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BackgroundMaternal obesity is associated with significant racial disparities. People who identify as non-Hispanic Black and Latinx are at the highest risk related adverse short- and long-term health outcomes (eg, hypertension in pregnancy and postpartum weight retention). Remote lifestyle interventions delivered during and after pregnancy hold promise for supporting healthy weight outcomes; however, few are tested in groups of people who self-identify as non-Hispanic Black and Latinx or address the neighborhood-level and psychosocial factors driving maternal health disparities. Implementing remote lifestyle interventions within community-based programs that serve birthing people may optimize trust and engagement, promote scalability and sustainability, and have the broadest public health impact. ObjectiveThe goal of this trial is to test the effectiveness of a culturally adapted remote lifestyle intervention (Healthy for Two–Home Visiting) implemented within home visiting compared to usual home visiting services on postpartum weight retention among pregnant or postpartum individuals, in particular those who identify as non-Hispanic Black and Latinx. Facilitators and barriers to implementation of the intervention within home visiting will be examined. MethodsWe describe the rationale and protocol for this hybrid type I effectiveness-implementation randomized controlled trial. In this paper, we highlight the community-engaged approach and trial design features that enable the implementation of the intervention within home visiting and demonstrate its applicability to the target population. Participants will be 360 pregnant individuals with overweight or obesity enrolled between 20 and 33 weeks of gestation and randomized 1:1 to Healthy for Two–Home Visiting or usual home visiting services. The primary outcome is weight retention at 6 months post partum, calculated as 6-month postpartum weight minus earliest pregnancy weight (≤18 wk of gestation). The measures of implementation include intervention feasibility, acceptability, reach, adoption, and fidelity. Throughout the paper, we highlight the community input used to improve intervention effectiveness and study implementation and as a strategy to promote maternal health equity. ResultsThis study was funded in June 2021, and recruitment began in April 2023. As of November 2024, we enrolled 90 participants. Data collection to assess the intervention’s effectiveness is expected to end in June 2026. Implementation evaluation is expected to conclude in December 2026. ConclusionsThis hybrid type I effectiveness-implementation randomized controlled trial integrates a culturally adapted remote lifestyle intervention into early home visiting services to examine its effectiveness on postpartum weight retention compared to usual home visiting. We anticipate that the study results will enable an understanding of the drivers of successful implementation within a community-based setting to maximize the future sustainability and dissemination of a strategy for reducing long-term obesity and other maternal health disparities. Trial RegistrationClinicaltrials.gov NCT05619705; https://clinicaltrials.gov/study/NCT05619705 International Registered Report Identifier (IRRID)DERR1-10.2196/62847

Maternal hypertension may be an underrecognized but important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth quintile. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Among 191 cases and 934 matched controls, hypertension prevalence was 14.1% among cases and 7.7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2.90, 95% CI 1.29, 6.57), but not among women with diagnosis during pregnancy (OR 1.68, 95% CI 0.98, 2.98). We found no association between the number of antenatal care contacts and perinatal death (p = 0.66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh.

Health care systems in low- and middle-income countries may not meet the needs of pregnant women where the burden of diabetes and hypertension is rapidly increasing. We asked recently pregnant women about ever having been screened for or diagnosed with hypertension or diabetes and their ANC-seeking experiences in a cross-sectional survey. We used chi-squared tests and logistic regression to test the associations between self-reported coverage of hypertension and diabetes screening, diagnoses, and elements of ANC by age, wealth, educational attainment, and gravidity. Among 4,692 respondents, for hypertension, 97% reported having been screened and 10% of screened women reported a diagnosis. Women 30-39 years of age (aOR 3.02, 95% CI 2.00, 4.56) or in the top wealth quintile (aOR 1.70, 95% CI 1.18, 2.44) were more likely to be diagnosed with hypertension compared to reference groups. Any hypertension diagnosis was associated with reporting four or more antenatal care contacts (44% vs. 35%, p < 0.01), blood pressure measurements (85% vs. 79%, p < 0.01), and urine tests (71% vs. 61%, p < 0.01) conducted during ANC visits. For diabetes, 46% of respondents reported having been screened and 3% of screened women reported a diagnosis. Women 30-39 years of age were more likely to be diagnosed with diabetes (aOR 8.19, 95% CI 1.74, 38.48) compared to the reference group. Any diabetes diagnosis was associated with reporting four or more ANC contacts (48% vs. 36%, p = 0.04) and having blood testing during pregnancy (83% vs. 66%, p < 0.01). However, the frequency and quality of ANC was below the national guidelines among all groups. Focused efforts to ensure that women receive the recommended number of ANC contacts, coupled with improved compliance with ANC guidelines, would improve awareness of hypertension and diabetes among women in Bangladesh.

BackgroundTo address the obesity epidemic, there is a need for novel paradigms, including those that address the timing of eating and sleep in relation to circadian rhythms. Electronic health records (EHRs) are an efficient way to identify potentially eligible participants for health research studies. Mobile health (mHealth) apps offer available and convenient data collection of health behaviors, such as timing of eating and sleep. ObjectiveThe aim of this descriptive analysis was to report on recruitment, retention, and app use from a 6-month cohort study using a mobile app called Daily24. MethodsUsing an EHR query, adult patients from three health care systems in the PaTH clinical research network were identified as potentially eligible, invited electronically to participate, and instructed to download and use the Daily24 mobile app, which focuses on eating and sleep timing. Online surveys were completed at baseline and 4 months. We described app use and identified predictors of app use, defined as 1 or more days of use, versus nonuse and usage categories (ie, immediate, consistent, and sustained) using multivariate regression analyses. ResultsOf 70,661 patients who were sent research invitations, 1021 (1.44%) completed electronic consent forms and online baseline surveys; 4 withdrew, leaving a total of 1017 participants in the analytic sample. A total of 53.79% (n=547) of the participants were app users and, of those, 75.3% (n=412), 50.1% (n=274), and 25.4% (n=139) were immediate, consistent, and sustained users, respectively. Median app use was 28 (IQR 7-75) days over 6 months. Younger age, White race, higher educational level, higher income, having no children younger than 18 years, and having used 1 to 5 health apps significantly predicted app use (vs nonuse) in adjusted models. Older age and lower BMI predicted early, consistent, and sustained use. About half (532/1017, 52.31%) of the participants completed the 4-month online surveys. A total of 33.5% (183/547), 29.3% (157/536), and 27.1% (143/527) of app users were still using the app for at least 2 days per month during months 4, 5, and 6 of the study, respectively. ConclusionsEHR recruitment offers an efficient (ie, high reach, low touch, and minimal participant burden) approach to recruiting participants from health care settings into mHealth research. Efforts to recruit and retain less engaged subgroups are needed to collect more generalizable data. Additionally, future app iterations should include more evidence-based features to increase participant use.

Objective Recent studies suggest that a systolic blood pressure (SBP) target of 120 mm Hg is appropriate for people with hypertension, but this is debated particularly in people with multiple chronic conditions (MCC). We aimed to quantitatively determine whether benefits of a lower SBP target justify increased risks of harm in people with MCC, considering patient-valued outcomes and their relative importance.Design Highly stratified quantitative benefit-harm assessment based on various input data identified as the most valid and applicable from a systematic review of evidence and based on weights from a patient preference survey.Setting Outpatient care.Participants Hypertensive patients, grouped by age, gender, prior history of stroke, chronic heart failure, chronic kidney disease and type 2 diabetes mellitus.Interventions SBP target of 120 versus 140 mm Hg for patients without history of stroke.Primary and secondary outcome measures Probability that the benefits of a SBP target of 120 mm Hg outweigh the harms compared with 140 mm Hg over 5 years (primary) with thresholds >0.6 (120 mm Hg better),

Background: Gestational diabetes mellitus (GDM) is associated with increased long-term risk of cardiovascular disease but the cardiovascular structural and functional changes that contribute to risk are not well understood. Objectives: The purpose of this study was to determine whether GDM is associated with adverse cardiac remodeling and endothelial dysfunction a decade after delivery, independent of type 2 diabetes. Methods: Women with deliveries between 2008 and 2009 were initially selected from a prospective clinical cohort. Pregnancy history was chart abstracted and a follow-up study visit was conducted at 8 to 10 years postpartum. Cardiac structure and function were assessed with echocardiography. Endothelial function was measured with peripheral arterial tonometry and glycocalyx analysis. Results: Among 254 women assessed at an average age of 38 years, 53 (21%) had prior GDM. At follow-up, women with GDM had more incident prediabetes or diabetes (58% vs 20% without GDM), more impairment in peripheral arterial tonometry (reactive hyperemia 1.58 vs 1.95; P = 0.01) and reduced perfusion, a marker of glycocalyx assessment (red blood cell filling 0.70 ± 0.04 vs 0.72 ± 0.05; P

Background: Gestational diabetes mellitus (GDM) is associated with increased risk of cardiovascular disease (CVD). Racial/ethnic differences in GDM prevalence have been described, but disparities by nativity and duration of US residence are not well studied. Methods: We analyzed data from 6088 women (mean age: 27.5 years [standard deviation: 6.3 years]) from the Boston Birth Cohort who self-identified as non-Hispanic Black (NHB; n = 2697), Hispanic (n = 2395), or non-Hispanic White (NHW; n = 996). Using multivariable logistic regression, we examined the cross-sectional association of nativity and duration of US residence (< 10 vs ≥ 10 years) with GDM within each race/ethnicity group. Results: Foreign-born NHB, NHW, and Hispanic women with a duration of US residence of < 10 years had a lower prevalence of CVD risk factors than those with US residence of ≥ 10 years, respectively, as follows: smoking (NHB: 1.7% vs 3.1%; NHW: 5.7% vs 8.1%; Hispanic: 0.4% vs 2.6%); obesity (NHB: 17.1% vs 23.4%; NHW: 3.8% vs 15.6%; Hispanic: 10.9% vs 22.7%); and severe stress (NHB: 8.7% vs 11.9%; NHW: 5.7% vs 28.1%; Hispanic: 3.8% vs 7.3%). In analyses adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women with a duration of US residence of < 10 years had higher odds of having GDM (adjusted odds ratio: 1.60, 95% confidence interval: 0.99-2.60), compared with their US-born counterparts, whereas foreign-born Hispanic women with a duration of US residence of < 10 years had lower odds of having GDM (adjusted odds ratio: 0.54, 95% confidence interval: 0.32-0.91). The odds of having GDM in Hispanic and NHB women with a duration of US residence of ≥ 10 years were not significantly different from those of their US-born counterparts. Conclusions: The “healthy immigrant effect” and its waning with longer duration of US residence apply to the prevalence of GDM among Hispanic women but not NHB women. Further research on the intersectionality of race and nativity-based disparities is needed. Résumé: Introduction: Le diabète sucré gestationnel (DSG) est associé à l’augmentation du risque de maladies cardiovasculaires (MCV). Les différences raciales/ethniques dans la prévalence du DSG ont été décrites, mais les disparités selon le lieu de naissance et la durée de résidence aux É.-U font l’objet de peu d’études. Méthodes: Nous avons analysé les données de 6 088 femmes (âge moyen : 27,5 ans [écart type : 6,3 ans]) de la Boston Birth Cohort qui ont déclaré être noires non hispaniques (NNH; n = 2 697), hispaniques (n = 2 395) ou blanches non hispaniques (BNH; n = 996). À l’aide de la régression logistique multivariée, nous avons examiné l’association transversale entre le lieu de naissance et la durée de résidence aux É.-U. (< 10 vs ≥ 10 ans), et le DSG dans chaque groupe racial/ethnique Résultats: Les femmes NNH, BNH et hispaniques nées à l’étranger qui avaient une durée de résidence aux É.-U. de < 10 ans avaient une prévalence plus faible des facteurs de risque de MCV que celles qui avaient une résidence aux É.-U. de ≥ 10 ans, et ce, de façon respective comme suit : le tabagisme (NNH : 1,7 % vs 3,1 %; BNH : 5,7 % vs 8,1 %; hispaniques : 0,4 % vs 2,6 %); l’obésité (NNH : 17,1 % vs 23,4 %; BNH : 3,8 % vs 15,6 %; hispaniques : 10,9 % vs 22,7 %); le stress important (NNH : 8,7 % vs 11,9 %; BNH : 5,7 % vs 28,1 %; hispaniques : 3,8 % vs 7,3 %). Lors de l’ajustement des caractéristiques sociodémographiques et des facteurs de risque de MCV, les femmes NNH nées à l’étranger qui avaient une durée de résidence aux É.-U. de < 10 ans montraient une plus grande probabilité d’avoir le DSG (rapport de cotes ajusté : 1,60, intervalle de confiance à 95 % : 0,99-2,60) que leurs homologues nées aux É.-U., alors que les femmes hispaniques nées à l’étranger qui avaient une durée de résidence aux É.-U. de < 10 ans montraient une plus faible probabilité d’avoir le DSG (rapport de cotes ajusté : 0,54, intervalle de confiance à 95 % : 0,32-0,91). La probabilité que les femmes hispaniques et NNH qui avaient une durée de résidence aux É.-U. de ≥ 10 ans aient le DSG n’était pas significativement différente de celles de leurs homologues nées aux É.-U. Conclusions: L’« effet de l’immigrant en bonne santé » et son déclin associé à la plus longue durée de résidence aux É.-U. s’appliquent à la prévalence du DSG chez les femmes hispaniques, mais non chez les femmes NNH. D’autres recherches sur l’intersectionnalité entre la race et les disparités selon le lieu de naissance sont nécessaires.

Abstract Background Patient and family engagement (PFE) has been defined as a partnership between patients, families, and health care providers to achieve positive health care outcomes. There is evidence that PFE is critical to improving outcomes. We sought to systematically identify and map the evidence on PFE strategies for adults with chronic conditions and identify areas needing more research. Methods We searched PubMed, CINAHL, EMBASE, and Cochrane, January 2015 to September 2021 for systematic reviews on strategies for engaging patients with chronic conditions and their caregivers. From each review, we abstracted search dates, number and type of studies, populations, interventions, and outcomes. PFE strategies were categorized into direct patient care, health system, and community-policy level strategies. We found few systematic reviews on strategies at the health system, and none at the community-policy level. In view of this, we also searched for original studies that focused on PFE strategies at those two levels and reviewed the PFE strategies used and study findings. Results We found 131 reviews of direct patient care strategies, 5 reviews of health system strategies, and no reviews of community-policy strategies. Four original studies addressed PFE at the health system or community-policy levels. Most direct patient care reviews focused on self-management support (SMS) (n = 85) and shared decision-making (SDM) (n = 43). Forty-nine reviews reported positive effects, 35 reported potential benefits, 37 reported unclear benefits, and 4 reported no benefits. Health system level strategies mainly involved patients and caregivers serving on advisory councils. PFE strategies with the strongest evidence focused on SMS particularly for patients with diabetes. Many SDM reviews reported potential benefits especially for patients with cancer. Discussion Much more evidence exists on the effects of direct patient care strategies on PFE than on the effects of health system or community-policy strategies. Most reviews indicated that direct patient care strategies had positive effects or potential benefits. A limitation of this evidence map is that due to its focus on reviews, which were plentiful, it did not capture details of individual interventions. Nevertheless, this evidence map should help to focus attention on gaps that require more research in efforts to improve PFE.

ABSTRACT: As the worldwide prevalence of overweight and obesity continues to rise, so too does the urgency to fully understand mediating mechanisms, to discover new targets for safe and effective therapeutic intervention, and to identify biomarkers to track obesity and the success of weight loss interventions. In 2016, the American Heart Association sought applications for a Strategically Focused Research Network (SFRN) on Obesity. In 2017, 4 centers were named, including Johns Hopkins University School of Medicine, New York University Grossman School of Medicine, University of Alabama at Birmingham, and Vanderbilt University Medical Center. These 4 centers were convened to study mechanisms and therapeutic targets in obesity, to train a talented cadre of American Heart Association SFRN‐designated fellows, and to initiate and sustain effective and enduring collaborations within the individual centers and throughout the SFRN networks. This review summarizes the central themes, major findings, successful training of highly motivated and productive fellows, and the innovative collaborations and studies forged through this SFRN on Obesity. Leveraging expertise in in vitro and cellular model assays, animal models, and humans, the work of these 4 centers has made a significant impact in the field of obesity, opening doors to important discoveries, and the identification of a future generation of obesity‐focused investigators and next‐step clinical trials. The creation of the SFRN on Obesity for these 4 centers is but the beginning of innovative science and, importantly, the birth of new collaborations and research partnerships to propel the field forward.

Background We aim to evaluate the association between meal intervals and weight trajectory among adults from a clinical cohort. Methods and Results This is a multisite prospective cohort study of adults recruited from 3 health systems. Over the 6‐month study period, 547 participants downloaded and used a mobile application to record the timing of meals and sleep for at least 1 day. We obtained information on weight and comorbidities at each outpatient visit from electronic health records for up to 10 years before until 10 months after baseline. We used mixed linear regression to model weight trajectories. Mean age was 51.1 (SD 15.0) years, and body mass index was 30.8 (SD 7.8) kg/m2; 77.9% were women, and 77.5% reported White race. Mean interval from first to last meal was 11.5 (2.3) hours and was not associated with weight change. The number of meals per day was positively associated with weight change. The average difference in annual weight change (95% CI) associated with an increase of 1 daily meal was 0.28 kg (0.02–0.53). Conclusions Number of daily meals was positively associated with weight change over 6 years. Our findings did not support the use of time‐restricted eating as a strategy for long‐term weight loss in a general medical population.

Background Gestational diabetes (GD) is associated with increased risk of long‐term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. Methods and Results We used data from the National Inpatient Sample (2004–2019). International Classification of Diseases, Ninth Revision (ICD‐9) or Tenth Revision (ICD‐10) codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63 115 002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2 435 301). The prevalence of both GD and obesity increased during the study period (P trends

Background: Rates of postpartum visit attendance are low among all women, and particularly for low-income women. Experts in obstetrics, women's health, and health disparities are calling for novel, holistic approaches to postpartum care to better meet the needs of women and that respond to existing health care disparities. Materials and Methods: We conducted a single-site parallel-arm randomized controlled trial to determine the feasibility and effect of a co-located, co-timed 4?6 weeks postpartum obstetrics visit and well-newborn pediatric visit (i.e., ?mommy-baby visit?) compared with an enhanced usual postpartum visit, that is, staff scheduled the postpartum visit for the patient before hospital discharge. Results: One hundred sixteen women, of whom 76.7% (n?=?89) were Latina immigrants, were enrolled postdelivery and randomized to a mommy-baby visit (n?=?58, 49.5%) or to enhanced usual care (n?=?58, 50.4%). Almost all study participants attended their postpartum visit (n?=?109, 94.0%). There was no significant difference in postpartum visit attendance rate by randomization assignment (91.4% of mommy-baby vs. 96.6% of enhanced usual care participants). Study participants, mommy-baby intervention and enhanced usual care arms combined, were significantly more likely to attend the postpartum visit than historical controls (94.0% vs. 69.7%, respectively, p?0.001). Conclusions: In a randomized controlled trial, we showed postpartum visit attendance rates were high for participants in both the mommy-baby and enhanced usual care arms. Postpartum visit scheduling assistance was provided to all participants and may have increased postpartum visit attendance and thereby attenuated the effect of the intervention. It is encouraging that a low-cost, low-tech, low-touch intervention, that is, postpartum appointment scheduling before hospital discharge, could increase postpartum visit attendance.

Abstract Background Pregnancy provides an opportunity to promote healthy lifestyle behaviors. This study’s aim was to explore the perspectives of pregnant and postpartum women and obstetric providers around behavioral lifestyle changes in pregnancy and postpartum. Methods We conducted a qualitative study with pregnant and postpartum patients recruited from 2 prenatal care clinics at an urban, academic hospital in the United States. In-depth interviews with 23 pregnant or postpartum women and 11 obstetric providers were completed between October 2015–April 2016. Interviews were audio-recorded and transcribed verbatim. We coded transcripts for thematic content and applied the PRECEDE-PROCEED framework for results to directly inform program development. Results Six themes highlighted the predisposing, enabling and reinforcing factors that enable and sustain health behavior changes in pregnancy and postpartum: 1) “Motivation to have a healthy baby” during pregnancy and to “have my body back” after delivery, 2) Pre-pregnancy knowledge and experiences about pregnancy and the postpartum period, 3) Prioritizing wellness during pregnancy and postpartum, 4) The power of social support, 5) Accountability, 6) Integration with technology to reinforce behavior change. Conclusions In this qualitative study, pregnant and postpartum women and obstetric providers described themes that are aimed at encouraging lifestyle changes to promote healthy weight gain in pregnancy and can directly inform the development of a behavioral weight management intervention for pregnant and postpartum women that is patient-centered and tailored to their needs.

Background Preeclampsia increases women's risks for maternal morbidity and future cardiovascular disease. The aim of this study was to identify opportunities for prevention by examining the association between cardiometabolic risk factors and preeclampsia across 2 pregnancies among women in a high‐risk US birth cohort. Methods and Results Our sample included 618 women in the Boston Birth Cohort with index and subsequent pregnancy data collected using standard protocols. We conducted log‐binomial univariate regression models to examine the association between preeclampsia in the subsequent pregnancy (defined as incident or recurrent preeclampsia) and cardiometabolic risk factors (ie, obesity, hypertension, diabetes mellitus, preterm birth, low birth weight, and gestational diabetes mellitus) diagnosed before and during the index pregnancy, and between index and subsequent pregnancies. At the subsequent pregnancy, 7% (36/540) had incident preeclampsia and 42% (33/78) had recurrent preeclampsia. Compared with women without obesity, women with obesity had greater risk of incident preeclampsia (unadjusted risk ratio [RR], 2.2 [95% CI, 1.1–4.5]) and recurrent preeclampsia (unadjusted RR, 3.1 [95% CI, 1.5–6.7]). Preindex pregnancy chronic hypertension and diabetes mellitus were associated with incident, but not recurrent, preeclampsia (hypertension unadjusted RR, 7.9 [95% CI, 4.1–15.3]; diabetes mellitus unadjusted RR, 5.2 [95% CI, 2.5–11.1]. Women with new interpregnancy hypertension versus those without had a higher risk of incident and recurrent preeclampsia (incident preeclampsia unadjusted RR, 6.1 [95% CI, 2.9–13]); recurrent preeclampsia unadjusted RR, 2.4 [95% CI, 1.5–3.9]). Conclusions In this diverse sample of high‐risk US women, we identified modifiable and treatable risk factors, including obesity and hypertension for the prevention of preeclampsia.

Abstract Background Older people with hypertension and multiple chronic conditions (MCC) receive complex treatments and face challenging trade-offs. Patients’ preferences for different health outcomes can impact multiple treatment decisions. Since evidence about outcome preferences is especially scarce among people with MCC our aim was to elicit preferences of people with MCC for outcomes related to hypertension, and to determine how these outcomes should be weighed when benefits and harms are assessed for patient-centered clinical practice guidelines and health economic assessments. Methods We sent a best-worst scaling preference survey to a random sample identified from a primary care network of Kaiser Permanente (Colorado, USA). The sample included individuals age 60 or greater with hypertension and at least two other chronic conditions. We assessed average ranking of patient-important outcomes using conditional logit regression (stroke, heart attack, heart failure, dialysis, cognitive impairment, chronic kidney disease, acute kidney injury, fainting, injurious falls, low blood pressure with dizziness, treatment burden) and studied variation across individuals. Results Of 450 invited participants, 217 (48%) completed the survey, and we excluded 10 respondents who had more than two missing choices, resulting in a final sample of 207 respondents. Participants ranked stroke as the most worrisome outcome and treatment burden as the least worrisome outcome (conditional logit parameters: 3.19 (standard error 0.09) for stroke, 0 for treatment burden). None of the outcomes were always chosen as the most or least worrisome by more than 25% of respondents, indicating that all outcomes were somewhat worrisome to respondents. Predefined subgroup analyses according to age, self-reported life-expectancy, degree of comorbidity, number of medications and antihypertensive treatment did not reveal meaningful differences. Conclusions Although some outcomes were more worrisome to patients than others, our results indicate that none of the outcomes should be disregarded for clinical practice guidelines and health economic assessments.

Abstract Introduction It is unknown whether rates of cognitive decline differ between older women and men with type 2 diabetes (T2D) and overweight or obesity. Methods Two to four cognitive assessments were obtained across up to 10 years from 2799 adults (mean age 68 years; 62% women) with T2D who had been enrolled in a clinical trial of weight loss intervention. Sex‐related differences in means and rates of decline of cognitive scores were assessed. Results Women outperformed men in verbal learning and processing speed (P

Purpose: Primary care providers (PCPs) play an important role in identifying and counseling obese patients to lose weight, but it is unknown whether PCP referral of patients into a weight loss intervention is associated with greater weight loss. The objectives are to determine if PCP referral is associated with greater 1) weight loss, 2) end of study patient–provider relationship quality, and 3) satisfaction and participation rates in the intervention. Methods: 415 obese patients enrolled in the Hopkins POWER trial from six primary care practices in the Baltimore area. We conducted a secondary analysis of results from the trial using longitudinal mixed-effects model and generalized linear model, adjusting for clinic, sex, age, and race. The primary outcome was absolute weight change from baseline to 24 months. Secondary outcomes were patient–provider relationship quality and satisfaction and participation rates in the intervention. Results: Participants in both PCP and non-PCP referral groups lost a similar amount of weight from baseline to 24 months. PCP referral was not significantly associated with percentage of completed coach contacts, web logins, and satisfaction with trial, but was associated with higher end of study patient–provider relationship quality (p = 0.007). Conclusions: Our study represents the first of its kind to examine the role of PCP referral of patients into a weight loss trial. While we did not find evidence that PCP referral is associated with increased weight loss, further research is needed to determine how PCPs can use their relationship with patients to promote weight loss and enhance intervention effects.

Introduction. Obesity is common among reproductive age women and disproportionately impacts racial/ethnic minorities. Our objective was to assess racial/ethnic differences in obesity-related dietary behaviors among pregnant and postpartum women, to inform peripartum weight management interventions that target diverse populations. Methods. We conducted a cross-sectional survey of 212 Black (44%), Hispanic (31%), and White (25%) women, aged ≥ 18, pregnant or within one year postpartum, in hospital-based clinics in Baltimore, Maryland, in 2013. Outcomes were fast food or sugar-sweetened beverage intake once or more weekly. We used logistic regression to evaluate the association between race/ethnicity and obesity-related dietary behaviors, adjusting for sociodemographic factors. Results. In adjusted analyses, Black women had 2.4 increased odds of fast food intake once or more weekly compared to White women (CI = 1.08, 5.23). There were no racial/ethnic differences in the odds of sugar-sweetened beverage intake. Discussion. Compared with White or Hispanic women, Black women had 2-fold higher odds of fast food intake once or more weekly. Black women might benefit from targeted counseling and intervention to reduce fast food intake during and after pregnancy.

Cigarette smoking during pregnancy is an important cause of poor maternal and infant health outcomes in the population eligible for Medicaid. These outcomes may be avoided or attenuated by timely, high-quality prenatal care. Using data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System for the period 2004-10, we examined the effects of two optional state Medicaid enrollment policies on smoking cessation, preterm birth, and having an infant who was small for gestational age. We used a natural experiment to compare outcomes before and after nineteen states adopted either of the two policies. The first policy, presumptive eligibility, permits women to receive prenatal care while their Medicaid application is pending. Its adoption led to a 7.7-percentage-point increase in smoking cessation but did not reduce adverse birth outcomes. The second policy, the unborn-child option, permits states to provide coverage to pregnant women who cannot document their citizenship or residency. Its adoption was not significantly associated with any of the three outcomes. The presumptive-eligibility enrollment policy will continue to be an important tool for promoting timely prenatal care and smoking cessation., (Project HOPE—The People-to-People Health Foundation, Inc.)