Background: There is maternity care crisis in the U.S. While the U.S. spends more money than other countries, our maternal/infant outcomes lag far behind. How can the midwifery model of care improve outcomes, and what can individuals choosing a homebirth in the U.S. tell us about how to improve hospital-based maternity care?

Purpose: To examine the experiences of homebirth participants to determine what elements might transcend birth location to bring improvements to overall maternity care.

Methods: Narrative in-person interviews and surveys were collected from midwives and 30 home birthing respondents including age; race, income level, political ideology, ethnicity; education, involvement in organized religion, and how they described the care they received in childbirth.

Results: Respondents expressed concerns about business policies over evidence-based practice in institutionalized maternity care. They wanted to avoid unnecessary potentially detrimental interventions in low-risk deliveries. Participants cited self-education about childbirth, increased time/personalized care provided by midwives, and personal experiences of empowerment and autonomy. Several had experienced prior hospital births and wanted to improve their experience. One respondent said homebirth allowed: “Having informed choice of medical decisions that I do not believe techno-medical based practice gives.” Another said she belly-danced through her labor, was not a victim and did not need anyone to rescue her. Respectful individualized care they could trust was important to them.

Discussion/Conclusions. Respondents presented clear thought-out reasoning for choosing homebirths using evidence-based reasoning. The midwifery model elements of care they identified can be incorporated in hospital-based care for improving maternity care outcomes.

Background: Early childhood nutrition shapes lifelong health, yet low-income children in the United States(US) continue to experience nutrition insecurity. This study examined how participation in the Women, Infants, and Children(WIC) program impacts exclusive breastfeeding and healthy eating habits among Children in the US.

Methods: This analysis includes 4,674 children aged 0–5 years from households at or below 185% of the Federal Poverty Level(FPL), using data from the National Survey of Children's Health(2022). Descriptive statistics and multivariable logistic regression analyses accounting for survey design were conducted. The main outcomes are exclusive breastfeeding and a healthy eating composite score.

Results: Of the 2016(42.13%) children in the WIC program, 16.31% had a medium-high healthy eating score, and 7.9% were exclusively breastfed. Children on WIC had lower exclusive breastfeeding odds (aOR=0.58, 95% CI 0.49–0.79) and a non-significant higher healthy eating index (aOR=1.03, 95% CI 0.79–1.35). Compared to Hispanic children, White children had a higher healthy eating score (aOR=1.75, 95% CI 1.27–2.39). Children of college-educated parents vs parents with less education had higher healthy eating scores (aOR=1.82, 95% CI 1.11–2.98), while children living in households with food insecurity had lower high healthy eating score odds (aOR=0.69, 95% CI 0.52–0.91). Larger households (≥4 members) had higher exclusive breastfeeding odds (aOR=3.47, 95% CI 1.52–7.90).

Conclusions: While WIC supports childhood nutrition, addressing unmet needs and sociodemographic disparities and expanding benefits and funding are crucial to maintaining nutrition equity. Public health must target sociodemographic inequities to ensure access to healthy foods and long-term well-being among children.

Background:

Managing diabetes (type 1 and type 2) in pediatric and young adult populations (ages 2–25 years) presents challenges related to developmental changes and healthcare access barriers. Telehealth and mobile health (mHealth) technologies have emerged as potential solutions, especially during the COVID-19 pandemic. However, the scope, effectiveness, and characteristics of telehealth interventions for diabetes management remain unclear.

Methods:

This scoping review followed the PRISMA-ScR framework to map the literature on telehealth interventions for diabetes management in young populations. A comprehensive search of PubMed and Scopus identified studies published from 2014 - 2024. Eligible studies assessed telehealth interventions. Data extraction focused on intervention type, duration, telehealth modality, and reported outcomes, including glycemic control (HbA1c) and quality of life (QoL).

Results:

Nine studies (N = 668) were included, primarily addressing type 1 diabetes, with a notable gap in type 2 diabetes research. Telehealth interventions included virtual consultations (n = 4), remote glucose monitoring (n = 3), and web-based education programs (n = 2). While overall HbA1c reductions were inconsistent, short-term interventions (<3 months) showed greater reductions (–0.46, CI: -0.85, -0.07). Communication-based interventions significantly improved HbA1c, while web-based education programs enhanced QoL (15.78, CI: 7.39, 24.17). Studies pre-pandemic showed greater effectiveness than those during the pandemic.

Conclusions:

Telehealth shows potential for short-term glycemic control and QoL improvements, particularly through communication-based and web-based education interventions. However, high heterogeneity, limited long-term evidence, and a lack of type 2 diabetes studies highlight the need for further research into telehealth’s sustained impact for pediatric and young adult populations.

Background: Low-income women navigate additional stressors during pregnancy that increase their susceptibility to adverse health events. Mindfulness interventions have received attention as an alternative to improve health outcomes among marginalized populations. The purpose of this review was to evaluate current mindfulness interventions focused on marginalized populations and its impact on health outcomes

Methods: PubMed, Embase, Web of Science, Scopus, ProQuest and CINAHL were systematically searched following PRISMA guidelines to identify studies. Hand-searched articles were also included. Selected key words included mindfulness, pregnancy, low income and low-socioeconomic status. Outcome measures included were depression, anxiety, and stress.

Results: The preliminary search yielded 80 studies with 6 meeting the inclusion criteria after screening. Most studies were randomized or non-randomized controlled trials with the mindfulness intervention lasting 6-8 weeks. Studies showed an 83% reduction in depression and a 33% decrease in self-perceived stress after intervention. However, no studies included any objective measures of stress (e.g., cortisol).

Background: South Korea's persistently low fertility rate has led to an increasing reliance on assisted reproductive technology to address infertility. In 2023, ART-conceived births accounted for 11.3% of all deliveries. Despite the growing use of ART, concerns remain regarding potential adverse neonatal outcomes associated with ART, particularly preterm birth and low birth weight.

Methods: A retrospective cohort study was conducted using claims data from the National Health Insurance Service of South Korea (2017–2022). The study included 256,972 newborns, both ART-conceived and naturally conceived. Propensity score matching minimized selection bias, and multivariable regression adjusted for confounding factors. Maternal variables included age, insurance type, residential region, pre-pregnancy medical history, and lifestyle factors.

Results: Infants conceived through ART had a significantly higher risk of preterm birth compared to naturally conceived infants (odds ratio [OR]: 1.970; 95% confidence interval [CI]: 1.940–2.000; p < 0.0001). They also exhibited a significantly lower birth weight (OR: 0.848; 95% CI: 0.846–0.850; p < 0.0001). In addition, maternal factors such as advanced maternal age, multiple pregnancies, thyroid disorders, and threatened abortion were significantly associated with an increased risk of preterm birth.

Conclusions: This nationwide study provides strong evidence that conception via assisted reproductive technology is linked to adverse neonatal outcomes, including increased risks of preterm birth and low birth weight. These findings highlight the importance of early maternal risk assessment and personalized prenatal care. As ART use rises in South Korea, targeted public health efforts and evidence-based policies are needed to improve neonatal outcomes and support fertility goals.

Background: Women’s empowerment is a major human right and objective of development policy. However, its global progress lags far behind stated goals, particularly in sub-Saharan Africa, where climate-related disasters and human-driven conflicts frequently occur. Therefore, examining the post conflict status of women using multi-dimensional empowerment indicators is crucial. We aimed to assess women’s empowerment and its associated factors in the study area.

Methods: A community-based cross-sectional survey was conducted in Tigray, Ethiopia. A sample of 1,477 pregnant women participated in the study. Multistage sampling techniques were employed, and data collected using a structured and pretested questionnaire. All covariates displaying a statistically significant association (p<0.05, two-sided) in the bivariable analysis was included in the final multivariable logistic regression model.

Results: The overall status of women’s empowerment was 8.2% (95%CI:6.9-9.78). Intra-familial factors: husband’s education with primary (AOR:2.66(1.30-5.43), secondary(AOR:4.69(2.23-9.84), and tertiary (AOR:3.60(1.20-10.83) levels, being from a model households (AOR:4.38(1.33-14.47), households with middle (AOR:3.50(1.13-8.37), high (AOR:3.10(1.25-7.67) wealth indexes, and those enrolled in productive safety net programs (AOR:2.37(1.25-4.50) were positively associated with women’s empowerment. In addition, dowry (AOR:1.82(1.10-5.300) and respondents perceived better justice availability for women and girls (AOR:3.00(1.05-8.60) were the community level predictors.

Conclusion: The overall status of women’s empowerment in Tigray was very low. This study recommends prioritizing investments in women's education, enhancing income-generating activities, spousal support and integrating gender-based violence interventions into women's empowerment initiatives as crucial steps in promoting robust and stable post-conflict societies, and may inform public policy related to gender equality through women’s empowerment.

Background:

In May 2023, the state of Michigan extended pregnancy-related Medicaid eligibility from 60 days to one year postpartum. Recognizing that insurance is necessary but not sufficient alone to access high-quality care, the objective of this study is to understand unmet healthcare needs among individuals with extended coverage in the year after birth.

Methods:

We conducted an online survey of individuals with Medicaid-paid births at Michigan Medicine between February and June 2024. Patients were contacted at 9 months postpartum via email with a unique survey link and recontacted via automated email reminders and a phone call if survey remained incomplete. Participants received $30 upon survey completion.

Results:

Among eligible individuals (N=554), 230 completed the survey (41.5%). Most respondents reported non-Hispanic Black (n=56/230, 24.3%), non-Hispanic White (n=154, 67.0%), or Hispanic (n=21, 9.1%) race and ethnicity.

With respect to healthcare use since delivery, 31.7% of patients reported no OBGYN or birth provider care (n=73/230) and 49.6% (n=114/230) reported no primary care. A high proportion of individuals reporting chronic conditions had not seen their specialist provider (n=60/158, 38.0%). Among individuals reporting unmet healthcare needs (7.5%, n=17/228), 41.2% reported the need for primary (n=7/17), 29.4% mental health (n=5/17), 23.5% OBGYN (n=4/17), and 23.5% chronic disease healthcare (n=4/17).

Conclusion:

Patients with extended Medicaid eligibility in the postpartum year face unmet healthcare needs, with many not receiving postpartum or chronic disease management care. Steps beyond coverage extensions alone are needed to address identified gaps and ensure optimal access to care.

Background: Children in rural areas, including those in Native American communities, are often diagnosed with autism spectrum disorder (ASD) later and less frequently than those in urban settings, delaying access to critical services such as behavioral therapy. Limited healthcare infrastructure, provider shortages, and socioeconomic barriers contribute to these disparities.

Methods: Data from children with ASD ages 3-17 years included in the 2022-2023 National Survey of Children’s Health (NSCH) were analyzed. Rural status was defined as residence in a nonmetropolitan area (i.e., an area with fewer than 10,000 residents). Indian Health Service (IHS) insurance coverage was also examined as a potential indicator of rural location. The primary outcome examined was behavioral therapy use for autism. Weighted bivariate analyses were performed.

Results: Children residing in urban areas had higher therapy utilization compared to those in rural areas (58.87% vs. 52.97%, p = 0.044). Individuals without IHS coverage were more likely to receive behavioral therapy than those with IHS coverage (59.0% vs. 45.95%, p = 0.041). When a different variable definition for therapy receipt was used, utilization remained higher in urban areas (55.89%) than in rural areas (49.19%, p = 0.021).

Conclusion: Findings suggest that rural versus urban children with ASD are less likely to utilize behavioral therapy, an association also observed for those with IHS versus other insurance coverage. Ongoing analysis will further clarify these healthcare disparities in rural and Native American populations and their implications for programs and policy.

Sleep deprivation affects approximately one in three individuals in the United States,
disrupting the body’s natural balance and reducing melatonin production. Melatonin, a hormone
secreted by the pineal gland, regulates circadian rhythms and is widely used as a supplement to
counteract the effects of sleep deprivation. However, the increasing use of high doses of
melatonin raises concerns about its potential effects on health, particularly fertility and anxiety.
This study investigated the impact of high doses of melatonin and sleep deprivation using
Drosophila melanogaster as a model organism due to its high reproduction rates, similar genome,
and easy maintenance. The female fertility assay was used to measure the number of embryos
per female as an indicator of fertility levels. An open field test assessed anxiety levels by
tracking the time spent in the center versus the edges of an area, as reduced time in the center is
associated with increased anxiety.
The results indicated that melatonin decreased time spent in the center and increased the
embryos per female. Sleep-deprived flies had less center time and increased embryos per female.
When exposed to both melatonin and sleep deprivation, flies had decreased center time and
embryos per female.
This project shows that melatonin and sleep deprivation, individually, raised anxiety and
fertility. Together, they decreased fertility levels and increased anxiety levels. Further testing
will reveal the specific relationship between melatonin and sleep deprivation using additional
trials and long-term testing. This work is important for informing health choices and guiding
safer melatonin use.