Tiffany A. Moore

Research on the human microbiome, particularly the gut microbiome, has expanded rapidly as its influence on health and behavior becomes increasingly evident. Once understood primarily in terms of digestion and immune function, the microbiome is now recognized as a key contributor to brain function, mood regulation, and social behavior. Emerging evidence links microbial dysbiosis to the onset and persistence of mood disorders, opening new pathways for mental health research and intervention. This paper challenges reductionist biomedical models by advancing a biopsychosocial framework for interpreting health outcomes related to microbiome dynamics. The gut–brain axis illustrates the biological complexity of these interactions, with microbial communities shaping neurodevelopment and neurotransmitter production. Psychologically, alterations in microbial composition have been associated with depression, anxiety, and stress responsivity, while social determinants—including early-life environments, socioeconomic conditions, and relationships—structure microbial variation in ways that may reinforce existing health inequities. Focusing on women’s health, this narrative review examines how microbial states both influence and are shaped by interconnected biological, psychological, and social factors. Interdisciplinary implications of microbiome research for understanding and achieving eubiosis and holistic models care in both research and clinical practice are discussed.

Background: Ectopic pregnancy has been observed to follow temporal patterns. Despite nearly a century of documented trends, no standardized approach has been established to define, understand, or investigate these patterns. Doing so could provide insights into possible environmental, biological, or sociocultural factors driving these patterns. Objective: This scoping review aimed to synthesize the evidence of temporal patterns in tubal ectopic pregnancy rates worldwide, assess the methodologies, and identify research gaps possibly hindering causal factors inquiry. Methods: Following Joanna Briggs Institute guidelines, we searched EMBASE, MEDLINE, CINAHL, The Cochrane Library, Scopus, and Google Scholar in June 2024. Peer-reviewed studies, gray literature, and editorial sources reporting seasonal, monthly, or quarterly fluctuations in tubal ectopic pregnancy incidence in humans were considered without limitation to publication year. Study characteristics, analytic approaches, noted limitations, temporal trends, and hypotheses to explain those trends were extracted and summarized descriptively. Results: Thirty-two studies spanning 18 countries, published between 1932 and 2022, met eligibility criteria. Many studies reported seasonal or monthly peaks, though findings were inconsistent worldwide. Data sources, incidence denominators, and methods for analyzing ectopic pregnancy temporal patterns were heterogenous. Studies used either the estimated conception date or diagnosis date as the timepoint of interest for analysis, a methodological difference that limited cross-study comparisons. Conclusions: There are significant methodological gaps in the study of ectopic pregnancy temporal patterns. To improve temporal analysis and generalizability, future research should use data sets that include outpatient records and conduct conception date-based analysis with universal units of time like weeks or months.

Background: Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness. Objective: This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group. Methods: A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model. Results: The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024. Conclusions: The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention. Trial Registration: ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615 International Registered Report Identifier (IRRID): DERR1-10.2196/58580

Objectives: Research on Black maternal populations often focuses on deficits that can reinforce biases against Black individuals and communities. The research landscape must shift towards a strengths-based approach focused on the protective assets of Black individuals and communities to counteract bias. This study engaged the local Black community using a strengths-based approach to discuss the assets of Black maternal populations and to inform the design of a future clinical trial focused on reducing Black maternal health disparities. Design: Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including the strengths of the local community, strengths specific to pregnant community members, how the strengths of community members can support pregnant individuals, and how the strengths of pregnant community members can facilitate a healthy pregnancy. The focus group interviews were transcribed verbatim and analyzed using thematic content analysis. Results: Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) the power of pregnancy and motherhood in Black women, (2) challenging negative perceptions and media representation of Black mothers, (3) recognizing history and reclaiming cultural traditions surrounding birth, and (4) community as the foundation of Black motherhood. Conclusion: Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered relationships with the Black community, elucidated possible solutions to improve Black women's health and wellness, and offered direction on our research design and intervention.

BACKGROUND Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness. OBJECTIVE This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group. METHODS A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model. RESULTS The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024. CONCLUSIONS The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention. CLINICALTRIAL ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/58580

Purpose: Chronic stress related to health disparities results in negative health outcomes for mothers and infants. The brain-gut-immune axis plays a significant role in perinatal health outcomes. Researchers have not focused on the effects of rural living on the maternal/infant gut microbiome. The purpose of our study was to validate recruitment protocols, data and specimen collection protocols, participant feedback, and participant retention strategies for future studies in a rural Nebraska population of mother/infant dyads. Sample: Mother/infant dyads living in Nebraska counties with a rural-urban commuting area (RUCA) code of three or greater (n = 17 dyads, n = 1 triad). Methods: We conducted a cross-sectional pilot feasibility study by collecting stool samples, actigraph data, sleep diaries, and health and lifestyle questionnaires from mother/infant dyads living in rural Nebraska counties. Findings: Retrospective review of this pilot study identified the main feasibility findings were primarily related to distance: 1) relying on virtual recruiting methods was cost-effective; 2) stool sample shelf-life created participant inconvenience; 3) shipping carrier delays affected collection timing of actigraph data; 4) participant access to shipping carrier drop-offs increased cost and inconvenience. Conclusion: Rural locations create barriers to research, but none are insurmountable. When working with rural populations, it is important to consider the potential adaptation of participant recruitment methods and protocol procedures, including careful attention to shipping and related time constraints that may impact data collection. DOI: https://doi.org/10.14574/ojrnhc.v23i2.740

Background: Research on Black maternal populations often focus on deficits that can reinforce biases against Black individuals and communities. To counteract this, the research landscape must shift towards a strengths-based approach, focusing on the protective assets of Black individuals and communities. To inform the design of a future clinical trial focused on reducing Black maternal health disparities, this study engaged the local Black community using a strengths-based approach to explore the assets of Black maternal populations. Methods: Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including (1) strengths of the local community, (2) strengths specific to pregnant community members, (3) how the strengths of the community members can support pregnant individuals, and (4) how the strengths of pregnant community members can facilitate a healthy pregnancy. Focus group interviews were analyzed by using thematic content analysis. Results: Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) The power of pregnancy and motherhood in Black women; (2) Challenging negative perceptions and media representation of Black mothers; (3) Recognizing history and reclaiming cultural traditions surrounding birth; and (4) Community as the foundation to Black motherhood. Conclusion: Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered important relationships with the Black community, elucidated possible solutions to improving Black women’s health and wellness, and offered direction on our research design and intervention.

Background: Pathologic changes in the microbiome (dysbiosis) have been implicated in affecting the growth and neurodevelopment of infants and children. There is evidence to suggest that prenatal and postnatal stressors may be a factor in dysbiosis and there is also a growing body of evidence to suggest that interventions may reduce this negative impact. A scoping review was undertaken to identify association between maternal and/or child microbiome with child growth and neurodevelopment. Additionally, intervention studies such as use of nutritional supplementation and its impact on the microbiome, growth and neurodevelopment were reviewed. Methods: An exhaustive literature search identified 654 relevant citations. After review of abstracts, 557 were eliminated, and 97 remained for full text review. We identified and reported on 42 articles which met inclusion criteria. Results: Seven studies examined associations between microbiome and neurodevelopment and 36 studies evaluated anthropometric measurements, most commonly weight, and microbiota relationships. One study evaluated both growth and neurodevelopment and microbiota. Fourteen studies evaluated supplemental nutrients. Preterm, low birth weight (LBW), and very low birth weight (VLBW) infants were most studied. Findings were inconclusive for consistent associations between microbiota and growth and neurodevelopment. Further, there were no consistent conclusive changes with prescribed treatment interventions. Discussion: There is a need for high-quality longitudinal studies evaluating repeated developmental assessment measures using consistent microbial analysis techniques to inform conclusions regarding the association between microbiome and infant and child growth and neurodevelopment. Additional intervention studies that may mitigate dysbiosis are warranted.

Background: Prior to the COVID-19 pandemic, parents of infants in the Neonatal Intensive Care Unit (NICU) frequently reported high levels of stress, uncertainty, and decreased parenting confidence. Early research has demonstrated that parents have had less access to their infants in the hospital due to restrictions on parental presence secondary to the pandemic. It is unknown how parents have perceived their experiences in the NICU since the beginning of the COVID-19 pandemic. The purpose of this study was to describe the lived experience of parents who had an infant in the NICU in the context of the COVID-19 pandemic to inform healthcare providers and policy makers for future development of policies and care planning. Methods: The study design was a qualitative description of the impact of the COVID-19 pandemic on parents’ experiences of having an infant in the NICU. Free-text responses to open-ended questions were collected as part of a multi-method study of parents’ experiences of the NICU during the first six months of the pandemic. Participants from the United States were recruited using social media platforms between the months of May and July of 2020. Data were analyzed using a reflexive thematic approach. Findings: Free-text responses came from 169 parents from 38 different states in the United States. Three broad themes emerged from the analysis: (1) parents’ NICU experiences during the COVID-19 pandemic were emotionally isolating and overwhelming, (2) policy changes restricting parental presence created disruptions to the family unit and limited family-centered care, and (3) interactions with NICU providers intensified or alleviated emotional distress felt by parents. A unifying theme of experiences of emotional distress attributed to COVID-19 circumstances ran through all three themes. Conclusions: Parents of infants in the NICU during the first six months of the COVID-19 pandemic experienced emotional struggles, feelings of isolation, lack of family-centered care, and deep disappointment with system-level decisions. Moving forward, parents need to be considered essential partners in the development of policies concerning care of and access to their infants.

Dysregulation of inflammatory processes is linked to perinatal complications yet a comprehensive description of cytokine levels throughout the perinatal period is lacking. We report prospective, se...