Background: Pregnancy associated cardiovascular pathologies have a significant impact on outcome for mother and child. Bioimpedance cardiography may provide additional outcome-relevant information early in pregnancy and may also be used as a predictive instrument for pregnancy-associated diseases. Methods: We performed a prospective longitudinal cohort trial in an outpatient setting and included 242 pregnant women. Cardiac output and concomitant hemodynamic data were recorded from 11th-13th week of gestation every 5th week as well as at two occasions post partum employing bioimpedance cardiography. Results: Cardiac output increased during pregnancy and peaked early in the third trimester. A higher heart rate and a decreased systemic vascular resistance were accountable for the observed changes. Women who had a pregnancy-associated disease during a previous pregnancy or developed hypertension or preeclampsia had a significantly increased cardiac output early in pregnancy. Furthermore, an effect of cardiac output on birthweight was found in healthy pregnancies and could be confirmed with multiple linear regression analysis. Conclusions: Cardiovascular adaptation during pregnancy is characterized by distinct pattern described herein. These may be altered in women at risk for preeclampsia or reduced birthweigth. The assessment of cardiac parameters by bioimpedance cardiography could be performed at low costs without additional risks.

The purpose of this study was to review the evidence linking maternal and paternal lifestyle habits in the preconception and prenatal period to adverse reproductive outcomes; to determine either the proportion of reproductive casualties which could be attributed to lifestyle risk, thus be amenable to prevention, or the information required to estimate the preventable portion of lifestyle-related reproductive casualties; and to examine a method for surveillance of reproductive health in the community which would provide the basis for a comprehensive information system suited to the needs of the research, planning, preventive medicine and health promotion communities. As a means of managing the size of the study report, only a representative set of lifestyles (smoking, alcohol consumption and nutrition) and research literature (major cohort and case-control studies in human populations) was reported in detail. A method was developed to review and describe the degree to which the evidence meets established criteria for causal association. The most recently available prevalence data for determining smoking, alcohol and nutritional risk, and incidence data for seven reproductive outcomes (infertility, spontaneous abortion, stillbirth, infant mortality, congenital anomalies, fetal growth and morbidity) in the British Columbia population were used to calculate the preventable portion of reproductive casualties in this community. A review of the variables required, compared with the data available, provided the basis for recommendations regarding a reproductive health information system to support community surveillance, evaluation and research. The study supports the conclusion that there is evidence of a causal link between exposure to lifestyle risks and the majority of adverse reproductive outcomes selected as indicators of reproductive health. The calculation of the preventable portion (etiologic fraction) of lifestyle-related reproductive casualties in British Columbia suggests the preventable portion associated with single lifestyle risk variables may be in the range of 10-50 percent. A more extensive and up-to-date set of population data for British Columbia is required to determine an accurate estimate. The benefits to be derived from an improved information system were detailed in the study. Reproductive health data collected for British Columbia is primarily outcome oriented with very little input data on which to base rational planning decisions for the improvement of reproductive health outcomes. The study recommends that a more comprehensive reproductive health information system, with an integrated, linked data base, be considered a high priority by government and all institutions, agencies and individuals working to improve reproductive health outcomes in British Columbia. The potential to improve reproductive health is significant enough to warrant action at the clinical and community level, but additional data are required to plan cost-effective intervention strategies, to monitor improvements in reproductive health, and to support applied research initiatives. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Infants of mothers who have received narcotics on a continuous basis during pregnancy are born physically dependent. Drug withdrawal, one of many detrimental effects, is initially the most apparent. Neonatal abstinence syndrome (NAS) was originally described as a generalized disorder characterized by signs of central nervous system hyperirritability, gastrointestinal dysfunction, respiratory distress, and a host of vague autonomic manifestations. Recent studies have suggested that these same signs follow withdrawal from other addicting drugs as well. Feeding problems are the most common and important concomitants of neonatal withdrawal, because sucking function is uncoordinated, ineffectual and poorly sustained. Previous studies have shown a natural history of recovery of sucking dysfunction during recovery from NAS. A disposable and practical apparatus for monitoring nutritive sucking behaviour was developed, based on a prototype previously described in the literature. A weighted scoring system which encompasses the full spectrum of withdrawal signs was also designed. No significant difference in sucking rate was observed between normal and NAS babies on day 1 (p=0.8). There was a highly significant difference on day 2 (prO.0001), day 3 (p=0.0005), and day 4 (p=0.006). No significant difference in nutrient consumption was observed between normal and NAS babies on day 1 (p=0.9) and day 2 (p=0.8). A significant difference was observed on day 3 (p=0.006) and day 4 (p=0.03). A significant inverse correlation was demonstrated between both sucking rate and nutrient consumption with the classical clinical signs of withdrawal over the first two months of life (r=-0.57, -0.51, respectively). The periodic monitoring of sucking rate of the passively addicted infant provides an objective gauge of the seventy of withdrawal in NAS, eliminating the subjectivity of evaluating changes in clinical signs. Therefore, it is recommended that sucking rate measurements be instituted as a standard guide to the management of withdrawal in these infants. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

Abstract BACKGROUND: The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS: A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS: The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION: The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis. / Revisión por pares

Thesis (MPH.) -- University of Limpopo, 2020 / The purpose of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and the associated risk factors in the Greater Giyani Area, Mopani District. Quantitative cross-sectional descriptive study was conducted to determine the prevalence rate and risk factors of GDM. Data was collected using questionnaire and data entry form. One hundred and one (101) pregnant women who were attending antenatal clinic visits at Nkhensani Hospital, Nkhensani Gateway Clinic and Giyani Healthcare Centre participated in the study. The SPSS programme was used and p-value of <0.05 was considered significant. The study found that the prevalence of GDM in the area was 1.9%. Pregnant women above 30 years with secondary education, employed, obese and at gestational age of 31-35 weeks were more likely to present with GDM. A family history of diabetes was significantly associated with development of GDM. In conclusion, the universal screening approach for GDM needs to be adopted by all health institutions.

Background: Prevention of unplanned pregnancy is a crucial aspect of preventing mother-to-child HIV transmission (PMTCT). However, we have little understanding of how HIV status and antiretroviral therapy (ART) may influence pregnancy planning. There are few data on pregnancy planning in HIV-infected South African women, and no comparative data with HIV-uninfected women. Methods: We conducted a cross-sectional study of 2105 pregnant women (1512 HIV-infected; 593 HIV-uninfected) ages 18-44 making their first antenatal clinic visit at a primary-level health care facility in Gugulethu, Cape Town. All women completed structured questionnaires including the London Measure of Unplanned Pregnancy (LMUP), a 6-item scale that categorizes pregnancies into planned, ambivalent and unplanned. Analyses examined LMUP results across 4 groups of participants: HIV-infected established on ART; known HIV-infected but not currently on ART; newly diagnosed HIV-infected; and HIV-uninfected. Results: Overall, the mean age was 29 years (SD: 5.63), 43% of women were married or cohabiting and 20% were nulliparous. The LMUP performed well across all groups (Cronbach's α=0.84). Levels of unplanned pregnancy were higher in HIV-infected versus HIV-uninfected women (50% vs. 33%, p<0.001); and highest in women not on ART. Overall, 69% of women reported contraceptive use in the year before pregnancy; this was strongly associated with unplanned pregnancy (p<0.001). Compared to HIV-uninfected women, HIV-infected women had significantly higher odds of unplanned pregnancy, even after adjusting for age, parity and cohabiting status. The odds were greatest among women newly-diagnosed with HIV and previously diagnosed but not on ART (OR: 1.43; 95% CI: 1.05-1.94 and OR: 1.56; 95% CI: 1.13-2.15, respectively). Increased parity and age <24 years were also associated with unplanned pregnancy (OR 1.83; 95% CI: 1.24-2.74 and OR 1.42; 95% CI: 1.25- 1.60 respectively). Conclusions: These data indicate high levels of unplanned pregnancy in a high HIV prevalence setting, highlighting missed opportunities for family planning and counselling services for HIVpositive women. Possible explanations for the high level of unplanned pregnancy observed include contraceptive failure and/or misuse thereof. Therefore, women living with HIV require additional support to avoid unplanned, particularly those who are younger and have one or more children.

A dissertation submitted in the Faculty of Education in partial fulfilment of the requirements for a Masters degree in Educational Psychology at the University of Zululand, South Africa, 2013. / This study examined the relationship between the Child Support Grant (CSG) and teenage pregnancy. The first objective of the study was to establish the relationship, if any, between teenage pregnancy and the Child Support Grant. The second objective was to determine whether or not the variable of educational level, religious affiliation, and location play a role in teenage pregnancy and the support grant. In order to achieve the aims of the study, the researcher constructed his own scale. The study used a quantitative methodology to establish the relationship between Child Support Grant and teenage pregnancy. Questionnaires were used to collect data. The questionnaires were distributed to fifty participants representing the total sample of the study. These questionnaires were correctly completed and were analysed using SPSS. The chi-square measure of association was used to test for the relationship between CSG and teenage pregnancy. The findings of the study indicated that teenagers differ in terms of whether there is a relationship between CSG and teenage pregnancy. Forty eight per cent of the participants were found to have a negative view on the notion that there is a relationship between CSG and teenage pregnancy, and fifty two per cent were favourably disposed. However, the difference was not statistically significant. In answering the second research question, this study revealed that variables such as educational level, location and religious affiliation did not have any influence on child support grant. This was confirmed by statistical tests performed. The limitations of the study were identified and suggestions for further research were documented.

Many pregnant women in the Appalachian Highlands region utilize buprenorphine as medication-assisted treatment (MAT) for opioid use disorder. This treatment is a tool used by medical teams to minimize patients’ drug cravings and optimize chances for a healthy pregnancy. Providers in our region have posited a relationship between MAT use and poor pregnancy weight gain based on clinical experience and observation. Appropriate weight gain in pregnancy is a critical determinant of pregnancy health; without it, pregnant mothers will possibly need nutritional supplementation. Therefore, understanding the association between buprenorphine use and weight gain may contribute to healthier pregnancies. In order to evaluate the association between buprenorphine use and weight gain in pregnant women using MAT, we conducted a retrospective chart review. A list of potential participants was generated by ETSU Population Health using ICD-10 codes. We enrolled patients who were cared for by ETSU Health and delivered babies between July 1, 2019 and June 30, 2021: a total of 504 patients. Of these, 96 were participants in the ETSU low-dose MAT clinic (Group 1), 109 were receiving MAT from other community clinics (Group 2), 97 were non-smoking women in the regular OB clinic (Group 3), and 202 were smoking women in the regular OB clinic (Group 4). Participants’ medical records were screened for inclusion and exclusion criteria. All patients were over age 18 with singleton pregnancies, had pregnancy care initiated in the first trimester, and delivered at or after 37 weeks’ gestation. Patients with confounding medical conditions including (but not limited to) Crohn’s disease, diabetes, heart disease, hypertension, fetal anomalies, or IUFD were excluded. In addition, patients were also excluded with BMI >30 or undocumented BMI, prenatal care initiated after the first trimester, transfer to another practice or lost to follow up, or other documented drug abuse other than opiate use disorder. After consideration of the above criteria, 262 patients were excluded and 242 patients remained in the study. Of these, 53 were in Group 1, 53 in Group 2, 45 in Group 3, and 90 in Group 4. All protected health information was stored in the ETSU HIPAA-compliant REDCap server. At this time, the project is in the data analysis stage, with results expected by the end of March 2023. If an association between buprenorphine use and lower weight gain in pregnancy is discovered, these results can be used to recommend additional measures such as nutritional supplementation to optimize maternal and fetal health during pregnancy. Final conclusions will be drawn after data analysis is complete and associations, or lack thereof, can be fully evaluated. Based on observations of obstetric providers in the region, some association between lower weight gain and buprenorphine use is anticipated.

The introduction of Primary Health Care (PHC) in Saudi Arabia has given nurses excellent opportunities and more responsibility to provide health education and advice in health promotion activities. Provision of appropriate and affordable dietary advice is an important role of the nurses in the Primary Health Care Centres (PHCC). Maternal nutrition is an essential element for the health status of the child, the family and the wider society. Many studies have suggested that there is a relationship between good nutritional intake during pregnancy and the successful outcome of the pregnancy. The present study was conducted to explore the knowledge and understanding of Saudi women and nurses in PHCC regarding nutritional intake during pregnancy. The study also looked at the effect of a short education programme on the nurses' nutritional knowledge and their subsequent practice. The aims of the study were to identify the understanding of Saudi women of pregnancy and nutritional intake during pregnancy, and to evaluate the effect of a short nutritional programme on diploma nurses. To achieve the aims, data collection was carried out in three phases. Phase one used semi-structured interview (tape recorded) on 10 pregnant women, selected randomly, to elicit the general understanding pregnant women had on pregnancy and pregnancy related areas. Phase two used a structured interview schedule on 100 pregnant women attending PHCC, selected systematically, to assess nutritional knowledge and their perception of nutritional advice given by the nurses in PHCC. Phase three was divided into two stages. The first stage used a self-administered questionnaire on 20 diploma nurses working in antenatal clinics in PHCC to assess their nutritional knowledge in relation to pregnancy. The questionnaire was used as both a pre-test and post-test instrument. Thereafter, based on the findings from phase one and two, a 20-hour continuing education (CE) programme was developed by the researcher on maternal nutrition for the diploma nurses. The second stage was to implement the programme to the nurses in five days. The effect of the programme was evaluated by an immediate post-test on nurses' knowledge and a follow-up post-test (after six months) to assess any lasting changes. Data analysis was carried out using content analysis for phase one. For the phase two and three, SPSS programme was used. Chi square was used to look for any association between knowledge scores and personal variables, paired Hest was used to assess the difference between pre-test and post-test. The results from the study showed that the majority of women attending the PHCC were illiterate or had little formal education, had a high pregnancy rate and had poor nutritional knowledge in relation to pregnancy. They preferred female health professional care and they preferred to have female doctors attending their antenatal care rather than the nurses. There was no significant difference between nurses' and women's nutritional knowledge. The results also showed a significant correlation between poor nutritional knowledge scores of the women and certain factors: the scores correlated positively with the level of education and negatively with the number of pregnancies. Regarding the programme, the results showed a significant increase in the nurses' nutritional knowledge scores from pre-test to post-test at p< 0.05, indicating that participants demonstrated increased nutritional knowledge as a result of participation in the programme. There was no significant difference between the initial post-test and the six-month follow-up. No significant relationships were identified between the nurses' scores and their age and years of experiences. The study also indicated that nurses in PHCC were not giving adequate nutritional advice to pregnant women in the views of these women and in my own observation. The findings suggest that frequent continuing education is essential for nurses in PHCC in Saudi Arabia to improve their skills and nutritional knowledge to be able to provide better care for women.

Objective: Reduced maternal levels of vitamin D, E and zinc during pregnancy has been linked to the development of asthma and allergic disease in children. The birth cohort investigated if maternal dietary intake in pregnant Saudi women was associated with childhood asthma and allergic disease up to 24 months of age. Methods: One thousand six hundred and twenty four women were recruited to a prospective birth cohort from an antenatal clinic in Riyadh, Saudi Arabia. A food frequency questionnaire was used to characterize diet during pregnancy and serum micronutrient levels were measured. 1436 singleton children were followed up at 6, 12 and 24 months of age by interview administrated telephone calls. Results: Multivariate analyses revealed no associations between the primary maternal dietary nutrient intakes of vitamin E and zinc and the respiratory outcomes in the cohort children at 24 months of age. There was a borderline significant association between increasing maternal zinc intake and maternal reports of food allergy in the cohort children at 24 months. Positive associations with maternal dietary folate intake with maternally reported ‘itchy rash for at least 6 consecutive months' (OR= 2.36 p-=0.020) and any food allergies (OR= 2.18 p= 0.025). Conclusion: This study suggests no conclusive evidence that maternal intake of vitamin D, E and zinc of Saudi women may lower the risks of developing asthma and allergic disease in early childhood. However, a higher dietary intake of folate during pregnancy increased the risk of reported itchy rash, eczema and food allergy in the cohort children up to 24 months. Further follow up of the cohort will provided evidence that will support or refute whether maternal diet during pregnancy is associated with asthma and allergic disease in childhood.