Abstract The aim of this study was to evaluate the treatment, course and outcome of pregnancy in Finland using two cohorts of diabetic women. The clinical cohort consisted of data from all 210 women with Type 1 diabetes and their 296 pregnancies managed between 1986 and 1995 in the two northernmost provinces of Finland. The register-based study population included all 1442 mothers with a singleton birth who had insulin treatment during pregnancy in 1991-1995 according to the Medical Birth Register. Of these mothers, 954 (66%) had pre-existing diabetes. Insulin-treated diabetes complicated 4.5/1000 births in Finland in 1991-1995, the prevalence of Type 1 diabetes being 2.9/1000 in the whole country and 3.3/1000 in Northern Finland. In the 1990's the care of these women shifted from tertiary level only to include the secondary level hospitals as well, and was more often carried out on an out-patient basis. This care policy in association with the self-monitoring of blood glucose levels contributed to an obvious improvement in glycaemic control during pregnancy. Despite that, the high proportion (73%) of women entering pregnancy with unsatisfactory glycaemic control did not decrease during the study period. Retinopathy complicated 134 (45.3%) diabetic pregnancies, while clinical nephropathy was found in 23 (7.8%) cases. Although retinopathy was more often aggravated during the first pregnancy, the occurrence of retinopathy or its severe form was not increased at the beginning of consecutive pregnancies. Of the mothers, 50 (16.9%) had pre-eclampsia during pregnancy, and in 28% of these cases it was classified as superimposed. It was found more often among primiparous than multiparous (25.6% vs. 11.0%, respectively), and its occurrence rose with the severity of diabetes. In both cohorts, the rates of preterm deliveries, Caesarean sections and large for gestational age (LGA) infants were significantly (p < 0.001) higher in Type 1 diabetic pregnancies than in the background population. The rates of congenital anomalies (CA) were 540-629/10000 in two study populations, both being 2-3-fold as compared to the background population. Cardiac malformations were most common, with anomalies in the genitourinary tract and the musculoskeletal organs being next in frequency. Sixty-three percent of malformed infants were boys. Though pregnancy itself was not found to worsen the prognosis of diabetes, at least in the short term, pregnancy in diabetic women still remains a high risk state with an increased rate of prematurity, operative deliveries, CAs and peri- and neonatal mortality. In order to decrease the mortality rate in diabetic births, attention should be directed at both the prevention of CA and at identifying the foetuses at risk for intrauterine death. The postneonatal mortality rate is also high, reflecting a shift in the deaths from the early neonatal period to a later age. Therefore, a combined mortality, including induced abortions, stillborns and infant deaths, would give a more realistic idea of the outcomes in diabetic pregnancies.

Master of Science / Department of Family Studies and Human Services / Anthony Jurich / Adolescent pregnancy has been an ongoing concern in society for many years. This concern is even greater among the African American community. Girls who experience a pregnancy or childbirth during adolescence often experience difficulties in school and future careers, as well as financial and mental instability. This report will examine how the pregnancy and childbirth experiences of African American teens influence their younger female siblings.

A literature review revealed 15 variables as commonly studied as associated with adolescent pregnancy. The research showed conflicting results in many of these areas. Twenty-one pregnant and 20 non-pregnant adolescents were tested using the Arlin Test of Formal Reasoning (ATFR) and the Reiss's Premarital Sexual Permissiveness Scale. Pregnant participants were expected to score lower than non-pregnant participants on the ATFR; and, the low permissives (based on responses to the Reiss's Premarital Sexual Permissiveness Scale) were expected to score higher than high permissives on the ATFR. However, the results did not support the hypotheses. Several areas were examined for exploratory purposes. There was a significant difference between high permissives and low permissives for parent/peer orientation for sexual behavior attitudes. Additional exploratory demographic information was collected using a General Information Questionnaire.

Background: Pre-eclampsia (PET) is one of the major causes of maternal and neonatal morbidity and mortality1. Misclassification of PET can lead to biased or erroneous results in epidemiologic studies resulting in false conclusions. Objectives: The objectives of this thesis are to determine the validity of PET diagnosis in pregnant women in administrative database using the ICD-10-CA codes, to explore the nature of misclassification, and to estimate whether misclassification of PET diagnosis in administrative database may result in biased conclusions. Methods: Pregnant women who participated in the Ottawa and Kingston (OaK) Birth Cohort study and delivered in the Ottawa Hospital were included in the study. All cases with hypertensive disorder of pregnancy in the study population were adjudicated to confirm diagnosis of PET. This adjudicated dataset was used as a reference standard. The PET incidence in hospital discharge database was compared with PET incidence calculated from the reference standard database. Results: 2887 of the requested charts were available for review. The PET incidence was much lower in administrative database (1.47%) than in the OaK Birth Cohort Study (3.6%). The results of the study demonstrated that hospital discharge database via ICD-10-CA was not very sensitive to determine incidence of PET since sensitivity of ICD-10-CA diagnostic codes for PET was low (35.92% with 95% Confidence Intervals (CI): 26.7; 45.9) but specificity, PPV, and NPV were high. The majority of misclassified cases belonged to the category (according to the proposed classification) “PET pregnancies coded with incorrect ICD-10-CA code” (78.88%) followed by the category “Pregnancies affected by PET coded as normal” (14.08%). Conclusion: Using hospital discharge database and ICD-10-CA coding to determine incidence of PET in certain settings may yield low sensitivity. Researchers should validate the results when using the hospital discharge database for PET research to ensure that the findings based on analyses of such data demonstrate what they claimed to demonstrate.

“Rapid repeat pregnancy”, which is common among young mothers, is the onset of pregnancy within 24 months of a previous pregnancy outcome. Teenage motherhood is associated with many economic, social, and health challenges. These challenges often become more serious and more difficult to manage after a subsequent delivery. The circumstances surrounding rapid repeat pregnancy among young mothers living in Ottawa remain unclear. This study explores the experiences, knowledge, and attitudes of young mothers towards rapid repeat pregnancy and contraception through a multi-method study. The multimethod study includes in-depth interviews with young mothers living in Ottawa who have experienced rapid repeat pregnancy and in-depth interviews with services providers who work with them. Results from the interviews indicate that young mothers often do not use post-partum contraception, actively and passively plan their pregnancies, experience violence, and have mental health and substance abuse issues. Many young mothers expressed that trying to access services, especially mental health support services, can be a long and difficult process. Key informants expressed the need for more sexpositive, youth-friendly sexual and reproductive health education. There is a need to identify and further develop youth-friendly services that young mothers feel comfortable accessing. Supporting efforts to increase adolescent mothers’ and service providers’ awareness of existing services appears warranted.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-24T11:56:49Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE PARA DEPÓSITO.pdf: 1020977 bytes, checksum: 8eff6af757005586cdc17a12637c3302 (MD5) / Made available in DSpace on 2017-07-24T11:56:49Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE PARA DEPÓSITO.pdf: 1020977 bytes, checksum: 8eff6af757005586cdc17a12637c3302 (MD5) Previous issue date: 2015-10-29 / Introdução: Cerca de 20% das gestantes apresentam fatores de morbidade e mortalidade que podem tornar a evolução da gestação desfavorável, constituindo o chamado grupo de alto risco. Esta é uma condição de maior probabilidade de comprometimento à saúde ou de significante risco materno ou fetal. A expectativa de risco de vida para si ou para o bebê pode predispor a gestante a apresentar um maior comprometimento em seu estado de saúde mental. Além de que a percepção do risco da mulher grávida pode influenciar os comportamentos de saúde durante a gravidez. Ser de alto risco, portanto, pode ser fator contribuinte para um estado de sofrimento mental e com isso necessitar de intervenções mais específicas. Objetivo: avaliar o estado de saúde mental de gestantes que preenchem critério para gestação de alto risco reprodutivo e validar um instrumento que medisse a percepção de risco destas gestantes. Método: realizado um estudo transversal conduzido em uma amostra de 456 gestantes, composta por 241 gestantes de alto risco e 215 gestantes de baixo risco como grupo comparativo, atendidas em serviços públicos de pré-natal, na cidade de Natal, RN. Avaliou-se o estado de saúde mental destas gestantes através da verificação da presença de Transtorno mental comum (TMC) e aplicou-se o instrumento Perception of Pregnancy Risk Questionnaire (PPRQ), como avaliação da percepção de risco, com a finalidade de validação à população brasileira. Resultados: A prevalência encontrada de TMC foi de 63,5% nas gestantes de alto risco, enquanto presente em 41,9% das gestantes de baixo risco (p<0,001). Na análise multivariada, o transtorno mental comum esteve associado a fatores como ser do grupo de risco, renda pessoal, planejamento da gravidez e história de transtorno mental anterior. O PPRQ demonstrou ser concordante entre suas variáveis e o seu total, além de boa confiabilidade extraída de uma alfa de Cronbach de 0,87 e adequado teste-resteste, semelhante ao instrumento original. Conclusão: De acordo com os dados disponíveis na literatura, consideramos que a prevalência de TMC em gestantes de alto risco encontrada neste estudo pode ser considerada alta, alertando para a importância da investigação sobre o estado de saúde mental nestas mulheres em serviços de pré-natal. A versão em português do PPRQ demonstrou resultados satisfatórios na tradução, adaptação e consistência interna, sugerindo esta versão para ser utilizado na população brasileira. / Introduction: About 20% of pregnant women have morbidity and mortality factors that can make the evolution of unfavorable pregnancy, constituting the so-called high-risk group. This is a condition likely to compromise the health or significant maternal or fetal risk. The expectation of life threatening for you or the baby may predispose pregnant women to have a greater commitment to their mental health. In addition to that the perception of the pregnant woman's risk may influence health behaviors during pregnancy. The fact to be at high risk can therefore be a contributing factor to a state of mental distress and thus require interventions that are more specific. Objective: To assess the mental health status of pregnant women who meet criteria for high-risk pregnancy and reproductive validate an instrument to measure the perception of risk of these pregnant women. Method: a cross-sectional study conducted in a sample of 456 pregnant women, consisting of 241 high-risk pregnant women and 215 low-risk pregnant women as a control group treated at public services prenatal, in the city of Natal, RN. We evaluated the mental health status of these pregnant women by checking the presence of common mental disorder (CMD) and applied the Perception instrument of Pregnancy Risk Questionnaire (PPRQ) as assessment of risk perception, in order to validate the Brazilian population. Results: The prevalence of CMD was 63.5% in high-risk pregnant women, while present in 41.9% of low-risk pregnant women (p <0.001). In multivariate analysis, the common mental disorder was associated with factors such as being risk group, personal income, pregnancy planning and history of previous mental disorder. The PPRQ proved concordant between your variables and their total, and good reliability extracted a Cronbach's alpha of 0.87 and adequate test-retest, similar to the original instrument. Conclusion: According to the data available in the literature, we believe that the prevalence of CMD in high-risk pregnant women in this study can be considered high, stressing the importance of research on the state of mental health in these women in prenatal services . The Portuguese version of Perception of Pregnancy Risk Questionnaire demonstrated satisfactory results in the translation, adaptation and internal consistency, suggesting that version to be used in the Brazilian Population.

This study was an examination of an intervention called the baby think it over doll in a small sample of teenagers. The study attempted to ascertain the impact of the doll on attitudes and beliefs surrounding early parenthood and a teen's future hopes.

Heart disease remains the most important non-obstetric cause of maternal mortality and morbidity during pregnancy, despite its low incidence of less than 1%. This is due to the decline in the number of deaths from haemorrhage, infection and toxemia. In addition, a striking change in the pattern of proportional distribution of organic heart disease in pregnant women is being noted, with a decrease in chronic rheumatic lesions and an increase in congenital cardiac disease. In the Third World rheumatic mitral valve disease remains a most important condition during pregnancy. It is currently rarely seen in Europe and the United States. Mitral stenosis is the most commonly encountered rheumatic heart lesion that complicates pregnancy. The normal circulatory changes during pregnancy aggravate this lesion as the reduced, fixed valve area obstructs blood flow from the left atrium to the left ventricle, causing pulmonary congestion and oedema. Careful and regular follow up of these patients is essential, and surgery is indicated if optimal medical management fails. Cardiac surgery duting pregnancy represents a risk to both the foetus and the mother. For most procedures extracorporeal circulation and heparinization are necessary and adds to the · adverse effects of the operation. Closed mitral valvotomy, however, is an excellent low risk operative procedure in patients with tight mitral stenosis without causing undue harm to the foetus. Cuttler described the first attempted surgery of the mitral valve in 1923 and since then the procedure has been improved to benefit many patients with tight mitral stenosis. The first reports of closed mitral valvotomy during pregnancy were in 1952. Al though a more precise valvotomy can be obtained with an open procedure, the closed operation avoids the risks of extracorporeal circulation, particularly detrimental to the foetus. This report is a review of the Groote Schuur Hospital experience of patients with mitral stenosis requiring closed mitral valvotomy during pregnancy since 1965. The aims of the study are to analyse the outcome of the pregnancy, the effects of valvotomy during pregnancy on both the mother and the foetus, and the outcome regarding restenosis of the mitral valve.

Background: Physical activity (PA) may influence fecundability through alterations in endocrine function. The limited studies that have evaluated PA and fecundability in non-clinical populations have utilized internet-based recruitment, contain potential issues in measurement, and have yielded inconclusive results. Methods: We evaluated the association between PA and time-to-pregnancy in the Effects of Aspirin in Gestation and Reproduction trial, which included 1228 women attempting pregnancy ages 18–40 with prior pregnancy loss. PA was measured at baseline using the short form of the International Physical Activity Questionnaire to determine hours/week of activity (vigorous, moderate, and walking) and hours/day of sedentary (sitting) behavior. Pregnancy was assessed using urine hCG assays. Discrete time Cox models were used to estimate fecundability odds ratios (FORs) adjusted for marital status and parity, accounting for left truncation and right censoring. Results: We observed a positive association between fecundability and vigorous PA of ≥ 4 hrs/week vs. none (FOR= 1.55, 95% CI: 1.17, 2.07) adjusted for marital status and parity. In stratified multivariable models, this association was most pronounced among overweight/obese women reporting vigorous PA of ≥ 4 hrs/week compared to none (FOR=2.27, 1.41, 3.65); however, there was no significant effect modification. Fecundability was not associated with categorical measures of moderate PA, walking, or sitting. Conclusion: In this study, fecundability was positively associated with vigorous PA. Further study is necessary to clarify possible mechanisms to explain the relationship through which vigorous PA might affect time-to-pregnancy; however, such improvements in fecundability may be related to a reduction in ovulatory disorders.

Background Teenage pregnancy is a public and global health concern that remains a substantial challenge in Low-income countries, particularly the densely populated countries, including Rwanda. The factors that contribute to teenage pregnancies are broad, with the most common are socioeconomic factors. The study aims to investigate the association of socioeconomic, demographic factors of teenagepregnancy in Rwanda. Methods This study uses a cross-sectional study of Demographic and Health Survey data from the national Representative of Rwanda Demographic and Health Survey done between 2014 and 2015. Our study Analysis used a weighted data sample of adolescents aged 19-24 years. Bivariate descriptive and logistic regression was used to examine the associated factors of Teenage Pregnancy. Results Descriptive bivariate analysis exhibit place of residence, wealth index and education attainment variables are statistically significant. Multivariate analysis found positive association with teenage pregnancy after adding all variables to control potential confounders in bivariate logistic regression. For example, education attainment (no education and primary); Religion (Protestant and Adventist); wealth index (poor and middle) teenager’s women and girls who lived in the eastern region were associated with pregnancy among women who were Below 20 years old. Conclusion There is a substantial increase in teenage pregnancy in Rwanda. The study results demonstrate that potential factors (economic status and education attainment) are more likely to correlate to teenage pregnancy in Rwanda. Socioeconomic and demographics factors should be strongly considered when designing policies to address teenage pregnancy in Rwanda. / <p>Thesis presentation of Socio-economic factors associated with teenage pregnancy in Rwanda: A secondary analysisof Rwanda Demographic and Health Survey data from 2014-2015 by Kalisa Francois</p>