Literature Collection

Background: Adverse social determinants of health (SDoHs), specifically psychosocial stressors and material hardships, are associated with early childhood obesity. Less is known about whether adverse SDoHs modify the efficacy of early childhood obesity prevention programs. Methods: We conducted a secondary analysis of publicly insured birthing parent-child dyads with Latino backgrounds participating in a randomized controlled trial of the Starting Early Program (StEP), a child obesity prevention program beginning in pregnancy. We measured baseline adverse SDoHs categorized as psychosocial stressors (low social support, single marital status, and maternal depressive symptoms) and material hardships (food insecurity, housing disrepair, and financial difficulties) individually and cumulatively in the third trimester. Logistic regression models tested effects of adverse SDoHs on StEP attendance. We then tested whether adverse SDoHs moderated intervention impacts on weight at age 2 years. Results: We observed heterogeneous effects of adverse SDoHs on outcomes in 358 parent-child dyads. While housing disrepair decreased odds of higher attendance [adjusted odds ratio (aOR) 0.52, 95% confidence interval (CI): 0.29-0.94], high levels of psychosocial stressors doubled odds of higher attendance (aOR 2.36, 95% CI: 1.04-5.34). Similarly, while certain adverse SDoHs diminished StEP impact on weight (e.g., housing disrepair), others (e.g., high psychosocial stress) enhanced StEP impact on weight. Conclusions: Effects of adverse SDoHs on intervention outcomes depend on the specific adverse SDoH. Highest engagement and benefit occurred in those with high psychosocial stress at baseline, suggesting that StEP components may mitigate aspects of psychosocial stressors. Findings also support integration of adverse SDoH assessment into strategies to enhance obesity prevention impacts on families with material hardships. Trial Registration: This study is registered on clinicaltrials.gov: Starting Early Obesity Prevention Program (NCT01541761); https://clinicaltrials.gov/ct2/show/NCT01541761.

INTRODUCTION: Depression and physical conditions such as gestational diabetes and hypertension frequently co-occur during pregnancy. However, the combined effect of these conditions on postnatal maternal health outcomes remains unclear. This study systematically summarises evidence on the impact of prenatal depression comorbid with gestational diabetes and/or hypertension on adverse postnatal maternal health outcomes. METHODS: A systematic review was conducted across PubMed, Medline, Scopus, Web of Science, Embase, PsycINFO, and Google Scholar to identify relevant studies. The study protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024573322). The Joanna Briggs Institute quality appraisal tool was used to assess study quality. An inverse variance-weighted random-effects meta-analysis was performed to pool effect estimates. Subgroup analyses, publication bias assessment, trim-and-fill analysis, and sensitivity analyses were conducted. RESULTS: Eleven studies with over one million participants were analysed. Prenatal depression comorbid with diabetes was associated with an increased risk of postpartum depression (PPD) (Odds Ratio (OR) = 1.80, 95 % CI: 1.26-2.59). Additionally, depression comorbid with hypertension during pregnancy was associated with a 28 % higher risk of postpartum cardiovascular disease (CVD) (OR = 1.28, 95 % CI: 1.14-1.43). Our subgroup and sensitivity analyses confirmed the primary findings. CONCLUSION: Prenatal depression, when co-occurring with gestational diabetes or hypertension, is linked to an increased risk of PPD and postpartum CVD. Early screening and integrated care for prenatal depression and pregnancy-related medical conditions may reduce postnatal complications and long-term maternal health risks.

OBJECTIVE: To describe the characteristics, treatment, and outcomes of pregnant women with opioid use disorder. METHODS: Women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 were enrolled in a prospective cohort study and followed through delivery (N=113). Buprenorphine or methadone was initiated clinically. The Addiction Severity Index was administered at enrollment. Prenatal and delivery data were systematically abstracted from medical charts. RESULTS: Most women in the cohort were non-Hispanic white (80.5%) with a mean age of 28 years. Few women were married (8.9%). More than half of the cohort had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing. A majority (70.8%) were infected with hepatitis C and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent. Regular substance used included heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (62.8%). Fifty-nine women (52.2%) were treated initially with prenatal buprenorphine and 54 (47.8%) with methadone; 49.6% also were taking concomitant psychotropic medications. Employment (0.766±0.289) and psychologic (0.375±0.187) Addiction Severity Index scores were the highest, indicating the most severe problems in these areas. Opioid use relapse did not differ by treatment (44.7% overall). Thirteen (22.5%) of 59 women treated with buprenorphine transitioned to methadone mainly because of positive opioid screens. Overall, 23.0% (n=26) of the cohort discontinued clinical care. The number of pregnancy losses was small (three therapeutic abortions, four miscarriages, one stillbirth), with an overall live birth rate of 90.8% (95% CI 82.7-95.9). CONCLUSION: These data on the social circumstances, substance use, treatment, and treatment outcomes of pregnant women with opioid use disorder may help clinicians to understand and treat this clinically complex population.

BACKGROUND: Diabetes affects over 3.3 million people in England, creating a significant health and economic burden. Continuous glucose monitoring (CGM) improves diabetes management but remains unevenly accessible, especially among Black and minority groups who face onset at younger ages, higher diabetes rates and complications. Updated NICE guidelines promote CGM access for all people with T1D and certain people with T2D, yet data on prescribing patterns in England are limited. This study investigates CGM prescribing across integrated care boards (ICBs) and primary care networks (PCNs), focusing on ethnicity and deprivation, to identify and address access disparities. METHODS: Cross-sectional analysis of publicly available data examined CGM prescribing patterns across England's PCNs, focusing on ethnicity and socio-economic factors. Data from OpenPrescribing, the National Diabetes Audit and Public Health England were analysed through descriptive and inferential statistics, including regression and Intraclass Correlation Coefficient (ICC) calculations, to assess disparities in prescribing ratio per 1000 people. RESULTS: Significant disparities in CGM prescribing across PCNs and ICBs are identified, shaped by ethnicity, age and socio-economic factors. The mean items prescription ratio is 4.87 per 1000 people, ranging from 0.26 to 11.59. People with T1D are generally younger, with only 15.5% over 65, compared to 52.0% in T2D. White individuals represent 83.6% of T1D cases, while South Asians and Afro-Caribbeans are more prevalent in T2D (14.5% and 5.3%, respectively). ICBs with below-average CGM prescribing have a higher percentage of Afro-Caribbean and South Asian populations compared to ICBs with above-average prescribing. For T1D, Afro-Caribbean representation is 6.7 (SD:7.0) in lower-prescribing ICBs versus 2.1 (SD:2.8) in higher-prescribing ICBs, and for T2D, it is 8.4 (10.4) versus 1.8 (SD:3.4) South Asian representation in low-prescribing ICBs is 10.6 (SD:13.7) for T1D and 21.9 (SD:20.5) for T2D, compared to 3.2 (SD:4.9) for T1D and 6.5 (SD:9.7) for T2D in higher-prescribing ICBs. CGM prescribing variance attributed to ethnicity and deprivation is 46.6% in T1D and 77.3% in T2D, indicating considerable socio-demographic impact. CONCLUSION: This study reveals significant ethnic disparities in CGM access, with Afro-Caribbean and South Asian groups facing a reduced prescribing ratio per 1000 people. Consistent NICE guideline adoption and targeted outreach are needed to improve equity in CGM access.