該前瞻性研究對香港中國裔孕婦的25羥基維生素D（25（OH）D）的水平及其影響因素進行調查，并對25（OH）D與甲狀旁腺激素（PTH）、孕期肌肉酸痛、不良妊娠結局、孕期及産後骨質流失，以及嬰兒的骨骼發育等關係進行探索，力求建立適用于香港的中國孕婦的25（OH）D正常值。 / 共有237名單胎妊娠婦女以及62名多胎妊娠的婦女在2010年8月至2011年11月間參加本研究中的隊列研究，分別在參加研究時（<20 孕周）、24-28孕周、31-36孕周以及産後6-11周進行抽血測量血清25（OH）D以及PTH水平，同時填寫一份包括對每月攝取含維生素D的食物以及營養補充劑頻度、接受日照情況及喜好、以及肌肉不適等情況的問卷，并在24-28孕周進行75克口服葡萄糖耐量試驗。參與隊列研究的單胎孕婦在20周前、31-36孕周以及産後隨訪時接受用定量超聲測量非優勢手的橈骨遠端以及中指近掌指骨的骨質超聲速率（SoS）。在産後複查時，對其嬰兒左側腓骨中部的骨質SoS進行測量。記錄婦女各次檢查時的體重、抽血月份紫外線輻射強度的歷史記錄、以及妊娠結局。另外募集一批孕婦參加病例對照研究，比較患早產（PTB）、子癇前期（PET）、妊娠糖尿病 （GDM）以及胎兒生長受限（FGR）併發癥的婦女與對照組 （體重指數以及抽血時紫外線強度配對）的血清25（OH）D水平。 / 孕婦在孕期的平均25（OH）D水平在44.7 ± 12.6 至48.9 ± 17.1 nmol/l範圍，25（OH）D水平與體重指數、維生素D營養補充劑、抽血時紫外線強度以及個人對陽光的喜好情況有關，而與胎兒數量、孕次、孕周以及終止妊娠無關。 / 單胎妊娠的孕婦三個孕期的血清25（OH）D與PTH水平均負相關，但在多胎妊娠中，二者無明顯相關性。PTH在孕期以及産後的變化相對不受25（OH）D影響。孕婦25（OH）D的水平與孕婦肌肉酸痛癥狀、産後恢復、孕期及產褥期骨質流失以及嬰兒骨質無關。患早期PTB（< 34孕周）、PET或FGR的孕婦的血清25（OH）D比對照組低，但GDM患者的25（OH）D水平與對照組無差別。血清25（OH）D低於34.3 nmol/l者的早期早產以及子癇前期的風險增高，低於50 nmol/l者發生胎兒生長受限的風險增高。服用維生素D補充劑情況可能影響25（OH）D與FGR的關係。 / 總而言之，血清25（OH）D水平不足以全面完全反映孕期維生素D的情況，對預測不良妊娠結局的作用有限。 / This prospective study explored the maternal serum level of 25(OH)D in Chinese pregnant women in Hong Kong and the factors affecting 25(OH)D level. It also explored the correlation between maternal 25(OH)D with PTH level, maternal musculoskeletal complaints, adverse pregnancy outcome, maternal bone turnover during pregnancy and postpartum, and the bone development of the offspring, aiming to explore and establish a normal range of 25(OH)D level in pregnancy for the Hong Kong Chinese women. / A total of 237 women with singleton pregnancy and 62 women with multiple pregnancies were recruited for the cohort study from August, 2010 to November, 2011. Maternal blood samplings for 25(OH)D and PTH measurements were performed at recruitment, 24-28 weeks, 31-36 weeks of gestation, and 6-11 weeks postpartum respectively. A questionnaire which included the monthly dietary and supplement intake of vitamin D, questions about sunlight exposure, and musculoskeletal complaints was administered on each visit. A 75g oral glucose tolerance test (OGTT) was performed on cohort cases at 24-28 weeks of gestation. Measurements of the speed of sound (SoS) at the distal one third of the maternal radius and the proximal phalanx of the third finger of the non-dominant side were performed with quantitative ultrasonography (QUS) measurement during the visits at the first and third trimesters, and postnatal period. The SoS at the left mid-shaft tibia of the offspring was determined during the postnatal visit. Maternal characteristics, ultraviolet radiation (UVR) intensity at blood sampling, and pregnancy outcome, were also recorded. Cases with pregnancy complications were recruited for case-control studies, and maternal 25(OH)D level was examined with respect to preterm birth (PTB), preeclampsia (PET), gestational diabetes (GDM), and fetal growth restriction (FGR, birthweight below the 10th percentile of the customized estimated birthweight). The controls were matched for booking body mass index (BMI) and UVR intensity at blood sampling. / The mean 25(OH)D level in ranged from 44.7 ± 12.6 to 48.9 ± 17.1 nmol/l in the three trimesters, and was related to BMI, vitamin D supplementation, UVR intensity at blood sampling, and the acceptance of sunlight exposure, but not the number of fetus, parity, gestational age, or the completion of pregnancy. / Inverse correlation between PTH and 25(OH)D were observed in singleton, but not in multiple, pregnancy. The change in maternal PTH level is found to be relatively independent from that of 25(OH)D. There was no correlation between maternal 25(OH)D level with musculoskeletal complaints, postnatal recovery, bone turnover during and after pregnancy, or the bone density of the offspring. Maternal 25(OH)D level was lower in women with early PTB ( < 34 weeks), PET, and FGR, but not for GDM. A maternal 25(OH)D level of lower than 34.3nmol/l and 50 nmol/l was associated with increased risk of early PTB, PET, and FGR respectively. But the correlation between maternal 25(OH)D level with FGR might be affected by supplementation. / In conclusion, serum level of 25(OH)D is insufficient in reflecting maternal vitamin D status and metabolism in pregnancy, and is of limited use in predicting adverse pregnancy outcome. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Hu, Zhiyang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 201-223). / Abstracts and appendixes also in Chinese. / Thesis dedication --- p.i / Acknowledgments --- p.ii / Abstract --- p.v / Abstract (Chinese) --- p.viii / List of Abbreviation --- p.x / Table of contents --- p.xiii / List of Figures --- p.xxii / List of Tables --- p.xxiv / Chapter Chapter 1: --- Literature Review --- p.1 / Chapter 1.1 --- The synthesis and metabolism of vitamin D --- p.3 / Chapter 1.1.1 --- The synthesis of vitamin D --- p.3 / Chapter 1.1.2 --- The metabolism of vitamin D --- p.4 / Chapter 1.1.3 --- Vitamin D binding protein --- p.10 / Chapter 1.1.4 --- Factors related to 25(OH)D level --- p.11 / Chapter 1.2 --- Function of vitamin D --- p.13 / Chapter 1.2.1 --- Mechanism of vitamin D function --- p.13 / Chapter 1.2.2 --- Classic function --- p.14 / Chapter 1.2.3 --- Non-classic function --- p.16 / Chapter 1.2.3.1 --- Immune system --- p.17 / Chapter 1.2.3.2 --- Cardiovascular system --- p.18 / Chapter 1.2.3.3 --- Cell proliferation and differentiation --- p.18 / Chapter 1.2.3.4 --- Neurological system --- p.19 / Chapter 1.2.3.5 --- Reproductive system --- p.20 / Chapter 1.2.3.6 --- Fetal development --- p.21 / Chapter 1.3 --- The definition of vitamin D deficiency --- p.21 / Chapter 1.4 --- Vitamin D status and pregnancy --- p.24 / Chapter 1.4.1 --- Alteration in vitamin D metabolism during pregnancy --- p.24 / Chapter 1.4.2 --- Factors affecting maternal serum level of 25(OH)D --- p.25 / Chapter 1.4.3 --- Vitamin D and bone resorption during pregnancy and lactation --- p.27 / Chapter 1.4.3.1 --- Alteration of calcium metabolism, bone absorption and the role of vitamin D --- p.27 / Chapter 1.4.3.2 --- Measurement of bone density in pregnant women and babies --- p.33 / Chapter 1.4.4 --- Current studies on maternal vitamin D status and pregnancy outcome --- p.35 / Chapter 1.4.4.1 --- Birthweight --- p.35 / Chapter 1.4.4.2 --- Infection --- p.37 / Chapter 1.4.4.3 --- Preterm delivery --- p.39 / Chapter 1.4.4.4 --- Diabetes (DM) and gestational diabetes (GDM) --- p.39 / Chapter 1.4.4.5 --- Hypertension and preeclampsia --- p.41 / Chapter 1.4.4.6 --- Multiple pregnancy, muscular symptoms --- p.42 / Chapter 1.4.4.7 --- Vitamin D supplementation and pregnancy outcome --- p.44 / Chapter 1.5 --- Defining vitamin D deficiency in pregnancy --- p.45 / Chapter 1.6 --- Objective of the study --- p.46 / Chapter Chapter 2: --- Study design and methods --- p.48 / Chapter 2.1 --- Case recruitment and study design --- p.48 / Chapter 2.1.1 --- Longitudinal singleton study --- p.49 / Chapter 2.1.2 --- Cross-sectional study --- p.50 / Chapter 2.1.2.1 --- Preterm birth (PTB) --- p.51 / Chapter 2.1.2.2 --- Preeclampsia (PET) --- p.51 / Chapter 2.1.2.3 --- Gestational diabetes (GDM) --- p.52 / Chapter 2.1.3 --- Multiple pregnancy study --- p.52 / Chapter 2.2 --- Measurements --- p.53 / Chapter 2.2.1 --- Hormonal analysis of serum levels of 25(OH)D and PTH --- p.53 / Chapter 2.2.2 --- Calculation of monthly intake of vitamin D from diet --- p.55 / Chapter 2.2.3 --- SoS measurements --- p.56 / Chapter 2.2.4 --- Ultraviolet radiation strength assessment --- p.59 / Chapter 2.3 --- Statistical analysis --- p.60 / Chapter Chapter 3 --- Longitudinal Study on the Level of and Factors Affecting Vitamin D in Singleton Pregnancy --- p.62 / Chapter 3.1 --- Introduction --- p.62 / Chapter 3.2 --- Material and method --- p.63 / Chapter 3.3 --- Statistics --- p.64 / Chapter 3.4 --- Results --- p.65 / Chapter 3.4.1 --- Demographic data of the subjects --- p.65 / Chapter 3.4.2 --- Maternal levels of 25(OH)D and PTH, and the factors affecting their levels --- p.66 / Chapter 3.4.2.1 --- Distribution of 25(OH)D level and PTH level in the four visits --- p.66 / Chapter 3.4.2.2 --- Dietary intake of vitamin D and supplementation --- p.69 / Chapter 3.4.2.3 --- Seasonality and sunlight exposure --- p.73 / Chapter 3.4.2.4 --- Parity --- p.76 / Chapter 3.4.3 --- Changes of maternal levels of 25(OH)D and PTH in pregnancy --- p.78 / Chapter 3.4.4 --- Independent factors related to maternal 25(OH)D level in pregnancy --- p.79 / Chapter 3.4.5 --- Maternal and fetal 25(OH)D level at delivery --- p.80 / Chapter 3.4.6 --- Muscular symptoms and other complaints in pregnancy, pregnancy outcome, and their relationships with maternal 25(OH)D level --- p.81 / Chapter 3.4.7 --- Postnatal recovery and factors related to postnatal level of 25(OH)D and PTH --- p.86 / Chapter 3.4.7.1 --- Postnatal symptoms and relationship with 25(OH)D and PTH --- p.86 / Chapter 3.4.7.2 --- The postnatal level of 25(OH)D and PTH in women with different feeding mode --- p.88 / Chapter 3.4.7.3 --- Independent factors related to postnatal 25(OH)D and PTH level --- p.89 / Chapter 3.4.7.4 --- Factors related to the change of 25(OH)D and PTH after delivery --- p.90 / Chapter 3.4.8 --- Correlation between 25(OH)D with PTH in pregnancy and postnatal period --- p.91 / Chapter 3.5 --- Discussion --- p.92 / Chapter 3.5.1 --- 25(OH)D level in Chinese pregnant women --- p.92 / Chapter 3.5.2 --- Factors related to maternal 25(OH)D level --- p.93 / Chapter 3.5.2.1 --- Dietary and supplementation --- p.93 / Chapter 3.5.2.2 --- Seasonality and outdoor activity --- p.96 / Chapter 3.5.2.3 --- Gestational age --- p.98 / Chapter 3.5.2.4 --- Age and parity --- p.98 / Chapter 3.5.3 --- Relationship of 25(OH)D level in the cord blood with maternal 25(OH)D level --- p.99 / Chapter 3.5.4 --- 25(OH)D level and muscular complains in pregnancy --- p.100 / Chapter 3.5.5. --- Postnatal recovery and 25(OH)D level --- p.101 / Chapter 3.5.6 --- PTH level in pregnancy and postnatal period --- p.101 / Chapter 3.6 --- Conclusion --- p.102 / Chapter Chapter 4 --- Longitudinal Study on the Relationship between Maternal 25(OH)D level with Changes of Maternal Bone Density in Pregnancy and Lactation, and Factors Affecting Bone Density of newborn Infants --- p.105 / Chapter 4.1 --- Introduction --- p.105 / Chapter 4.2 --- Material and method --- p.106 / Chapter 4.3 --- Statistics --- p.108 / Chapter 4.4 --- Results --- p.108 / Chapter 4.4.1 --- Demographic data --- p.108 / Chapter 4.4.2 --- Maternal bone density and the changes in pregnancy and postnatal recovery --- p.109 / Chapter 4.4.2.1 --- Maternal bone density in the first trimester and related factors --- p.109 / Chapter 4.4.2.2 --- Maternal bone density in the three visits --- p.109 / Chapter 4.4.2.3 --- The change in maternal bone density in the three visits --- p.110 / Chapter 4.4.2.4 --- Diversity in the change of bone density in pregnant women --- p.112 / Chapter 4.4.3 --- Factors related to the changes in bone density --- p.114 / Chapter 4.4.3.1 --- Changes between the first and the third trimesters --- p.114 / Chapter 4.4.3.2 --- Change between the third trimester and postnatal visits --- p.116 / Chapter 4.4.4 --- The bone density in infants and related factors --- p.120 / Chapter 4.5 --- Discussion --- p.122 / Chapter 4.5.1 --- Maternal bone density changes in pregnancy and postnatal period --- p.122 / Chapter 4.5.2 --- Factors related to the maternal bone density changes in pregnancy and postnatal period --- p.124 / Chapter 4.5.2.1 --- Initial bone density, parity, and BMI --- p.125 / Chapter 4.5.2.2 --- 25(OH)D and PTH level --- p.126 / Chapter 4.5.2.3 --- Supplement --- p.127 / Chapter 4.5.2.4 --- Lactation --- p.128 / Chapter 4.5.2.5 --- Height --- p.129 / Chapter 4.5.3 --- Factors related to bone density of the infant. --- p.130 / Chapter 4.5.3.1 --- Maternal 25(OH)D level --- p.130 / Chapter 4.5.3.2 --- Gestational age and birthweight --- p.131 / Chapter 4.5.3.3 --- Maternal bone density change --- p.131 / Chapter 4.5.3.4 --- The gender of the offspring and feeding method --- p.132 / Chapter 4.6 --- Conclusion --- p.133 / Chapter Chapter 5 --- Maternal 25(OH)D Level in Multiple Pregnancy --- p.134 / Chapter 5.1 --- Introduction --- p.134 / Chapter 5.2 --- Material and method --- p.135 / Chapter 5.3 --- Statistics --- p.136 / Chapter 5.4 --- Results --- p.137 / Chapter 5.4.1 --- Demographic data of the subjects --- p.137 / Chapter 5.4.2 --- The level of 25(OH)D in multiple pregnancy and singleton pregnancy --- p.137 / Chapter 5.4.3 --- Supplementation in multiple pregnancy --- p.140 / Chapter 5.4.4 --- The change of maternal 25(OH)D and PTH levels in the three trimesters --- p.141 / Chapter 5.4.5 --- 25(OH)D level in cord blood and its correlation with 25(OH)D level of the sibling --- p.143 / Chapter 5.4.6 --- Correlation between 25(OH) with PTH in pregnancy --- p.143 / Chapter 5.5 --- Discussion --- p.144 / Chapter 5.5.1 --- 25(OH)D level in multiple pregnancy and singleton pregnancy --- p.144 / Chapter 5.5.2 --- Supplementation in multiple pregnancy --- p.146 / Chapter 5.5.3 --- Changes of maternal levels of 25(OH)D and PTH in the three trimesters in multiple pregnancy --- p.146 / Chapter 5.5.4 --- The PTH/25(OH) correlation --- p.147 / Chapter 5.6 --- Conclusion --- p.148 / Chapter Chapter 6 --- Maternal level of 25(OH)D in complicated pregnancy --- p.150 / Chapter 6.1 --- Introduction --- p.150 / Chapter 6.2 --- Method --- p.153 / Chapter 6.2.1 --- Preterm birth --- p.155 / Chapter 6.2.2 --- Preeclampsia --- p.155 / Chapter 6.2.3 --- Gestational diabetes --- p.156 / Chapter 6.2.4 --- Fetal growth restriction --- p.157 / Chapter 6.2.5 --- The association between 25(OH)D level with pregnancy complication --- p.158 / Chapter 6.3 --- Statistics --- p.159 / Chapter 6.4 --- Results --- p.160 / Chapter 6.4.1 --- Setting of the cutoff values of hypovitaminosis D --- p.160 / Chapter 6.4.2 --- Preterm birth --- p.160 / Chapter 6.4.3 --- Preeclampsia --- p.164 / Chapter 6.4.4 --- Gestational diabetes --- p.168 / Chapter 6.4.4.1 --- Case-control study --- p.168 / Chapter 6.4.4.2 --- Factors affecting OGTT results --- p.170 / Chapter 6.4.5 --- Fetal growth restriction --- p.173 / Chapter 6.5 --- Discussion --- p.179 / Chapter 6.5.1 --- Adjustment for confounders for case-control study --- p.179 / Chapter 6.5.2 --- PTB and 25(OH)D level --- p.181 / Chapter 6.5.3 --- PET and 25(OH)D level --- p.182 / Chapter 6.5.4 --- GDM and 25(OH)D level --- p.186 / Chapter 6.5.5 --- FGR and 25(OH)D level --- p.189 / Chapter 6.5.6 --- Defining vitamin D deficiency in pregnancy --- p.192 / Chapter 6.6 --- Conclusion --- p.195 / Chapter Chapter 7 --- Summary --- p.196 / References --- p.201 / Chapter Appendix 1 --- Antenatal questionnaire (English/Chinese) --- p.224 / Chapter Appendix 2 --- Postnatal questionnaire (English/Chinese) --- p.238

Leung Yee Fong, Vivian. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 159-169). / Acknowledgments --- p.i / Legend for figures --- p.ii / Legend for tables --- p.v / List of abbreviations --- p.vii / Abstract --- p.viii / Chapter Ch 1 --- Introduction --- p.1 / Chapter 1.1 --- Embryology --- p.1 / Chapter 1.1.1 --- Embryology of amniotic cavity --- p.1 / Chapter 1.1.2 --- Embryology of kidney and bladder --- p.3 / Chapter Ch 2 --- Background: What is already known about amniotic fluid volume? --- p.7 / Chapter 2.1 --- Normal physiology --- p.7 / Chapter 2.1.1 --- The origin of amniotic fluid: Where does it come from? --- p.8 / Chapter 2.1.2 --- Where does the amniotic fluid go? How reabsorbed? --- p.14 / Chapter 2.1.3 --- How is amniotic fluid volume controlled? --- p.18 / Chapter 2.2 --- Abnormal physiology --- p.26 / Chapter 2.2.1 --- Too much liquor: polyhydramnios --- p.26 / Chapter 2.2.2 --- Too little liquor: oligohydramnios --- p.28 / Chapter 2.2.3 --- Diseases and gender differences that may be related to parity and amniotic fluid volume --- p.30 / Chapter 2.3 --- Techniques of measuring amniotic fluid volume --- p.32 / Chapter 2.3.1 --- History --- p.32 / Chapter 2.3.2 --- Current most popular technique: amniotic fluid index --- p.38 / Chapter 2.4 --- Summary of what is known and not yet known about amniotic fluid volume --- p.48 / Chapter Ch 3 --- Aims of this study --- p.49 / Chapter Ch4 --- Method --- p.50 / Chapter 4.1 --- Equipment --- p.50 / Chapter 4.2 --- Subject selection criteria --- p.50 / Chapter 4.2.1 --- Criteria --- p.50 / Chapter 4.2.2 --- Total number of subjects studied --- p.51 / Chapter 4.2.3 --- Total number of subjects selected fulfilling all criteria --- p.51 / Chapter 4.2.4 --- Subject preparation --- p.52 / Chapter 4.3 --- Technique --- p.53 / Chapter 4.3.1 --- "Standard measurement of BPD， AC, FL and EFW" --- p.53 / Chapter 4.3.2 --- Standard measurement of Doppler --- p.54 / Chapter 4.3.3 --- Amniotic fluid index --- p.55 / Chapter 4.3.4 --- Bladder volume --- p.59 / Chapter 4.3.5 --- Fetal renal pelvis --- p.61 / Chapter 4.3.6 --- Intra-observer error techniques and calculation --- p.63 / Chapter 4.4 --- Techniques used in analysis --- p.65 / Chapter Ch5 --- Results --- p.67 / Chapter 5.1 --- Fetal parameters --- p.68 / Chapter 5.1.1 --- Fetal biparietal diameter (BPD) --- p.68 / Chapter 5.1.2 --- Fetal abdominal circumference (AC) --- p.69 / Chapter 5.1.3 --- Fetal femur length (FL) --- p.70 / Chapter 5.1.4 --- Pulsatility index values of umbilical artery --- p.71 / Chapter 5.1.5 --- Birth weight (BW) --- p.74 / Chapter 5.1.6 --- Estimated fetal weight --- p.76 / Chapter 5.2 --- Amniotic fluid index --- p.79 / Chapter 5.2.1 --- Amniotic fluid index-overall --- p.79 / Chapter 5.2.2 --- Amniotic fluid index-male and female --- p.81 / Chapter 5.2.3 --- The ten segments of amniotic fluid index distribution --- p.83 / Chapter 5.2.4 --- Amniotic fluid index relationship to estimated fetal weight --- p.86 / Chapter 5.2.5 --- Amniotic fluid index with gravidity and parity --- p.89 / Chapter 5.2.6 --- Amniotic fluid index with estimated fetal weight of different parity (best fit line) for both male and female --- p.93 / Chapter 5.3 --- Fetal urinary bladder volume (BV) --- p.96 / Chapter 5.3.1 --- Bladder volume-overall --- p.96 / Chapter 5.3.2 --- Bladder volume-male and female --- p.97 / Chapter 5.3.3 --- Bladder volume with estimated fetal weight- overall --- p.100 / Chapter 5.3.4 --- Bladder volume with estimated fetal weight in both male and female --- p.101 / Chapter 5.3.5 --- Bladder volume with gravidity and parity --- p.103 / Chapter 5.3.6 --- Bladder volume with amniotic fluid index --- p.105 / Chapter 5.4 --- Anteroposterior diameter of the fetal renal pelvis --- p.106 / Chapter 5.5 --- Hydronephrosis index values --- p.107 / Chapter Ch 6 --- Discussion --- p.108 / Chapter 6.1 --- Review of the study --- p.108 / Chapter 6.2 --- Discussion on subject --- p.111 / Chapter 6.2.1 --- Gestational age chosen --- p.111 / Chapter 6.2.2 --- Subject preparation --- p.112 / Chapter 6.3 --- Discussion of method --- p.114 / Chapter 6.3.1 --- Equipment --- p.114 / Chapter 6.3.2 --- Technique --- p.117 / Chapter 6.4 --- Discussion on results --- p.128 / Chapter 6.4.1 --- Normality of population --- p.128 / Chapter 6.4.2 --- Low birth weight/ IUGR in Chinese and Caucasian --- p.129 / Chapter 6.4.3 --- Cut-off points to detect oligohydramnios and polyhydramnios --- p.132 / Chapter 6.4.4 --- Amniotic fluid index-relationship with fetal weight --- p.143 / Chapter 6.4.5 --- Amniotic fluid index-relationship to parity --- p.145 / Chapter 6.4.6 --- "Relationship between gender, estimated fetal weight and amniotic fluid index" --- p.147 / Chapter 6.4.7 --- Parity and cut-off points for oligohydramnios and polyhydramnios --- p.150 / Chapter 6.4.8 --- Relationship of amniotic fluid volume to urinary function --- p.152 / Chapter Ch 7 --- Conclusions --- p.157 / References --- p.159

Li Siu-yan Susan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 156-168). / Abstracts in English and Chinese. / Abstract (English version) --- p.i / Abstract (Chinese version) --- p.iii / Acknowledgements --- p.v / Table of Contents --- p.vi / List of figures --- p.ix / Chapter I. --- INTRODUCTION --- p.1 / Background of the study --- p.1 / Chapter II. --- LITERATURE REVIEW --- p.5 / Maternal role attainment --- p.6 / Transitional theory --- p.16 / Feminist approaches to transition to motherhood --- p.23 / Local research on transition to motherhood --- p.26 / The rationale of the study --- p.30 / Chapter III. --- METHODS --- p.34 / Design --- p.34 / Setting --- p.39 / Sample --- p.39 / Ethical issues --- p.41 / Data collection --- p.42 / Data analysis --- p.46 / Trustworthiness of the study --- p.53 / Summary --- p.57 / Chapter IV. --- FINDINGS AND DISCUSSION --- p.59 / Conceptual categories --- p.61 / Keeping harmony --- p.62 / Giving of self --- p.63 / Discontinuity of self --- p.64 / Caring for (m)other --- p.75 / Replenishing --- p.91 / Daydreaming --- p.92 / Fortifying support --- p.98 / Developing self --- p.117 / Rewards of mothering --- p.118 / Achieving maternal competency --- p.121 / Renegotiating relationships --- p.127 / With mother-in-law --- p.130 / With husband --- p.135 / With work --- p.137 / The storyline --- p.139 / Chapter V. --- CONCLUSIONS AND RECOMMENDATIONS --- p.141 / Summary of the study --- p.141 / Implications for midwifery practice --- p.146 / Limitations and recommendations for further study --- p.152 / Personal reflections on study --- p.153 / References --- p.156 / Appendix / Chapter A. --- Letters of approval - The Chinese University of Hong Kong --- p.169 / Chapter B. --- Letters of approval - general hospital --- p.170 / Chapter C. --- Subject information sheet for the participants (English and Chinese version) --- p.171 / Chapter D. --- Consent form from the participant (English and Chinese version) --- p.173 / Chapter E. --- Transcripts in Chinese language --- p.175 / Chapter F. --- Translation of transcripts in English --- p.195 / Chapter G. --- Demographic summary of interview participants --- p.214

Submitted by FÁBIO SIQUEIRA null (fabiosqr@gmail.com) on 2017-02-02T16:15:56Z No. of bitstreams: 1 Tese Fábio Siqueira.pdf: 5157545 bytes, checksum: e3110e94c65818e724da50cfc84cb635 (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-02-06T15:51:30Z (GMT) No. of bitstreams: 1 siqueira_f_dr_bot.pdf: 5157545 bytes, checksum: e3110e94c65818e724da50cfc84cb635 (MD5) / Made available in DSpace on 2017-02-06T15:51:30Z (GMT). No. of bitstreams: 1 siqueira_f_dr_bot.pdf: 5157545 bytes, checksum: e3110e94c65818e724da50cfc84cb635 (MD5) Previous issue date: 2017-01-27 / Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS) / Objetivo: verificar a prevalência do estreptococo do grupo B em gestantes de Taguatinga, Distrito Federal, Brasil. Desenho: Estudo transversal. Local: Taguatinga (Região metropolitana de Brasília), Distrito Federal, Brasil. Introdução: o estreptococo do Grupo B é responsável por infecções graves em neonatos, resultante da transmissão vertical por gestantes colonizadas nas regiões anal, perineal ou vaginal. A identificação das pacientes colonizadas e uso de profilaxia intraparto podem reduzir o risco de infeção neonatal Métodos: Estudo transversal em pacientes gestantes entre a 35 e 37ª. semana de gravidez. Foi coletado material das pacientes para identificação laboratorial do Estreptococo do grupo B. Também foram coletados dados epidemiológicos das pacientes como peso, altura, índice da massa corporal, uso de antibióticos durante a gravidez, comorbidades durante a gravidez (diabetes, doenças hipertensivas, hipotireoidismo), gemelaridade, entre outras. Resultados: a amostra foi composta de 501 gestantes e a prevalência para o estreptococo do grupo B foi de 14%. A média de idade foi de 29 anos e o índice de massa corporal de 30,7. Durante a gravidez 204 pacientes tiveram algum tipo de infecção e 201 foram usaram antibióticos, 95 foram diagnosticadas com diabetes melito gestacional e 74 com alguma doença hipertensiva. Conclusão: a prevalência encontrada não difere do verificado por outros autores. Dentre os fatores estudados nenhum manifestou-se como fator de risco ou de proteção para a colonização materna para o estreptococo do grupo B. / Objective: To verify the prevalence of group B streptococcus (GBS) in pregnant women in Taguatinga, Federal District, Brazil. Design: Cross-sectional study. Setting: Taguatinga (metropolitan region of Brasilia), Federal District, Brazil. Sample: 501 pregnant women Methods: This cross-sectional study was conducted in pregnant women between the 35th and 37th week of pregnancy. Samples were collected from patients for laboratory identification of GBS. Epidemiological data were also collected from patients, including weight, height, body mass index, use of antibiotics during pregnancy, pathologies during pregnancy (diabetes, hypertensive disease, hypothyroidism), and twin pregnancy. Main outcome measures: Presence or absence of GBS in pregnant women. Results: The sample was composed of 501 pregnant women, and the prevalence of GBS was 14%. The average age was 29 years, and the average body mass index was 30.7. During pregnancy, 204 patients had some kind of infection, 201 of them have used antibiotics, 95 were diagnosed with gestational diabetes mellitus, and 74 were diagnosed with some kind of hypertensive disease. Conclusion: The prevalence found does not differ from that verified by other authors. None of the studied factors was a risk or protection factor for maternal GBS colonization. / FEPECS: 064.000.052/2012

Orientador: Vera Therezinha de Medeiros Borges / Coorientador: Iracema de Mattos Paranhos Calderon / Banca: Roberto Antônio de Araújo Costa / Banca: Meliza Goi Roscani / Resumo: Introdução: Diabetes Melito Gestacional (DMG) constitui risco para desenvolver diabetes melito tipo 2 e os seus possíveis desdobramentos futuros. É considerado fator de risco independente para doença cardiovascular, a principal causa de morte entre a população diabética. Objetivos: Identificar e comparar as alterações estruturais e da função diastólica cardíaca em gestantes portadoras de diabetes gestacional e gestantes sem patologias, e verificar se existem correlações entre características clínicas e variáveis bioquímicas maternas com o índice de massa ventricular (iMVE) e a razão entre pico de velocidade do fluxo diastólico transmitral no início da diástole (E') e pico de velocidade do fluxo diastólico transmitral durante a contração atrial (A'). Sujeitos e Métodos: Foi realizado estudo prospectivo e transversal em gestantes com DMG (n=21) e gestantes sem patologias (n=23). Todas as gestantes realizaram ecocardiograma entre a 34ª. e a 37ª. semanas de gestação, cujos resultados foram analisados estatisticamente para comparação entre os grupos estudados, adotando-se o limite mínimo de significância de 95% (p<0,05). Resultados: Entre as características clínicas e variáveis bioquímicas estudadas, os valores de idade, paridade, índice de massa corpórea pré-gestacional e gestacional, glicemia de jejum e hemoglobina glicada foram significativamente maiores no grupo DMG. Das variáveis estruturais, a espessura da parede posterior, do septo interventricular, a massa do VE e o iMVE foram significativamente maiores ... / Abstract: Background: Gestational Diabetes Mellitus (GDM) is a risk condition for developing type 2 diabetes and its possible future developments. It is considered an independent risk factor for cardiovascular disease, the leading cause of death among diabetic patients. Objective: To identify and compare the structural and diastolic function in pregnant women with gestational diabetes mellitus and healthy pregnant women and verify possible correlation between clinical and biochemical variables with maternal ventricular mass index (LVMI) and the ratio of peak of transmitral diastolic flow velocity in early diastole (E') and peak velocity of transmitral diastolic flow during atrial contraction (A'). Subject and Methods: This was a prospective cross-sectional study in women with GDM (n = 21) and healthy pregnant women (n = 23). All the women underwent echocardiography between the 34th. and the 37th. weeks of gestation, and the results were statistically analyzed for comparison between groups, adopting the threshold of significance of 95% (p <0.05). Results: Clinical features and biochemical variables, values for age, parity, body mass index gestational and before pregnancy, fasting glucose and hemoglobin A1c were significantly higher in GDM group. Posterior wall thickness, interventricular septum, LV mass and LV mass index were significantly higher in GDM group. The E' and E'/A' were significantly lower in the GDM group, which also showed a positive correlation between LVMI, fasting glucose and pregnancy body mass index. Conclusion: Pregnant women with GDM have different diastolic profile, near to dysfunctional pattern, but within the range of normal values for the parameters studied. Even so, as the dysfunctional pattern tends to evolve with advancing age, it is recommended to these women more rigorous monitoring of glycemic control and cardiovascular system / Mestre

Orientador: José Carlos Peraçoli / Coorientador: Paulo Roberto Margotto / Banca: Paulo Sérgio França / Banca: Roseli Mieko Yamamoto Nomura / Resumo: O objetivo desta revisão foi apresentar informações atuais sobre a prevalência do sobrepeso e da obesidade e discutir as evidências acerca do impacto desses estados nutricionais na saúde da mãe e do concepto. A busca pelos artigos foi realizada através de pesquisa nos bancos de dados MEDLINE/PUBMED e SCIELO abrangendo os últimos 5 anos e através da revisão das referências bibliográficas dos artigos selecionados. Diante de assuntos com resultados discordantes ou sem informações satisfatórias, procedemos a uma terceira etapa de busca, usando ampla variedade de termos. Os artigos encontrados foram selecionados por avaliação subjetiva, considerando metodologia, tamanho da amostra, coerência nas conclusões e o ano de publicação. Informações atuais sustentam uma prevalência elevada e crescente do sobrepeso e da obesidade. Fortes evidências associam esses estados nutricionais no período pré-gestacional ao desenvolvimento de hipertensão específica da gestação, diabete gestacional, gestação com 41 semanas ou mais, tromboembolismo, realização de cesariana, infecção puerperal, macrossomia, malformações fetais e mortes fetal e neonatal. O excesso de peso no período pré-gestacional é um dos mais importantes fatores de risco à saúde da mãe e do concepto, cuja importância aumenta por se tratar de fator de risco modificável. A gestante obesa deve ser considerada de alto risco e é recomendável que as mulheres estejam com o peso o mais próximo possível do normal antes da concepção / Abstract: The goal of this review was to present up-to-date information on the prevalence of overweight and obesity and to discuss the evidence regarding the impact of these nutrition-related conditions on the health of mother and fetus. We conducted a search for articles in the MEDLINE, PUBMED and SCIELO databases covering the past 5 years, and reviewed the bibliographical references contained in the articles selected. After reviewing cases with discordant results or lacking satisfactory data, we proceeded to a third step using a wide variety of TORs. Articles were selected by subjective evaluation in terms of methodology, sample size and year of publication. We found strong evidence linking excess weight before pregnancy with the development of pregnancy-induced hypertension, gestational diabetes, pregnancy at 41 weeks or over, thromboembolism, cesarean section, puerperal infection, macrosomia, birth defects and fetal and neonatal deaths. Excess weight during pre-pregnancy is one of the major risk factors affecting the health of mother and fetus. It is especially important to realize that this is a modifiable risk factor. Since obese pregnant women must be considered at high risk it is recommended that they should focus on attaining a normal weight before conceiving / Mestre

Orientador: Iracema Matos Paranhos Calderon / Coorientador: Adriana Pederneiras Rebelo da Silva / Banca: Simone Gonçalves de Almeida / Banca: Belmiro Gonçalves Pereira / Resumo: A nutrição adequada é importante na gestação e, sobretudo, naquelas complicadas pelo diabete. Avaliar o consumo alimentar, pelo Índice de Qualidade de Dieta (IQD), em gestantes portadoras de Diabetes Melito Gestacional (DMG), referenciadas para o serviço especializado. Estudo transversal e descritivo em 65 gestantes portadoras de DMG, após a 20ª semana. O consumo alimentar foi quantifi cado pelo VET R24h, e pelo VET QFA, e qualifi cado pelo IQD, proposto por Fisberg et al. (2004), adaptado para a população de gestantes diabéticas. 67,7% das gestantes apresentavam IMC pré-gestacional ≥ 25 kg/m2. O valor calórico observado no R24h foi de 1657 ± 532 kcal. De acordo com o IQD, a dieta foi adequada em 51,6% das gestantes. Os componentes de pior pontuação foram os vegetais e os produtos lácteos. A ingestão de carnes, sódio e gordura total receberam as maiores pontuações. O IQD, referenciado pelo R24h e aplicado como instrumento de avaliação nutricional, evidenciou que a dieta foi considerada inadequada ou com necessidade de adequação em metade da população de gestantes avaliadas. Estas inadequações foram relacionadas à baixa ingestão de verduras e legumes e de leite e produtos lácteos. Tais resultados indicam a necessidade de priorizar ações educativas no pré-natal, para incentivar o consumo de vegetais e produtos lácteos entre essas gestantes, portadoras de DMG / Abstract: To proper nutrition is important during pregnancy and especially in those complicated by diabestes. Evaluating food intake, the Indicators of Diet Quality (IDQ), in pregnant women with GDM, referenced to the specialist service. Descriptive cross-sectional study in 65 pregnant women with Gestacinal Diadetes Mellitus (GDM) after 20 weeks. Food intake was measured by R24h VET and the FFQ, and qualifi ed IDQ proposed by Fisberg et al. (2004), adapted for the population of diabetic women. 67.7% of the women had pré-pregnancy BMI ≥ 25 kg/m2 . The caloric value was observed in 24-hour recall of 1657 ± 532 kcal. According to IDQ, the diet was adequate in 51.6% of pregnant women. The components were the worst score vegetables and dairy products. The intake of meat, total fat and sodium received the highest scores. IDQ, referenced by 24-hour recall and applied as a tool for nutritional assessment showed that the diet was considered inappropriate or in need of adjustment in half of the pregnant population evaluated. These inadequacies were related to low intake of vegetables and milk and dairy products. These results indicate the need to prioritize educational activities in prenatal care, to encourage consumption of vegetables and dairy products from these pregnant women, suffering from DMG / Mestre

Orientador: Iracema de Mattos Paranhos Calderon / Coorientador: Adenilda Cristina Honorio-França / Banca: Lígia Maria Suppo de Souza Rugolo / Banca: Patrícia Palmeiras / Banca: Solange Barros Carbonare / Banca: Silvana Andrea Molina Lima / Resumo: Não disponível / Abstract: Not available / Doutor

A atenÃÃo integral proposta pela EstratÃgia SaÃde da FamÃlia contempla uma reorientaÃÃo do modelo assistencial, superando o antigo mÃtodo centrado na doenÃa. Por essa abordagem peculiar, os trabalhadores da saÃde podem ter uma visÃo inovadora, tanto centrada na pessoa, como focada no contexto amplo da famÃlia, com novos modos de cuidar. Este estudo teve como objetivo desenvolver uma tecnologia leve aplicada a gestantes vulnerÃveis à rejeiÃÃo da gravidez e concepto, buscando fortalecer o vÃnculo mÃe-filho-mundo. Tratou-se de uma abordagem norteada pela pesquisa-cuidado, cujo propÃsito foi beneficiar as participantes pelas diferentes formas de cuidar. A coleta de dados ocorreu pela aplicaÃÃo de formulÃrios, recursos de filmagem e gravaÃÃo de cinco sessÃes grupais, captando a essÃncia do fenÃmeno da rejeiÃÃo, tanto nas falas, como na linguagem corporal das participantes. Alguns resultados quantitativos foram apresentados em grÃficos e tabelas construÃdos a partir dos programas Excel e World versÃo 2010. A anÃlise desses dados delineou o perfil sociodemogrÃfico que vulnerabilizava o contexto da maternagem entre as participantes. Os dados qualitativos foram avaliados e confrontados pela abordagem fenomenolÃgica de Moustakas, a qual se adequou a esta pesquisa por ser mais focada na descriÃÃo das experiÃncias das participantes. A anÃlise revelou que um ambiente, no qual predominam a violÃncia intrafamiliar, a ausÃncia do parceiro, a dependÃncia econÃmica materna, carÃncias de uma mÃe suficientemente boa, memÃrias punitivas dessa mÃe e o nÃo planejamento da gravidez, percebida como sem sentido, influencia diretamente na negaÃÃo da maternidade, constituindo-se um entrave na relaÃÃo harmÃnica mÃe-filho-mundo. Tais fatores podem ser reproduzidos em um mecanismo de rejeiÃÃo, transmitido a cada geraÃÃo familiar. Subjetivamente, foram relatados sentimentos de medo, inseguranÃa, impotÃncia, mÃgoa, vergonha e negaÃÃo na construÃÃo da descriÃÃo estrutural deste estudo. Durante a aplicaÃÃo da pesquisa-cuidado, verificou-se a relevÃncia do cuidado na abordagem de grupo, como proposta de desconstruir o fenÃmeno da rejeiÃÃo. Propiciou-se, assim, um resgate aos princÃpios da maternagem, transcrito nas falas e observado nas imagens por meio de sete unidades de significado, inicialmente caracterizadas pela mÃgoa, desprezo, rejeiÃÃo, aborto e ambivalÃncia de sentimentos, reestruturadas pela resiliÃncia e finalizadas pela aceitaÃÃo. Por fim, à extremamente relevante se promover uma assistÃncia eficaz Ãs gestantes mais vulnerÃveis à rejeiÃÃo e instituir grupos como suporte nos eixos da saÃde mental e cuidado.

A gravidez na adolescÃncia em comunidades de baixa renda surge como um problema multifacetado que envolve uma sÃrie de fatores e indicadores que estimulam o aumento das experiÃncias sexuais das adolescentes, potencializando sua condiÃÃo de vulnerabilidade. Este estudo teve como objetivo compreender os fatores individuais, sociais e familiares à vulnerabilidade para gravidez entre adolescentes de uma comunidade de baixo poder aquisitivo em Fortaleza, CearÃ. Estudo com multimÃtodos, desenvolvido em quatro fases, interrelacionadas. Na primeira fase, (1 semestre de 2009), participaram 15 adolescentes nuligrÃvidas, e foi identificado o significado da gravidez na adolescÃncia a partir de quatro prÃticas expressivas utilizando-se a arte-terapia, cujos depoimentos geraram trÃs temas: 1) adolescÃncia, fase feliz; 2) experiÃncias de mudanÃa e 3) responsabilidade face a gravidez. A segunda fase (1 semestre de 2010), apreendeu a percepÃÃo de mÃes de adolescentes sobre as causas associadas a gravidez nesta fase. Mediante o mÃtodo de anÃlise temÃtica, desvelou 2 categorias: 1. Maus-tratos contra a adolescente e; 2. ViolÃncia contra a mulher. Na fase seguinte, (2 semestre 2010), foram apreendidos os motivos da gravidez na percepÃÃo de adolescentes mÃes (n=17), cujos dados apontaram: descuido com o planejamento familiar, a mudanÃa de status social e o desejo da maternidade. Na Ãltima fase, (1 semestre de 2011), foram identificados fatores individuais, sociais e familiares relacionados com a vulnerabilidade para gravidez em 136 adolescentes. Os resultados apontaram trÃs fatores individuais e cinco familiares associados à gÃnese da gravidez na adolescÃncia, o fato de ser casada (RR= 4,38, IC=95%: 2,38-8,07, p= 0,003), o nÃo uso do preservativo na Ãltima relaÃÃo sexual (RR= 4,81, IC=95%: 1,26-18,31, p= 0,0021), a baixa autoestima (RR= 3,02, IC=95%: 1,60-5,71, p= 0,0014), a presenÃa de problema ou violÃncia no contexto familiar (p= 0,005), oconsumo de Ãlcool pelo pai (p= 0,039), a ausÃncia de diÃlogo com a mÃe (p= 0,004), a reaÃÃo punitiva materna com o desempenho escolar ruim (p= 0,002) e a ridicularizaÃÃo da filha pela mÃe (p= 0,001). Os estudos demonstraram que o significado da gravidez na adolescÃncia foi associado à independÃncia financeira, à evasÃo escolar e à violÃncia domÃstica. AlÃm de desfechos negativos, a gravidez na adolescÃncia foi motivada por um desejo de a jovem adquirir respeito da sociedade e reconhecimento em sua vida, como uma mulher âde verdadeâ, a partir da posiÃÃo assumida de mÃe. Os fatores associados à gravidez na adolescÃncia foram diretamente relacionados à vulnerabilidade individual e social e ao ambiente familiar negligente, ao qual estÃo expostas essas adolescentes, uma vez que se encontram em condiÃÃes desfavorÃveis financeiramente. / Teenage pregnancy in low-income communities emerged as a multifaceted problem that involves a number of factors and indicators that stimulate increased sexual experiences of adolescents, increasing their vulnerability condition. This study aimed to understand the individual, social and familial vulnerability to adolescent pregnancy in a low income community in Fortaleza, CearÃ. Study with multimÃtods developed in four phases, interrelated. In the first phase (1st half of 2009), attended by 15 teenagers nuligrÃvidas, and to identify the significance of teenage pregnancy from four expressive practices using art therapy, whose testimony led to three themes: 1) adolescence stage happy, 2) changing experiences and 3) liability to pregnancy. The second phase (1st half of 2010), seized the perception of mothers about the causes of teenage pregnancy associated with this stage. Through the method of thematic analysis unveiled two categories: 1. Maltreatment among the teen and 2. Violence against women. In the next phase, (2nd half 2010), were seized on the grounds of pregnancy perception of adolescent mothers (n = 17), whose data showed: neglect of family planning, the change of social status and desire for motherhood. In the last phase (1st half of 2011), we identified the individual, social and family-related vulnerability to pregnancy in 136 adolescents. The results showed three individual factors and five family members associated with the genesis of teenage pregnancy, the fact of being married (RR = 4.38, 95% CI: 2.38 to 8.07, p = 0.003), not using condom at last intercourse (RR = 4.81, 95% CI: 1.26 to 18.31, p = 0.0021), low self-esteem (RR = 3.02, 95% CI: 1, 60 to 5.71, p = 0.0014), the presence of trouble or violence within the family (p = 0.005), alcohol consumption by the father (p = 0.039), absence of dialogue with the mother (p = 0.004), maternal punitive reactions with poor school performance (p = 0.002) and ridicule the child by the mother (p = 0.001). Studies have shown that the meaning of teenage pregnancy was associated with financial independence, to truancy and domestic violence. In addition to negative outcomes, teenage pregnancy was motivated by a desire to acquire the young about the society and recognition in your life as a woman "real" from the position adopted mother. Factors associated with teenage pregnancy were directly related to individual vulnerability and social and family environment negligent, which are exposed to these teenagers, since they are financially unfavorable conditions.