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Prenatal vitamin D deficiency and prenatal depression are both separately associated with adverse perinatal outcomes; however, to our knowledge no studies have investigated the effects of having both risk factors. Our objective was to determine to what extent vitamin D deficiency predicts adverse perinatal outcomes and whether elevated depressive symptoms in pregnancy places women at additional increased risk. This study was a secondary data analysis of prospective data collected from a cohort of pregnant women (N = 101) in an obstetric clinic of a large medical center. Maternal vitamin D deficiency (serum 25(OH)D [less than or equal to] 20 ng/ml) and depressive symptoms (Edinburgh Postnatal Depression Scale, EPDS) were assessed in early pregnancy. A composite of four adverse perinatal outcomes (low birth weight, preterm birth, small-for-gestational age, and preeclampsia) were abstracted from medical charts. Nineteen of the 101 women had one or more adverse perinatal outcome and 84% with an adverse outcome (16/19) were not White. Both prenatal and time of delivery vitamin D deficiency were associated with developing an adverse outcome compared to those vitamin D sufficient (prenatal relative risk 3.43; 95% CI 1.60-7.34, p = 0.004; delivery time relative risk 5.14, 95% CI 2.68-9.86, p = 0.004). These both remained significant after adjusting for BMI. A higher rate of adverse outcome was found when women had both prenatal vitamin D deficiency and elevated depressive symptoms (EPDS [greater than or equal to] 10). Sixty percent with both risk factors had an adverse perinatal outcome versus 17% with only one or neither risk factor (relative risk 3.60; 95% CI 1.55-8.38, p = 0.045), worthy of investigation with larger samples. Together, prenatal vitamin D deficiency and elevated depressive symptoms in pregnancy may increase risk for adverse perinatal outcomes, especially in racial minorities. Obstetric providers should consider routine prenatal depression screening. The impact of vitamin D supplementation to reduce risk for adverse perinatal outcomes should be studied in prospective trials. Our results suggest that supplementation early in pregnancy might be especially beneficial for depressed women., Author(s): Eynav Elgavish Accortt [sup.1] , Amy Lamb [sup.1] , James Mirocha [sup.2] , Calvin J. Hobel [sup.1] Author Affiliations: (Aff1) 0000 0001 2152 9905, grid.50956.3f, Department of Obstetrics and [...]

In her presidential address at the American Occupational Therapy Association's 2017 Annual Conference & Centennial Celebration, Amy Lamb honored occupational therapy's past and embraced its future. Occupational therapy practitioners have the power to serve as change agents, demonstrating their value during everyday opportunities as they design the future of occupational therapy. [ABSTRACT FROM AUTHOR]

The article focuses on the function of occupational therapy in dealing with the needs of people on primary care. Topics discussed include the need for a collaboration between patients, their families and care providers to effectively manage severe medical conditions, factors that affect health care reforms such as increased expenditures, health insurance and aging population, and the American Occupational Therapy Association's (AOTA) Occupational Therapy Code of Ethics and Ethics Standards.