word count: 249 Manuscript word count: 3,118 Bulleted novelty statement:This historical cohort study examined the impact of gestational diabetes mellitus (GDM) after excluding pre-existing diabetes in mothers who delivered from 1981-2011 in Manitoba, Canada. First Nations (FN) women had 2-times more GDM and were 3-times more likely to develop postpartum diabetes than non-FN women. Postpartum diabetes in both FN and non-FN mothers was affected by GDM, lower family income and rural residence. The relative risk of developing postpartum diabetes in non-FN women was higher than FN women. The findings suggest that the reduction of GDM and socioeconomic inequities are required for preventing postpartum diabetes in FN and non-FN women.Running title: GDM and subsequent diabetes in mothers 2 Abstract Background: Over the past 30 years, the prevalence of diabetes has steadily increased among

Background: First Nations (FN) women have a higher risk of diabetes than non-FN women in Canada. Prenatal education and breastfeeding may reduce the risk of diabetes in mothers and offspring. The rates of breastfeeding initiation and participation in the prenatal program are low in FN communities. Methods: A prenatal educational website, social media-assisted prenatal chat groups and community support teams were developed in three rural or remote FN communities in Manitoba. The rates of participation of pregnant women in prenatal programs and breastfeeding initiation were compared before and after the start of the remote prenatal education program within 2014-2017. Findings: The participation rate of FN pregnant women in rural or remote communities in the prenatal program and breastfeeding initiation during 1-year after the start of the community-based remote prenatal education program were significantly increased compared to that during 1-year before the start of the program (54% versus 36% for the participation rate, 50% versus 34% for breastfeeding initiation, p < 0¢001). Availability of high-speed Wi-Fi and/or postpartum supporting team were associated with favorite study outcomes. Positive feedback on the remote prenatal education was received from participants. Interpretation: The findings suggest that remote prenatal education is feasible and effective for improving the breastfeeding rate and engaging pregnant women to participate in the prenatal program in rural or remote FN communities. The remote prenatal education remained active during COVID-19 in the participating communities, which suggests an advantage to expand remote prenatal education in other Indigenous communities.

Objectives Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non‐restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward SDF. Aim To understand Indigenous community members' views on pediatric dental surgery to treat ECC under general anesthesia (GA) and receptivity to SDF as an alternative to restorative surgery. Methods Focus groups and sharing circles congruent with an Indigenous ways of gathering information were conducted. Three interviewers engaged eight groups of First Nation and Metis communities in three rural Indigenous communities and ne metropolitan urban setting in Manitoba, Canada. Overall, 59 individuals participated. Open coding was guided by grounded theory and further analysis using Nvivo 12 software™. Results Participants mean age was 35.6 years, 88 percent (52 individuals) had a least one child, and 32 percent (19 individuals) were employed. Eight themes emerged, including respondents' fear of dental surgery under GA, fear of pain after dental surgery, parents' need for more information before accepting SDF treatment, and concern about the black staining of treated lesions. Conclusions Indigenous parents' acceptance of SDF as a treatment option is contingent on having more information and assurance that treatment under GA can be avoided. Understanding Indigenous parents' views may ensure better acceptance of SDF as a minimally invasive treatment option to manage ECC. A cautious and informative approach to SDF implementation in Indigenous communities is recommended.

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Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.