Objetivo: Determinar el valor predictivo del Índice Cerebro Placentario y del flujo anormal del Ductus Venoso de Aranzio, medido por velocimetría Doppler, en pacientes con preeclampsia, en relación a un resultado perinatal adverso. Materiales y métodos: Estudio prospectivo, no experimental, longitudinal, de tipo correlacional. Se realizaron exámenes ultrasonográficos Doppler para determinar el Índice Cerebro Placentario y el flujo anormal del Ductus Venoso de Aranzio, en los 7 días previos al parto, en 160 pacientes con diagnóstico de preeclampsia severa admitidas en la Unidad de Medicina Fetal y Diagnóstico Prenatal del Servicio de Obstetricia de Alto Riesgo del Hospital Guillermo Almenara Irigoyen – EsSalud. El resultado perinatal adverso fue definido por los siguientes parámetros: Cesárea por SFA, APGAR menor 7 a los 5´, Líquido amniótico meconial, Oligohidramnios, pH de la arteria umbilical menor 7,2, Admisión en UCI neonatal, RCIU. Se utilizó estadística descriptiva para la variable dependiente y estadística inferencial mediante el estadístico chi cuadrado (x²) y prueba exacta de Fisher, con un nivel de significancia de 0,05; confiabilidad del 95%. Además se calculó la sensibilidad, especificidad y valores predictivos positivo y negativo de la variable independiente. Conclusiones: Se ha demostrado que la alteración del Índice Cerebro Placentario y del Flujo del Ductus Venoso de Aranzio medido por flujometría Doppler fetal, detecta a más del 65% de los recién nacidos con resultado perinatal adverso e hipoxia fetal y se asocia a la ocurrencia del mismo. Además esta es una prueba predictiva, estadísticamente significativa, de RCIU y de oligohidramnios, en pacientes con preeclampsia severa. El presente estudio se realizó con un muestreo no aleatorio, por ende, este hecho de no aleatoriedad, pudiera plantear problemas de validez externa. / Objective: To ascertain the value of cerebral-placental ratio and the abnormal fluxo of Aranzio´s Ductus Venous and for identifying newborns with neonatal morbidity in pregnancies complicated by severe preeclampsia. Study Design: A longitudinal and correlational study of 160 patients with severe preeclampsia (PA > 160/110, proteinuria 3+) was performed Doppler study done by one operador within 7 days before delivery. An abnormal cerebral-placental ratio and abnormal resistance and pulsabilility index of ductus venous were used to identificate fetal asphixia (cardiac insuficiency). The results belong 5 percentile were considered abnormal. These results were matched with perinatal results considered as abnormal. Results: Maternal characteristic were: age 33, parity 1, primigravid 45%, prenatal care 85%, gestational age at enrollment 35,1 weeks. The probability of detection IUGR is 65% and oligohydramnios 61,2%. Conclusion: The cerebral-placental ratio and abnormal fluxo of Aranzio´s Ductus venous identifies 65 % or more of the newborns with severe neonatal morbidity in pregnancies with severe preeclampsia.

Thesis (Ph.D.)--Brown University, 2008. / Vita. Advisor : Suzanne M. de la Monte. Includes bibliographical references.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 171-195). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 171-195). Also available on the Internet.

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 248-277). Also available in print.

The objective of this dissertation research was to determine the specific actions of chronically elevated catecholamines on; 1.) fetal growth and ß-cell function during the third trimester in vivo in an ovine model of placental insufficiency-induced intrauterine growth restriction (PI-IUGR), and 2.) regulation of insulin secretion in vitro utilizing the mouse insulinoma cell line Min6.At 0.7-gestation, fetal weights were not different but PI fetuses had lower (P<0.05) basal blood oxygen content, plasma glucose, IGF-1, and insulin concentrations and greater norepinephrine concentrations (891±211 vs. 292±65 pg/ml; P<0.05) compared to controls. Glucose-stimulated insulin secretion (GSIS) was lower in PI than control fetuses (0.34±0.03 vs. 1.08±0.06 ng/ml; P<0.05). ADR-block increased GSIS in PI fetuses (1.19±0.11) but decreased GSIS in controls (0.86±0.02 ng/ml). Insulin content per islet was not different between PI and control fetuses. We concluded that elevated fetal plasma norepinephrine, in PI fetuses at 0.7 gestation, precedes growth restriction and suppresses insulin concentrations, and ADR-block revealed compensatory β-cells stimulus-secretion responsiveness. Therefore, to determine the effects of chronic hypercatecholamine exposure on fetal growth and β-cell function independent of hypoglycemia and hypoxemia, we performed surgical sham or adrenal demedullation (AD) at 0.65 gestation on control and IUGR fetuses (n= 5 Control-Sham, 5 Control-AD, 5 IUGR-Sham, 5 IUGR-AD fetuses). Studies commenced at 0.9 gestation under ambient conditions and steady-state reversal of arterial pO2 between IUGR and control fetuses. Plasma norepinephrine was 5-fold higher in IUGR-Sham vs. Control-Sham and reduced in IUGR-AD fetuses to concentrations not different from Control-Sham fetuses. Fetal mass was lower in IUGR vs. control fetuses but 92% greater in IUGR-AD compared to IUGR-Sham fetuses. Basal plasma glucose and arterial pO2 were lower in IUGR-Sham vs. Control-Sham, and IUGR-AD vs. Control-AD fetuses. Basal and glucose-stimulated insulin concentrations compared to Control-Sham were lower in IUGR-Sham and IUGR-AD and Control-AD fetuses. Oxygenation improved GSIS in IUGR-Sham and IUGR-AD fetuses. In conclusion, hypoglycemia, hypoxemia and norepinephrine interdependently and differentially regulate aspects of fetal growth and β-cell function in the IUGR fetus. In Min6 cells, we determined that GSIS responsiveness is enhanced and adrenergic receptor α2A is desensitized cells following chronic exposure to epinephrine.

Northern British Columbian Aboriginal mothers raising adolescents with Fetal Alcohol Spectrum Disorder (FASD) face many challenges. This interpretive ethnography provides an understanding of how these mothers interpreted and responded to their adolescents' FASD. It affirms the experiences of Aboriginal mothers and acknowledges their life stories and those of their adolescent children.The concepts of vulnerability, marginalization, and mothering, conceptualized within the theoretical perspectives of postcolonialism, provided the framework for this study. Postcolonial perspectives were particularly relevant to this research: the explicit aftereffects of colonialism on the well-being of Aboriginal women have shaped the worldview of mainstream society resulting in marginalization and stigmatization. A postcolonial perspective suggests that FASD is a problem compounded by colonization; until the underlying compounding issues are addressed, the incidence of FASD among Aboriginal people will continue to increase.English-speaking Aboriginal women with one or more children between the ages of 14 and 18 years affected by FASD were recruited for the study. Appropriate measures were taken to ensure trustworthiness, verisimilitude, and legitimacy. Data collection included three sequential audio-recorded interviews with eight women over a specific time. Interview data were enhanced by document review, intervals of observation participation, and the examination of other historically and culturally relevant data.The interpretive theory derived from the data, Mothering from the Margins, explains how Aboriginal mothers raise their adolescent children who have FASD. The theory provides a perspective that enables nurses to view mothers with adolescents affected by FASD in an all-encompassing manner, and unifies the experiences of participants mothering adolescents with FASD. Aboriginal mothers of adolescents with FASD continue to experience societal blame and marginalization for consuming alcohol during pregnancy. This study extends the knowledge of how this blaming and marginalization experience plays out in the lives of both mothers and children. The findings debunk the stereotypical myth that Aboriginal mothers are not good mothers. In fact, the findings from this study demonstrate how, despite all the difficulties and challenges faced by study participants, they have demonstrated adaptability, confidence, and care in their mothering roles.

In this thesis I used Caenorhabitis elegans as a model of Fetal Alcohol Spectrum Disorder (FASD) to study the physical and behavioral effects of ethanol exposure during embryonic development. Davis et al. (2008) found that ethanol exposure during larval development in C. elegans produced physical/developmental and behavioral effects; however, whether exposure during embryonic development might produce similar outcomes remained to be elucidated. Because the type and degree of effects caused by developmental ethanol exposure was dependent on the pattern of ethanol treatment, in the first part of the thesis I investigated the physical/developmental effects of embryonic exposure to various ethanol doses, exposure durations, onsets and frequencies. I found that exposure to >30% ethanol for an hour during embryonic development was necessary to lower hatch rate, delay reproductive onset, and reduce body size in C. elegans. Furthermore, exposure during early embryonic development caused a larger effect than exposure during later stages, and multiple exposures produced a worse outcome than a single exposure for a comparable duration. In the second part of the thesis, I investigated locomotory activities and habituation of adult C. elegans exposed to various patterns of embryonic ethanol treatment. I found that the rate of locomotion was altered differently by chronic and acute embryonic ethanol exposure, but I did not find any effect in short- or long-term habituation. In summary, I have characterized the pattern of embryonic ethanol exposure necessary to produce physical/developmental effects in C. elegans, and identified the types of exposure conditions that would cause worse outcomes than others; in addition, I have found that embryonic ethanol exposure affects the rate of locomotion in C. elegans. In this thesis, I have established a foundation for the future investigation into the physical and motor defects caused by embryonic ethanol exposure in C. elegans.

The current document is a paper-based thesis investigating the lived experiences of parents raising children with Fetal Alcohol Spectrum Disorder (FASD) in Ontario, Canada. Historically, researchers have approached the exploration of families with the notion that families of children with a developmental disability would present with a pathological profile. However, a recent paradigm shift has transitioned the focus from deficit-based outcomes to those that highlight positive outcomes. Therefore, the first paper included is a qualitative analysis of factors that facilitate family adaptation. Interpretative phenomenological analysis (IPA) was used to analyze semi-structured interviews with parents of children with FASD. Parents utilize a number of coping strategies, supports, and transformational outcomes that enable them to adapt to raising their child with FASD. The second paper included is also a qualitative analysis examining demands that hinder family adaptation. Parents discussed five stressors that hinder successful family adaptation. Recommendations from parents of children with FASD and implications for increasing knowledge and awareness of the disability are discussed.

This research explored the risk and protective factors associated with criminality among adults with Fetal Alcohol Spectrum Disorder (FASD). While previous research has focused on identifying the factors that contribute to legal issues, there is a paucity of research on the protective factors that may lead to more positive outcomes for adults with FASD. The first paper examined the methodological issues encountered while conducting a mixed methods study on the experience of offenders and non-offenders with FASD. Difficulties with participant recruitment, the sample size, the terminology employed, and the appropriateness of psychometric measures were significant challenges that emerged during the research project. The second paper was a qualitative study that investigated the experience of adults with prenatal alcohol exposure and their families to determine the risk and protective factors for criminality. Families reported that neurobehavioural impairments such as difficulty with self-regulation and social skills deficits, combined with environmental demands that exceeded the capabilities of the individual with FASD, were important contributors to criminality. However, structure and supervision, education and employment, social and financial support, and positive peer influence were found to mitigate the risk of criminal behavior among adults with FASD. The findings from this thesis highlight the importance of including families in the research process as well as the need to have more family-centered services.