Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biochemical Sciences Candidate: Bc. Jana Stehnová Supervisor: Prof. MUDr. Jaroslav Dršata, CSc. Consultant: MUDr. Mgr. Sylvie Špitálníková, Ph.D. Title of diploma thesis: Laboratory investigation of thyreoidea in pregnancy Thyroid diseases are very common in the Czech Republic. It is reported that up to 46% of the population suffer with thyroid diseases. Women are afflicted with the desease 4 to 8 times more often than men, and particularly in pregnancy, hormones of the thyroid gland play an important role in developing, maintaining and progress of pregnancy. In this work, we focused on creating the reference intervals for TSH, fT4 and antiTPO in the first trimester of pregnancy, which are recommended as the main markers of thyroid assessment of thyroid function during pregnancy. Reference intervals created by us were compared with the recommended reference intervals of the supplied Roche diagnostics. Our reference file was compiled from a group of 81 pregnant women and divided into individual weeks of the first trimester (weeks 11, 12 and 13). Reference intervals were calculated according to the recommendation, such as 2.5th and 97.5th percentile of our reference group for each week and then the resulting average...

Protection of human foetus - summary The thesis gives a detailed analysis of the extent and standard of protection of the human foetus in the Czech legal system, concentrating on the aspects of criminal law. In the introductory part it presents a brief chronological survey of the synopses of the most significant instruments which constitute the subject of the thesis. The legal institutions concerned are - in the minimum necessary extent - put in the context of several key international agreements, with the emphasis laid on the provisions of the Convention on Biomedicine whose concept significantly influenced that of the Czech medical law. Also the role of civil law and its connection - both as regards the terminology and content - with the other relevant provisions of the legal system are briefly mentioned in the third chapter. However, the thesis focuses mainly on criminal law and therefore its greatest part is concerned with the means by which criminal code guarantees the protection of human foetus. Not only does it give a survey of selected criminal offences and their matters of issue, but it also underlines their connection with the provisions of the first part of the law in question as far as the interpretation and application are concerned. A brief separate chapter deals with the connection of...

Protection of a human foetus The aim of this thesis is to deal with the protection of the human foetus in the scope of the Czech legal environment as well as in the relation with the international law. The work provides the insight into the specific law areas as constitutional law, criminal law and also private law and deals with the specific rules contended in the single act as the Interruption of the pregnancy act and the new Specific medical services act. The substantial part of the legal discussion is supported by examination of the decisions of the courts both international and national which reflect the protection of human foetus. The thesis focuses on the protection of human foetus in its complexity and shall provide the comparative material which compares the protection of the human foetus within the specific law disciplines. The analysis of single legal problems and issues of the protection of the human foetus is not exhaustive and focuses on the protection and state of the human foetus in specific statutes. The protection of the human foetus represents quite discussable issue which provides a large number of questions to be answered and leads to the discussions which are reflected in this work. The key issue is researched under the actual conditions of the legal system and also with the...

The thesis the Welfare of women during pregnancy and maternity deals with benefits which are connected with pregnancy, childbirth and maternity. The payment is based on more laws, especially act of on sickness insurance and act of state social support. I also didn't forget to mention some important international organisations, which affect in the area of social security and also the modification of security within European Union. I tried to treat my theme in different way, unlike it had been treated before. I proceed chronologically during description of individual benefits, this mean that I started with Compensatory benefit in pregnancy and maternity and I finished with parental allowance. This also corresponds with the structure of my thesis. I chose this method, because in my opinion this way of treating of the problem becomes more understandable. The thesis consists of introduction, eight chapters and the conclusion. In the introduction I mentioned reasons why I have chosen the theme and basic information concerning the social security law in Czech Republic. The first chapter is about progress of Social security law, especially in the area of present-day Czech Republic. The first chapter is divided into the 3 subchapters and the last one is also divided into another three sections. On the...

Reproductive health patterns in post-Soviet Central Asian countries Abstract This study aims to evaluate reproductive health patterns among post-Soviet Central Asian republics since their independence. The reproductive health indicators of individual countries were researched and compared. Furthermore, cluster country groups among selected post-Soviet, post-Socialist and capitalist countries were identified based on certain reproductive health indicators for the beginning and the end of the research period. The subsequent research was focused on 1999 Kazakhstan Demographic and Health Survey data. This thesis explores statistically significant factors influencing pregnancy outcomes in the country. According to the results, never married, urban women, women of Ukrainian, Russian, and other ethnicities, women living in the East and North regions were more likely to terminate a first pregnancy by an induced abortion rather than giving a live birth. Additionally, the same categories were proven to be statistically significant using the Poisson regression analysis, except the regions were shown to be the West and the North. Keywords: post-Soviet Central Asia, reproductive health, maternal mortality, pregnancy outcomes

According to the World Health Organization (2016), 10% of all pregnant women worldwide suffers from some kind of mental disorder, mainly depression. This is considered a women’s health issue and there is a great lack of studies conducted in low- and middle- income countries. The aim of this study was to study the prevalence of depressive symptoms amongst Thai pregnant women, in the upper northeast of Thailand, and their need of support from surrounding social relationships. A cross-sectional descriptive design with a quantitative method was used for this study. The results show that 28% of the participants had a possible minor or major depression scoring > 10 on the Edinburgh Postnatal Depression Scale. 51.6% of the women reported feeling anxious or worried during the past seven days. Health personnel were mostly needed as support regarding knowledge and attention during pregnancy and childbirth. Husband/partner were mainly wanted as support with attention and concern about pregnancy, reaching an understanding with spouse’s family, support related to the baby’s gender and support with household activities. Mother/mother-in-law was the most important source of support regarding taking care of the baby. In conclusion, screening and interventions towards perinatal depression is much needed in the upper northeast of Thailand. Further research is required to investigate the role of social support during pregnancy. / Enligt världshälsoorganisationen, WHO (2016), lider 10% av alla gravida kvinnor i världen av psykisk ohälsa, främst depression. Detta ses som ett kvinnohälsoproblem världen över och bristen på forskning på detta ämne är stor, framförallt i låg- och medelinkomstländer.Syftet med denna studie var att mäta prevalensen av depressiva symtom hos Thailändska gravida kvinnor i nordöstra Thailand samt deras behov av stöd från människor i deras omgivning. Kvantitativ metod med tvärsnittsdesign användes i denna studie. Resultatet visar att 28% av kvinnorna som deltog i denna studie lider av möjlig depression. 51.6% av kvinnorna rapporterade att de hade upplevt ångest eller oro någon gång under de senaste sju dagarna. Sjukvårdspersonal var mest efterfrågade som stöd angående kunskap om egenvård vid graviditet och förlossning. Många av kvinnorna uppgav att de främst ville ha stöd från sin man/partner. Speciellt i frågor beträffande omsorg och omtanke under graviditeten, barnets kön, hjälp med hushållssysslor och för att få förståelse från mannens/partnerns familj. Kvinnans mor/svärmor visade sig vara ett viktigt stöd vad gällande omhändertagandet av barnet. Det finns ett stort behov av att screena gravida kvinnor för depression samt tillämpa åtgärder för att förebygga och behandla perinatal depression i nordöstra Thailand. Ytterligare forskning är nödvändig för att vidare undersöka kvinnors behov av stöd under graviditet.

Background: Despite progress made in the last decades, malaria persists as a pressing health issue in sub-Saharan Africa. Pregnant women are particularly vulnerable to infection and serious health outcomes for themselves and their unborn child. Risk can be mitigated through appropriate use of control measures such as insecticide-treated bed nets. Although social networks can influence uptake of preventive strategies, the role of social influence on bed net ownership has not been explored. During an evaluation of a bed net distribution programme, the influence of non-health care advisors on ownership and use of bed nets by pregnant women in Kumasi, Ghana was examined. Methods: Data were collected through in-person interviews with 300 pregnant women seeking antenatal care in an urban hospital in Kumasi, Ghana. Participants were asked about their bed net ownership, bed net use, and information about three personal contacts that they go to for pregnancy advice. Information about these advisors was combined into an influence score. Logistic regression models were used to determine the association between the score and bed net ownership. Those who owned a bed net were further assessed to determine if interpersonal influence was associated with self-reported sleeping under the bed net the previous night. Results: Of the 294 women in the analysis, 229 (78%) reported owning bed nets. Of these bed net owners, 139 (61%) reported using a bed net the previous night. A dose response relationship was observed between the interpersonal influence score and bed net ownership and use. Compared to the lowest influence score, those with the highest influence score (> 1 SD above the mean) were marginally more likely to own a bed net [OR = 2.37, 95% CI (0.87, 6.39)] and much more likely to use their bed net [5.38, 95% CI (1.89, 15.25)] after adjusting for other factors. Conclusions: Interpersonal influence appears to have modest impact on ownership and use of bed nets by pregnant women in an urban area of Ghana. Further investigations would need to be conducted to determine if the relationship is causal or if individuals who associate are simply more likely to have similar practices.

Magister Curationis - MCur / Despite the awareness of the importance of initiating antenatal care in the first trimester of a pregnancy (before 12 weeks gestation), late initiation of antenatal care (on or after 24 weeks of gestation) remains a common trend amongst pregnant women. The late initiation of antenatal care poses such a risk, to both the pregnant women and their unborn babies that it can contribute to maternal and foetal mortality and morbidity. The late initiation of antenatal care, an entirely avoidable occurrence, has an impact on targets set by the United Nations Millennium Development Goals (MDGs), now focusing on the Sustainable Development Goals (SDG‟s) set out by the United Nations. This study aim to investigate the factors which contribute to and cause the late initiation of antenatal care in pregnant women in a region in the Western Cape. Aim: The aim of this study was to investigate the factors that influence pregnant woman and contribute to late initiation of antenatal care (after 24 weeks gestational age) in one health facility/district in Cape Town. The findings of the study identified possible factors that may cause pregnant women to initiate antenatal care late in pregnancy and these findings could facilitate planning and possible interventions targeting the importance of early initiation in the community.

<div>This dissertation addresses the overarching question, “What are the processes, antecedents, and outcomes of first-time mother’s pregnancy disclosures to their supervisors?” Two new theoretical disclosure models, the antecedent pregnancy disclosure model (APDM) and the outcome pregnancy disclosure model (OPDM), were empirically tested to address this question. Utilizing longitudinal data, these models examined the direct, mediation, and moderation effects associated with expecting women’s pregnancy disclosure experiences. </div><div><br></div><div>The APDM and OPDM drew upon disclosure theories (e.g., Afifi & Steuber, 2009; Greene, 2009), the interpersonal process model (Reiss & Shaver, 1988), and work-life literatures to extend disclosure theorizing through an examination of the work-related predictors of disclosure decision making and the interpersonal, relational, and career outcomes associated with expecting mother’s disclosure experiences. The APDM identified both individual-level (e.g., perceived career risk) and organization-level (e.g., structural support) predictors for the specific types of disclosure strategies women used to inform their supervisors that they were pregnant.</div><div><br></div><div> The APDM also tested two mechanisms (i.e., disclosure efficacy and anticipated disclosure strategy) as potential mediators between predictors and enacted disclosure strategies at T2 (see Figure 2). The OPDM built upon findings of the APDM to examine the association between enacted disclosure strategies and relational, psychological, and career outcomes while testing the role of perceived supervisor responsiveness as both a moderator and mediator to these effects (see Figure 3). Results of data analysis (N = 131) revealed that perceived organizational support and perceived risk influenced expecting women’s engagement in specific disclosure strategies at T2 through differing mechanisms (see APDM). Additionally, results suggest that the different disclosure strategies that women enacted at T2 were significantly associated with expecting women’s career, relational, and psychological outcomes (see OPDM). Theoretical and practical implications are discussed. </div><div><br></div>

The progesterone (P4) produced by the corpus luteum (CL) is essential for maintenance of pregnancy. On the other hand, the interferon tau (IFNT) produced by the embryo during elongation process, besides being the primary signal for recognition, also is responsible for maintenance of the CL during early pregnancy. The presence of oxytocin receptors (OXTR) in endometrium during expected time of luteolysis is determinant for trigger the uterine release of prostaglandin F2&#8733; (PGF), which is in charge of CL regression. The IFNT avoid the luteolysis by suppressing the OXTR appearance. However, during second month, accessory CLs are able to regress, indicating that the PGF release occurs with the advancing of the pregnancy and the mechanisms that initiated luteolysis are recovered. Therefore, failures in maintenance of the CL can cause luteolysis and pregnancy loss during this period of 30 to 60 days, which is one of the most important problems in reproductive efficiency in cattle, specially when in vitro produced (IVP) embryos are transferred. Two experiments were designed to study this factors, focused on point when uterus recover its PGF release during pregnancy and to identify possible differences between those mechanisms on pregnancies from IVP or artificial insemination (AI) embryos. The first study evaluated circulating PGF metabolite (PGFM) after an oxytocin challenge throughout first two months of pregnancy in lactating Holstein cows. Treatment with oxytocin did not affected PGFM concentration in d11 pregnant (P) and non-pregnant (NP), on d18 had a little increase in P cows, while increased 2-fold in NP cows. Oxytocin-induced PGFM in P cows on day 25 was greater than d18 P, however was lower than P cows on d53 and d60. Days 32, 39 and 46 of pregnancy had intermediate response. The second study evaluated the oxytocin-induced PGFM in Nelore cows pregnant from AI or IVP embryos on days 17 and 31, and its association with factors that can impact in success of the pregnancy, such as P4 levels, conceptus length on d18 and size of the embryo on d32. Also, OXTR and interferon-stimulated gene 15 (ISG15) gene expression were evaluated and located in uterine endometrium. Embryo size on d32 and P4 on d31, were higher in AI than IVP. Cows from IVP on d17 presented lower oxytocin-induced PGFM than AI in the same day, however, d31 for both groups had higher PGF release after oxytocin. On d31 there was similar PGFM increase in synchronized non-inseminated group (NI). The OXTR are highly suppressed on pregnant cows on d18, especially in IVP group, but were high expressed in NI cows and on d32 for both groups, AI being higher than IVP at this day. The ISG15 had irrelevant expression on NI and d32 groups, while had extremely high expression in d18 pregnant cows for both groups. Concluding, the CL in early pregnancy is maintained by PGF release suppression, while during second month there is oxytocin-induced PGF release, suggesting that other mechanisms are responsible for maintaining CL after d25. In addition, these results demonstrate there are signaling differences between IVP and AI pregnancies, impacting the molecular and endocrine environment that influences PGF release during these time points. / A progesterona (P4) produzida pelo corpo lúteo (CL) é essencial para a manutenção da gestação. Por sua vez, o interferon tau (IFNT) produzido pelo embrião durante o processo de alongamento, além de ser o sinal primário para reconhecimento e manutenção da gestação também é responsável pela manutenção do CL durante a gestação inicial. A presença de receptores de ocitocina (OXTR) no endométrio no momento esperado da luteólise é determinante para liberação uterina de prostaglandina F2&#8733; (PGF), a qual é responsável pela regressão do CL. O IFNT evita a ocorrência da luteólise por meio da supressão da expressão de OXTR no endométrio. Entretanto, durante o segundo mês de gestação, CLs acessórios, principalmente contralaterais são capazes de regredir, indicando que ocorre liberação de PGF pelo útero conforme a gestação avança, e os mecanismos que iniciam a luteólise são restabelecidos. Portanto, falhas na manutenção do CL podem causar luteólise e perdas gestacionais de 30 para 60 dias, um dos importantes problemas de eficiência reprodutiva em bovinos, principalmente quando embriões produzidos in vitro (PIV) são transferidos. Dois estudos foram delineados para estudar estes fatores, com foco em determinar o momento em que o útero gravídico retoma a liberação de PGF, e identificar prováveis diferenças entre estes mecanismos em gestações de embriões PIV ou de inseminação artificial (IA). O primeiro estudo avaliou a concentração circulante do metabólito de PGF (PGFM) após desafio com ocitocina durante os primeiros dois meses de gestação em vacas Holandesas lactantes. O tratamento com ocitocina não afetou a concentração de PGFM em vacas de d11 prenhes (P) e não-prenhes (NP), no d18 apresentou um ligeiro aumento em vacas P, enquanto aumentou cerca de duas vezes em relação ao nível basal em vacas NP. O aumento de PGFM induzido por ocitocina em vacas P no dia 25 foi maior que P em d18, entretanto foi menor que vacas P nos dias 53 e 60. Os dias 32, 39 e 46 da gestação tiveram resposta intermediária. O segundo estudo avaliou a PGFM circulante em resposta a ocitocina em vacas Nelore prenhes de embriões PIV ou IA, nos dias 17 e 31 de gestação, e sua associação com fatores que podem impactar no sucesso da prenhes, como P4 circulante, tamanho de concepto no d18, e o tamanho de embrião no d32. Além disso, foi avaliada e localizada a expressão de OXTR e do gene estimulado por interferon 15 (ISG15) no endométrio uterino. O tamanho de embrião no dia 32 e a P4 circulante no dia 31 foram maiores no grupo IA. Vacas do grupo PIV d17 apresentaram menor resposta a ocitocina na concentração de PGFM do que as de IA no mesmo dia, contudo no dia 31 ambos os grupos tiveram maior resposta do que PIV d17. As vacas do d31 dos dois grupos tiveram aumento na PGFM similar às vacas não-inseminadas (NI). Os OXTR foram altamente suprimidosnas vacas prenhes do d18, especialmente no grupo PIV, mas com alta expressão em vacas NI e no dia 32 para os dois grupos, sendo a IA com maior expressão que a PIV neste dia. O gene ISG15 apresentou expressão irrelevante em NI e d32 para IA e PIV, mas apresentou expressão extremamente alta no d18 nos dois grupos prenhes. Conclui- se que o CL na gestação inicial é mantido pela supressão da liberação de PGF, enquanto que no segundo mês, ocitocina induz liberação de PGF, sugerindo que outros mecanismos regem a manutenção do CL a partir do dia 25. Além disso, nossos resultados demonstram que há diferenças entre a sinalização de gestações provenientes de embriões PIV e IA, que impactam no ambiente molecular e endócrino, influenciando a liberação de PGF nestes momentos.