Introdução - O uso de bicos artificiais é um hábito cultural com alta prevalência em diversos países. Profissionais e mães acreditam que o uso desses utensílios seja inofensivo, ou mesmo necessário, para o desenvolvimento da criança, tendo atitude indiferente ou permissiva frente ao seu uso indiscriminado. Há mais de 30 anos, consenso científico internacional reconhece bicos artificiais e leites industriais como responsáveis por parte dos índices de morbimortalidade infantil e alterações na saúde da criança. Objetivo - Analisar a influência de fatores socioeconômicos, biológicos e da atuação dos serviços de saúde sobre o uso de bicos artificiais (chupetas e mamadeiras) entre crianças menores de um ano nas capitais brasileiras e Distrito Federal(DF). Métodos- Estudo com delineamento transversal realizado a partir do banco de dados da II Pesquisa de Prevalência de Aleitamento Materno nas Capitais e DF em 2008 na segunda fase da Campanha Nacional de Multivacinação. Foi utilizada amostra por conglomerados, com sorteio em dois estágios. O questionário era composto por questões fechadas incluindo perguntas sobre o uso de chupeta e mamadeira no dia anterior à pesquisa. Foram analisados os fatores associados ao uso de bicos artificiais considerando três desfechos: 1)Uso exclusivo da chupeta; 2)Uso exclusivo da mamadeira; e 3)Uso de bicos artificiais (chupeta e mamadeira). As razões de prevalência e os intervalos de confiança foram obtidos por meio da regressão de Poisson seguindo modelo hierárquico. Resultados Participaram 34.366 crianças menores de um ano. Identificou-se como fatores associados ao uso exclusivo de chupeta mãe trabalhar fora do lar (RP=1,18), primiparidade (RP=1,28), não ter mamado na 1ªhora (RP=1,15) e uso de chá no1ºdia em casa (RP=1,37). Para o uso exclusivo de mamadeira, identificou-se: mãe trabalhar fora do lar (RP=1,39), primiparidade (RP=1,28), baixo peso ao nascer (RP=1,21) não ter mamado na 1ªhora (RP=1,08), uso de leite artificial (RP=1,82) e do chá (RP=1,96) no 1ºdia em casa. O uso de bicos artificiais associou-se ao trabalho materno fora do lar (RP=1,43), primiparidade (RP=1,21), parto cesáreo (RP=1,06), bebês do sexo masculino (RP=1,07), baixo peso ao nascer (RP=1,11), ter nascido em hospital não credenciado como Amigo da Criança (RP=1,12), realizar acompanhamento de saúde na UBS/SUS (RP=0,91), ter ingerido leite artificial (RP=2,06), água (RP=1,18) e chá (RP=1,38) no 1ºdia em casa. Conclusão Caracterizaram-se diferentes perfis de usuários de bicos artificiais, chupetas e mamadeiras. Observaram-se semelhanças e diferenças para cada desfecho. As semelhanças indicam os fatores comuns aos quais profissionais da saúde devem estar atentos. Já as diferenças sugerem que a utilização de chupeta e/ou mamadeira envolve diversas dimensões da vida da mulher/criança/família, perpassando aspectos biopsicossociais e culturais. / Introduction - The use of artificial nipples is a cultural habit with a high prevalence in many different countries. Professionals and mothers believe that the use of those tools is harmless or even necessary for the child\'s development therefore they do not discriminate their use having a permissive approach towards them. For over 30 years, international scientific consensus recognizes artificial nipples and industrialized milk as responsible for part of the morbidity and mortality rates and changes in child\'s health. Objective - To analyze the influence of socioeconomic, biological factors and the health services on the use of pacifier and baby\'s bottle among children under one year old in Brazilian Capitals and Federal District (FD). Methods Cross-sectional study conducted from the database of the Second Research Prevalence of Breastfeeding in all the Brazilian Capitals and FD performed in 2008 in the second phase of the National Vaccination Campaign. Cluster sampling was used, with a draw in two-stages. The questionnaire consisted of closed questions including questions about the use of pacifier and baby\'s bottle on the day preceding the survey. We analyzed the factors associated with the use of artificial nipples considering three possible outcomes: 1)Exclusive use of a pacifier, 2)Exclusive use of the baby\'s bottle, and 3)Use of artificial nipples (pacifiers and baby\'s bottle). Prevalence ratios (PR) and confidence intervals were obtained using Poisson regression following a hierarchical model. Results Sample included 34 366 children under one year old. It was identified as factors associated with exclusive use of a pacifier mother working outside the home (PR = 1.18), primiparity (PR = 1.28), not having breastfed within first hour (PR = 1.15) and use of tea on first day at home (PR = 1.37). For the exclusive use of a bottle, were identified: mother working outside the home (PR = 1.39), primiparity (PR = 1.28), low birth weight (PR = 1.21) had not suckled within first hour (PR = 1.08), use of artificial milk (PR = 1.82) and tea (PR = 1.96) on first day at home. The use of artificial teats was associated with maternal employment outside the home (OR = 1.43), primiparity (PR = 1.21), Cesarean section (PR = 1.06), male infants (PR = 1, 07), low birth weight (PR = 1.11), was born in a hospital is not accredited as \"Baby Friendly\" (PR = 1.12), perform health monitoring in the UBS / SUS (PR = 0.91) , having drunk formula (PR = 2.06), water (PR = 1.18) and tea (PR = 1.38) on first day at home. Conclusion - It was found various user profiles of of pacifier and/or baby\'s bottle. It was observed similarities and differences for each outcome. The similarities indicate common factors to which health professionals should be aware. And the differences suggest that the use of artificial nipples, pacifier or baby\'s bottle involves several dimensions of women\'s lives, biopsychosocial and cultural aspects.

Introdução: Investigar os fatores associados à condição perineal no parto vaginal pode possibilitar modificações no cuidado com o períneo, de forma a contribuir para menores frequências de episiotomia e de lacerações perineais. Objetivos: Identificar os fatores associados à episiotomia; identificar os fatores associados à integridade perineal no parto vaginal; descrever os motivos apontados para a realização de episiotomia por enfermeiras obstétricas; e identificar as manobras de proteção perineal realizadas por enfermeiras obstétricas em um Centro de Parto Normal. Método: Estudo transversal com coleta de dados prospectiva por meio de formulário aplicado junto às enfermeiras obstétricas de um Centro de Parto Normal intra-hospitalar de São Paulo e que incluiu dados de todas as mulheres que deram à luz neste serviço no período de fevereiro de 2014 a janeiro de 2015. Na análise estatística, as associações entre as variáveis dependentes (episiotomia e integridade perineal) e as variáveis sociodemográficas, obstétricas e assistenciais foram estimadas por meio de Odds Ratios (OR), calculadas por meio de regressão logística binária univariada e múltipla com intervalos de confiança de 95 por cento (IC 95 por cento ), no programa estatístico SPSS versão 20. Foram realizadas análises separadas para cada variável dependente. Os motivos para a realização de episiotomia e o uso de manobras de proteção perineal foram descritos por meio de frequências e porcentagens. O estudo foi aprovado nos Comitês de Ética em Pesquisa das instituições proponente e coparticipante. Resultados: Foram analisados os dados de 802 mulheres (frequência de episiotomia de 23,8 por cento , 191 mulheres; integridade perineal de 25,9 por cento , 208 mulheres; laceração perineal de 50,3 por cento , 403 mulheres). Os fatores independentemente associados à episiotomia foram: não ter parto vaginal anterior (OR 26,72; IC 95 por cento 15,42-46,30), uso de ocitocina durante o trabalho de parto (OR 1,69; IC 95 por cento 1,12-2,57), puxos dirigidos (OR 2,05; IC 95 por cento 1,23-3,43), intercorrência no trabalho de parto (OR 2,61; IC 95 por cento 1,43-4,77) e posição semissentada no parto (5,45; IC 95 por cento 1,06-28,01). O uso de uma manobra de proteção perineal (OR 0,11; IC 95 por cento 0,04-0,26) ou de duas manobras ou mais (OR 0,09; IC 95 por cento 0,04-0,22) se apresentou como fator de proteção contra a episiotomia. Em relação à integridade perineal, os fatores independentemente associados foram: ter parto vaginal anterior (OR 3,88; IC 95 por cento 2,41-6,23) e cor da pele autorreferida não branca (OR 1,43; IC 95 por cento 1,01-2,04). As indicações para episiotomia incluíram, predominantemente, motivos relacionados às condições e dimensões do períneo. As manobras de proteção perineal foram utilizadas em aproximadamente 95 por cento dos partos vaginais, mas não impactaram as taxas de integridade perineal. Conclusões: As variáveis associadas à episiotomia incluíram, em sua maioria, fatores que podem ser controlados pelo profissional de saúde. Estas variáveis não impactaram as taxas de integridade perineal. Informar os profissionais que atuam na assistência ao parto e as mulheres que buscam esse atendimento sobre os fatores associados à condição perineal no parto vaginal pode contribuir para a redução da frequência de episiotomia e para preservar a integridade perineal no parto vaginal. / Introduction: To investigate factors associated with perineal condition in vaginal delivery can result in modifications in the perineal care, in order to decrease the frequency of episiotomy and perineal lacerations in the vaginal delivery. Objectives: To identify factors associated with an episiotomy; to identify factors associated with perineal integrity in vaginal delivery; to describe the reasons for performing an episiotomy by nurse-midwives; and to identify the perineal protection maneuvers performed by nurse-midwives in a Birth Centre. Methods: Cross-sectional study with prospective data collection carried out through the application of a form to nurse-midwives in an In-hospital Birth Centre located in São Paulo city, Brazil, which included all women who gave birth in this service from February 2014 to January 2015. In the statistical analysis, the associations between the outcome variables (episiotomy and perineal integrity) and the sociodemographic, obstetric and care-related variables were estimated by Odds Ratios (OR), calculated in univariate and multivariate binary logistic regression models with a 95 per cent confidence intervals (95 per cent CI), in the SPSS software, version 20. Separated analyses were performed for each one of the outcome variables. The reasons for performing an episiotomy and the use of perineal protection maneuvers were described as frequencies and percentages. The study was approved in the Research Ethics Committees of the proposing and the co-participant institutions. Results: Data of 802 women were analysed (frequency of episiotomy of 23.8 per cent , 191 women; perineal integrity of 25.9 per cent , 208 women; perineal laceration of 50.3 per cent , 403 women). Factors identified as independently associated with an episiotomy were: no previous vaginal delivery (OR 26.72; 95 per cent CI 15.42-46.30), oxytocin use during labour (OR 1.69; 95 per cent CI 1.12-2.57), coached pushing (OR 2.05; 95 per cent CI 1.23-3.43), complications during labour (OR 2.61; 95 per cent CI 1.43-4.77) and semi-sitting position at delivery (OR 5.45; 95 per cent CI 1.06-28.01). The use of a perineal protective maneuver (OR 0.11; 95 per cent CI 0.04-0.26) or two maneuvers or more (OR 0.09; 95 per cent CI 0.04-0.22) was a protective factor against an episiotomy. Regarding the perineal integrity, the factors independently associated to this condition were: a previous vaginal delivery (OR 3.88; 95 per cent CI 2.41-6.23) and self-reported non-white skin color (OR 1.43; 95 per cent CI 1.01-2.04). Most of the indications for an episiotomy included reasons related to perineal conditions and dimensions. The perineal protection maneuvers were used in nearly 95 per cent of vaginal deliveries, but did not affect the perineal integrity rates. Conclusions: Most of the variables associated with an episiotomy were related to factors that can be controlled by the professional who provides labour and birth care. These variables did not influence the perineal integrity rates. To inform childbirth care professionals and women who are users of these services about the factors associated with the perineal condition at the childbirth can contribute for reducing the frequency of episiotomy and to preserve the perineal integrity in the vaginal delivery.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2017-10-03T18:27:24Z No. of bitstreams: 1 Dissertacao_¿dila.pdf: 1532213 bytes, checksum: fce458fbd017786823906f750a30e2a4 (MD5) / Made available in DSpace on 2017-10-03T18:27:24Z (GMT). No. of bitstreams: 1 Dissertacao_¿dila.pdf: 1532213 bytes, checksum: fce458fbd017786823906f750a30e2a4 (MD5) Previous issue date: 2015-06-25 / The Baby Friendly Hospital Initiative (BFHI) has goals, called ¿Ten Steps to Successful Breastfeeding¿. Despite evidence of the benefits of the BFHI on improving breastfeeding rates, there are few certified hospitals. The aim of this study was to verify the effectiveness of educational activities proposed by the BFHI for the increased prevalence of newborns placed skin-to-skin with their mothers in the first hour of life. To this end, survey was conducted using a quantitative methodology in municipal public maternity João Pessoa. Educational activities with health professionals followed for pre- and post-intervention were carried out. The effectiveness of educational activity was assessed using face to face interview with 211 women, who comprised two independent groups for evaluation pre and post intervention. The variables were described by mean, standard deviation, frequency and proportions. Hypothesis tests used were the chi-square test and Fisher's exact for differences between proportions and ¿t¿ test of Student paired for differences between means Groups of mothers pre and post intervention were similar, allowing the comparison of the studied outcome. Only 10 mothers (9.3%) in group 1 and 12 (11.5%) in group 2 underwent the fourth step of the BFHI. The only variable that was associated (p <0.01) with the outcome analyzed in both groups was the type of delivery. Participated in the educational intervention 77 workers (less than 35% of the audience). There was a difference between mean percentage of adequate responses of these professionals in the pre- and post-test (p <0.01). The workshops proved to be efficient as regards the acquisition of theoretical knowledge by participants. However, seizure of these concepts in the BFHI's fourth step did not result in modification of praxis. / A Iniciativa Hospital Amigo da Criança (IHAC) constitui-se de metas, denominadas de ¿Dez Passos para o Sucesso do Aleitamento Materno¿. Apesar das evidências em relação aos benefícios da IHAC sobre a melhoria dos índices de aleitamento materno, ainda há poucos hospitais certificados. O objetivo deste estudo foi verificar a efetividade de ações educativas propostas pela IHAC para o aumento da prevalência de recém-nascidos colocados em contato pele a pele com as suas mães na primeira hora de vida. Para tal, realizou-se uma pesquisa-ação, com abordagem quantitativa, em uma maternidade pública municipal de João Pessoa. Foram realizadas ações educativas com profissionais de saúde, seguidas de avaliação pré e pós-intervenção. A efetividade da ação educativa foi avaliada por meio de entrevistas face a face com 211 mulheres, que compreenderam dois grupos independentes para avaliação no pré e pós-intervenção. As variáveis foram descritas por meio de média, desvio padrão, frequência e proporções. Os testes de hipóteses utilizados foram o qui-quadrado de Pearson e Exato de Fisher para diferenças entre proporções e teste ¿t¿ de Student pareado para diferenças entre médias. Os grupos de puérperas pré e pós-intervenção foram semelhantes, permitindo a comparação do desfecho estudado. Apenas 10 puérperas (9,3%) do grupo 1 e 12 (11,5%) do grupo 2 realizaram o 4º da IHAC. A única variável que mostrou associação (p<0,01) com o desfecho analisado, em ambos os grupos, foi o tipo de parto. Participaram da intervenção educativa 77 profissionais (menos de 35% do público-alvo). Houve diferença entre percentual médio de respostas adequadas desses profissionais no pré e pós-testes (p<0,01). As oficinas mostraram-se eficientes no que se refere à aquisição de conhecimento teórico pelos participantes. No entanto, a apreensão desses conceitos em relação ao 4º passo da IHAC não resultou em modificação da práxis.

Introdução: Investigar os fatores associados à condição perineal no parto vaginal pode possibilitar modificações no cuidado com o períneo, de forma a contribuir para menores frequências de episiotomia e de lacerações perineais. Objetivos: Identificar os fatores associados à episiotomia; identificar os fatores associados à integridade perineal no parto vaginal; descrever os motivos apontados para a realização de episiotomia por enfermeiras obstétricas; e identificar as manobras de proteção perineal realizadas por enfermeiras obstétricas em um Centro de Parto Normal. Método: Estudo transversal com coleta de dados prospectiva por meio de formulário aplicado junto às enfermeiras obstétricas de um Centro de Parto Normal intra-hospitalar de São Paulo e que incluiu dados de todas as mulheres que deram à luz neste serviço no período de fevereiro de 2014 a janeiro de 2015. Na análise estatística, as associações entre as variáveis dependentes (episiotomia e integridade perineal) e as variáveis sociodemográficas, obstétricas e assistenciais foram estimadas por meio de Odds Ratios (OR), calculadas por meio de regressão logística binária univariada e múltipla com intervalos de confiança de 95 por cento (IC 95 por cento ), no programa estatístico SPSS versão 20. Foram realizadas análises separadas para cada variável dependente. Os motivos para a realização de episiotomia e o uso de manobras de proteção perineal foram descritos por meio de frequências e porcentagens. O estudo foi aprovado nos Comitês de Ética em Pesquisa das instituições proponente e coparticipante. Resultados: Foram analisados os dados de 802 mulheres (frequência de episiotomia de 23,8 por cento , 191 mulheres; integridade perineal de 25,9 por cento , 208 mulheres; laceração perineal de 50,3 por cento , 403 mulheres). Os fatores independentemente associados à episiotomia foram: não ter parto vaginal anterior (OR 26,72; IC 95 por cento 15,42-46,30), uso de ocitocina durante o trabalho de parto (OR 1,69; IC 95 por cento 1,12-2,57), puxos dirigidos (OR 2,05; IC 95 por cento 1,23-3,43), intercorrência no trabalho de parto (OR 2,61; IC 95 por cento 1,43-4,77) e posição semissentada no parto (5,45; IC 95 por cento 1,06-28,01). O uso de uma manobra de proteção perineal (OR 0,11; IC 95 por cento 0,04-0,26) ou de duas manobras ou mais (OR 0,09; IC 95 por cento 0,04-0,22) se apresentou como fator de proteção contra a episiotomia. Em relação à integridade perineal, os fatores independentemente associados foram: ter parto vaginal anterior (OR 3,88; IC 95 por cento 2,41-6,23) e cor da pele autorreferida não branca (OR 1,43; IC 95 por cento 1,01-2,04). As indicações para episiotomia incluíram, predominantemente, motivos relacionados às condições e dimensões do períneo. As manobras de proteção perineal foram utilizadas em aproximadamente 95 por cento dos partos vaginais, mas não impactaram as taxas de integridade perineal. Conclusões: As variáveis associadas à episiotomia incluíram, em sua maioria, fatores que podem ser controlados pelo profissional de saúde. Estas variáveis não impactaram as taxas de integridade perineal. Informar os profissionais que atuam na assistência ao parto e as mulheres que buscam esse atendimento sobre os fatores associados à condição perineal no parto vaginal pode contribuir para a redução da frequência de episiotomia e para preservar a integridade perineal no parto vaginal. / Introduction: To investigate factors associated with perineal condition in vaginal delivery can result in modifications in the perineal care, in order to decrease the frequency of episiotomy and perineal lacerations in the vaginal delivery. Objectives: To identify factors associated with an episiotomy; to identify factors associated with perineal integrity in vaginal delivery; to describe the reasons for performing an episiotomy by nurse-midwives; and to identify the perineal protection maneuvers performed by nurse-midwives in a Birth Centre. Methods: Cross-sectional study with prospective data collection carried out through the application of a form to nurse-midwives in an In-hospital Birth Centre located in São Paulo city, Brazil, which included all women who gave birth in this service from February 2014 to January 2015. In the statistical analysis, the associations between the outcome variables (episiotomy and perineal integrity) and the sociodemographic, obstetric and care-related variables were estimated by Odds Ratios (OR), calculated in univariate and multivariate binary logistic regression models with a 95 per cent confidence intervals (95 per cent CI), in the SPSS software, version 20. Separated analyses were performed for each one of the outcome variables. The reasons for performing an episiotomy and the use of perineal protection maneuvers were described as frequencies and percentages. The study was approved in the Research Ethics Committees of the proposing and the co-participant institutions. Results: Data of 802 women were analysed (frequency of episiotomy of 23.8 per cent , 191 women; perineal integrity of 25.9 per cent , 208 women; perineal laceration of 50.3 per cent , 403 women). Factors identified as independently associated with an episiotomy were: no previous vaginal delivery (OR 26.72; 95 per cent CI 15.42-46.30), oxytocin use during labour (OR 1.69; 95 per cent CI 1.12-2.57), coached pushing (OR 2.05; 95 per cent CI 1.23-3.43), complications during labour (OR 2.61; 95 per cent CI 1.43-4.77) and semi-sitting position at delivery (OR 5.45; 95 per cent CI 1.06-28.01). The use of a perineal protective maneuver (OR 0.11; 95 per cent CI 0.04-0.26) or two maneuvers or more (OR 0.09; 95 per cent CI 0.04-0.22) was a protective factor against an episiotomy. Regarding the perineal integrity, the factors independently associated to this condition were: a previous vaginal delivery (OR 3.88; 95 per cent CI 2.41-6.23) and self-reported non-white skin color (OR 1.43; 95 per cent CI 1.01-2.04). Most of the indications for an episiotomy included reasons related to perineal conditions and dimensions. The perineal protection maneuvers were used in nearly 95 per cent of vaginal deliveries, but did not affect the perineal integrity rates. Conclusions: Most of the variables associated with an episiotomy were related to factors that can be controlled by the professional who provides labour and birth care. These variables did not influence the perineal integrity rates. To inform childbirth care professionals and women who are users of these services about the factors associated with the perineal condition at the childbirth can contribute for reducing the frequency of episiotomy and to preserve the perineal integrity in the vaginal delivery.

Abstract available in Journal of the Academy of Nutrition and Dietetics.

PURPOSE: Pregnancy is a physically impactful process in a woman’s life. During this time, a woman will gain weight and research has shown that many women will retain some extra weight after delivery. Because of this, recovery in the postpartum period is pivotal to avoiding the implications of weight retention. The postpartum period is vastly understudied in both the research and medical communities and this gap between pregnancy and postpartum research needs to be bridged. Therefore, the purpose of this study was to investigate metabolic changes from pregnancy to postpartum and to study how factors such as sleep and breastfeeding can impact metabolic values in the postpartum period. METHODS: Women participated in a pregnancy study visit at 32-34 weeks of gestation (n = 25) and attended two subsequent visits at 4-6 months (n = 25) and 12-13 months postpartum (n = 16). At these visits, the women had a baseline blood draw and baseline metabolic measurements taken via indirect calorimetry. At the pregnancy visit, participants completed a demographic survey and a dietary questionnaire (DHQ-II). At the postpartum visits, they completed the same surveys, along with validated sleep and breastfeeding surveys. RESULTS: Absolute resting metabolic rate (RMR) was significantly higher during pregnancy than at 4-6 months postpartum and 12-13 months postpartum (p < 0.001 and p = 0.001, respectively). Accounting for body weight, relative RMR was significantly higher during pregnancy than at 4-6 months postpartum. With regard to sleep, women deemed to be “good sleepers” had a significantly higher relative RMR than those who were deemed “poor sleepers” (23.6 ± 2.5 vs 20.8 ± 2.3, p = 0.009). With regard to breastfeeding, women who breastfed had a relative RMR than the women who did not breastfeed (22.8 ± 2.6 vs 20.4 ± 2.3, p = 0.046). CONCLUSIONS: There are hypermetabolic changes that take place during pregnancy. These values seem to decrease into the postpartum period. Women who demonstrate an improved sleep quality and who opt to breastfeed tend to have improved metabolic responses. This could help combat the struggle with postpartum weight retention that some women face.

Background: Preterm birth is a major public health concern in the US. Previous studies have suggested that quality of the mother-father relationship, social support, and neighborhood violence may be associated with preterm birth; however, findings are equivocal. Objectives: The main objectives of this dissertation were: 1) to determine the modifying effect of perceived residential environment on the association between quality of mother–father relationship and preterm birth in a sample of African-American women, 2) to examine whether the receipt of social support modifies the association between neighborhood violence exposure and preterm birth in a nationally representative sample of US women, and 3) to determine the extent to which neighborhood violence mediates the association between neighborhood deprivation and preterm birth in a geographic cohort of women in Richmond city, Virginia. Methods: Data were obtained from three sources – 1) Life-course Influences on Fetal Environments (LIFE) study, 2) National Longitudinal Study of Adolescent to Adult Health, and 3) live birth records, police crime reports and census data for Richmond city, Virginia. Multivariable log-binomial regression models were used to examine the modifying effect of perceived residential environment on the association between quality of mother–father relationship and preterm birth, as well as the modifying effect of social support on the association between neighborhood violence exposure and preterm birth. Multilevel structural equation modeling was used to examine the mediational influence of neighborhood violence on the association between neighborhood deprivation and preterm birth. Results: For the association between neighborhood violence exposure and preterm birth, maternal receipt of social support modified the association [(Tertile 1: adjusted prevalence ratio (APR)=1.12; 95% CI=1.11-1.13, p<.0001); (Tertile 2: APR=1.07; 95% CI=1.06-1.08, p<.0001); and (Tertile 3: APR=0.88; 95% CI=0.86-0.89, p<.0001)] in a nationally representative sample of US women. No significant interaction was observed between any domain of the mother–father relationship and perceived maternal residential environment (all p > 0.05) in a sample of African American women. Additionally, no significant association was found between the quality of mother–father relationship and preterm birth (Trust domain: APR=1.03, 95% CI=0.99-1.07; dependability domain: APR=1.01, 95% CI=0.98-1.06; criticism domain: APR=1.03, 95% CI=0.99-1.07). The association between neighborhood deprivation and preterm birth in a geographic cohort of women in Richmond city, Virginia, was not mediated by neighborhood violence (β=0.063, 95% CI= –0.025, 0.151). Conclusions: Rates of preterm birth in women exposed to neighborhood violence may be improved by providing adequate social support during the pregnancy period. Insufficient evidence was found to support the modifying effect of perceived residential environment on the association between the mother-father relationship and preterm birth, as well as the mediational effect of neighborhood violence on the association between neighborhood deprivation and preterm birth. Future studies are needed to confirm these findings.

Recent advancements have uncovered environmental contributions to obesity and diabetes etiology. In fact, perinatal malnutrition resulting in low birth weight (LBW) has been shown to correlate with later life obesity and impaired glucose tolerance in aged offspring. LBW can result from a myriad of developmental perturbations including macronutrient restriction, hypoxia, maternal stress and toxin exposure. Polychlorinated biphenyls (PCBs) are ubiquitous environmental pollutants that bioaccumulate in the food chain resulting in dietary exposure in humans. Maternal and cord blood PCB levels are inversely associated with birth weight, and recent studies indicate that perinatal exposures to PCBs contribute to gender-specific obesity development in children. PCBs have also been shown to enter breast milk resulting in direct exposure in early postnatal life. Therefore, we hypothesized that perinatal PCB exposure cause developmental blight resulting in decreased birth weight and increased adiposity and glucose intolerance with aging. We found that mice perinatally exposed to PCBs did not differ in birth weight, but exhibited sex-specific effects on adiposity. Females perinatally exposed to PCBs were significantly more obese at 7 weeks of age while male offspring exhibited no difference in fat mass but had decreased lean mass compared to controls. With aging, the differences in females dissipated while the male offspring decreased lean mass persisted. Male offspring perinatally exposed to PCBs displayed impaired glucose tolerance at 7 weeks of age but normalized over time, while the females were glucose intolerant only after 6 months of age. This impairment of glucose tolerance was not attributed to insulin resistance. These data illustrate time-dependent and sex-specific perturbations of maternal PCB exposure on offspring body composition and glucose homeostasis. As the liver is a major facilitator in glucose homeostasis and xenobiotic detoxification, we investigated PCB-induced alterations in hepatic gene expression and found attenuated expression of glycolytic genes and increased expression of detoxifying and antioxidant genes in both PCB-exposed maternal and offspring livers. Taken together, these data demonstrate a role for perinatal pollutant exposure in the etiology of glucose intolerance. Further studies are required to elucidate the mechanisms causing sex-specific modulation of body composition and glucose intolerance.

The state of global health and wellbeing is threatened by the pervasive and dangerous decision to engage in unprotected sex. Only male or female condoms can prevent the spread of both sexually transmitted infections and unintended pregnancies. Despite this, condoms remain dangerously underused because of the perception that they diminish sexual pleasure. The pleasure gap in the design and promotion of condoms cripples sexual health outcomes. Acknowledging and harnessing the power of pleasure in sexual-decision making is key to increasing condom use.

Physical activity guidelines encouraging activity among healthy pregnant women have been issued by the Centers for Disease Control and Prevention, yet Latina women remain more sedentary than non-Latina white women. Latina women are also at higher risk for gestational diabetes mellitus and, among Latina women, Puerto Rican women have the highest rates of low birth weight and preterm-related infant death. This dissertation utilized data from the Latina GDM study, a prospective cohort study of 1,231 Latina women recruited early in pregnancy and followed through delivery. Participants were interviewed in early and mid pregnancy for assessment of sociodemographics, acculturation, medical, and behavioral factors, in addition to administration of the Kaiser Physical Activity Survey for assessment of physical activity and sedentary behaviors. Birth outcomes were abstracted from medical records following delivery. In the first chapter, we assessed the prevalence of three health behaviors (meeting physical activity guidelines, meeting fruit/vegetable consumption guidelines, and cigarette smoking) in early and mid pregnancy and identified multiple factors associated with meeting health behavior guidelines in pregnancy. In the second chapter, we examined participation in sedentary behaviors, such as time spent TV watching, sitting at work, and low levels of sports and exercise, in pre, early and mid pregnancy in relation to maternal glucose intolerance and gestational diabetes mellitus. In the final chapter, we analyzed four types of physical activity (sports/exercise, household/caregiving, occupational, and active transportation) as well as total activity in relation to risk of preterm birth and small-for-gestational age. Findings represent the first study of physical activity and maternal/fetal outcomes conducted exclusively among Latina women, a group largely understudied in epidemiologic research. Results will guide culturally specific intervention programs in this high risk population.