The significant parallels between cell plasticity during embryonic development and carcinoma progression have helped us understand the importance of the epithelial-mesenchymal transition (EMT) in human disease. Our expanding knowledge of EMT has led to a clarification of the EMT program as a set of multiple and dynamic transitional states between the epithelial and mesenchymal phenotypes, as opposed to a process involving a single binary decision. EMT and its intermediate states have recently been identified as crucial drivers of organ fibrosis and tumor progression, although there is some need for caution when interpreting its contribution to metastatic colonization. Here, we discuss the current state-of-the-art and latest findings regarding the concept of cellular plasticity and heterogeneity in EMT. We raise some of the questions pending and identify the challenges faced in this fast-moving field.

In vitro fertilization patients should be advised of the increased risk for adverse perinatal outcomes. Obstetricians should not only manage these pregnancies as high risk but also avoid iatrogenic harm caused by elective preterm labor induction or cesarean.

Public Health Poliy Forum foster and encourage the beneficent instincts of those who work within them is a far more difficult task than changing attitudes or even beliefs. Changing organizational behavior is a harder, more timeconsuming, and slower process and requires more scarcely available skills than changing individual attitudes, even among groups of individuals.To ensure that dying patients are permitted as much infonned self-determination and treated with as much dignity as possible, it is not enough to educate or reeducate entire generations of physicians, nurses, and administrators. We must also figure out how to make hospitals, as complex organizations fulfilling multiple tasks and operating under multiple constraints, operate in a way more consonant with such values. That's a more daunting task, but one no less com-

OBJECTIVE:To characterize the changes in health status experienced by a multi-ethnic cohort of women during and after pregnancy. DESIGN: Observational cohort.SETTING/PARTICIPANTS: Pregnant women from 1 of 6 sites in the San Francisco area (N =1,809). MEASUREMENTS AND MAIN RESULTS:Women who agreed to participate were asked to complete a series of telephone surveys that ascertained health status as well as demographic and medical factors. Substantial changes in health status occurred over the course of pregnancy. For example, physical function declined, from a mean score of 95.2 prior to pregnancy to 58.1 during the third trimester (0-100 scale, where 100 represents better health), and improved during the postpartum period (mean score, 90.7). The prevalence of depressive symptoms rose from 11.7% prior to pregnancy to 25.2% during the third trimester, and then declined to 14.2% during the postpartum period. Insufficient money for food or housing and lack of exercise were associated with poor health status before, during, and after pregnancy. CONCLUSIONS:Women experience substantial changes in health status during and after pregnancy. These data should guide the expectations of women, their health care providers, and public policy. W hile pregnancy is a common event for reproductive-age women, surprisingly little has been published about the physical and emotional changes that typically occur during pregnancy and the postpartum period.1-3 Better understanding of the changes in health status that occur over the course of pregnancy could help women define their expectations, and provide data to inform public policies related to the health and function of women. For example, three quarters of reproductive-age women are in the work force. 4 Over 90% of working women continue to work while pregnant, with the majority working into the month before delivery. Of the 60% of women who return to work within 1 year of the birth of their first child, two thirds are back at work within 3 months. 4 Evidence about the health status of women could inform policies related to leave and disability around the time of pregnancy. Finally, better characterization of the physical and emotional changes that typically occur would allow the definition of risk factors for greater or persistent declines in functional status, so that women at risk could be targeted for interventions to promote health and well-being. Because primary care providers provide care for women of reproductive age before, during, and after pregnancy, it is particularly important for them to be aware of the changes in health status that women experience around the time of pregnancy. 5,6Several small studies suggest that the functional status of reproductive-age women is lower during pregnancy and the postpartum period than at other times. [1][2][3]7 A study of 393Canadian women found that pregnant women had more limitations due to emotional problems, and lower levels of vitality, physical functioning, and social functioning than a sample of nonpregnant women. 2 Less is kno...

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Interventions to prevent excessive gestational gain may need to start before pregnancy. Women at risk for inadequate gain would also benefit from interventions directed toward modifiable factors during pregnancy.

Women's beliefs about the proper amount of weight gain and provider recommendations for weight gain vary significantly by maternal prepregnancy BMI. Many women report incorrect advice about gestational weight gain, and women with high or low prepregnancy BMI are more likely to have an incorrect target weight gain. New approaches to provider education are needed to implement the IOM guidelines for gestational weight gain.

II-2.