Orofacial clefts (OFCs) are among the most common structural birth defects and a public health problem. Several studies suggest that maternal obesity pre-existing diabetes mellitus (DM), and the underlying metabolic abnormalities, may be involved in the pathogenesis of cleft lip (CL) and cleft palate (CP) birth defects. Although hypertension and gestational diabetes mellitus (GDM) have been associated in a few studies with congenital birth defects, studies examining the risk associated with OFCs are limited. The overall objective of this dissertation was to examine the association between maternal obesity, DM, GDM, and hypertension and the risk of OFCs in case-control studies. Analyses of data from an international consortium revealed that maternal obesity (pre-pregnancy BMI >30), compared to normal weight (18.525), was associated with an increased risk of cleft palate with or without cleft lip (CP/L) (adjusted odds ratio (aOR) =1.13 [95% confidence intervals (CI) 1.01-1.25]). We also found a marginal association between maternal underweight and CP/L (1.0 [reference]; aOR=1.14 [0.97-1.34]. CL only was not associated with maternal bodyweight. Interestingly, among college-graduates, there was no increased risk of CP, but mothers with less than a completed college education had an increased risk of CP for underweight and obesity. Investigation of the Utah OFC data provided evidence that maternal GDM is significantly associated with isolated (aOR=2.63 [1.30-5.34]) and non-isolated clefts (aOR=2.66 [1.02-6.97]). Maternal hypertension is significantly associated with non-isolated clefts (aOR=6.56 [2.18-19.77]). We found a further elevated risk of OFCs among GDM mothers and those with hypertension who were also obese. The analyses of data from an international consortium revealed significant associations between maternal diabetes and the risk of OFCs. The estimated relative risk of DM for isolated OFCs was 1.33 [1.14-1.54] and was slightly higher for multiple OFCs (aOR=1.86 [1.44-2.40]). Diabetic mothers with abnormal body-mass-index had an increased risk for having inborn with OFCs. Throughout the dissertation, we demonstrated the extent in which maternal obesity, pre-existing DM, GDM, and maternal hypertension may increase the risk of OFC birth defects. The results highlight the need for pre-conceptional program planning for the prevention of OFCs with screening for abnormal glucose tolerance and hypertension.

Background: Prior work examining the association of maternal obesity and neonatal mortality indicate the presence of a positive relationship. However, regional evidence to provide insight on country-level heterogeneities within sub-Saharan Africa (SSA) with nationally representative datasets are non-existent. Objective: We aimed to determine the relationship between maternal obesity and neonatal mortality at the country level in SSA countries. Moreover, we also estimate regional measures of association to complement previous findings. Methods: Demographic and Health Survey (DHS) data from 34 SSA countries conducted from 2006–2016 were used for this study. After missing data (36.9% of cases) were addressed with multiple imputations, we identified a total of 175,860 women for the analysis. Complete case and multiply imputed datasets were analyzed individually with multilevel logistic regression models. Potential confounders adjusted for in the regression model included maternal age, level of educational attainment, area of residence, access to prenatal care, birth order and multiple birth (singleton vs twin birth). Regional and country-specific associations were computed, and unadjusted and adjusted odds ratios (ORs), along with the confidence intervals (CIs) were reported. Findings: Of the total study population, 8,451 (7.6%) were obese. In the regional level analyses, maternal obesity was associated with 40% increased odds of neonatal deaths. This finding was consistent in subgroup analyses by urban and rural residence, and geographic region of residence in SSA. Additionally, obese women were more likely to report neonatal death in the first week of life (OR, days 0–1: 1.39, 95% CI 1.15–1.69; OR, days 2–6: 1.35, 95% CI 1.02–1.79). In the individual country analyses, majority of the countries studied had central estimates supporting elevated odds of neonatal mortality, but the confidence intervals were imprecise. Conclusion: This study highlights the potential burden of neonatal mortality borne by obese women in SSA. There is, however, a need for longitudinal studies to confirm the results.

No description available.

Bakgrund: Att vara överviktig mamma och vilja amma kan ha många utmaningar. Överviktiga kvinnor över hela världen har ofta problematik med att få igång mjölkproduktionen. De har även svårt att positionera sitt barn för att de ska kunna ta ett bra tag av bröstvårtan på grund av de stora brösten. Detta är något som skapar både stress, ångest och oro hos kvinnorna på olika sätt. Att främja en hälsosam amning genom att lära sig att ge rätt stöd till överviktiga kvinnor är ett av distriktssköterskans arbetsområden. Syfte: Att beskriva överviktiga mödrars upplevelser av svårigheter vid amning och upplevelser av stöd under barnets första sex månader. Metod: Allmän litteraturöversikt med kvalitativ ansats och deskriptiv design. Resultat: Resultatet baserades på tio kvalitativa artiklar som resulterade i tre huvudkategorier och åtta subkategorier. Huvudkategorierna var Upplevelser av fysiska utmaningar vid amning, Upplevelser av psykiska utmaningar vid amning och Upplevelser av stöd vid amning. Slutsats: Överviktiga mammor upplevde fysiska och psykiska utmaningar i samband med amning samt behov av amningsstöd. Kvinnorna upplevde både oro och ångest vilket gjorde dem stressade att amma utanför hemmiljön eller i sällskap av andra oavsett om det var familj eller andra. Det sociala stödet kunde ge en positiv amningsstart och bidra till en fortsatt framgångsrik amning. Utbildning och kunskapsinhämtande kan även vara relevant för vårdpersonal inom mödra- och barnhälsovård för att ge dem verktyg att på ett professionellt och respektfullt sätt få kvinnorna att känna sig sedda och vara delaktiga i sin vård. / Background: Being an overweight mother and wanting to breastfeed presents many challenges. Overweight and obese women all over the world often have problems getting the milk production started and has difficulties positioning their newborn to make them get a good hold of the nipple because of the large breasts. This creates both stress, anxiety and worry in different ways. Promoting healthy breastfeeding by learning how to provide the right support to overweight women is one of the district nurse's areas of work.  Aim: To describe obese mothers' experiences of difficulties with breastfeeding and the experiences of support during the newborn child's first six months.  Method: General literature overview with a qualitative approach and descriptive design Results: The results were based on ten qualitative articles that revealed three main categories along with eight subcategories. The main categories were Experiences of physical challenges during breastfeeding, Experiences of psychological challenges during breastfeeding and Experiences of support during breastfeeding. Conclusion: Overweight and obese mothers experienced physical and psychological challenges associated with breastfeeding as well as the need for breastfeeding support. The women experienced both worry and anxiety, which made them stressed to breastfeed outside of the home environment or in the company of others, regardless of whether it was members of the family or others. The social support could provide a positive breastfeeding initiation and continued successful breastfeeding. Education and knowledge recess can also be relevant for health workers in maternal and child healthcare to give them the relevant tools when meeting with these women in a professional and respectful way to make them feel seen and involved in their care.

No description available.

Introduction: While the paradoxical association between overweight and household food insecurity (HFI) is well established amongst low-income women, findings remain inconclusive amongst children. The purpose of this study was to determine the relationship between household food insecurity (HFI) and child overweight outcomes in an inner-city, pre-school and school aged population. Methods: This study used a cross-sectional study design augmented by validated Early Pregnancy Study (EPS) data collected during a pregnancy 6 years prior. A random subset of mothers of child-bearing age (23-44 years) and the child resulting from that pregnancy (between 4-7 years of age at time of re-enrollment) were tracked and re-enrolled in this follow-up study. The primary exposure, HFI, was captured using an adaptation of the standardized US Food Security Scale -- embedded within a larger self-report questionnaire addressing selected maternal and child influences (such as health, exercise, and dietary risk factors) on child weight patterns. Maternal and the child BMI outcome was determined through in-home clinical assessment of height and weight and using standard CDC based cutoffs to classify weight status. Self-report and biologically confirmed prenatal EPS data were also obtained to establish useful baseline data and to enhance study results. Exploratory hypotheses examined: (1) Interrelatedness between select maternal and child health, social-environmental, and socio-demographic exposures and (2) Household food insecurity (HFI), prenatal and current maternal and child exposures were explored for their relationship with child BMI. Results: Thirty-six mother-child dyads participated in this follow-up study. Twenty-eight percent of mothers reported HFI; 83% of mothers were classified as overweight or obese and 58% of children were categorized as at-risk for overweight or overweight. Most bi-variate analyses yielded non-significant results, though in-utero drug use was significantly correlated, and mothers who tested positive for tobacco use during pregnancy were also likely to test positive for marijuana use, as determined through biological confirmation (p<0.05). Additionally, current maternal BMI as well as current maternal hip-to-waist ratio were each significantly associated with current child BMI (p<0.05). One unexpected finding included a significant association between current maternal BMI and presence of a co-morbidity in the child (p<0.05). No significant relationships were found between HFI or additional exploratory multivariate models looking at independent effects of prenatal and current maternal-child exposures in predicting child overweight, though current maternal BMI was predictive of child overweight in most analyses. Access to electronic medical record information was highly predictive of participation in this follow-up study (p<0.001). Discussion: This study provided an opportunity to better characterize an attrition-prone population, and, while it is possible to track and identify these women through electronic medical record databases, recruitment efforts were labor-intensive and attrition rates particularly high (~22% of mothers re-enrolled). Overall, the influence of household food insecurity on child overweight remains unclear. However, study findings also demonstrated that maternal weight alone was highly predictive of child overweight as early as pre-school, mirroring empirical evidence in this area. Ultimately, childhood obesity is more effectively prevented when treated as a familial concern. Future studies should continue to explore cumulative influences catalyzing obesity in young children in order to better inform understanding of early obesity onset. / Public Health

This thesis reports on a qualitative exploration of the experiences of 30 women designated as ‘high risk’ due to the co-existence of ‘maternal obesity’ (BMI ≥ 30) and Gestational Diabetes Mellitus (GDM)/Type Two Diabetes Mellitus (T2DM) in pregnancy. This is examined in the context of medico-scientific/public health/ popular media discourses pertaining to ‘maternal obesity’/GDM/T2DM in pregnancy. ‘Maternal obesity’/GDM/T2DM in pregnancy are increasingly prevalent and clinically associated in manifold ways. Increasing prevalence is linked to the ‘global epidemic’ of ‘obesity’/diabetes: now commonly referred to as ‘diabesity’. Current biomedical knowledge asserts ‘maternal obesity’ and diabetes (‘maternal diabesity’) synergise in causing adverse pregnancy outcomes, have long term health implications for the offspring and contribute to an ‘intergenerational cycle’ of ‘obesity’/diabetes. This is the first qualitative study to consider pregnancy/post-birth experiences of women with co-existing ‘maternal obesity’ and GDM/T2DM in pregnancy from a sociological perspective. Participants undertook a series of auto/biographical narrative interviews. Longitudinal engagement provided nuanced psycho-social insight into women’s perceptions/experiences and the socio-cultural context of their lives. Analysis of pertinent ‘pregnancy’ Internet fora postings augmented interview data and was utilised for comparative/corroborative purposes. Participants were predominantly of low socio-economic status, congruent with epidemiological data. The concept of pregnancy ‘planning’ was not resonant and few women accessed/felt predisposed to access preconception care. Women did not identify as ‘obese’, and knowledge/perception of risks associated with the medical ‘conditions’ was low. Women perceived themselves to be stigmatised due to their weight in society and specifically within healthcare. Many participants were experiencing acute/chronic stress which appeared to have mediated risk perceptions/compromised diabetic regimen adherence. Expense of ‘healthy’ eating/diabetic diet was considered prohibitive. Women’s material circumstances/socio-cultural milieux may militate against ability to minimise risk and effect lifestyle change. Policy and practice, for the most part, fails to take this into account.

Made available in DSpace on 2016-03-15T19:39:56Z (GMT). No. of bitstreams: 1 Cyntia Moraes Teixeira.pdf: 299481 bytes, checksum: 9bb0d211bcfc9fdcd4b0b8dbed28d6e4 (MD5) Previous issue date: 2012-08-09 / Universidade Presbiteriana Mackenzie / Obesity has been considered epidemic in the whole world and is a risk factor for the development of hypertension, dyslipidemia, hyperglycemia, type 2 diabetes and hepatic steatosis. The increase of obesity in during pregnancy not only increases the risk of developing cardiovascular diseases but may also be related to abnormalities in the developing CNS of embryos, for example, reduction of potential long-term (LTP) in the hippocampus and neurogenesis . It is possible that the reduced levels of BDNF observed in these embryos, are involved with the injury in the processes of learning and memory observed in these animals. Studies also show that BDNF is reduced in fetuses of mothers with maternal subclinical hypothyroidism. These puppies have worsening neurological development, with deficits in long and short term memory. Here we evaluated whether maternal obesity may alter levels of BDNF and enzyme expression of type III deiodinase (D3) in the brains of pups, with consequent alteration of local levels of T3 to 7 °, 10 ° and 16 ° day-old post -natal. Our results showed that obesity reduced the expression of D3 on the 7th day of postnatal life of the offspring of obese mothers, but not in later days. There were no significant alterations in the levels of BDNF in any of the evaluated days. Our data suggest that it is possible that thyroid hormone is involved in neurophysiological abnormalities observed in offspring of obese rats. / A obesidade é uma epidemia de ordem mundial que é fator de risco para o desenvolvimento de hipertensão arterial, dislipidemia, hiperglicemia, diabetes tipo 2 e esteatose hepática. O aumento de obesidade em gestantes além de aumentar o risco do desenvolvimento de doenças cardiovasculares, também pode estar relacionado com anomalias no desenvolvimento do Sistema Nervoso Central dos embriões como, por exemplo, redução dos potenciais de longa duração (LTP) e da neurogênese no hipocampo. É possível que os níveis reduzidos de BDNF observados nestes embriões, estejam envolvidos com o prejuízo nos processos de aprendizado e memória exibidos por esses animais. Estudos também mostram que o BDNF se encontra reduzidos em fetos de mães com hipotiroidismo subclínico materno. Estes filhotes apresentam piora no desenvolvimento neurológico, demonstrando déficits na memória de longo e de curto prazo. O presente avaliou se a obesidade materna pode alterar os níveis de BDNF e a expressão da enzima desiodase do tipo III (D3) no cérebro dos filhotes, com consequente alteração dos níveis locais de T3 ao 7°, 10° e 16° dias de vida pós-natal. Os nossos resultados mostraram que a obesidade reduziu a expressão da D3 no 7º dia de vida pós-natal dos filhotes de mães obesas, mas não nos dias posteriores, sem alteração significativa nos níveis de BDNF. Não houve alteração significativa nos níveis de BDNF em nenhum dos dias avaliados. Os nossos dados sugerem que é possível que o hormônio tiroideano esteja envolvido nas alterações neurofisiológicas observadas em filhotes de ratas obesas.

One of the first embryonic structures generated during early human development is the neural tube. The embryonic process of neurulation, including neural tube closure, is necessary for proper brain and spinal cord development, whereas improper closure leads to neural tube defects including anencephaly, spina bifida, and craniorachischisis. The mechanism by which these defects occur is unknown, but some evidence suggest that redox disruption may play a role. Cellular redox state is important in regulating key processes during neural tube closure, including differentiation, proliferation, gene expression, and apoptosis. This study aims to determine whether redox potential shifts and these key processes are affected similarly or differentially after treatment with three neural tube defect-inducing developmental toxicants: ceramide (C2), valproic acid (VPA), and fumonisin (FB1). Using the P19 cell model of neurogenesis, in both undifferentiated and terminally differentiated cells, we analyzed glutathione (GSH) redox (Eh) potential to evaluate the effect of each toxicant over time. We show that in C2 and VPA treated cultures an oxidizing shift occurs, but interestingly, FB1 treatment results in a reducing shift in embryonic GSH Eh as compared to untreated cultures. Using the chick embryo model, comparable redox shifts were observed as were seen in P19 cells, supporting similarity between the models. To better understand how differential shifts in the redox state can result in similar defects, we then examined potential variances in neuronal differentiation and cellular proliferation, survival, metabolism, adhesion, and gene expression under each treatment. We report changes to cellular and embryonic endpoints that support dysmorphogenesis, likely the result of oxidizing or reducing stress that altered redox state. These results support the need for broad comparative analyses such as this to determine whether toxicants that cause the same types of defects, whether NTDs or others, act through similar or different mechanisms. This can better inform preventative measures used to reduce the risk and occurrence of birth defects.

Maternal obesity has significant consequences on the lifelong health of the developing child and rising global incidences make it one of the most common comorbidities during pregnancy. Offspring of obese mothers are at an increased risk of hospitalization for respiratory infections throughout childhood, which predispose these children to non-communicable respiratory diseases in later life. Animal models of maternal high fat diet (mHFD) feeding have observed common inflammatory outcomes with obesogenic models, but the effect on offspring varies with timing of the nutritional challenge and diet composition across studies. These studies demonstrate significant alterations to circulating and lung specific immune cells but the sequence of events that link maternal diet to these fetal outcomes are unclear, nor have they been tested in the context of a bacterial respiratory infection. Streptococcus pneumonaie is the most common causative pathogen of bacterial pneumonia and meningitis, making it of high clinical relevance. We aimed to investigate the effect of a mHFD (45% kcal from fat) during gestation and lactation, on offspring outcome and recovery from Streptococcus pneumoniae infection. Immunophenotyping, both before and after infection, revealed a hypo-inflammatory phenotype in circulating monocytes of the mHFD offspring with a decreased capacity to both initiate and terminate inflammatory responses. These offspring had significantly higher bacterial counts in lung tissues during infection and sustained cellular inflammation in survivors. In this thesis, we present foundational work on the detrimental influence of excess maternal nutrition on offspring immune function and infection outcomes, which may be involved in susceptibility to inflammatory and chronic disease in later life. A better understanding of this deep and lasting influence of the maternal environment will allow us to target preconception health as a form of harm reduction, informing stake holders and institutions to direct efforts towards DOHaD knowledge translation. / Thesis / Master of Science (MSc)