Association between mindful and practical eating skills and eating behaviors among racially diverse pregnant women in four selected clinical sites in the United States

Background: Mindful eating is a promising strategy to address problematic eating behaviors; however, little is known about its applicability during pregnancy. No studies have examined the combined effects of mindful and practical eating skills on eating behaviors. Aim: We examined associations between mindful and practical eating skills and eating behaviors (nutritional intake and emotional eating) among pregnant women who received psychoeducation on healthy eating and pregnancies. Methods: Participants were racially-diverse pregnant women (14-42 years) from four clinical sites in Detroit, Michigan, and Nashville, Tennessee (N = 741). We conducted multiple linear regression to examine associations between mindful (hunger cues, satiety cues, mindful check-ins) and practical (food diary/journal, MyPlate method) eating skills and nutritional intake. We calculated residualized change scores to represent changes in the quality of nutritional intake from second to third trimester. We performed multiple logistic regression to examine associations between mindful and practical eating skills and emotional eating. Results: Women improved over time in eating behaviors (better nutrition, less emotional eating). Regular use of MyPlate was associated with better nutritional intake (unstandardized coefficient [B] = -0.61), but food diaries were not. We found a significant interaction in predicting emotional eating: For those regularly paying attention to hunger cues, some use of MyPlate (Adjusted Odds Ratio [AOR] = 0.39) and especially regular use of MyPlate (AOR = 0.13) reduced the likelihood of emotional eating during pregnancy. Conclusion: Enhancing both mindful and practical eating skills, such as paying attention to hunger cues, and using the MyPlate method, may facilitate pregnant women's ability to improve their eating behaviors.

Real-time heart rate variability biofeedback amplitude during a large-scale digital mental health intervention differed by age, gender, and mental and physical health

Heart rate variability biofeedback (HRVB) is an efficacious treatment for depression and anxiety. However, translation to digital mental health interventions (DMHI) requires computing and providing real-time HRVB metrics in a personalized and user-friendly fashion. To address these gaps, this study validates a real-time HRVB feedback algorithm and characterizes the association of the main algorithmic summary metric-HRVB amplitude-with demographic, psychological, and health factors. We analyzed HRVB data from 5158 participants in a therapist-supported DMHI incorporating slow-paced breathing to treat depression or anxiety symptoms. A real-time feedback metric of HRVB amplitude and a gold-standard research metric of low-frequency (LF) power were computed for each session and then averaged within-participants over 2 weeks. We provide HRVB amplitude values, stratified by age and gender, and we characterize the multivariate associations of HRVB amplitude with demographic, psychological, and health factors. Real-time HRVB amplitude correlated strongly (r = .93, p < .001) with the LF power around the respiratory frequency (~0.1 Hz). Age was associated with a significant decline in HRVB (β = -0.46, p < .001), which was steeper among men than women, adjusting for demographic, psychological, and health factors. Resting high- and low-frequency power, body mass index, hypertension, Asian race, depression symptoms, and trauma history were significantly associated with HRVB amplitude in multivariate analyses (p's < .01). Real-time HRVB amplitude correlates highly with a research gold-standard spectral metric, enabling automated biofeedback delivery as a potential treatment component of DMHIs. Moreover, we identify demographic, psychological, and health factors relevant to building an equitable, accurate, and personalized biofeedback user experience.

Perceived Stress and Depressive Symptoms Are Associated With Emotional Eating but Not Nutritional Intake During Pregnancy: A Prospective Cohort Study

INTRODUCTION

Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support.

METHODS

Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms.

RESULTS

Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects.

DISCUSSION

Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.

Working Status of First-Time Postpartum Mothers and Telomere Length-A 1-Year Prospective Study

OBJECTIVE

Transitioning to motherhood can create work family conflicts affecting mothers' health. Although employment is generally associated with longer telomeres, this may diminish during the early years of child-rearing. This study aimed to assess the impact of work reentry on telomere length (TL) among first-time mothers.

METHODS

In this 1-year prospective study, a total of 103 first-time postpartum mothers participated from two medical institutions in Northern Israel; they completed validated questionnaires, reported their current working status, and provided dried blood spots measuring TL.

RESULTS

We found that working status significantly predicted change in TL and was negatively correlated with change in TL over time (β = -0.245; 95% confidence interval, -0.169, -0.018; P = 0.016).

CONCLUSIONS

Identifying ideal timing of work reentry is recommended for first-time postpartum mother's optimal health and TL.

Cohort profile: the longitudinal National Growth and Health Study (NGHS) of black and white girls from Northern California tracking how behavioural and psychosocial risk factors predict cardiovascular risk and biological ageing in midlife and in offspring

PURPOSE

The National Heart, Lung and Blood Institute Growth and Health Study (NGHS) prospectively collected anthropometric, biospecimens, clinical, health behaviour and psychosocial measures associated with cardiovascular disease from childhood to young adulthood. The aim of the current study was to assess the impact of stress, dysregulated eating and social genomic biomarkers on cardiometabolic risk factors among the original participants now in midlife and their children.

PARTICIPANTS

Beginning in 1987-1988, NGHS recruited black and white girls (age 9-10 years) from socioeconomically diverse backgrounds from from three sites: Cincinnati, Ohio; Washington, DC; and Western Contra Costa County, California (N=2379) and followed them for 10 years. The study maintained an 89% retention rate. The current study is 30 years after the start of the original study and focused on the participants of California (n=887) and their children aged 2-17 years. We re-enrolled 624 of 852 eligible participants (73%): 49.2% black and 50.8% white. The mean age was 39.5 years. Among the 645 eligible biological children, 553 were enrolled; 49% black and 51% white, with 51.5% girls and 48.5% boys. The mean age was 9.3 years.

FINDINGS TO DATE

Longitudinal analysis of adolescent drive for thinness predicted higher scores for drive for thinness during midlife, which was indirectly associated with greater adult body mass index through adult drive for thinness. Latent trajectory modelling of adolescent growth over 10 years found that women with persistently high weight trajectory had twice the odds of having children who met the definition for obesity compared with the persistently normal group, adjusting for adult weight.

FUTURE PLANS

New studies on neighbourhood socioeconomic status, food insecurity and additional biomarkers of chronic stress, microbiome and accelerated ageing (ie, telomere length and epigenetic clock) are underway. We are developing a 10-year follow-up to understand changes in ageing biomarkers of the participants and their children.

TRIAL REGISTRATION NUMBER

NCT00005132.

Are pregnancy and parity associated with telomere length? A systematic review

BACKGROUND

Women's reproduction requires increased energy demands, which consequently may lead to cellular damage and aging. Hence, Telomere Length (TL), a biomarker of biological aging and health status may possibly serve as a biomarker of reproductive effort. The aim of this systematic review is to evaluate telomere dynamics throughout pregnancy and the association between parity and TL.

METHODS

A systematic search was conducted across seven databases including CINAHL, Cochrane, PsycINFO, Proquest, PubMed; Scopus; and Web of Science, using keywords and MeSH descriptors of parity and TL. Predefined inclusion and exclusion criteria were used to screen abstracts and titles. After the removal of duplicates, 3431 articles were included in the primary screening, narrowed to 194 articles included in the full-text screening. Consensus was reached for the 14 studies that were included in the final review, and the Newcastle-Ottawa scale (NOS) was utilized to assess the quality of the selected studies. A mini meta-analysis utilized JASP 0.17.3 software and included 4 applicable studies, comprising a total of 2564 participants to quantitatively assess the estimated effect size of parity on TL.

RESULTS

Of the 11 studies reviewed on parity and TL, four demonstrated a negative correlation; one - a positive correlation and six -found no correlation. Studies demonstrating a negative correlation encompassed rigorous methodological practices possibly suggesting having more children is associated with enhanced telomere attrition. Of the four longitudinal studies assessing telomere dynamics throughout pregnancy, most found no change in TL from early pregnancy to postpartum suggesting pregnancy does not affect TL from early pregnancy to early postpartum. The meta-analysis revealed a negative, yet, non-significant effect, of the estimated effect size of parity on TL(ES = -0.009, p = 0.126, CI -0.021, 0.03).

CONCLUSIONS

Studies assessing pregnancy, parity and TL yielded mixed results, most likely due to the different research methods utilized in each study. Improvements in study design to better understand the short-term effects of pregnancy on TL and the effect of parity on TL over time, include precise definitions of parity, comparisons of different age groups, inclusion of reproductive lifespan and statistically adjusting for potential confounders in the parity and TL relationship.

Envisioning the Future of Well-Being Efforts for Health Care Workers-Successes and Lessons Learned From the COVID-19 Pandemic

Importance

The National Academy of Medicine's National Plan for Health Workforce Well-Being provides recommendations for supporting the mental health and well-being of health care workers. This article aims to guide implementation of National Academy of Medicine recommendations by describing 2 programs at Columbia University Irving Medical Center and the University of California, San Francisco (UCSF), designed early in the COVID-19 pandemic to respond to the behavioral health needs of the health care workforce. The development of these programs, their similarities and differences, and the key lessons learned are discussed.

Observations

The well-being programs, CopeColumbia and UCSF Cope, shared key elements. Both efforts were led by their respective departments of psychiatry and used similar frameworks. Teams created strategic cross-university partnerships to share difficulties and successes across both programs. Moreover, both programs addressed compounding stressors of racial and political unrest, evaluated program components, and created resources for employee self-management. CopeColumbia and UCSF Cope differed in approaches to identifying high-risk employees and formal assessment and treatment pathways. From the authors' experience implementing these programs and having knowledge regarding health care workforce burnout, this article offers recommendations for the development of well-being programs. These include structural changes and resources to promote group and individual well-being emphasizing equity and justice, intentional involvement of psychiatry on well-being leadership teams, and bold efforts to destigmatize mental health care alongside clear paths to mental health treatment.

Conclusions and Relevance

The impact of the COVID-19 pandemic revealed a need for institutions to support the mental health and emotional well-being of health care workers. By outlining the development and implementation of 2 well-being programs in large academic health care settings and making recommendations to promote workforce well-being, it is the authors' hope that leaders will be empowered to carry forward critical changes. Most importantly, implementing plans now will provide the resilience needed both for the long shadow of the pandemic and future crises.

Cellular allostatic load is linked to increased energy expenditure and accelerated biological aging

Stress triggers anticipatory physiological responses that promote survival, a phenomenon termed allostasis. However, the chronic activation of energy-dependent allostatic responses results in allostatic load, a dysregulated state that predicts functional decline, accelerates aging, and increases mortality in humans. The energetic cost and cellular basis for the damaging effects of allostatic load have not been defined. Here, by longitudinally profiling three unrelated primary human fibroblast lines across their lifespan, we find that chronic glucocorticoid exposure increases cellular energy expenditure by ∼60%, along with a metabolic shift from glycolysis to mitochondrial oxidative phosphorylation (OxPhos). This state of stress-induced hypermetabolism is linked to mtDNA instability, non-linearly affects age-related cytokines secretion, and accelerates cellular aging based on DNA methylation clocks, telomere shortening rate, and reduced lifespan. Pharmacologically normalizing OxPhos activity while further increasing energy expenditure exacerbates the accelerated aging phenotype, pointing to total energy expenditure as a potential driver of aging dynamics. Together, our findings define bioenergetic and multi-omic recalibrations of stress adaptation, underscoring increased energy expenditure and accelerated cellular aging as interrelated features of cellular allostatic load.

Association between maternal eating and young child feeding in a community sample

BACKGROUND

Early childhood is a pivotal period for the development of healthy eating practices. One way to promote child health is to identify early modifiable factors that affect child eating and weight. Given the intergenerational transmission of eating behaviors, this study examined how mothers' eating behaviors were associated with child feeding practices, and whether child weight-for-length (z-WFL) moderated this relation, in a community sample.

METHODS

Participants were 72 mother-child dyads. Maternal eating behaviors-emotional, external and restrained-were assessed 9-months postpartum, using the Dutch Eating Behavior Questionnaire. Child feeding-restrictive, pressure, and concern about overeating/overweight or undereating/underweight-was measured using the Infant Feeding Questionnaire, and child z-WFL were assessed 18-months postpartum. Linear regressions were used to test the main effect of maternal eating and the interaction effect of maternal eating and child z-WFL, on child feeding practices.

RESULTS

Maternal restrained eating was associated with child pressure feeding, and contrarily with concerns about overeating/overweight. However, a significant interaction between child z-WFL and both maternal emotional and external eating were found with regard to concern about child undereating/underweight. Paradoxically, among children who weighed more, greater maternal emotional and greater external eating were associated with greater concern about child undereating/underweight.

CONCLUSIONS

In this community sample, mothers were more likely to report contradictory feeding practices and concerns, suggesting complicated relations among a mother's own eating behavior, her child's weight, and her perceptions of child eating and weight. This may indicate a need for better communication and support of infant feeding practices.

TRIAL REGISTRATION

Data was collected as part of two grants (MAMAS Grant ID: HL097973-01; SEED Grant ID: HL116511-02) conducted at the University of California, San Francisco (UCSF). All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by institutional review board at UCSF.

Is it me or my child? The association between maternal depression and children's behavior problems in mothers and their children with or without autism

Bidirectional associations between maternal depression and child behavior problems have been reported in prior research, however, few studies examine these relations across varied family contexts. This study examined parenting stress and child diagnosis of autism spectrum disorder (ASD) as moderators of bidirectional associations between maternal depression and child behavior problems over time. Our sample included 86 mother-child dyads who reported maternal depressive symptoms, child behavior problems, and parenting stress at three time points over more than 1 year. Approximately half were mothers of children with ASD (n = 41) and half were mothers of neurotypical children (n = 45). We tested the bidirectional associations between maternal depressive symptoms and children's behavior problems and the potential moderating role of parental stress or child ASD diagnosis on these bidirectional associations using aggregated, lagged, and linear mixed models. Even after controlling for lagged maternal depressive symptoms, child behavior problems were associated with greater subsequent maternal depression at the between-person level, but not at the within-person level. The converse relation of prior maternal depressive symptoms on subsequent child behavior problems was not significant. Neither parenting stress nor child ASD diagnosis moderated bidirectional associations between maternal depressive symptoms and children's behavior problems. Child behavior predicted maternal depression, but the converse was not true, regardless of parenting stress levels or child's ASD diagnosis. For mothers experiencing elevated parenting stress and those with children with ASD, this may help alleviate elevated feelings of guilt related to their children's behavior problems.

Adolescent BMI trajectory and associations with adult metabolic syndrome and offspring obesity

OBJECTIVE

This study examined the association of adolescent BMI trajectory with adult metabolic syndrome (MetSyn) and with intergenerational obesity.

METHODS

This study used data from the National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study (1987-1997). Data from the 20-year follow-up (2016-2019) study were included from the original participants (N = 624) and their children (N = 645). Adolescent BMI trajectories were identified using latent trajectory modeling. Mediation analysis using logistic regression models was performed to estimate confounder-adjusted odds ratios (OR) and 95% CI between adolescent BMI trajectory and adult MetSyn. Using similar methods, the association between BMI trajectory and offspring obesity was examined.

RESULTS

Latent trajectory modeling identified four patterns: "weight loss then gain" (N = 62); "persistently normal" (N = 374); "persistently high BMI" (N = 127); and "weight gain then loss" (N = 61). Women who had a persistently high BMI trajectory had twice the odds of having children who met the definition for obesity compared with the persistently normal group, adjusting for adult BMI (OR: 2.76; 95% CI: 1.39-5.46). None of the trajectory groups was associated with adult MetSyn compared with the persistently normal group.

CONCLUSIONS

Intermittent adolescent obesity may not confer MetSyn risk during adulthood. However, maternal adolescent BMI trajectories that are persistently high may increase the odds of intergenerational obesity among offspring.

GRANDPARENTS’ EDUCATION IS ASSOCIATED WITH GRANDCHILDREN’S EPIGENETIC AGE IN THE NGHS STUDY

We leveraged information solicited from three generations (grandparents, mothers, and grandchildren) to examine the association between mothers’ childhood SES (based on grandparents’ educational attainment) and their children’s epigenetic age and whether the association was mediated by mothers’ life course socioeconomic and health-related factors. Mothers were recruited to the NHLBI Growth and Health Study when they were 9 or 10 and followed for ten consecutive years (1987-1998). Grandparents reported their highest education during the baseline interviews. Mothers were then re-contacted three decades later (ages 37-42) to participate in the National Growth and Health Study (NGHS), and health information of their youngest children (i.e., grandchildren; N = 241, ages 2-17) were collected, including their saliva samples to calculate epigenetic age. Two epigenetic ages were estimated (Horvath and Hannum), and DNA methylation age accelerations (DNAmAAs) were calculated using residuals from regressing chronologic age on each epigenetic age metrics. Mothers’ life course socioeconomic and health-related mediators included childhood BMI trajectories (from age 9 to 19), highest education level, adult health behavior, and adult c-reactive protein (CRP). Adjusted for age and sex, grandchildren with college degree grandparents showed significantly slower Horvath’s DNAmAA than those with no college degree. The association between grandparent’s education level and grandchildren’s DNAmAA was partially mediated by mothers’ life course socioeconomic and health-related factors, especially mothers’ education, health behavior, and CRP. Grandparents’ educational attainment is a critical socioeconomic context of mothers’ early rearing, and it might have a long-lasting impact on their grandchildren’s epigenetic marker.

CHILDHOOD SES IS ASSOCIATED WITH FASTER WORSENING METABOLIC SYNDROME SEVERITY FOR BLACK RELATIVE TO WHITE WOMEN

This analysis examined whether early life SES was associated with longitudinal changes in metabolic syndrome (MetS) severity among Black and white women. Data were from 531 women (non-Hispanic Black=263; non-Hispanic white=268, Mage=39) in the National Growth and Health Study (NGHS). Information about parental education was collected during the baseline survey when participants were 9. Information regarding MetS severity were collected during year-7 (Mage=16), year-10 (Mage=19), and year-30 (Mage = 39) follow-up studies. Controlling for baseline body mass index, smoking status, and marital status, Black participants showed a faster increase in MetS severity across two decades. Early life SES (b=.03, SE=.01, p<.05), independent of current SES, was associated with faster worsening MetS severity among Black relative to white women. The socioeconomic context of early rearing is an important factor for racial disparities in accelerated aging among these early midlife Black and white women.

The Effects of a Prenatal Mindfulness Intervention on Infant Autonomic and Behavioral Reactivity and Regulation

OBJECTIVE

Maternal health and wellness during pregnancy are associated with long-term health outcomes in children. The current study examined whether infants of women who participated in a mindfulness-based intervention during pregnancy that reduced levels of stress and depression, increased physical activity, and improved glucose tolerance differed on biobehavioral markers of psychopathological and physical health risk compared with infants of women who did not.

METHODS

Participants were 135 mother-infant dyads drawn from a racially and ethnically diverse, low-income sample experiencing high stress. The women participated in an intervention trial during pregnancy that involved assignment to either mindfulness-based intervention or treatment-as-usual (TAU). Infants of women from both groups were assessed at 6 months of age on sympathetic (preejection period), parasympathetic (respiratory sinus arrhythmia), and observed behavioral (negativity and object engagement) reactivity and regulation during the still face paradigm. Linear mixed-effects and generalized linear mixed-effects models were used to examine treatment group differences in infant outcomes.

RESULTS

Relative to those in the intervention group, infants in the TAU group showed a delay in sympathetic activation and subsequent recovery across the still face paradigm. In addition, infants in the intervention group engaged in higher proportions of self-regulatory behavior during the paradigm, compared with the TAU group. No significant effect of intervention was found for parasympathetic response or for behavioral negativity during the still face paradigm.

CONCLUSIONS

Findings provide evidence that maternal participation in a short-term, group mindfulness-based intervention during pregnancy is associated with the early development of salutary profiles of biobehavioral reactivity and regulation in their infants. Because these systems are relevant for psychopathology and physical health, prenatal behavioral interventions may benefit two generations.

0200 Does Sleep Predict Antibody Response and Maintenance to the COVID-19 Vaccine?

Introduction

There is growing evidence that insufficient sleep can negatively impact the immune system, including vaccination response. Prior laboratory studies have shown that acute sleep restriction can result in impaired antibody resposne to the hepatitis A and influenza vaccine. Similarly, prospective studies have shown that short sleep duration, measured by self-report and wrist actigraphy, is associated with muted antibody responses. These prior findings have critical implications for the COVID-19 pandemic and the efficacy and durability of the COVID-19 vaccines currently available. Whether sleep accounts for variability in response to the COVID-19 vaccination series has not been investigated.

Methods

We recruited 530 healthy participants (mean age= 52.4, SD=12.1, range: 18-88 years; 64.1% female) who were naive to the COVID-19 vaccination series. Participants completed self-report questionaires (e.g., Pittsburgh Sleep Quality Index) and morning sleep diaries for 7-consecutive days surrounding COVID-19 vaccine administrations. Additionally, 198 participants wore a sleep tracking device (Oura ring) continuously for ~2 months beginning prior to vaccination, which provides behavioral sleep data on days prior to and following the COVID-19 vaccination series. Blood samples were collected prior to vaccination, +1 month after their final vaccine shot (peak response), and +6 months after their final vaccine shot (maintenance); neutralization assays using pseudotype virus will be carried out to quantify antibody titers.

Results

Data collection concludes December 2021, with antibody assays to be completed February 2022. Initial baseline data indicates that most participants reported poor overall global sleep quality (PSQI mean=6.3, SD=3.6; 52% PSQI&gt;5). Linear mixed models will be conducted to test associations between habitual sleep duration (averaged over the measurement time points), sleep efficiency, and subjective sleep quality with antibody responses over time. Additionally, we will report on the relevance of sleep timing (midpoint) and vaccination timing (receiving the vaccine in the morning vs afternoon vs evening), and the role of self-reported sleep disorders (e.g., obstructive sleep apnea) and shift worker status. Covariates in these analyses will include age, gender, race, body mass index, prior COVID infection, and vaccine type (Moderna, Pfizer, Johnson and Johnson).

Conclusion

These analyses will provide new knowledge about the role of sleep in mounting and maintaining antibody response to the COVID-19 vaccination series. These findings may provide novel insights into when and for whom improvements in sleep may result in better vaccine efficacy.

Support (If Any)

R24AG048024

Advocacy to support climate and health policies: recommended actions for the Society of Behavioral Medicine

Climate change poses serious threats to public health and is exacerbating health inequities. Policy changes are essential to mitigate climate change impacts on human and planetary health. The purpose was to describe recommendations by the Policy and Advocacy Subgroup of the Society of Behavioral Medicine (SBM) Climate Change, Behavior Change and Health Presidential Working Group (PWG). The Policy and Advocacy subgroup was comprised of experts in public health, climate policy, and health behavior change, who worked together to identify priorities and develop recommendations. We worked under the premise that building political will for climate policy action is the most urgent goal, and we recommended promotion of citizen advocacy for this purpose. Because citizen advocacy is a set of behaviors, SBM members can use behavioral science to identify and scale up interventions, working collaboratively with communities targeted for marginalization. Recommendations for SBM included establishing an organizational home for climate and health work, providing training and resources, engaging in climate advocacy as an organization, and networking with other organizations. Recommendations for a proposed SBM Climate and Health Committee, Council, or Special Interest Group included developing trainings and resources, seeking opportunities for networking and collaborations, and identifying a research agenda. Individual behavior changes are insufficient to address climate change; policy actions are needed. SBM and similar organizations can support their members to work in developing, evaluating, and scaling up advocacy interventions for action on climate policy to magnify the power of the health and medical sectors to protect planetary and human health.

The Role of Behavioral Medicine in Addressing Climate Change-Related Health Inequities

Climate change is the greatest threat to global health in human history. It has been declared a public health emergency by the World Health Organization and leading researchers from academic institutions around the globe. Structural racism disproportionately exposes communities targeted for marginalization to the harmful consequences of climate change through greater risk of exposure and sensitivity to climate hazards and less adaptive capacity to the health threats of climate change. Given its interdisciplinary approach to integrating behavioral, psychosocial, and biomedical knowledge, the discipline of behavioral medicine is uniquely qualified to address the systemic causes of climate change-related health inequities and can offer a perspective that is currently missing from many climate and health equity efforts. In this article, we summarize relevant concepts, describe how climate change and structural racism intersect to exacerbate health inequities, and recommend six strategies with the greatest potential for addressing climate-related health inequities.

Examining Experiences of Poor Sleep During Pregnancy: A Qualitative Study to Inform the Development of a Prenatal Sleep Intervention

Background

Poor sleep is common during pregnancy and is associated with increased risk of negative health outcomes. Research indicates that physical discomfort and having an active mind are primary factors for prenatal sleep disturbances. Mindfulness-based interventions have the potential for addressing these factors, but have yet to be optimized for this purpose in this population.

Objective

The objective of this study was to gather input from pregnant and postpartum individuals about the value of a mindfulness-based program for improving prenatal sleep and their preferred content and delivery format.

Methods

We conducted 2 focus groups with 12 pregnant people experiencing poor sleep quality and 3 individual interviews with postpartum people. Interviews were thematically analyzed.

Results

The majority of participants expressed strong interest in a mindfulness program for improving prenatal sleep. Participants reported that pregnancy-specific physical discomfort and worry (both general and pregnancy-specific) affected their sleep. Participants wanted sleep education, and strategies for calming the mind, reducing physical discomfort, reducing impact of bedtime partners on sleep, and tips for improving sleep schedule and quality. Participants recognized the convenience of an online intervention and the social benefits of an in-person intervention and favored a hybrid delivery model.

Conclusion

Addressing prenatal sleep problems is an unmet need. Given the challenges and discomfort women face during pregnancy, and the importance of adequate sleep for promoting mental and physical health during pregnancy, sleep difficulties are critical to address. A mindfulness-based intervention for improving prenatal sleep was deemed of high interest to this perinatal population.

Rationale and study protocol for a randomized controlled trial to determine the effectiveness of a culturally relevant, stress management enhanced behavioral weight loss intervention on weight loss outcomes of black women

BACKGROUND

Obesity is a persistent public health concern and a risk factor for many chronic diseases including at least 13 different cancers. Adult Black females have the highest prevalence of obesity (57%) compared to other racial/gender groups in the U.S. Although behavioral weight loss (BWL) interventions have demonstrated effectiveness, Black females tend to lose less weight than White counterparts. The higher prevalence of chronic psychological stress reported by Black females may contribute to their disproportionate prevalence of obesity and observed suboptimal weight loss. This study will examine the effectiveness of a 12-month culturally-targeted, stress management-enhanced BWL intervention on weight loss and stress reduction among Black females in a fully-powered randomized, controlled trial.

METHODS

Adult Black females with obesity (n = 340) will be randomized to either a culturally targeted stress management-enhanced BWL intervention (BWL-Stress) or the same BWL intervention alone (BWL-alone). The primary outcome is weight change at month 6. Secondary outcomes will include changes in stress measures (e.g., perceived stress, cortisol), energy intake, and physical activity at month 6. We will also assess process measures (e.g., treatment adherence, treatment burden). Each outcome will also be evaluated at month 12 to assess longer-term effects of the intervention.

DISCUSSION

This novel approach for enhancing an evidence-based BWL program with culturally-targeted stress management strategies for Black females addresses an understudied barrier to effective weight management among a population at high risk for obesity and obesity-related chronic diseases. This study will potentially elucidate psychological or behavioral mechanisms linking our novel intervention to study outcomes. If the intervention is proven to be effective, this study will have significant clinical and public health implications for weight management among Black females.

TRIAL REGISTRATION

This study was registered on ClinicalTrials.gov , identifier NCT04335799t , on April 6, 2020.

Stress and telomere shortening: Insights from cellular mechanisms

Short telomeres confer risk of degenerative diseases. Chronic psychological stress can lead to disease through many pathways, and research from in vitro studies to human longitudinal studies has pointed to stress-induced telomere damage as an important pathway. However, there has not been a comprehensive model to describe how changes in stress physiology and neuroendocrine pathways can lead to changes in telomere biology. Critically short telomeres or the collapse of the telomere structure caused by displacement of telomere binding protein complex shelterin elicit a DNA damage response and lead to senescence or apoptosis. In this narrative review, we summarize the key roles glucocorticoids, reactive oxygen species (ROS) and mitochondria, and inflammation play in mediating the relationship between psychological stress and telomere maintenance. We emphasis that these mediators are interconnected and reinforce each other in positive feedback loops. Telomere length has not been studied across the lifespan yet, but the initial setting point at birth appears to be the most influential point, as it sets the lifetime trajectory, and is influenced by stress. We describe two types of intergenerational stress effects on telomeres - prenatal stress effects on telomeres during fetal development, and 'telotype transmission" -the directly inherited transmission of short telomeres from parental germline. It is clear that the initial simplistic view of telomere length as a mitotic clock has evolved into a far more complex picture of both transgenerational telomere influences, and of interconnected molecular and cellular pathways and networks, as hallmarks of aging where telomere maintenance is a key player interacting with mitochondria. Further mechanistic investigations testing this comprehensive model of stress mediators shaping telomere biology and the telomere-mitochondrial nexus will lead to better understanding from cell to human lifespan aging, and could lead to anti-aging interventions.

Longitudinal hair cortisol in low-income young children: A useful biomarker of behavioral symptom change?

Early childhood is a developmental period characterized by significant plasticity, heterogeneity in behaviors and biological functioning. Yet, cumulative cortisol secretion, as measured by hair cortisol, has not been examined longitudinally in relation to change in behavioral problems in young children. The current study examined cross-sectional and longitudinal associations between hair cortisol and changes in behavior problems in a combined sample (N = 88) of two groups of young children from low-income families: 1) A trauma-exposed sample that participated in Child-Parent Psychotherapy (CPP) (n = 43; Mean Age = 4.31, SD = 1.16; 53% Female; 77% Hispanic), and 2) A community sample of children from families experiencing high stress (n = 45; Mean Age = 3.20, SD = 0.29; 67% Female; 58% Hispanic). Cortisol was assayed from hair collected from children at baseline and, on average, one year later. Mothers completed the Child Behavior Checklist at the same time hair samples were collected. Baseline hair cortisol in children was not associated with maternally-reported child behavioral problems at baseline and did not predict change in behavior problems over time. In contrast, increases in cortisol were associated with greater improvement in child behavior problems (b = -2.98, p < 0.05), controlling for group status and relevant covariates. Subgroup analyses showed that cortisol change across one year significantly differed between the two groups (p = 0.043): on average, community children exhibited a decrease, whereas CPP children demonstrated no change. Hair cortisol concentration was similarly related to improvements in mother-reported behavior problems across both CPP and community groups over time. In summary, there were no cross-sectional associations with hair cortisol, whereas increases were associated with improved child well-being. Findings demonstrate an important link between this increasingly common biomarker and child health, but suggest that changes over time may be more informative than cross-sectional associations.

Kindness and cellular aging: A pre-registered experiment testing the effects of prosocial behavior on telomere length and well-being

Objective

Prosocial behavior can improve psychological well-being and physical health. However, the underlying biological mechanisms that mediate the relationship between prosociality and health remain unclear. In this pre-registered experiment, we tested whether a 4-week kindness intervention could slow leukocyte telomere shortening and increase well-being.

Methods

Community adults (N ​= ​230) were randomly assigned to complete 1 of 3 activities, each week for 4 weeks: to perform 3 kind acts for other people, to perform 3 kind acts for themselves, or to list daily activities. At baseline and post-intervention, participants came to the lab to provide a small dried blood spot (DBS) sample via finger prick for analysis of telomere length. Participants completed psychological measures (e.g., loneliness, life satisfaction) at baseline, post-intervention, and at the 2-week follow up.

Results

Participants who performed kind acts for others did not demonstrate hypothesized changes in well-being, nor in telomere length, relative to controls. Exploratory analyses revealed that, relative to controls, participants who did kind acts for others showed reductions in loneliness through the 2-week follow up.

Conclusions

The salubrious effects of prosocial behavior in the short term are not likely due to the inhibition of cellular aging (at least as indexed by telomere length). However, extending kindness to others holds promise as a future research direction for interventions to alleviate loneliness.

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Prosocial behavior is associated with better health, but mechanisms remain unclear.

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We report a pre-registered investigation of prosocial behavior and telomere length.

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A 4-week prosocial behavior intervention did not slow rates of telomere shortening.

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Performing prosocial behavior for others was linked with reductions in loneliness.

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Prosocial behavior may reduce loneliness but does not appear to impact telomeres.

Cost-Effectiveness Of A Workplace Ban On Sugar-Sweetened Beverage Sales: A Microsimulation Model

Sugar-sweetened beverages (SSBs) increase chronic disease risk. We estimated the impact on employee health and health care spending of banning SSB sales in California-based health care organizations. We used survey data from a large, multisite health care organization in California, sampling 2,276 employees three months before and twelve months after a workplace SSB sales ban was imposed. We incorporated the survey data into a simulation model to estimate chronic disease incidence and costs. We estimated that an SSB ban as effective as the one observed would save about $300,000 per 10,000 people over ten years among similar employers, as a result of averted health care and productivity spending—after both SSB sales losses and non-SSB beverage sales gains were accounted for. Sales bans would typically need to reduce SSB consumption by 2.2 ounces per person per day for lost revenue to be fully offset if there were no increase in non-SSB beverage sales.

Maternal Psychological Resilience During Pregnancy and Newborn Telomere Length: A Prospective Study

OBJECTIVE

In the context of the importance of elucidating the determinants of the initial, newborn setting of telomere length (TL), it is increasingly evident that maternal stress and stress-related processes during pregnancy play a major role. Although psychological resilience may function as a buffer, research in this area has not yet examined its potential role vis-à-vis that of stress. The authors examined the relationship between maternal psychological resilience during pregnancy and newborn TL.

METHODS

In a sample of 656 mother-child dyads from the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction cohort, multiple serial assessments were conducted over the course of pregnancy to quantify maternal stress, negative and positive emotional responses to pregnancy events, positive affect, and perceived social support. Principal component analysis identified two latent factors: stress and positivity. A measure of resilience was computed by regressing the positivity factor on the stress factor, in order to quantify positivity after accounting for stress. TL was measured using quantitative polymerase chain reaction in leukocytes extracted from cord blood shortly after birth. Linear regression was used to predict newborn TL from maternal resilience during pregnancy, adjusting for other potential determinants.

RESULTS

Maternal stress significantly predicted shorter newborn TL (β=-0.079), and positivity significantly predicted longer TL (β=0.135). Maternal resilience (positivity accounting for stress) was significantly and positively associated with newborn TL (β=0.114, 95% CI=0.035, 0.189), with each standard deviation increase in resilience predicting 12% longer newborn TL.

CONCLUSIONS

The results indicate that maternal psychological resilience may exert a salubrious effect on offspring telomere biology and highlight the importance of enhancing maternal mental health and well-being during pregnancy.

Persistent organic pollutants and maternal glycemic outcomes in a diverse pregnancy cohort of overweight women

BACKGROUND

Animal and human studies suggest certain persistent organic pollutants (POPs) may impact glucose metabolism; however, few epidemiologic studies have examined environmental determinants of glycemic outcomes during pregnancy. Our objective is to evaluate associations between exposures to individual and mixture of POPs and measures of prenatal fasting glucose, insulin, and insulin resistance during pregnancy in overweight women.

METHODS

A cohort of overweight and obese pregnant women (N = 95) was recruited from California. Blood samples were collected during late first or second trimester (median = 16 weeks' gestation; range = 10-24 weeks). Exposures included serum concentrations of polybrominated diphenyl ethers (PBDEs) and hydroxylated metabolites (OH-PBDEs), polychlorinated biphenyls (PCBs), and poly- and perfluoroalkyl substances (PFASs). Outcomes included serum concentrations of fasting plasma glucose, fasting plasma insulin, and calculated homeostatic model assessment of insulin resistance (HOMA-IR). Generalized linear models were used to evaluate cross-sectional associations between individual and aggregate POPs and mean percent difference in fasting glucose, fasting insulin, and HOMA-IR. Bayesian kernel machine regression (BKMR) was used to assess the relative importance of each exposure to the association with our outcomes, using conditional and group posterior inclusion probabilities (PIPs).

RESULTS

Study participants were racially/ethnically diverse and nearly half were below the federal poverty level. Across PBDEs and OH-PBDEs, the direction of associations with fasting glucose, fasting insulin and HOMA-IR were varied. A doubling of PCB-138, PCB-153, PCB-180, and ∑PCBs concentrations was associated with a 2.10% mmol/L (95%CI: 0.49%, 3.74%), 2.10% mmol/L (95%CI: -0.14%, 4.39%), 2.10% mmol/L (95%CI: 0.12%, 4.12%), and 2.81% mmol/L (95%CI: 0.38%, 5.31%) increase in fasting glucose, respectively. Exposure to individual PCBs was positively associated with both fasting insulin and HOMA-IR. All PFAS were inversely associated with fasting glucose, fasting insulin, and HOMA-IR. In BKMR models of fasting glucose, all four chemical classes were important contributors to the overall mixture, with PFASs identified as the most important contributor.

DISCUSSION

Prenatal PCB exposure was positively associated while certain PBDE and PFAS analytes were inversely associated with fasting glucose concentrations in overweight women. Further examination of the relationship between POPs exposure and glycemic functioning in a larger study population of women during pregnancy is warranted.

Maternal Stress During Pregnancy Predicts Infant Infectious and Noninfectious Illness

OBJECTIVES

To examine the association between prenatal stress and infant physical health in the first year of life within an understudied, racially and ethnically diverse, highly stressed community sample. We expected that greater stress exposure would predict higher rates of infant illness.

STUDY DESIGN

Low-income, racially/ethnically diverse, overweight women with low medical risk pregnancies were recruited (2011-2014) during pregnancy. Pregnancy Stressful Life Events were assessed retrospectively (mean, 11.88 months postpartum). Perceived stress was assessed twice during pregnancy (at a mean of 17.4 weeks and again at a mean of 25.6 weeks) and at 6 months postpartum. Women with live births (n = 202) were invited; 162 consented to the offspring study. Medical records from pediatric clinics and emergency departments for 148 infants were abstracted for counts of total infectious illnesses, total noninfectious illness, and diversity of illnesses over the first year of life.

RESULTS

The final analytic sample included 109 women (mean age, 28.08 years) and their infants. In covariate-adjusted negative binomial models, maternal perceptions of stress across pregnancy were positively associated with infant illness. Each 1-point increase in average stress was associated with a 38% increase in incidence of infant infections (Incidence rate ratio, 1.38; 95% CI, 1.01-1.88; P < .05), a 73% increase in noninfectious illness (IRR, 1.73; 95% CI, 1.34-2.23; P < .05), and a 53% increase in illness diversity (IRR, 1.53; 95% CI, 1.25, 1.88; P < .01); effect sizes were larger for perceived stress later in pregnancy. Stressful life events count and postnatal stress were not uniquely associated with illness.

CONCLUSIONS

In line with recommendations from the American Academy of Pediatrics to screen for maternal perinatal depression, screening and support for stress reduction during pregnancy may benefit both maternal and child health.

The association of maternal psychosocial stress with newborn telomere length

BACKGROUND

Telomere length in early life predicts later length, and shortened telomere length among adults and children has been linked to increased risk of chronic disease and mortality. Maternal stress during pregnancy may impact telomere length of the newborn.

METHODS

In a diverse cohort of 355 pregnant women receiving prenatal and delivery care services at two hospitals in San Francisco, California, we investigated the relationship between self-reported maternal psychosocial stressors during the 2nd trimester of pregnancy and telomere length (T/S ratio) in newborn umbilical cord blood leukocytes. We examined financial strain, food insecurity, high job strain, poor neighborhood quality, low standing in one's community, experience of stressful/traumatic life events, caregiving for a dependent family member, perceived stress, and unplanned pregnancy. We used linear regression and Targeted Minimum Loss-Based Estimation (TMLE) to evaluate the change in the T/S ratio associated with exposure to each stressor controlling for maternal age, education, parity, race/ethnicity, and delivery hospital.

RESULTS

In TMLE analyses, low community standing (-0.09; 95% confidence interval [CI]-0.19 to 0.00) and perceived stress (-0.07; 95% CI -0.15 to 0.021 was marginally associated with shorter newborn telomere length, but the associations were not significant after adjusting for multiple comparisons. All linear regression estimates were not statistically significant. Our results also suggest that the association between some maternal stressors and newborn telomere length varies by race/ethnicity and infant sex.

CONCLUSIONS

This study is the first to examine the joint effect of multiple stressors during pregnancy on newborn TL using a flexible modeling approach.

Are long telomeres better than short? Relative contributions of genetically predicted telomere length to neoplastic and non-neoplastic disease risk and population health burden

Background

Mendelian Randomization (MR) studies exploiting single nucleotide polymorphisms (SNPs) predictive of leukocyte telomere length (LTL) have suggested that shorter genetically determined telomere length (gTL) is associated with increased risks of degenerative diseases, including cardiovascular and Alzheimer’s diseases, while longer gTL is associated with increased cancer risks. These varying directions of disease risk have long begged the question: when it comes to telomeres, is it better to be long or short? We propose to operationalize and answer this question by considering the relative impact of long gTL vs. short gTL on disease incidence and burden in a population.

Methods and findings

We used odds ratios (OR) of disease associated with gTL from a recently published MR meta-analysis to approximate the relative contributions of gTL to the incidence and burden of neoplastic and non-neoplastic disease in a European population. We obtained incidence data of the 9 cancers associated with long gTL and 4 non-neoplastic diseases associated with short gTL from the Institute of Health Metrics (IHME). Incidence rates of individual cancers from SEER, a database of United States cancer records, were used to weight the ORs in order to align with the available IHME data. These data were used to estimate the excess incidences due to long vs. short gTL, expressed as per 100,000 persons per standard deviation (SD) change in gTL. To estimate the population disease burden, we used the Disability Adjusted Life Years (DALY) metric from the IHME, a measure of overall disease burden that accounts for both mortality and morbidity, and similarly calculated the excess DALY associated with long vs. short gTL.

Results

Our analysis shows that, despite the markedly larger ORs of neoplastic disease, the large incidence of degenerative diseases causes the excess incidence attributable to gTL to balance that of neoplastic diseases. Long gTL is associated with an excess incidence of 94.04 cases/100,000 persons/SD (45.49–168.84, 95%CI) from the 9 cancer, while short gTL is associated with an excess incidence of 121.49 cases/100,000 persons/SD (48.40–228.58, 95%CI) from the 4 non-neoplastic diseases. When considering disease burden using the DALY metric, long gTL is associated with an excess 1255.25 DALYs/100,000 persons/SD (662.71–2163.83, 95%CI) due to the 9 cancers, while short gTL is associated with an excess 1007.75 DALYs/100,000 persons/SD (411.63–1847.34, 95%CI) due to 4 non-neoplastic diseases.

Conclusions

Our results show that genetically determined long and short telomere length are associated with disease risk and burden of approximately equal magnitude. These results provide quantitative estimates of the relative impact of genetically-predicted short vs. long TL in a human population, and provide evidence in support of the cancer-aging paradox, wherein human telomere length is balanced by opposing evolutionary forces acting to minimize both neoplastic and non-neoplastic diseases. Importantly, our results indicate that odds ratios alone can be misleading in different clinical scenarios, and disease risk should be assessed from both an individual and population level in order to draw appropriate conclusions about the risk factor’s role in human health.

Prenatal Maternal Objective and Subjective Stress Exposures and Rapid Infant Weight Gain

OBJECTIVES

To evaluate the associations between 3 prenatal stress exposures and rapid infant weight gain.

STUDY DESIGN

Participants were 162 maternal-child dyads drawn from a nonrandomized controlled trial evaluating a prenatal intervention for reducing women's stress and excessive gestational weight gain and subsequent longitudinal observational study of offspring outcomes. Participants were predominantly low-income and racial or ethnic minorities, and mothers were overweight or obese prepregnancy. Primary exposures were objective stress exposures (number of stressful life events) and subjective distress (maternal perceived stress and depressive symptoms) during pregnancy. The primary outcome was rapid infant weight gain from birth to 6 months, assessed via birth records and in-person anthropometry measurements.

RESULTS

In total, 28% of the sample (N = 40) met criteria for rapid infant weight gain. In adjusted models, exposure to prenatal stressful life events was associated with increased odds of rapid infant weight gain (OR 1.40, 95% CI 1.07-1.83, P = .014). Neither prenatal perceived stress (OR 0.47, 95% CI 0.16-1.37, P = .17) nor depressive symptoms (OR 0.89, 95% CI 0.76-1.03, P = .13) were significantly associated with rapid infant weight gain.

CONCLUSIONS

Each additional stressful life event a woman experienced during pregnancy was associated with 40% greater odds of rapid infant weight gain. Future research should evaluate whether prenatal interventions that focus on reducing exposure to stressful events prevent rapid infant weight gain.

Diet Quality and Depression in A Midlife Biracial Cohort of Women: The Role of Stress And Early Life Adversity

Objectives

Stress exposure may impose an altered physiological state to modify relations between diet and the brain. We investigate if current perceived stress and childhood trauma might moderate diet quality and depression risk associations in women.

Methods

Preliminary data for white and black women (n = 326, mean age: 39 y) taking part in the National Growth and Health Study follow-up were analyzed by multiple logistic regression models. Women at-risk for depression (score ≥ 16) were identified by the CES-D scale. Alternative Healthy Eating Index (AHEI)-2010 scores (continuous) were calculated from 3-day food records (averaged). Current perceived stress (scoring in the top tertile on Cohen's Perceived Stress Scale; here ≥20) and past childhood trauma (any exposure to physical abuse, sexual abuse, or a household member afflicted with addiction) were examined as effect modifiers (binary). Interaction terms between AHEI scores and each stress measure were tested in crude and final logistic models adjusted for race, income, and health status. Subsequent marginal analyses evaluated significance of differences in predicted probability of depression risk between stressed and non-stressed groups over AHEI.

Results

Interactions between AHEI and high perceived stress (P = 0.03), past physical abuse (P = 0.08), and past sexual abuse (P = 0.04) were significant in crude models. After adjustment, AHEI with high stress (P = 0.04) and physical abuse (P = 0.09) maintained some significance. In crude and adjusted models, predicted probabilities of depression risk were significantly higher (P &lt; 0.05) in high vs. low perceived stress women, as well as between women with past physical or sexual abuse vs. those without. However, these differences were only observed for AHEI scores above certain thresholds (in adjusted analyses: approx. AHEI ≥35 for high perceived stress, AHEI ≥58 for physical abuse, and AHEI ≥55 for sexual abuse). For AHEI scores outside those ranges, differences between predicted probabilities of depression were not seen (P &gt; 0.05). Prior living with addiction did not modify diet-depression relations (P &gt; 0.05).

Conclusions

Complex interplay between stress and adversity, diet quality, and depression in adult women exists, substantiating need for more research to understand underlying vulnerabilities and potential dietary intervention.

Funding Sources

NIH/NICHHD.

Cardiovascular Disease-Related Pregnancy Complications Are Associated with Increased Maternal Levels and Trajectories of Cardiovascular Disease Biomarkers During and After Pregnancy

Background: Having a pregnancy complicated by hypertensive disorders of pregnancy (HDP) and/or having a small or preterm baby put a woman at risk for later cardiovascular disease (CVD). It is uncertain if higher maternal CVD risk factors (reflected by increased peripartum CVD biomarker levels) account for this risk, or if experiencing a complicated pregnancy itself increases a woman's CVD risk (reflected by an increase in biomarker trajectories from early pregnancy to postpartum). Methods: We conducted a secondary analysis of an 8-week mindful eating and stress reduction intervention in 110 pregnant women. We used mixed linear regression analysis to compare CVD biomarker levels and trajectories, between women with and without a CVD-related pregnancy complication (including HDP [gestational hypertension or preeclampsia] or having a small for gestational age [<10th percentile] or preterm [<37 weeks] baby), at three times: (1) 12-20 weeks of gestation, (2) 3 months postpartum, and (3) 9 months postpartum. CVD biomarkers studied included serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI), blood pressure (BP), interleukin-6 (IL-6), tumor necrosis factor, and lipids. We adjusted for age, maternal smoking, prepregnancy BMI, BP, age × time, and BMI × time. Results: Women had a mean age of 28 years (standard deviation [SD] 6), mean prior pregnancies of 0.8 (SD 1.0), and 22 women had one or more CVD-related pregnancy complications. HOMA-IR, diastolic BP, triglyceride, high-density lipoprotein cholesterol, and IL-6 average levels, but not trajectories, differed among women with complicated versus normal pregnancy (all p values were ≤0.04). Peripartum glucose and systolic BP trajectories were statistically greater in complicated versus normal pregnancies (p values were 0.008 and 0.01, respectively). Conclusion: We conclude that the experience of a complicated pregnancy in addition to elevated CVD risk factor levels may both increase a woman's risk of future CVD. ClinicalTrials.gov Identifier: NCT01307683.

Associations between sociodemographic characteristics and exposures to PBDEs, OH-PBDEs, PCBs, and PFASs in a diverse, overweight population of pregnant women

Exposures to persistent organohalogen chemicals during pregnancy are associated with adverse health effects. Low-income, minority women with pre-existing co-morbidities may be particularly vulnerable to these exposures, but have historically been understudied. We aimed to characterize exposures to multiple chemical classes among a sample of ethnically diverse, lower income, overweight or obese pregnant women. Serum concentrations of polybrominated diphenyl ethers (PBDEs) and their hydroxylated metabolites (OH-PBDEs), polychlorinated biphenyls (PCBs), and poly- and perfluoroalkyl substances (PFASs) were measured in 98 pregnant women (California; 2011-2013). Aggregate exposures were evaluated using correlational clustering, a "chemical burden" score, and PCA. Associations between sociodemographic characteristics and individual and aggregate exposures were evaluated using multivariable linear regression. Clustering and PCA both produced four groupings: (PC1) PBDEs/OH-PBDEs, (PC2) PCBs, (PC3) PFNA/PFOA/PFDeA, (PC4) PFHxS/PFOS. Race/ethnicity and prepregnancy BMI were associated with PBDEs, OH-PBDEs and PC1. Maternal age was associated with PCBs and PC2. Parity was associated with PBDEs, OH-PBDEs and PC2. Poverty was negatively associated with PCBs, whereas food insecurity was positively associated with PFOS. We observed variations in sociodemographic profiles of exposures by chemical class and weak across-class correlations. These findings have implications for epidemiologic studies of chemical mixtures and for exposure reduction strategies.

Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model

Background

Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity.

Method

We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression.

Results

Women in MMT showed significant reductions in perceived stress (β = − 0.16) and depressive symptoms (β = − 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = − 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group.

Conclusion

A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population.

Clinical Trials.gov #NCT01307683.

An 8-Week Relaxation Program Consisting of Progressive Muscle Relaxation and Mindfulness Meditation to Reduce Stress and Attenuate Stress-Driven Eating

BACKGROUND

Stress is often associated with the intake of energy-dense palatable foods. This trial examined the feasibility and preliminary efficacy of an 8-week worksite-based relaxation intervention to address psychological stress and unhealthy food intake.

METHODS

Thirty-six men and women were exposed to an acute stressor, while physiological and psychological responses were assessed, prior to being offered a test meal. Participants were then randomised to a relaxation intervention (RELAX; face-to-face classes and daily home practice of progressive muscle relaxation and mindfulness meditation), or a wait-list control (CON). All measures were repeated after the intervention.

RESULTS

Intervention compliance was high (80% ± 19% face-to-face; 79% ± 18% home practice), and each session acutely reduced perceived stress (p < .001) and increased relaxation (p < .001). After 8 weeks, trait mindfulness was increased (p = .025), along with reduced tension (p = .013) and increased relaxation (p < .05) post-acute stressor in the intervention group. There was no effect of the intervention on palatable eating, cravings, or energy intake at a laboratory test meal, with small associated effect sizes (d = 0.01-0.3).

CONCLUSIONS

The program studied here is feasible and sessions transiently reduce perceived stress and improve mindfulness; however, the program may not influence the physiological response to an acute stressor or appetite and eating variables.

Obstructive sleep apnea, nighttime arousals, and leukocyte telomere length: the Multi-Ethnic Study of Atherosclerosis

STUDY OBJECTIVES

Sleep disturbances and sleep apnea are associated with increased vulnerability to age-related disease, altering molecular pathways affecting biological aging. Telomere length captures one component of biological aging. We evaluated whether objectively assessed sleep and sleep apnea relate to leukocyte telomere length (LTL) in the Multi-Ethnic Study of Atherosclerosis (MESA).

METHODS

Men and women aged 44-84 years (n = 672) from the MESA Stress and MESA Sleep studies underwent polysomnography and 7 day actigraphy (at Exam 5) and assessment of LTL (at baseline [Exam 1] and about 10 years later [Exam 5]).

RESULTS

General linear models adjusting for age, sex, race/ethnicity, BMI, physical activity, and smoking found that severe obstructive sleep apnea (OSA; apnea-hypopnea index > 30) was cross-sectionally associated with shorter LTL (p = 0.007). Modest associations of shorter LTL with less rapid eye movement sleep, more stage 1 sleep, wake after sleep onset >30 min, and long sleep duration were found, but these effects were diminished after adjusting for lifestyle and OSA. Exploratory analyses found that higher arousal index at Exam 5 was associated with greater LTL decline over the prior 10 years (p = 0.004).

CONCLUSIONS

OSA was associated with shorter LTL. Individuals with high-arousal frequency had greater leukocyte telomere attrition over the prior decade. These findings suggest that sleep apnea and sleep fragmentation are associated with accelerated biological aging.

Neighborhood Typology and Cardiometabolic Pregnancy Outcomes in the Maternal Adiposity Metabolism and Stress Study

OBJECTIVE

This study aimed to assess associations between neighborhood typologies classified across multiple neighborhood domains and cardiometabolic pregnancy outcomes and determine variation in effectiveness of a mindfulness-based stress-reduction intervention on outcomes across neighborhood types.

METHODS

Neighborhoods of participants in the Maternal Adiposity Metabolism and Stress (MAMAS) intervention (n = 208) were classified across dimensions of socioeconomic, food, safety, and service/resource environments using latent class analysis. The study estimated associations between neighborhood type and three cardiometabolic pregnancy outcomes-glucose tolerance (GT) during pregnancy, excessive gestational weight gain, and 6-month postpartum weight retention (PPWR)-using marginal regression models. Interaction between neighborhood type and intervention was assessed.

RESULTS

Five neighborhood types differing across socioeconomic, food, and resource environments were identified. Compared with poor, well-resourced neighborhoods, middle-income neighborhoods with low resources had higher risk of impaired GT (relative risk [RR]: 4.1; 95% confidence Interval [CI]: 1.1, 15.5), and wealthy, well-resourced neighborhoods had higher PPWR (beta: 3.9 kg; 95% CI: 0.3, 7.5). Intervention effectiveness varied across neighborhood type with wealthy, well-resourced and poor, moderately resourced neighborhoods showing improvements in GT scores. PPWR was higher in intervention compared with control groups within wealthy, well-resourced neighborhoods.

CONCLUSIONS

Consideration of multidimensional neighborhood typologies revealed important nuances in intervention effectiveness on cardiometabolic pregnancy outcomes.

Poor Sleep Quality, Psychological Distress, and the Buffering Effect of Mindfulness Training During Pregnancy

OBJECTIVE/BACKGROUND

Poor sleep quality is common in pregnancy and associated with increased psychological distress, which has adverse consequences for families. Emerging theory suggests that mindfulness-based interventions may help reduce cognitive and emotional reactivity to stressful events. The current study examines the effects of a mindfulness-based intervention on the relationship between poor sleep quality and increased depression symptom severity and perceived stress during pregnancy. Additionally, we explored the prevalence of poor sleep quality in this unique sample and the impact of intervention on sleep quality.

PARTICIPANTS

Participants were 215 ethnically diverse, overweight and obese, predominantly low-income pregnant women drawn from a study examining the impact of an 8-week mindfulness-based program (Mindful Moms Training; MMT) to reduce excessive gestational weight gain, stress, and depression compared to treatment as usual (TAU).

METHODS

Participants reported global sleep quality, depressive symptoms, and perceived stress at baseline and postintervention.

RESULTS

Most participants (63%) were categorized as poor sleepers at baseline. MMT participants did not experience significantly greater improvement in sleep quality compared to TAU participants. Baseline poor global sleep quality predicted increased depression symptom severity for all participants. Baseline poor global sleep quality predicted increased perceived stress for the TAU group only; this association was not evident in the MMT group.

CONCLUSIONS

Poor sleep quality is prevalent in overweight and obese predominantly low-income pregnant women. Poor sleep quality was associated with worsening psychological distress, but mindfulness training significantly attenuated the influence of poor sleep on perceived stress.

The mindful moms training: development of a mindfulness-based intervention to reduce stress and overeating during pregnancy

Background

Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress and non-homeostatic eating behaviors – or eating for reasons other than hunger or caloric need. We developed a mindfulness-based intervention for high-risk, low-income overweight pregnant women over a series of iterative waves using the Obesity-Related Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its effects on stress and eating behaviors.

Methods

Overweight pregnant women (n = 110) in their second trimester were enrolled in an 8-week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as well as stress, depression and eating behaviors before and after the intervention. We also examined whether pre-to-post intervention changes in outcomes of well-being and eating behaviors were associated with changes in proposed mechanisms of mindfulness, acceptance, and emotion regulation.

Results

Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and facilitator fidelity was very good. Of the women who completed class evaluations, at least half reported that each of the three class components (mindful breathing, mindful eating, and mindful movement) were “very useful,” and that they used them on most days at least once a day or more. Women improved in reported levels of mindfulness, acceptance, and emotion regulation, and these increases were correlated with reductions in stress, depression, and overeating.

Conclusions

These findings suggest that in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy.

Trial registration

ClinicalTrials.gov NCT01307683, March 8, 2011.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1757-6) contains supplementary material, which is available to authorized users.

Chronic Obesity and Incident Hypertension in Latina Women Are Associated with Accelerated Telomere Length Loss over a 1-Year Period

AIMS

Shorter telomere length is associated with increased chronic disease risk in adulthood including diabetes mellitus and cardiovascular risk. Few studies have evaluated the relationship between telomere length change and incident disease risk in populations with a high percentage of overweight and obesity.

RESULTS

In an urban Latina population recruited in San Francisco (n = 82) with a high prevalence of overweight and obesity (78.4%), we assessed leukocyte telomere length and telomere length change over a 1-year period in relation to obesity, chronicity of obesity, and incident metabolic disease risk 5-6 years later. We also assessed the relationship between telomere length change over a 1-year period and weight loss. There were no significant associations between baseline telomere length and socio-demographics including age and ethnicity, or current weight status. Telomere length change, however, was associated with being obese at baseline and previous years of chronic obesity. A high percentage of women who were obese at baseline were also obese the year before (90%) and 2 years before (85%). Obesity at baseline was an independent predictor for increased telomere length attrition (β = -346.9, -568.4 to -125.4; P < 0.01). Similarly, chronic obesity was associated with increased risk for accelerated attrition (β = -280.6, -518.4 to -42.8; P < 0.01).

INNOVATION

We speculate that accelerated attrition may be a harbinger of metabolic disease. We also found that those who had or developed hypertension had accelerated attrition [-407.4 ± 464.0 vs. -168.1 ± 643.6 (P = 0.03)].

CONCLUSION

In populations with chronic and long-standing obesity, telomere length attrition rate, rather than baseline telomere length may be a more sensitive indicator of health status including chronic disease development.

Cord blood klotho levels are inversely associated with leptin in healthy Latino neonates at risk for obesity

BACKGROUND

Klotho serum levels reflect nutritional state in adults including obesity and anorexia. The relationship between cord blood klotho levels at birth and parameters of growth including anthropometrics are not known.

METHODS

We evaluated the relationship between cord blood klotho, leptin and adipocyte hormones and infant, child and maternal anthropometrics and maternal depression in a cohort of 73 children. Non-parametric tests were used to assess differences between dichotomous and categorical predictors and klotho levels and Spearman's rank coefficients were used to assess the relationship between klotho levels and continuous predictors. A multivariable log transformed linear regression model was used to test for independent predictors of serum klotho levels.

RESULTS

Mean klotho levels were 2864.9±1409.7 (pg/mL) in cord blood and we found no relationship with infant sex, delivery specifics including gestational age or anthropometrics at birth. There was similarly no association between klotho levels at birth and future obesity at age 2. Leptin levels at birth were inversely associated with klotho levels in multivariable models after adjusting for other covariates (p<0.01). Similarly, in multivariable models insulin levels were inversely correlated with klotho levels (p=0.03). Leptin levels in our cohort of at-risk infants were more than 50% higher than other studies with neonates.

CONCLUSIONS

We found no associations between weight or length at birth or obesity in early childhood and cord blood klotho levels. Cord blood klotho levels were inversely correlated with leptin and insulin levels at birth and should be further investigated to better understand the inter-relationship between this hormone and key regulators of growth and adiposity.

Increased Cellular Aging by 3 Years of Age in Latino, Preschool Children Who Consume More Sugar-Sweetened Beverages: A Pilot Study

BACKGROUND

Previous studies in adults and older children find that sugar-sweetened beverage (SSB) consumption increases risk for obesity and cellular aging, as measured by leukocyte telomere length (LTL).

METHODS

In a previously described, San Francisco-based Latino birth cohort, where telomere length was measured at birth, we evaluate the relationship between beverage consumption (including SSB and 100% fruit juice), obesity, and LTL at 2-3 years old, as well as change in LTL from birth. LTL (T/S Ratio) was measured in 61 children (mean 2.4 years ±0.6 standard deviation). Multivariable linear regression models are used to ascertain beverage type and obesity as independent predictors of LTL and change in LTL.

RESULTS

Mean telomere length was 1.58 ± 0.20 (T/S Ratio) and mean yearly change was -0.08 ± -0.09 (T/S Ratio). Predictors of shorter telomere length at age 2-3 included increased consumption of SSB (Beta Coeff = -0.009 95% CI [-0.02 to -0.0008]; p = 0.03). Telomere length at birth was the strongest predictor of rate of attrition from birth to 2-3 years of age and males tended to have more rapid attrition.

CONCLUSION

Excessive SSB consumption impacts early childhood immune system health adversely, possibly before the development of obesity.

Shorter preschool, leukocyte telomere length is associated with obesity at age 9 in Latino children

The aim of this study was to determine the potential role of leukocyte telomere length as a biomarker for development of childhood obesity in a low-income Latino population. A birth cohort of Latino children (N = 201) in San Francisco (recruited May 2006-May 2007) was followed until age 9 and assessed annually for obesity and dietary intake. Leukocyte telomere length was measured at 4 and 5 years (n = 102) and assessed as a predictor for obesity at age 9, adjusting for known risk factors. Furthermore, leukocyte telomere length at age 4 and 5 was evaluated as a possible mediator of the relationship between excessive sugar-sweetened beverage consumption and obesity at age 9. Shorter leukocyte telomere length in preschoolers was associated with obesity at age 9 (adjusted odds ratio 0.35, 95% confidence interval 0.13-0.94) after adjustment for known risk factors. Telomere length mediated 11% of the relationship between excessive sugar-sweetened beverage consumption and obesity. Shorter leukocyte telomere length may be an indicator of future obesity risk in high-risk populations as it is particularly sensitive to damage from oxidative stress exposure, including those from sugar-sweetened beverages.

Effect of prenatal mindfulness training on depressive symptom severity through 18-months postpartum: A latent profile analysis

OBJECTIVE

We examined whether prenatal mindfulness training was associated with lower depressive symptoms through 18-months postpartum compared to treatment as usual (TAU).

METHOD

A controlled, quasi-experimental trial compared prenatal mindfulness training (MMT) to TAU. We collected depressive symptom data at post-intervention, 6-, and 18-months postpartum. Latent profile analysis identified depressive symptom profiles, and multinomial logistic regression examined whether treatment condition predicted profile.

RESULTS

Three depressive symptom severity profiles emerged: none/minimal, mild, and moderate. Adjusting for relevant covariates, MMT participants were less likely than TAU participants to be in the moderate profile than the none/minimal profile (OR = 0.13, 95% CI = 0.03-0.54, p = .005).

CONCLUSIONS

Prenatal mindfulness training may have benefits for depressive symptoms during the transition to parenthood.