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1
Edwards, Lisa J. "Maternal undernutrition and fetal blood pressure and the hypothalamo-pituitary adrenal axis in the late gestation fetal sheep." Title page, table of contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phe2654.pdf.
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Includes bibliographical references (leaves 228-257). Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.
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Benton, Samantha Jayne. "Angiogenic factors in placentally-mediated pregnancy complications." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/50014.
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Placentally-mediated pregnancy complications include pre-eclampsia, intrauterine growth restriction (IUGR), placental abruption and some causes of stillbirth. These complications are believed to arise from abnormal placental development in early gestation that leads to compromised placental function in later pregnancy which can adversely affect both mother and fetus. It is a priority in obstetrics to identify these pregnancies early and accurately so that appropriate monitoring and intervention can optimise outcomes for these mothers and babies. Novel biomarkers such as angiogenic factors in the maternal circulation may improve the prediction and/or diagnosis of these complications by adding to the information gained from tools already used in clinical practice. In this thesis, I investigated angiogenic factors in 1) the diagnosis of pre-eclampsia using new clinical immunoassays, 2) the prediction of placentally-mediated complications in a high-risk pregnancy cohort and 3) the diagnosis of placental IUGR in pregnancies with small for gestational age (SGA) fetuses. Additionally, I investigated the association between levels of circulating angiogenic factors and the presence of histopathological lesions of dysfunction in the placenta after delivery. I found that angiogenic factors, particularly low circulating placental growth factor (PlGF), had high sensitivity and specificity in the diagnosis of pre-eclampsia but all markers had poor performance as predictive markers for placentally-mediated complications. In pregnancies with SGA fetuses, low maternal PlGF discriminated between fetuses with placental IUGR (defined by the presence of histological lesions of placental dysfunction) from constitutionally small fetuses (no pathological lesions present) with high sensitivity and high negative predictive value. Additionally, low maternal PlGF in the second trimester was associated with the presence of lesions of placental dysfunction in pregnancies at high-risk for placentally-mediated complications. Low maternal PlGF was also associated with lesions of placental dysfunction as well as altered placental morphology in pregnancies with SGA fetuses. Taken together, these findings suggest that PlGF may be an antenatal marker of placental dysfunction and may provide a novel clinical tool to identify pregnancies with placental dysfunction. This work improves our understanding of angiogenic factors in placentally-mediated complications and contributes to the growing body of evidence supporting their integration in clinical practice.<br>Medicine, Faculty of<br>Obstetrics and Gynaecology, Department of<br>Graduate
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ElMoursi, Mohamed Saad Elsayed. "Quantification of placental dysfunction in pregnancy complications." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/17262/.
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Background The pathogenetic mechanisms behind placental dysfunction-related complications like preeclampsia and intrauterine growth restriction have remained perplexing till now, in part because of lack of well-defined structural and functional molecular characterisation. There is growing evidence that links trophoblast debris and the existence of syncytial nuclear aggregates (SNA) to the pathogenesis of gestational diseases. Characterisation and quantification of structural and functional parameters of placental dysfunction may give researchers a clearer picture of the mechanisms underlying the development of high risk pregnancy. Methods Placental samples were obtained from normal term pregnancies, preterm controls, as well as from pregnancies complicated by preeclampsia (PET), intrauterine growth restriction (IUGR) and PET-IUGR. Formalin-fixed, paraffin-embedded sections were visualised with H&E, stained using immunohistochemistry (IHC) and digitally scanned. Using stereological methodology, volumes of placental SNAs, trophoblasts, villi and capillaries were measured. Three dimensional (3D) volume reconstructions of terminal placental villi with SNAs and fibrinoid degenerations were created. IHC-labelled slides were analysed by image analysis algorithms. Differential expression of placental genes and miRNAs, hypothesised to regulate cell death in placental dysfunction, were quantified using RT-qPCR. BeWo cell lines were carried out for in vitro validation of the effects miRNAs regulating programmed cell death (PCD) using flow cytometry and western blotting. Results Specific morphometric patterns of villous, trophoblasts, SNA and capillary volumes were demonstrated with characteristic higher SNAs and lower capillary volumes in PET placentae with reciprocal patterns in IUGR placentae showing a negative correlation pattern between nuclear aggregates and capillary volumes. Image analysis of immune-labelled slides showed a higher autophagy marker expression in PET and a positive correlation to SNAs as well as a balanced reciprocal expression patterns with apoptosis. Moreover, miR-204 transfected BeWo cells showed a similar balanced reciprocal regulation of autophagy and apoptosis expressions. Conclusion We have demonstrated that applying stereology-based and image analysis on digitised placental sections can be useful in quantifying and dissecting structural and functional patterns in normal and abnormal placental function. 3D reconstruction model are a novel approach towards placental characterisation in normal and complicated pregnancies. The study also showed that miR-204 plays a vital role in the regulation of placental autophagy and apoptosis, critical in the pathophysiology of placental dysfunction.
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Rodie, Vanessa Angela. "Metabolic complications of pregnancy and cardiovascular disease risk." Thesis, University of Glasgow, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.421118.
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Demetriou, Charalambos. "Investigating genetic factors associated with complications of pregnancy." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/30728.
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This PhD project sets out to investigate the role of genetic factors associated with fetal growth restriction and recurrent miscarriage (RM), two of the most common complications of pregnancy. This work studied large cohorts of patients collected from specialist clinics in West London with the aim of better understanding their underlying molecular aetiology. The first part of this project focused on the paternally expressed, maternally imprinted gene, IGF2, which is a key growth hormone critical for in utero growth in mice. Its role in human fetal growth has remained ambiguous, as it has only been studied in term tissues. mRNA expression levels of IGF2 and other genes were investigated in 260 chorionic villus samples collected at 11-13 weeks' gestation. Transcript levels of IGF2 revealed a significant positive correlation with birth weight (P=0.009). Critically, small for gestational age neonates had significantly lower IGF2 levels than appropriate for gestational age neonates (P=3.6x10-7). Next a study was undertaken to investigate a potential role for disturbed imprinting in products of conception (POC). This work first involved a detailed analysis of the POC DNA to establish levels of maternal cell contamination. POCs could then be more accurately evaluated to investigate the status of known imprinted genes. Interestingly, in a number of POCs, known maternally expressed genes were found to be paternally expressed and vice versa. This suggested that some miscarriages might be associated with or even caused by abnormal imprinting. Two approaches were then used to study genetic factors associated with RM. The first involved a genetic association study with a placental anti-coagulant protein Annexin A5 that contains four nucleotide substitutions (M2 haplotype) in its promoter. Patient and control haplotypes were determined and compared in 500 White European pairs that had RMs and 250 control trios. Carriers of the M2 haplotype were found to exhibit higher RM risk than non-carriers, which was in agreement with previous studies. However, this is only true for the patients who suffered with early miscarriages. The second study involved analysis of a single family where the patient had experienced a total of 29 miscarriages but had no successful pregnancies. Next-generation exome sequencing was carried on family members to search for a potential rare genetic variant gene causative of the RM phenotype. Two candidate genes with potentially damaging mutations were investigated in more depth by sequencing them in cohorts of Asian RM patients (n=100) and White European RM patients (n=120). In one of the genes, three novel variants and one very rare SNP, which were all predicted to be damaging by different prediction programs, were identified in a total of four Asian patients. Future studies to further investigate these potential mutations, involves functional analysis of each variant such as site-directed mutagenesis and protein-protein interactions.
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Björklund, Anders. "Hypoglycaemia in pregnancy : hypoglycaemic clamp studies during and after pregnancy in women with IDDM /." Stockholm, 1998. http://diss.kib.ki.se/search/diss.se.cfm?19980605bjor.
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Wilkerson, Diana Sue. "Perinatal complications as predictors of infantile autism." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/833467.
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This study investigated the impact of perinatal complications on the developing child and the relationship of those complications to the development of autism in an individual. The biological mothers of autistic children (N = 183) completed the Maternal Perinatal Scale, a maternal selfreport which surveys complications of pregnancy and medical conditions of the mother. Archival data on normals (N = 209), obtained during previous perinatal investigations, was utilized as a control group.Previous research in this area has been limited, with no definitive conclusions. All previous investigators have declined to state that events identified in previous research were definitely related to the development of autism.An overall multivariate test was performed to determine if significant differences existed between the autistic and normal subjects. Following this exploration of the data, previously identified complications were entered into a stepwise discriminant analysis in the order of theirtheoretical importance to determine the extent of their contribution to autism. Following this analysis, medical conditions of the mothers (items 27-47 as included on the MPS) were entered into the stepwise analysis to determine their contribution, if any, to autism in the sample.The results of this analysis revealed that the two groups differed significantly on three of the ten factors of the MPS. The overall multivariate test was highly significant and revealed that the groups differed on Factor 2 (Gestational Age), Factor 4 (Maternal Morphology), and Factor 8 (Intrauterine Stress). Moreover, five of the six previously identified items were found to be significant. These were: prescriptions raken during pregnancy, length of labor, viral infection,, abnormal presentation at delivery, and low birthweight. Three of the maternal medical conditions examined were also highly significant and contributed to separation between groups. These were: urinary infection, high temperatures, and depression. These were items which have not been identified in previous investigations.Based on discriminant analysis of the 10 factors of the MPS, 65% of the cases were correctly grouped. The MPS would be a useful clinical tool in identification of those children who are at risk for development of autism.<br>Department of Educational Psychology
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Cheung, Tung-fai. "Maternal malnutrition : effects on growth and development of rat pups /." Hong Kong : University of Hong Kong, 1997. http://sunzi.lib.hku.hk/hkuto/record.jsp?B1971256X.
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Nevin, James. "Pregnancy-associated cervical cancer." Thesis, University of Cape Town, 1991. http://hdl.handle.net/11427/26272.
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Walker, Kate Frances. "Late pregnancy complications in women of advanced maternal age." Thesis, University of Nottingham, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.718852.
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The age of childbearing is rising in women living in industrialised nations. Advanced maternal age is associated with a small increased risk of term antepartum stillbirth. Labour induction would likely reduce stillbirth, but might also increase Caesarean delivery, already high for older women. The aim of this thesis was to design and conduct a randomised controlled trial of induction of labour at 39 weeks versus expectant management for nulliparous women aged over 35 years. In total 619 women participated and the trial showed that induction of labour has no adverse short-term effects on maternal or neonatal outcomes. In particular, it does not increase caesarean section rate. A cost-utility analysis of the trial was performed and demonstrated that induction of labour is associated with a small gain in QALYs and is not more expensive than expectant management. One key secondary outcome of the trial was maternal satisfaction. There is a lack of a robust validated tool for evaluating labour experience in the UK therefore a study of 350 women was performed to validate a Swedish instrument (Childbirth Experience Questionnaire) in the UK. This study demonstrates that the Childbirth Experience Questionnaire is a valid and reliable measure of childbirth experience in the UK population. A study examining the causes of 2850 cases of antepartum stillbirth in women of advanced maternal age using anonymised national data found that stillbirths in women over 35 years old are more likely to be due to major congenital anomalies, mechanical causes, maternal disorders or associated obstetric factors than women less than 35. In 2013, a systematic review of randomised controlled trials of induction of labour versus expectant management at term found that a policy of induction was associated with a 17% reduction in the risk of caesarean section. An IPD meta-analysis of induction of labour versus expectant management at term in women with intact membranes by subgroups of maternal age has shown that induction in women of advanced maternal age has no statistically significant effect on caesarean section rates.
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Syngelaki, Argyro. "Screening for pregnancy complications at 11-13 weeks' gestation." Thesis, Manchester Metropolitan University, 2015. http://e-space.mmu.ac.uk/595938/.
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Background: The current approach to prenatal care, which was established more than 80 years ago, is characterised by a high concentration of visits in the third-trimester of pregnancy which implies that firstly, most complications occur at this late stage of pregnancy and secondly, most adverse outcomes are unpredictable during the first or even the second trimester. Objectives: The objective of this thesis is to provide evidence that most pregnancy complications are predictable as early as 12 weeks’ gestation. The pregnancy complications examined include fetal aneuploidies, fetal structural defects, preeclampsia, preterm birth, gestational diabetes mellitus and fetal macrosomia. Methods: I have critically examined fourteen articles reporting on screening for pregnancy complications at 11-13 weeks’ gestation, where more than 90,000 singleton pregnancies were prospectively assessed at 11-13 weeks’ gestation as part of a routine prenatal visit for screening for trisomy 21. We recorded a series of maternal characteristics and history, measured maternal weight and height, performed a detailed ultrasound examination of the fetus, measured maternal uterine artery Doppler pulsatility index and maternal mean arterial pressure and collected blood for analysis of biomarkers for prospective or retrospective analysis. All data were prospectively entered into our data base as well as the pregnancy outcomes as soon as they became available. Ethical approval was obtained for these studies. Multivariate regression analysis was used to define the contribution of each maternal characteristic and history in predicting each adverse outcome and those with a significant contribution formed an algorithm to estimate the background risk (a priori risk) for each one of these complications. The potential value of biophysical and biochemical markers in improving the performance of the a priori risk in predicting adverse pregnancy outcomes, was evaluated. Results: First trimester effective screening for adverse pregnancy outcomes was provided by a combination of maternal factors and biophysical or biochemical markers. The developed predictive models could correctly identify the vast majority of aneuploidies, early preeclampsia and more than half of the cases of spontaneous preterm birth and gestational diabetes. First trimester prediction of fetal macrosomia was less effective compared with other complications. First trimester examination of fetal anatomy was feasible resulting in a high detection of fetal non-chromosomal defects, including more than half of fetal cardiac defects. Conclusions: Assessment of the mother and fetus at 11-13 weeks’ gestation can provide effective early identification of the high risk group of pregnancies with fetal and maternal adverse outcomes.
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Chaudhry, Shazia Hira. "The Association of Homocysteine with Placenta-Mediated Pregnancy Complications." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39425.
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Background: Preeclampsia, small for gestational age (SGA), placental abruption, and fetal death are pregnancy complications linked to the utero-placental vasculature with serious consequences for maternal and infant well-being. Elevated homocysteine, a marker of cardiovascular disease risk, is postulated to play a role in placenta-mediated complications, but epidemiologic studies have reported inconsistent findings. The two primary objectives of this thesis were to 1: comprehensively investigate the association of homocysteine with placenta-mediated complications and examine modifying effects of pre-specified factors on this association, and 2: comprehensively investigate determinants of maternal homocysteine during pregnancy.
Methods: A systematic review and meta-analysis of prospective studies was conducted to address thesis objective 1. The Ottawa and Kingston (OaK) Birth Cohort, a prospective cohort study that recruited pregnant women between 2002 and 2009, was used to address thesis objectives 1 and 2. Homocysteine concentration was measured between 12 and 20 weeks gestation. Analyses based on the OaK Birth Cohort consisted of multivariable regressions using restricted cubic splines to model associations with continuously distributed variables.
Results: Objective 1: In an analysis of 7587 participants, a significant association between homocysteine concentration and a composite outcome of any placenta-mediated complication was observed (odds ratio (OR) for a 5 µmol/L increase: 1.63, 95% Confidence Interval (CI) 1.23-2.16) and SGA (OR 1.76, 95% CI 1.25-2.46), with potential modifying effects of the methylene tetrahydrofolate reductase (MTHFR) 677C>T variant (SGA) and high-risk pregnancy (preeclampsia).
In the systematic review identifying 30 prospective cohort or nested case-control studies, a random effects meta-analysis of pooled mean differences in homocysteine between cases and controls in 28 studies revealed significantly higher means for SGA: 0.35 µmol/L (95% CI 0.19 to 0.51, I2=33%); and preeclampsia: 0.87 µmol/L (95% CI 0.52 to 1.21, I2=92%). Significant sources of heterogeneity were study region (SGA and preeclampsia), adjusting for covariates (preeclampsia), folate status (preeclampsia), and severity (preeclampsia).
Objective 2: In 7587 OaK participants, factors related to favourable health status were associated with lower maternal homocysteine concentrations. Folic acid supplementation during pregnancy of >1 mg/day did not substantially increase serum folate concentration.
Conclusion: This thesis suggests an independent effect of slightly higher homocysteine concentration in the early to mid-second trimester on the risk of any placenta-mediated complication, SGA, and preeclampsia. Modifying effects explain some of the variability in previous studies. Favourable preconception health status was associated with lower maternal homocysteine.
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Wang, Ling. "Effects of perinatal malnutrition on brain development in rats." Click to view the E-thesis via HKUTO, 2006. http://sunzi.lib.hku.hk/hkuto/record/B37930333.
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章彤輝 and Tung-fai Cheung. "Maternal malnutrition: effects on growth and development of rat pups." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1997. http://hub.hku.hk/bib/B31236698.
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Nilsson, Emma. "Genetic epidemiological studies of adverse pregnancy outcomes and the role of schizophrenia /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-590-9/.
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Matte, Susan Marie. "HOW PREGNANT DIABETIC WOMEN VIEW THEIR PREGNANCIES." Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/275243.
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Burton, Sarah L. "Logistic regression models and their application in medical discrimination and diagnosis." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364332.
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Linné, Yvonne. "Factors affecting weight development after pregnancy - the SPAWN (Stockholm Pregnancy And Women's Nutrition) study /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-405-4/.
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Chambers, Andrea Suzanne. "Relaxation During Pregnancy to Reduce Stress and Anxiety and Their Associated Complications." Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/195435.
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Stress and anxiety during pregnancy predict perinatal complications over the course of pregnancy and labor as well as premature birth and low infant birth weight. The current study examined whether relaxation training provided to women at the beginning of the 2nd trimester could reduce stress and anxiety and assessed the impact of the intervention on perinatal complications, premature delivery, and infant outcomes at birth. Twenty-six moderately anxious pregnant women between 14 and 20 weeks gestation participated in the treatment study. Women completed a baseline laboratory assessment that involved questionnaires and a psychophysiological assessment. They were randomized to receive either six weeks of relaxation training or a list of tips for reducing stress (control). Women repeated the laboratory tasks post-treatment (Time 2) and again between 34 and 36 weeks gestation (Time 3). The treatment condition did not lead to greater mood change than the control condition at either Time 2 or 3. Several analyses, however, suggest relaxation training has the potential for reducing negative mood and complications over the course of pregnancy. Moderator analyses also revealed the treatment more efficacious for those with greater physiological flexibility.
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Porter, Charlene. "Immunological, molecular and proteomic evaluation of pregnancy associated conditions using human placental models." Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=167960.
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Haemolytic Disease of the Foetus and Newborn (HDFN) and Foetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) are the most clinically relevant alloimmune disorders of pregnancy caused by maternal alloimmunisation to paternally derived foetal red blood cell (RhD) and platelet antigens (HPA-1a) respectively. Recombinant Fc-modified antibodies have been designed as inert potential biotherapeutics to compete with maternal alloantibodies and reduce foetal mortality. Fc-modified anti-D (Fog1G1 Δnab) and anti-HPA-1a (B2G1Δnab & B2G1Δnac) have been evaluated for their materno-foetal transport capacity using human placental models. For future in vivo efficacy, Fc-modified antibodies should transport at similar rates to wild-type antibodies (Fog1G1 and B2G1). The placental perfusion model showed that the Δnab mutation appeared to lower the transport capability of anti-D and anti-HPA-1a across the placenta. In a Human Umbilical Endothelial Vein Cell (HUVEC-c) cell culture model, transport of HPA-1a was favoured in a basal to apical direction and was statistically significant at hours 12 and 24 (p=0.002 & p=0.010 respectively). The relative order of transport was B2G1Δnac > B2G1 > B2G1Δnab implying the Δnac mutation enhances transport across the foetal endothelium. Since approximately 40% of RhD negative women give birth to RhD negative babies, these women currently receive anti-D prophylaxis unnecessarily. Foetal DNA was successfully extracted from maternal plasma and genotyped for foetal RhD status using Real-Time PCR. Foetal genotyping results revealed 96% and 98% concordance with cord blood serology for maternal blood samples taken at booking (~16 weeks) and at 28 weeks gestation respectively. Two-dimensional Difference in Gel Electrophoresis (2-D DiGE) was used to evaluate the normal placental proteome of syncytiotrophoblast membrane particles (STBMs) generated from placental perfusion. Eleven differentially expressed protein species were identified when comparing different STBM samples. Future work aims to compare the normal placental proteome with the proteome of placentas from complicated pregnancies (e.g. PE, IUGR, PTL and Trisomies 13, 18 and 21) to discover potential biomarkers for screening.
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Wang, Ling, and 王玲. "Effects of perinatal malnutrition on brain development in rats." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B37930333.
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Hamel, Lois C. "Planning for a Healthier Birth and Beyond: Strategies Women Use to Manage Gestational Diabetes." Fogler Library, University of Maine, 2003. http://www.library.umaine.edu/theses/pdf/HamelLC2003.pdf.
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Picard, Sylvie. "Les complications hepatiques de l'anorexie mentale grave : influence de l'apport proteino-energetique." Lyon 1, 1989. http://www.theses.fr/1989LYO1M077.
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Ives, Angela Denise. "Breast cancer and pregnancy : how does a concurrent or subsequent pregnancy affect breast cancer diagnosis, management and outcomes?" University of Western Australia. School of Surgery, 2010. http://theses.library.uwa.edu.au/adt-WU2010.0038.
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[Truncated abstract] A diagnosis of breast cancer is a life-changing event for any woman. For young women and their families it can be devastating. Women aged less than 45 years make up 20% of new cases of breast cancer diagnosed annually in Australia. With the trend for women to delay pregnancy, young women diagnosed with breast cancer may want at least the option to become pregnant after diagnosis and treatment but little is known about how pregnancy affects breast cancer or how breast cancer affects pregnancy. The aims of this thesis were to investigate how concurrent and subsequent pregnancy affects the development and outcomes of breast cancer and how breast cancer affects a concurrent or subsequent pregnancy. This study describes two groups of women identified from the entire Western Australian population less than 45 years of age when diagnosed with: 1. Gestational breast cancer, defined as breast cancer diagnosed while a woman is pregnant or in the first twelve months after completion of a pregnancy; and 2. Breast cancer who subsequently conceive. This study focused on three main areas; patterns of care and outcomes for women diagnosed with gestational breast cancer and those women diagnosed with breast cancer who subsequently conceived; the imaging and pathological characteristics of gestational breast cancer; and lastly the psychosocial issues associated with gestational breast cancer. ... This result was statistically significant. In an age and staged matched case control study lymph node negativity did not purvey a survival advantage for women diagnosed with gestational breast cancer as it did for the non- gestational breast cancer controls. Women diagnosed with breast cancer who have good prognosis tumours need not necessarily wait two years to become pregnant. In an age matched case control study women diagnosed with gestational breast cancer were more likely to have extensive insitu carcinoma, higher mitotic rates and tumours with medullary like features than their age matched controls. In a Cox's proportional hazards regression model which included pathological characteristics, there was no significant difference in survival for women diagnosed with gestational breast cancer were compared to women diagnosed with non-gestational breast cancers. The psychosocial issues for women diagnosed with gestational breast cancer are similar to other young women diagnosed with breast cancer but the effect on the 9 lives of women dealing with pregnancy and breast cancer simultaneously was much greater. The issues of breast cancer and pregnancy are complex at both a physical and psychological level. Much more research is needed to understand the mechanisms of how pregnancy affects breast cancer and its spread. Women who are pregnant when diagnosed with breast cancer or who consider pregnancy after their diagnosis need unbiased support from those around them. Survival is important but other survivorship issues may be just as important. To translate these findings into clinical practice and offer directions for future research eleven recommendations are proposed.
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Tong, Stephen. "Investigation of novel endocrine markers of early pregnancy and later pregnancy health." Monash University, Dept. of Obstetrics and Gynaecology, 2004. http://arrow.monash.edu.au/hdl/1959.1/9689.
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Zetterström, Karin. "Chronic Hypertension and Pregnancy : Epidemiological Aspects on Maternal and Perinatal Complications." Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.
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<p>These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.</p><p>The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. </p><p>The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. </p><p>The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.</p><p>A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia. </p>
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Zetterström, Karin. "Chronic hypertension and pregnancy : epidemiological aspects on maternal and perinatal complications /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.
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Aye, Christina. "The influence of pregnancy complications on fetal and neonatal cardiovascular development." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:e3353669-2a87-4e68-9905-a4beb1d7fb9c.
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It is becoming increasingly clear that exposure to pregnancy complications such as hypertensive disorders of pregnancy and premature birth (birth before 37 weeks gestation) have a long term and specific effect on future cardiovascular disease development and risk in the offspring. Those born to a preeclamptic pregnancy have been shown to have double the risk of stroke in adulthood and studies have consistently shown an increase in blood pressure in these individuals. Higher blood pressure has also been observed in those born preterm in addition to specific cardiac modifications in young adulthood. Through detailed cardiovascular phenotyping, this thesis investigates the effects of exposure to in utero maternal hypertension and/or a preterm birth on offspring cardiovascular development in the antenatal and early postnatal period in a newly established cohort of infants. A stratified recruitment strategy was employed in order to recruit similar numbers of mother and infant dyads from hypertensive and normotensive pregnancies across a range of gestations. Nomograms for fetal ventricular volume and mass using two dimensional echocardiography were created. These were then used, along with postnatal normative data, to create trajectories of offspring cardiovascular development from 15 weeks postmenstrual age through to three months post birth in order to overlay datasets from babies born preterm. It was demonstrated that premature infants have similar in utero cardiac development to controls but post birth they undergo disproportionate cardiac hypertrophy which is associated with a degree of diastolic impairment. Preterm infants at birth had a unique ventricular shape, but these changes had attenuated by three months of age. Exposure to in utero maternal hypertension also appeared to have a deleterious effect and on further investigation, postnatal ventricular hypertrophy was also observed when analysis was restricted to term born infants exposed to this pregnancy complication. Additionally, offspring born to a hypertensive pregnancy demonstrated an increased microvascular density loss over the first three months of life. This was associated with a reduction in vasculogenic potential in their human umbilical vein endothelial cells and also increased levels of maternal anti-angiogenic biomarkers at birth. Again, there was a trend to suggest maternal hypertension and prematurity may have an additive effect. These microvascular changes were not, however, correlated with cardiac hypertrophy in the whole cohort over the same period, but, intriguingly, when subgroup analysis was performed, increased microvascular density loss was correlated with increased left ventricular mass indexed to body size at three months of age in term born infants but not in the preterm group. It was then shown that preterm offspring had reduced heart rate variability measures at birth suggesting autonomic dysfunction. This was, however, not correlated with any previously demonstrated cardiovascular developmental changes in the early postnatal period. Offspring exposed to maternal hypertension and those born small for gestational age did not demonstrate any difference in heart rate variability at birth compared to controls. The results from my thesis point towards the perinatal and early postnatal period as being a critical window for cardiovascular development. As up to 8% of pregnancies are affected by hypertensive disorders of pregnancy and approximately 10% of all births are preterm, understanding the mechanisms behind these findings and their relevance to long term cardiovascular disease in this population is of great public health interest. Modification of clinical care and discovery of novel targets for disease prevention during this potentially tractable period will be of future interest.
29
Bakun, O. V., and D. Ashish. "THE INFLUENCE OF PYELONEPHRITIS COMPLICATIONS ON COURSE OF PREGNANCY AND LABOR." Thesis, Буковинський державний медичний університет, 2014. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/9600.
Texte intégralRésumé :
Pyelonephritis - nonspecific, infectious-inflammatory process with primary and primary lesion interstitial tissue walls and renal tubules, with subsequent involvement of glomerular and vascular system.
Different pathological conditions, which provoked acute stage of chronical pyelonephritis among pregnant women has been analized. Among: anomalies of kidney development, glomerulonephritis, hypertonic disease, preeclampsia and oth. According retrospective investigation of case history of women of postpartum period which have complicated pyelonephritis of Chernivtsi region has been received such characteristics: general amount of cases of nephrological complicated diseases during 2010-2013 consists 87; ratio of these diseases consists: pyelonephritis - 78,16%, glomerulonephritis - 9,1% and oth. - 12,74%. Most part of all background conditions, which contributes development of acute stage of chronical pyelonephritis compound anomalies of kidney development (51%), among them the most - single left kidney (34%). Different groups of exciters of chronical pyelonephritis during pregnancy has been analized: Ar. Piogenes, Streptococcus spp., E. coli, Candida albicans, St. aureus, Enterobacter aerogenus, S. Haemolyticus, S. epidermidis. Negative results of bacteriological examination of urine after finishing course of antibioticotherapy has been founded efficacy of antibioticotherapy in pregnant women with complicated pyelonephritis. The disappearance or significant reduction in the severity of the clinical manifestations of the disease: negative Pasternatsky symptom, disappearance of pain in the lumbar region, the normalization of body temperature and reduce the intensity of other general clinical symptoms.<br>Кафедра акушерства та гінекології
30
Myers, Patricia D. "The Association of Maternal Pregnancy Complications and Sudden Infant Death Syndrome." [Tampa, Fla.] : University of South Florida, 2003. http://purl.fcla.edu/fcla/etd/SFE0000068.
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31
Shub, Alexis. "Periodontal disease and adverse pregnancy outcomes." University of Western Australia. School of Women's and Infants' Health, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0184.
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[Truncated abstract] Periodontal disease is a common and underdiagnosed disease in humans that may have adverse effects on pregnancy outcomes. The aim of this thesis was to investigate the effects of periodontal disease in pregnancy by means of two observational human studies and the development of animal models of fetal and uterine exposure to periodontopathic bacteria and lipopolysaccharide. I performed a prospective study examining the rates of preterm birth, small for gestational age neonates and neonatal inflammation in 277 women who had undergone a detailed antenatal periodontal examination and oral health questionnaire. Periodontal disease was associated with small for gestational age neonates, and increased CRP levels in umbilical cord blood, but no effect was seen on the rate of preterm birth. Maternal oral health symptoms predicted both periodontal disease and newborn biometry. In a retrospective case control study, I examined the role of periodontal disease in perinatal mortality. Participants included 53 women who had experienced a perinatal loss for which no cause could be found after thorough investigation, and 111 control women. Women who had experienced a perinatal loss were more than twice as likely as controls to have periodontal disease. The incidence of periodontal disease was even higher in women in whom the perinatal loss was due to extreme prematurity. In contrast to my prospective study, risks to the pregnancy could not be predicted by maternal oral health behaviours or oral health symptoms. In order to better understand the mechanisms regulating the associations described in the human studies, two animal models were developed; one to investigate acute exposure and the second to investigate long-term exposure to periodontal pathogens. The first study examined the effects of administration of a bolus of periodontopathic bacteria and lipopolysaccharide to the pregnant sheep. Injection of bacteria and lipopolysaccharide in the amniotic fluid of the pregnant preterm sheep caused a high rate of fetal lethality, disturbance of fetal acid base status and inflammation of the fetus and membranes. Given the circumstances of exposure to periodontopathic pathogens in human periodontal disease, a model investigating long-term exposure to periodontopathic lipopolysaccharide on pregnancy outcomes was developed. ... Overall, I have demonstrated that maternal periodontal disease is associated with adverse pregnancy outcomes including fetal growth restriction and possibly perinatal loss. Mechanisms regulating these effects are likely to be mediated by fetal adaptations to intrauterine inflammation resulting in altered fetal development, growth or survival. Randomised controlled trials that are currently in progress will provide further information on the effects of periodontal disease in human pregnancy, and the efficacy of treatment to reduce these adverse outcomes.
32
Yatich, Nelly J. "The effect of malaria and intestinal helminth coinfection on birth outcomes in Ghana." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008r/yatich.pdf.
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Okong, Pius. "Maternal morbidity in Uganda : studies on life-threatening pregnancy complications in low-income settings /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-127-X/.
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34
Gilbert, Jeffrey Stephen. "Cardiorenal adaptations of the ovine fetus and offspring to maternal nutrient restriction." Laramie, Wyo. : University of Wyoming, 2005. http://proquest.umi.com/pqdweb?did=1044392391&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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Öhman, Inger. "Newer antiepileptic drugs in women of child-bearing age : pharmacokinetic studies during pregnancy, breastfeeding, and contraception /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7357-046-X/.
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36
KAZAMA, SHARON WONG. "THE EFFECTS OF STRESS AND MARITAL INTIMACY ON PREGNANCY AND BIRTH COMPLICATIONS." Diss., The University of Arizona, 1987. http://hdl.handle.net/10150/184150.
Texte intégralRésumé :
The present prospective longitudinal investigation examined the relationship of life event stress and marital intimacy to pregnancy and birth complications (N = 65). As expected, marital intimacy had a significant buffering effect on stress, but had no relationship with pregnancy and birth complications. In addition, stress levels were not related to pregnancy outcome. Social desirability and conflict resolution on the intimacy measure, as well as ethnicity were significantly related to pregnancy and birth complications. Particular attention is focused on social desirability and its implications for future social support research.
37
Gebremedhin, Amanuel Tesfay. "Effects of interpregnancy interval on pregnancy complications in a high-income country." Thesis, Curtin University, 2021. http://hdl.handle.net/20.500.11937/85548.
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Using a high-quality, population-based cohort spanning over 35 years in WA, we found insufficient evidence to suggest that short intervals increase the risk of hypertensive disorders of pregnancy (HDPs) and gestational diabetes. However, long intervals (>24 months) were associated with an increased risk of HDPs. Findings from this thesis suggest that optimal intervals vary by maternal age and previous pregnancy complications at birth prior to the interval and challenge the applicability of the current birth spacing recommendations, including WHO, to high-income settings such as Australia.
38
Fournet, Martine. "Réalimentation de la personne agée dénutrie : évolution des paramètres cliniques et biologiques." Bordeaux 2, 1989. http://www.theses.fr/1989BOR25100.
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39
Didrickson, Susanna. "Facing Uncertainty on Two Fronts: The Experience of Being Pregnant While One's Husband is Deployed." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/578608.
Texte intégralRésumé :
This qualitative descriptive study investigated the unique and specific impact of being pregnant while one's husband was deployed to a combat zone. Three specific aims were used to address the study objectives 1) Describe the experience of being pregnant while one's husband is deployed 2) Describe the women's experiences with health-care providers 3) Describe the types of support women sought or had access to during pregnancy. Participants were 16 women who had been pregnant while their husbands were deployed for greater than 30 days from 2004-2014, with no prior personal history of being deployed. Participants completed demographic questionnaires on their pregnancy course, and their husband's military and deployment history. Semi-structured telephone interviews were conducted with each participant individually. Content and matrix analysis were utilized to explore the study aims. The Stress and Coping Model by Lazarus and Folkman (1984) provided the theoretical framework for this study. Communication was an important part of receiving support from the husband and daily communication (n=4, 25%) was associated with more problem-based coping (75%) and feelings of emotional support from the husband (38%). Six participants stated a history of preterm labor or birth, and most of those participants used emotion-based coping predominantly (57%). Participants who perceived that their husbands experienced significant danger were more likely to use emotion-based coping (56%). Participants overall had more positive interactions with certified nurse midwives (76%) and civilian obstetric physicians (77%), and reported more negative interactions with military obstetric providers (87%). Primiparous participants reported that 61% of all experiences with providers were positive while multiparous participants were more likely to have negative (66%) or mixed (6%) experiences. Support systems sought or accessed were different for officer and enlisted wives as well as for different ages. The wives of enlisted soldiers were more likely to not participate, or have an unfavorable view (52%) of the FRGs. Whereas, the wives of officers felt more support and involvement (69%). Wives who were 29-years-old or less sought out more support from friends/co-workers (33%) than the 30-years-old or older group (19%). The 30-years-old or older group was more likely to have sought support from family (50%) versus the 29-years-old or younger group (40%). The difference in support sought or accessed from the FRG between the two age groups was much less significant (28% for ≤ 29-years old versus 31% for ≥ 30-years old). The findings from this study could be adapted to create a screening tool that would alert providers to those pregnant women who might need specific resources or social support.
40
Bayingana, Claude. "The prevalence of members of the "red complex" in pregnant women as revealed by PCR and BANA hydrolysis." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria called red complex (Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes which can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother&rsquo<br>s immune system to infection by these periodontopathogens, brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the prevalence of red complex, using BANA and PCR in subginginval plaque samples from pregnant women. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending a Mitchells Plain ante-natal clinic. Plaque samples were analyzed by the enzymatic BANA-test for detection of the presence of red complex and DNA was extracted and analyzed using 16 rDNA-Polymerase Chain Reaction (PCR).<br />
<br />
Seventy-nine percent of pregnant women showed gingival index scores of &ge<br>1 of which 74.24% harboured by at least one of the members of the red complex. P.gingivalis was the most prevalent of the three members of the red complex. Findings of this study confirmed a need for dental preventive measures in pregnant women and microbial monitoring of suspected periodontopathogenes. This could be achieved by joint cooperation between Maternity Obstetric Units (MOU), Dentistry and oral microbiology departments. The results of this study revealed that although PCR is more sensitive than BANA in detecting members of the red complex, BANA showed a better association with the indices used to diagnose periodontal disease.
41
Laresgoiti, Servitje Estibalitz. "Effect of Stress, Emotional Lability and Depression on the Development of Pregnancy Complications." Thesis, Walden University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3591710.
Texte intégralRésumé :
<p> Chronic stress and other emotional factors may have relevant impacts on pregnancy outcomes because they are related to neuroendocrine changes that lead to alterations in immunomodulation during pregnancy. In this quantitative prospective cross-sectional study, the relationship of emotional lability, depression, and stress during pregnancy and the development of preterm labor, preeclampsia, placental abruption, and low birth weight for gestational age babies was examined. Additionally, social support scores were compared to levels of stress/anxiety, depression, and emotional lability in pregnant women. Two hundred and forty two pregnant women who received prenatal services at the National Institute of Perinatology in Mexico City were evaluated during the 2<sup>nd</sup> or 3<sup>rd</sup> trimester of pregnancy and followed until pregnancy termination. Logistic regression analyses showed that being single significantly predicted preeclampsia and preterm birth, and the presence of social support significantly decreased the likelihood of preterm birth development. In the logistic regression model, family income significantly predicted the development of abruptio placentae. MANCOVA results revealed a significant difference among the social support categories on the combined dependent variables (stress/anxiety, depression, and emotional lability). The ANCOVA reported significant differences between social support scores, and stress/anxiety and depression scores. ANCOVA also showed significant differences between the number of pregnancies and stress scores. A 2X2 factorial analysis of variance showed a significant main effect of stress and depression on newborn weight. By promoting awareness of the importance of emotional factors during pregnancy among healthcare workers and pregnant women, this study contributed to positive social change.</p>
42
Laresgoiti, Servitje Servitje Estibalitz. "Effect of Stress, Emotional Lability and Depression on the Development of Pregnancy Complications." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1074.
Texte intégralRésumé :
Chronic stress and other emotional factors may have relevant impacts on pregnancy outcomes because they are related to neuroendocrine changes that lead to alterations in immunomodulation during pregnancy. In this quantitative prospective cross-sectional study, the relationship of emotional lability, depression, and stress during pregnancy and the development of preterm labor, preeclampsia, placental abruption, and low birth weight for gestational age babies was examined. Additionally, social support scores were compared to levels of stress/anxiety, depression, and emotional lability in pregnant women. Two hundred and forty two pregnant women who received prenatal services at the National Institute of Perinatology in Mexico City were evaluated during the 2nd or 3rd trimester of pregnancy and followed until pregnancy termination. Logistic regression analyses showed that being single significantly predicted preeclampsia and preterm birth, and the presence of social support significantly decreased the likelihood of preterm birth development. In the logistic regression model, family income significantly predicted the development of abruptio placentae. MANCOVA results revealed a significant difference among the social support categories on the combined dependent variables (stress/anxiety, depression, and emotional lability). The ANCOVA reported significant differences between social support scores, and stress/anxiety and depression scores. ANCOVA also showed significant differences between the number of pregnancies and stress scores. A 2X2 factorial analysis of variance showed a significant main effect of stress and depression on newborn weight. By promoting awareness of the importance of emotional factors during pregnancy among healthcare workers and pregnant women, this study contributed to positive social change.
43
Hill, S. Kristian. "Maternal perinatal events as predictors of sensory-motor functioning in normal children." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1117100.
Texte intégralRésumé :
The relationship between perinatal complications and sensory-motor functions was examined. Information from the Maternal Perinatal Scale (MPS) was used to predict factor scores of the Dean Sensory-Motor Battery (DSMB). Participants were 187 normal nonreferred children who were administered the DSMB while their mothers completed the MPS. Using MPS items as predictors, separate stepwise regression analyses for each DSMB factor found that 11 - 16% of variance could be accounted for in sensory-motor performance. At least three MPS items significantly contributed to the prediction of each DSMB factor. Predictors of Sensory and Simple Motor functions (DSMB Factor I) included maternal bleeding during pregnancy, delay between membrane rupture (water break) and onset of labor, and evidence of hypoxia. Evidence of hypoxia, maternal bleeding during pregnancy, and delay between water break and labor onset were predictive of Motor and Complex Sensory functions (DSMB Factor II). In addition, gender of the child joined maternal bleeding during pregnancy, amount of swelling during pregnancy, and mother's height in predicting Subcortical Motor functions (DSMB Factor III). Additional analyses using a canonical correlation confirmed the results of the regression analyses. A linear composite of sensory and motor variables was primarily defined by DSMB factors I and II. The linear composite of perinatal information was defined primarily by the same items that emerged as significant predictors of sensorymotor functions in the regression analyses. Most notably, a redundancy analysis indicated that about 20% of variance in DSMB factor scores could be accounted for by a linear composite of perinatal information. In general, sensory-motor performance decreased as severity of perinatal complications increased. Results were discussed in terms of the implications of using a normal non-referred population. More importantly, the present data suggested the possibility that 1) the relationship between perinatal complications and sensory-motor functions may exist on a continuum rather than the dichotomous diagnosis/no diagnosis, and 2) the synergistic influence of multiple perinatal complications may contribute to the manifestation of clinically significant behaviors. The role of sensory-motor functions as a foundation for more complex behaviors is also discussed.<br>Department of Educational Psychology
44
Friebert, Alyssa Marie. "Assessment of Maternal and Infant Outcomes of Moderately Malnourished Pregnant Adolescents in Malawi." DigitalCommons@CalPoly, 2018. https://digitalcommons.calpoly.edu/theses/1884.
Texte intégralRésumé :
Background: Adolescent childbearing and maternal malnutrition are common in low- and middle-income countries and are associated with increased risk for poor maternal and infant outcomes. Adolescent pregnancy compounded with moderate malnutrition exacerbates outcomes common to both individually. Supplementary foods may be a way to improve outcomes in malnourished adolescent pregnant women.
Objective: To retrospectively assess maternal and infant outcomes in moderately malnourished pregnant young adolescents (16-17 YO), older adolescents (18-19 YO), and adults (≥20 YO) in response to one of three nutritional interventions and in a pooled treatment group analysis, and to assess differences in infant outcomes by infant gender.
Methods: Height, weight, MUAC, and FH were measured in pregnant women with MUAC >20.6 cm and < 23.0 cm at baseline (N=1828) every 2 weeks over the course of enrollment while receiving either: 1) macro- and micronutrient fortified, peanut-based, ready-to-use supplementary food (RUSF), 2) corn-soy blended flour with a prenatal multiple micronutrient supplement (CSB-UNIMMAP), or 3) corn-soy blended flour with iron and folic acid (CSB-IFA). Each provided approximately double the RDA of most micronutrients, 900 kcal/day and 33-36 g/day protein. Postpartum maternal and infant measurements were taken at delivery, and after 6 and 12 weeks. Maternal age at enrollment variable was transformed from a continuous variable into a categorical variable; young adolescent (16-17 YO), older adolescent (18-19 YO), and adults (≥20 YO). General linear models with normal errors were used to compare: 1. Adolescent maternal and infant outcomes by intervention, 2. Adolescent maternal and infant outcomes by maternal age within each intervention group, 3. Maternal and infant outcomes in a pooled treatment analysis by maternal age, 4. Interaction effects between maternal age and intervention, 5. Infant outcomes by infant gender. If differences between groups were detected, they were tested using the Tukey HSD test (response) or the likelihood ratio-based odds ratios (categorical). Odds ratios were measured using effects likelihood ratio tests via logistic regression. Response variables included in the analyses were BMI and fundal height at enrollment.
Results: There were 297 young adolescents, 582 older adolescents, and 949 adults enrolled. Adolescents enrolled in the study at a younger gestational age than the adult mothers. Upon enrollment, BMI was greater and FH was smaller in the adolescent mothers than adults. At delivery, adolescent mothers had gained less weight on treatment, delivered with a lower final MUAC and FH, had increased odds of delivering extremely prematurely, and the greatest odds for delivering before recovery from malnutrition (MUAC ≥23.0 cm). Infants of young adolescent mothers were inferior anthropometrically to infants of the older mothers and had greatest odds of being underweight and stunted through 12 weeks of age. Young adolescents had the greatest odds for delivering LBW infants compared to the adults. Catch up growth was observed in the infants of older adolescents by 12 weeks of age; however, no catch up was observed for the infants of young adolescents. No one intervention was more helpful than another in determining maternal and infant outcomes of the adolescent mothers, and male infants had greater odds of being underweight and stunted at 6 and 12 weeks of age.
Conclusions: Although adolescents did not appear to have characteristics of more severe clinical malnutrition, such as lower BMI, lower maternal height, and increased rates of HIV at baseline, maternal and infant outcomes were worse for the adolescent mothers compared to the older, more mature mothers. Adolescents gained less weight during pregnancy and delivered smaller infants that were unable to catch up linearly and with weight gain. Pregnant adolescents, particularly young adolescents, are a high-risk population and public health efforts should be made to delay the age of first pregnancy.
45
Challis, Kenneth. "Monitoring pregnancy for improved perinatal outcome in Mozambique /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-406-2/.
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46
Toivo, Aini-Kaarin. "Perceptions and experiences of pregnant women towards HIV voluntary antenatal counselling and testing in Oshakati Hospital, Namibia." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
Texte intégralRésumé :
This study focused on perceptions and experiences of pregnant women who opted in against those who opted out of voluntary antenatal HIV counseling and testing. The pregnant women's perceptions and experiences were assessed in order to gain insight into their views towards voluntary antenatal counseling and testing.
47
Fritz, Kathleen Gary. "Development of a urinary metabolic ratio that reflects systemic theophylline elimination during pregnancy." Scholarly Commons, 1993. https://scholarlycommons.pacific.edu/uop_etds/2245.
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A number of studies have investigated the natural history of asthma in pregnancy. Most of the data suggests that the course of asthma for a given patient is unpredictable. Turner, et al.7 summarize the data from all of the English-language literature of studies on the effect of pregnancy on astha. Of 1054 cases examined, 49% of the asthma conditions remained unchanged, 22% got worst and 29% became better.7
Theophylline has been used safely during pregnancy. A review of the literature by O'Brien, showed that no teratogenic effects were associated with the use of theophylline in 117 cases and aminophylline in 76 cases examined.39,40 Blood concentration in newborns have been found to be similar to concentrations in the mothers.41,42,43 Problems developed because theophylline clearance may be altered during pregnancy and necessitate dosage adjustments and careful drug level monitoring.44
RATIONALE FOR STUDY
Campbell, et al.45 developed a caffeine urinary metabolic ratio, in which they were able to demonstrate a correlation between changes in metabolic rations and clearance. The change in the metabolic ration explained the alteration in clearance and determined the specific Cytochrome P-450 system involved.
Various physiologic changes occurring during pregnancy can cause changes in drug disposition. Pharmacokinetic parameters that need to be considered are plasma protein binding capacity, absorption, drug metabolizing enzyme activity, renal excretory function and volume of distribution.44,46,47
This study was developed to determine if changes in theophylline disposition during pregnancy were due to changes in drug metabolizing enzyme activity. A urinary test was designed to investigate the ratios of unchanged theophylline and theophylline metabolites to monitor changes in the various Cytochrome P-450 isoenzyme systems. Changes in the ratios could provide a noninvasive procedure to assess the effect of modulating agents or conditions (such as pregnancy) on theophylline metabolizing enzyme activity.
48
Vääräsmäki, M. (Marja). "Care and outcome of Finnish diabetic pregnancy." Doctoral thesis, University of Oulu, 2001. http://urn.fi/urn:isbn:951426469X.
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Abstract
The aim of this study was to evaluate the treatment, course and outcome of pregnancy in Finland using two cohorts of diabetic women. The clinical
cohort
consisted of data from all 210 women with Type 1 diabetes and their 296 pregnancies managed between 1986 and 1995 in the two northernmost provinces of
Finland. The register-based study population included all 1442 mothers with a singleton birth who had insulin treatment during pregnancy in 1991-1995
according to the Medical Birth Register. Of these mothers, 954 (66%) had pre-existing diabetes.
Insulin-treated diabetes complicated 4.5/1000 births in Finland in 1991-1995, the prevalence of Type 1 diabetes being 2.9/1000 in the whole country and
3.3/1000 in Northern Finland. In the 1990's the care of these women shifted from tertiary level only to include the secondary level hospitals as well, and
was more often carried out on an out-patient basis. This care policy in association with the self-monitoring of blood glucose levels contributed to an
obvious improvement in glycaemic control during pregnancy. Despite that, the high proportion (73%) of women entering pregnancy with unsatisfactory
glycaemic control did not decrease during the study period.
Retinopathy complicated 134 (45.3%) diabetic pregnancies, while clinical nephropathy was found in 23 (7.8%) cases. Although retinopathy was more often
aggravated during the first pregnancy, the occurrence of retinopathy or its severe form was not increased at the beginning of consecutive pregnancies. Of
the mothers, 50 (16.9%) had pre-eclampsia during pregnancy, and in 28% of these cases it was classified as superimposed. It was found more often among
primiparous than multiparous (25.6% vs. 11.0%, respectively), and its occurrence rose with the severity of diabetes.
In both cohorts, the rates of preterm deliveries, Caesarean sections and large for gestational age (LGA) infants were significantly (p < 0.001) higher
in
Type 1 diabetic pregnancies than in the background population. The rates of congenital anomalies (CA) were 540-629/10000 in two study populations, both
being 2-3-fold as compared to the background population. Cardiac malformations were most common, with anomalies in the genitourinary tract and the
musculoskeletal organs being next in frequency. Sixty-three percent of malformed infants were boys.
Though pregnancy itself was not found to worsen the prognosis of diabetes, at least in the short term, pregnancy in diabetic women still remains a high
risk state with an increased rate of prematurity, operative deliveries, CAs and peri- and neonatal mortality. In order to decrease the mortality rate in
diabetic births, attention should be directed at both the prevention of CA and at identifying the foetuses at risk for intrauterine death. The postneonatal
mortality rate is also high, reflecting a shift in the deaths from the early neonatal period to a later age. Therefore, a combined mortality, including
induced abortions, stillborns and infant deaths, would give a more realistic idea of the outcomes in diabetic pregnancies.
49
Mathai, Elizabeth. "Genital and urinary tract infections in pregnancy in southern India : diagnosis, management and impact on perinatal outcome /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-129-6/.
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Chalana, Vikram. "Deformable models for segmentation of medical ultrasound images /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/8025.
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