Dissertations / Theses on the topic 'Pregnant women Pregnancy Exercise for pregnant women'

Thesis (M.S.)--West Virginia University, 1999.
Title from document title page. Document formatted into pages; contains vi, 78 p. : ill. Vita. Includes abstract. Includes bibliographical references (p. 47-50).

Introduction: Obesity during pregnancy is linked to many negative health effects for mothers and offspring. The majority of interventions with obese pregnant women based on physical activity have had limited success suggesting alternative approaches are needed. Sedentary behaviour is defined as waking activities that expend very low energy, 1.5 metabolic equivalents or below, while reclining, lying or sitting. Spending too much time sedentary has been identified as a risk factor for health, regardless of physical activity levels. We hypothesised that targeting sedentary behaviour may be a suitable alternative to reduce health risks during gestation among pregnant women who are morbidly obese (defined as body mass index, BMI > 40 Kg/m²). Aim and objectives: The aim was to explore sedentary behaviour among obese pregnant women and to propose an intervention to reduce the time obese pregnant women spend sedentary, through an active sitting exercise intervention. To conduct a systematic review of the literature to determine the proportion of time spent in sedentary behaviour among pregnant women, and the association of sedentary behaviour with pregnancy outcomes in mothers and offspring. To estimate total energy expenditure, and energy expended in sedentary activities in morbidly obese and lean pregnant women. To assess the feasibility of an active sitting exercise intervention for morbidly obese pregnant women, designed using a patient involvement in research method. Systematic Review: A systematic review of the literature reporting sedentary behaviour during pregnancy and its effects on pregnancy outcomes was conducted. Twenty six publications were included in the systematic review up until October 2015, and a further 18 were identified in the update completed in April 2018. Pregnant women spent at least 50% of their time in sedentary activities. Associations between increased time sedentary and higher risk of macrosomia, higher risk of pre-eclampsia, higher risk of developing gestational diabetes mellitus, and larger new-born abdominal circumference were observed, as the main findings. Most of included studies scored an intermediate quality, only two of the 44 studies scored a good quality. Cross-sectional study. A cross-sectional study was conducted, using the Pregnancy Physical Activity Questionnaire (PPAQ), and the Actical accelerometer, to assess energy expenditure, and energy expended in sedentary behaviour. Based on the PPAQ, women who were morbidly obese expended significantly more energy per day, as total expenditure, than lean pregnant women, which was confirmed by the Actical. During sedentary behaviour lean pregnant women expended significantly less energy than morbidly obese pregnant women, based on the PPAQ. No differences were observed between lean and morbidly obese pregnant women in the proportion of time spent in sedentary activities, nor in time sedentary. Exercise Intervention Design A patient involvement in research approach was used to design an active sitting exercise intervention for morbidly obese pregnant women. Twenty three women took part in the design of the intervention, enabling design of a final protocol including six exercises, to be performed in two sets of 10 repetitions. Active sitting exercise intervention An intervention based on active sitting exercises for morbidly obese pregnant women to reduce sedentary time was conducted to assess the feasibility. Thirty morbidly obese pregnant women were recruited of whom 20% completed the exercise intervention. The main reason not to complete the intervention was lack of time. Conclusion: A better understanding of sedentary behaviour is needed for the design of effective interventions to help to reduce the adverse effects of morbid obesity on pregnancy, especially as prevalence is growing. More time spent in light intensity activities rather than in sedentary behaviour may play a role as contributing to reduce those risks associated with obesity during pregnancy, and to reduce time spent sedentary. Participants have shown real interest in helping to design an effective exercise intervention. Involving and empowering participants in how to take care of themselves as part of the intervention helps to increase their commitment. Giving participants the tools to take care of their own health and their babies' should be considered as part of the intervention with very obese pregnant women. Providing the information in how and why exercise might help, and basing the intervention in giving participants easy and realistic tasks that they could do on their own and around their own environment, will help to increase their commitment. This appears to be a feasible and effective strategy.

This study evaluated the effects of participation in aerobic exercise on pregnancy outcomes. Pregnancy outcomes included type of delivery, length of labor, gestational age, neonatal birth weight, and maternal weight gain. The 137 nulliparas were categorized as active (N=44) or sedentary (N=93) based on self-reported aerobic exercise. Findings from this study suggest that pregnant women who were active during pregnancy were more likely to have vaginal deliveries than sedentary women. No significant differences between active and sedentary women were found in neonatal birth weight, maternal weight gain, length of labor, or gestational age.

Background Excessive gestational weight gain (GWG) poses significant risk for maternal and neonatal health. Various guidelines have recommended healthy diets and enhancing physical activity during pregnancy to prevent excessive GWG. However, results of intervention studies are inconsistent in the developed countries, and there are no official guidelines and few interventions for GWG in China. This paper aims to review and synthesize relevant studies on diet and physical activity interventions to prevent excessive GWG so that practical suggestions can be provided to public health authorities in China. Methods This systematic review was performed using PubMed, Google and Google Scholar to search all relevant studies in English and randomised controlled trials (RCTs) that investigated diet and physical activity interventions to limit excessive GWG up to May 2014. The quality of included studies was assessed using CONSORT statement and JADAD scale. Results Nine studies describing diet and physical activity interventions to prevent excessive GWG were incorporated in the systematic review. Overall, the contents of interventions were diverse, which consisted of one-to-one counselling, and community-based physical activity interventions. Weekly mailed newsletters and supportive telephone calls were used as assistive tools to remind pregnant women of limiting excessive GWG. Seven studies showed less weight gain in pregnant women receiving the intervention, of which four studies demonstrated a reduction in excessive GWG in women with varying body mass index (BMI) spanning the normal, overweight and obese categories, while three studies reported a reduction of excessive GWG only in normal weight women and obese women need to be paid attention in the future. Conclusions The effectiveness of diet and physical interventions to limit excessive GWG may not be confirmed because of limited quality or sample size of intervention studies. However, studies have demonstrated reduction of excessive GWG during pregnancy, in addition to persistent healthy behaviours following such interventions during pregnancy. Further meta-analyses of RCTs studies should be done to confirm the effectiveness of such interventions among Chinese women.
published_or_final_version
Public Health
Master
Master of Public Health

The general purpose of this research was to investigate physical activity levels as a correlate of selected aspects of psychological health among pregnant women. Specifically, the aims of the study were (1) to provide a cross-sectional description of changes in physical self-concept, mood, and perceived stress during pregnancy; (2) to evaluate physical activity patterns of pregnant women over time during pregnancy; and (3) to determine if there is a difference between physical activity and physical self-concept, mood, perceived stress and/or burnout symptoms during pregnancy. Participants were pregnant women from various antenatal clinics at King Edward Memorial Hospital. The women completed a questionnaire package containing questions on physical activity levels and measures of physical self-concept, social physique anxiety, perceived stress, mood and burnout symptoms. A series of ANOVAs was used to provide a descriptive profile of how these psychological variables change during the course of pregnancy. Significant time-related differences were found for the perceived health subscale of the PSDQ and the tension subscale for the BRUMS. Findings also suggested a significant association between physical activity, and physical self-perceptions, most importantly self-esteem. Higher levels of physical activity were also found to be closely related to positive mood states, lower levels of perceived stress and fewer burnout symptoms. No significant association was found between physical activity and social physique anxiety.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Objetivo: delinear, implementar e avaliar a efetividade de uma intervenção - inserção sistematizada da promoção da alimentação saudável e caminhada no lazer na atenção pré-natal rotineira realizada por médicos e enfermeiros em unidades de saúde da família - sobre cinco práticas alimentares e a realização de caminhada no lazer por gestantes. Métodos: estudo de intervenção controlado, não randomizado, no qual participaram 42 médicos/enfermeiros e uma amostra (n=353) de gestantes por eles assistidas em unidades de atenção primária à saúde da rede pública do município de Botucatu-SP, Brasil. O estudo foi dividido em duas etapas: avaliação das mudanças em conhecimentos e práticas dos profissionais e avaliação do impacto da intervenção sobre os comportamentos das gestantes por eles assistidas. Na primeira, foi delineada e implementada uma ação educativa (AE), com 16 horas, presenciais, dirigida a médicos e enfermeiros que assistem gestantes em 9 unidades de saúde da família, com o objetivo de ampliar/adequar seus conhecimentos sobre alimentação e atividade física na gestação e organizar o processo de trabalho para a inserção sistematizada no pré-natal da promoção de 5 práticas alimentares (3 frutas diariamente; 2 porções de hortaliças e 2 de feijão, pelo menos em 5 dias da semana; consumo esporádico (no máximo uma vez por semana) de refrigerante e/ou biscoito industrializado) e da orientação das gestantes para a realização de caminhada no lazer. A AE incluiu um curso de imersão (8hs) com todos os profissionais e 3 oficinas de trabalho em cada unidade de saúde. Os conhecimentos e práticas dos participantes (n=22), antes e após a intervenção, foram comparados aos de um grupo controle (n=20), formado pelos profissionais de 8 unidades básicas de saúde de modelo tradicional (UBS) situadas no mesmo município e que não foram envolvidas na intervenção. Nos dois grupos, os conhecimentos...
Objective: to design, implement and evaluate the effectiveness of an intervention - systematic insertion of promoting healthy eating and leisure-time walking during in routine prenatal care performed by doctors and nurses in family health care units - over five dietary practices and the realization of leisure-time walking at by pregnant women. Methods: this is a controlled intervention study, not randomized, in which took part 42 doctors/nurses and a sample (n=353) of pregnant women attended by those professionals in primary health care settings to public health care in the city of Botucatu-SP, Brazil. The study has been divided into two stages. The first one was the implementation and evaluation of an educational activity (EA), with 16 hours, by attendance, addressed to doctors and nurses who assist pregnant women in nine family health care units, in order to extend/adapt their knowledge of nutrition and physical activity during pregnancy and then introduce routinely and systematically in prenatal care the promotion of 5 dietary practices (3 fruit daily; 2 servings of vegetables and two servings of beans, at least 5 days a week; sporadic consumption (maximum once a week) of soda and / or industrialized cookie), and guidance of pregnant women to walking during leisure time. The knowledge and practices of the participants (n=22) before and after the EA, have been compared to a control group (n=20), formed by professionals of eight traditional health care units not involved in the educational activity. This knowledge has been evaluated in both groups with a self-applied questionnaire, elaborated for this research; practices (guidance for leisure-time walking and healthy eating) have been measured by interviews with pregnant women assisted by two professional groups, in their homes. We have generated two scores of knowledge (about walking and nutrition) and we have used ANOVA for repeated measures to assess changes before and after the ...

Orientador: Maria Antonieta de Barros Leite Carvalhães
Coorientador: Maria Helena D'Aquino Benício
Banca: Daniela Saes Sartorelli
Banca: Luiza Cristina Godim Domingues Dias
Banca: Paula Andrea Martins
Banca: Silvia Justina Papini
Resumo: Objetivo: delinear, implementar e avaliar a efetividade de uma intervenção - inserção sistematizada da promoção da alimentação saudável e caminhada no lazer na atenção pré-natal rotineira realizada por médicos e enfermeiros em unidades de saúde da família - sobre cinco práticas alimentares e a realização de caminhada no lazer por gestantes. Métodos: estudo de intervenção controlado, não randomizado, no qual participaram 42 médicos/enfermeiros e uma amostra (n=353) de gestantes por eles assistidas em unidades de atenção primária à saúde da rede pública do município de Botucatu-SP, Brasil. O estudo foi dividido em duas etapas: avaliação das mudanças em conhecimentos e práticas dos profissionais e avaliação do impacto da intervenção sobre os comportamentos das gestantes por eles assistidas. Na primeira, foi delineada e implementada uma ação educativa (AE), com 16 horas, presenciais, dirigida a médicos e enfermeiros que assistem gestantes em 9 unidades de saúde da família, com o objetivo de ampliar/adequar seus conhecimentos sobre alimentação e atividade física na gestação e organizar o processo de trabalho para a inserção sistematizada no pré-natal da promoção de 5 práticas alimentares (3 frutas diariamente; 2 porções de hortaliças e 2 de feijão, pelo menos em 5 dias da semana; consumo esporádico (no máximo uma vez por semana) de refrigerante e/ou biscoito industrializado) e da orientação das gestantes para a realização de caminhada no lazer. A AE incluiu um curso de imersão (8hs) com todos os profissionais e 3 oficinas de trabalho em cada unidade de saúde. Os conhecimentos e práticas dos participantes (n=22), antes e após a intervenção, foram comparados aos de um grupo controle (n=20), formado pelos profissionais de 8 unidades básicas de saúde de modelo tradicional (UBS) situadas no mesmo município e que não foram envolvidas na intervenção. Nos dois grupos, os conhecimentos...
Abstract: Objective: to design, implement and evaluate the effectiveness of an intervention - systematic insertion of promoting healthy eating and leisure-time walking during in routine prenatal care performed by doctors and nurses in family health care units - over five dietary practices and the realization of leisure-time walking at by pregnant women. Methods: this is a controlled intervention study, not randomized, in which took part 42 doctors/nurses and a sample (n=353) of pregnant women attended by those professionals in primary health care settings to public health care in the city of Botucatu-SP, Brazil. The study has been divided into two stages. The first one was the implementation and evaluation of an educational activity (EA), with 16 hours, by attendance, addressed to doctors and nurses who assist pregnant women in nine family health care units, in order to extend/adapt their knowledge of nutrition and physical activity during pregnancy and then introduce routinely and systematically in prenatal care the promotion of 5 dietary practices (3 fruit daily; 2 servings of vegetables and two servings of beans, at least 5 days a week; sporadic consumption (maximum once a week) of soda and / or industrialized cookie), and guidance of pregnant women to walking during leisure time. The knowledge and practices of the participants (n=22) before and after the EA, have been compared to a control group (n=20), formed by professionals of eight traditional health care units not involved in the educational activity. This knowledge has been evaluated in both groups with a self-applied questionnaire, elaborated for this research; practices (guidance for leisure-time walking and healthy eating) have been measured by interviews with pregnant women assisted by two professional groups, in their homes. We have generated two scores of knowledge (about walking and nutrition) and we have used ANOVA for repeated measures to assess changes before and after the ...
Doutor

No período gestacional a mulher está mais suscetível às recomendações dos profissionais de saúde que a acompanha durante todo o pré-natal, sendo um momento propicio para orientá-las a adotarem um estilo de vida ativo. Entretanto, devido à alta prevalência de inatividade física na gestação, deve-se analisar a lacuna que existe entre a recomendação e a prática de atividade física no lazer/exercício físico realizado pelas mulheres neste período. Dessa maneira, o objetivo do presente estudo é verificar a associação entre a prática regular de atividades físicas no lazer e/ou exercícios físicos na gestação e orientações recebidas durante o atendimento de pré-natal. Trata-se de um estudo transversal com 290 puérperas (captadas no pós-parto imediato) de dois hospitais de Santo André, sendo um da rede pública e outro da rede privada de atendimento de pré-natal. Adicionalmente, participaram 45 profissionais de saúde captados em clínicas, hospitais, consultórios e postos de saúde. Utilizou-se um questionário para obter informações referentes à prática de atividade física no lazer/exercício físico e ao aconselhamento realizado pelo profissional de saúde. Para avaliar associação e concordância foi realizado o teste de qui-quadrado, a análise de regressão logística binomial e análise de Kappa, considerando-se o nível de significância inferior a 5%. As usuárias do serviço privado possuíam maior idade, renda e escolaridade (p<0,001). Todavia, as puérperas do serviço público apresentavam maior nível de atividade física (p<0,001) e consequentemente maior gasto energético (p<0,001). Mas, 56,8% do gasto energético eram influenciados pela atividade física doméstica (p=0,011). Houve maior frequência de recomendação para a prática de atividade física no lazer/exercício físico para as mulheres do serviço privado. A prática de atividade física pré-gestacional e a presença de recomendação do profissional de saúde estavam associados ao nível de atividade física no lazer, aumentando a chance da mulher atingir a recomendação (150 minutos de atividade física semanal). A maioria das mulheres citou a falta de tempo e de interesse como principais barreiras a adoção de um estilo de vida ativo. Em relação aos profissionais, observou-se que há associação entre a recomendação de atividade física no lazer e a formação do profissional. A prática da caminhada e a hidroginástica foram as atividades mais recomendadas. Em relação ao volume semanal e a intensidade da atividade física, 35,4% dos profissionais recomendavam pelo menos 150 minutos e 66,7% recomendavam a intensidade leve. Não houve concordância entre as informações percebidas pelas mulheres durante o pré-natal com as recomendações proferidas pelos profissionais de saúde, demonstrando a importância de desenvolver estratégias para suprir esta lacuna na comunicação entre a usuária e o profissional. Ainda assim, observa-se que a adequação de conteúdo e forma das recomendações realizadas durante as consultas de pré-natal podem auxiliar no quadro do estilo de vida ativo da mulher. Sugere-se a realização de novos estudos com intervenções com os profissionais de saúde para que se possa formar uma equipe multidisciplinar e oferecer a saúde materno-fetal uma melhor qualidade de vida
During pregnancy women are more susceptible to the recommendations of health professionals who accompanies throughout the prenatal, being a propitious moment to target them to take an active lifestyle. However, due to the high prevalence of physical inactivity during pregnancy, you should analyze the gap between the recommendation and the practice of physical activity in leisure / exercise performed by women in this period. Thus, the objective of this study is to assess the association between regular physical activity in leisure and / or physical exercise during pregnancy and guidance received during prenatal care. It is a cross-sectional study of 290 women (captured in the immediate postpartum) of two hospitals in Santo André, one of public and other private health care providers of prenatal care. In addition, 45 health professionals raised in clinics, hospitals, clinics and health posts attended. We used a questionnaire to obtain information regarding the practice of leisure physical activity / exercise and counseling performed by a healthcare professional. The association agreement and the chi-square test and analysis of binomial logistic regression and analysis of agreement Kappa, considering the level of less than 5% significance was conducted. The private service users had higher age, income and education (p <0.001). However, the mothers of the public service had a higher level of physical activity (p <0.001) and consequently higher energy expenditure (p <0.001). But 56.8% of energy expenditure were influenced by domestic physical activity (p = 0.011). There was a higher frequency of recommendation for physical activity in leisure / exercise for women in the private service. The practice of pre-pregnancy physical activity and the presence of the recommendation of the health professional was associated with level of physical activity during leisure time, increasing the chance of women reach the recommended (150 minutes of physical activity per week). Most women cited lack of time and interest as the main barriers to adoption of an active lifestyle. Regarding professional, it was observed that there is an association between the recommendation of physical activity during leisure time and professional training. The practice of walking and aerobics were recommended activities. Regarding the weekly volume and intensity of physical activity, 35.4% of the professionals recommend at least 150 minutes and 66.7% recommended light intensity. There was no agreement between the information perceived by women during the prenatal to the recommendations given by health professionals, demonstrating the importance of developing strategies to fill this gap in communication between the user and the professional. Still, it is observed that the suitability of content and form of the recommendations made during prenatal consultations can assist within the active lifestyle of women. It is suggested to conduct further studies with interventions with health professionals so that they can form a multidisciplinary team and provide maternal-fetal a better quality of life

Orientador: Iracema de Mattos Paranhos Calderon
Banca: José Eduardo Corrente
Banca: Rita Maria dos Santos Puga Barbosa
Banca: Flor Ernestina Martinez Espinosa
Banca: Evelyne Marie Therese Mainbourg
Resumo: A atividade física é definida como qualquer movimento corporal produzido pelos músculos esqueléticos que resulte em gasto energético maior que os níveis de repouso. Em mulheres não gestantes e com risco para desenvolver Diabetes Melito Gestacional (DMG), a atividade física pode contribuir para prevenir ou retardar o aparecimento da doença. Na gestação complicada pelo diabete materno, a atividade física regular favorece a normoglicemia e o adequado ganho de peso. A hipótese deste estudo é que a prática de atividade física regular, anterior à gestação, resulte em benefícios na gestação e previna o ganho de peso materno excessivo e o desenvolvimento do DMG. O Pregnancy Physical Activity Questionnaire (PPAQ) é um questionário estruturado, semiquantitativo, autoadministrado e de fácil entendimento, no qual as gestantes relatam o tempo gasto em 32 diferentes tipos de atividades cotidianas. Este questionário já foi validado em diferentes populações de gestantes, mas ainda não foi relacionado ao diagnóstico do DMG. O objetivo deste estudo foi aplicar e avaliar a aplicabilidade do PPAQ e investigar possíveis associações entre atividade física prévia à gestação e a ocorrência de sobrepeso/obesidade e de DMG. Foram incluídas 250 gestantes, entre a 20ª e 28ª semanas de gestação, acompanhadas na assistência pré-natal de Unidades Básicas de Saúde, ou da Família, no município de Manaus/AM. As gestantes foram devidamente informadas e assinaram o Termo de Consentimento Livre e Esclarecido (TCLE). Delineou-se um estudo de corte transversal, composto por dois segmentos: APLICABILIDADE do instrumento de avaliação de atividade física [PPAQ] em gestantes brasileiras e ASSOCIAÇÃO dos resultados do PPAQ com a ocorrência de sobrepeso, obesidade e DMG
Abstract: Not available
Doutor

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A atividade física é definida como qualquer movimento corporal produzido pelos músculos esqueléticos que resulte em gasto energético maior que os níveis de repouso. Em mulheres não gestantes e com risco para desenvolver Diabetes Melito Gestacional (DMG), a atividade física pode contribuir para prevenir ou retardar o aparecimento da doença. Na gestação complicada pelo diabete materno, a atividade física regular favorece a normoglicemia e o adequado ganho de peso. A hipótese deste estudo é que a prática de atividade física regular, anterior à gestação, resulte em benefícios na gestação e previna o ganho de peso materno excessivo e o desenvolvimento do DMG. O Pregnancy Physical Activity Questionnaire (PPAQ) é um questionário estruturado, semiquantitativo, autoadministrado e de fácil entendimento, no qual as gestantes relatam o tempo gasto em 32 diferentes tipos de atividades cotidianas. Este questionário já foi validado em diferentes populações de gestantes, mas ainda não foi relacionado ao diagnóstico do DMG. O objetivo deste estudo foi aplicar e avaliar a aplicabilidade do PPAQ e investigar possíveis associações entre atividade física prévia à gestação e a ocorrência de sobrepeso/obesidade e de DMG. Foram incluídas 250 gestantes, entre a 20ª e 28ª semanas de gestação, acompanhadas na assistência pré-natal de Unidades Básicas de Saúde, ou da Família, no município de Manaus/AM. As gestantes foram devidamente informadas e assinaram o Termo de Consentimento Livre e Esclarecido (TCLE). Delineou-se um estudo de corte transversal, composto por dois segmentos: APLICABILIDADE do instrumento de avaliação de atividade física [PPAQ] em gestantes brasileiras e ASSOCIAÇÃO dos resultados do PPAQ com a ocorrência de sobrepeso, obesidade e DMG

This paper attempted to determine the effect that gastrointestinal discomforts, socioeconomic status, dietary knowledge and beliefs about foods to omit during pregnancy had on the nutritional status of pregnant women. Hemoglobin, upper arm muscle circumference, weight for height and eating patterns measured nutritional status. Twenty women in their second trimester of pregnancy, active duty or the dependent wife of an Air Force E-4 and below, were surveyed. Questionnaires and anthropometric measures were used. Pearson Product Moment Correlations and a canonical correlation were accomplished. Data analysis indicated a significant negative correlation between eating patterns and gastrointestinal discomfort. There was a significant positive correlation between beliefs about foods to omit and eating patterns. Significant negative correlations existed between dietary knowledge and military status, monthly grocery bill, and number of people fed.

Health care providers’ (N = 421) implicit perceptions of pregnant women based on age, race or ethnicity, marital status, and socioeconomic status are assessed through a true-experiment design. Ordinal and binary regression analyses revealed that respondents felt more pity for an unmarried than married pregnant woman and more anger toward an unemployed pregnant woman without health insurance compared to a pregnant woman who was employed with health insurance. Male, Asian, and Hispanic respondents were less likely to help the pregnant woman, Black and protestant respondents were more likely to express some degree of anger toward the pregnant woman, and male and protestant respondents assigned more responsibility to the woman for her pregnancy. Additionally, respondents’ open-ended suggestions varied based on the pregnant woman’s characteristics. Implications and future directions are discussed.

Thesis (DPsych) -- School of Life and Social Sciences, Swinburne University of Technology, 2007.
Submitted in partial requirement fulfillment of the requirements for the award of the Professional Doctorate in Counselling Psychology, Swinburne University of Technology, 2007". "February 2007". Includes bibliographical references (p. 247-256).

Background: : Few investigators have evaluated the association between early pregnancy social support and depression; however, increased social support may improve mental health during pregnancy. Our objective is to examine whether in early pregnancy there is an association between social support and maternal depression among women in Peru. Methods: : 2,062 pregnant women participated in structured interviews. Early pregnancy social support was measured using the Social Support Questionnaire (SSQ-6). We evaluated the number of individuals that participants could turn to in different situations (Social Support Number Score; SSQN) and their satisfaction with support received (Social Support Satisfaction Score; SSQS). Median SSQN and SSQS characterized participants according to high and low levels of support. SSQN family vs. non-family support were also evaluated separately. Antepartum depression was assessed using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: : 39.6% of women reported high SSQN and 45.5% reported high SSQS. Approximately 25% had antepartum depression. Women with high SSQN had 22% lower odds of antepartum depression (OR = 0.78; 95%CI: 0.63–0.97). Similarly, women with high SSQS scores had 45% lower odds of antepartum depression (OR = 0.55; 95%CI: 0.45–0.68). Women with high SSQN non-family scores had 30% lower odds antepartum depression compared to those with low SSQN non-family scores (OR = 0.70; 95%CI: 0.57–0.86). The association between SSQN family scores and antepartum depression did not reach statistical significance. Conclusion: : Increased social support may improve maternal mental health during pregnancy and this association should be assessed in longitudinal studies.
This research was supported by awards from the National Institutes of Health ( NIH ), National Institute of Minority Health and Health Disparities ( T37-MD-001449 ) and Eunice Kennedy Shriver National Institute of Child Health and Human Development ( R01-HD-059835 ). The NIH had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
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Revisión por pares
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
OBJECTIVE: To examine the construct validity of the 9 item Traumatic Events Questionnaire (TEQ) and to evaluate the extent to which experiences of trauma assessed using the TEQ are associated with symptoms of psychiatric disorders among 3342 pregnant women in Lima, Peru. METHODS: Symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) while the PTSD Checklist-civilian (PCL-C) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess symptoms of PTSD and generalized anxiety. Hierarchical logistic regression procedures were used to evaluate relations between TEQ and symptoms of psychiatric disorders. RESULTS: The majority of participants (87.8%) experienced at least one traumatic event (mean = 2.5 events). The trauma occurrence score was moderately correlated with symptoms of PTSD (PCL-C: rho = 0.38, P-value < 0.0001), depression (EPDS: rho = 0.31, P-value < 0.0001; PHQ-9: rho = 0.20, P-value < 0.0001), and GAD (GAD-7: rho = 0.29, P-value < 0.0001). Stronger correlations were observed between the trauma intensity score with symptoms of psychiatric disorders (PCL-C: rho = 0.49, P-value < 0.0001; EPDS: rho = 0.36, P-value < 0.0001; PHQ-9: rho = 0.31, P-value < 0.0001; GAD-7: rho = 0.39, P-value < 0.0001). CONCLUSION: Given the high burden of trauma experiences and the enduring adverse consequences on maternal and child health, there is an urgent need for integrating evidence-based trauma informed care programs in obstetrical practices serving Peruvian patients.
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The purpose of this project was to create a brochure based on current healthy pregnancy outcome recommendations with additional recommendations for reducing organophosphate (OP) pesticide exposure and promotion of nutrition quality of organic versus conventionally grown food. Specific objectives of the project were: (a) review the literature and depth of the problem, (b) review existing similar healthy pregnancy outcome educational material, (c) develop a brochure for the purpose of educating women of childbearing age and pregnant women about healthy pregnancy outcome recommendations, and (d) develop tools to measure learner comprehension of the information presented in the brochure, as well as obtain recommendations for improving the brochure. An expert panel reviewed the brochure and modifications were made based on their suggestions. Implementing the resulting evidence-based brochure could help increase healthy pregnancy outcomes and improve the overall health of women and children.

Drug and alcohol addiction in pregnant women is a significant public health issue. The purpose of this study was to assess drug and alcohol addiction in pregnant women and the setting in which they sought service or treatment to determine whether U.S. census regions and race data could predict the type of addiction service or treatment that pregnant addicts chose. The theories of self-efficacy, cognitive behavioral therapy, and rational emotive behavioral therapy were used as the theoretical framework for this study. The research questions were used to examine whether there was a relationship between the source of addiction treatment referral and the type of addiction service or treatment setting for pregnant addicts that reside in the United States at the time of their initial admission for treatment. This quantitative study used archival data from the 2012 Treatment Episode Dataset – Admission from the Substance Abuse and Mental Health Services Administration. Data analysis included the Chi square (χ2) test of independence and a multinomial regression. There was a significant relationship (p < .001) between the source of treatment program referral and type of service/treatment setting for pregnant women who were diagnosed with only an alcohol addiction and both an alcohol and illicit drug addiction. U.S. census region and race did predict the type of addiction service/treatment setting for pregnant addicts diagnosed with an alcohol addiction, as well as those diagnosed with a drug addiction, at the time of treatment admission. Results from this study can be used to address an under researched area of addiction treatment and could aid in changing the behaviors of pregnant addicts, thereby potentially promoting positive social change.

Introduction: Substance use, including cigarette smoking, while pregnant can lead to a plethora of health concerns for both the mother and unborn child including premature birth, low birth weight, and stillbirth. Compared with women nationally, pregnant women in Tennessee are more than three times as likely to smoke during pregnancy. Preliminary findings suggest high levels of religious commitment may be reliable predictors of negative health behaviors. However, the association between religious commitment and substance use has not been thoroughly investigated in pregnant populations. Using a brief measure of religious commitment, it was hypothesized that pregnant women with higher levels of religious commitment would be significantly less likely to engage in cigarette smoking and other substance use. Methods: Participants included 654 pregnant women involved in the Tennessee Intervention for Pregnant Smokers program who completed multiple interviews during pregnancy. Of interest in the current investigation, participants’ religious commitment was measured using two items from the 12-item Surrender Scale, and a 1-item church attendance measure from the Brief Multidimensional Measure of Religiousness/Spirituality. Participants also completed a background information form assessing demographic characteristics, smoking habits, and drug use, with final substance use variables composites of both self-report and urine drug screen results. Results: Direct logistic regression was performed to assess associations between religious commitment and both smoking status (at conception and delivery) and other substance use. All models included level of education, age, marital status, and insurance status. The full direct model predicting smoking status at conception was statistically significant, χ2 (5, n = 654) = 178.76, p < .001, indicating the model could distinguish between participants who did and did not report smoking early in pregnancy. The model as a whole explained between 24% and 32% of the variance in smoking status, and correctly classified 71% of cases. All variables made statistically significant and unique contributions to the model, including religious commitment (OR=.857). A similar pattern was found in the model predicting smoking status at delivery χ2 = 157.01, p < .001. A third regression, using the same predictors, examining the impact of religious commitment on any illicit drug use prior to or during pregnancy, was also statistically significant, χ2 = 58.46, p < .001. Conclusions and Implications: In this sample, religious commitment predicted smoking status and other drug use during and prior to pregnancy. Inquiry into religious commitment as an additional gauge of health behaviors may be beneficial to healthcare professionals. Future research should investigate the possible mechanism of how religious commitment influences health behaviors in pregnancy.

Abstract BACKGROUND: The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS: A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS: The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION: The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis.
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Objective: To describe the worldwide experience of Bacillus anthracis infection reported in pregnant and postpartum women. Data Sources: Studies were identified through MEDLINE, WEB OF SCIENCE, EMBASE, and GLOBAL HEALTH databases from inception until April 2012. The keywords [(“anthrax” or “anthracis”) and (“pregna*” or “matern*” or “post partum” or “postpartum” or “puerperal” or “lact*” or “breastfed*” or “fetal” or “fetus” or “neonate” or “newborn” or “abort*” or “uterus”)] were used. In addition, all references from selected articles were reviewed, hand searches were conducted and relevant authors were contacted. Methods of Study Selection: The inclusion criteria were: 1) published articles referring to women diagnosed with an anthrax infection during pregnancy or within six months postpartum, 2) any article type reporting patient-specific data, 3) articles in any language, and 4) non-duplicate cases. Non-English articles were professionally translated. Duplicate reports, unpublished reports and review articles depicting previously identified cases were excluded. Tabulation, Integration and Results: Two authors independently reviewed articles for inclusion. The primary search of the 4 databases yielded 800 articles and the secondary cross-reference search revealed 146 articles. Seven articles from these searches met inclusion criteria. By contacting the lead author of the largest systematic review of inhalation anthrax to date, 6 additional articles, published before the databases’ inception, were identified that met inclusion criteria. In total, 19 cases of anthrax infection were found, 16 in pregnant women and 3 in postpartum women. Conclusions: Based on these case reports, anthrax infection in pregnant and postpartum women is associated with high rates of maternal and fetal death. Evidence of possible maternal-fetal transmission of B. anthracis was identified in early case reports. Transmission of B. anthracis through breast milk has not been reported. This review provides important insight to guide anthrax treatment and prophylaxis recommendations for pregnant and postpartum women.

Maternal obesity is an increasing concern in the obstetric population. It confers increased morbidity and mortality to the mother and offspring during pregnancy and delivery as well as potential long-term increase in risk of ill health to the offspring. There are currently few effective interventions and no pharmacological therapies. Potential mechanisms to account for ill health in obese non-pregnant individuals include excess inflammation, both systemically and within specific tissues such as adipose, as well as alterations in metabolic regulation including hyperglycaemia, reduced sensitivity to insulin and altered adipokine expression. In healthy pregnancy, there are significant adaptations to maternal metabolism, including the development of profound systemic insulin resistance. We hypothesize that there exists an interaction between the metabolic adaptations of pregnancy and those occurring in obesity which could provide a physiologically plausible mechanism which could contribute to the pathogenesis of adverse outcomes associated with obese pregnancies. In this thesis, we sought to understand and define the metabolic adaptations to pregnancy in severely obese women. Anthropometric characteristics are described in a longitudinal case-control study of apparently healthy obese (BMI > 40kg/m2) pregnant women. Systemic adipokine and pro- inflammatory cytokine profiles were measuring using ELISA. Indices of insulin sensitivity were assessed at three time points in pregnancy. In a cohort study of healthy pregnant women in the third trimester, transcript levels of adipokines and inflammatory cytokines in paired subcutaneous and omental adipose tissue biopsies were quantified and correlated these transcript levels with booking body mass index (BMI). Obese pregnant women gained less weight in pregnancy compared to lean women, but had significantly elevated fasting third trimester glucose, as well as elevated blood pressure and fasting insulin resistance throughout pregnancy. Fasting leptin was elevated throughout pregnancy in obese compared with lean pregnancy women; however, in the third trimester there was no correlation between adipose tissue leptin mRNA levels and BMI. Transcript levels of IL-6 were positively correlated with BMI in subcutaneous but not omental adipose tissue; no other positive correlations with BMI were shown. Hyperinsulinaemic euglycaemic clamps with concomitant use of stable isotope tracers were carried out in a case-control study of healthy obese pregnant women to characterise in detail whole body insulin sensitivity, endogenous glucose production and rate of lipolysis. In contrast to the original hypothesis, by the third trimester, there were few differences between lean and obese pregnant women in whole body glucose disposal (WGD) and endogenous glucose production. Compared with non-pregnant women, lean pregnant women demonstrated approximately 60% decrement in WGD; in contrast, obese non-pregnant women were already significantly insulin resistant but did not develop further insulin resistance in response to pregnancy. 3-Tesla (3T) Magnetic Resonance Imaging (MRI) and 1H-Magnetic Resonance Spectroscopy (1H-MRS)was used to assess abdominal fat distribution, hepatic and skeletal muscle lipid content in a case-control study of healthy pregnant women in the third trimester. As expected, obese pregnant women have greater adipose accumulation in both subcutaneous and intra-abdominal adipose depots and greater lipid accumulation in skeletal muscle. However, hepatic lipid content was low in both groups and there were no significant differences between lean and obese pregnant women. This was not expected as both groups are profoundly insulin resistant at this at this gestation, and in non-pregnant individuals, insulin resistance at this level would be expected to drive hepatic lipid accumulation, and may point to a pregnancyspecific hepato-protective mechanism. In conclusion, in this thesis, it has been shown that while obese women are insulin resistant with an adverse metabolic profile, that there does not appear to be the expected worsening of this profile in response to pregnancy and that by the end of pregnancy, lean women have a similar phenotype. Instead, while lean women are exposed to this environment only towards the end of pregnancy, obese women and their offspring are exposed throughout gestation, including key periods of fetal development in early pregnancy. This prolonged exposure may account for the excess pathologies in such pregnancies, potentially by exhausting what physiological reserve such women have pre-pregnancy. Potential therapies must therefore be optimally timed to improve the metabolic profile of obese women in early pregnancy, without hindering the required adaptations of the third trimester.

Context: The Olo (egg-milk-orange) intervention offers vulnerable pregnant women food vouchers and supplements, tools, and nutritional counselling to support healthy pregnancy outcomes. Goal: To evaluate Olo’s contribution to the nutritional intakes and eating practices, as well as participants’ appreciation of the intervention. Methods: Participants (n=30) responded to questionnaires, dietary recalls and participated in a semi-structured interview (n=10). Results: Olo reduced the proportion of participants at risk of inadequate intakes for many micronutrients, mainly due to the prenatal multivitamins rather than the food offered. Most participants (96.7%) did not follow Olo’s typical recommendations but if so, they would have hypothetically consumed an average of 746 additional calories and be at risk of excessive intakes for folic acid (80.0%) and iron (33.3%). Olo also contributed to reduce the impact of isolation and solitude. Conclusion: The Olo intervention may need to be adapted to better respond to the participants’ social and dietary needs.

The primary objective of this research is to explore the determinants of compliance to iron supplement medication among a sample of pregnant women. The data is based on a larger research project on Nutritional Anemia collected by the Nutrition Center of the Philippines, from 1980 to 1982. The focus of analysis is on compliance as a dependent variable. Also, three sets of factors are used to explain compliance behavior. These are: socio-demographic, treatment, and social psychological factors. The sample consists of 377 pregnant women who were interviewed to explore the research problem. Data are obtained from a survey, and are analyzed using zero-order correlations and multiple regression techiques. Results of the zero-order correlation analysis show that the socio-demographic and treatment factors have weak relationships with compliance rate. Moreover, among the social-psychological factors, three are found to have significant positive correlations with compliance rate; and these are, folk health beliefs, perceived knowledge about the benefits of vitamins, and mothers‘ health practices. The results of the multiple regression analysis indicate that, with controls, all the potential determinants are not significantly related to compliance rate. The study results are then evaluated in the light of the literature on compliance in the United States. A compliance model is then suggested which serves as a guideline for future research. However, even with the establishment of this compliance model, a question concerning the operationalization of the variables remains. Some suggestions on measures of the variables are provided.
Master of Science

Thesis (M.S.)--West Virginia University, 1999.
Title from document title page. Document formatted into pages; contains vi, 51 p. Vita. Includes abstract. Includes bibliographical references (p. 33-36).

Pregnancy outcomes have improved tremendously in developed countries. Notwithstanding, it is still a huge challenge in developing countries, especially Sub-Saharan Africa. In 2015 in Nigeria, about 145 women died daily from pregnancy-related causes. Similarly, nearly 2,300 children under 5 years were lost in the same year. Nigeria consistently underperformed in some of the critical pregnancy indicators such as maternal and neonatal mortality, second worst only to India in the world. Studies on poor pregnancy outcomes are scarce in Nigeria. The purpose of this quantitative, retrospective cross-sectional study was to use local evidence to ascertain the risk factors that predict poor pregnancy outcomes for women of childbearing age (15-49 years old) in Nigeria. The theoretical framework for this study was the social cognitive theory. Secondary data from 400 pregnant women from Island Maternity Hospital, Nigeria, was used for this study. Five central research questions were analyzed through univariate and multiple logistic regressions. The results indicated moderate to strong statistically significant associations between outcomes of last pregnancy, gestational age at delivery, mode of delivery, and the timing of antenatal care booking with maternal mortality, neonatal mortality, and low birth weight, even after controlling for other covariates. Findings from this study may foster positive social change by further enhancing the understanding of poor pregnancy outcomes, especially in Nigeria. It will help public health practitioners, policymakers, community leaders and other stakeholders to design strategies and interventions that will take advantage of cultural and religious norms and educational status of women of childbearing age in promoting reproductive health in Nigeria.

The epidemic of maternal obesity is increasing worldwide. Simple, effective and acceptable interventions are needed to combat obesity and improve pregnancy outcomes in women with metabolic risk factors such as dyslipidaemia and obesity. Dietary and lifestyle interventions reduce gestational weight gain, however, their effect on maternal and fetal outcomes is not clearly known. I conducted a large pragmatic randomised trial to evaluate the effectiveness of a Mediterranean-based dietary intervention to reduce the risk of adverse maternal and fetal outcomes in pregnant women with metabolic risk factors (The ESTEEM trial). The intervention significantly reduced gestational diabetes and gestational weight gain by an average of 1.2 Kg with some protective effect on fetal outcomes. I analysed the methodological challenges encountered in the trial and discussed applied solutions. I conducted a systematic review on the commonly used dietary assessment tools in trials involving pregnant women to assess their characteristics, validity, and applicability. Self-reporting dietary tools were the most commonly used to assess dietary intake in pregnancy such as food frequency questionnaires. Only 8% of studies validated the chosen tools and applied a defined adherence criterion. I applied the findings of this review to develop and validate a custom designed food frequency questionnaire, and a short 12 items questionnaire, to assess the participants' adherence in the ESTEEM study. I assessed the dietary intake in a randomised cohort from the ESTEEM study and compared the questionnaires' accuracy to 24 hour dietary recalls as the reference method. Both the FFQ and the short questionnaire performed well for assessing the adherence to and the intake of key foods in the Mediterranean diet. I systematically reviewed available online information sources on the risks and management of obesity in pregnancy in the English language. I assessed 53 websites for their information credibility, accuracy, readability, content and technological quality. Overall I found that non-governmental funded websites that are obesity-specific and targeting healthcare users presented better overall information quality.

Thesis (PhD)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Pregnancy is a vulnerable time in settings such as sub-Saharan Africa, and is associated with exposure to a multitude of physiological, social and psychological risks. High HIV prevalence, and the fact that many women will test for HIV for the first time during their pregnancy, has raised concern about women‘s psychological health during pregnancy. Depression during the antenatal period is of public health concern as it has been shown to be associated with poorer foetal and delivery outcomes, risky behaviours, and poorer uptake of antenatal care. Antenatal depression is a predictor of postnatal depression, and postnatal depression has been associated with poor maternal sensitivity and attachment in mothers which is known to result in increased behavioural and developmental difficulties in children. The aim of this research was to provide a clear, in depth and culturally sensitive understanding of the manifestation of depression in pregnant women in a rural area with high HIV prevalence in South Africa. The research method included a diagnostic assessment of depression in 109 women in their third trimester of pregnancy, and an in-depth qualitative examination of the contextual framework within which HIV testing and depression are experienced with a sub-sample of 56 women. The quantitative results demonstrated that the prevalence of antenatal depression was high (46.7%), with close to half of the women being diagnosed with depression. Presentations of depression most frequently included disturbances in mood, loss of interest and suicide ideation. Symptoms which overlap with common side effects of pregnancy such as loss of energy and weight change did not result in an overestimation of depression. Likewise, very little evidence of the somatisation of depression, or particular cultural barriers to the diagnosis of depression based on DSM-IV criteria was found. Rates of suicide ideation were high and equally common among HIV positive as HIV negative women. Factors significantly associated with depression included living within a family homestead, access to a regular source of income and practical support from a partner. Both income and partner support had a negative association with depression. Living away from a family or parental home had a positive association with depression. The results showed that the Edinburgh Postnatal Depression Scale (EPDS) was effective in identifying depression and that a shorter three item version was as effective as longer versions. A positive score for depressed mood on the EPDS was significantly associated with HIV, suggesting that the EPDS is a good screening tool for elevated psychological risks among HIV positive women post HIV testing. Qualitative results showed that having an unsupportive partner and the occurrence of relationship or familial conflict played an important role in the development of emotional distress during pregnancy and resulted in a high number of unwanted pregnancies. Partner and familial conflict was intertwined with cultural practices which govern the acceptability of childbearing among unmarried women and the social recognition of partnerships and paternal responsibilities. Testing for HIV was considered a stressful life event for all women regardless of their HIV status and was a particularly negative life event for women who tested HIV positive or for women who had concerns over partner infidelity. Disclosure among HIV positive women frequently lead to increased partnership conflict. Qualitative findings suggested that depression and emotional distress after HIV testing did interfere with women‘s ability to engage with prevention messages. Women who were coping well with learning their HIV positive status had high levels of family disclosure and subsequent family support in common. The implication of this research is that it is important that public health programmes screen for depression among childbearing women. These data suggests that a shorter three item version of the EPDS along with screening for partner and family support or conflict would effectively detect most women at high risk for depression. Likewise, public health interventions for women with depression which are implemented in primary health care facilities and in isolation of the partnership and familial context within which depression occurs are not likely to be effective. Further research is needed to establish the precise prevalence of antenatal and postnatal depression in women at high risk for HIV; to validate the effectiveness of a shorter screening tool in resource limited settings; and to establish risk and protective factors, and trimester specific risks which could inform the design of cost effective interventions in poorly resourced settings.
AFRIKAANSE OPSOMMING: Swangerskap in Afrika, suid van die Sahara, is ʼn kwesbare tydperk met blootstelling aan ʼn menigte fisiologiese, sosiale en sielkundige risiko‘s. Die hoë voorkoms van HIV en die feit dat baie vrouens gedurende swangerskap vir die eerste keer vir HIV wil toets, het ‗n besorgdheid oor vrouens se sielkundige gesondheid gedurende swangerskap laat ontstaan. Depressie gedurende die voorgeboortelike periode is van belang vir publieke gesondheid, want daar is bewyse wat dui op ‗n verband tussen depressie en swakker fetale en geboorte resultate, riskante gedrag en verminderde gebruik van voorgeboortelike sorg . Voorgeboortelike depressie is ʼn indikasie van moontlike nageboortelike depressie en nageboortelike depressie word geassosieer met swak moederlike sensitiwiteit en die gebrekkige vorming van ‗n band tussen moeder en kind; wat reeds bewys is om te lei tot verhoogde gedrags- en ontwikkelingsprobleme in kinders. Die doel van hierdie navorsing was om ʼn duidelike, indiepte en kulturele-sensitiewe begrip van die manifestasie van depressie in swanger vroue in ʼn landelike omgewing met hoë HIV voorkoms in Suid Afrika te verkry. Die navorsingsmetode sluit in ʼn simptomatiese beraming van depressie by 109 vroue in hul derde trimester van swangerskap en ʼn indiepte kwalitatiewe ondersoek na die kontekstuele raamwerk waarbinne HIV toetse en depressie ondervind word met ʼn sub-steekproef van 56 vrouens. Die bevinding was dat die voorkoms van voorgeboortelike depressie hoog was, 46.7 %, met feitlik die helfte van die vrouens wat met depressie gediagnoseer is. In die meeste gevalle het die voorkoms van depressie gepaard gegaan met ʼn verandering in gemoedstoestand, ʼn verlies aan belangstelling en selfmoordgedagtes. Simptome wat ooreenstem met algemene newe-effekte van swangerskap, soos verlies aan energie en verandering in gewig, het nie bygedra tot ʼn oorberekening van depressie nie. Soortgelyk is baie min bewyse gevind dat somatosasie van depressie, of spesifieke kulturele grense, tot die diagnose van depressie gebaseer op DSM-IVkriteria bydra. Die oorweging van selfmoord was hoog en algemeen tussen beide HIV-positiewe en HIV-negatiewe vouens. Faktore wat aansienlik met depressie geassosieer word, sluit in om in ʼn familiegroep te bly, toegang tot ʼn vaste bron van inkomste en die praktiese ondersteuning van ʼn lewensmaat. Beide inkomste en die ondersteuning van ʼn lewensmaat het ʼn negatiewe verbintenis met depressive. Om nie by familie of in ʼn ouerhuis te bly nie het ʼn positiewe assosiasie met depressive. Alhoewel HIV-status verband hou met depressie, was dit nie uitermate die geval nie, alhoewel daar ʼn gebrek aan statistiese kragdoeltreffendheid was om die effek van HIV vas te stel, gegee die beperkte grootte van die steekproef. Die resultate het getoon dat die EPDS graderingsinstrument effektief was om depressie te identifiseer en dat ʼn korter driepunt weergawe daarvan net so effektief was soos die langer weergawe. ʼn Positiewe telling vir ʼn depressiewe gemoedstoestand op die EPDS het ʼn betekenisvolle assosiasie met HIV en dui daarop dat die EPDS ʼn goeie graderingsinstrument is vir verhoogde sielkundige risiko by HIV-positiewe vrouens, selfs al is HIV-positiewe vrouens in dié steekproef statistieksgewys nie meer geneig tot depressie as HIV-negatiewe vrouens nie. Kwalitatiewe resultate toon dat ʼn lewensmaat wat nie ondersteunend is nie en die voorkoms van verhoudings- of familiekonflik ʼn belangrike rol speel in die ontwikkeling van emosionele angs gedurende swangerskap en dit het gelei tot ʼn groot aantal ongewenste swangerskappe. Konflik met ʼn lewensmaat en met familie was verweefd met kulturele gebruike wat die aanvaarbaarheid van geboortes onder ongetroude vrouens beheer en die sosiale erkenning van verhoudings en die vader se verantwoordelikhede. ʼn HIV-toets is as ʼn stresvolle lewensgebeurtenis beskou deur alle vroue, ongeag van hulle HIV-status en was ʼn besondere negatiewe lewensgebeurtenis vir vroue wat HIV-positief getoets het of vir vroue wat bekommerd was oor hulle lewensmaats se getrouheid. Onthulling van die HIV-status van positiewe vrouens het gereeld tot verhoogde konflik in verhoudings gelei. Kwalitatiewe bevindings dui daarop dat depressie en emosionele angs na ʼn HIV-toets inmeng met ʼn vrou se vermoë om ag te slaan op voorkomingsboodskappe. Vroue wat die kennis van hulle HIV-positiewe status goed hanteer het, het hoë vlakke van bekendmaking van hulle status en die ondersteuning van hulle familie in gemeen. Die implikasie van die navorsing is dat dit belangrik is vir publieke gesondheidsorgprogramme om te toets vir depressie onder swanger vroue. Die resultate dui daarop dat ʼn korter driepunt weergawe van die EPDS, saam met ʼn ondersoek na die ondersteuning van of konflik met ʼn lewensmaat en familie, effektief kan wees om vroue met ʼn hoë risiko vir depressie te identifiseer. Soortgelyk, publieke gesondheidsingryping in primêre gesondheidsorg fasiliteite vir vroue met depressie wat in isolasie van die lewensmaat en familie konteks, waar depressie voorkom geadministreer word, is onwaarskynlik om te slaag. Bevindings onderskryf die belangrikheid van ondersteuning vir die familie om effektief te kan reageer en herstel van stresvolle faktore soos onbeplande swangerskappe en HIV-diagnose, in ʼn konteks wat swaar deur HIV geaffekteer word, aangesien dit ʼn voorkomende effek op depressie kan hê. Verdere navorsing is nodig om die presiese voorkoms van voorgeboortelike en nageboortelike depressie in vrouens met ʼn hoë blootstelling aan HIV vas te stel; om die sukses van ʼn korter graderingsinstrument in arm omgewings te staaf; en om die risiko en beskermende faktore vas te stel en trimester spesifieke risiko‘s wat die ontwerp van ʼn koste-effektiewe ingryping in gebiede met ontoereikende hulpbronne kan beïnvloed.

INTRODUCTION: Pulmonary embolism (PE) is a major cause of mortality during pregnancy. It is estimated that about 20% of maternal deaths in north america are due to PE. A lung V/Q study in a standard (non-gravid) patient typically consists of a low dosage ventilation study followed by a higher dosage perfusion study. In some centers however, perfusion-only imaging, without accompanying ventilation imaging has been employed. In this method, a several-fold lower dose of radioactivity is used. Perfusion-only imaging has multiple advantages. In addition to reduction of radiation dose to the mother and the fetus, there is decreased cost to the health-care system as well as improved patient convenience and shortened hospital workflow. OBJECTIVES: The present study aimed at assessing the negative predictive value (among other diagnostic accuracy measures) of perfusion-only imaging in a large group of pregnant patients with suspected pulmonary embolism. METHODS: This study was a retrospective cohort study of the entire pregnant patients with suspected PE who underwent V/Q scan at The Ottawa Hospital and their V/Q scans were available in the PACS system. After acquiring REB approval, a comprehensive search in the PACS (Picture Archiving and Communication System) was conducted to find pregnant patients who were assessed for PE in our division since 2004 (the earliest date the V/Q images were available in our system). A statistical consultation was made before the initiation of data collection and at the time of data analysis. All patients who met the inclusion criteria were included. Initially a nuclear medicine resident with 2 years of experience read all the perfusion- only images. The PISAPED criteria were used for image interpretation. Then the results were compared against the reports made by nuclear medicine staffs that were available to us in our electronic system and a final interpretation was made after such comparison. The follow-up clinical notes were used as the gold standard to make a final diagnosis of PE. Finally, diagnostic accuracy measures were calculated. RESULTS: A total of 364 patients were included. Mean maternal age at the time of lung V/Q scan was 30.3 years-old (SD=5.8) ranging from 16 to 51 years-old. From a total of 362 lung perfusion scans, 316/362 (87.3%) scans interpreted as normal, 17/362 (4.7%) scans were interpreted as high probability and 29/362 (8.0%) scans were interpreted as non-diagnostic. Pulmonary embolism was diagnosed in a total of 15 patients directly after performing lung scan. None of the patients with normal perfusion-only scans were diagnosed later with PE, proving a negative predictive value of 100%. The sensitivity and specificity of perfusion-only imaging after including the non-diagnostic studies were 100% (100% to 100%) and 99.1% (88.1% to 94.1%), respectively with a negative predictive value of 100% (100% to 100%) and a positive predictive value of 32.6% (19.1% to 46.2%). Conclusion: The results of the current study show that perfusion-only imaging has a very high negative predictive value for PE in pregnant population and therefore can exclude PE with a very high degree of accuracy.

Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain. Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms. Material and methods: The intervention group consisted of 155 obese (BMI >30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program. Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained <7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain <7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain. Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain <7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.

This attempt to validate the brief AAS and WAST against the gold-standard CTS2 resulted in sensitivities of 34.8% (AAS) and 45.5% (WAST) for physical IPV; however both identified a much smaller number of cases of sexual violence than the CTS2 in a rural pregnant population.