Despite advances in obstetric care, hypertensive disorders continue to complicate pregnancies at a high rate. Worldwide, hypertensive disorders affect up to 10% of pregnancies. The United States has seen a 25% increase in the incidence of hypertensive disorders over the last two decades (American College of Obstetricians and Gynecologists, 2017). These complications constitute one of the greatest causes of maternal and perinatal morbidity and mortality with an estimated 50,000 to 60,000 deaths per year across the world (American College of Obstetricians and Gynecologists, 2017). Although the etiology of hypertensive disorders remains unclear, there may be an association with both maternal biological and psychological distress in the development of the disorder. Although both distress and biomarkers have been identified in association with a hypertensive disorder, little data exist examining the components of distress and the alterations in biomarkers in women developing these disorders. Due to the limited evidence, a critical need exists to examine the relationship of perceived maternal distress and biomarker measures in the development of a hypertensive disorder during pregnancy in order to better understand this phenomenon. The purposes of this dissertation were to: 1) understand the experience of having a hypertensive disorder during pregnancy; 2) to investigate the association of perceived stress and changes in immune response via biomarker measures in women who develop a hypertensive disorder during pregnancy; 3) to review, summarize, and evaluate the literature examining the relationship between perceived maternal distress (stress, anxiety, and depression) and the development of a hypertensive disorder; and 4) to investigate the association of perceived distress in the development of a hypertensive disorder during pregnancy. Data obtained from a qualitative study of women with a hypertensive disorder during pregnancy placed on bed rest reported several stressors associated with the experience. These stressors related to differing and often conflicting management plans by different providers and not feeling providers heard their concerns. The evidence supports these women experience stress during this pregnancy complication. Analysis of data obtained at each trimester of pregnancy did identify differences in biomarker levels based on perceived stress and women with a hypertensive disorder and those without a hypertensive disorder. Evidence from a systematic review of literature supporting maternal distress in the development of a hypertensive disorder was mixed. However, few studies existed and of those reviewed, most lacked rigor. Analysis of data obtained early and late in pregnancy did not indicate a relationship between psychological distress and the development of a hypertensive disorder in pregnancy. Women with a higher BMI were 12% more likely to develop a hypertensive disorder. The factors associated with the development of a hypertensive disorder are complex. Maternal perceived stress and inflammatory responses differ between women with a hypertensive disorder and those without a hypertensive disorder in pregnancy; however maternal distress did not differ between groups. Body mass index was associated with the development of hypertension in pregnancy. Clinicians need to include assessment of maternal BMI as a modifiable risk factor in the development of a hypertensive disorder during pregnancy. In addition, although psychological distress was not associated with the development of a hypertensive disorder, women still suffer with components of distress. Clinicians could identify and support women experiencing distress thereby promoting a healthier pregnancy.

Made available in DSpace on 2016-04-28T20:40:15Z (GMT). No. of bitstreams: 1 Jamile Santos Souza.pdf: 657696 bytes, checksum: 27d5a612e3a46a4855d9641e0efda0b5 (MD5) Previous issue date: 2010-05-07 / Hypertensive disorders of pregnancy are one of the major complications of pregnancy and postpartum and are considered the first cause of maternal and perinatal mortality in the world, with repercussions on the female psyche. Objective: To assess pregnant women hospitalized for pregnancy hypertension syndrome levels of anxiety and depression, as well as ways of coping with problems. Method: Using the Hospital Anxiety and Depression Scale and Mode of Coping in 30 pregnant women hospitalized for medical diagnosis of hypertensive disorder of pregnancy at the Prof.. Carlos da Silva Lacaz Hospital. Results: 66.7% had anxiety symptoms and 36.7% had depressive symptoms. There is positive correlation between the presence of anxiety symptoms and depressive symptoms. Regarding the mode of confronting the problem, the focus on emotion and religiosity / wishful thinking are related to the presence of anxiety symptoms. The absence of anxious and depressive symptoms are directly related to the presence of the mode of coping with focus on the problem and seeking social support. Conclusion: pregnant women with gestational hypertension syndrome with symptoms depression and anxiety need to be encouraged to interact with family and friends as a resource for coping. Also, it is necessary to health professionals working with this population the encouragement of practices with focus on behaviors that allow the woman to approach the stressor and its reassessment in order to establish an action plan to address the problem of hypertension of pregnancy and maternal and fetal risks / As síndromes hipertensivas gestacionais representam uma das mais importantes complicações do ciclo gravídico-puerperal e são consideradas a principal causa de mortalidade materna e perinatal do mundo, com repercussões no psiquismo feminino. Objetivo: avaliar em gestantes hospitalizadas por síndrome hipertensiva gestacional os níveis de ansiedade e depressão, bem como os modos de enfrentamento de problemas. Método: utilização da Escala Hospitalar de Ansiedade e Depressão e da Escala de Modo de Enfrentamento de Problema em 30 gestantes hospitalizadas por diagnóstico médico de síndrome hipertensiva gestacional, na enfermaria obstétrica do Hospital Profº. Carlos da Silva Lacaz. Resultados: 66,7% apresentaram sintomas ansiosos e 36,7% apresentaram sintomas depressivos. Existe correlação positiva entre a presença do sintoma ansioso e o sintoma depressivo. Em relação ao modo de enfrentamento do problema, o foco na emoção e religiosidade/ pensamento fantasioso estão relacionados à presença do sintoma ansioso. A ausência dos sintomas ansiosos e depressivos estão diretamente relacionados à presença do modo de enfrentamento com foco no problema e na busca de apoio social. Conclusão: as gestantes com síndrome hipertensiva gestacional que apresentam sintomas ansiosos e depressivos precisam ser estimuladas a interagir com familiares e amigos como recurso de enfrentamento. Também, torna-se necessário aos profissionais de saúde que trabalham com esta população, o incentivo a práticas com foco em comportamentos que possibilitem à gestante a aproximação do estressor e sua reavaliação a fim de estabelecer um plano de ação para enfrentar o problema da hipertensão gravídica e dos riscos maternos e fetais

Background: Although lifestyle modification is the cornerstone of GDM management, the evidence base on which dietary recommendations to prevent GDM is diverse and has not been synthesized in a consistent fashion. Objectives: The overall objective of this thesis is to assess the relationship of diet patterns, foods, and nutrients with GDM risk. Specifically, we seek to: 1) Quantify the relationship between dietary factors and GDM and metabolic disorders of pregnancy; 2) Compare the effects of dietary factors on markers of glycemic control, such as fasting glucose, fasting insulin, HbA1c, and the homeostatic model assessment for insulin resistance (HOMA-IR); 3) Assess the association and interaction between carbohydrate quality, and genetic load on the risk of developing GDM using data from 2 prospective birth cohort studies. Methods: We follow the approach set by the Cochrane Group’s Handbook for Systematic Review of Interventions to conduct meta-analyses and assess the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. We analyze prospective cohort data of 2,504 women from the CHILD and START studies, which enrolled women of White-Caucasian and South Asian ethnicity. We quantify carbohydrate quality by deriving the glycemic index and load (GL), and total and added sugar intake. We construct a gene score using 102 loci that were previously associated with type 2 diabetes in genome-wide association studies. Results: 1) The meta-analysis identified high-quality evidence that red meat increases GDM risk; however, most associations of foods and nutrients with GDM and other metabolic disorders of pregnancy are of low-quality; 2) The network meta-analysis identified that most dietary interventions given with gestational weight gain advice will lower fasting glucose; 3) In South Asians, a high GL coupled with a high genetic load increased GDM risk six fold, but a high total sugar intake in the presence of a high genetic load reduced GDM risk. This paradoxical finding may be explained by a high correlation between total sugars and other healthy foods. Conclusions: Few valid associations between dietary factors and GDM risk exist. GL and total sugars may modify the genetic risk of GDM in South Asians but not in White-Caucasians. Further research is needed to determine effective interventions that can assist women in adopting healthier eating habits during pregnancy. / Thesis / Doctor of Philosophy (PhD) / Gestational diabetes mellitus (GDM) is glucose intolerance that first appears during pregnancy. Although lifestyle modification is the cornerstone of GDM management, dietary recommendations for GDM prevention are sparse. The overarching objective of this thesis is to describe the relationships between diets, foods, and nutrients and GDM and metabolic disorders of pregnancy and to understand whether carbohydrate quality can modify a genetic predisposition to diabetes. In the systematic literature reviews, high-quality evidence showed that red meat increases GDM risk. Moderate-quality evidence showed that several dietary factors also influence the risk of GDM and metabolic disorders of pregnancy, but most of the existing evidence is of low-quality. More high-quality studies are needed before dietary interventions can be implemented In our genetic study, we observed that carbohydrate quality may modify the genetic risk of diabetes in South Asians but not in White-Caucasians and conclude that carbohydrate quality may provide only a limited assessment of overall diet quality.

Abstract A low level of physical activity and poor physical fitness are important risk factors of chronic non-communicable diseases and all-cause mortality. Much of the risk of these diseases originates in fetal life. The associations of early-life determinants with physical activity and fitness later in life are as yet not well studied. The aim of this work was to investigate early-life factors as predictors of physical activity and fitness in adolescence and young adulthood. We assessed a wide range of parental and pregnancy-related factors in 16-year-old adolescent participants of the Northern Finland Birth Cohort 1986 (n=7,344), and focused on the long-term consequences of preterm birth in the 23-year-old adult participants of the ESTER study (n=1,161). Prenatal and parental predictors of low physical activity and cardiorespiratory fitness in adolescence included high gestational age-related birth weight as well as parental overweight or obesity. Also, both short and long gestational lengths were associated with lower physical activity, and maternal gestational diabetes mellitus and smoking during pregnancy were associated with lower cardiorespiratory fitness. Young adults born before 34 weeks of gestation reported substantially less leisure-time physical activity than those born at term, although this was not detected by accelerometer measurement. Those born preterm had lower muscular fitness, as individuals born before 37 weeks were able to perform fewer modified push-ups, and those born before 34 weeks had lower handgrip strength, but no difference was observed in cardiorespiratory fitness. Based on questionnaire data, young adults born before 34 weeks perceived themselves to be less fit than their term-born peers. Most individuals exposed to preterm birth or maternal gestational disorders are relatively healthy when reaching adulthood. However, their lower levels of physical activity and physical fitness compared with their peers born at term may contribute to a higher risk of chronic non-communicable diseases in later life. Finding physical activities that are suitable for each individual is essential to promote well-being and health and diminish the increased disease risk later in life. / Tiivistelmä Vähäinen fyysinen aktiivisuus ja heikko fyysinen kunto ovat merkittäviä kroonisten sairauksien ja ennenaikaisen kuoleman riskitekijöitä. Jo sikiökautisten tekijöiden tiedetään vaikuttavan syntyvän lapsen kroonisten sairauksien riskiin myöhemmin elämässä, mutta elämän varhaisvaiheen tekijöiden yhteyttä myöhempään fyysiseen aktiivisuuteen ja kuntoon on tutkittu verrattain vähän. Väitöstutkimuksen tavoitteena oli selvittää elämän varhaisvaiheen tekijöiden yhteyttä fyysiseen aktiivisuuteen ja kuntoon nuoruusiässä ja nuorena aikuisena. Tarkastelimme useiden vanhempiin ja raskausaikaan liittyvien tekijöiden vaikutuksia Pohjois-Suomen syntymäkohortti 1986 16-vuotistutkimuksessa (n=7344) ja keskityimme ennenaikaisen syntymän pitkäaikaisvaikutuksiin ESTER-tutkimuksen 23-vuotiaiden nuorten aikuisten aineistossa (n=1161). Tutkimustulostemme mukaan raskauden kestoon suhteutettu suuri syntymäpaino sekä vanhempien ylipaino tai lihavuus ennustivat vähäisempää liikunta-aktiivisuutta ja heikompaa kestävyyskuntoa nuoruusiässä. Sekä keskimääräistä lyhyempi että pidempi raskaudenkesto olivat yhteydessä vähäisempään liikunta-aktiivisuuteen ja äidin raskausdiabetes ja tupakointi raskauden aikana puolestaan heikompaan kestävyyskuntoon. Alle 34-viikkoisena syntyneet raportoivat liikkuvansa nuorena aikuisena vapaa-aikanaan huomattavasti vähemmän kuin täysiaikaisena syntyneet, vaikka eroa ei kiihtyvyysantureilla mitattuna fyysisessä aktiivisuudessa havaittukaan. Verrattuna täysiaikaisena syntyneisiin, ennenaikaisesti syntyneillä aikuisilla oli heikompi lihaskunto etunojapunnerrustestillä mitattuna ja hyvin ennenaikaisesti syntyneillä käden puristusvoima oli heikompi. Kestävyyskunnossa ei havaittu eroja. Hyvin ennenaikaisesti syntyneet myös arvioivat fyysisen kuntonsa huonommaksi kuin täysiaikaisena syntyneet ikätoverinsa. Vaikka valtaosa ennenaikaisena syntyneistä ja äidin raskaudenaikaisille sairauksille altistuneista on aikuisena varsin terveitä, liikunnan vähäisyys ja heikko fyysinen kunto voivat lisätä kroonisten sairauksien riskiä myöhemmin elämässä. Siksi tähän ryhmään kuuluvia tulisi erityisesti auttaa löytämään itselleen sopivia liikuntamuotoja hyvinvoinnin ja terveyden edistämiseksi ja siten myöhempien sairauksien ennaltaehkäisemiseksi.