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ObjectivesTo assess deviations in longitudinally measured cytokines with preterm birth (PTB).MethodsProspective longitudinal study targeting 80 subjects. Phlebotomy specimens for broad panel of cytokine analysis were obtained at three time (T) intervals: first trimester (T1: 8-14 weeks' gestation), second trimester (T2: 18-22 weeks' gestation), and third trimester (T3: 28-32 weeks' gestation). Important demographics and outcomes were tracked. Data were stratified and the target groups were analyzed as follows: "Uncomplicated" (delivered ≥37 weeks) or "Preterm Birth" (

In 2009, the National Academy of Sciences (NAS) called for more interdisciplinary and community-engaged approaches to teaching and learning in the agricultural and life sciences to better respond to the food system challenges of the 21st century. As a result, institutions from across the nation have responded with a number of experiential learning and service-learning frameworks and practices aimed to enhance the academic experience for both student and community stakeholders. Sustainable agriculture education, with its explicit focus on experiential learning, interdisciplinarity, and values-based programming, has emerged as a promising approach to strengthen the fabric of agriculture and life sciences education. The purpose of this paper is to illustrate the complex role of service learning as a central approach to undergraduate teaching and learning where interdisciplinary teaching, experiential learning, and community engagement are core goals. Specifically, we conducted a single embedded case study of a sustainable agriculture education program at a land grant university to explore how this triad was organized and possible service learning outcomes. Our case study was informed by semi-structured interviews of faculty and community partner stakeholders, participant observations of faculty and students, and secondary data analysis of course syllabi and other programmatic artifacts. Despite different understandings and practices of service learning by faculty within this, we found a common core of best practices. We conclude with criteria and best practices to guide teaching and learning from this triad perspective.

To evaluate the association between psychotropic medication and inflammatory biomarkers in women with antenatal depressive symptoms (ADS). In this cross-sectional secondary analysis of a prospective multicenter observational study, 723 pregnant women underwent a depression screen using the Center for Epidemiologic Studies Depression Scale (CES-D) between 12 and 21 weeks gestation. Self-reported use of medications for depression and/or anxiety was corroborated with the medical record to document exposure to pharmacotherapy. Serum was collected and inflammatory biomarkers (IFNγ, IL13, IL6, IL8, TNFα, CRP) were measured concomitantly. Women were included if they fell into one of three categories: ADS responsive to treatment (CES-D

ObjectiveTo evaluate the association between prenatal stress and gestational weight gain (GWG).Study designThis was an analysis of women recruited between 2013-2015 from four sites in the US. We tested associations between responses at 32-35 weeks to the Life Experiences Survey (LES), a 37-item measure of events and perceived stress, and GWG categories. Bivariable comparisons and logistic regression were used to estimate the association between the total LES score and the odds of achieving adequate GWG.ResultAmong the 725 women, those with adequate GWG had lower median LES scores (5) compared to women with inadequate (7) and excessive (7) GWG, p = 0.02. After adjusting for age, initial BMI, income, education, marital status and gestational diabetes, lower LES scores (multiples of the median) were associated with adequate GWG (aOR 0.81, 95% CI 0.67-0.98).ConclusionLower reported stress, as measured by the LES, was associated with a greater chance of women achieving adequate GWG. This relationship highlights the potential for interventions directed toward psychosocial support to have salutary effects upon GWG.

Research suggests the health consequences of economic hardship can be transmitted across generations. Some of these disparities are thought to be passed to offspring during gestation. But this hypothesis has not been tested in contemporary American samples, and the mechanisms of transmission have not been characterized. Accordingly, this study had two goals: first, to determine if women exposed to economic hardship during childhood showed higher rates of adverse birth outcomes; and second, to evaluate the contribution of inflammation, psychosocial, lifestyle, and obstetric characteristics to this phenomenon. This prospective study enrolled 744 women with singleton pregnancies (59.1% White; 16.3% Black; 18.7% Latina; 5.9% Other). Childhood economic hardship was measured by self-report. Birth outcomes included length of gestation and incidence of preterm birth; birth weight percentile and small for gestational age; length of hospital stay and admission to Special Care Nursery. Analyses revealed that mothers' childhood economic hardship was independently associated with multiple adverse birth outcomes, even following adjustment for demographics, maternal education, and obstetrical confounders. Women raised in economically disadvantaged conditions had shorter gestation length and higher preterm delivery rates. Their babies had lower birth weights, were more likely to be small for gestational age, stayed in the hospital longer, and had more Special Care Nursery admissions. Mediation analyses suggested these associations arose through multiple pathways, and highlighted roles for inflammation, education, adiposity, and obstetric complications. Collectively, these findings suggest that childhood economic hardship predisposes women to adverse birth outcomes, and highlights likely behavioral and biological mechanisms.

The placenta is the principal regulator of the in utero environment, and disruptions to this environment can result in adverse offspring health outcomes. To better characterize the impact of in utero perturbations, we assessed the influence of known environmental pollutants on the expression of microRNA (miRNA) in placental samples collected from the National Children's Study (NCS) Vanguard birth cohort. This study analyzed the expression of 654 miRNAs in 110 term placentas. Environmental pollutants measured in these placentas included dichlorodiphenyldichloroethylene (DDE), bisphenol A (BPA), polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), arsenic (As), mercury (Hg), lead (Pb), and cadmium (Cd). A moderated t-test was used to identify a panel of differentially expressed miRNAs, which were further analyzed using generalized linear models. We observed 112 miRNAs consistently expressed in >70% of the samples. Consistent with the literature, miRNAs located within the imprinted placenta-specific C19MC cluster, specifically mir-517a, mir-517c, mir-522, and mir-23a, are among the top expressed miRNA in our study. We observed a positive association between PBDE 209 and miR-188-5p and an inverse association between PBDE 99 and let-7c. Both PCBs and Cd were positively associated with miR-1537 expression level. In addition, multiple let-7 family members were downregulated with increasing levels of Hg and Pb. We did not observe DDE or BPA levels to be associated with placental miRNA expression. This is the first birth cohort study linking environmental pollutants and placental expression of miRNAs. Our results suggest that placental miRNA profiles may signal in utero exposures to environmental chemicals.

For more than two decades, prenatal care has been a cornerstone of our nation's strategy for improving pregnancy outcomes. In recent years, however, a growing recognition of the limits of prenatal care and the importance of maternal health before pregnancy has drawn increasing attention to preconception and internatal care. Internatal care refers to a package of healthcare and ancillary services provided to a woman and her family from the birth of one child to the birth of her next child. For healthy mothers, internatal care offers an opportunity for wellness promotion between pregnancies. For high-risk mothers, internatal care provides strategies for risk reduction before their next pregnancy. In this paper we begin to define the contents of internatal care. The core components of internatal care consist of risk assessment, health promotion, clinical and psychosocial interventions. We identified several priority areas, such as FINDS (family violence, infections, nutrition, depression, and stress) for risk assessment or BBEEFF (breastfeeding, back-to-sleep, exercise, exposures, family planning and folate) for health promotion. Women with chronic health conditions such as hypertension, diabetes, or weight problems should receive on-going care per clinical guidelines for their evaluation, treatment, and follow-up during the internatal period. For women with prior adverse outcomes such as preterm delivery, we propose an internatal care model based on known etiologic pathways, with the goal of preventing recurrence by addressing these biobehavioral pathways prior to the next pregnancy. We suggest enhancing service integration for women and families, including possibly care coordination and home visitation for selected high-risk women. The primary aim of this paper is to start a dialogue on the content of internatal care.

ProblemAnalyses of the expression pattern of multiple cytokines are frequently required for characterization of the status of the immune system as it pertains to Th type bias and intrinsic levels of inflammation. Classically, analysis of cytokine expression patterns has been performed by enzyme-linked immunosorbent assays (ELISA) for each separate analyte. A new technology, Luminex MAP, facilitates the simultaneous evaluation of multiple immune mediators with advantages of higher throughput, smaller sample volume, and lower cost. Validation of this technology has been limited to small sample sets, limited use of clinical study specimens, and use of non-commercial reagents.MethodsNinety-six specimens from women over the course of their respective pregnancies were evaluated for cytokine concentrations using commercially available ELISA kits and commercially available Luminex MAP kits according to the manufacturers' directions. Correlations between data sets were evaluated using Pearson's correlation coefficient (r).ResultsExcellent correlations were demonstrated for IL-1 beta, IL-4, IL-5, IL-6, IL-10, IFN gamma, and TNF alpha, in contrast to IL-12 p 70 and IL-13.ConclusionsLuminex multiplex technology has distinct advantages and is a valid alternative method to ELISA for the evaluation of the majority of cytokines tested and for the characterization of immune system status.

Objectives. We compared health behaviors and health outcomes among US-born, African-born, and Caribbean-born pregnant Black women and examined whether sociodemographic and psychosocial characteristics explained differences among these population subgroups. Methods. We analyzed data from a prospective cohort study conducted in Philadelphia, Pennsylvania, with a series of nested logistic regression models predicting tobacco, alcohol, and marijuana use and measures of physical and mental health. Results. Foreign-born Black women were significantly less likely to engage in substance use and had better self-rated physical and mental health than did native-born Black women. These findings were largely unchanged by adjustment for sociodemographic and psychosocial characteristics. The foreign-born advantage varied by place of birth: it was somewhat stronger for African-born women than for Caribbean-born women. Conclusions. Further studies are needed to gain a better understanding of the role of immigrant selectivity and other characteristics that contribute to more favorable health behaviors and health outcomes among foreign-born Blacks than among native-born Blacks in the United States. (Am J Public Health. 2010; 100:2185-2192. doi: 10.2105/AJPH.2009.174755)

Objectives. We compared the association between advancing maternal age and risk of preterm delivery across 4 groups (Black smokers, Black nonsmokers, White smokers, White nonsmokers) and within the context of neighborhood deprivation levels. Methods. We obtained data from linked census and birth records for singletons (n=182938) delivered by women aged 20 to 39 years in Philadelphia, Pennsylvania; Baltimore, Maryland; 16 Michigan cities; 3 Maryland counties; and 2 North Carolina counties. Results from area-specific multilevel logistic regression models were combined to obtain pooled estimates of relations between maternal age and risk of preterm delivery. We repeated the models after categorizing women by neighborhood deprivation level (low, medium, and high). Results. Among multiparous women, there was a significant age-related increase in preterm delivery in 3 of the 4 groups. The adjusted odds ratio per 5-year age increase was 1.31 in Black smokers, 1.11 in Black nonsmokers, and 1.16 in White smokers. In each group, the odds ratio increased as neighborhood deprivation increased. Conclusions. These results support the 'weathering' hypothesis, suggesting that Black women, women with high-risk behaviors, and women living in highdeprivation neighborhoods may develop 'accelerated aging' that increases preterm delivery risk. (Am J Public Health. 2009;99:1864-1871. doi:10.2105/AJPH. 2008.151589)

Epidemiological evidence suggests that maternal psychosocial stress, strenuous physical activity and fasting are independent risk factors for preterm birth and low birth weight. Data from clinical studies consistently demonstrate that women in preterm labor have significantly elevated levels of corticotropin-releasing hormone compared with age-matched control subjects. Because production of corticotropin-releasing hormone appears to be stress sensitive, this neuropeptide may play a critical role in the physiological mediation among stressful experiences, work stress and fasting and risk of preterm birth. In addition to the direct effect of elevated corticotropin-releasing hormone on the initiation of labor, it may have an immunomodulatory effect such that women with high levels of corticotropin-releasing hormone may be more susceptible to infection or the pathological consequences of infection. We review the epidemiological data linking maternal stress, physical strain and fasting to preterm birth and low birth weight and review the plausible biological pathways through which these exposures may increase risk of preterm birth. The timing of these exposures is considered important. Future research and clinical programs addressing these exposures must consider assessments and interventions before pregnancy. KEY WORDS: * preterm birth * psychosocial stress * social environment * corticotropin-releasing hormone (CRH) * perinatal infection

This article reports on the comfort level of 97 eighth grade teachers using non-traditional teaching strategies in sexuality education classes. Most were comfortable teaching sexuality education and undeterred by external factors such as students' religious beliefs, lack of administrative support, or parental protest. However, a quarter to a third of teachers reported never or rarely using activities such as roleplays, small-group discussions, and problem-solving exercises. Multiple regression indicated that only gender was a significant predictor of such usage. The greatest perceived barriers to teaching sexuality education and using alternative teaching strategies were lack of materials, lack of time, and difficulty with facilitation under traditional classroom structure. Although more research is needed to better understand barriers to using alternative strategies, teachers in two focus groups (n = 19) suggested 1) restructuring classroom settings to match the demands of new teaching strategies, and 2) 'experience appropriate' curricula. (J Sch Health. 1996;66(5):140-144), Over the past 10 years, research has shown that traditional knowledge-based curricula increase students understanding, but do little to change actual sexual risk-taking behavior.[1-3] In response, new health education curricula [...]

Abstract Background We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service. Methods A secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program. Results Although common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, p = 0.45). Enabling factors (p = 0.058), older maternal age (p = 0.03) and smoking (p = < 0.0001) were independently associated with participation. Conclusions Actively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.

Abstract Background Recruitment and retention of patients for randomized control trial (RCT) studies can provide formidable challenges, particularly with minority and underserved populations. Data are reported for the Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large RCT targeting risk factors for repeat preterm births among women who previously delivered premature (< 35 weeks gestation) infants. Methods Design of the PCPPP incorporated strategies to maximize recruitment and retention. These included an advanced database system tracking follow-up status and assessment completion rates; cultural sensitivity training for staff; communication to the community and eligible women of the benefits of participation; financial incentives; assistance with transportation and supervised childcare services; and reminder calls for convenient, flexibly scheduled appointments. Analyses reported here: 1) compare recruitment projections to actual enrollment 2) explore recruitment bias; 3) validate the randomization process 4) document the extent to which contact was maintained and complete assessments achieved 5) determine if follow-up was conditioned upon socio-economic status, race/ethnicity, or other factors. Results Of eligible women approached, 1,126 (77.7%) agreed to participate fully. Of the 324 not agreeing, 118 (36.4%) completed a short survey. Consenting women were disproportionately from minority and low SES backgrounds: 71.5% consenting were African American, versus 38.8% not consenting. Consenting women were also more likely to report homelessness during their lifetime (14.6% vs. 0.87%) and to be unmarried at the time of delivery (81.6% versus 47.9%). First one-month postpartum assessment was completed for 83.5% (n = 472) of the intervention group (n = 565) and 76% (426) of the control group. Higher assessment completion rates were observed for the intervention group throughout the follow-up. Second, third, fourth and fifth postpartum assessments were 67.6% vs. 57.5%, 60.0% vs. 48.9%, 54.2% vs. 46.3% and 47.3% vs. 40.8%, for the intervention and control group women, respectively. There were no differences in follow-up rates according to race/ethnicity, SES or other factors. Greater retention of the intervention group may reflect the highly-valued nature of the medical and behavior services constituting the intervention arms of the Project. Conclusion Findings challenge beliefs that low income and minority women are averse to enrolling and continuing in clinical trials or community studies.

Abstract Objective To determine the value of maternal height and weight data on birth certificate records when estimating prevalence of overweight and obese adults at the neighborhood level. Research Design and Methods Regression analysis was used to determine how much variation in the percentage of the adult population with a body mass index (BMI) of ≥ 25 (based on survey data) could be accounted for by the percentage of mothers with BMI ≥ 25 (based on birth certificate data) -- alone and in combination with other sociodemographic characteristics of census tracts. Results Alone, the percentage of mothers with BMI ≥ 25 explained more than half (R2 = .52) of the variation in the percentage of all residents in census tracts with BMI ≥ 25; in combination with several measures of the sociodemographic characteristics of the census tracts, 75% ( R2 = 75.2) of the variation is explained. Conclusions Maternal height and weight data available from birth certificate records may be useful for identifying neighborhoods with relatively high or low prevalence of adult residents who are overweight or obese. This is especially true if used in combination with readily available census data.

In 2009, the National Academy of Sciences (NAS) called for more interdisciplinary and communityengaged approaches to teaching and learning in the agricultural and life sciences to better respond to the food system challenges of the 21st century. As a result, institutions from across the nation have responded with a number of experiential learning and service-learning frameworks and practices aimed to enhance the academic experience for both student and community stakeholders. Sustainable agriculture education, with its explicit focus on experiential learning, interdisciplinarity, and values-based programming, has emerged as a promising approach to strengthen the fabric of agriculture and life sciences education. The purpose of this paper is to illustrate the complex role of service learning as a central approach to undergraduate teaching and learning where interdisciplinary teaching, experiential learning, and community engagement are core goals. Specifically, we conducted a single embedded case study of a sustainable agriculture education program at a land grant university to explore how this triad was organized and possible service learning outcomes. Our case study was informed by semi-structured interviews of faculty and community partner stakeholders, participant observations of faculty and students, and secondary data analysis of course syllabi and other programmatic artifacts. Despite different understandings and practices of service learning by faculty within this, we found a common core of best practices. We conclude with criteria and best practices to guide teaching and learning from this triad perspective. [ABSTRACT FROM AUTHOR]