Yu-Hsuan Lai

Background: The collection of dietary behavior data is crucial in childbearing populations. In addition to observed inequities in perinatal dietary intake and quality, burdensome assessment methods (eg, 24-h dietary recall) may limit research participation for some groups. Ecological momentary assessment (EMA) is associated with reduced recall bias and participant convenience, but there is a dearth of studies with diverse cohorts. Objective: Our aim is to describe participant completion of food intake items in EMA surveys, overall and across individual characteristics (eg, prepregnancy BMI). Methods: Using secondary EMA data from participants in a longitudinal study, we report average completion rates of survey items regarding dietary behavior (eg, number of meals eaten in a day) across individual demographic variables (eg, age) and combined strata (eg, race+age) during late pregnancy and throughout 12 months post partum. Results: In our analytic sample (N=310), the average completion rate was 52.4% (SD 27.8%) during pregnancy, rising to 59.1% (SD 22.0%) after giving birth. Participants who were older (>30 y), overweight before pregnancy, self-identified as White, working, or earning higher annual income (>US $50,000) had higher average completion rates than their counterparts. Examining combined strata, we found some variation in survey completion within racial groups. Black participants using a study phone had higher average completion rates during pregnancy and post partum, but this relationship was reversed for White participants. Conclusions: Our secondary analysis showed relatively stable engagement with EMA surveys in a childbearing cohort across 15 months. Increased completion rates among privileged groups (eg, White, higher income) may demonstrate the impact of socioeconomic advantages on individual health behaviors. Investigators should consider how intersections between race and other factors (eg, employment) may impact participation and data collection.

Racial inequities in postpartum weight have been documented with limited studies on the influences of racism and other forms of discrimination. In a prospective longitudinal study applying ecological momentary assessment (EMA) and ambulatory assessment of weight, we measured the association between discrimination, stress, and postpartum weight change. The Postpartum Mothers Mobile Study is a cohort of 313 pregnant and birthing individuals who were followed during their second and third trimesters through 1 year postpartum. They were recruited in clinical settings between 2017 and 2020 in a major city center in Pennsylvania. Measures of racism and gender-based discrimination were collected via random EMA surveys throughout pregnancy and postpartum, and weight was collected via Bluetooth-enabled scales at least weekly. Among Black participants, a 10% increase in the number of days a participant experienced racial discrimination in the past month was associated with retaining 0.3 more pounds, a 10% increase in EMA gender discrimination was associated with retaining 0.4 more pounds, and EMA stress reported in the past month was associated with decreased weight retention. Chronic experiences of racial and gender discrimination may contribute to weight retention immediately after pregnancy and beyond.

BACKGROUND Background: Collection of dietary behavior data is crucial in childbearing populations. In addition to observed inequities in perinatal dietary intake and quality, burdensome assessment methods used (e.g., 24-hour dietary recall) may limit research participation for some groups. Ecological momentary assessment (EMA) is associated with reduced recall bias and participant convenience, but there is a dearth of studies with diverse cohorts. OBJECTIVE Objective: Our aim is to describe participant completion of dietary intake items in EMA surveys, overall and across individual characteristics (e.g., pre-pregnancy body mass index). METHODS Methods: Using EMA data from participants in a longitudinal study, we report average completion rates of survey items regarding dietary behavior (e.g., number of meals eaten in a day) across demographic variables (e.g., age) and intersectional strata (e.g., race + age) during late pregnancy and throughout 12 months’ postpartum. RESULTS Results: In our analytic sample (N=310), average completion rates were 59.1% during pregnancy, dropping to 52.4% after giving birth. Participants who were older (>30 years), overweight before pregnancy, self-identified as white, working, or earning higher annual income (>$50,000) had higher average completion rates than their counterparts. Examining intersectional strata, we found some variation in survey completion within racial groups. Black participants using a study phone had higher average completion rates during pregnancy and postpartum, but this relationship was reversed for white participants. CONCLUSIONS Discussion: We showed relatively stable engagement with EMA surveys in a childbearing cohort across 15 months. Increased completion rates among privileged groups (e.g., white, higher income) may demonstrate the impact of socioeconomic advantages on individual health behaviors. Investigators should consider how intersections between race and other factors (e.g., employment) may impact participation and data collection.

Background: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. Objective: This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. Methods: We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: “pre” phase (baseline), “early” phase (first case of COVID-19 reported in United States), “during” phase (stay-at-home orders), and “post” phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. Results: Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=–0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). Conclusions: There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. International Registered Report Identifier (IRRID): RR2-10.2196/13569

BACKGROUND Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. OBJECTIVE This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. METHODS We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: “pre” phase (baseline), “early” phase (first case of COVID-19 reported in United States), “during” phase (stay-at-home orders), and “post” phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. RESULTS Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=–0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). CONCLUSIONS There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. INTERNATIONAL REGISTERED REPORT RR2-10.2196/13569

Background: In the United States, there are considerable racial inequities in adverse perinatal outcomes. Exposure to racism, sexism, and other forms of oppression may help explain these inequities.Objectives: To describe the application of real‐time data collection using ecological momentary assessment (EMA) and smartphone technology to assess exposure to stress, racism, sexism, microaggressions, and other forms of oppression.Methods: The Postpartum Mothers Mobile Study (PMOMS) is an ongoing longitudinal cohort study that began recruitment in December 2017. Participants delivering at a hospital in Pittsburgh, PA are recruited by 29 weeks' gestation. Using smartphones and smart scales, participants complete daily surveys related to psychosocial, behavioural, and contextual factors and weigh themselves weekly for approximately 15 months. We provide a preliminary descriptive analysis of EMA self‐reported measures of stress, racism, sexism, and microaggressions; and non‐EMA measures of stress and major discrimination.Results: The sample (n = 230) is 63.5% White, 24.8% Black/African American, and 7% Hispanic origin. The most commonly reported item from the Major Discrimination Scale is being unfairly fired (18.1% of the sample). Of those, 31.7% and 17.1% attribute unfair firing to their gender and race, respectively. From the random EMA measures, on average, participants report experiences of racism and sexism at least once daily, in an average 12‐hour day over the 4‐week period. Black participants indicate about two experiences per day of racism, and White participants indicate more than 1 per day of sexism. Mean stress levels from the EMA measures were similar to the stress measures collected at baseline.Conclusions: The methods applied in PMOMS provide real‐time data regarding how participants' daily experiences of stress and discrimination influence their lives. Future work will include understanding if and how these EMA measures may relate to already established measures of racism, sexism, and stress; and ultimately understanding associations with perinatal inequities.

Objective: To assess the bioburden in an orthokeratology contact lens (OK) care system (defined by microbial identification from OK case fluid) and to identify the risk factors causing high bioburden for pediatric OK wearers in southern Taiwan. Methods: A prospective study for the investigation of bioburden in the OK care system was performed in a tertiary medical center in southern Taiwan. Microbial isolates from the case fluids soaking OKs were analyzed, and pathogenicity was determined. Age, gender, OK experiences, and contact lens care habits were considered the potential risk factors of microbial bioburden (colony-forming units per milliliter) for causal analysis. Results: Forty-one OK wearers (20 female and 21 male subjects) participated in this study. The mean age was 12.7 years, and the mean OK-wearing experience was 3.5 years. A total of 86 microbial strains were isolated from 38 culture-positive specimens. Frequently reported pathogens in contact lens–related microbial keratitis were less common in the current study, but still present, including 4 strains (5%) of Serratia marcescens, 1 strain (1%) of Pseudomonas aeruginosa, and 1 strain (1%) of Staphylococcus aureus. Microbial bioburden of the OK care system was significantly higher (P<0.05) in male subjects. Conclusions: The contamination rate of the OK care system was high, and many isolated microorganisms had potential pathogenicity. Reinforcement of proper contact lens care and education should be mandatory for OK wearers, particularly for male subjects, to decrease the risk of high bioburden of the OK care system.

The new strategy reported here facilitated analysis of long and highly structured genetic sequences, realizing specific identification of NDM and accurate evaluation of its drug resistance.