Objective: Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. Method: The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. Results: Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n ϭ 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. Conclusion: Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. Clinical Impact StatementThe current study highlights the high rates of chronic trauma exposure, PTSD, and depression based on self-report measures among pregnant African American women served in an OB/GYN clinic within a public urban hospital. Identification of PTSD in particular among providers and engagement in care among these women was limited and demonstrates the need for improved screening for trauma and PTSD, more accessible culturally responsive trauma-informed care, and better identification of potential barriers to such care for pregnant women within these at-risk communities.

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Background: Breastfeeding is emerging as an important reproductive rights issue in the care of trans and gender nonconforming people. This study sought to understand the tools available to professionals working in the field of trans health to help trans women induce lactation and explore the concept of unmet need. Methods: In November 2018, we conducted a cross-sectional study which surveyed attendees at the World Professional Association for Transgender Health (WPATH) symposium in Buenos Aires, Argentina. Eligible participants were 18 + years old, had professional experience with transgender populations, were able to complete a survey in English, and were conference attendees. Descriptive data were collected using a 14-item written survey encompassing demographic characteristics, experience in transgender health, and lactation induction in trans women. Results: We surveyed 82 respondents (response rate 10.5%), the majority of whom were healthcare professionals (84%). Average age of respondents was 42.3 years old. They represented 11 countries and averaged 8.8 years of work at 21.3 h/week with trans populations. Healthcare professionals in this sample primarily specialized in general/ internal medicine, psychology, endocrinology, and obstetrics/gynecology. One-third of respondents (34%) stated that they have met trans women who expressed interest in inducing lactation. Seventeen respondents (21%) knew of providers, clinics, or programs that facilitated the induction of lactation through medication or other means. Seven respondents (9%) have helped trans women induce lactation with an average of 1.9 trans women in the previous year. Two protocols for lactation induction were mentioned in free text responses and 91% believe there is a need for specialized protocols for trans women. Conclusion: This exploratory study demonstrates healthcare professionals' interest in breastfeeding protocols for lactation induction in trans women. Additional studies are needed to capture insights from breastfeeding specialists, e.g. lactation consultants and peripartum nurses, and to understand patients' perspectives on this service.

INTRODUCTION: Despite having been linked to numerous benefits for both mother and child, many women do not initiate breastfeeding postpartum. The current study aims to identify sociodemographic, psychiatric, and obstetric predictors of self-reported breastfeeding at the postpartum visit. METHODS: Pregnant women of all gestational ages (n=238) were recruited at Grady Memorial Hospital in Atlanta, GA, through the Grady Trauma Project. IRB approval was obtained for the study. Trauma exposure, depression, and PTSD symptoms were assessed. Data were abstracted from the medical record regarding prenatal care, delivery outcomes, perinatal complications, and breastfeeding. RESULTS: In the current sample, 32.4% reported breastfeeding and 67.6% reported bottle-feeding (formula). African American women (P=.021) and women with less education (P=.024) were less likely to breastfeed. Increased breastfeeding was associated with increased gravidity (P=.003), prior preterm births (P=.004), prior abortions (p less than 0.001), APGAR score at 5 minutes (p less than 0.001), NICU admission (p less than 0.001), estimated blood loss at delivery (p less than 0.001), delivery complications (p less than 0.001), number of triage visits (P=.013), and admissions from triage (P=.019). CONCLUSION: Our results indicate that more adverse perinatal and prenatal factors are predictive of greater breastfeeding. This may be due to increased interaction with providers in a hospital setting, or increased confidence in breastfeeding ability due to success in prior pregnancies. However, the rate of women who breastfeed was significantly below the national average (83.2%) and standards set for Healthy People 2020 breastfeeding goals. Provider education may be key to improving likelihood of successful breastfeeding initiation.

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