Establishment of pregnancy in ruminants requires blastocyst development to form an elongated filamentous conceptus that produces interferon tau (IFNT), the pregnancy recognition signal, and initiate implantation. Blastocyst growth and development is dependent upon secretions from the uterine endometrium. An early increase in post-ovulatory circulating levels of progesterone (P4) stimulates blastocyst growth and conceptus elongation in ruminants. Microarray analysis was used to identify candidate P4-regulated genes and regulatory networks in the endometrium that govern peri-implantation blastocyst/conceptus growth and development. The first study was conducted to validate effects of P4 and/or pregnancy on expression of candidate genes identified by microarray analysis. The genes included: ANGPTL3, CHGA, CLEC4E, CXCL14, EFNA1, EFNB1, FABP3, IFNG, IL6, LGALS3, PTH, RBP4, SLIT2, SLIT3, and VWF. Early P4 treatment up-regulated CXCL14 gene expression in Day 9 ovine endometrium compared to control endometrium, and FABP3, IFNG, IL6 and LGALS3 in Day 12 early P4-treated ovine endometrium. Expression of ANGPTL3, CHGA, CXCL14, EFNA1, EFNB1, LGALS3 and RBP4 was affected by day of pregnancy. Treatment of ewes with P4+RU486 (P4 receptor antagonist) reduced expression of ANGPTL3, CHGA, EFNA1, EFNB1, FABP3, IFNG, IL6, LGALS3, RBP4, and SLIT2, SLIT3 and VWF in comparison to Day 12 P4-treated endometrium. The second study evaluated expression of genes identified by microarray analysis in endometrium from pregnant and cyclic ewes. Genes evaluated included those from the first study. ANGPTL3, CHGA, CXCL14, EFNA1, EFNB1, IFNG, LGALS3, PTH, RBP4, SLIT2, SLIT3 and VWF were affected by day, status and/or their interaction between Days 10 and 16. Of note, FABP3 increased 21-fold between Days 14 to 18 of pregnancy, and IL6 increased 37-fold between Days 14 to 20 of pregnancy. In situ hybridization analysis detected FABP3 mRNA in both luminal and superficial glandular epithelia of pregnant ewes and trophectoderm, whereas IL6 mRNA was detected in immune cells within uterine luminal epithelium and glandular epithelium and trophectoderm. Collectively, these results identify candidate genes encoding for biologically active molecules that regulate growth and development of the ovine conceptus during the peri-implantation period of pregnancy.

Thesis (MAppSc in Pharmacy)--University of South Australia, 1995

Screening pregnant women for substance use appears unworthy of debate given the harmful impacts on the fetus, pregnancy outcomes, the woman herself and her offspring to adulthood. However while screening is routine for conditions such as impaired glucose control, obstetric care providers are often reluctant to intervene with substance use, citing knowledge deficits and a lack of effective screening tools. General negativity about the value of intervention and stereotypical views of substance users have also been identified. This study examined existing screening tools and investigated the World Health Organization’s ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) Version 3.0, focussed on tobacco, alcohol and cannabis, the substances most used in the targetted public hospital clinics. The ASSIST Version 3.0’s performance in pregnancy was assessed using a two-pronged harm categorization: risk to the fetus and risk to the woman as an individual user. For the latter, levels of risk concordant with cut-offs for the general population were utilized. The ASSIST Version 3.0 performed only moderately well versus established self-report tools: the Revised Fagerstrom Tolerance Questionnaire (RTQ) for tobacco, the T-ACE for alcohol, and the Timeline FollowBack (TLFB) for cannabis. Most participants used tobacco (98 of 104); predominance of tobacco use was likely linked to the recognized difficulty in stopping, despite cessation of other substances. Kappa analyses of Specific Substance Involvement Scores (SSIS) on ASSIST Version 3.0 for tobacco did not support changing cut-offs for the woman as an individual user; however, ROC curves delineated an SSIS of 4 as indicative of fetal risk for both alcohol and cannabis. As all 98 tobacco users were ‘high risk’ users, a cut-off indicative of fetal risk for tobacco could not be determined but may be feasible by further research with first trimester women. Identifying tobacco use with an established tobacco-specific tool should be the first screening for pregnant women. If tobacco use is identified, screening for other substance use can be initiated and there may be a place for the ASSIST Version 3.0 in that context. Obstetric care providers need to then be willing and competent to address identified use, whilst avoiding unhelpful stereotyping. / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2010

Thesis (MAppSc in Pharmacy)--University of South Australia, 1995

Aims : The aims of the study were to describe the experiences of the midwives who were part of the first Australian CenteringPregnancy Pilot Study and to inform the future development of CenteringPregnancy. Background CenteringPregnancy is a model of group antenatal care that has evolved over the past two decades in North America. A pilot study that explored the feasibility of implementing CenteringPregnancy in Australia was undertaken in 2006-2008. I was the research midwife employed to coordinate this study and I explored the experiences of the midwives who were participants as the focus of my Master of Midwifery (Honours) research. Method : An Action Research approach was undertaken to study the implementation of CenteringPregnancy in Australia. This included a qualitative descriptive study to describe and explore the experiences of the midwives who were participants. The study was set in two hospital antenatal clinics and two outreach community health-care centres in southern Sydney. Eight midwives and three research team members formed the Action Research group. Data collected were primarily from focus groups and surveys and were analysed using simple descriptive statistics and thematic content analysis. Findings : CenteringPregnancy enabled midwives to develop relationships with the women in their groups and with their peers in the Action Research group. The group antenatal care model enhanced the development of relationships between midwives and women that were necessary for professional fulfilment and the appreciation of relationship-based care. The use of supportive organisational change, enabled by Action Research methods, facilitated midwives to develop new skills that were appropriate for the group care setting and in line with a strengths-based approach. Issues of low staffing rates, lack of available facilities for groups, time constraints, recruitment difficulties and resistance to change impacted on widespread implementation of CenteringPregnancy. Conclusions : The experience of the midwives who provided CenteringPregnancy care suggests that it is an appropriate model of care for the Australian midwifery context, particularly if organisational support and recruitment strategies and access to appropriate facilities are addressed. The midwives who undertook CenteringPregnancy engaged in a new way of working that enhanced their appreciation of relationship-based care and was positive to their job satisfaction. Implications for practice Effective ways to implement CenteringPregnancy models of care in Australia were identified in this study. These included a system of support for the midwives engaging in facilitating groups for the first time. It is important that organisations also develop other supportive strategies, including the provision of adequate group spaces, effective recruitment plans and positive support systems for change management. In the light of current evidence the development of continuity of care models which enhance the relationship between an individual women and her midwife, it is important to explore the effects of group care on this unique relationship.

Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library. / The current study aimed to assess the efficacy and safety of buprenorphine maintenance for the treatment of illicit opioid dependence during pregnancy. Parameters investigated assessed pregnancy progression and Neonatal Abstinence Syndrome (NAS) compared to methadone maintenance and non-opioid exposed control pregnancies. This is the first study to present results comparing the two treatment groups to a control population. The trial was a prospective, non-randomised, open-label, flexible dosing study (n=25 for each group). Women were recruited up to a gestational age of 28 weeks and their infants observed postnatally for 4 weeks. Methadone and buprenorphine doses did not change significantly from recruitment to delivery and were 48.40±5.95 mg.day⁻¹ and 7.46±O.84 mg.day⁻¹ respectively at delivery. Both subjective and objective measures of maternal withdrawal were significantly lower for buprenorphine compared to the methadone group (p<O.Ol and p<O.05, respectively) at the sub-optimal does observed in this study. Direct drug effects were similar between methadone and buprenorphine groups and did not change over the course of pregnancy. Additional substance use during pregnancy was significantly higher for methadone and buprenorphine groups compared to controls but was not significantly different between each other. Patterns of maternal symptom complaints during pregnancy were higher for methadone and buprenorphine compared to controls but were not significantly different to each other and raised several issues regarding maternal health, and re-dosing in the antenatal period. Obstetric complications in the antenatal period and during labour and delivery were similar between the three groups. There was no significant difference between the three groups for infant gestational age at delivery or their Apgar scores. However, methadone exposed infants were significantly smaller than control infants (birth weight p<O.05, body length p<O.05, head circumference p<O.05) while buprenorphine exposed infants did not differ to controls. There was no significant difference between methadone and buprenorphine exposed infants for the percentage of infants who required pharmacological treatment to control NAS (methadone 60%, buprenorphine 48%). However, significantly less morphine was required to control NAS in buprenorphine compared to methadone exposed infants (methadone: 40.07 ± 3.95 mg, buprenorphine: 22.77 ± 4.29 mg; p<0.05) and may have been due to reduced placental transfer of buprenorphine. The current study observed buprenorphine to be at least as efficacious as methadone for the treatment of opioid dependence during pregnancy while minimising NAS. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1259912 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2006

Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library. / The current study aimed to assess the efficacy and safety of buprenorphine maintenance for the treatment of illicit opioid dependence during pregnancy. Parameters investigated assessed pregnancy progression and Neonatal Abstinence Syndrome (NAS) compared to methadone maintenance and non-opioid exposed control pregnancies. This is the first study to present results comparing the two treatment groups to a control population. The trial was a prospective, non-randomised, open-label, flexible dosing study (n=25 for each group). Women were recruited up to a gestational age of 28 weeks and their infants observed postnatally for 4 weeks. Methadone and buprenorphine doses did not change significantly from recruitment to delivery and were 48.40±5.95 mg.day⁻¹ and 7.46±O.84 mg.day⁻¹ respectively at delivery. Both subjective and objective measures of maternal withdrawal were significantly lower for buprenorphine compared to the methadone group (p<O.Ol and p<O.05, respectively) at the sub-optimal does observed in this study. Direct drug effects were similar between methadone and buprenorphine groups and did not change over the course of pregnancy. Additional substance use during pregnancy was significantly higher for methadone and buprenorphine groups compared to controls but was not significantly different between each other. Patterns of maternal symptom complaints during pregnancy were higher for methadone and buprenorphine compared to controls but were not significantly different to each other and raised several issues regarding maternal health, and re-dosing in the antenatal period. Obstetric complications in the antenatal period and during labour and delivery were similar between the three groups. There was no significant difference between the three groups for infant gestational age at delivery or their Apgar scores. However, methadone exposed infants were significantly smaller than control infants (birth weight p<O.05, body length p<O.05, head circumference p<O.05) while buprenorphine exposed infants did not differ to controls. There was no significant difference between methadone and buprenorphine exposed infants for the percentage of infants who required pharmacological treatment to control NAS (methadone 60%, buprenorphine 48%). However, significantly less morphine was required to control NAS in buprenorphine compared to methadone exposed infants (methadone: 40.07 ± 3.95 mg, buprenorphine: 22.77 ± 4.29 mg; p<0.05) and may have been due to reduced placental transfer of buprenorphine. The current study observed buprenorphine to be at least as efficacious as methadone for the treatment of opioid dependence during pregnancy while minimising NAS. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1259912 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2006

Thesis (M. Phil.)--University of Hong Kong, 2008. / Also available in print.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2007. / Title from title screen (site viewed Apr. 29, 2008). PDF text: ix, 121 p. : ill. ; 1 Mb. UMI publication number: AAT 3278295. Includes bibliographical references. Also available in microfilm and microfiche formats.

Diss. (sammanfattning) Stockholm : Karol. inst., 2000. / Härtill 6 uppsatser.