TY - BOOK AU - Institute of Medicine A2 - Adam C. Berger A2 - Steve Olson TI - The Economics of Genomic Medicine: Workshop Summary SN - DO - 10.17226/18276 PY - 2013 UR - https://nap.nationalacademies.org/catalog/18276/the-economics-of-genomic-medicine-workshop-summary PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The sequencing of the human genome and the identification of links between specific genetic variants and diseases have led to tremendous excitement over the potential of genomics to direct patient treatment toward more effective or less harmful interventions. Still, the use of whole genome sequencing challenges the traditional model of medical care where a test is ordered only when there is a clear indication for its use and a path for downstream clinical action is known. This has created a tension between experts who contend that using this information is premature and those who believe that having such information will empower health care providers and patients to make proactive decisions regarding lifestyle and treatment options. In addition, some stakeholders are concerned that genomic technologies will add costs to the health care system without providing commensurate benefits, and others think that health care costs could be reduced by identifying unnecessary or ineffective treatments. Economic models are frequently used to anticipate the costs and benefits of new health care technologies, policies, and regulations. Economic studies also have been used to examine much more specific issues, such as comparing the outcomes and cost effectiveness of two different drug treatments for the same condition. These kinds of analyses offer more than just predictions of future health care costs. They provide information that is valuable when implementing and using new technologies. Unfortunately, however, these economic assessments are often limited by a lack of data on which to base the examination. This particularly affects health economics, which includes many factors for which current methods are inadequate for assessing, such as personal utility, social utility, and patient preference. To understand better the health economic issues that may arise in the course of integrating genomic data into health care, the Roundtable on Translating Genomic-Based Research for Health hosted a workshop in Washington, DC, on July 17-18, 2012, that brought together economists, regulators, payers, biomedical researchers, patients, providers, and other stakeholders to discuss the many factors that may influence this implementation. The workshop was one of a series that the roundtable has held on this topic, but it was the first focused specifically on economic issues. The Economics of Genomic Medicine summarizes this workshop. ER - TY - BOOK AU - Institute of Medicine A2 - Sarah S. Brown A2 - Leon Eisenberg TI - The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families SN - DO - 10.17226/4903 PY - 1995 UR - https://nap.nationalacademies.org/catalog/4903/the-best-intentions-unintended-pregnancy-and-the-well-being-of PB - The National Academies Press CY - Washington, DC LA - English KW - Behavioral and Social Sciences KW - Health and Medicine AB - Experts estimate that nearly 60 percent of all U.S. pregnancies—and 81 percent of pregnancies among adolescents—are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted. Now, current issues—health care and welfare reform, and the new international focus on population—are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts. This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs. The Best Intentions explores problematic definitions—"unintended" versus "unwanted" versus "mistimed"—and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear. Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care." The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals. ER - TY - BOOK AU - Institute of Medicine AU - National Research Council A2 - Anne Brown Rodgers A2 - Ann L. Yaktine TI - Leveraging Action to Support Dissemination of the Pregnancy Weight Gain Guidelines: Workshop Summary SN - DO - 10.17226/18410 PY - 2013 UR - https://nap.nationalacademies.org/catalog/18410/leveraging-action-to-support-dissemination-of-the-pregnancy-weight-gain-guidelines PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Food and Nutrition AB - Since 1990, when the last guidelines for weight gain during pregnancy were issued, the average body weight of women entering their childbearing years has increased considerably, with a greater percentage of these women now classified as overweight or obese. Women of childbearing age are also more likely to have chronic conditions such as high blood pressure or diabetes and to be at risk for poor maternal and child health outcomes. All of these factors increase the likelihood of poor pregnancy outcomes for women and their infants. As part of the continuing effort of The Institute of Medicine (IOM) and the National Research Council (NRC) to promote the revised pregnancy weight gain guidelines recommended in their 2009 study Weight Gain During Pregnancy: Reexamining the Guidelines, the IOM and NRC convened a workshop in March, 2013, to engage interested stakeholders, organizations, and federal agencies in a discussion of issues related to encouraging behavior change that would reflect the updated guidelines on weight gain during pregnancy. During the workshop, the IOM and NRC presented newly developed information resources to support guidance based on the recommendations of the 2009 report. Leveraging Action to Support Dissemination of the Pregnancy Weight Gain Guidelines summarizes the workshop's keynote address and the various presentations and discussions from the workshop, highlighting issues raised by presenters and attendees. Interested stakeholders, organizations, health professionals, and federal agencies met to discuss issues related to encouraging behavior change that would reflect the updated guidelines on weight gain during pregnancy. This report discusses conceptual products as well as products developed for dissemination, ways to facilitate and support behavior change to achieve healthy weight pre- and postpregnancy, and how to put the weight gain guidelines into action to implement change. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Jennifer E. DeVoe A2 - Amy Geller A2 - Yamrot Negussie TI - Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity SN - DO - 10.17226/25466 PY - 2019 UR - https://nap.nationalacademies.org/catalog/25466/vibrant-and-healthy-kids-aligning-science-practice-and-policy-to PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Children are the foundation of the United States, and supporting them is a key component of building a successful future. However, millions of children face health inequities that compromise their development, well-being, and long-term outcomes, despite substantial scientific evidence about how those adversities contribute to poor health. Advancements in neurobiological and socio-behavioral science show that critical biological systems develop in the prenatal through early childhood periods, and neurobiological development is extremely responsive to environmental influences during these stages. Consequently, social, economic, cultural, and environmental factors significantly affect a child's health ecosystem and ability to thrive throughout adulthood. Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity builds upon and updates research from Communities in Action: Pathways to Health Equity (2017) and From Neurons to Neighborhoods: The Science of Early Childhood Development (2000). This report provides a brief overview of stressors that affect childhood development and health, a framework for applying current brain and development science to the real world, a roadmap for implementing tailored interventions, and recommendations about improving systems to better align with our understanding of the significant impact of health equity. ER - TY - BOOK AU - Institute of Medicine AU - National Academies of Sciences, Engineering, and Medicine TI - Roundtable on Translating Genomic-Based Research for Health: 2011 Annual Report DO - 10.17226/26250 PY - 2012 UR - https://nap.nationalacademies.org/catalog/26250/roundtable-on-translating-genomic-based-research-for-health-2011-annual PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine ER - TY - BOOK AU - Institute of Medicine TI - Clinical Preventive Services for Women: Closing the Gaps SN - DO - 10.17226/13181 PY - 2011 UR - https://nap.nationalacademies.org/catalog/13181/clinical-preventive-services-for-women-closing-the-gaps PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Women suffer disproportionate rates of chronic disease and disability from some conditions, and often have high out-of-pocket health care costs. The passage of the Patient Protection and Affordable Care Act of 2010 (ACA) provides the United States with an opportunity to reduce existing health disparities by providing an unprecedented level of population health care coverage. The expansion of coverage to millions of uninsured Americans and the new standards for coverage of preventive services that are included in the ACA can potentially improve the health and well-being of individuals across the United States. Women in particular stand to benefit from these additional preventive health services. Clinical Preventive Services for Women reviews the preventive services that are important to women's health and well-being. It recommends that eight preventive health services for women be added to the services that health plans will cover at no cost. The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The services include improved screening for cervical cancer, sexually transmitted infections, and gestational diabetes; a fuller range of contraceptive education, counseling, methods, and services; services for pregnant women; at least one well-woman preventive care visit annually; and screening and counseling for interpersonal and domestic violence, among others. Clinical Preventive Services for Women identifies critical gaps in preventive services for women as well as measures that will further ensure optimal health and well-being. It can serve as a comprehensive guide for federal government agencies, including the Department of Health and Human Services and the Center for Disease Control and Prevention; state and local government agencies; policy makers; health care professionals; caregivers, and researchers. ER - TY - BOOK AU - Institute of Medicine AU - National Academy of Sciences TI - Nutrition Services in Perinatal Care: Second Edition SN - DO - 10.17226/2022 PY - 1992 UR - https://nap.nationalacademies.org/catalog/2022/nutrition-services-in-perinatal-care-second-edition PB - The National Academies Press CY - Washington, DC LA - English KW - Food and Nutrition AB - This book focuses on nutrition services beginning in the preconceptional period and extending well beyond birth. It provides the rationale for the recommended nutritional services; briefly describes the necessary elements of these services; and indicates the personnel, knowledge, skills, and specialized education or training that may be needed to deliver them. It will be useful to policymakers, hospital administrators, directors of health centers, physicians in private or group practices, and others responsible for setting such standards and for overseeing health care services for expectant and new mothers and their infants. ER - TY - BOOK AU - Institute of Medicine TI - Nutrition During Pregnancy and Lactation: An Implementation Guide SN - DO - 10.17226/1984 PY - 1992 UR - https://nap.nationalacademies.org/catalog/1984/nutrition-during-pregnancy-and-lactation-an-implementation-guide PB - The National Academies Press CY - Washington, DC LA - English KW - Food and Nutrition KW - Health and Medicine AB - Authorities agree that nutritional care for pregnant, about-to-be pregnant, and nursing women can prevent health problems that are costly in terms of both dollars and quality of life. Yet many women still receive little guidance regarding maternal nutrition. Now, health care professionals can turn to a handy, practical guide for help in smoothly integrating maternal nutritional care into their practices. Nutrition During Pregnancy and Lactation provides physicians, nurses, primary care providers, and midwives with a ready-made, step-by-step program for helping new mothers. The guide—based on the two most authoritative volumes available on the topic, both from the Institute of Medicine—Nutrition During Pregnancy (1990) and Nutrition During Lactation (1991)—makes the findings and recommendations detailed in these books readily accessible for daily use. In keeping with recommendations by the U.S. Surgeon General, the guide promotes breastfeeding and includes practical information for mothers on how to breastfeed. Providing background details, resource lists, and a "toolbox" of materials, this implementation guide makes nutritional care simple and straightforward. Part I walks the health care professional through the process of providing nutritional advice for new mothers—from the pre-pregnancy questionnaire to the final postpartum visit. It includes helpful tools such as weight charts and checklists to follow during each patient visit. It also offers suggestions on encouraging nutritional eating habits and helping patients with problems such as nausea and nursing twins. Part II offers a wide range of practical information and guidelines on important topics, such as serving culturally diverse populations, making dietary assessments throughout pregnancy and lactation, and providing dietary advice in understandable, day-to-day terms. The guide explains how to determine if patients need vitamin-mineral supplements and what regimens to recommend. And, it includes information on referring patients to federal food and nutrition programs. The guide is tabbed for quick reference and each page is designed for the reader to find information easily. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine TI - Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda SN - DO - 10.17226/25201 PY - 2019 UR - https://nap.nationalacademies.org/catalog/25201/fostering-healthy-mental-emotional-and-behavioral-development-in-children-and-youth PB - The National Academies Press CY - Washington, DC LA - English KW - Behavioral and Social Sciences AB - Healthy mental, emotional, and behavioral (MEB) development is a critical foundation for a productive adulthood. Much is known about strategies to support families and communities in strengthening the MEB development of children and youth, by promoting healthy development and also by preventing and mitigating disorder, so that young people reach adulthood ready to thrive and contribute to society. Over the last decade, a growing body of research has significantly strengthened understanding of healthy MEB development and the factors that influence it, as well as how it can be fostered. Yet, the United States has not taken full advantage of this growing knowledge base. Ten years later, the nation still is not effectively mitigating risks for poor MEB health outcomes; these risks remain prevalent, and available data show no significant reductions in their prevalence. Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda examines the gap between current research and achievable national goals for the next ten years. This report identifies the complexities of childhood influences and highlights the need for a tailored approach when implementing new policies and practices. This report provides a framework for a cohesive, multidisciplinary national approach to improving MEB health. ER - TY - BOOK AU - Institute of Medicine TI - Toward Quality Measures for Population Health and the Leading Health Indicators SN - DO - 10.17226/18339 PY - 2013 UR - https://nap.nationalacademies.org/catalog/18339/toward-quality-measures-for-population-health-and-the-leading-health-indicators PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The Institute of Medicine (IOM) Committee on Quality Measures for the Healthy People Leading Health Indicators was charged by the Office of the Assistant Secretary for Health to identify measures of quality for the 12 Leading Health Indicator (LHI) topics and 26 Leading Health Indicators in Healthy People 2020 (HP2020), the current version of the Department of Health and Human Services (HHS) 10-year agenda for improving the nation's health. The scope of work for this project is to use the nine aims for improvement of quality in public health (population-centered, equitable, proactive, health promoting, risk reducing, vigilant, transparent, effective, and efficient) as a framework to identify quality measures for the Healthy People Leading Health Indicators (LHIs). The committee reviewed existing literature on the 12 LHI topics and the 26 Leading Health Indicators. Quality measures for the LHIs that are aligned with the nine aims for improvement of quality in public health will be identified. When appropriate, alignments with the six Priority Areas for Improvement of Quality in Public Health will be noted in the Committee's report. Toward Quality Measures for Population Health and the Leading Health Indicators also address data reporting and analytical capacities that must be available to capture the measures and for demonstrating the value of the measures to improving population health. Toward Quality Measures for Population Health and the Leading Health Indicators provides recommendations for how the measures can be used across sectors of the public health and health care systems. The six priority areas (also known as drivers) are population health metrics and information technology; evidence-based practices, research, and evaluation; systems thinking; sustainability and stewardship; policy; and workforce and education. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Robert Pool TI - The Interplay Between Environmental Chemical Exposures and Obesity: Proceedings of a Workshop SN - DO - 10.17226/21880 PY - 2016 UR - https://nap.nationalacademies.org/catalog/21880/the-interplay-between-environmental-chemical-exposures-and-obesity-proceedings-of PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Environment and Environmental Studies AB - In March 2015, the National Academies of Sciences, Engineering, and Medicine held a workshop to explore the role that chemical exposures may play in the development of obesity. The obesity epidemic that has gripped the United States and much of the developed world for the past several decades has proved remarkably resistant to the various approaches tried by clinicians and public health officials to fight it. This raises the possibility that, in addition to the continued exploration of consumer understanding and behavior, new approaches that go beyond the standard focus on energy intake and expenditure may also be needed to combat the multifactorial problem of obesity. The speakers at the workshop discussed evidence from both studies with animal models and human epidemiological studies that exposure to environmental chemicals is linked both to weight gain and to glucose tolerance, insulin sensitivity, inflammation, and other aspects of the metabolic syndrome. In addition to conventional environmental chemical exposures, this workshop also included one panel to discuss the potential role of other exposures, including sugar, artificial sweeteners, and antibiotics, in aiding or causing obesity. The participants also examined possible biological pathways and mechanisms underlying the potential linkages. This publication summarizes the presentations and discussions from the workshop. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Steve Olson TI - Obesity in the Early Childhood Years: State of the Science and Implementation of Promising Solutions: Workshop Summary SN - DO - 10.17226/23445 PY - 2016 UR - https://nap.nationalacademies.org/catalog/23445/obesity-in-the-early-childhood-years-state-of-the-science PB - The National Academies Press CY - Washington, DC LA - English KW - Food and Nutrition AB - Among the many troubling aspects of the rising prevalence of obesity in the United States and elsewhere in recent years, the growth of early childhood overweight and obesity stands out. To explore what is known about effective and innovative interventions to counter obesity in young children, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Obesity Solutions held a workshop in October 2015. The workshop brought together many of the leading researchers on obesity in young children to describe the state of the science and potential solutions based on that research. Participants explored sustainable collaborations and new insights into the implementation of interventions and policies, particularly those related to nutrition and physical activity, for the treatment and prevention of obesity in young children. Obesity in the Early Childhood Years summarizes the presentations and discussions from the workshop. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Susan C. Scrimshaw A2 - Emily P. Backes TI - Birth Settings in America: Outcomes, Quality, Access, and Choice SN - DO - 10.17226/25636 PY - 2020 UR - https://nap.nationalacademies.org/catalog/25636/birth-settings-in-america-outcomes-quality-access-and-choice PB - The National Academies Press CY - Washington, DC LA - English KW - Behavioral and Social Sciences KW - Health and Medicine AB - The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings. ER - TY - BOOK AU - National Research Council AU - Institute of Medicine A2 - Nancy Kirkendall A2 - Carol House A2 - Constance F. Citro TI - Research Opportunities Concerning the Causes and Consequences of Child Food Insecurity and Hunger: Workshop Summary SN - DO - 10.17226/18504 PY - 2013 UR - https://nap.nationalacademies.org/catalog/18504/research-opportunities-concerning-the-causes-and-consequences-of-child-food-insecurity-and-hunger PB - The National Academies Press CY - Washington, DC LA - English KW - Food and Nutrition KW - Behavioral and Social Sciences KW - Health and Medicine AB - Section 141 of The Healthy, Hunger-Free Kids Act of 20101 provides funding for a research program on the causes and consequences of childhood hunger and food insecurity, and the characteristics of households with childhood hunger and food insecurity, with a particular focus on efforts to improve the knowledge base regarding contributing factors, geographic distribution, programmatic effectiveness, public health and medical costs, and consequences for child development, well-being, and educational attainment. The Economic Research Service and Food and Nutrition Service of the US Department of Agriculture conducted two outreach efforts to obtain input from the research community and other stakeholders to help focus on areas and methods with the greatest research potential. First, Food and Nutrition Service sought written comments to selected questions through publication of a Federal Register Notice. The second option was to convene a workshop under the auspices of the Committee on National Statistics of the National Research Council and the Food and Nutrition Board of the Institute of Medicine. Research Opportunities Concerning the Causes and Consequences of Child Food Insecurity and Hunger is the summary of that workshop, convened in Fall 2012 to examine research gaps and opportunities to advance understanding of the causes and consequences of child hunger in the United States. This report reviews the adequacy of current knowledge, identifies substantial research gaps, and considers data availability of economic, health, social, cultural, demographic, and other factors that contribute to childhood hunger or food insecurity. It also considers the geographic distribution of childhood hunger and food insecurity; the extent to which existing federal assistance programs reduce childhood hunger and food insecurity; childhood hunger and food insecurity persistence, and the extent to which it is due to gaps in program coverage; and the inability of potential participants to access programs, or the insufficiency of program benefits or services. Research Opportunities Concerning the Causes and Consequences of Child Food Insecurity and Hunger will be a resource to inform discussions about the public health and medical costs of childhood hunger and food insecurity through its focus on determinants of child food insecurity and hunger, individual, community, and policy responses to hunger, impacts of child food insecurity and hunger, and measurement and surveillance issues. ER - TY - BOOK TI - Paying Attention to Children in a Changing Health Care System SN - DO - 10.17226/5408 PY - 1996 UR - https://nap.nationalacademies.org/catalog/5408/paying-attention-to-children-in-a-changing-health-care-system PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - America's health care system is being reshaped by a variety of market-driven changes, and states are emerging as the major governmental influence on health care policy. Amid these changes, the health and well-being of children can slip from view. Although most children are fundamentally healthy, they require health care that emphasizes preventive services, such as immunizations and regular monitoring of physical and psychosocial growth and development. This volume takes a broad look at access and quality of care for pregnant women, children, and mothers. Among the issues addressed are the scope of benefits available under various health care reform efforts and services for special-needs children under managed care. ER - TY - BOOK AU - Institute of Medicine A2 - Adrienne Stith Butler A2 - Ellen Wright Clayton TI - A Review of the HHS Family Planning Program: Mission, Management, and Measurement of Results SN - DO - 10.17226/12585 PY - 2009 UR - https://nap.nationalacademies.org/catalog/12585/a-review-of-the-hhs-family-planning-program-mission-management PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - A Review of the HHS Family Planning Program provides a broad evaluation of the Title X family planning program since its establishment in 1970. The program successfully provides family planning services to its target audience of low-income individuals, but there is room for improvement. While the program's core goals are apparent, a secondary set of changing priorities has emerged without a clear, evidence-based strategic process. Also, funding for the program has increased in actual dollars, but has not kept pace with inflation or increased costs. Several aspects of the program's structure could be improved to increase the ability of Title X to meet the needs of its target population. At the same time, the extent to which the program meets those needs cannot be assessed without a greater capacity for long-term data collection. A Review of the HHS Family Planning Program recommends several specific steps to enhance the management and improve the quality of the program, as well as to demonstrate its direct contribution to important end results, such as reducing rates of unintended pregnancy, cervical cancer, and infertility. The book will guide the Office of Family Planning toward improving the effectiveness of the program. Other parties who will find the research and recommendations valuable include programs receiving Title X funding from the Office of Family Planning, policy makers, researchers, and professional organizations. ER - TY - BOOK AU - Institute of Medicine AU - National Research Council TI - Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report SN - DO - 10.17226/11817 PY - 2007 UR - https://nap.nationalacademies.org/catalog/11817/influence-of-pregnancy-weight-on-maternal-and-child-health-workshop PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report summarizes a one and a half day workshop convened in May 2006 that reviewed U.S. trends in maternal weight (prior to, during, and after pregnancy) among different populations of women; examined the emerging research findings related to the complex relationship of the biological, behavioral, psychological, and social interactions that affect maternal and pregnancy weight on maternal and child health outcomes; and discussed interventions that use this complex relationship to promote appropriate weight during pregnancy and postpartum. Given the unprecedented environment in the United States in which two-thirds of the adult population meets the criteria for being overweight or obese, the implications for women in the reproductive age period are unique in the history of the country. The concerns for maternal and infant health are real. The questions and answers tackled by committee members and workshop participants were not easy. Nevertheless, having an opportunity to explore what is known, examine the gaps in knowledge, and explore what to do now and in the future build a pathway for further inquiry and action. This report summarizes the workshop proceedings and highlights key themes that deserve further attention. The participants in this workshop describe what is known about recent trends in maternal weight gain and the impact of maternal weight during pregnancy on the health of mothers and their children. The workshop provided a valuable opportunity to assess trends that have occurred since the publication of an earlier study by the Institute of Medicine (IOM), which included guidelines for recommended weight gain during pregnancy. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine A2 - Theresa Wizemann A2 - Andrew March A2 - Carolyn Shore TI - Inclusion of Pregnant and Lactating Persons in Clinical Trials: Proceedings of a Workshop SN - DO - 10.17226/26790 PY - 2023 UR - https://nap.nationalacademies.org/catalog/26790/inclusion-of-pregnant-and-lactating-persons-in-clinical-trials-proceedings PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Approximately 4 million pregnant people in the United States give birth annually, and 70 percent of these individuals take at least one prescription medication during their pregnancy. Yet, due to a number of historical, ethical, legal, scientific, and societal issues, pregnant and lactating persons are often excluded from clinical trials. As a result, pregnant and lactating persons are often taking drugs based on limited information about the benefits and risks to themselves and their developing or newborn baby. The National Academies Forum on Drug Discovery, Development, and Translation convened a workshop in June 2022 for stakeholders to examine the current state of evidence generation for drug products used by pregnant and lactating persons and discuss barriers and opportunities for including these populations in clinical trials. This publication summarizes the presentations and discussion of the workshop. ER - TY - BOOK AU - Institute of Medicine A2 - Andrew M. Pope A2 - Alvin R. Tarlov TI - Disability in America: Toward a National Agenda for Prevention SN - DO - 10.17226/1579 PY - 1991 UR - https://nap.nationalacademies.org/catalog/1579/disability-in-america-toward-a-national-agenda-for-prevention PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Disability in America presents a five-prong strategy for reducing the incidence and prevalence of disability as well as its personal, social, and economic consequences. Although the preferred goal is to avoid potentially disabling conditions, the authoring committee focuses on the need to prevent or reverse the progression that leads to disability and reduced quality of life in persons with potentially disabling conditions. Calling for a coherent national program to focus on prevention, the committee sets forth specific recommendations for federal agencies, state and local programs, and the private sector. This comprehensive agenda addresses the need for improved methods for collecting disability data, specific research questions, directions for university training, reform in insurance coverage, prenatal care, vocational training, and a host of other arenas for action. ER - TY - BOOK AU - Institute of Medicine A2 - Leslie A. Pray TI - Examining a Developmental Approach to Childhood Obesity: The Fetal and Early Childhood Years: Workshop Summary SN - DO - 10.17226/21782 PY - 2015 UR - https://nap.nationalacademies.org/catalog/21782/examining-a-developmental-approach-to-childhood-obesity-the-fetal-and PB - The National Academies Press CY - Washington, DC LA - English KW - Food and Nutrition KW - Health and Medicine AB - Recent scientific evidence points to the origins of childhood obesity as an outcome of the dynamic interplay of genetic, behavioral, and environmental factors throughout early development, with a compelling body of evidence suggesting that both maternal and paternal nutritional and other exposures affect a child's risk of later obesity. The burgeoning field of epigenetics has led researchers to speculate that many of the observed associations between early developmental exposures and later risk of childhood obesity are mediated, at least in part, through epigenetic mechanisms. To explore the body of evolving science that examines the nexus of biology, environment, and developmental stage on risk of childhood obesity, the Institute of Medicine and the National Research Council convened a workshop in February 2015. The workshop focused on the prenatal period, infancy, and early childhood and addressed evidence from both animal and human studies. Workshop objectives were to (1) identify epigenetic-mediated relationships between exposure to risk factors during sensitive periods of development (gestation through age 3) and subsequent obesity-related outcomes; (2) explore the science around periods of plasticity and potential reversibility of obesity risk in the context of early childhood development; and (3) examine the translation of epigenetic science to guide early childhood obesity prevention and intervention to reduce obesity risk. This report summarizes the information presented and discussed at the workshop. ER -