Maternal morbidity and mortality rates in the United States continues to rise, with a wide range of contributing factors such as mental illness, cardiovascular disease and systemic inequality. This metastudy provides a holistic view of the research that has been published on the issue of U.S. maternal healthcare from 2000-2022. The patterns of publications on specific topics over time can tell us what is perceived as a current major cause by physicians, public leaders, researchers, and the public. A deeper dive into systemic inequality as a cause of maternal morbidity and mortality highlights it as a major contributor to these high rates, but that progress is slowly being made through the implementation of detection and prevention tactics, as well as accessible prenatal programs and care.
Methods: Participants were recruited from the parent REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. ActicalTM accelerometers provided estimates of PA variables, including moderate-to-vigorous PA (MVPA), high light PA (HLPA), low light PA (LLPA) and sedentary time, for 4-7 consecutive days. Prevalence and incidence of cognitive impairment were defined by the Six-Item Screener. Letter fluency, animal fluency, word list learning and Montreal Cognitive Assessment (orientation and recall) were conducted to assess executive function and memory.
Results: Of the 7,339 participants who provided accelerometer wear data > 4 days (70.1 ± 8.6 yr, 54.2% women, 31.7% African American), 320 participants exhibited impaired cognition. In cross-sectional analysis, participants in the highest MVPA% quartile had 39% lower odds of cognitive impairment than those in the lowest quartile (OR: 0.61, 95% C.I.: 0.39-0.95) after full adjustment. Further analysis shows most quartiles of MVPA% and HLPA% were significantly associated with executive function and memory (P<0.01). During 2.7 ± 0.5 years of follow-up, 3,385 participants were included in the longitudinal analysis, with 157 incident cases of cognitive impairment. After adjustments, participants in the highest MVPA% quartile had 51% lower hazards of cognitive impairment (HR: 0.49, 95% C.I.: 0.28-0.86). Additionally, MVPA% was inversely associated with change in memory z-scores (P<0.01), while the highest quartile of HLPA% was inversely associated with change in executive function and memory z-scores (P<0.01).
Conclusion: Higher levels of objectively measured MVPA% were independently associated with lower prevalence and incidence of cognitive impairment, and better memory and executive function in older adults. Higher levels of HLPA% were also independently associated with better memory and executive function. The amount of MVPA associated with lower risk of cognitive impairment (259 min/week) is >70% higher than the minimal amount of MVPA recommended by PA guidelines.
damage, immune system activation, impaired protein function, or aberrant DNA methylation. In the case of DNA methylation, I demonstrate that inhibiting DNA methylation dynamics can impair long-term memory formation, while the nurse-to- forager transition is not altered. These experiments could serve as the bases for and reference groups of studies testing the effects of metal or metalloid toxicity on DNA methylation. Each potential mechanism provides an avenue for investigating how neural function is influenced by the physiological status of non-neural organs. And from an ecological perspective, my results highlight the need for environmental policy to consider sublethal effects in determining safe environmental toxin loads for honey bees and other insect pollinators.