID: 37543442 DOI: 10.1016/j.whi.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Racial/ethnic and nativity disparities in gestational diabetes mellitus (GDM) persist in the United States. Identified factors associated with these differences do not fully explain them. Research has recognized psychosocial stress as a potentially modifiable risk factor for GDM. METHODS We used New York City Pregnancy Risk and Assessment Monitoring System data (2009-2014) linked with birth certificate items (n = 7,632) in bivariate and multivariate analyses to examine associations between 12 psychosocial stressors (modeled three ways: individual stressors, grouped stressors, stress constructs) and GDM across race/ethnicity and nativity, and if stressors explain racial/ethnic/nativity differences in GDM. RESULTS U.S. and foreign-born Black and Hispanic women reported higher stressors relative to U.S.-born White women. In fully adjusted models, the financial stress construct was associated with a 51% increased adjusted risk of GDM, and adding all stressors doubled the risk. Psychosocial stressors did not explain the elevated risk of GDM among foreign-born Black (adjusted risk ratio, 2.18; 95% confidence interval, 1.53-3.11), Hispanic (adjusted risk ratio, 1.57; 95% confidence interval, 1.10-2.25), or Asian/Pacific Islander (adjusted risk ratio, 4.10; 95% confidence interval, 3.04-5.52) women compared with U.S.-born White women. CONCLUSIONS Historically minoritized racial/ethnic and immigrant women have an increased risk of psychosocial stressors and GDM relative to U.S.-born White women. Although financial and all stressors predicted higher risk of GDM, they did not explain the increased risk of GDM among immigrant women and women from minoritized racial/ethnic groups. Further examination into racial/ethnic and nativity inequalities in stress exposure and rates of GDM is warranted to promote healthier pregnancies and birth outcomes.
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Affiliation(s)
- Kristin Erbetta
- Simmons University School of Social Work, Boston, Massachusetts.
| | - Joanna Almeida
- Simmons University School of Social Work, Boston, Massachusetts
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Soni B, Jayaseelan V, Kattimani S, Rengaraj S, Arikrishnan K, Veerasetty N. Association between common mental disorder and glycemic control in women with gestational diabetes: A mixed-method study. Indian J Psychiatry 2023; 65:941-948. [PMID: 37841546 PMCID: PMC10569327 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_402_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 10/17/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is associated with an increased risk of mental health disorders among pregnant women. Poor mental health can negatively impact glycemic control in women with GDM, leading to adverse outcomes for both the mother and the baby. Aim To determine the prevalence of common mental disorder (CMD) in women with GDM and its association with poor glycemic control. Additionally, to explore the reasons and coping strategies for CMD in women with GDM. Methods A sequential explanatory mixed-method study was conducted among 351 women with GDM visiting a tertiary care hospital. The prevalence of CMD was assessed using Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Perceived Stress Scale (PSS). Glycemic control was determined based on two-hour postprandial blood glucose levels. In-depth interviews were conducted with six women who screened positive for CMD and had poor glycemic control. Data were analyzed using SPSS v23 and stats v12. Chi-square test and Poisson regression were performed, and adjusted prevalence ratios (aPRs) were reported. Results The prevalence of CMD was found to be 19.08% (95% CI: 15.32%-23.52%), with 18.2% (95% CI: 14.5%-22.6%) anxiety symptoms 8.3% (95% CI: 5.8%-11.6%) depressive symptoms and stress each. CMD was significantly related to poor glycemic control (aPR: 1.58; 95% CI: 1.23-2.03; P value <0.001). The qualitative analysis revealed individual, family, health, and facility factors influencing mental health and glycemic control. Conclusion Common mental health disorders are prevalent in women with GDM. It has a negative association with glycemic control. Implementing a routine screening program in the ANC clinic can aid in early identification and prompt management of the CMD and its associated complications.
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Affiliation(s)
- Bhanushree Soni
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Venkatachalam Jayaseelan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sasirekha Rengaraj
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kalaiselvy Arikrishnan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Naveenkumar Veerasetty
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Long ES, Penalver Bernabe B, Xia K, Azcarate-Peril MA, Carroll IM, Rackers HS, Grewen KM, Meltzer-Brody S, Kimmel MC. The microbiota-gut-brain axis and perceived stress in the perinatal period. Arch Womens Ment Health 2023; 26:227-234. [PMID: 36897389 PMCID: PMC10063483 DOI: 10.1007/s00737-023-01300-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/08/2023] [Indexed: 03/11/2023]
Abstract
Perinatal perceived stress can contribute to worse health outcomes for the parent-child dyad. Given the emerging relationship between the microbiota-gut-brain axis and stress, this study sought to elucidate connections between bowel symptoms and the gut microbiome in relation to perceived stress at three time points in the perinatal period: two during pregnancy and one postpartum. Ninety-five pregnant individuals participated in a prospective cohort study from April 2017 to November 2019. Researchers assessed Perceived Stress Scale-10 (PSS); bowel symptoms (according to the IBS Questionnaire); psychiatrist assessment of new onset or exacerbated depression and anxiety; and fecal samples analyzed for alpha diversity (measures of gut microbiome diversity utilizing Shannon, Observed OTUs, and Faith's PD) at each timepoint. Covariates included weeks of gestation and weeks postpartum. PSS scores were divided into "Perceived Self-Efficacy" and "Perceived Helplessness." Increased gut microbial diversity was associated with decreased bowel symptoms, decreased overall perceived stress, increased ability to cope with adversity, and decreased distress in the postpartum period. This study found a significant association between a less diverse microbial community, lower self-efficacy early in pregnancy, and greater bowel symptoms and perceived helplessness later in the perinatal period, relationships that may ultimately point to novel diagnostic methods and interventions for perceived stress based on the microbiota-gut-brain axis.
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Affiliation(s)
- Emily S Long
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Beatriz Penalver Bernabe
- Department of Biomedical Engineering, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Kai Xia
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - M Andrea Azcarate-Peril
- Departments of Medicine and Nutrition, Microbiome Core, University of North Carolina, Chapel Hill, NC, USA
| | - Ian M Carroll
- Department of Nutrition, University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA
| | - Hannah S Rackers
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Karen M Grewen
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Mary C Kimmel
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.
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Zierden HC, Marx-Rattner R, Rock KD, Montgomery KR, Anastasiadis P, Folts L, Bale TL. Extracellular vesicles are dynamic regulators of maternal glucose homeostasis during pregnancy. Sci Rep 2023; 13:4568. [PMID: 36941297 PMCID: PMC10027885 DOI: 10.1038/s41598-023-31425-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023] Open
Abstract
Homeostatic regulation of the maternal milieu during pregnancy is critical for maternal and fetal health. The placenta facilitates critical communication between maternal and fetal compartments, in part, through the production of extracellular vesicles (EVs). EVs enable tissue synchrony via cell-cell and long-distance communication and are at their highest circulating concentration during pregnancy. While much work has been done investigating how physiological challenges in pregnancy affect the fetus, the role of placental communication in maternal health has not been well examined. We previously identified placental O-glycosyl transferase (OGT), a glucose-sensing enzyme, as a target of maternal stress where OGT levels and activity affected the O-glycosylation of proteins critical for EV cargo loading and secretion. Here, we hypothesized that placental OGT plays an essential role in maternal homeostatic regulation during pregnancy via its regulation of maternal circulating EV concentrations. Our studies found that changes to key metabolic factors over the circadian cycle, including glucocorticoids, insulin, and glucose, were significantly associated with changes in circulating EV concentration. Targeting placental OGT in mice, we found a novel significant positive relationship between placental OGT and maternal circulating EV concentration that was associated with improving maternal glucose tolerance during pregnancy. Finally, an intravenous elevation in EVs, matching the concentration of EVs during pregnancy, shifted non-pregnant female glucose sensitivity, blunted glucose variance, and improved synchrony of glucose uptake. These data suggest an important and novel role for circulating EVs as homeostatic regulators important in maternal health during pregnancy.
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Affiliation(s)
- Hannah C Zierden
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, MD, 20740, USA
| | - Ruth Marx-Rattner
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Kylie D Rock
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27695, USA
| | - Kristen R Montgomery
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Neuroscience Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Pavlos Anastasiadis
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 21201, USA
| | - Lillian Folts
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Biomedical Sciences Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Tracy L Bale
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- The Anschutz Foundation Endowed Chair in Women's Integrated Mental and Physical Health Research at the Ludeman Center, Aurora, CO, USA.
- Department of Psychiatry, University of Colorado School of Medicine, CU Anschutz Medical Campus, 12800 E. 19th Avenue, Aurora, CO, 80045, USA.
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Peñalver Bernabé B, Maki PM, Cunningham JL, Eisenlohr-Moul T, Tussing-Humphreys L, Carroll IM, Meltzer-Brody S, Gilbert JA, Kimmel M. Interactions between perceived stress and microbial-host immune components: two demographically and geographically distinct pregnancy cohorts. Transl Psychiatry 2023; 13:3. [PMID: 36609477 PMCID: PMC9822983 DOI: 10.1038/s41398-022-02276-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 01/09/2023] Open
Abstract
Higher stress during pregnancy associates with negative outcomes and elevated inflammation. The gut microbiota, reflecting environment and social interactions, alongside host immune responses have the potential to better understand perceived stress and identify when stress is excessive in pregnancy. Two U.S. cohorts of 84 pregnant individuals, composed of urban women of color and suburban white women, completed the Perceived Stress Scale-10 (PSS-10) and provided fecal and blood samples at two time points. Confirmatory Factor Analysis assessed the robustness of a two-factor PSS-10 model (Emotional Distress/ED and Self-Efficacy/SE). Gut microbiota composition was measured by 16 S rRNA amplicon sequencing and the immune system activity was assessed with a panel of 21 T-cell related cytokines and chemokines. ED levels were higher in the suburban compared to the urban cohort, but levels of SE were similar. ED and SE levels were associated with distinct taxonomical signatures and the gut microbiota data improved the prediction of SE levels compared with models based on socio-demographic characteristics alone. Integration of self-reported symptoms, microbial and immune information revealed a possible mediation effect of Bacteroides uniformis between the immune system (through CXCL11) and SE. The study identified links between distinct taxonomical and immunological signatures with perceived stress. The data are congruent with a model where gut microbiome and immune factors, both impacting and reflecting factors such as close social relationships and dietary fiber, may modulate neural plasticity resulting in increased SE during pregnancy. The predictive value of these peripheral markers merit further study.
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Affiliation(s)
- Beatriz Peñalver Bernabé
- Department of Biomedical Engineering, College of Engineering and Medicine, University of Illinois Chicago, Chicago, IL, USA. .,Center of Bioinformatics and Quantitative Biology, University of Illinois Chicago, Chicago, IL, USA.
| | - Pauline M. Maki
- grid.185648.60000 0001 2175 0319Department of Psychology, College of Medicine, University of Illinois Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL USA
| | - Janet L. Cunningham
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Tory Eisenlohr-Moul
- grid.185648.60000 0001 2175 0319Department of Psychology, College of Medicine, University of Illinois Chicago, Chicago, IL USA ,grid.185648.60000 0001 2175 0319Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL USA
| | - Lisa Tussing-Humphreys
- grid.185648.60000 0001 2175 0319Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL USA
| | - Ian M. Carroll
- grid.410711.20000 0001 1034 1720Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, NC USA
| | - Samantha Meltzer-Brody
- grid.410711.20000 0001 1034 1720Department of Psychiatry, University of North Carolina, Chapel Hill, NC USA
| | - Jack A. Gilbert
- grid.266100.30000 0001 2107 4242Department of Pediatrics and Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA USA
| | - Mary Kimmel
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Omowale SS, Gary-Webb TL, Wallace ML, Wallace JM, Rauktis ME, Eack SM, Mendez DD. Stress during pregnancy: An ecological momentary assessment of stressors among Black and White women with implications for maternal health. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221126808. [PMID: 36148967 PMCID: PMC9510975 DOI: 10.1177/17455057221126808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Stress can lead to adverse physiological and psychological outcomes. Therefore, understanding stress during pregnancy provides insight into racial disparities in maternal health, particularly Black maternal health. OBJECTIVES This study aimed to describe (1) daily exposure to self-reported stress levels during pregnancy, and (2) sources of stress among participants that identified as Black or White using data collected via ecological momentary assessment. METHODS We leveraged survey data from the Postpartum Mothers Mobile Study, a prospective longitudinal study using ecological momentary assessment data collection methods to describe patterns of stress during pregnancy. This article is descriptive and documents patterns of self-reported stress levels and sources of stress. Frequencies and percentages of stress responses were computed to describe these patterns. RESULTS The sample (n = 296) was 27% Black (n = 78) and 63% White (n = 184). Results were based on at least one measurement of that stress level during pregnancy. A similar number of Black and White participants reported no stress during pregnancy. White (85%-95%) and Black (60%-70%) participants reported low to moderate levels of stress. Black participants (38%) and White participants (35%) reported experiencing high stress. Black and White participants reported similar sources of stress: stress from a partner, too many things to do, a baby or other children, and financial concerns. White participants reported work as a top stressor, and Black participants reported financial issues as a top source of stress. CONCLUSION This study provides insight into daily exposure to stress that has implications for maternal health. We described patterns of self-reported stress and sources of stress among Black and White participants. The daily exposures to stress reported by this sample exist within a context of root causes of structural inequities in education, health care, income, wealth, and housing that must be addressed to achieve maternal health equity.
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Affiliation(s)
- Serwaa S Omowale
- California Preterm Birth Initiative,
University of California San Francisco, San Francisco, CA, USA,Department of Obstetrics, Gynecology
& Reproductive Sciences, School of Medicine, University of California San
Francisco, San Francisco, CA, USA,School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of
Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - John M Wallace
- School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Mary E Rauktis
- School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Shaun M Eack
- School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Dara D Mendez
- Department of Epidemiology, School of
Public Health, University of Pittsburgh, Pittsburgh, PA, USA,Department of Behavioral and Community
Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA,
USA,Division of General Internal Medicine,
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Dara D Mendez, Department of Epidemiology,
School of Public Health, University of Pittsburgh, 5130 Public Health, 130 De
Soto Street, Pittsburgh, PA 15261, USA.
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Erbetta K, Almeida J, Waldman MR. Racial, ethnic and nativity inequalities in gestational diabetes mellitus: The role of racial discrimination. SSM Popul Health 2022; 19:101176. [PMID: 35928172 PMCID: PMC9343416 DOI: 10.1016/j.ssmph.2022.101176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kristin Erbetta
- Simmons University, 300 the Fenway, Boston, MA, 02115, USA
- Corresponding author.
| | - Joanna Almeida
- Simmons University, 300 the Fenway, Boston, MA, 02115, USA
| | - Marcus R. Waldman
- University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
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Yap PPH, Papachristou Nadal I, Rysinova V, Basri NI, Samsudin IN, Forbes A, Noor NM, Supian ZA, Hassan H, Paimin F, Zakaria R, Mohamed Alias SR, Ismail Bukhary NB, Benton M, Ismail K, Chew BH. Study protocol on risk factors for the diagnosis of gestational diabetes mellitus in different trimesters and their relation to maternal and neonatal outcomes (GDM-RIDMAN). BMJ Open 2022; 12:e052554. [PMID: 35882454 PMCID: PMC9330332 DOI: 10.1136/bmjopen-2021-052554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is often associated with adverse pregnancy outcomes. However, the association of risk factors with GDM diagnosis, maternal and neonatal health outcomes is less established when compared with women without GDM. We aim to examine the diagnostic accuracy of the conventional and novel risk factors for a GDM diagnosis and their impact on maternal and neonatal health outcomes. METHODS AND ANALYSIS This retrospective cohort and nested case-control study at six public health clinics is based on medical records and questionnaire survey of women between 2 and 12 months postpartum. The estimated required sample size is 876 complete records (292 cases, 584 control, at a ratio of 1:2). Oral glucose tolerance test results will be used to identify glucose dysregulation, and maternal and neonatal outcomes include maternal weight gain, pre-eclampsia, polyhydramnios, mode of delivery, preterm or postdate birth, complications in labour, birth weight, gestational age at birth, Apgar score, congenital anomaly, congenital hypothyroidism, neonatal death or stillbirth, hypoglycaemia and hyperbilirubinaemia. Psychosocial measures include the WHO Quality of Life: brief, mother-infant bonding (14-item Postpartum Bonding Questionnaire and 19-item Maternal Postnatal Attachment Scale), anxiety (7-item Generalised Anxiety Disorder), depression (9-item Patient Health Questionnaire) and stress (Perceived Stress Scale symptoms) questionnaires. The comparative incidences of maternal and neonatal health outcomes, the comparative prevalence of the psychosocial outcomes between women with GDM and without GDM, specificity, sensitivity, positive and negative predictive values of the risk factors, separately and combined, will be reported. All GDM risk factors and outcomes will be modelled using multivariable regression analysis and the receiver operating characteristics curve will be reported. ETHICS AND DISSEMINATION This study was approved by the Malaysia Research and Ethics Committee, Ministry of Health Malaysia. Informed consent will be obtained from all participants. Findings will be submitted for publications in scientific journals.
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Affiliation(s)
- Pamela Phui Har Yap
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Iliatha Papachristou Nadal
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Veronika Rysinova
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Nurul Iftida Basri
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Intan Nureslyna Samsudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Angus Forbes
- Division of Care in Long-term Conditions, King's College London, London, UK
| | - Nurain Mohd Noor
- Clinical Research Centre (CRC), Hospital Putrajaya Malaysia, Putrajaya, Malaysia
| | - Ziti Akthar Supian
- Klinik Kesihatan Seri Kembangan, Ministry of Health Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Haslinda Hassan
- Klinik Kesihatan Puchong, Ministry of Health Malaysia, Puchong, Selangor, Malaysia
| | - Fuziah Paimin
- Klinik Kesihatan Putrajaya Presint 9, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Rozita Zakaria
- Klinik Kesihatan Putrajaya Presint 18, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | | | - Madeleine Benton
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Clinical Research Unit, Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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12
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Carbonneau E, Dumas A, Brodeur-Doucet A, Fontaine-Bisson B. A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes. Nutrients 2022; 14:nu14061151. [PMID: 35334807 PMCID: PMC8951613 DOI: 10.3390/nu14061151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m2. This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.
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Affiliation(s)
- Elise Carbonneau
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Centre NUTRISS—Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec, QC G1V 0A6, Canada
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
- Correspondence:
| | - Alex Dumas
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
| | | | - Bénédicte Fontaine-Bisson
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
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13
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Tan HS, Agarthesh T, Tan CW, Sultana R, Chen HY, Chua TE, Sng BL. Perceived stress during labor and its association with depressive symptomatology, anxiety, and pain catastrophizing. Sci Rep 2021; 11:17005. [PMID: 34417541 PMCID: PMC8379208 DOI: 10.1038/s41598-021-96620-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022] Open
Abstract
Perceived stress is a dimension of the maternal stress response, however little data is available on perceived stress levels and its associated psychological risk factors during labor. In this secondary data analysis from a prospective study evaluating epidural regimens, we investigated the potential associations between depressive symptomatology, anxiety, and pain catastrophizing with perceived stress during labor. Healthy nulliparous adult women with term singleton pregnancies requesting for epidural analgesia in early labor were included. Assessments were administered after epidural analgesia and adequate pain relief were achieved. Perceived stress (Perceived Stress Scale, PSS, high PSS ≥ 16), depressive symptomatology (Edinburgh Postnatal Depression Scale, EPDS, high EPDS ≥ 10), and pain catastrophizing (Pain Catastrophizing Scale, PCS, high total PCS ≥ 25) were assessed as categorical variables. Additionally, anxiety (State-trait Anxiety Inventory, STAI), PCS total and its subscales (rumination, magnification and helplessness) were analyzed as continuous variables. Univariate and multivariable logistic regression models were used to identify factors associated with high PSS. Of 801 women included, 411 (51.9%) had high PSS. High EPDS (OR 2.16, 95%CI 1.36–3.44), increasing trait anxiety (OR 1.17, 95%CI 1.14–1.20), and increasing pain magnification (OR 1.12, 95%CI 1.05–1.19) were independently associated with high PSS. Depressive symptomatology, trait anxiety, and pain magnification were associated with perceived stress during labor, providing impetus for future research aimed at detecting and alleviating stress and its psychological or pain association factors.
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Affiliation(s)
- Hon Sen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore
| | - T Agarthesh
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Chin Wen Tan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Helen Yu Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Pediatrics Academic Clinical Program, Duke-NUS Medical School, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Tze-Ern Chua
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Pediatrics Academic Clinical Program, Duke-NUS Medical School, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Ban Leong Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore, Singapore. .,Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, Muñoz-Christian K, Schaffner A, Shields L, Heaney C, McHugh A, Wing RR. Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional. Trials 2021; 22:256. [PMID: 33827659 PMCID: PMC8024941 DOI: 10.1186/s13063-021-05204-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence. METHODS The principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1-3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks' gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures. DISCUSSION The Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks. TRIAL REGISTRATION ClinicalTrials.gov NCT02763150 . Registered on May 5, 2016.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | | | - Todd Hagobian
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Karen Muñoz-Christian
- Department of World Languages and Cultures, California Polytechnic State University, San Luis Obispo, CA USA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA USA
| | - Laurence Shields
- Dignity Health, Marian Regional Medical Center, Santa Maria, CA USA
| | - Casey Heaney
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Angelica McHugh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
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