IAHB 1998620 -SUPPLEMENTARY TABLES Supplement Table S1. Comparisons a of bioactive human milk components by infant sex b after excluding outlying values for leptin (n=1observation), adiponectin (n=1 observation) and interleukin-6 (n=2 observations observations) 1-month post-delivery 3-months post-delivery Unadjusted GM Ratio (95% CI) Adjusted d GM Ratio (95% CI) Unadjusted GM Ratio (95% CI) Adjusted e GM Ratio (95% CI) Leptin (pg/ml) --c --c 0.90 (0.74, 1.09) 0.88 (0.75, 1.02) Adiponectin (ng/ml) --c --c 0.95 (0.84, 1.07) 0.93 (0.82, 1.04) Interleukin-6 (pg/ml) 0.82 (0.60, 1.11) 0.83 (0.61, 1.14) 1.06 (0.80, 1.39) 1.01 (0.77, 1.32) a Linear mixed models were estimated with random effects for laboratory batch. Geometric mean ratios are reported for the logtransformed breast milk components b Females are defined as the reference group c There were no outlying values for leptin or adiponectin measures at 1-month post-delivery. d Adjusted for centre, maternal race/ethnicity, delivery mode, parity, BMI categories, income, maternal age, infant age at 1 month, and gestational age e Adjusted for centre, maternal race/ethnicity, delivery mode, parity, BMI categories, income, maternal age, infant age at 3 months, gestational age, and breastfeeding status at 3 months

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Objective: Describe nutrition and physical activity practices, nutrition self-efficacy and barriers, and food program knowledge within Family Child Care Homes (FCCH), and differences by staffing. Design: Baseline, cross-sectional analyses of the Happy Healthy Homes randomized trial (NCT03560050). Setting: FCCH in Oklahoma, United States Participants: FCCH providers (n=49, 100% women, 30.6% Non-Hispanic Black, 2.0% Hispanic, 4.1% American Indian/Alaska Native, 51.0% Non-Hispanic white, 44.2±14.2 years of age. 53.1% had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers, and food program knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (p<0.01). Results: The prevalence of meeting all nutrition and physical activity best practices ranged from 0.0-43.8% and 4.1-16.7%, respectively. Average nutrition and physical activity scores were 3.2±0.3 and 3.0±0.5 (max 4.0), respectively. Sum nutrition and physical activity scores were 137.5±12.6 (max 172.0) and 48.4±7.5 (max 64.0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73.9-84.7%) felt they could meet food program best practices; however, knowledge of food program best practices was lower than anticipated (median 63-67% accuracy). More providers with additional staff had higher self-efficacy in family style meal service than did those who did not (p=0.006). Conclusions: Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.

body mass index (BMI) and 1st-and 2nd-trimester concentrations of sFlt-1/PlGF as a potential biologic pathway for placental insufficiency. STUDY DESIGN: We conducted secondary analyses of data and samples from a large, multi-site prospective cohort study of nulliparous pregnant women conducted in the U.S. First-and 2nd-trimester blood samples, 1st-trimester BMI, demographic, lifestyle, and pregnancy data were gathered for all participants. sFlt-1 and PlGF concentrations were measured for a subsample of 1,502 cases (delivery<37weeks, preeclampsia or eclampsia, birthweight for gestational age <5th%, or stillbirth) and 911 controls. We used one-way ANOVA and multivariable linear and logistic regression models to test the association of BMI and sFlt-1/PlGF ratio, using a previously published ratio cutoff of 38 in logistic regression. We identified potential confounders a priori and used backward elimination to determine the best-fit model. RESULTS: Plots of mean sFlt-1/PlGF ratios by BMI category and gestational week showed lower ratios in overweight and obese groups in the 1st trimester, which reversed to higher ratios among overweight and obese groups in the 2nd trimester (Fig. 1). After controlling for clinical and demographic factors, women in all high BMI groups had significantly lower mean sFlt-1/PlGF ratios than normal weight women in the 1st trimester (Table 1). In the 2nd trimester, women with BMI 35 had a 35% higher mean sFlt-1/PlGF ratio than normal weight women (p¼0.009). Logistic regression suggested increased odds of a 2nd-trimester ratio 38 among women with BMI 35, though not statistically different from 1.0 (OR 2.59, 95% CI 0.95-7.08). CONCLUSION: Early pregnancy BMI is associated with alterations in firstand second-trimester sFlt-1/PlGF ratios. Findings suggest a potential physiologic pathway between obesity and placental insufficiency.