Untreated depression in pregnancy may result in adverse health outcomes to both the mother and her unborn child. Pharmacotherapy with antidepressants is the most common treatment option for depression; however, the decision to treat with medication becomes complicated by pregnancy. Risk benefit assessments are critical tools to guide the treatment decision. Factors that should be included in these analyses include the pharmacokinetics and pharmacodynamics of antidepressants in pregnancy and their maternal and fetal safety. The economic cost of untreated maternal depression is also important to keep in mind. When the pharmacokinetics of the antidepressants venlafaxine and bupropion were studied in pregnancy it was found that the apparent oral clearance rate of bupropion was increased in late pregnancy when compared to early pregnancy (p = 0.03). There was a trend for lower area under the curve for these medications when the third trimester was compared to the first trimester. When the metabolism of antidepressants was investigated using hair analysis it was found that there was increased metabolism in pregnancy when compared to the postpartum period for citalopram (p = 0.02) but not venlafaxine (p = 0.77). Follow up of depressive symptoms throughout pregnancy identified that depression scores were highest in the first trimester of pregnancy, which may be due to concurrent nausea and vomiting of pregnancy. A meta-analysis of paroxetine use in early pregnancy demonstrated that there was no increased risk for cardiac malformations; case-control studies had an odds ratio of 1.18 (CI95: 0.88 – 1.59) while a weighted average difference of 0.3% was found in case-control studies (CI95: -0.1 – 0.7%, p = 0.19) The direct medical costs incurred by the Ontario government due to discontinuation of antidepressant medications in pregnancy was estimated to exceed $20,000,000 CAD. The management of depression in pregnancy with pharmacotherapy is an important and complex issue. My study documents the advantages of conducting risk benefit assessments for vulnerable populations such as pregnant women with depression.

No description available.

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

Thesis (Ph. D.)--State University of New York at Binghamton, Department of Psychology, Clinical Psychology, 2009. / Includes bibliographical references.

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 168-194). Also available in print.

Background: Although efforts to reduce iron deficiency during pregnancy have been made, programmes often struggle with their participants’ compliance and effectiveness is low. Nevertheless, there is only little information about determinants of compliance. The aim of this thesis is to investigate which factors contribute to women’s compliance to iron supplementation during pregnancy in rural Bangladesh. Methods: Secondary analysis of data collected within a randomized trial in Matlab, Bangladesh (MINIMat trial). 4436 pregnant women were assigned to six micronutrient supplementation groups. Questionnaires were administered and anthropometric measurements were taken. Compliance was measured using the eDEM® counting device which recorded every time a pill bottle was opened. Results: In linear regression maternal age, socio economic status (SES) and education showed a positive association with compliance (p<0.001). Parity showed a negative association (p=0.045). Knowledge of effects of iron supplementation and perception of importance of iron supplementation were not significantly associated with compliance. Experiencing positive effects of iron supplementation was related to higher compliance to iron supplementation, while experiencing nausea was related to lower compliance to iron supplementation (p<0.001). Dislike of the tablets (p<0.001) and other reasons that were not specifically mentioned (p=0.015) were significantly associated with a decrease in compliance. Conclusion: Pregnant women’s compliance to iron supplementation was determined by different factors. Educating women about anaemia, iron deficiency and iron supplementation should not be the only strategy to achieve high compliance. Development of supplements that cause fewer side effects should be considered and more research investigating determinants of compliance should be performed.

Expecting to become pregnant or to get someone pregnant in the near future separates adolescents in terms of both their current circumstances and future experiences. Drawing on life course, social control, and reasoned action perspectives, this study examined the predictors and outcomes of adolescents’ pregnancy expectations in the National Longitudinal Survey of Youth 1997, emphasizing non-linearity in the meaning and implications of such expectations during a critical period when youths’ future plans begin to change from hypothetical ideas to actual realities. The results suggested that the number and type of risky behaviors during adolescence were associated with an increased level of pregnancy expectations that, in turn, predicted later childbearing. Importantly, risky behaviors also moderated the link between pregnancy expectations in adolescence and fertility in young adulthood, with childbearing more likely to follow split expectations when youth also engaged in risky behavior. These patterns did not vary substantially by gender. / text

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Gestational Trophoblastic Disease (GTD) encompasses a spectrum of disease that involves abnormal trophoblastic proliferation. It includes hydatidiform mole (HM), placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT) and choriocarcinoma (CCA). While HMs are abnormal pregnancies with limited invasive potential, CCAs are true malignancies requiring chemotherapy. Although the majority of HM is resolved by surgical intervention, approximately 8-30% of them would develop into persistent GTD. In addition to that, being the most aggressive neoplasm in GTD, choriocarcinoma is a frankly malignant gestational trophoblastic neoplasm (GTN) that could be arisen from HM and could be fetal when widespread metastasis is developed. However, the underlying mechanisms of this disease progression are still unclear. FBI-1 (Factor that Binds to Inducer of Short Transcripts (IST) protein 1) is a transcription factor that has been observed to be overexpressed in various types of human cancers. Recently, overexpression of FBI-1 is also reported in GTD and also in association with GTN development. However, the causes of FBI-1 overexpression in GTD are still unclear. This study aims to investigate gene amplification as a possible cause of FBI-1 overexpression in GTD. A quantitative real time PCR (qPCR) assay was established and was used to investigate ZBTB7A (the gene encoding FBI-1) amplification in GTD cell lines and clinical samples. Using our qPCR assay, we demonstrated that ZBTB7A is not amplified in the CCA cell lines JEG-3 and JAR, in comparison with an immortalized trophoblast cell line HTR-8/SVneo. Testing ZBTB7A amplification in clinical samples also obtained similar findings although overexpression of FBI-1 was demonstrated in our previous studies. This is the first report illustrating absence of ZBTB7A amplification in cells with FBI-1 overexpression. There are other techniques that can detect gene amplification and/or other genetic and epigenetic mechanisms that may govern FBI-1 expression in GTD. Further studies will be worthwhile to pursue as FBI-1 is a potential target for cancer therapy. / published_or_final_version / Pathology / Master / Master of Medical Sciences

published_or_final_version / Medicine / Master / Doctor of Medicine