Introduction: Several factors have been observed to influence the value of newborn screening analytes (NBS) and should be adjusted for in the interpretation of blood spot samples. The thesis aimed to examine the association of NBS with 1) mode of delivery among term infants and 2) clinical subtypes (i.e., spontaneous onset of labour) of birth among preterm infants. Methods: A retrospective population-based cross-sectional study design was employed. A multivariable logistic regression model was used to examine associations between NBS and mode of delivery among term infants and subtypes among preterm infants. Results: 1) Metabolic profiles of infants born by planned cesarean delivery differ from those born by vaginal delivery following spontaneous onset of labour and 2) Metabolic profiles of preterm infants did not differ by clinical subtype. Conclusions: Our findings conclude that mode of delivery is an important covariate to consider in future modelling studies, but the inclusion of preterm birth subtypes is less compelling.

No description available.

Since the 1970s, the United States has encountered an increasing proportion of Cesarean deliveries (CS), surpassing the advised 10-15% maximum rate established in 1985 by the World Health Organization (World Health Organization, 1985). This increasing rate has fueled correlational and causational studies observing the impact of Cesarean delivery on several aspects of infant health. Previous studies on CS infants have observed a delay in gut colonization by beneficial bacteria – for instance Bifidobacteria – traditionally transmitted from the mother’s gut and vaginal microbiome as other environmental factors have influenced the initial microflora (Biasucci et al., 2010; Dong, Yang, & Wang, 2010; Penders et al., 2006). In addition, an increasing proportion of births are occurring within a home setting, providing an opportunity to study how these possible environmental factors may influence bacterial colonization. This initial gastrointestinal colonization is considered one of the most important factors towards immune system development and general health. This thesis proposes an examination of how the mode and setting of delivery influence the diversity of Bifidobacterium species in infants’ initial gut microbiomes. Additionally, while several studies have examined the impact of specific bacterial species on immune system development, this study will provide an approach to understanding how differences in the overall gastrointestinal (GI) ecologies of CS and vaginal delivery (VD) infants impact immune system development.

Introduction: Pre-pregnancy obesity was prevalent among 18% of women who delivered in Örebro in 2017. The rate has increased and previous international studies have identified obesity as a major risk factor for poor reproductive health among women. Aim: To analyze the association between maternal pre-pregnancy obesity and major obstetrical outcomes within the Örebro region. Methods: This retrospective observational study collected data from 1st Jan. 2015 to 30th Jun. 2018 via the Swedish Pregnancy Register. All women, who delivered simplex deliveries in the Örebro region during the study period, were eligible for inclusion. Exclusion criteria were BMI <18.5 kg/m2, delivery by forceps, incomplete data and admission to antenatal care at >17 gestational weeks. Women were categorized into obese (BMI >30 kg/m2) or non-obese (BMI <29.9 kg/m2) and compared by several obstetrical outcomes. Results: Of the 6846 included women, 17.8% were classified as obese. Obese women had several adverse maternal obstetrical outcomes. They had a significantly increased risk of undergoing induction of labor (OR 1.85), cesarean delivery (CD) (OR 1.46), emergency CD (OR 1.38), repeated CD (OR 1.47), having longer cesarean duration, higher total blood loss, and higher fetal birthweight. Conclusions: Pre-pregnancy obesity, among women in the Örebro region, is associated with significantly increased risk of adverse maternal outcomes during delivery and intervention before, during and after delivery should be further studied in order to minimize risk of complications in this risk group.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2015-08-04T21:49:38Z No. of bitstreams: 1 DAIENE-ROSA-GOMES-Disserta??o-VERS?O-FINAL.pdf: 966973 bytes, checksum: 1e27e5956e56ed34c52950b749b981c0 (MD5) / Made available in DSpace on 2015-08-04T21:49:38Z (GMT). No. of bitstreams: 1 DAIENE-ROSA-GOMES-Disserta??o-VERS?O-FINAL.pdf: 966973 bytes, checksum: 1e27e5956e56ed34c52950b749b981c0 (MD5) Previous issue date: 2014-03-24 / Background: Obesity in children is a public health problem of great magnitude. In recent decades, there has been increasing rates of caesarean sections and obesity, and might have a possible causal relationship between the two events. Objective: To assess the association between cesarean section delivery and overweight at six years of age in a city in northeastern Brazil. Methods: This is a birth cohort conducted with 672 children followed in home visits until the sixth year of age. The outcome variable was overweight obtained by body mass index by age and the main independent variable was cesarean delivery. Were evaluated as covariates: gender; birth weight (<2500g, ?2500g); duration of breastfeeding (<12 months ?12 months); calories intake at 72 months (<1935 kcal, ?1935 kcal); physical activity at school; means of transport to go to school; maternal excessive weight gain during pregnancy; family income (?1 minimum wage, ? 2 minimum wages); maternal schooling; maternal overweight and maternal work. The association of caesarean delivery and overweight was estimated by logistic regression analysis, with the significance level of 5% and its respective 95% confidence interval. Results: Overweight was present in 36.6% of children born by cesarean section compared with 20.2% of those born by vaginal delivery. The association between overweight and cesarean delivery remained statistically significant after adjusting for confounders (OR = 1.96, 95% CI 1.61; 3.22). Conclusion: The results support the assumption that the birth by cesarean delivery is associated with an increased risk of overweight in childhood. Pregnant women should be warned about the increased risk of being overweight for those children born by cesarean delivery. / INTRUDU??O: Recentemente, o tipo de parto ganhou aten??o como potencial fator de risco para a obesidade na inf?ncia. Acredita-se que diferen?as na composi??o da microbiota intestinal das crian?as nascidas por parto ces?reo e vaginal contribui para o incremento da obesidade, pressuposto questionado por alguns pesquisadores. OBJETIVO: Avaliar a associa??o entre o nascimento por parto ces?reo e o excesso de peso aos seis anos de idade, na cidade de Feira de Santana, Bahia. M?TODOS: Trata-se de uma coorte de nascidos vivos. Foram acompanhados 672 crian?as, em visitas domiciliares, at? o sexto ano. A vari?vel desfecho foi o excesso de peso obtido pelo IMC/idade e a vari?vel independente principal o parto ces?reo. Foram avaliadas como co-vari?veis: sexo; peso ao nascer (<2500g, ?2500g); dura??o do aleitamento materno (<12 meses, ?12 meses); consumo alimentar aos 72 meses (<1935 kcal, ?1935 kcal); atividade f?sica na escola; meio de transporte para ir ? escola; ganho excessivo de peso durante a gesta??o; renda familiar (?1 sal?rio m?nimo, ? 2 sal?rios m?nimos); escolaridade materna; excesso de peso materno e trabalho fora do lar. A an?lise utilizada foi a regress?o log?stica, considerando o n?vel de signific?ncia de 5% e o intervalo de confian?a de 95%. RESULTADOS: O excesso de peso esteve presente em 36.6% das crian?as nascidas por parto ces?reo em compara??o com 20.2% daquelas nascidas por parto vaginal. A associa??o entre excesso de peso e parto ces?reo manteve-se estatisticamente significante ap?s o ajuste pelas vari?veis confundidoras (OR=1.96; IC 95% 1.61, 3.22). CONCLUS?O: Os resultados refor?am o pressuposto de que o nascimento por parto ces?reo est? associado a um aumento de risco de excesso de peso na inf?ncia. As gestantes devem ser alertadas quanto ao maior risco de excesso de peso para aquelas crian?as nascidas por cesariana.

Cesarean delivery is one of the most frequently performed surgical procedures in the United States with 1 in 3 women giving birth by cesarean section. Nurses play a significant role during the labor and delivery process; yet in a hospital in west Texas, nurses lacked knowledge of the current evidence-based obstetric guidelines that were developed to reduce the primary cesarean delivery rates and associated complications. The purpose of this project was to evaluate the content of educational materials developed to inform obstetrical nurses and midwives about labor support strategies to avoid cesarean delivery. Guided by Knowles's whole-part-whole model, a presentation was developed that included evidence-based guidelines and labor-support strategies for positioning and pain management to decrease the choice of cesarean section when not indicated. A 9-member panel with at least 5 years obstetrical expertise evaluated the materials. Based on a descriptive analysis of questionnaire data, experts had a 100% level of agreement that while the educational program material had the potential to promote nursing care practices that would decrease the number of primary cesarean deliveries, changing clinical delivery practices would likely be met with staff resistance. An evidence-based educational program with preventive strategies to decrease primary cesarean deliveries might produce positive social change by prompting obstetric teams to choose these preferred alternatives to avoid to cesarean delivery, and subsequently, decrease associated complication rates, promote faster maternal recovery after childbirth, and decrease the financial burden on the health care system.

Approximately 35.1% of live births for the state of Georgia were delivered by the cesarean delivery procedure with significant variation among hospitals. The purpose of this research was to develop a population-based hospital profiling methodology for study of the cesarean delivery procedure. This was a retrospective, observational design, using a 2012 linked dataset that included maternity deliveries from all nonfederal hospitals. The research was guided by Robson 10 Group Classification System, propensity score methodologies, and ethical precepts, for the development of hospital profiles and the study of variations in the cesarean delivery procedure. Key research questions aimed to determine whether hospital profiling methodologies differed according to risk adjustment methods and statistical techniques. Propensity score matching with stratification methods aimed to determine whether there were differences in patient treatment effects on the cesarean delivery outcome. Findings suggested there was a significant difference in hospital ranks and model effects according to the statistical technique and the risk adjustment methods applied. Propensity score matching with stratification demonstrated an increased risk of the cesarean delivery procedure across strata, with the majority of high risk patients situated in the 90th percentile ranges and questionable utilization practice among other strata. Applying profiling methodologies at the facility and population level could advance statewide quality improvement programs for the timely reduction in the variation of inappropriate utilization of the cesarean delivery procedure.

<p>För det nyfödda barnet är det viktigt att direkt få hud mot hud kontakt och därmed en bra möjlighet att knyta an till sina föräldrar. En tidig anknytning ligger till grund för barnets utveckling och välbefinnande. Efter ett kejsarsnitt separeras mamman och barnet de första timmarna postpartum. Denna studie var en beskrivande litteraturstudie med syfte att beskriva om anknytningen påverkas mellan föräldrar och barn efter ett kejsarsnitt. Relevant litteratur har söks genom databaserna Medline och Cinahl. Urvalskriterierna var att artiklarna svarade på studiens syfte, var skrivna på engelska och hade abstrakt. 18 artiklar valdes som har granskats och kvalitetsbedömts. De flesta studier var kvantitativa och jämförande. Resultatet redovisades i en figur, löpande text och i en tabell. Studien har visat på flera negativa tendenser under den första tiden efter förlossningen som försenad anknytning och amning. Mamman hade även svårigheter att sköta om barnet under de första dagarna postpartum vilket gav pappan en mer framträdande roll. Den första tiden efter förlossningen är en viktig tidpunkt för anknytningen. Det är därför viktigt att vårdpersonal har kännedom om anknytningsteorin och vet hur de ska arbeta för att stärka och stötta familjen den första tiden så att familjen får en god anknytning och en bra start.</p> / <p>For the newborn child it is important that directly have skin to skin connection and thereby a good ability to bond with his parents. An early attachment is very important for the child’s wellbeing and comfort. After a cesarean delivery mother and child are separated the child’s first hours in life. The purpose of this review literature study was to find out if the attachment between the child and the patents affects after a cesarean delivery. Relevant literature has been found in the Medline and the Cinahl databases. The criteria of selection where that the study’s responded to this study’s purpose, that they where written in English and had an abstract. 18 study’s where chosen and has been revised and quality judged. Most of the study’s where quantitative and comparative. The result is shows in a figure, running text and in a table. The study has shown several negative tendencies during the postpartum period such as bonding delay and later breast-feeding establishment. The mother had also difficulties to take care of her child the first day’s postpartum witch gave the father a more leading role in the caretaking activities. The first day’s postpartum is crucial for the attachment and it is important that caregivers has knowledge about the attachment theory and that they know how to strengthening and support the family so they can establish a fine bonding and attachment.</p>

För det nyfödda barnet är det viktigt att direkt få hud mot hud kontakt och därmed en bra möjlighet att knyta an till sina föräldrar. En tidig anknytning ligger till grund för barnets utveckling och välbefinnande. Efter ett kejsarsnitt separeras mamman och barnet de första timmarna postpartum. Denna studie var en beskrivande litteraturstudie med syfte att beskriva om anknytningen påverkas mellan föräldrar och barn efter ett kejsarsnitt. Relevant litteratur har söks genom databaserna Medline och Cinahl. Urvalskriterierna var att artiklarna svarade på studiens syfte, var skrivna på engelska och hade abstrakt. 18 artiklar valdes som har granskats och kvalitetsbedömts. De flesta studier var kvantitativa och jämförande. Resultatet redovisades i en figur, löpande text och i en tabell. Studien har visat på flera negativa tendenser under den första tiden efter förlossningen som försenad anknytning och amning. Mamman hade även svårigheter att sköta om barnet under de första dagarna postpartum vilket gav pappan en mer framträdande roll. Den första tiden efter förlossningen är en viktig tidpunkt för anknytningen. Det är därför viktigt att vårdpersonal har kännedom om anknytningsteorin och vet hur de ska arbeta för att stärka och stötta familjen den första tiden så att familjen får en god anknytning och en bra start. / For the newborn child it is important that directly have skin to skin connection and thereby a good ability to bond with his parents. An early attachment is very important for the child’s wellbeing and comfort. After a cesarean delivery mother and child are separated the child’s first hours in life. The purpose of this review literature study was to find out if the attachment between the child and the patents affects after a cesarean delivery. Relevant literature has been found in the Medline and the Cinahl databases. The criteria of selection where that the study’s responded to this study’s purpose, that they where written in English and had an abstract. 18 study’s where chosen and has been revised and quality judged. Most of the study’s where quantitative and comparative. The result is shows in a figure, running text and in a table. The study has shown several negative tendencies during the postpartum period such as bonding delay and later breast-feeding establishment. The mother had also difficulties to take care of her child the first day’s postpartum witch gave the father a more leading role in the caretaking activities. The first day’s postpartum is crucial for the attachment and it is important that caregivers has knowledge about the attachment theory and that they know how to strengthening and support the family so they can establish a fine bonding and attachment.

Pregnancy in women with hemoglobinopathy has been associated with an increased risk of adverse pregnancy outcomes. We conducted a historical cohort study using Discharge Abstract Database for the fiscal year 1991-1992 through 2007-2008. We estimated the frequency of pregnant women with hemoglobinopathy and examined their associations with adverse pregnancy outcomes. Women with sickle cell disease are more likely to develop pre-eclampsia and preterm labor, and to undergo cesarean delivery than women with nutritional deficiency anemia, suggesting that there are other mechanisms beyond anemia that may be responsible for an increased risk of adverse pregnancy outcomes. The data suggested a synergistic effect of hemoglobinopathy and pre-eclampsia on preterm labor and cesarean delivery. Prediction models for pre-eclampsia, preterm labor and cesarean delivery were created and internally validated for women with hemoglobinopathy, with satisfactory discrimination and calibration.