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OBJECTIVE:To characterize the changes in health status experienced by a multi-ethnic cohort of women during and after pregnancy. DESIGN: Observational cohort.SETTING/PARTICIPANTS: Pregnant women from 1 of 6 sites in the San Francisco area (N =1,809). MEASUREMENTS AND MAIN RESULTS:Women who agreed to participate were asked to complete a series of telephone surveys that ascertained health status as well as demographic and medical factors. Substantial changes in health status occurred over the course of pregnancy. For example, physical function declined, from a mean score of 95.2 prior to pregnancy to 58.1 during the third trimester (0-100 scale, where 100 represents better health), and improved during the postpartum period (mean score, 90.7). The prevalence of depressive symptoms rose from 11.7% prior to pregnancy to 25.2% during the third trimester, and then declined to 14.2% during the postpartum period. Insufficient money for food or housing and lack of exercise were associated with poor health status before, during, and after pregnancy. CONCLUSIONS:Women experience substantial changes in health status during and after pregnancy. These data should guide the expectations of women, their health care providers, and public policy. W hile pregnancy is a common event for reproductive-age women, surprisingly little has been published about the physical and emotional changes that typically occur during pregnancy and the postpartum period.1-3 Better understanding of the changes in health status that occur over the course of pregnancy could help women define their expectations, and provide data to inform public policies related to the health and function of women. For example, three quarters of reproductive-age women are in the work force. 4 Over 90% of working women continue to work while pregnant, with the majority working into the month before delivery. Of the 60% of women who return to work within 1 year of the birth of their first child, two thirds are back at work within 3 months. 4 Evidence about the health status of women could inform policies related to leave and disability around the time of pregnancy. Finally, better characterization of the physical and emotional changes that typically occur would allow the definition of risk factors for greater or persistent declines in functional status, so that women at risk could be targeted for interventions to promote health and well-being. Because primary care providers provide care for women of reproductive age before, during, and after pregnancy, it is particularly important for them to be aware of the changes in health status that women experience around the time of pregnancy. 5,6Several small studies suggest that the functional status of reproductive-age women is lower during pregnancy and the postpartum period than at other times. [1][2][3]7 A study of 393Canadian women found that pregnant women had more limitations due to emotional problems, and lower levels of vitality, physical functioning, and social functioning than a sample of nonpregnant women. 2 Less is kno...

Interventions to prevent excessive gestational gain may need to start before pregnancy. Women at risk for inadequate gain would also benefit from interventions directed toward modifiable factors during pregnancy.

Women's beliefs about the proper amount of weight gain and provider recommendations for weight gain vary significantly by maternal prepregnancy BMI. Many women report incorrect advice about gestational weight gain, and women with high or low prepregnancy BMI are more likely to have an incorrect target weight gain. New approaches to provider education are needed to implement the IOM guidelines for gestational weight gain.

Latinos recently became the largest racial/ethnic minority group of US children. The Latino Consortium of the American Academy of Pediatrics Center for Child Health Research, consisting of 13 expert panelists, identified the most important urgent priorities and unanswered questions in Latino child health. Conclusions were drawn when consensus was reached among members, with refinement through multiple iterations. A consensus statement with supporting references was drafted and revised. This article summarizes the key issues, including lack of validated research instruments, frequent unjustified exclusion from studies, and failure to analyze data by pertinent subgroups. Latino children are at high risk for behavioral and developmental disorders, and there are many unanswered questions about their mental health needs and use of services. The prevalence of dental caries is disproportionately higher for Latino children, but the reasons for this disparity are unclear. Culture and language can profoundly affect Latino children's health, but not enough cultural competency training of health care professionals and provision of linguistically appropriate care occur. Latinos are underrepresented at every level of the health care professions. Latino children are at high risk for school dropout, environmental hazards, obesity, diabetes mellitus, asthma, lack of health insurance, nonfinancial barriers to health care access, and impaired quality of care, but many key questions in these areas remain unanswered. This article suggests areas in which more research is needed and ways to improve research and care of Latino children.