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Both acute and chronic stress can cause allostatic overload, or long-term imbalance in mediators of homeostasis, that results in disruptions in the maternal-placental-fetal endocrine and immune system responses. During pregnancy, disruptions in homeostasis may increase the likelihood of preterm birth and preeclampsia. Expectant mothers traditionally have high rates of anxiety and depressive disorders, and many are susceptible to a variety of stressors during pregnancy. These common life stressors include financial concerns and relationship challenges and may be exacerbated by the biological, social, and psychological changes occurring during pregnancy. In addition, external stressors such as major weather events (eg, hurricanes, tornados, floods) and other global phenomena (eg, the coronavirus disease 2019 pandemic) may contribute to stress during pregnancy.This review investigates recent literature published about the use of nonpharmacologic modalities for stress relief in pregnancy and examines the interplay between psychiatric diagnoses and stressors, with the purpose of evaluating the feasibility of implementing nonpharmacologic interventions as sole therapies or in conjunction with psychotherapy or psychiatric medication therapy. Further, the effectiveness of each nonpharmacologic therapy in reducing symptoms of maternal stress is reviewed. Mindfulness meditation and biofeedback have shown effectiveness in improving one's mental health, such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied postpartum and in response to pregnancy challenges. Although some of these nonpharmacologic interventions can be convenient and low cost, there is a trend toward inconsistent implementation of these modalities. Future investigations should focus on methods to increase ease of uptake, ensure each option is available at home, and provide a standardized way to evaluate whether combinations of different interventions may provide added benefit.

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version.If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting). Your paper will be maintained in active status for 21 days from the date of this letter. If we have not heard from you by Jul 09, 2019, we will assume you wish to withdraw the manuscript from further consideration. REVIEWER COMMENTS:Reviewer #1:1. Title. The study is about racial disparities in the evaluation and treatment of postpartum pain. Data were obtained from an electronic medical record, but the study is not about "using the electronic medical record" per se. The EMR is not mentioned in the results. Would consider revising the title. Precis.Suggest summarizing what you found rather than writing that you found something.3. Abstract. This is a faithful summary of the manuscript. a. Might include a sentence in the results about the number of women studied (1751), and something about the number of times pain was assessed, as there were > 31K pain scores. b. Line 59. Would define OTE. c. Lines 62-63. Would delete or revise this sentence, because the reader may infer that your study is not novel, e.g. convey that the previous studies were not postpartum women. 4. Introduction. a. Lines 67-68. Higher perinatal morbidity and mortality among fetuses and infants of black women, or higher morbidity and mortality among black women? b. Lines 82-84. This appears to be the objective, but it is not a complete sentence. Minor, but the authors aren't comparing EMR data with other data, so does this merit being part of the study objective? c. Lines 84-87. The authors hypothesized that black women would undergo fewer pain assessments and receive less pain medication. That is fine, but if perhaps the authors (instead) didn't think they were denying women needed pain medication but thought it would be an important question to investigate, could rephrase accordingly. 5. Methods. a. Generally the inclusion and exclusion criteria go in the methods. The Ns are considered results. b. Line 103. What is the Carolina Data Wearhouse? c. Line 118-129. Were the EMR data (pain scores and other variables evaluated) recorded per protocol in a table or other method of data-entry that was readily searchable in aggregate, or did investigators need to sort...

An interactive, multimedia, virtual patient module was designed and developed on compact disc (CD-ROM) to address the need for student dentists to increase their competence and decrease their perception of difficulty in caring for children with developmental disabilities. A development team consisting of pediatric dentistry faculty members, parents of children with developmental disabilities, an individual with a developmental disability, and educational specialists developed an interactive virtual patient case. The case involved a ten-year-old child with Down syndrome presenting with a painful tooth. Student dentists were required to make decisions regarding proper interactions with the child, as well as appropriate clinical procedures throughout the case. Differences in perceived difficulty level and knowledge change were measured, as well as the student dentists' overall satisfaction with the learning experience. Significant results were obtained in both perceived difficulty level and knowledge-based measures for student dentists. Participants reported overall satisfaction with the modules. Preparing student dentists to provide sensitive and competent care for children with developmental disabilities is a critical need within dentistry. This study demonstrated that an interactive, multimedia (CD-ROM), virtual patient learning module for student dentists is potentially an effective tool in meeting this need.

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Despite persistent racial disparities in preterm birth in the United States among non-Hispanic black women compared with non-Hispanic white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in preterm birth persist among non-Hispanic black women with high socioeconomic status. STUDY DESIGN: We conducted a population-based cohort study of all live births in the United States from 2015 through 2017 using birth certificate data from the National Vital Statistics System. We included singleton, nonanomalous live births among women who were of high socioeconomic status (defined as having !16 years of education, private insurance, and not receiving Women, Infants, and Children benefits) and who identified as non-Hispanic white, non-Hispanic black, or mixed non-Hispanic black and white race. The primary outcome was preterm birth <37 weeks; secondary outcomes included preterm birth <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500 g as a surrogate for preterm birth <37 weeks, birthweight <1500 g as a surrogate for preterm birth <34 weeks, and birthweight <750 g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with c 2 , Student t test, and logistic regression.RESULTS: A total of 2,170,686 live births met inclusion criteria, with 92.9% non-Hispanic white, 6.7% non-Hispanic black, and 0.4% both non-Hispanic white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high