Quality of Blood Pressure Monitoring During Telehealth Visits for Pregnant Patients at Risk of Preeclampsia.

Introduction: Preeclampsia is a significant cause of morbidity and mortality. The United States Preventative Services Task Force released 2023 recommendations encouraging more research on telehealth's role in facilitating blood pressure monitoring for patients with hypertensive disorders of pregnancy, including preeclampsia. This study evaluates the integration of self-measured blood pressure (SMBP) into telehealth obstetric visits during the COVID-19 pandemic for pregnant patients at risk of preeclampsia. Methods: A retrospective chart review was conducted of patients with one or more preeclampsia risk factors who delivered at a tertiary hospital from January to March 2021. Information pertaining to patients' number of antepartum, postpartum, and telehealth visits, blood pressure cuff access, and documentation of SMBP readings was recorded. Analyses were conducted in RStudio version 2022.12.0 + 353 (R Foundation for Statistical Computing). Results: Of 721 eligible patients, 244 (33.8%) had 2 or more ante- or postpartum telehealth visits. Of these 244 patients, 142 (58.2%) had chart documentation of owning a home blood pressure cuff. Only 106 (43.4%) had 1 or more SMBP documented in their telehealth visit notes, and they were more likely to have received care at federally qualified health centers than maternal fetal medicine clinics (p = 0.018) or private clinics (p < 0.001). Charts revealed no explanation for lack of blood pressure documentation during telehealth visits for most cases (n = 129, 93.5%). Conclusions: Opportunities exist to standardize blood pressure recording and documentation during telehealth visits, especially for patients with risk factors for preeclampsia, and to advocate for greater access to home blood pressure cuffs for all pregnant patients.

Pacific Islands Families Study: adverse impact of food insecurity on child body composition.

AIM: COVID-19 has exacerbated food insecurity, unemployment, inequities and poverty in Aotearoa. Here, we tested the hypothesis that exposure to malnutrition due to household food insecurity during foetal life and early infancy is associated with body composition in adolescence. METHODS: As part of the Pacific Islands Families Study, 1,376 Pacific Island mothers were asked questions about food security at six weeks postpartum in the year 2000. At age 14 years, 931 youth completed in-school assessments of height and weight. Of these youth, 10 girls and 10 boys from each weight decile were randomly selected to participate in a nested sub-study involving dual x-ray absorptiometry measurements, which included appendicular skeletal muscle mass (ASMM) and visceral adipose tissue (VAT). RESULTS: Boys born to families experiencing food insecurity had greater birthweights and greater % fat, less % ASMM and greater % VAT of total weight at age 14 years compared to boys born into food secure households. In contrast, there were no differences in birthweight or body composition at age 14 years by household food insecurity status among girls. CONCLUSION: This study shows that household food insecurity during early development is associated with higher abdominal and visceral fat in boys, which may have health risks in later life.

Fluctuating asymmetry, a marker of poor growth quality, is associated with adult male metabolic rate.

OBJECTIVES: Life history theory, a branch of evolutionary theory, predicts the existence of trade-offs in energetic allocation between competing physiological functions. The core metabolic cost of self-maintenance, measured by resting metabolic rate (RMR), represents a large component of human daily energy expenditure. Despite strong selective pressures for energetic frugality and high observed interindividual variation in RMR, the link between RMR and energetic allocation to life-history traits remains understudied in humans. MATERIALS: In a sample of 105 (m = 57, f = 48), we investigated the relationship between adult RMR and investment in growth quality, as measured by fluctuating asymmetry (FA). RESULTS: Measurement of RMR and FA in university rowers revealed a significant positive correlation amongst males (n = 57, r = 0.344, p = 0.005, 1-tailed; standardized 95% CI, 0.090 to 0.598). Convincing evidence for a correlation among females was not found (n = 48, r = 0.142, p = 0.169, 1-tailed, standardized 95% CI, -0.152 to 0.435). DISCUSSION: The data suggest that low-quality asymmetrical growth is associated with later-life metabolic inefficiencies in males. Energetic investment in processes (likely concerning the stress-response) unrelated to growth during childhood may thereby trade-off against adult metabolic efficiency. We suggest that the presence of a relationship between RMR and FA in males but not females may be explained by the additional metabolic strain associated with larger body size and increased male muscularity, which may amplify the inefficiencies arising from low-quality growth.

Brown Adipose Expansion and Remission of Glycemic Dysfunction in Obese SM/J Mice.

We leverage the SM/J mouse to understand glycemic control in obesity. High-fat-fed SM/J mice initially develop poor glucose homeostasis relative to controls. Strikingly, their glycemic dysfunction resolves by 30 weeks of age despite persistent obesity. The mice dramatically expand their brown adipose depots as they resolve glycemic dysfunction. This occurs naturally and spontaneously on a high-fat diet, with no temperature or genetic manipulation. Removal of the brown adipose depot impairs insulin sensitivity, indicating that the expanded tissue is functioning as an insulin-stimulated glucose sink. We describe morphological, physiological, and transcriptomic changes that occur during the brown adipose expansion and remission of glycemic dysfunction, and focus on Sfrp1 (secreted frizzled-related protein 1) as a compelling candidate that may underlie this phenomenon. Understanding how the expanded brown adipose contributes to glycemic control in SM/J mice will open the door for innovative therapies aimed at improving metabolic complications in obesity.