Background: The purpose of our study was to determine whether women of reproductive age with history of low birth weight (LBW) deliveries have higher allostatic load (AL), a measure of the cumulative toll of chronic stress, than those with normal-weight deliveries. Methods: We used data from women ages 17-35 who responded to the National Health and Nutrition Examination Survey (NHANES) reproductive-health questionnaire, 1999-2006. Women reported history of LBW infants and those who were preterm. We classified preterm-LBW and term-LBW as surrogates for preterm birth (PTB) and small for gestational age (SGA), respectively. Normal weight included those without LBW infant history. We utilized nine biomarkers measured in NHANES to determine AL and used linear regression to compare unadjusted and adjusted means. Results: We identified 877 women divided among SGA (2%), PTB (10%), and normal groups (88%). The SGA group had higher unadjusted and adjusted AL scores than did the normal group (2.82 -0.35 vs. 1.92 -0.07, p = 0.011); women in the PTB group had higher AL scores than did the referent in adjusted analyses (2.58 -0.21 vs. 1.92 -0.07, p = 0.001). Conclusions: Women with history of SGA or PTB had higher AL than did those with normal birth weight outcomes. This suggests a link between adverse pregnancy outcomes, chronic stress, and subclinical disease.

Objective Preeclampsia is a multisystemic disorder of pregnancy associated with maternal and fetal complications as well as later-life cardiovascular disease. Its exact cause is not known. We developed a pregnancy-specific multisystem index score of physiologic risk and chronic stress, allostatic load (AL), early in pregnancy. Our objective was to determine whether AL measured early in pregnancy was associated with increased odds of developing preeclampsia. Methods Data were from a single-center, prospectively collected database in a 1:2 individual-matched case control of women enrolled at <15 weeks gestation. We matched 38 preeclamptic cases to 75 uncomplicated, term deliveries on age, parity, and lifetime smoking status. AL was determined using 9 measures of cardiovascular, metabolic, and inflammatory function. Cases and matched controls were compared using conditional logistic regression. We compared the model's association with preeclampsia to that of obesity, a well-known risk factor for preeclampsia, by assessing goodness-of-fit by Akaike information criterion (AIC), where a difference >1-2 suggests better fit. Results Early pregnancy AL was higher in women with preeclampsia (1.25 +/- 0.68 vs. 0.83 +/- 0.62, p=0.002); women with higher AL had increasing odds of developing preeclampsia (OR 2.91, 95% CI 1.50-5.65). The difference between AIC for AL and obesity was >2 (AIC 74.4 vs. 84.4), indicating AL had a stronger association with preeclampsia. Conclusion Higher allostatic load in early pregnancy is associated with increasing odds of preeclampsia. This work supports a possible role of multiple maternal systems and chronic stress early in pregnancy in the development of preeclampsia.

Background Allostatic load (AL) measures the cumulative impact of chronic stress and is associated with adverse health outcomes. A novel scoring system has previously been developed for AL in early pregnancy that is associated with pre-eclampsia. It was hypothesized that AL, as identified by the present model, is associated with psychosocial stressors and, specifically, poor sleep quality. Methods Women were selected from a low-risk, community-dwelling study population who enrolled at <15 weeks gestation. Nine physiologic components were divided among the domains of cardiovascular, metabolic, and inflammatory function. Spearman’s rank correlations were used to examine the association of AL with age, income, the Revised Prenatal Distress Questionnaire (NuPDQ), Inventory of Depressive Symptoms (IDS), and Pittsburgh Sleep Quality Index (PSQI). The Wilcoxon rank-sum test was used to compare AL by race and educational attainment. Results A total of 103 women were identified, with: a mean age of 29.8 ± 5.0 years, 17.5% black, and mean gestational age 12.2 ± 1.1 weeks. Allostatic load was positively correlated with the PSQI (ρ=0.23, p=0.018). There were no associations with age, income, prenatal distress, race, or depression scores. College-educated women had lower AL compared with those with less education (0.57 ± 0.43 vs 0.81 ± 0.55, p=0.045). Conclusion Higher AL, measured by the pregnancy-specific model, was associated with poorer sleep quality and lower educational attainment, both of which were considered to be chronic stressors. These relationships were consistent with previous findings in non-pregnant populations, and suggest that AL may be useful for capturing the physiologic impact of chronic stress in early pregnancy.

The rapidly growing Hispanic American population is experiencing an academic achievement gap that seems to be rooted in disparities in early childhood education and literacy development. Children of non-English-speaking immigrant parents are at greatest risk of poor school performance, but there is potential to capitalize on immigrants' drive by encouraging them to engage with their children in dialog while reading native-language storybooks. This paper reports on a community-based randomized controlled trial (N = 79) delivered to mostly Mexican immigrant parents of preschool-age children. Intervention group parents attended three monthly 60-minute sessions based on the Dialogic Reading Model-C.A.R. (Comment and Wait, Ask Questions and Wait, and Respond by Adding More), which teaches parents to have a conversation about pictures in books, with the goal of enhancing verbal exchanges with the child in the parent's native language. After the 3-month intervention, parents in the bilingual early language development intervention reported placing greater value on children's active verbal participation in reading compared to control group parents who participated in a healthy lifestyle intervention. These results suggest that Hispanics' educational outcomes may be improved by educating parents on the value of playful conversations with young children while reading books in one's native language.

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Opinion (63.9%, n5263) received discharge prescriptions with fewer average MMEs (159.53661.64) than those who delivered before the publication (36%, n5148) (187.35653.42), chi-square (1, N5411)517.71, P,.001.CONCLUSION: Patients delivering via cesarean after the published ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs, but there was no difference between prescriptions written the day of versus before discharge.

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