BACKGROUND/OBJECTIVES:Sufficient preconception vitamin D may promote robust implantation and higher human chorionic gonadotropin (hCG) levels, potentially increasing nausea and vomiting in pregnancy. We assessed associations between maternal serum 25-hydroxyvitamin D (25(OH)D) at both preconception and 8 weeks' gestation with nausea and vomiting during early pregnancy. We hypothesized that women with sufficient vitamin D status or those who improved their levels in early gestation, would have higher odds of nausea and vomiting compared to women who were deficient or insufficient. METHODS:This secondary analysis of the randomized EAGeR Trial included women with 1-2 prior pregnancy losses and 25(OH)D measured at preconception (n = 774) and 8 weeks' gestation (N = 641). Nausea and vomiting were captured via medical records and daily symptom diaries. 25(OH)D was categorized as deficient (≤20 ng/mL), insufficient (21-29 ng/mL), or sufficient (≥30 ng/mL). Logistic regression and generalized estimating equations (GEE) estimated associations. RESULTS:Women who improved from deficient/insufficient preconception to sufficient by 8 weeks had higher odds of nausea and vomiting in early pregnancy compared to those remaining sufficient (aOR: 1.71; 95% CI: 1.12, 2.61). Conversely, those remaining deficient/insufficient (aOR: 0.34; 95% CI: 0.20, 0.60) or declining to deficiency (aOR: 0.44; 95% CI: 0.22, 0.87) had lower odds. In longitudinal models, deficiency was associated with lower odds of daily vomiting (aOR: 0.54; 95% CI: 0.28, 1.04), though estimates were imprecise. CONCLUSION:Dynamic changes in vitamin D status from preconception to early pregnancy appear to be associated with nausea and vomiting in early pregnancy. Improvement of sufficiency increased emesis odds, while persistent deficiency correlated with fewer symptoms. These findings suggest vitamin D may be associated with nausea and vomiting through hormonal or placental signaling mechanisms in early gestation.

OBJECTIVE:To evaluate associations between maternal serum 25-hyroxyvitamin D [25(OH)D] measured at both preconception and 8 weeks gestation and the risk of preeclampsia. STUDY DESIGN:A secondary analysis of the EAGeR Trial (2006-2012), which was a multisite, prospective, double-blind, block-randomized, placebo-controlled clinical trial of women with regular menstrual cycles and 1-2 prior pregnancy losses. Analyses were restricted to participants who conceived and had a live birth (N = 552) and serum 25(OH)D measured at preconception and 8 weeks' gestation. MAIN OUTCOME MEASURES:Log-binomial regression with robust standard errors estimated risk ratios (RR) and 95% confidence intervals (CI) for preeclampsia across 25(OH)D categories. Inverse probability weighting accounted for selection bias from restricting analyses to live births. RESULTS:Overall, 55 (10.0%) women developed preeclampsia. In adjusted models excluding body mass index (BMI), deficient preconception 25(OH)D levels (≤20 ng/ml) were associated with an increased preeclampsia risk (RR: 2.32, 95% CI: 1.09, 4.95) compared with sufficient levels (≥30 ng/ml). These associations were attenuated after adjusting for BMI and other covariates (RR: 1.45, 95% CI: 0.64, 3.29). No significant associations were observed for insufficient 25(OH)D or for concentrations measured at 8 weeks' gestation. CONCLUSION:Deficient preconception 25(OH)D levels may be associated with an increased risk of preeclampsia, although this relationship appears partly mediated by BMI. These findings highlight the preconception period as a potentially critical window for optimizing maternal vitamin D status and reducing future preeclampsia risk. Addressing maternal nutritional status before conception may offer a novel prevention strategy warranting confirmation in larger and more diverse populations.

Female genital cutting (FGC) may lead to clinical infertility (failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse) through gynaecologic morbidity and reduced sexual frequency, but previous studies were inconclusive. Therefore, we examined if FGC and FGC severity were associated with longer time-to-pregnancy (TTP) in Nigeria. We restricted 2013 Nigeria Demographic Health Survey (NDHS) data to women at risk of pregnancy at the time of the interview (18-44 years, married/cohabiting, sexually active, not using contraception, and not sterilised) with self-reported FGC status (n = 4,431). Using the current duration approach, we conducted weighted accelerated-failure-time regression survival modelling to estimate time ratios for TTP by FGC status/severity, stratified by parity as a proxy for primary (nulliparous) and secondary (parous) infertility. Thirty-three percent of women reported having undergone FGC (severity: Type I: 2.9%, Type II: 17.7%, Type III: 1.6%, Unknown/missing severity: 10.9%). Overall, there were no differences in TTP between those with and without FGC. However, nulliparous women with Type III FGC had longer TTP (adjTR = 11.80, 95% CI: 4.09-34.01). FGC was not significantly associated with longer TTP for other severity groups or among parous women.

Background/Objectives: To examine relationships between maternal-serum 25(OH)D levels at preconception and 8 weeks' gestation and the risk of vaginal bleeding and subchorionic hemorrhage during pregnancy. Methods: A secondary analysis of the EAGeR Trial, which is a prospective, multisite, randomized controlled trial that enrolled 1228 women with 1-2 prior pregnancy losses. Analyses were restricted to participants who became pregnant and had 25(OH)D measured at preconception (n = 747) and 8 weeks' gestation (n = 605). Vaginal bleeding and subchorionic hemorrhage were assessed via medical record extraction, which captured clinically recognized symptoms at medical visits measured at any point throughout pregnancy. Symptom severity of vaginal bleeding was assessed via time-varying self-reported symptoms across early pregnancy through 3-8 weeks gestation using daily diaries. Logistic regression models evaluated associations between maternal-serum 25(OH)D levels (deficient ≤ 20 ng/mL; insufficient 21-29 ng/mL; sufficient ≥ 30 ng/mL) and vaginal bleeding and subchorionic hemorrhage, while generalized estimating equations (GEE) models were used to evaluate time-varying symptom severity of vaginal bleeding from daily diary data. Results: Those who remained 25(OH)D deficient/insufficient had increased odds of having a subchorionic hemorrhage (aOR: 2.18; 95% CI: 1.13, 4.20) compared to those who had sufficient levels at both time points. In longitudinal GEE models, women with deficient preconception 25(OH)D had greater odds of moderate-to-heavy bleeding (vs. none) (aOR: 3.02; 95% CI: 1.13, 8.13), but no association was observed for light bleeding (aOR: 1.07; 95% CI: 0.58, 2.00). Findings were directionally similar, yet less precise when restricted to pregnancies resulting in a live birth. Conclusions: Persistently low vitamin D from preconception to early pregnancy is associated with increased risk of subchorionic hemorrhage and moderate/heavy vaginal bleeding, highlighting the importance of vitamin D sufficiency for implantation and early placental development.

AbstractIn June 2022, the U.S. Supreme Court ruling in Dobbs v. Jackson Women's Health Organization ended the federal constitutional right to abortion in the United States. As a result, 12 states now ban abortion in nearly all circumstances and several states restrict abortion access to early gestational limits. This article considers how abortion bans and restrictions have influenced maternal morbidity and mortality, sentinel indicators of our nation's health. This article discusses the availability of routinely collected U.S. data for studying abortion bans and restrictions on maternal morbidity and mortality, study design and context considerations for estimating consequences of abortion bans and restrictions, and recommendations about how to improve data collection and dissemination.

Importance:The 2022 Supreme Court decision Dobbs v. Jackson Women's Health Organization and the subsequent legal restrictions to abortion have prompted national discussion about the importance of abortion access for maternal health. A commonly cited statistic in these debates, based on data from 1998 to 2005, is that the risk of death associated with childbirth is approximately 14 times higher than that of abortion. Objective:To estimate the ratio of pregnancy-related to abortion-related mortality using updated data (2018-2021), capturing increased detection of maternal death and increased safety of abortion since the original estimate. Design, Setting, and Participants:This cross-sectional study included all births (live and stillbirths) and pregnancy-related deaths from the National Vital Statistics System from 2018 to 2021. The number of abortion related deaths was obtained from the Pregnancy Mortality Surveillance System, and the number of abortions was obtained from the Guttmacher Institute. Data were analyzed between February and October 2025. Main Outcomes and Measures:Pregnancy-related deaths were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes A34, O10 to O95, O96, O98 to O99. Pregnancy- and abortion-related mortality ratios were calculated per 100 000 births and abortions, respectively, per year and overall. To calculate the ratio, the pregnancy-related mortality rate per 100 000 births was divided by the abortion-related mortality rate per 100 000 abortions. Sensitivity analyses excluded ICD-10 codes commonly misclassified as pregnancy related and COVID-19-related deaths. Results:During the period between 2018 and 2021, there were 14 902 571 births and 3 662 580 abortions. The mean ratio between pregnancy-related and abortion-related mortality was 69.6 (range, 52.9-105.2). Excluding nonspecific causes of pregnancy-related death, the mean pregnancy- to abortion-related mortality ratio was 52.9 (range, 38.2-74.2). Further excluding COVID-19-related mortality, the ratio was 44.3 (range, 34.5 to 74.2). Conclusions and Relevance:This cross-sectional study found that the ratio of pregnancy- to abortion-related mortality from 2018 to 2021 ranged from 44.3 to 69.6, at least 3 times higher than the ratio of 14.7 calculated using data from 1998 to 2005. These findings suggest that by taking away the option to end a pregnancy, abortion bans force pregnant people to take on the increased health risks associated with continued pregnancy.

Background: Maternal health in the United States is in crisis, and perinatal mental health conditions are emerging as a critical contributor to maternal morbidity and mortality. Perinatal mood and anxiety disorders (PMADs) encompass a range of mental health disorders experienced during pregnancy and 1 year after delivery. Expanding the perinatal mental health workforce to include paraprofessionals could help address a national shortage of mental health professionals.Objective: This scoping review aims to investigate the literature on perinatal mental health interventions delivered by community health workers (CHWs) or paraprofessionals in the United States.Methods: Studies on interventions addressing perinatal mental health were included if delivered by CHWs or paraprofessionals in the United States. Seven databases were searched via EBSCO through August 29, 2025. No publication year limits were applied. Results were exported to Zotero for deduplication, Catchii for screening, and Excel for data extraction and analysis. Risk of bias was not assessed.Results: After removing 4148 duplicates from the 7524 records identified, 3376 records were screened, and 13 studies met the inclusion criteria. CHW-delivered interventions for PMADs in the United States varied in design, content, and implementation. Most were initiated during the antenatal period, extended postnatally, and targeted primary prevention of depression symptoms. Ten studies evaluated outcomes among predominantly low-income, Latina, or Black mothers in urban environments. Interventions enhanced social support, cognitive, emotional, behavioral, parenting, and practical skills. Intervention results varied. Most studies reported positive effects: all nonexperimental designs found statistically significant improvements in depressive symptoms, and many experimental designs demonstrated statistically significant improvements in depressive symptoms among women receiving adequate intervention dosage.Conclusions: This review expands knowledge of perinatal mental health interventions delivered by CHWs and health paraprofessionals in the United States, including information about populations served, CHWs, intervention characteristics, and outcomes. Gaps in evidence and recommendations for future research are presented.

Background Racial disparities in maternal hypertension (i.e., prepregnancy and gestational) due to experiences of racism may contribute to ongoing racial disparities in US birth outcomes, including low birth weight and preterm birth. Despite evidence linking racism and adverse birth outcomes, no studies have examined the plausible association between area-level negative racial sentiment and disparities in maternal hypertension. To address this gap, we used 2016-2021 US birth certificate data to examine the associations between state-level Twitter-derived negative sentiments toward racial/ethnic minorities and maternal hypertension. We further examined if these associations increased during periods of heightened racial discrimination.Methods We used 2016-2021 US natality data with geographic identifiers for pregnancy data for singleton births (n = 22,618,566) and a random sample of 1% of publicly available tweets from 2016-2021 (n = 56,400,097) using Twitter's Academic Application Programming Interface. We calculated annual state-level negative racial sentiment by averaging sentiment scores of all posts referencing a racial category. These scores, divided into quartiles, included five sentiment measures: one toward all racially minoritized groups and four race-specific (Black, Asian, Latinx, and White). We merged data for each year and used log-binomial regression to estimate prevalence rate ratios (PRRs) for prepregnancy and gestational hypertension, adjusting for individual maternal characteristics and state-level demographics. We additionally stratified analyses into time periods before and during the COVID-19 pandemic and Black Lives Matter movement (2016-2019 and 2020-2021, respectively).Results In our sample, 2.2% of individuals had prepregnancy hypertension and 7.7% had gestational hypertension. From 2016-2021, the prevalence of both types of maternal hypertension increased for individuals across all racial and ethnic groups. Individuals in states with the highest quartile of negative racial minority sentiment had a 36% higher (95% CI: 1%-83%) prevalence of prepregnancy hypertension and a 20% higher (95% CI: 0%-45%) prevalence of gestational hypertension compared to those in the lowest quartile. In 2020 and 2021, the prevalence of prepregnancy hypertension among individuals in racially minoritized groups was 51% greater (95% CI:12%-103%) in the 4th quartile compared to the 1st quartile and showed a higher magnitude of association compared to 2016-2019. In 2020-2021, among Black individuals, those in the highest quartile of anti-Black sentiment had a 31% higher (95% CI: 2%-69%) prevalence of prepregnancy hypertension, and the 19% increase in prepregnancy hypertension among Asian individuals in the highest quartile of anti-Asian sentiment was borderline significant (95% CI: 0%-44%). Patterns for gestational hypertension were not consistent across time and when examining race-specific sentiment.Conclusion Higher levels of state-level negative racial sentiment are associated with increased prevalence of prepregnancy and gestational hypertension among racially minoritized groups, and the association with prepregnancy hypertension appears to strengthen during periods of heightened racial tension and discrimination. These findings highlight the role of area-level racism as a contributor to maternal health disparities.

Background: In the United States, 11.1% of households experience food insecurity; however, pregnant women are disproportionately affected. Maternal food insecurity may affect infant feeding practices, for example, through being a source of chronic stress that may alter the decision to initiate and continue breastfeeding. Thus, we sought to determine whether prenatal food insecurity was associated with breastfeeding (versus not) and exclusive breastfeeding duration among Oregon women.Method: The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) data of live births from 2008 to 2015 and the Oregon PRAMS-2 follow-up survey were used (n = 3,624) in this study. Associations with breastfeeding initiation and duration were modeled with multivariable logistic regression and accelerated failure time (AFT), respectively. Models were adjusted for maternal sociodemographic and pre-pregnancy health characteristics.Results: Nearly 10% of women experienced prenatal food insecurity. For breastfeeding initiation, unadjusted models suggested non-significant decreased odds (odds ratio (OR) 0.88 [confidence intervals (CI): 0.39, 1.99]), whereas adjusted models revealed a non-significant increased odds (OR 1.41 [CI: 0.58, 3.47]). Unadjusted AFT models suggested that food-insecure mothers had a non-significant decrease in exclusive breastfeeding duration (OR 0.76 [CI: 0.50, 1.17]), but adjustment for covariates attenuated results (OR 0.89 [CI: 0.57, 1.39]).Conclusions: Findings suggest minimal differences in breastfeeding practices when exploring food security status in the prenatal period, though the persistence of food insecurity may affect exclusive breastfeeding duration. Lower breastfeeding initiation may be due to other explanatory factors correlated with food insecurity and breastfeeding, such as education and marital status.

STUDY QUESTION Does the prevalence of 12-month infertility in Burkina Faso, C & ocirc;te d'Ivoire, Kenya, and Uganda differ between women trying to conceive and the broader population of women exposed to unprotected sex, and how are prevalence estimates affected by model assumptions and adjustments?SUMMARY ANSWER Estimates of 12-month infertility among tryers ranged from 8% in Burkina Faso to 30% in C & ocirc;te d'Ivoire, increasing substantially among a larger population of women exposed to unprotected intercourse.WHAT IS KNOWN ALREADY While having a child is a fundamental human experience, the extent to which women and couples experience infertility is a neglected area of research, particularly in sub-Saharan Africa. Existing estimates of infertility in this region vary widely from 2% to 32%, however, potential impacts of variability in study populations and model assumptions have not been well-examined.STUDY DESIGN, SIZE, DURATION We used cross-sectional nationally representative survey data from Burkina Faso, C & ocirc;te d'Ivoire, Kenya, and Uganda. We employed a multi-stage cluster random sampling design with probability proportional to the size selection of clusters within each country to produce representative samples of women aged 15-49. Samples ranged from 3864 in C & ocirc;te d'Ivoire to 9489 in Kenya.PARTICIPANTS/MATERIALS, SETTING, METHODS We created two analytic samples in each country-tryers and a broader sample of women exposed to unprotected sex-exploring differences in population characteristics and estimating the period prevalence of 12-month infertility using the current duration (CD) approach. We also examined the impact of several model assumptions within each of the two analytic samples, including adjustments for recent injectable contraceptive use, unrecognized pregnancy, infertility treatment, underreported contraceptive use, and sexual activity.MAIN RESULTS AND THE ROLE OF CHANCE Employing the CD approach among tryers produced an overall 12-month infertility prevalence of 7.9% (95% CI 6.6-12.7) in Burkina Faso, 29.6% (95% CI 15.3-100.0) in C & ocirc;te d'Ivoire, 24.5% (95% CI 16.5-34.6) in Kenya, and 14.7% (95% CI 8.1-22.4) in Uganda. Results among women exposed to unprotected intercourse indicated much higher levels of infertility, ranging from 22.4% (95% CI 18.6-30.8) in Uganda to 63.7% (95% CI 48.8-87.9) in C & ocirc;te d'Ivoire. Sensitivity analyses suggest infertility estimates are particularly sensitive to adjustments around pregnancy recognition timing and sexual activity, with little impact of adjustments for recent injectable contraceptive use, infertility treatment, and underreporting of traditional and coital dependent contraceptive use.LIMITATIONS, REASONS FOR CAUTION There was substantial digit preference in responses at 12 months, particularly among the tryers, which could introduce bias. Data quality concerns in the reproductive calendar may impact the accuracy of the CD approach among the broader sample of women exposed to unprotected sex, particularly with regard to underreported contraceptive use, induced and spontaneous abortions, and unrecognized pregnancies. Lastly, we lacked information on postpartum amenorrhea or abstinence.WIDER IMPLICATIONS OF THE FINDINGS Understanding the inconsistencies in definition and analytic approach and their implications for infertility estimation is important for reliably monitoring population-level infertility trends, identifying factors influencing infertility, improving prevention programs, and ensuring access to quality treatment and services. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Bill & Melinda Gates Foundation (INV009639) and the National Institute of Child Health and Human Development (K01HD107172). The funders were not involved in the study design, analyses, manuscript writing, or the decision to publish. The authors have no conflicts of interest to declare.TRIAL REGISTRATION NUMBER N/A.

This study assesses differences in breastfeeding initiation trends between Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants and WIC-eligible nonparticipants before, during, and after the 2022 infant formula disruption.

ABSTRACTThis study examines the association between Afghan women’s autonomy (WA) and experience of domestic violence (physical, sexual, and emotional) in the previous 12 months, and whether this association is moderated by education status. We used data from 19,098 married women aged 15-49, who completed the 2015 Afghanistan Demographic and Health Survey- the first and only national survey administered in the country. WA was measured across 5 domains (healthcare, visiting family, household purchases, spending, and contraceptive use). Adjusted odds ratios and 95% confidence intervals for the association between domestic violence in the past 12 months (any vs. none) and WA were estimated using multiple logistic regression and adjusted for covariates. Interaction terms between education status and WA were also assessed. We found that the experience of physical, emotional, and sexual violence was 45% 30%, and 7%, and at least 1 in 2 had no autonomy. After adjustment, compared to women without autonomy, WA in healthcare decisions, spending, visiting families, and household purchases significantly decreased the odds of physical violence. Similarly, WA in healthcare decisions and spending significantly decreased the odds of sexual violence. Lastly, WA in spending and not using contraception was associated with reduced odds of emotional violence. We also found a greater protective effect of WA in visiting family among women with any education across each domestic violence outcome. These findings provide insights into areas for intervention to address gender inequalities (Sustainable Development Goal 3) and mitigate adverse health outcomes for mothers and their children (Goal 5).

OBJECTIVE:To examine pregnancy-related mortality ratios before (January 2019-March 2020) and during (April 2020-December 2020 and 2021) the coronavirus disease 2019 (COVID-19) pandemic overall, by race and ethnicity, and by rural-urban classifications using vital records data.METHODS:Mortality and natality data (2019-2021) were obtained from the Centers for Disease Control and Prevention's WONDER database to estimate pregnancy-related mortality ratios, which correspond to any death during pregnancy or up to 1 year after the end of a pregnancy from causes related to the pregnancy per 100,000 live births. Pregnancy-related mortality ratios were determined from International Classification of Diseases, Tenth Revision codes A34, O00-O96, and O98-O99. Overall pregnancy-related mortality ratios were partitioned by whether COVID-19 was listed as a contributory cause, and quarterly estimates were compared between 2019 and 2021. Pregnancy-related mortality ratios were compared by race and ethnicity and rural-urban residence before (2019-March 2020) and during (April 2020-December 2020 and 2021) the COVID-19 pandemic.RESULTS:Pregnancy-related mortality was significantly higher in 2021 (45.5/100,000 live births) compared with during the pandemic in 2020 (36.7/100,000 live births) and before the pandemic (29.0/100,000 live births). Pregnancy-related mortality ratios increased across all race and ethnicity and rural-urban residence categories in 2021. The largest increase occurred among American Indian/Alaska Native people during 2021 compared with April-December of 2020 (pregnancy-related mortality ratio 160.8 vs 79.0/100,000 live births, 104% relative change, P =.017). Medium-small metropolitan (52.4 vs 37.7/100,000 live births, 39.0% relative change, P <.001) and rural (56.2 vs 46.5/100,000 live births, 21.0% relative change, P =.05) areas had a larger increase in 2021 compared with April-December 2020 compared with large urban areas (39.1 vs 33.7/100,000 live births, 15.9% relative change, P =.009).CONCLUSION:Pregnancy-related mortality ratios increased more rapidly in 2021 than in 2020, consistent with rising rates of COVID-19-associated mortality among women of reproductive age. This further exacerbated racial and ethnic disparities, especially among American Indian/Alaska Native birthing people.

BACKGROUND:Technology advancement has allowed more frequent monitoring of biomarkers. The resulting data structure entails more frequent follow-ups compared to traditional longitudinal studies where the number of follow-up is often small. Such data allow explorations of the role of intra-person variability in understanding disease etiology and characterizing disease processes. A specific example was to characterize pathogenesis of bacterial vaginosis (BV) using weekly vaginal microbiota Nugent assay scores collected over 2 years in post-menarcheeal women from Rakai, Uganda, and to identify risk factors for each vaginal microbiota pattern to inform epidemiological and etiological understanding of the pathogenesis of BV.METHODS:We use a fully data-driven approach to characterize the longitudinal patters of vaginal microbiota by considering the densely sampled Nugent scores to be random functions over time and performing dimension reduction by functional principal components. Extending a current functional data clustering method, we use a hierarchical functional clustering framework considering multiple data features to help identify clinically meaningful patterns of vaginal microbiota fluctuations. Additionally, multinomial logistic regression was used to identify risk factors for each vaginal microbiota pattern to inform epidemiological and etiological understanding of the pathogenesis of BV.RESULTS:Using weekly Nugent scores over 2 years of 211 sexually active and post-menarcheal women in Rakai, four patterns of vaginal microbiota variation were identified: persistent with a BV state (high Nugent scores), persistent with normal ranged Nugent scores, large fluctuation of Nugent scores which however are predominantly in the BV state; large fluctuation of Nugent scores but predominantly the scores are in the normal state. Higher Nugent score at the start of an interval, younger age group of less than 20 years, unprotected source for bathing water, a woman's partner's being not circumcised, use of injectable/Norplant hormonal contraceptives for family planning were associated with higher odds of persistent BV in women.CONCLUSION:The hierarchical functional data clustering method can be used for fully data driven unsupervised clustering of densely sampled longitudinal data to identify clinically informative clusters and risk-factors associated with each cluster.

This Viewpoint discusses the importance of collaboration among the agencies responsible for documenting rates of maternal mortality to ensure more accurate, reliable, and timely estimates.

Objective Describe long-term breastfeeding initiation trends by prenatal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and race/ethnicity. Design Cross-sectional study of birth certificate data from 2009 to 2017 in 24 states that adopted the 2003 birth certificate revision by 2009. Participants Term births with hospital costs covered by Medicaid (N = 6,402,704). Main Outcome Measures Breastfeeding initiation. Analysis The descriptive characteristics of WIC participants and WIC-eligible nonparticipants were compared by year and race/ethnicity using the chi-square test of independence or t tests. Adjusted breastfeeding initiation prevalence was estimated using linear regression models with county fixed effects, controlling for sociodemographic and obstetric/health factors. Trends were compared by WIC status overall and within racial/ethnic groups. Differences and P values were assessed using interaction terms between WIC and year. Results Breastfeeding initiation increased for WIC participants and nonparticipants. Special Supplemental Nutrition Program for Women, Infants, and Children participants had lower adjusted breastfeeding initiation (2009: 69.0%; 2017: 78.5%) than nonparticipants (2009: 70.8%; 2017: 80.1%) (P < 0.001 per year). Breastfeeding initiation increased more rapidly in WIC participants than in nonparticipants for non-Hispanic Asian/Pacific Islander (21.4% and 8.6%, respectively; P < 0.001) and American Indian/Alaskan Native (13.6% and 8.1%, respectively; P = 0.02)—narrowing the gap between WIC participants and nonparticipants over time. Conclusions and Implications Annual birth certificate data provide detailed information for monitoring trends and disparities in breastfeeding initiation by prenatal WIC status. These findings can inform WIC and maternal child health program efforts to improve breastfeeding promotion for populations with low-income and racial/ethnic groups.

Objectives: We aimed to compare differences in receipt of any and specific types of fertility services between people with Medicaid and private insurance.Methods: We used National Survey of Family Growth (2002-2019) data and linear probability regression models to examine the association between insurance type (Medicaid or private) and fertility service use. The primary outcome was use of fertility services in the past 12 months, and secondary outcomes were use of specific types of fertility services at any time: 1) testing, 2) common medical treatment, and 3) use of any fertility treatment type (testing, medical treatment, or surgical treatment of infertility). We additionally calculated time-to-pregnancy using a method that es-timates the unobserved total amount of time the respondent spent trying to become pregnant using their current duration of pregnancy attempt at the time of the survey. We calculated time-to-pregnancy ratios across respondent characteristics to examine if insurance type was associated with differential time-to-pregnancy.Results: In adjusted models, Medicaid coverage was associated with an 11.2-percentage point (95% confidence interval:-22.3 to-0.0) lower use of fertility services in the past 12 months compared with private coverage. Relative to private coverage, Medicaid insurance was also associated with large and statistically significantly lower rates of ever having used infertility testing or any fertility services. Insurance type was not associated with differences in time-to-pregnancy.Conclusions: People covered by Medicaid were less likely to have used fertility services compared with people with private insurance. Differences in coverage of fertility services between Medicaid and private payers may represent a barrier to fertility treatment for Medicaid recipients.& COPY; 2023 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.

BACKGROUND:Despite the tenets of rights-based, person-centered maternity care, racialized groups, low-income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality.METHODS:We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having "high" respectful care. To examine associations between respectful care and self-reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi-Cal (Medicaid) insurance status were assessed.RESULTS:Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0-1.8). By race/ethnicity, the association was largest for non-Hispanic Black women (2.7 [1.1-6.7]) and Asian/Pacific Islander women (2.3 [0.9-5.6]). Doula support predicts higher odds of respectful care among women with Medi-Cal (1.8 [1.3-2.5]), but not private insurance.CONCLUSIONS:Doula support was associated with high respectful care, particularly for low-income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low-income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.

To describe long-term breastfeeding initiation trends by prenatal WIC participation and race/ethnicity among low-income women in the U.S. We used birth certificate data (2009–2017) for 24 states that adopted the 2003 birth certificate revision by 2009. The analytic sample included term births with hospital costs covered by Medicaid. Descriptive characteristics of WIC participants and WIC-eligible nonparticipants were assessed by year and race/ethnicity. Adjusted breastfeeding initiation prevalence was estimated using linear regression with county fixed effects, controlling for sociodemographic, obstetric, and health factors. Trends were compared by WIC status overall and within racial/ethnic groups. Breastfeeding initiation increased for WIC participants and WIC-eligible nonparticipants (2009 to 2017). WIC participants had consistently lower breastfeeding initiation (2009: 68.6%; 2017: 78.0%) compared to nonparticipants (2009: 72.1%; 2017: 81.3%). The gap between WIC participants and nonparticipants narrowed more for Non-Hispanic Asian/Pacific Islander and non-Hispanic American Indian/Alaska Native women due to a larger increase among WIC participants (% Change: 32.4% and 12.9%, respectively) compared with nonparticipants (% Change: 11.4%, 6.4%). Breastfeeding statistics are often underrepresented among certain racial/ethnic groups, particularly for low-income populations. These findings can inform WIC and other maternal child health program efforts to improve breastfeeding initiation and reduce disparities. This study was funded by cooperative agreement between the United States Department of Agriculture Economic Research Service and the University of Maryland, College Park. The findings and conclusions in this publication are those of the authors and should not be construed to represent any official USDA or US Government determination or policy.

Background: Recent studies have suggested a link between reproductive health and later-life chronic conditions, yet the mechanism remains unclear. One proposed mechanism is through chronic inflammation. The objective of this study was to examine the association between endometriosis and uterine fibroids and biomarkers of inflammation and cellular aging. Materials and Methods: We used data from the National Health and Nutrition Examination Survey (N = 2342; 1999-2002). Adjusted logistic and linear regression were used to examine the association between these two reproductive conditions and elevated C-reactive protein (CRP; >3.0 mg/L) and leukocyte telomere length (T/S ratio), respectively. Given that a greater length of time spent with a condition may represent persistence of an inflammatory process, we further examined the association between time since disease diagnosis on telomere length among the subset of women with diagnosed endometriosis and fibroids. Results: Women with endometriosis had greater odds of having elevated CRP than those without endometriosis (OR = 1.60; 95% CI: 1.05 to 2.45). Women with endometriosis had a shorter telomere length than women without endometriosis (-3.4, 95% CI: -7.3 to -0.3 in age-adjusted models and -2.9, 95% CI: -8.8 to 3.5 in fully adjusted models). Telomeres were 1% (95% CI: -1.2 to -0.6) shorter for every elapsed year since endometriosis diagnosis. No substantive patterns emerged between uterine fibroids and CRP or telomere length. Conclusions: Women with endometriosis (or a longer duration of time spent with endometriosis) had higher inflammatory markers and shorter mean telomere length. These results provide further insights into potential mechanisms linking endometriosis to chronic disease and later-life health.