BackgroundGestational diabetes mellitus (GDM) contributes to the epidemic of diabetes and obesity in mothers and their offspring. The primary objective of this pilot study was to: 1) refine the GDM Management System (GooDMomS), a web-based pregnancy and postpartum behavioral intervention and 2) assess the feasibility of the intervention.MethodsIn phase 1, ten semi-structured interviews were conducted with women experiencing current or recent GDM mellitus GDM to garner pilot data on the web based intervention interface, content, and to solicit recommendations from women about refinements to enhance the GooDMomS intervention site. Interviews were audiotaped, transcribed and independently reviewed to identify major themes with Atlas.ti v7.0. In phase 2, a single-arm feasibility study was conducted and 23 participants were enrolled in the GooDMomS program. Participants received web lessons, self-tracking of weight and glucose, automated feedback and access to a message board for peer support. The primary outcome was feasibility, including recruitment and retention and acceptability. Secondary outcomes included the proportion of women whose gestational weight gain (GWG) was within the Institute of Medicine (IOM) guidelines and who were able to return to their pre-pregnancy weight after delivery.ResultsComments from semi-structured interviews focused on: 1) usability of the on-line self-monitoring diary and tracking system, 2) access to a safe, reliable social network for peer support and 3) ability of prenatal clinicians to access the on-line diary for clinical management. Overall, 21 (91 %) completed the pregnancy phase. 15/21 (71 %) of participants were within the Institute of Medicine (IOM) guidelines for GWG. Sixteen (70 %) completed the postpartum phase. 7/16 (43 %) and 9/16 (56 %) of participants returned to their pre-pregnancy weight at 6 and 30 weeks postpartum, respectively.ConclusionsThis study documents the feasibility of the GooDMomS program. The results can have implications for web technology in perinatal care and inform the current care paradigm for women with GDM. Findings are supportive of further research with recruitment of a larger sample of participants and comparison of the outcomes with the intervention and standard care.Trial registrationThe study was registered at ClinicalTrials.gov on May 15, 2012 under protocol no. NCT01600534.

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Background Medication treatment for opioid use disorder (M-OUD) is underutilized, despite research demonstrating its effectiveness in treating opioid use disorder (OUD). The UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (UNC ECHO for MAT) project was designed to evaluate interventions for reducing barriers to delivery of M-OUD by rural primary care providers in North Carolina. A key element was tele-conferenced sessions based on the University of New Mexico Project ECHO model, comprised of case discussions and didactic presentations using a “hub and spoke” model, with expert team members at the hub site and community-based providers participating from their offices (i.e., spoke sites). Although federal funders have promoted use of the model, barriers for providers to participate in ECHO sessions are not well documented. Methods UNC ECHO for MAT included ECHO sessions, provider-to-provider consultations, and practice coaching. We conducted 20 semi-structured interviews to assess perceived usefulness of the UNC ECHO for MAT intervention, barriers to participation in the intervention, and persistent barriers to prescribing M-OUD. Results Participants were generally satisfied with ECHO sessions and provider-to-provider consultations; however, perceived value of practice support was less clear. Primary barriers to participating in ECHO sessions were timing and length of sessions. Participants recommended recording ECHO sessions for viewing later, and some thought incentives for either the practice or provider could facilitate participation. Providers who had participated in ECHO sessions valued the expertise on the expert team; the team's ability to develop a supportive, collegial environment; and the value of a community of providers interested in learning from each other, particularly through case discussions. Conclusions Despite the perceived value of ECHO, barriers may prevent consistent participation. Also, barriers to M-OUD delivery remain, including some that ECHO alone cannot address, such as Medicaid and private-insurer policies and availability of psychosocial resources.

Objectives: Involuntary child removal via the child protection system disproportionately affects marginalized women, yet the impacts on maternal health are under-investigated. This study prospectively examined the association of child removal with self-rated health of mothers who are sex workers. Given high levels of intergenerational family separation in this population, particularly among Indigenous sex workers, we also estimated joint effects of child removal spanning two generations.Methods: Analyses drew on 2010-2015 data from AESHA (An Evaluation of Sex Workers' Health Access), a prospective cohort of sex workers (n=950) in Vancouver, Canada. Using logistic regression with generalized estimating equations, we modeled the association of past child

igh rates of infant mortality and morbidity persist in North Carolina despite efforts at the state and federal level to improve women's physical health and access to prenatal care in order to promote healthy birth outcomes. While infant mortality and low birth weight rates have declined over the past decade, more focused attention to women's behavioral health, specifically mental illness and substance use disorders, is needed to further close this gap. Women's mental health and substance use are often overlooked as determinants of both preconceptional health and pregnancy outcomes. This is regrettably shortsighted: addiction and mental illness not only pose risks to prenatal development and birth outcomes but also impair women's ability to be safe and sober mothers. Promoting positive birth outcomes requires that health care providers, policymakers, and communities in North Carolina collaborate to create a system of comprehensive care in order to support women's recovery from mental illness and substance abuse. PrevalenceThough overall rates of having any mental disorder are similar for men and women, the prevalence of specific disorders vary greatly by gender. According to the National Household Survey on Drug Use and Health, in 2007 the prevalence of serious mental illness (defined as a diagnosable mental, behavioral, or emotional disorder with substantial functional impairment) was higher in women, particularly those of reproductive age, than in men: 13.5% in women versus 10% in men for ages 18-25 and 10.1% versus 5.5% for ages 26-49.1 More women, 11.6% versus 7.7%, suffered mood disorders. 1 Substance use disorders are less common among women, with overall prevalence of substance use disorders of 5.7% among women as compared to 12.3% among men. 1Mental illness and substance use disorders are associated with significant morbidity, mortality, and disability. One in four individuals visiting a health care provider has at least one mental or behavioral disorder, yet these often go undiagnosed and untreated. 2 In the United States, only about one in four individuals who need substance abuse treatment receive it. 3 Failure to diagnose and treat has serious negative consequences. Mental illnesses are associated with increased risk of cardiovascular disease and diabetes and an increase of high-risk behaviors associated with substance abuse or HIV transmission. 2 Women who abuse substances are at increased risk for a variety of adverse health outcomes, including breast cancer, infertility, mental illness, unintentional injuries, suicide, and intimate partner violence. 4-9 This relationship between mental health, and substance use disorders, and risk behaviors is supported by data from the North Carolina Treatment Outcomes and Program Performance System (NC-TOPPS), a state reporting system that captures service and