BACKGROUND: Postpartum depression (PPD) is a major public health concern affecting maternal well-being and child development. In Lebanon, nearly one-third of postpartum women screen positive for PPD, yet routine screenin...BACKGROUND: Postpartum depression (PPD) is a major public health concern affecting maternal well-being and child development. In Lebanon, nearly one-third of postpartum women screen positive for PPD, yet routine screening remains inconsistent. The American Academy of Pediatrics recommends that pediatricians screen for PPD during early well-child visits, but pediatric clinicians’ knowledge, attitudes, and practices in Lebanon remain unclear. METHODS: A national cross-sectional online survey targeted practicing pediatricians and pediatric trainees in Lebanon. Online questionnaires, shared via institutional emails and personal social media connections, assessed knowledge of screening tools, attitudes toward responsibility, current practices, perceived barriers, and training needs. Responses were received from 102/1221 pediatricians and 89/155 trainees (response rates: 8.3% and 57.4%). Descriptive statistics, bivariate analyses, and multivariable logistic regression identified predictors of knowledge, resource awareness, and willingness to attend training. RESULTS: Only 34.0% identified the Edinburgh Postnatal Depression Scale as a commonly used screening tool, and 20.4% correctly identified recommended screening timing. Overall, 86.9% reported no formal training in PPD screening. Although 69.1% supported standardized tools, only 22.8% of pediatricians used them in practice, with most relying on clinical impression. Nearly half (48%) believed obstetricians/gynecologists should be primarily responsible for screening, whereas 32.8% identified pediatricians. Pediatricians were more aware of referral resources than trainees (aOR 6.24; 95% CI 2.52–15.48) but less willing to attend training (aOR 0.15; 95% CI 0.05–0.44). Major barriers included limited awareness of mental health services (31.9%), cultural stigma (29.3%), and time constraints (20.9%). CONCLUSION: Significant gaps exist in knowledge, training, and implementation of PPD screening among pediatric clinicians in Lebanon. Despite recognizing its importance, pediatricians often defer responsibility and rely on subjective assessment rather than standardized tools. Addressing training deficits, clarifying professional roles, and improving access to referral resources are essential to enhance early detection.
BACKGROUND: Ample research explores marital structures' impact on children's nutrition, yet results are mixed, and pathways remain underexplored. In this study, we examine the effect of marital structure on children's nu...BACKGROUND: Ample research explores marital structures' impact on children's nutrition, yet results are mixed, and pathways remain underexplored. In this study, we examine the effect of marital structure on children's nutritional status while estimating the mediation and moderation effects of household size and women's empowerment, respectively. METHODS: We analyzed the latest Demographic and Health Survey data from 24 sub-Saharan African countries to evaluate the odds of stunting, anaemia, and underweight in children from polygynous households compared to those with single mothers and monogamous caregivers, using multinomial logit regression. RESULTS: Children from polygynous households were more likely to be anaemic, stunted, and underweight. Children of empowered monogynous mothers were associated with lower risks of malnutrition, whereas an increase in household size amplified childhood malnutrition in single and polygynous families. Wealth and sanitation also influenced childhood nutrition, with poorer households and those lacking proper sanitation experiencing worse nutritional outcomes. CONCLUSION: This study underscores the complexity of the maternal structure and children's outcomes and suggests interventions that seek to improve children's nutrition status should factor mother's empowerment and household size as key influencers.
Roesler A, Geusens F, Van Uytsel H
… +3 more, Varnfield M, Devlieger R, Bogaerts A
Matern Child Health J
· 2026 Apr · PMID 41934584
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INTRODUCTION: Excessive gestational weight gain (EGWG) poses significant health risks, including increased pregnancy complications, obesity, and metabolic disorders. Addressing EGWG is critical for women with a history o...INTRODUCTION: Excessive gestational weight gain (EGWG) poses significant health risks, including increased pregnancy complications, obesity, and metabolic disorders. Addressing EGWG is critical for women with a history of EGWG, as recurrence is common in consecutive pregnancies. This study presents findings from a subanalysis of the intervention arm of the INTER-ACT multi-center randomied controlled trial (RCT), which evaluated the impact of a combined mobile health (mHealth) and face-to-face lifestyle coaching intervention on EGWG recurrence during consecutive pregnancies. METHODS: This subanalysis focuses on the intervention arm of the INTER-ACT RCT, conducted in six hospitals in Flanders, Belgium. The intervention consisted of two phases: the interpregnancy period (six weeks to six months postpartum) and the consecutive pregnancy (before 15 weeks post-conception to birth). Participants (n = 172) with a history of EGWG received health coaching and used an app to self-monitor weight, steps, and mental health. A multiple regression model assessed the effects of self-monitoring and coaching attendance on EGWG during the consecutive pregnancy in the intervention arm. RESULTS: App engagement decreased from 78% during the interpregnancy period to 37% during the consecutive pregnancy. Self-monitoring behaviors (logging weight, steps, and mental health) or coaching attendance did not independently predict EGWG. A prior history of EGWG was the strongest predictor of EGWG recurrence, followed by older maternal age. CONCLUSION: While mHealth interventions can promote self-monitoring, sustaining engagement across pregnancies remains challenging. Future strategies should focus on improving long-term adherence to mHealth tools to enhance GWG outcomes and maternal health, especially for women motivated to engage with these technologies. These findings, derived from the intervention arm of the INTER-ACT RCT, suggest that further research is needed to assess the broader applicability of these results.
INTRODUCTION: There are many barriers a woman may encounter when trying to achieve her breastfeeding goals. Returning to the workplace poses one of the most significant obstacles faced by women. Human resource practices...INTRODUCTION: There are many barriers a woman may encounter when trying to achieve her breastfeeding goals. Returning to the workplace poses one of the most significant obstacles faced by women. Human resource practices can either support or hinder breast milk expression in the workplace. However, there is limited research on the breastfeeding experiences and challenges faced by employees working for state government agencies. METHODS: Data were collected through a cross-sectional qualitative mixed-methods approach consisting of surveys and interviews with current female employees working for the State of Utah. The survey was sent to 10,033 employees, and 1,137 responded. However, 521 had breastfed during their employment, and 459 ultimately met the inclusion criteria for the analysis. Ten interviews were conducted with individuals randomly selected from a subset of the 459 participants who indicated their willingness to be interviewed. Analysis of the data consisted of thematic review and central tendency comparisons. RESULTS: The data analysis revealed that employee experiences may vary by agency. In general, employees expressed stress and anxiety related to pumping at work. Overall, more employees described negative experiences related to workplace environment, job responsibilities, or lack of supervisor support than those who had neutral or positive ones. Experiences have also improved at the State of Utah over time due to teleworking and paid parental leave, but more can be done to better accommodate its employees. CONCLUSION: Employee breastfeeding experiences may be related to the agency culture, work environment, and employer support. Expressing milk at the workplace can generate stress and anxiety for breastfeeding employees. Employee-friendly policies may help improve these experiences.
PURPOSE: Despite its high relevance, there is little data surrounding parent acceptability of research that involves neurobiological data collection. The present mixed-method study examined parent acceptability of neuroi...PURPOSE: Despite its high relevance, there is little data surrounding parent acceptability of research that involves neurobiological data collection. The present mixed-method study examined parent acceptability of neuroimaging and hormonal biomarker collection in the context of an evidence-based child-focused intervention. METHODS: Parent participants (N = 173) were recruited from prior hospital-based studies that did not involve biomarker collection, including a clinical-research parenting program designed to treat child behavioral challenges in at-risk groups. Parents answered survey questions, detailing perspectives on research-based brain neuroimaging and hormonal biomarker collection in children and caregivers. Analyses adopted a mixed-methods approach to assess both quantitative and qualitative data. RESULTS: Half or more parent participants indicated interest in the proposed methodologies, with high acceptability reflected in themes surrounding knowledge translation and indicators of child functioning and treatment effectiveness. Expressed concerns surrounded procedure tolerability, timing, and data privacy. Acceptability was highest among parents who concurrently reported elevated child behavior problems and parental mental health stress. Acceptability was also highest for saliva cortisol collection due to procedure ease. CONCLUSIONS: Neuroimaging and hormonal biomarker collection appear promising for capture of brain and physiologic plasticity in neurologically at-risk children and their caregivers. Future efforts should focus on procedure transparency and sensitively adapting methodologies to meet patient and family needs.
Parrish JW, Strahle S, Vance S
… +2 more, Kirby RS, Kotelchuck M
Matern Child Health J
· 2026 Mar · PMID 41784744
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INTRODUCTION: Integrating administrative data with the Pregnancy Risk Assessment Monitoring System (PRAMS) enhances the evaluation of maternal and child health (MCH) programs, policies, and outcomes. METHODS: Despite its...INTRODUCTION: Integrating administrative data with the Pregnancy Risk Assessment Monitoring System (PRAMS) enhances the evaluation of maternal and child health (MCH) programs, policies, and outcomes. METHODS: Despite its proven value, past efforts to integrate PRAMS with administrative data have been inconsistent across jurisdictions, limiting broader applicability. To address this, the CDC partnered with the Association of State and Territorial Health Officials (ASTHO) to convene the PRAMS Data Linkage Learning Community. RESULTS: Drawing on the experiences of 12 participating states, prior research, and expert input, a five-phase generalized PRAMS linkage framework—Linkage Preparation, Data Preparation, Data Linkage, Research Data Set Creation and Analysis, and Sustainability—was developed. DISCUSSION: This framework provides practical tools and strategies to overcome common challenges and supports continuous and expanded use of data linkages. By enabling jurisdictions to explore MCH outcomes across diverse data sources, the framework promotes data-driven policy decisions, targeted interventions, and replication efforts that advance the field of maternal and child health.
Al-Jumaa I, Sabbagh G, Abushaban N
… +2 more, Hulett D, de Bocanegra HT
Matern Child Health J
· 2026 Mar · PMID 41746474
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INTRODUCTION: Arab refugees, immigrants, and migrants (RIMs) experience barriers in accessing accurate health information. To combat this, the Refugee Reproductive Health Network (ReproNet) developed Arabic, culturally c...INTRODUCTION: Arab refugees, immigrants, and migrants (RIMs) experience barriers in accessing accurate health information. To combat this, the Refugee Reproductive Health Network (ReproNet) developed Arabic, culturally concurrent health literacy sessions that included pre-recorded presentations on postpartum care. We evaluated the impact of these group sessions on postpartum knowledge and health literacy in the Arab RIM community in Southern California. METHODS: We recruited a convenience sample of 51 Arab RIMs through community organizations and the ReproNet client list for one in-person and three virtual informational sessions on postpartum care. We administered pre- and 2-4 week post-session surveys to measure e-Health Literacy (eHL) and Postpartum Health Literacy (PHL). We conducted descriptive analyses and t-tests to assess mean differences using SAS 9.4. RESULTS: Of the 51 attendees, 47 participants completed both the pre- and post-tests. Most participants were college-educated, single, and had never had a live birth. The average age was 39.3 years. We observed a significant increase in both eHL and PHL after the informational sessions. Females under the age of 35 had improved more in PHL than those over 35. Nulliparous females had a lower PHL baseline than parous females. DISCUSSION: Group health literacy training sessions that implement culturally concurrent methods, including pre-recorded presentations, are effective in increasing postpartum knowledge and health literacy in the Arab RIM community, regardless of parity. Enhancing PHL has the potential to reduce the risks of postpartum complications, such as postpartum depression (PPD), and can potentially contribute to postpartum females' mental and physical health.
Maturino K, Morton J, Weston K
… +1 more, Anbari A
Matern Child Health J
· 2026 Feb · PMID 41741881
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OBJECTIVE: We aimed to explore how women living in places with legalized recreational cannabis perceive perinatal cannabis use, and how legalization potentially impacts their experiences. METHODS: Between September 2024...OBJECTIVE: We aimed to explore how women living in places with legalized recreational cannabis perceive perinatal cannabis use, and how legalization potentially impacts their experiences. METHODS: Between September 2024 and December 2025, we searched databases including PubMed, CINAHL, Scopus, PsycINFO, and Web of Science. All research reports were screened and evaluated based on the inclusion and exclusion criteria. Theory-generating qualitative meta-synthesis methodology was used to extract, analyze, and synthesize the findings from included qualitative research reports. Quality appraisal of each study was also conducted. RESULTS: Nineteen qualitative research reports were included, and eight themes were identified. Themes included (1) recreational cannabis legalization, (2) clinical policies and practice, (3) stigma and discrimination, (4) access to and desire for information, (5) clinician-patient relationships, (6) most trusted sources: family and friends, (7) perceptions and experiences and (8) self-management. CONCLUSION: This qualitative meta-synthesis highlights the complex interplay of public policy, institutional and community, interpersonal, and intrapersonal factors influencing women’s perceptions of and experiences with perinatal cannabis use, as well as provides valuable insight into the decision-making process. These implications can help inform targeted public health and clinical practice interventions to address the complexities of cannabis use during the perinatal period.
Matern Child Health J
· 2026 Mar · PMID 41739303
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OBJECTIVE: To explore the combined effects of COVID-19 and the infant formula shortage. METHODS: A cross-sectional survey explored breastfeeding behavior by COVID-19 infant feeding guidance, access to lactation support,...OBJECTIVE: To explore the combined effects of COVID-19 and the infant formula shortage. METHODS: A cross-sectional survey explored breastfeeding behavior by COVID-19 infant feeding guidance, access to lactation support, and awareness and effect of the infant formula shortage. A multilinear regression model with backward elimination with bootstrapping was used to determine statistically significant predictors of breastfeeding duration. Text responses were analyzed to calculate the number and type of effects of the infant formula shortage. RESULTS: The number of effects of the infant formula shortage on the family, access to lactation support in the hospital, and number of hours of employment outside the home were the three most predictive variables for breastfeeding duration. However, access to lactation support was the only predictor that was statistically significant. Free form text responses demonstrated that formula feeding and some breastfeeding parents felt stress from the infant formula shortage. DISCUSSION: Access to lactation support in the hospital is widely recognized as a predictor of breastfeeding success. The decrease in lactation support that occurred during the COVID-19 pandemic may have created a barrier to breastfeeding. It is also remarkable that, regardless of feeding practice, the infant formula shortage created stress for families. CONCLUSIONS FOR PRACTICE: Access to a lactation consultant continues to be a significant contributor to breastfeeding behavior. Infant formula shortages may create risks for formula fed and breastfed infants. Breastfeeding protection and promotion may be a critical step in decreasing dependence on infant formula.
Nishide M, Hilton DCK, Sholler GF
… +5 more, Winlaw DS, Dunwoodie SL, Nassar N, Lain SJ, Blue GM
Matern Child Health J
· 2026 Feb · PMID 41718919
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INTRODUCTION: Most congenital heart disease (CHD) is due to a combination of genetic and environmental factors. Recent findings suggest a polygenic inheritance in more complex CHD, highlighting a role for environmental f...INTRODUCTION: Most congenital heart disease (CHD) is due to a combination of genetic and environmental factors. Recent findings suggest a polygenic inheritance in more complex CHD, highlighting a role for environmental factors in final disease presentation. Using data linkage, this study investigated the association of prenatal factors and maternal chronic health conditions with CHD severity. METHOD: Patients from the Kids Heart BioBank (n = 2389) were linked to the NSW Perinatal Data Collection and the NSW Admitted Patient Data Collection containing prenatal and maternal health records. CHD cases were grouped into two categories according to disease severity: (i) complex CHD (comprising patients requiring neonatal intervention, n = 581) and (ii) other CHD (comprising patients requiring intervention after the neonatal period, n = 1808). Prenatal factors and chronic health conditions were coded using ICD-10-AM classification and compared across severity groups and healthy controls (n = 58,624). RESULTS: Analyses identified a significant increase in preexisting diabetes mellitus (p = 0.003), and urinary tract infections (p = 0.01) in mothers of infants with complex CHD compared to other CHD. Conversely, circulatory system disorders and preeclampsia/gestational hypertension were reduced in mothers of infants with complex CHD compared to other CHD (p = 0.01 and p = 0.06, respectively). These risks remained after adjusting for confounding factors including socioeconomic status, smoking, age at pregnancy, gestational age and year of birth. CONCLUSION: These findings suggest an important role for prenatal factors and maternal chronic health conditions in CHD severity, in line with previous reports supporting polygenic inheritance in complex disease with contributions from environmental 'stressors' in the final disease presentation. Importantly, these findings hold promise for future primary prevention for complex CHD through therapeutic treatments of potentially modifiable factors in pregnancy.
George CV, Bhatia D, Righton O
… +9 more, El Dirani Z, White SL, Poston L, Quotah O, Schoenaker DAJM, Lavelle F, Timon CM, Flynn AC, Dunne P
Matern Child Health J
· 2026 Feb · PMID 41712055
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INTRODUCTION: Gestational diabetes mellitus (GDM) is a common pregnancy-related complication. The modest benefits of interventions to prevent GDM in women with high risk during pregnancy has shifted the focus to the prec...INTRODUCTION: Gestational diabetes mellitus (GDM) is a common pregnancy-related complication. The modest benefits of interventions to prevent GDM in women with high risk during pregnancy has shifted the focus to the preconception period. However, research on the effectiveness of preconception interventions in women who are more likely to develop GDM is lacking. This review aimed to assess the effect of preconception interventions, including behavioural strategies, supplementation, and pharmacological treatments on reducing the incidence of GDM. METHODS: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were first searched in February 2023 and updated in December 2025 (PROSPERO CRD42020177976). Randomised controlled trials (RCTs) evaluating dietary/physical activity (PA)/combined, nutritional supplementation or pharmacological intervention in the pre-pregnancy period in women at high risk of developing GDM conducted in any country and reported in English were included. The pre-pregnancy period was defined as the period before and/or between pregnancies. A narrative synthesis was conducted in line with the Synthesis Without Meta-analysis guidelines, and each study was assessed using the Cochrane risk of bias tool. RESULTS: Six RCTs, equating to nine publications (n = 909 participants in total) were included. Two interventions were conducted during the pre-pregnancy period and discontinued upon conception, and the remaining four were delivered pre-pregnancy and continued throughout pregnancy. Five trials focused on modifying both dietary intake and PA and one trial modified diet only. No studies reported a significant effect of preconception behaviour change intervention on GDM development; however, five of the trials were underpowered to do so. DISCUSSION: Limited evidence fitted this review’s inclusion criteria, highlighting a considerable research gap. Future well designed, adequately powered RCTs of behaviour change and/or pharmacotherapy in women at higher risk for developing GDM are necessary to inform preconception care guidelines to improve the immediate and long-term health of women and their infants.
Matern Child Health J
· 2026 Mar · PMID 41706303
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OBJECTIVES: Reproductive complications vary across rural and urban areas in the Southeastern U.S., yet maternal mental health-an important precursor to such complications-remains understudied. This study is the first to...OBJECTIVES: Reproductive complications vary across rural and urban areas in the Southeastern U.S., yet maternal mental health-an important precursor to such complications-remains understudied. This study is the first to examine how mental disorders may contribute to disparities in hypertensive disorders of pregnancy (HDP) between urban and rural settings. METHODS: We used South Carolina (SC) data on delivery hospitalizations for more than 270,000 mothers presenting with HDP who have given birth only once between 1999 and 2017. A Fairlie decomposition method was performed to examine the contribution of diagnosed maternal mental health conditions, and social inequalities account for the urban-rural differences in HDP prevalence. RESULTS: The prevalence of HDP was 5.75% among urban mothers and 6.16% among rural mothers. Fairlie decomposition results indicated that maternal factors such as education attainment, chronic hypertension, and gestation age explained 90% of the geographic disparities in the HDP prevalence. Interestingly, differences in maternal mental health conditions, such as mental disorders of pregnancy and perinatal mood and anxiety disorders, reduced the urban-rural gap in the HDP prevalence. CONCLUSIONS FOR PRACTICE: Our results highlight the importance of individual and community drivers required to improve maternal mental health conditions. More community support systems for the mental health along with reproductive health will greatly improve maternal health outcomes.
Twinomuhwezi E, Kiragga AN, Banturaki G
… +9 more, Achieng M, Nampala J, Bagaya I, Kigozi J, Castelnuovo B, Hazra R, Yiannoutsos CT, Wools-Kaloustian KK, East Africa International Epidemiology Databases to Evaluate AIDS (IeDEA) Consortium
Matern Child Health J
· 2026 Feb · PMID 41706302
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PURPOSE: Community tracing for disengaged pregnant and post-partum women with HIV(PPWH) shows promise, yet few studies detail the practical challenges of tracing, particularly in the Prevention of Mother-to-Child Transmi...PURPOSE: Community tracing for disengaged pregnant and post-partum women with HIV(PPWH) shows promise, yet few studies detail the practical challenges of tracing, particularly in the Prevention of Mother-to-Child Transmission programs (PMTCT). Standard guidelines and evidence-based approaches remain lacking. We share lessons from our experiences in tracing disengaged PPWH in an urban PMTCT program in Uganda, where nurse counselors joined outreach teams to trace lost PPWH women via calls and home visits. DESCRIPTION: The parent study was a prospective case–control study conducted in Uganda at six urban clinics. We integrated study nurse counsellors into the program’s outreach team to support the participant tracing activities. A team of outreach workers, including study nurse counsellors, traced the disengaged women through telephone calls and home visits. ASSESSMENT: Experiences encountered and lessons learned by the nurse-counselors encompassed the following domains: non-disclosure, stigma, and cultural practices; sex of the tracer (outreach worker); client mobility; incorrect locator information; community-specific names; deregistration of phone lines; and non-disclosure of exposure status in infants whose mother had died. CONCLUSION: Experienced outreach workers should complete locator forms, multiple phone number should be collected and those of trusted confidents should be identified, psychosocial issues should be addressed early, outreach team members should come from the local community, locator information should be kept up to date, an electronic system with the capacity to store GPS coordinates should be considered, gender match tracers to the client, local protocols should be developed for the disclosure of exposure status for infants whose mothers have died.
Chaparro MP, Perkins S, Price AW
… +2 more, Wolfe SM, Probert K
Matern Child Health J
· 2026 Jan · PMID 41689672
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PURPOSE: To describe the Children's Healthy Weight State Capacity Building Program (CHW-SCBP) and report on progress after 3 years of program implementation. DESCRIPTION: The CHW-SCBP was a 5-year cooperative agreement (...PURPOSE: To describe the Children's Healthy Weight State Capacity Building Program (CHW-SCBP) and report on progress after 3 years of program implementation. DESCRIPTION: The CHW-SCBP was a 5-year cooperative agreement (2020-2025) between the Association of State Public Health Nutritionists (ASPHN) and the Health Resources & Services Administration (HRSA), with the specific objective of developing state models in maternal child health (MCH) nutrition integration, which could then be implemented and replicated in states nationwide. Three states - North Dakota, Oregon, and Wisconsin - were selected to be part of CHW-SCBP and worked with ASPHN on their specific priorities and models of MCH nutrition integration. The implementation of the CHW-SCBP program followed two strategies, based on the goals of the HRSA Notice of Funding Opportunity (HRSA-20-043): (1) the workforce strategy, focused on increasing the MCH nutrition competency of the state Title V workforce and (2) the data strategy, focused on optimizing MCH nutrition-related data sources to contribute to data-driven programs and activities related to assessment, policy development, and assurance, within states' Title V. ASSESSMENT: Activities implemented within the workforce and data strategies, as well as each state's outcomes, are summarized and discussed. Results from Year 3 program evaluation are also included. CONCLUSION: The CHW-SCBP program successfully engaged with the three selected states, increasing the MCH nutrition competency of their Title V workforce and their knowledge and usage on MCH nutrition data. Sustainability plans need to be developed for program gains to be maintained beyond the CHW-SCBP funding period.
Matern Child Health J
· 2026 Mar · PMID 41653255
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BACKGROUND: Attachment and Biobehavioral Catch-up (ABC) is a home visiting program designed for parents of children between birth and 48 months of age who have experienced early adversity. Previous research demonstrated...BACKGROUND: Attachment and Biobehavioral Catch-up (ABC) is a home visiting program designed for parents of children between birth and 48 months of age who have experienced early adversity. Previous research demonstrated that ABC enhances parental sensitivity and reduces parental intrusiveness through both in-person and hybrid delivery methods (Roben et al.in Child Development 88(5):1447–1452, 2017, https://doi.org/10.1111/cdev.12898 ; Schein et al. in Child Maltreatment28(1):24–33, 2023, https://doi.org/10.1177/10775595211072516 ). However, the relative effectiveness of in-person versus exclusive telehealth implementation had yet to be explored. METHODS: The current study examined changes in parental sensitivity and intrusiveness from pre- to post-intervention in community implementation settings among 201 families receiving ABC either in-person or via telehealth. Parenting behaviors were analyzed through coded video recordings of parent-child free play interactions, collected before and after the intervention. RESULTS: Parental sensitivity increased for both implementation methods, with in-person delivery showing significantly greater improvement than telehealth. Parental intrusiveness also decreased for both groups, with no significant difference between the two implementation methods. CONCLUSIONS: ABC was effective in improving parenting behaviors when delivered both in person and via telehealth in real-world community settings. Findings suggest that while telehealth delivery is a viable implementation option, in-person services may offer additional benefits for enhancing parental sensitivity, with implications for service delivery decisions in home visiting programs.