Using three separate and unique sources of data, this study was designed to address: a) the associations between pregnancy-related violence and femicide with sociodemographic characteristics of victims and offenders and with family dynamics, b) how pregnancy affects the risk for threats of violence, power and control tactics, physical violence, stalking, sexual violence, and femicide, and c) how pregnancy contributes to increased severity of abuse. The overall results reveal a significant statistical correlation between pregnancy and the increased risk of intimate partner abuse on many dimensions, including physical abuse, stalking and harassment, sexual abuse, threats of serious harm and death, lethality risk, and power and control. The correlation between pregnancy and femicide is less clear and in need of further examination. While the nature of pregnancy as a risk factor across multiple dimensions of abuse is certainly pervasive, the findings indicate that power and coercive control warrants close attention as a potentially prominent and dangerous dynamic. Women of younger age, those single or divorced, residing with an IP, and having children in the home were shown to have a significantly increased risk of non-lethal and lethal IPV in all three samples. The findings contribute evidence to existing literature concerning potentially catastrophic outcomes for pregnancies occurring in an abusive context, including extremely high rates of miscarriage in abusive relationships. Implications for practice and for research are discussed.

Every year, approximately 21 million girls aged 15 to 19 living in low- and middle-income countries (LMICs) become pregnant and over 12 million of these girls give birth. Complications from pregnancy are the leading cause of death for girls aged 15 to 19 in LMICs and adolescent mothers face an elevated risk of life-long morbidities due to pregnancy and childbirth. The risk of early childbearing and its associated consequences vary significantly depending on age, socioeconomic status, and place of residence. Adolescents affected by conflict or natural disasters are often recognized as one of the most vulnerable groups in this regard; among the countries with the highest adolescent birth rates globally, most are affected by conflict or fragility. This dissertation aimed to fill a critical gap in the literature on adolescent pregnancy in humanitarian settings. The three studies in this dissertation utilize qualitative and quantitative research to better understand the myriad drivers of adolescent pregnancy and, in the context of protracted conflict in Democratic Republic of the Congo (DRC), how exposure to armed conflict may or may not modify certain risk and protective factors. The findings of this dissertation confirm that risk and protective factors for adolescent pregnancy are numerous, interrelated, and complex; preventing early and unintended pregnancy requires multi-level interventions that build the protective assets of adolescents while also engaging with male partners, parents and caregivers, and community members. The research deepens this understanding by demonstrating the extent to which long-standing and deeply rooted sociocultural norms influence adolescents’ individual and inter-personal behaviors in diverse contexts, including settings affected by armed conflict. Thus, instead of considering how standalone risk and protective factors for adolescents differ depending on the context, the research highlights the importance of understanding linkages between environmental, inter-personal, and individual factors and the pathways through which these linkages influence reproductive health decision-making among adolescents. This dissertation also provides new evidence as to how the presence of armed conflict does not uniformly influence risk and protective factors for adolescent pregnancy. Instead, it finds that, in the case of DRC, underlying social norms and differences in social, demographic, and economic characteristics outweigh the effect of armed conflict on incidence of adolescent pregnancy. This finding does not mean that armed conflict does not have any impact on adolescent pregnancy; rather, it confirms the need for continued research in different humanitarian contexts and informs how to apply best practices from development settings to improve sexual and reproductive health (SRH) outcomes among adolescents affected by humanitarian crises. Meeting the SRH needs of adolescents requires going beyond service provision and understanding the numerous, interrelated risk and protective factors that exist at the individual, inter-personal, and community levels. Situations of conflict and displacement may present additional complexities for understanding and meeting the SRH needs of adolescents. However, this dissertation shows the feasibility of conducting research and utilizing existing data to understand some of the root causes of adolescent pregnancy in a conflict-affected setting. Moreover, the studies highlight how more robust evidence can challenge some of our longstanding assumptions about adolescents affected by humanitarian crises. Continued rigorous research and taking the time to listen to adolescents and their communities can lead to more responsive adolescent SRH programs and services that contribute to adolescents’ healthy transitions to adulthood.

BACKGROUND: Pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM) are among the leading causes of disability and death for women and their babies. Identifying risk factors for these pregnancy-related complications is essential to their prevention. Studies identifying preventive models for PIH and GDM are few. OBJECTIVES: This study was designed to evaluate lifestyle and personal predictors of PIH and GDM in a cohort of nearly 20,000 pregnant women. METHODS: The exposure data for the study were derived from a combination of a telephone interview and a questionnaire completed approximately 2 months after conception during the period from 1984 to 1987. The initial questionnaires asked for information on three periods: 3 months before conception, at conception, and 2 months after conception. Subjects included 19,312 women, aged 18-<45 years, who did not have excessive intakes of alcohol or food, were neither underweight (BMI >18.5) nor extremely overweight (BMI <40), and did not use illegal drugs during the first trimester of pregnancy. Outcome data on the mother and baby were collected approximately one year after the expected data of delivery. Logistic regression models were used to estimate the odds ratios (OR), and 95% confidence intervals (CI), as well as receiver operating characteristic (ROC) curves predicting PIH and GDM. Akaike Information Criteria (AIC) were used to select the best predictors of these two outcomes. Factors found not to affect PIH or GDM (based on a two-unit decrease in the AIC) were excluded from the final models. RESULTS: Based on the outcome data collected, there were 204 PIH cases, 358 GDM cases, and 538 who had PIH and/or GDM. After selecting the outcome predictors using AIC values, we identified three predictive models—one each for PIH, GDM, and either PIH or GDM. Factors found to predict PIH included age, previous hypertension or type 1 or 2 diabetes, pre-pregnancy BMI, parity, exercise, red meat consumption, margarine consumption, cigarette smoking, and weight change at 2 months. The final AIC value for PIH was 2084.12 and the AUC value was 0.76. GDM was predicted by age, previous GDM (in an earlier pregnancy), pre-pregnant BMI, height, exercise, race, dairy consumption, and cigarette smoking, with an AIC value of 3288.74 and an AUC value of 0.70. The combined model (predicting either PIH or GDM) was best predicted by age, history of GDM in a previous pregnancy, pre-pregnant BMI, previous history of hypertension, height, exercise, dairy consumption, red meat consumption, parity numbers, cigarette smoking, and weight change at 2 months with an AIC value of 3288.74 and an AUC value of 0.71. CONCLUSIONS: In these analyses, separate models predicting PIH and GDM were better than a combined model predicting PIH or GDM. These final models indicate that we can reasonably identify women who are at increased risk for adverse maternal outcomes associated with hypertensive disorders or diabetes during pregnancy.

No description available.

The purpose of this descriptive study was to assess the thoughts, feelings, and actions of pregnant teens at significant decision-making times: time of intercourse, confirmation of pregnancy, and six weeks post delivery. Factors associated with adolescent pregnancy and patterns of behavior were analyzed. Examination of the extant literature on adolescent pregnancy yielded insight into parental, socio-economic, and partner factors. The interview protocol emanated from the literature analysis. The interaction of these factors on the thoughts, feelings, and actions of female teens was the focus of the study. Data from personal recurrent interviews of pregnant teens over a four-month period served as the basis for analyzing thoughts, feelings, and actions. Analysis of individual and group thoughts, feelings, and actions generated behavior patterns relevant to each of the three decision-making times. / Ed. D.

The purpose of this research was to measure attitudinal differences between pregnant and nonpregnant teenagers. The sample was comprised of 192 junior and senior high school students. The pregnant group consisted of 87 teenagers enrolled in a Continuing Education Program for pregnant teens. The non-pregnant group was enrolled in a regular junior and senior high school. Comparisons were made of motivations for parenthood, romantic love attitudes and perception of need satisfaction. Analysis of Variance, one-way classification, was used to test the significance of the differences between the means of the two groups for each of the three variables. Pearson product moment correlation coefficients were computed to determine the degree in relationship among variables. / Ph. D.

An animal model (Rattus norvegicus) was employed to study the effects of chronic prenatal alcohol exposure on pup development and on the functional efficacy of pup vocalizations on the maternal behavior of the dam. Subjects were 72 dams and their litters. Dams were matched by weight and assigned to either an Ethanol (EtOH), a Pair-fed (PF), or an Untreated Control (UC) group. Ethanol dams received 15% ethanol as their sole source of fluid throughout the experiment. Pair-fed dams were fed isocalorically to EtOH dams. Untreated Control dams received food and water ad libitum. Dam's retrieval behavior was assessed in a runway choice situation when pups were 3, 5, 7, and 9 days old. Developmental measures were taken on pups from ages 0 through 13 days. Blood ethanol concentrations were also analyzed for dams and pups. The data showed that the BEC of EtOH dams was .1% and that EtOH pups showed a negligible BEC postpartum. Prenatal alcohol exposure was shown to have a direct pharmacological and indirect nutritional effect on pup development. Ethanol dams retrieved a reliably smaller percentage of pups and retrieved reliably more slowly than did controls. Pair-fed pups showed a higher rate of calling than did other pups and tended to be chosen more often by UC and PF dams than were EtOH or UC pups. Ethanol dams tended to chose UC pups more often than other pups. These findings suggest that chronic prenatal alcohol exposure produces altered behavior and responsiveness in the dam and the pup. This altered behavior and responsiveness may have a synergistic effect on the interaction between the dam and the pup. / Master of Science

Height, skinfold, and circumference measurements were obtained from 29 normal weight and 17 overweight (>110% of desirable weight for height) healthy pregnant women every four weeks during their second trimester of pregnancy. The mean weight gain and food intake values were not significantly different for both groups. Measurements increased at a greater rate for the normal weight gravidas than for the overweight gravidas in almost every case. For both groups, increases in fat stores were greater in the central sites than in the peripheral sites. No clear relationship between age, prepregnant weight, and weight gain during the second trimester with the birthweight of the baby was found. The infant birthweights of both groups were at an optimal level ( >2500 grams) except for one (born to the mother 151% of her desirable weight for height). The similarity in results for the two groups is greatly due to there not being a large enough difference in prepregnant weights between the two groups. Nevertheless, the results do lend support to a 20 to 30 pound weight gain for an optimal outcome of pregnancy for healthy pregnant women with a wide range of prepregnancy weights. Those women 150% or more of their desirable weight for height may need to gain on the lower end of the spectrum due to their excess endogenous reserves and to possible harm to the fetus with large gains. / Master of Science

Although current professional and public opinion support the right of the client to make an informed decision about entering and continuing in a psychotherapy or counseling relationship, research studying the effects of informed consent on client behaviors and attitudes in the medical, research, and mental health fields has resulted in equivocal findings. This study looked at the effects of an informed consent procedure on client behaviors and attitudes in a pro-life pregnancy counseling center where the center's primary goal is to reduce the number of abortion decisions among clients. Thirty of the center's clients (Experimental Group) were given an Informed Consent Sheet that explicitly stated the center's policies, procedures, and goals while another 30 clients {Control Group) were exposed to the center's regular procedures which did not include this Informed Consent Sheet. Results of subsequently administered questionnaires showed that there were no differences between groups regarding their stated intention to abort a potential pregnancy, nor were there any differences between groups on their attitudes toward their counselors and their counseling experience, in general.

This study investigated the relatic~mship between social support networks and their effects on sexual behavior during adolescence. The PSS-Fr and the PSS-Fa (Prociando & Heller, 1983) were used to establish the participants' overall perception of their social support networks from their friends and from their family. The Healthy Oakland Teen Survey (Ekstrand et al., 1996) was used to measure the perceived prevalence of risk behaviors among friends of the adolescents, attitudes regarding sexually active students, sexual behavior, and social networks. The predicted result of the experiment was that the strength of an adolescent's social support network would be a predictor for teenage pregnancy. A relationship was found between family support and the number of sexual partners.