Faculty Bibliography

Background: Pregnancy is a crucial period to improve cardiovascular health (CVH) for mothers and their families. The current study emphasizes framework-guided factors that influence the adaptation of an evidence-based intervention (Parents as Teachers and Healthy Eating Active Living Taught at Home [PAT + HEALTH]) to support healthy gestational weight gain and postpartum weight management among pregnant women with obesity and their infants in Nigeria. Methods: From May to June 2023, 43 in-depth interviews were conducted with 11 parents, 15 community health extension workers (CHEWs)/health educators, and 17 policymakers/ healthcare supervisors in the Federal Capital Territory, Nigeria. Additionally, nine focus groups were conducted with 75 participants. Interviews were recorded, de-identified, and transcribed. The updated Consolidated Framework for Implementation Research (CFIR 2.0) informed the development of the interview guides and the thematic analysis. Transcripts were double-coded using Dedoose. Results: We identified assessing context, tailoring strategies, local attitudes, and sustainability as constructs to consider when adapting and implementing the PAT + HEALTH intervention successfully within the Nigerian primary care context. For example, policymakers and healthcare supervisors emphasized the feasibility of the intervention, including raising community awareness, planning for hard-to-reach areas, and ensuring supportive supervision of CHEWs delivering the intervention. Additional factors included customizing educational content and delivery methods to fit the cultural, socioeconomic, and environmental contexts of Nigerian families. CHEWs highlighted the importance of public education on locally available foods for better nutrition. Potential barriers to the PAT + HEALTH intervention included local attitudes influenced by sociocultural factors, such as food taboos, and structural factors, including limited financial support for the long-term sustainability of some components of the home visiting program. Conclusions: Building on these formative activities, the ENHANCE CVH trial will advance dissemination and implementation science by adapting, testing, and evaluating the effectiveness and implementation of the PAT + HEALTH intervention among pregnant women with obesity and their infants in Nigeria in a cluster randomized trial. Trial registration: ClinicalTrials.gov/NCT06773299, Registration Date: January 14, 2025.

BACKGROUND/UNASSIGNED:Effective management of alcohol withdrawal syndrome during hospitalization is paramount to patient safety and quality care. NYC Health + Hospitals initiated a quality improvement project to pilot an electronic health record (EHR) integrated, nurse-driven CIWA-Ar symptom-triggered protocol, including recommendations for medications for alcohol use disorder (MAUD), in medical and surgical units at 3 public hospitals. OBJECTIVE/UNASSIGNED:To describe implementation processes and to report related implementation outcomes (appropriateness, feasibility, and adoption) of the updated CIWA-Ar protocol in a safety net hospital setting. METHODS/UNASSIGNED:NYC Health + Hospitals implemented a standardized CIWA-Ar symptom-triggered, nurse-driven EHR protocol on March 15, 2022. The protocol included order sets, practice advisories, task lists, and reminders for assessments and orders. We measured nursing perspectives on feasibility and appropriateness at 6 months via a survey. We measured provider adoption as the proportion of admissions with a CIWA-Ar protocol ordered among admissions that triggered a recommendation, and MAUD use as the proportion of admissions with a MAUD order during hospitalization among all patients with a protocol ordered. RESULTS/UNASSIGNED:= .249). CONCLUSIONS/UNASSIGNED:The CIWA-Ar protocol was appropriate, feasible, and adopted at NYC public hospitals. Quality improvements to ensure protocol fidelity with benzodiazepine dosing and MAUD prescribing are needed.

Evidence is inconsistent regarding which windows of PM_2.5 exposure are critical for adverse perinatal outcomes. We investigated associations between timing of gestational PM_2.5 exposure and perinatal outcomes. Participants included 19,108 mother-infant dyads from 51 sites of the Environmental influences on Child Health Outcomes (ECHO) cohort. Repeated measures of PM_2.5 exposure were included based on high-resolution spatiotemporal models for trimesters 1-3, early first trimester (≤14 days), and late first trimester (70-92 days). We estimated associations of PM_2.5 exposure (per 5 μg/m³ increase) and continuous outcomes (gestational age at birth [GA] and birthweight for gestational age z-scores [BWZs]) using generalized estimating equation (GEE) models for linear regression. Poisson regression via GEE was used to estimate risk ratios (RRs) of PM_2.5 exposure (per 5 μg/m³ increase) with binary outcomes (preterm birth [PTB], <37 completed weeks of gestation), and term small for gestational age [SGA], <10th percentile). We explored effect modification by participants' characteristics. In fully adjusted models, early 1st trimester PM_2.5 exposure was associated with lower BWZ (β = -0.03, 95 % CI -0.06, -0.001); association with term SGA was RR = 1.06, 95 % CI 0.99, 1.13. Results were mostly null for other windows of gestational exposure. When stratified by sex, early pregnancy PM_2.5 exposure and lower BWZ associations were observed among females, but not males. Suggestive evidence indicates that associations of PM_2.5 exposure with GA, PTB risk, and term SGA risk may vary by maternal race and ethnicity. Our results suggest that policies and practices that reduce the risks of PM_2.5 exposure, particularly in pre-conception and early pregnancy, may improve perinatal outcomes.

OBJECTIVE:To evaluate whether the risk of long COVID among individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy differs from that of individuals who were not pregnant at time of virus acquisition. METHODS:We conducted a multicenter observational cohort study at 79 NIH RECOVER (Researching COVID to Enhance Recovery) sites. Individuals assigned female at birth aged 18-45 years with an index (first) SARS-CoV-2 infection on or after December 1, 2021, were included. The exposure was pregnancy (any gestational age) at the time of index SARS-CoV-2 infection. The primary outcome was long COVID 6 months after index infection , defined as RECOVER-Adult Long COVID Research Index score 11 or higher based on a detailed symptom survey. To account for confounding and differential selection between participants who were pregnant and not pregnant at infection, propensity score-matching methods were used to balance the groups on variables potentially associated with both pregnancy status and long COVID. RESULTS:Overall 2,423 participants were included; 580 (23.9%) were pregnant at index SARS-CoV-2 infection. The median age at infection was 33 years (interquartile range 28-38 years), and 2,131 of participants (90.0%) with known vaccination status were vaccinated. After propensity score matching, the adjusted long COVID prevalence estimates 6 months after index infection were 10.2% (95% CI, 6.2-14.3%) among those pregnant at infection and 10.6% (95% CI, 8.8-12.4%) among those not pregnant at infection. Pregnancy was not associated with a difference in adjusted risk of long COVID (adjusted risk ratio 0.96, 95% CI, 0.63-1.48). CONCLUSION/CONCLUSIONS:Acquisition of SARS-CoV-2 during pregnancy was not associated with a differential risk of long COVID at 6 months compared with similar-aged individuals who acquired SARS-CoV-2 outside of pregnancy.

BACKGROUND:There is growing interest in understanding the link between early life exposures to ambient air pollution and childhood blood pressure; however, existing findings, largely from single site/cohort studies, are inconclusive. METHODS:(per 10-ppb) exposures with blood pressure outcomes were estimated using linear and Poisson regressions adjusted for sociodemographic, lifestyle, temporal, and spatial confounders. RESULTS:with both SBP (β: -2.42, 95 %CI: -4.70, -0.14) and DBP (β: -1.94, 95 %CI: -3.81, -0.08) percentiles were suggested. CONCLUSION/CONCLUSIONS:and blood pressure was counterintuitive and warrants further investigation.

Liver transplant (LT) recipients experience a wide range of comorbidities, leading to frequent healthcare encounters. Until now, national registries, which have limited exposures and outcomes, and laborious small cohort studies have been the main data sources for LT research. Cosmos database offers electronic health record (EHR)-based insights into LT recipients at the national level with granular data. We evaluated if Cosmos data is representative of the entire US LT recipient population. Using Cosmos (N=20,235) and the national Scientific Registry of Transplant Recipients (SRTR) (N=51,281), we identified adult, first-time LT recipients between 7/2016-12/2022. We compared demographics, clinical data, and mortality across datasets, calculating Kaplan-Meier survival estimates and multi-variable Cox regressions. Recipient characteristics were highly comparable (e.g., female: Cosmos=36.5% vs. SRTR=36.4%, Black: 6.8% vs. 7.2%; BMI: 28.5 kg/m2 [24.8-32.9] vs. 28.2 [24.6-32.4]). Lab values were similar across cohorts, including MELD (24 [17-30] vs. 23 [16-30]). Transplant indications, donor characteristics, and 5-year survival (Cosmos 83.1% [82.3-83.8) vs. SRTR 80.9% [80.4-81.3]) were similar. The associations of clinical factors with survival were similar across both groups. Cosmos database demonstrated acceptable generalizability to the general US LT recipient population, which may advance LT research through a better understanding about LT recipients' experiences and outcomes.

Maternal psychological distress during pregnancy and the early postpartum period is a risk factor for dysregulated affective and regulatory function in young infants. Animal models suggest that perinatal stress may alter offspring development via allopregnanolone (ALLO) exposure. For example, variations in placentally derived ALLO in preterm infants have been linked with altered fetal neurodevelopment. However, no studies have investigated naturalistic variations in ALLO concentrations in maternal milk as a potential moderator of associations between maternal distress and infant temperament during the postnatal period. The current study assesses associations among ALLO concentrations in human milk, maternal psychological distress, and infant temperament in 81 mother-infant dyads (31 females) measured at approximately 6.5 months postpartum (M = 6.55 months, range = 5.5-8 months). Results indicated that human milk ALLO concentration moderated effects of maternal psychological distress on infant regulatory capacity. Specifically, there was a negative association between maternal psychological distress and regulatory capacity in infants of mothers with below-mean ALLO concentrations, but not in infants of mothers with above-mean ALLO concentrations. However, there were no effects of ALLO on infant negative affect or surgency/positive affect. This study provides some of the first preliminary evidence that ALLO concentrations in human milk may moderate associations between maternal psychological distress and infant regulatory capacity.

CONTEXT/UNASSIGNED:Plasticizers such as bisphenols and phthalates are endocrine-disrupting chemicals and lead to development of metabolic diseases. OBJECTIVE/UNASSIGNED:To examine associations of prenatal exposure to bisphenols and phthalates with metabolic dysfunction. DESIGN/UNASSIGNED:This study was nested in the New York University (NYU) Children's Health and Environment Study, a prospective birth cohort. SETTING/UNASSIGNED:Participants were recruited at three NYU-affiliated hospitals. PATIENTS OR OTHER PARTICIPANTS/UNASSIGNED:Eligible participants were ≥18 years old, <18 weeks pregnant, and had a medically stable pregnancy. EXPOSURES/UNASSIGNED:Twelve phthalate metabolites and two bisphenols were measured in early and mid-pregnancy (<18 and 18-25 weeks) urine samples. Bisphenols were summed, and phthalate metabolites were grouped based by molecular weights and relevant parent compounds. MAIN OUTCOME MEASURES/UNASSIGNED:Logistic and linear regression models assessed chemicals groups' associations with gestational diabetes mellitus (GDM), glucose disturbance (including impaired glucose tolerance (IGT)), and blood glucose response to glucose challenge test (GCT), adjusting for sociodemographic and pregnancy-related factors. RESULTS/UNASSIGNED:Seventy-nine (6.8%) had GDM, 303 (26.1%) had IGT, and blood glucose response to GCT ranged from 22-386 mg/dL. Bisphenol A (BPA) was negatively associated with blood glucose response to GCT (-1.47 [-2.84, -0.10]), while diethylhexyl phthalate (DEHP; 2.67 [0.98, 4.36]) and high molecular weight phthalates (1.94, [0.17, 3.71]) were positively associated with blood glucose response to GCT. DEHP was also linked to glucose disturbance (1.16 [1.02, 1.31]). CONCLUSION/UNASSIGNED:Our findings suggest that phthalate exposure is associated with GDM. Further mechanistic studies are warranted, particularly given the inverse associations with BPA exposure.

BACKGROUND:The school environment plays a vital role in shaping children's health and well-being. Nutrition education supports health promotion and disease prevention; however, it is unclear how comprehensive curricula are in the content they cover. This study explored the content of K-12 nutrition curricula in US public schools. METHODS:We analyzed nutrition education curricula from the 2023-2024 school year across a target sample of 50 states. Materials were collected through online searches and phone calls to districts and schools. We employed content analysis to assess nutrition concepts and modes of curriculum delivery, using a codebook to systematically code the curricula. RESULTS:We obtained 110 curricula across 38 states. Common concepts included macronutrients (54.5%), micronutrients (55.4%), food groups (58%), and the benefits of good nutrition (69%). Fewer curricula addressed consequences of poor nutrition (44.5%) or behavioral changes like portion size (38.1%). Most curricula (87.2%) used didactic methods, with only 19.5% incorporating hands-on activities. Broader topics such as environmental impacts of food choices (17.2%) were less common. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY/UNASSIGNED:Nutrition education plays a critical role in shaping children's long-term health outcomes; however, challenges remain in ensuring consistent and high-quality instruction. CONCLUSIONS:Nutrition education in the US focuses on core nutrition concepts and often relies on didactic methods, with limited hands-on activities. This highlights the need for more engaging, standardized programs.

Positive airway pressure (PAP) adherence is lower in African Americans (AAs) and, possibly, Hispanics as compared to Whites. Access to other treatment modalities is also limited in these groups. In children, obstructive sleep apnea (OSA) prevalence is higher among AAs, Hispanics, and Asian Americans. AA children have lower rates of adenotonsillectomy. Interventions to dissipate misconceptions about sleep and OSA, better patient-provider communication, and standardized and targeted surveys and procedures are necessary to minimize this problem. This section will review disparities in PAP treatment and other options, as well as children's phenotypes, associated factors, and potential interventions.