WONDER online databases include county-level Compressed Mortality (death certificates) since 1979; county-level Multiple Cause of Death (death certificates) since 1999; county-level Natality (birth certificates) since 1995; county-level Linked Birth / Death records (linked birth-death certificates) since 1995; state & large metro-level United States Cancer Statistics mortality (death certificates) since 1999; state & large metro-level United States Cancer Statistics incidence (cancer registry cases) since 1999; state and metro-level Online Tuberculosis Information System (TB case reports) since 1993; state-level Sexually Transmitted Disease Morbidity (case reports) since 1984; state-level Vaccine Adverse Event Reporting system (adverse reaction case reports) since 1990; county-level population estimates since 1970. The WONDER web server also hosts the Data2010 system with state-level data for compliance with Healthy People 2010 goals since 1998; the National Notifiable Disease Surveillance System weekly provisional case reports since 1996; the 122 Cities Mortality Reporting System weekly death reports since 1996; the Prevention Guidelines database (book in electronic format) published 1998; the Scientific Data Archives (public use data sets and documentation); and links to other online data sources on the "Topics" page.

BackgroundRecurrent pregnancy loss (RPL) presents a major challenge in reproductive medicine, with lifestyle factors, especially dietary patterns, potentially influencing pregnancy outcomes. This study aimed to explore the relationship between adherence to preconception dietary patterns and pregnancy outcomes in women with RPL.MethodsThe study included 475 women with RPL at Renji Hospital, Shanghai Jiao Tong University School of Medicine. Participants completed a semi-quantitative food frequency questionnaire (FFQ) to assess adherence to six pre-defined dietary patterns at preconception: the American Heart Association Diet (AHA), Trichopoulou Mediterranean Diet (TMED), Panagiotakos Mediterranean Diet (PMED), Alternate Mediterranean Diet (AMED), Healthy Eating Index-2015 (HEI-2015), and Dietary Approaches to Stop Hypertension (DASH). Pregnancy loss, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and other adverse pregnancy outcomes (APO) (e.g., preterm birth, low birth weight) were ascertained using medical records.ResultsSignificant associations were observed between adherence to the AHA diet and reduced risks of pregnancy loss [adjusted RR (95% CI), highest quartile (Q4) vs. lowest quartile (Q1): 0.36 (0.17, 0.78), P-trend = 0.043], GDM [adjusted RR (95% CI), highest quartile (Q4) vs. lowest quartile (Q1): 0.28 (0.10, 0.75), P-trend = 0.006], HDP [adjusted RR (95% CI), highest quartile (Q4) vs. lowest quartile (Q1): 0.12 (0.03, 0.57), P-trend = 0.008], and other adverse pregnancy outcomes [adjusted RR (95% CI), highest quartile (Q4) vs. lowest quartile (Q1): 0.04 (0.01, 0.35), P-trend = 0.001]. Similar associations were found for the AHEI, AMED, and TMED diets regarding pregnancy loss, GDM, and HDP, while the PMED and DASH diets showed no significant associations. Additionally, higher levels of moderate-to-vigorous physical activity and lower energy and fat intake were associated with increased live birth rates.ConclusionGreater adherence to the AHA diet during the preconception period was linked to lower risks of pregnancy loss, and adverse pregnancy outcomes. These findings support the AHA diet for patients with recurrent pregnancy loss, indicating that healthy dietary patterns may improve pregnancy outcomes and highlight the need for further research on their impact on fertility.

Our multidisciplinary team of legal, clinician, and perinatal epidemiology experts designed a study to assess the effects of state regulation of midwives on patient access to high quality maternity care in the US. We developed a novel, weighted scoring system that ranks all 50 states and DC on level of midwifery integration, and then linked state scores to maternal and newborn outcomes. In our study we demonstrate that greater integration of midwives is associated with significantly higher rates of physiologic birth outcomes, lower rates of obstetric interventions, and fewer adverse neonatal outcomes. Our new Midwifery Integration Scoring System provides an evidenced-informed tool that can identify barriers to effective health human resource allocation in maternity care, based on population-level health outcomes data. In the current context of the Sustainable Development Goals to facilitate equitable access to skilled maternity providers, we believe that our findings will be of great interest to your readers. We uploaded the 1) Midwifery Integration Scoring System and 2) the data set that includes all data points needed to replicate the results presented in our paper. Most of the data is for the year 2014 and comes from the CDC. Other data sources are detailed in the publication and a short data dictionary will be uploaded soon.