Objective: To examine the qualitative literature on low-income women's perspectives on the barriers to high-quality prenatal and postpartum care. Data Sources and Study Setting: We performed searches in PubMed, Web of Science, Embase, SocIndex, and CINAHL for peer-reviewed studies published between 1990 and 2021. Study Design: A systematic review of qualitative studies with participants who were currently pregnant or had delivered within the past 2 years and identified as lowincome at delivery. Data Collection/Extraction Methods: Two reviewers independently assessed studies for inclusion, evaluated study quality, and extracted information on study design and themes.Principal Findings: We identified 34 studies that met inclusion criteria, including 23 focused on prenatal care, 6 on postpartum care, and 5 on both. The most frequently mentioned barriers to prenatal and postpartum care were structural. These included delays in gaining pregnancy-related Medicaid coverage, challenges finding providers who would accept Medicaid, lack of provider continuity, transportation and childcare hurdles, and legal system concerns. Individual-level factors, such as lack of awareness of pregnancy, denial of pregnancy, limited support, conflicting priorities, and indifference to pregnancy, also interfered with the timely use of prenatal and postpartum care. For those who accessed care, experiences of dismissal, discrimination, and disrespect related to race, insurance status, age, substance use, and language were common.Conclusions: Over a period of 30 years, qualitative studies have identified consistent structural and individual barriers to high-quality prenatal and postpartum care. Medicaid policy changes, including expanding presumptive eligibility, increased reimbursement rates for pregnancy services, payment for birth doula support, and extension of postpartum coverage, may help overcome these challenges.

Background: Imaging biomarkers for neurodegenerative disease are understudied in diverse populations. The completed Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) and recently launched New IDEAS studies evaluate the clinical impact of amyloid PET in large samples of Medicare beneficiaries across the U.S. with MCI or dementia, enabling comparisons between patients from different racial and ethnic backgrounds. Method: Amyloid PET was performed in 18,295 IDEAS Study participants recruited from 590 clinical sites between 2016-2018. Dementia specialists completed pre-and post-PET case report forms. Medicare claims were followed for 12 months. New IDEAS will enroll 7000 Medicare beneficiaries (minimum 2000 African Americans and 2000 Latinos) with MCI or dementia at ∼350 memory clinics across the US between 2020-2023, following analogous procedures. Quantified social determinants of health (quality of education, midlife/current income, marital status and living arrangement) will be measured. A team involving Vanderbilt University, University of North Carolina and the Alzheimer's Association will use community engaged research principles (community stakeholders as study champions, tailored recruitment strategies) to ensure cohort diversity.Result: Recruitment in IDEAS included a low proportion of minority participants (83.9% White (N=15,568), 3.4% African American (N=639), 4.6% Hispanic (N=848), 1.8% Asian (N=328)). The proportion of positive amyloid scans was lower for African Americans (53.8%), Hispanics (54%) and Asians (45.1%) compared to Whites (62.7%).African Americans (52%), Hispanics (56%) and Asians (47%) presented more frequently with dementia (as opposed to MCI) than Whites (37%). There were disparities in vascular risk factors (hypertension/diabetes: 68%/28% African Americans, 55%/26% Hispanics, 48%/25% Asians, 50%/15% Whites) and lower educational attainment for African Americans and Hispanics. New IDEAS will examine the impact of amyloid PET on health outcomes and patient management in the total cohort and

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