Postpartum depression is by definition a major depression with an onset during the first weeks after delivery. In practice, however, the term, postpartum depression is used to characterize all kinds of depressive symptoms after childbirth. The aims of this thesis were to investigate the prevalence of depressive symptoms during late pregnancy, in the puerperium and four years after delivery, and to analyze the mothers’ estimation of personal health and their children’s behavior at the age of four. Additional goals were to test the predictive power of potential associated factors of postpartum depression during pregnancy and the puerperium and finally, to elucidate possible genetic or neuropeptidergic explanatory variables behind the development of postpartum depression. A population-based sample of 1489 women was screened with the Edinburgh Postnatal Depression Scale and the prevalence of depressive symptoms was 17% in late pregnancy and 13% postpartum. Antenatal depressed mood was related to postpartum depression. In a cross-sectional study we later found that postpartum depression was associated with subsequent depressive symptoms and current health problems four years after childbirth. Four-year-old boys of postpartum depressed mothers and children of mothers with a subsequent depressive status had more behavior problems than children of non-symptomatic mothers did, according to the mothers’ opinion. The strongest associated factors for postpartum depression, in a case-control study, were sick leave during pregnancy mainly due to pregnancy complications, e.g. hyperemesis and premature contractions and a high number of visits to the antenatal care clinic. There was no association between delivery complications or complications in the perinatal period and postpartum depression. The theory that depressive symptoms in late pregnancy or postpartum are connected with CYP2D6 genotype could not be confirmed. In a rat model, we found that pregnancy and parturition influence the concentrations of neuropeptide Y, cholecystokinin, substance P and galanin in the rat brain. This result supports the hypothesis that neuropeptidergic systems in the brain influence the mood changes around childbirth. In conclusion, postpartum depression is a common feature with influence on both maternal and child well being. / Pages 26 and 57 containing illustrations are removed from the electronic version. On the day of the public defence the status of article IV was: Accepted for publication.

Syfte och frågeställningar Studiens syfte var att undersöka gravida kvinnors aktivitetsvanor under respektive trimester samt barnens födelsevikt. Därför undersöktes moderns fysiska aktivitetsnivå och om den påverkade barnets födelsevikt samt huruvida moderns ålder hade betydelse för vilken form av fysisk aktivitet som utfördes. I studien granskades även om det förelåg någon skillnad beträffande barnets medelfödelsevikt mellan mödrarnas åldersgrupper. Frågeställningarna var: 1. Gravida kvinnors fysiska aktivitetsvanor - Antal dagar i veckan - Aktiviteter som utfördes - Anledning till inaktivitet 2. Fanns det någon skillnad mellan fysisk aktiva och inaktiva mödrar gällande barnets medelfödelsevikt? - Den fysiska aktivitetsnivåns påverkan på barnets födelsevikt. 3. Skiljde sig valet av fysisk aktivitet och barnets medelfödelsevikt åt mellan mödrarna i respektive åldersgrupp? - Förelåg det någon skillnad mellan kvinnornas åldersgrupper gällande om de var fysiskt aktiva eller inaktiva? Metod Fyra BCV (Barnavårdscentraler) i en storstadskommun kontaktades och totalt delades 116 stycken enkäter ut. Vi fick tillbaka 58 enkäter och analyserade dem i SPSS. Efter insamlandet av enkäten hölls kortare gruppsamtal med sköterskorna på respektive BVC där de fick dela med sig av sina erfarenheter inom området och kring vårt valda ämne. Litteratursökningen som gjordes innebar att vi tittade på tidigare studier för att få en större kunskap inom det valda området. Denna litteratursökning gjordes främst på Internet med hjälp av olika databaser men även utländsk litteratur studerades. Resultat Resultatet visade att den fysiska aktivitetsnivån hos de gravida kvinnorna sjönk desto senare in i graviditeten de kom. Den form av fysisk aktivitet som kvinnorna valde främst var promenader, men även gruppträning, styrketräning samt annan aktivitet fanns med som dominerande aktiviteter. Främsta anledningen till inaktiviteten som kvinnorna själva angav var medicinska skäl/komplikationer kopplade till graviditeten. För de tre trimestrarna kunde ingen nämnvärd skillnad ses på barnens medelfödelsevikt mellan de kvinnor som varit fysiskt aktiva under graviditeten och de som varit inaktiva enligt vår egen klassificering. Det var främst de yngre mödrarna som stod för denna inaktivitet. Det studien även fann var att de mödrar som födde barnen med en låg födelsevikt, var de kvinnor som under sin graviditet varit mest fysiskt aktiva. Resultaten visade också på att valet av fysisk aktivitet skiljde sig en aning åt mellan de båda åldergrupperna av mödrar och att barnen till de yngre mödrarna hade en obetydligt högre medelfödelsevikt. Slutsats Vi kan inte från studien dra några generella slutsatser inom ämnet men materialet kan användas för vidare forskning inom området och för att testa olika hypoteser. / Aim and questions The aim of this study was to examine pregnant women’s habits in physical activity during the three trimesters and the birth weight of the children. There for the mother’s level of physical activity and if it had any correlation with the birth weight of the child were examined. We furthermore wanted to see if there was a difference between the older and younger women in the choice of activities and in the children’s birth weight. The questions were: 1. Pregnant women’s habits in physical activity - The number of days per week - The activities that were practised - The reasons for inactivity 2. Was there a difference between physically active and inactive mothers when it comes to the child’s birth weight? - The level of physical activities’ influence on the child’s birth weight 3. Was there a difference in the choice of physical activity and the child’s birth weight between the mothers in respectively age-group? - Was there a difference between the women in respectively age-group considering weather or not they were physically active? Method Four child health centres in a big city municipality were contacted and 116 questionnaires were given out. We received back 58 questionnaires and analyzed them in SPSS. After that shorter interviews were held with the nurses in groups where they shared their experiences in the field. We also looked into other studies made in the field on the Internet and in different databases and literature to get a deeper understanding in the subject. Results The study showed that the level of physical activity amongst the pregnant women decreased the later in the pregnancy that they proceeded. The study also showed that the pregnant women all in all during the three trimesters foremost practised walks, but weight-lifting, grouptraining and other activities were also performed. The main reason for inactivity was medical reasons/complications connected to the pregnancy. There was no considerable difference in the children’s mean birth weight between the active and inactive mothers according to our definition and it was foremost the younger mothers that were inactive. The study also found that the mothers that gave birth to the children with low birth weight were also the ones that had been most physically active during their pregnancy. The result also showed that there was a small difference in the choice of activities between the two age-groups in the mothers and the children to the younger mothers had an insignificant higher mean birth weight. Conclusion The results of the study is not enough to make any general conclusions in our subject but it can be used as a foundation for further research in the field and to test different hypothesises.

The consequences of rape can be both psychologically and physically damaging to the victim. Unfortunately, it is all too frequently the case that attitudes against the victim in the form of acceptance of rape myths and other forms of victim-blaming serve merely to perpetuate these psychological consequences. This study looks at both the theoretical feminist and psychoanalytic perspectives that lay the groundwork for the foundations of Western culture’s inability to understand and empathize the female bodily condition in terms of rape and pregnancy, and the psychological effects that contribute to juror perceptions of rape victims and attitudes towards abortion. A study was run comparing a control trial transcript of a rape case, a transcript where the victim became pregnant, and one where she had an abortion as a result of her pregnancy, against responses to questions of rapist and victim-blame and empathy. The results were scattered, but overall there were significant differences in jurors perceptions of the rape, the victim, and the rapist that fluctuated as a result of pregnancy or abortion being admitted into evidence.

No description available.

Statement of the problem The primary objective of this thesis was to determine the best study design to evaluate the safety and effectiveness of an intermediate dose of low molecular weight heparin for secondary prevention of pregnancy associated VTE (PAVTE). An RCT was deemed unfeasible,so the use of a single arm study with prior evaluation of feasibility with a pilot study is proposed. // Methods - A systematic review was conducted to evaluate the efficacy of current strategies used for secondary prevention of PAVTE.A survey was used to elicit the non-inferiority margin. // Results - The pooled proportion of recurrent VTE in patients treated with full dose LMWH was 0.012(95% CI 0.006 to 0.02) and the rate of major bleeding was 0.025(95% CI=0.01 to 0.041). The non-inferiority margin was elicited at 2.5%. // Conclusions - Although a randomized controlled trial should be conducted whenever possible, in certain scenarios they are unfeasible. Therefore, an alternative study design should perhaps be used to evaluate the safety and efficacy of therapeutic strategies.

Much of the maternal health care literature on Aboriginal women is biomedical in its focus, covering topics such as gestational diabetes, abnormal birth weight, and infant morality. There has also been some exploration of First Nations womens relationships with health professionals. There is a dearth of literature that addresses First Nations womens choices, experiences, knowledges (traditional and medical), attitudes, beliefs and values surrounding their pregnancies and prenatal health care. This qualitative study conducted by a Mikmaw woman explores Mikmaw womens perceptions of their maternal health, the relationships that support or serve Mikmaw women during their pregnancy, birthing, and postpartum delivery in two First Nations communities in Nova Scotia. The stories of fourteen Mikmaw female participants, ranging from young women to Elders, were explored using a narrative inquiry approach that is consistent with First Nations oral traditions of storytelling. Stories were told in a focus group and individual interviews. Data collection, analysis, and interpretation was guided by an Indigenous framework of two superimposed medicine wheels: (1) holistic model of health (mental, physical, emotional and spiritual), and; (2) maternal health life cycle (becoming a woman, teachings during pregnancy, experiences during birth, motherhood and the fourth trimester: after birthing). This study found that the colonization of birthing has significantly impacted Mikmaw maternal health experiences, and is characterized by a tension between western medical knowledge and Mikmaq traditional knowledge systems that plays out very strongly during this critical period in the life of a woman and her child. In addition, recognition of the socio-cultural context of Mikmaq women is critical to understanding their decision making in regards to maternal health. The results suggest there is a need to create culturally sensitive models of maternal health that incorporate First Nations traditional knowledge of maternity and Western medical knowledge.

The objective was to investigate the effects of progesterone (P4) on luteinizing hormone (LH) release, follicle development, and oocyte competence in cattle. We tested the general hypotheses that: 1) The suppressive effect of P4 on gonadotrophin releasing hormone (GnRH)-mediated LH release can be overcome by increasing GnRH dose or pre-treatment with estradiol (E2); and 2) a shorter period of P4 exposure during the growing phase of the ovulatory follicle improves oocyte competence and fertility after fixed-time artificial insemination or superstimulation in cattle. <p>In the first experiment, heifers (n=22) were treated with 100 or 200 µg of GnRH or pretreated with E2 prior to administration of GnRH during high or low circulating P4 concentrations to characterize LH release (Chapter 2). Increasing the dose of GnRH did not alter LH secretion; however, E2 pretreatment overcame the suppressive effect of high P4 on LH secretion. Cattle with lower (n=11) P4 concentrations had higher circulating LH concentrations than those with higher P4 concentrations (n=11), and tended to have higher ovulation rates. <p>Two experiments were conducted to determine the effect of the duration of P4 exposure during the ovulatory wave on fertility followed fixed-time artificial insemination or superstimulation. In the first experiment (Chapter 3), the dominant follicle was allowed to grow for 3 days (n=181) or 6 days (n=184). Six days of growth resulted in a larger dominant follicle, but in both groups, ovulatory follicles had similar capacities to ovulate and establish pregnancy. In the second experiment (Chapter 4), multiple follicles were allowed to grow for 3 or 6 days by 8 or 14 injections of FSH (at 12-hour intervals). There was no difference between groups for ovulation rate or total ova/embryo recovery rate. Although the 3-day group had higher embryo quality at slaughter (4 days after insemination), further development (7, 9, and 10 days after insemination) did not differ among groups. The effect of FSH starvation following 4 days of FSH treatment (Chapter 4) resulted in loss of ovulatory capability. Overall, a shorter duration of P4 exposure during ovulatory follicle growth did not improve fertility after fixed-time AI or oocyte competence after superstimulation.

This review of sexual education in the United States broadly defines the two most common approaches in sexual education seen in this country today. I cover the status of certain sexual behaviors and risks amongst the teenage population in the U.S. and specifically cover reported sexual activity in high school students and overall data on teen pregnancies and sexually transmitted infections (STIs). This work specifically looks at Maine, California, Texas, Maryland, North Carolina, and New Mexico to highlight the variety of state policies concerning sexual education and the differences in teenage sexual behaviors that exist within each of those six states. A description of how cultural influences can affect a young person’s sexual behavior is also given. In the final discussion section of this paper I have emphasized the need for more comprehensive sexual education programs in the United States and the importance of providing culturally sensitive programs in order to continue the fight against teenage pregnancy and STI rates in adolescents.

Purpose To investigate associations between maternal use of selected medications during early pregnancy and the risk of hypospadias in male infants. Methods We used data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study. We analyzed data from 1,537 case infants with second or third degree isolated hypospadias and 4,314 male control infants born from 1997-2007. Exposure was based on reported use of any prescription or over-the-counter medication or herbal product, for which there were at least 5 exposed cases, from 1 month before to 4 months after conception, excluding topicals, vitamins, minerals, and products for which the components were unknown. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were estimated using multivariable logistic regression, adjusting for several confounders. Results Of the 195 medication components with at least 5 exposed cases, 89 components met the inclusion criteria and were assessed-28 herbal and 61 non-herbal components. Hypospadias was associated with reported use of cephalexin (aOR 3.06; 95% CI 1.02, 9.18), phenylpropanolamine HCl (aOR 2.68; 95% CI 1.06, 6.80), and ibuprofen (aOR 1.16; 95% CI 1.00, 1.34), in primary analyses. Conclusions We replicated a previously observed association between maternal exposure to phenylpropanolamine HCl and hypospadias. The associations with cephalexin and ibuprofen have not previously been reported. Given the exploratory nature of the analyses, these results should be considered hypothesis-generating. Better understanding of the potential fetal effects will allow clinicians and women of childbearing age to make more informed decisions regarding the use of medications during pregnancy.

The objective was to investigate the effects of progesterone (P4) on luteinizing hormone (LH) release, follicle development, and oocyte competence in cattle. We tested the general hypotheses that: 1) The suppressive effect of P4 on gonadotrophin releasing hormone (GnRH)-mediated LH release can be overcome by increasing GnRH dose or pre-treatment with estradiol (E2); and 2) a shorter period of P4 exposure during the growing phase of the ovulatory follicle improves oocyte competence and fertility after fixed-time artificial insemination or superstimulation in cattle. <p>In the first experiment, heifers (n=22) were treated with 100 or 200 µg of GnRH or pretreated with E2 prior to administration of GnRH during high or low circulating P4 concentrations to characterize LH release (Chapter 2). Increasing the dose of GnRH did not alter LH secretion; however, E2 pretreatment overcame the suppressive effect of high P4 on LH secretion. Cattle with lower (n=11) P4 concentrations had higher circulating LH concentrations than those with higher P4 concentrations (n=11), and tended to have higher ovulation rates. <p>Two experiments were conducted to determine the effect of the duration of P4 exposure during the ovulatory wave on fertility followed fixed-time artificial insemination or superstimulation. In the first experiment (Chapter 3), the dominant follicle was allowed to grow for 3 days (n=181) or 6 days (n=184). Six days of growth resulted in a larger dominant follicle, but in both groups, ovulatory follicles had similar capacities to ovulate and establish pregnancy. In the second experiment (Chapter 4), multiple follicles were allowed to grow for 3 or 6 days by 8 or 14 injections of FSH (at 12-hour intervals). There was no difference between groups for ovulation rate or total ova/embryo recovery rate. Although the 3-day group had higher embryo quality at slaughter (4 days after insemination), further development (7, 9, and 10 days after insemination) did not differ among groups. The effect of FSH starvation following 4 days of FSH treatment (Chapter 4) resulted in loss of ovulatory capability. Overall, a shorter duration of P4 exposure during ovulatory follicle growth did not improve fertility after fixed-time AI or oocyte competence after superstimulation.