Annals of Epidemiology最新文献

{"title":"Commentary on community-engaged epidemiology and abolitional possibility with a case study on aluminum worker health","authors":"Elizabeth S. McClure ,&nbsp;Pavithra Vasudevan ,&nbsp;Cherrel K. Manley ,&nbsp;Elizabeth Teka","doi":"10.1016/j.annepidem.2025.08.009","DOIUrl":"10.1016/j.annepidem.2025.08.009","url":null,"abstract":"<div><div>This collaborative project addresses the possibilities and limits of occupational epidemiology in supporting struggles for environmental justice through a case study of aluminum smelting. We focus on illness and toxic exposure among Black workers and their families in Badin, North Carolina, a primary aluminum smelting plant site for Alcoa, in operation from 1915 to 2007. We conducted two quantitative analyses—one documenting disparities in work exposure trajectories, and one comparing mortality rates among workers to those in the general population. Supplementing these conventional epidemiological methods, we developed a third approach in collaboration with community members: an open-ended household survey designed to gather qualitative data regarding former workers’ job histories, medical histories, and concerns related to toxic exposures and discrimination at the smelting plant. This approach was conceived in response to residents’ questions about disparate health outcomes of toxic exposure in the workplace. The current occupational epidemiology literature published about aluminum smelting does not reflect concerns voiced by community collaborators regarding the extent of harm caused by occupational exposure to toxins, nor does it include analyses of race or gender disparities due to discriminate labor divisions. We argue that despite the discipline’s history of efforts to address health inequities, contemporary occupational epidemiology is limited in its methodological capacity eliminate health disparities rooted in structural racism. We illustrate how such a method may both broaden the scientific knowledge base and support organizing towards developing an abolitional approach to epidemiology.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 102-106"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A spatially dynamic agent-based model for assessing the effect of gentrification-induced migration and HIV transmission among heterosexual African American/Black women","authors":"Shayla Nolen ,&nbsp;Sam E. Bessey ,&nbsp;Chanelle J. Howe ,&nbsp;Bridgette M. Rice ,&nbsp;Katie B. Biello ,&nbsp;Brandon D.L. Marshall","doi":"10.1016/j.annepidem.2025.08.007","DOIUrl":"10.1016/j.annepidem.2025.08.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Develop a spatially dynamic agent-based model to assess the impact of gentrification-induced migration on HIV transmission among heterosexual African American/Black women.</div></div><div><h3>Methods</h3><div>We simulated a population of heterosexual African American/Black adults diagnosed with or at risk for HIV in a spatially dynamic agent-based model. We included behavioral and HIV-related probabilities based on neighborhood of residence, distance to healthcare facilities from their neighborhood, and neighborhood disadvantage status. To assess the impact of gentrification, migration was implemented in the model using probabilities that varied based on the gentrification status of their neighborhood. We then compared this scenario to a scenario where gentrification does not impact migration.</div></div><div><h3>Results</h3><div>Among African American/Black women, we estimated their mean incidence rates for the scenarios with and without gentrification impacting out-migration to be 57.2 and 57.4 per 100,000, respectively.</div></div><div><h3>Conclusions</h3><div>Gentrification appears to have minimal impact on HIV transmission based on some metrics, possibly because of the displacement of people most affected by HIV.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 122-129"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144887237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Criminal justice intimate partner victimization before, during and after pregnancy among birthing parents screened postnatally by public health nurses","authors":"Monica Serena Perner ,&nbsp;Natalia Pacifico ,&nbsp;Maria Paula Godoy ,&nbsp;Marni Brownell ,&nbsp;Marcelo Luis Urquia","doi":"10.1016/j.annepidem.2025.07.063","DOIUrl":"10.1016/j.annepidem.2025.07.063","url":null,"abstract":"<div><h3>Background</h3><div>Intimate partner violence (IPV) is a global problem, disproportionately affecting women. Pregnancy offers a unique opportunity to identify IPV.</div></div><div><h3>Methods</h3><div>This population-based data linkage study includes residents of Manitoba, Canada who gave birth from 2006–2020 and were eligible for the Families First Screening (FFS) (n = 194,280). The FFS is a universal screening tool completed typically within one week postpartum by public-health nurses, which includes questions on current history of relationship violence and distress, including pregnancy. We assessed the associations of these responses with criminal justice identified IPV (JIIPV) two years before through two years after pregnancy (2004–2022) using logistic and multinomial regressions models.</div></div><div><h3>Results</h3><div>The prevalence of JIIPV at any time around pregnancy among birthing parents without distress/violence during pregnancy was 36.6 per 1000 pregnancies. Compared to them, those who reported both violence and relationship distress had a prevalence of 474.5/1000 [Odds Ratio (OR): 23.8; 95 %CI: 21.4, 26.4, and adjusted OR (AOR): 5.4; 95 %CI: 4.8, 6.1]. Those who did not respond to distress/violence questions and those who did not participate in the FFS had also higher prevalence of JIIPV. Observed patterns persisted before, during and after pregnancy.</div></div><div><h3>Conclusion</h3><div>Screening by public health nurses identifies families seriously affected by JIIPV around pregnancy.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 72-80"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV incidence and associated risk factors among key populations accessing routine testing through the national health coverage system in Thailand: A nationwide real-world study","authors":"Sadiporn Phuthomdee ,&nbsp;Sirinya Teeraananchai ,&nbsp;Rattaphon Triamwichanon ,&nbsp;Patchara Benjarattanaporn ,&nbsp;David C. Boettiger ,&nbsp;Nittaya Phanuphak","doi":"10.1016/j.annepidem.2025.09.006","DOIUrl":"10.1016/j.annepidem.2025.09.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess HIV incidence and associated factors among key populations (KPs) including men who have sex with men (MSM), transgender women (TGW), sex workers (SW), and people who inject drugs (PWID) using data from the Universal Health Coverage program.</div></div><div><h3>Methods</h3><div>HIV testing data were collected from KP individuals aged ≥ 15 years diagnosed HIV-negative at least once between 2015 and 2022. Flexible parametric survival analysis was used to estimate HIV incidence and identify associated factors.</div></div><div><h3>Results</h3><div>Among 373,300 individuals tested, 65 % were MSM, 26 % SW, 8 % PWID, and 2 % TGW. HIV incidence rates were highest among MSM (2.23 per 100 person-years, PYs), followed by TGW (2.06 per 100 PYs), PWID (0.46 per 100 PYs), and SW (0.41 per 100 PYs). In multivariable analysis, MSM had significantly higher risk compared to PWID (adjusted hazard ratio (aHR 0.13), SW (aHR 0.20), and TGW (aHR 0.77). Youth among KPs had a 7.30-fold higher risk compared to those aged ≥ 50 years. A decline in incidence was observed in more recent years.</div></div><div><h3>Conclusions</h3><div>HIV incidence is declining all KPs but remains highest among MSM and TGW, particularly youth, highlighting the need for targeted prevention to end HIV in Thailand.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 178-186"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse childhood experiences (ACEs) and adolescent reproductive health: Differentiating household and community adversity.","authors":"Christine M Forke, Laura G Barr, Laura Sinko, Melissa E Dichter, Peter F Cronholm","doi":"10.1016/j.annepidem.2025.07.022","DOIUrl":"10.1016/j.annepidem.2025.07.022","url":null,"abstract":"<p><strong>Purpose: </strong>To add to existing knowledge on relationships between Conventionally-identified Adverse Childhood Experiences (ACEs) and adolescent reproductive health (ARH) outcomes, we identified contributions of Expanded (community-level) ACEs, integrating measures of ACE co-occurrence and burden.</p><p><strong>Methods: </strong>Secondary analysis of 2012-2013 Philadelphia ACEs data from a population-based adult sample. Weighted regressions, adjusted for age, sex, race/ethnicity, and socioeconomic status, tested associations between Conventional and Expanded ACEs (separately and co-occurring) and ACE burden (lowest to highest exposure) with: early sexarche (<15 years), adolescent pregnancy (<19 years), and unintended adolescent pregnancy.</p><p><strong>Results: </strong>Conventional ACEs showed strong dose-response relationships with all outcomes (aOR range: 2.04-4.96, p < 0.05). Expanded ACEs were associated with early sexarche (aOR=2.50; 95 % CI: 1.27, 4.94), adolescent pregnancy (aOR=1.69; 95 % CI: 1.16, 2.46), and unintended adolescent pregnancy (aOR=1.54; 95 % CI: 1.04, 2.29); dose-response patterns were inconsistent. Co-occurring Conventional and Expanded ACEs produced the greatest odds for all outcomes except early sexarche (aOR range: 3.20-14.97, p < 0.05).</p><p><strong>Conclusions: </strong>Conventional and Expanded ACEs are important independently and jointly. ARH outcomes peaked when Conventional and Expanded ACEs co-occurred and both exposures were high. Results suggest that Conventional ACEs may be overestimated when assessed in isolation, highlighting the importance of considering Expanded ACEs to minimize bias and target appropriate interventions.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":"7-15"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the link between socioeconomic factors and rheumatoid arthritis: Insights from a large Austrian study.","authors":"Mathias Ausserwinkler, Maria Flamm, Sophie Gensluckner, Kathrin Bogensberger, Bernhard Paulweber, Eugen Trinka, Patrick Langthaler, Christian Datz, Boris Lindner, Bernhard Iglseder, Elmar Aigner, Bernhard Wernly","doi":"10.1016/j.annepidem.2025.07.025","DOIUrl":"10.1016/j.annepidem.2025.07.025","url":null,"abstract":"<p><strong>Introduction: </strong>Austria, a country with a high standard of living and a well-developed healthcare system, still experiences socioeconomic status (SES) disparities that impact health outcomes. Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with significant disability and comorbidities. While SES has been linked to RA prevalence and disease severity, its role in a high-income country like Austria remains underexplored. This study investigates the association between SES factors-education, income, employment status and migration background-and RA prevalence and outcomes.</p><p><strong>Methods: </strong>This population-based study used data from the Paracelsus 10,000 cohort in Salzburg, Austria and a cross-sectional design. A total of 9256 participants aged 40-77 years were analyzed, including 289 individuals diagnosed with RA based on the ACR/EULAR classification criteria. SES was assessed through self-reported education, income, employment status and country of birth. Logistic regression models were used to evaluate the association between SES and RA, adjusting for age, sex, metabolic syndrome, smoking and alcohol consumption.</p><p><strong>Results: </strong>RA prevalence was significantly lower among individuals with higher education (OR = 0.55, 95 % CI: 0.37-0.82 for medium education; OR = 0.41, 95 % CI: 0.25-0.68 for high education). Lower household income correlated with higher RA prevalence. Employment disparities were evident, with RA patients exhibiting higher rates of unemployment and work disability.</p><p><strong>Conclusion: </strong>Despite Austria's high standard of living, SES remains a key determinant of RA prevalence. Lower levels of education, income and employment are associated with higher rates of RA, highlighting the need for targeted public health interventions. Strengthening healthcare access, promoting early screening and offering economic support to vulnerable groups could be important steps toward reducing these disparities. Further research should explore the underlying mechanisms of this association and examine whether socioeconomic disparities also influence disease progression and patient outcomes.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":"66-71"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating longitudinal variability in prediction models: A comparison of machine learning and logistic regression in a cohort study with long follow-up.","authors":"L M de Groot, J W R Twisk, A A L Kok, M W Heymans","doi":"10.1016/j.annepidem.2025.07.060","DOIUrl":"10.1016/j.annepidem.2025.07.060","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical prediction models benefit from longitudinal data. While the predictive value of a predictor's mean and change over time is well-established, the role of variability around this change is underexplored. Machine Learning methods can be effective in analyzing longitudinal data with long follow-up periods. This study evaluated the predictive value of mean, change, and variability, comparing Random Forest, Lasso regression, and logistic regression.</p><p><strong>Methods: </strong>We compared models including only mean and change to models also incorporating variability. Predictor selection, interpretability, and performance were compared across methods. Performance was assessed using AUC, sensitivity, specificity, PPV, NPV, and calibration. Data were drawn from the Longitudinal Aging Study Amsterdam to predict depression using 81 longitudinal parameters. Models were trained on 70 % and validated on 30 % of the data. To ensure robustness, analyses were repeated over 500 random splits, and aggregated results were reported.</p><p><strong>Results: </strong>Including variability improved AUCs for all methods. Predictor selection overlapped across models, and regression coefficients aligned with Random Forest partial dependence plots. Lasso showed the highest training AUC but poorer test performance, while logistic regression and Random Forest showed more stable results. Calibration was acceptable, though predicted risks remained below 0.6.</p><p><strong>Conclusion: </strong>Machine Learning methods did not outperform logistic regression. Nonetheless, incorporating variability in longitudinal predictors enhances prediction, especially with expected changes in predictors, e.g., ageing populations.</p>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":" ","pages":"51-65"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatially consistent annual Socio-Economic Indexes for Areas (SEIFA) data for Australian statistical areas, 1996–2021","authors":"Rebecca A. Reid ,&nbsp;Suzanne Mavoa ,&nbsp;Sarah Foster ,&nbsp;Julia Gilmartin-Thomas ,&nbsp;Jerome N. Rachele","doi":"10.1016/j.annepidem.2025.08.008","DOIUrl":"10.1016/j.annepidem.2025.08.008","url":null,"abstract":"<div><h3>Purpose</h3><div>National census data are frequently used as a source of area-level socioeconomic information. However, this data is less suitable for longitudinal analysis due to infrequent data collection and changes to administrative boundaries of census areas. This study aims to address these limitations by generating annual, geographically consistent Socio-Economic Indexes for Areas (SEIFA) from the Australian Bureau of Statistics (ABS) for 1996 – 2021.</div></div><div><h3>Methods</h3><div>Geographic Information Systems (GIS) were used to update historic spatial data to align with a set of contemporary boundaries. SEIFA estimates for non-census years were generated using linear interpolation.</div></div><div><h3>Results</h3><div>The final dataset includes 59,421 Statistical Area 1 s (SA1) after excluding areas with no SEIFA data for any census year. The methodology resulted in annual, spatially, and temporally consistent SEIFA data from 1996 to 2021 standardised to the 2021 SA1 boundaries.</div></div><div><h3>Conclusion</h3><div>Creating annual SEIFA data at a small geographic scale addresses key challenges associated with tracking area-level socioeconomic factors over time. By standardising data across multiple years, this approach maintains consistency in geographic units, to overcome potential limitations of using census data in longitudinal research.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 130-140"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic inflammation-based refinement of triglyceride glucose index for predicting new-onset cardiovascular disease: A nationwide multicenter cohort study","authors":"Liangyu Yin ,&nbsp;Lan Zhong ,&nbsp;Yinghui Huang ,&nbsp;Jinghong Zhao","doi":"10.1016/j.annepidem.2025.08.022","DOIUrl":"10.1016/j.annepidem.2025.08.022","url":null,"abstract":"<div><h3>Background</h3><div>Triglyceride glucose (TyG) index is a surrogate marker of insulin resistance, which has been related to cardiovascular disease (CVD) risk. However, the predictive rationale for incorporating triglyceride and glucose is not well established. Furthermore, whether inflammatory information adds prognostic value to TyG remains largely unknown.</div></div><div><h3>Methods</h3><div>This cohort study involved 7456 participants without pre-existing CVD. CVD events were defined as physician-diagnosed coronary heart disease (CHD) and/or stroke during follow-up. The predictive abilities of TyG, triglycerides, glucose, C-reactive protein (CRP), a TyC index (triglycerides [mg/dL]+60 ×CRP [mg/L]) and a TyG-C index (TyG+CRP [mg/L]) were compared. Using multivariable Cox models, hazard ratios (HR) of any and type-specific CVD according to TyG-C tertiles (T) were estimated.</div></div><div><h3>Results</h3><div>The median age of participants was 57.0 years. There were 3448 (46.2 %) men and 4008 (53.8 %) women. During the follow-up of up to 6 years, 1470 CVD, 1114 CHD and 487 stroke incidents occurred. TyG showed comparable discrimination to triglycerides in predicting new-onset CVD and CHD, and similar performance to glucose in predicting stroke (all <em>P</em> &gt; 0.05). TyG-C was superior to TyG and other investigated indices for predicting CVD (Harrell’s C-index [95 %CI]=0.557 [0.541–0.573], all <em>P</em> &lt; 0.05). TyG-C tertiles were monotonically associated with CVD risk (HR [95 %CI]: T2 vs T1, 1.200 [1.050–1.372]; T3 vs T1, 1.282 [1.121–1.468], <em>P</em> trend&lt;0.001). Similar patterns were observed for CHD and stroke. These associations attenuated with age (all <em>P</em> interaction&lt;0.001).</div></div><div><h3>Conclusion</h3><div>TyG does not outperform its components in predicting new-onset CVD. TyG-C might serve as a better biomarker of CVD risk.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 114-121"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational weight change patterns in pregnant people with obesity class I, II, and III receiving care from community-based health care centers","authors":"Sarah-Truclinh T. Tran ,&nbsp;Anna Booman ,&nbsp;Miguel Marino ,&nbsp;Jean O’Malley ,&nbsp;Amy Palma ,&nbsp;Teresa Schmidt ,&nbsp;Kristin Lyon-Scott ,&nbsp;Jonathan M. Snowden ,&nbsp;Rachel Springer ,&nbsp;Kalera Stratton ,&nbsp;Kimberly K. Vesco ,&nbsp;Janne Boone-Heinonen","doi":"10.1016/j.annepidem.2025.08.005","DOIUrl":"10.1016/j.annepidem.2025.08.005","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify pregnancy weight patterns among people with obesity class I, II, and III, and how they lead to total gestational weight change (GWC) relative to Institute of Medicine (IOM) recommendations.</div></div><div><h3>Methods</h3><div>We examined clinically measured pregnancy weights from 7196 individuals with pre-pregnancy obesity receiving care from a national network of community-based health care organizations (2004–2020). We conducted obesity class-stratified, group-based trajectory modeling, then characterized identified GWC patterns with respect to sociodemographic and clinical characteristics.</div></div><div><h3>Results</h3><div>GWC trajectories included two patterns exhibiting early weight loss that was later regained (n = 4113), two with consistent weight gain (n = 3026), and, among individuals with class III obesity, a fifth pattern (n = 57) exhibiting weight loss that was not regained by delivery. Trajectories that met the total GWC IOM recommendations exhibited 1st trimester weight loss followed by at/above-IOM recommended 2nd and 3rd trimester GWC. Trajectories with 1st trimester weight gain exceeded the total GWC recommendation. Public health insurance, tobacco use, and Black race were generally more common in trajectories with the highest rates of weight loss or gain.</div></div><div><h3>Conclusions</h3><div>Obesity class-specific GWC recommendations should address safe levels of 1st trimester weight loss and dissonance between recommended total GWC and 2nd and 3rd trimester gain rates.</div></div>","PeriodicalId":50767,"journal":{"name":"Annals of Epidemiology","volume":"110 ","pages":"Pages 95-101"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}