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Background The prevalence of hypertensive disorders of pregnancy (HDPs) in India is 11%, which is one of the highest rates globally. Existing research on HDPs in India primarily focuses on biological risk factors, with minimal research on how socioecological factors combine to increase risk of HDPs. We conducted a rapid review using Bronfenbrenner’s Ecological Model to understand the social and cultural factors associated with HDPs among Indian pregnant women to identify possible intervention targets that may uniquely improve health in this population. Bronfenbrenner’s Ecological Model is a framework that can be used to understand the complex relationship between multiple influences on health. Methods We reviewed studies published between January 2010 and January 2024 using PubMed, Science Direct, and Scopus databases. Search terms included variants of hypertension, pregnancy, and India. Inclusion criteria were: (1) peer-reviewed journal article; (2) published between January 2010 to January 2024; (3) participants consisted of Indian women living in India; (4) studies evaluated socioecological risk factors associated with HDPs. One independent reviewer performed searches, screening, data extraction, and quality assessment. Each included study was then organized within Bronfenbrenner’s Ecological Model. Results A total of 921 studies were generated from the initial search, with 157 exclusions due to duplicates. Following screening for inclusion and exclusion criteria at the title/abstract and full text levels, 17 studies remained in the final review. Socioecological risk factors of HDPs were identified at each level, with the most commonly identified influences including: low socioeconomic status (SES), lacking community education and knowledge on HDP management and prevention, and lacking prenatal HDP screening. Conclusion This study determined that the high risk for HDPs in India is influenced by many intertwined socioecological factors. Women in rural and low SES areas need more health education on HDP management and prevention. There also needs to be more adequate prenatal HDP screening, with at least 4 and ideally 8 prenatal visits. Prenatal screenings should be accompanied with culturally appropriate patient education, especially for low SES women who have limited literacy, so that they can effectively make individual and microsystemic lifestyle decisions aimed at either managing or preventing HDPs.

Existing clinical intravascular imaging modalities are not capable of accurate detection of critical plaque pathophysiology in the coronary arteries. This study reports the first intravascular catheter combining intravascular ultrasound (IVUS) with multispectral fluorescence lifetime imaging (FLIm) that enables label-free simultaneous assessment of morphological and biochemical features of coronary vessels in vivo . A 3.7 Fr catheter with a fiber-optic channel was constructed based on a 40 MHz clinical IVUS catheter. The ability to safely acquire co-registered FLIm-IVUS data in vivo using Dextran40 solution flushing was demonstrated in swine coronary arteries. FLIm parameters from the arterial wall were consistent with the emission of fluorophores present in healthy arterial wall (collagen, elastin). Additionally, structural and biochemical features from atherosclerotic lesions were acquired in ex vivo human coronary samples and corroborated with histological findings. Current results show that FLIm parameters linked to the amount of structural proteins (e.g. collagen, elastin) and lipids (e.g. foam cells, extracellular lipids) in the first 200 μm of the intima provide important biochemical information that can supplement IVUS data for a comprehensive assessment of plaques pathophysiology. The unique FLIm-IVUS system evaluated here has the potential to provide a comprehensive insight into atherosclerotic lesion formation, diagnostics and response to therapy.

Background It is estimated that 30% of women globally have experienced sexual violence (SV) and many of these cases result in sexual violence related pregnancies (SVRP). Social and structural inequities may impact access to reproductive healthcare for those who become pregnant as a result of SV. Methods Using Bronfenbrenner’s Bioecological Systems Theory as an organizing framework, we conducted a rapid review to identify barriers to accessing reproductive healthcare after SV. We reviewed studies published between 2010 and 2024, synthesizing results from PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Global Health, and Embase. A total of 15 studies met the following inclusion criteria: (a) published in a peer-reviewed journal between January 2010 and February 2024, (b) written in English, and (c) evaluated barriers to reproductive healthcare services and resources for people who become pregnant as a result of SV. Study populations were located both within and outside the US. Results The primary barriers identified included: lack of access to care, lack of provider training in trauma-informed care, fear of stigmatization, victim blaming, internalized shame, and retaliation. Conclusions This review can be used to understand specific barriers to reproductive healthcare for those who have experienced SV and the level or levels at which they are functioning. These findings can be used to tailor reproductive health policy, training, and community-based interventions aimed at mitigating and/or eliminating these barriers.

Background The First Five Yolo Welcome Baby (WB) program, initiated in 2021, is a nurse home visiting initiative funded by local and federal dollars. It aims to address postpartum health in low-income, uninsured, or Medi-Cal insured families in Yolo County, California. Amid persisting inequities in maternal health, especially in low-income and historically marginalized communities, WB was designed to overcome barriers to postpartum care access and provide essential support for social, emotional, and physical wellbeing for mothers and their families. The purpose of this study was to evaluate this program in terms of key outcomes, including participant and provider experience and perceptions. Methods This mixed-methods study examined quantitative and qualitative data from 541 WB program participants between March 2022 and February 2024. Quantitative data included service utilization, demographic information, mental health screenings, and breastfeeding outcomes. Qualitative data, gathered through semi-structured interviews with 30 participants (15 English-speaking and 15 Spanish-speaking) and 15 providers explored participant and provider perceptions of program benefits and challenges. Thematic analysis was used to categorize qualitative data, and results were integrated with quantitative findings. Results Most program participants identified as Hispanic/Latino (58%) and over half had a language preference other than English (48.8%), primarily Spanish. Quantitative results revealed high postpartum visit completion (74.5% for both two- and six-week visits) and a breastfeeding continuation rate of 75.2% at three months. Depression and anxiety screenings indicated substantial mental health needs, with 13.9% screening positive for depression and 19.4% screening positive for anxiety. Qualitative findings highlighted six themes, including the importance of access to social support and community resources, overcoming logistical barriers for low-income families, and facilitating healthcare continuity for mothers and infants. Participants emphasized the role of nurse home visitors in bridging gaps in healthcare access and providing emotional support, particularly for families with a language preference other than English. Conclusions This study underscores the critical role of postpartum nurse home visiting programs in addressing social and structural determinants of health and reducing inequities in maternal health outcomes. By connecting low-income families with healthcare and community resources, WB has shown promise in promoting maternal and infant health. Further research on similar programs in diverse and larger populations could enhance our understanding of their long-term impact on health equity.

Background Rising rates of overweight and obesity globally have led to an increasing number of women who enter pregnancy with excess weight, posing significant health risks to mothers and infants. Mobile health interventions, such as smartphone apps, may be a solution to improving pregnancy outcomes, however, limited randomized studies have examined this approach for gestational weight gain (GWG) and postpartum weight retention (PPWR). We report results from a double-blinded, randomized control trial of Goals for Reaching Optimal Wellness ( GROWell ), a mobile app and text-based intervention designed to improve diet quality and associated weight outcomes in pregnant and postpartum women. Methods Women living in California with BMI = 25–42 kg/m 2 and a singleton, uncomplicated pregnancy were recruited via social media or clinic in early pregnancy from January 2021 through March 2023. After completing a baseline survey, participants were randomized to GROWell or an educational control. Participants completed online surveys of diet quality and other health behaviors and self-weighed using study-provided Bluetooth scales. Modified Poisson regression tested for differences in excess GWG and 6-month PPWR. Results Using block randomization in permuted blocks of three based on prepregnancy BMI, race/ethnicity, and recruitment source) 453 racially and ethnically diverse participants (237 attention control, 216 intervention) were enrolled. Mean age was 33.6 ± 4.1 years and mean BMI was 30.9 ± 4.28 kg/m 2 . Excess GWG was observed in 36% of the control group and 35% of the intervention group. PPWR was observed in 26% of the control group and 23% of the intervention group. Conclusions Compared to an attention control, GROWell was not associated with lower rates of excess GWG or PPWR. However, study rates of excess GWG and PPWR were lower in both groups compared to averages in the US and several Western nations. Future studies should investigate the potential of text-based educational support on weight and other health indicators among childbearing women. Trial registration ClinicalTrials.gov identifier NCT04449432. Registered on June 26, 2020.

Background During public health emergencies, including the COVID-19 pandemic, access to adequate healthcare is crucial for providing for the health and wellbeing of families. Pregnant and postpartum people are a particularly vulnerable subgroup to consider when studying healthcare access. Not only are perinatal people likely at higher risk for illness, mortality, and morbidity from COVID-19 infection, they are also at higher risk for negative outcomes due to delayed or inadequate access to routine care. Methods We surveyed 820 pregnant people in California over two waves of the COVID-19 pandemic: (1) a ‘non-surge’ wave (June 2020, n  = 433), and (2) during a ‘surge’ in cases (December 2020, n  = 387) to describe current access to perinatal healthcare, as well as concerns and decision-making regarding childbirth, over time. We also examined whether existing structural vulnerabilities – including acute financial insecurity and racial/ethnic minoritization – are associated with access, concerns, and decision-making over these two waves. Results Pregnant Californians generally enjoyed more access to, and fewer concerns about, perinatal healthcare during the winter of 2020–2021, despite surging COVID-19 cases and hospitalizations, as compared to those surveyed during the COVID-19 ‘lull’ in the summer of 2020. However, across ‘surge’ and ‘non-surge’ pandemic circumstances, marginalized pregnant people continued to fare worse – especially those facing acute financial difficulty, and racially minoritized individuals identifying as Black or Indigenous. Conclusions It is important for clinicians, researchers, and policymakers to understand whether and how shifting community transmission and infection rates may impact access to perinatal healthcare. Targeting minoritized and financially insecure communities for increased upstream perinatal healthcare supports are promising avenues to blunt the negative impacts of the COVID-19 pandemic on pregnant people in California.

IntroductionPregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century.MethodsWe conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health.ResultsMany of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week.DiscussionPregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.SignificanceConsistent with other studies, we found that anxiety, depression, and stress levels in our pregnant cohort were higher than reported pre-pandemic and that anxious-depressive symptomology predicted worse sleep, poorer nutrition, and less physical activity. New in this study was that these relationships were the same for primiparous and multiparous pregnant people, did not change with gestational age, and that while sleep and nutrition worsened throughout pregnancy, physical activity actually increased, regardless of anxious-depressive symptomology. Also new to this study was that multiparous pregnant people had more worries about their and their baby’s wellbeing than first time mothers.

A clinically compatible fluorescence lifetime imaging microscopy (FLIM) system was developed. The system was applied to intraoperative in vivo imaging of head and neck squamous cell carcinoma (HNSCC). The endoscopic FLIM prototype integrates a gated (down to 0.2 ns) intensifier imaging system and a fiber-bundle endoscope (0.5-mm-diameter, 10,000 fibers with a gradient index lens objective 0.5 NA, 4-mm field of view), which provides intraoperative access to the surgical field. Tissue autofluorescence was induced by a pulsed laser (337 nm, 700 ps pulse width) and collected in the 460 ± 25 nm spectral band. FLIM experiments were conducted at 26 anatomic sites in ten patients during head and neck cancer surgery. HNSCC exhibited a weaker florescence intensity (~50% less) when compared with healthy tissue and a shorter average lifetime (τHNSCC = 1.21 ± 0.04 ns) than the surrounding normal tissue (τN = 1.49 ± 0.06 ns). This work demonstrates the potential of FLIM for label-free head and neck tumor demarcation during intraoperative surgical procedures.

Clinical trials worldwide were disrupted when the COVID-19 pandemic began in early 2020. Most intervention trials moved to some form of remote implementation due to restrictions on in-person research activities. Although the proportion of remote trials is growing, they remain the vast minority of studies in part due to few successful examples. Our team transitioned Goals for Reaching Optimal Wellness (GROWell), an NIH-funded (R01NR017659) randomized control trial (RCT; ClinicalTrials.gov identifier NCT04449432) originally designed as a hybrid intervention, into a fully remote clinical trial. GROWell is a digital dietary intervention for people who enter pregnancy with overweight or obesity. Primary outcomes include gestational weight gain and six-month postpartum weight retention. Strategies that we have tested, refined, and deployed include: (a) use of a HIPAA-compliant, web-based participant recruitment and engagement platform; (b) use of a HIPAA-compliant digital health platform to disseminate GROWell and conduct study visits (c) interconnectivity of these two platforms for seamless recruitment, consent, enrollment, intervention delivery, follow-up, and study team blinding; (d) detailed SMS messages to address initial challenges with protocol adherence; (e) email notifications alerting the study team about missed participant surveys so they can follow-up; (f) remuneration using email gift cards with recipient choice of vendor; and (g) geotargeting social media campaigns to improve participation of Black Indigenous and People of Color Communities. These strategies have resulted in screen failure rates improving by 7%, study task adherence improving by an average of 20–30% across study visits, and study completion rates of 82%. Researchers may consider some or all of these approaches in future remote mHealth trials.