INTRODUCTION: Allergic women have been reported to give birth to more children than non-allergic women, speculatively explained by the former's predisposition for Th2 polarization, possibly favoring pregnancy. AIM: The aim of this study was to test the hypothesis that allergy is associated with more Th2-deviated responses to paternal antigens throughout pregnancy. METHODS: Blood samples were collected on six occasions during pregnancy and two occasions postpartum (pp). Of the 86 women initially included, 54 women had a normal pregnancy and completed the sampling procedures. Eleven women fulfilled the strict criteria for allergy (allergic symptoms and circulating IgE antibodies to inhalant allergens) and 23 were strictly non-allergic (non-sensitized without symptoms). The numbers of blood mononuclear cells secreting IFN-gamma and IL-4, spontaneously and in response to paternal alloantigens, were compared between the groups. RESULTS: The numbers of spontaneously as well as paternal antigen-induced IFN-gamma- and IL-4-secreting cells were similar in allergic and non-allergic pregnant women on all occasions. A similar increase in the numbers of both IFN-gamma- and IL-4-secreting cells were found in allergic and non-allergic women during pregnancy, both regarding spontaneous and paternal antigen-induced secretion. CONCLUSIONS: This study does not support the hypothesis of a more pronounced Th2-deviation to paternal antigens in allergic pregnant women compared with non-allergic pregnant women, as measured by number of cytokine-secreting cells. The observed increase of both IFN-gamma- and IL-4-secreting cells during normal pregnancy may be interpreted as a Th2-situation, since the effects of IL-4 predominate over the effects of IFN-gamma.

It is highly recommended for women to take multivitamin/mineral supplements during the periconceptional and prenatal periods. Studies have confirmed that taking prenatal multivitamins prevents maternal iron deficiency anemia, and reduces the risk for neural tube defects (NTDs). To date, research aimed at optimizing the use of multivitamins before and during pregnancy has been minimal. My thesis focused on two challenges of periconceptional and prenatal multivitamin supplementation. The first challenge was gastrointestinal (GI) adverse events such as nausea and constipation which may be attributed to iron content and tablet size. Pregnant women are highly susceptible to GI adverse events since 80% experience nausea and vomiting of pregnancy. A prospective, randomized, controlled, open-label study was conducted to investigate whether a low-iron, small-tablet prenatal multivitamin can reduce GI adverse events, and improve supplement tolerability and adherence, relative to a high-iron, small-tablet prenatal multivitamin. We determined that low iron dose did not produce a significant difference, while small tablet size could be considered an important factor. Moreover, our results confirmed that adherence was poor in pregnant women. We were prompted to identify determinants which could predict adherence to prenatal multivitamins. Our retrospective study determined that predictors of adherence are rooted in women’s prior experiences with multivitamin use. The second challenge we addressed was achieving adequate blood folate concentrations for prevention of NTDs. If adherence is poor, standard dosing of 0.4-1 mg folic acid may not produce the blood folate concentrations needed in women prior to conception. We investigated the pharmacokinetics of 5 mg folic acid. Our prospective, parallel, open-labeled study, comparing a single dose of 5 mg to 1.1 mg folic acid, confirmed that folic acid follows linear (proportional) pharmacokinetics. However, our prospective, randomized, controlled, open-labeled, multiple-dose study determined that repeated use of folic acid at these 2 doses followed non-linear pharmacokinetics. Nevertheless, our data confirmed that 5 mg folic acid can produce higher blood folate concentrations, with a faster rate, which can counter the effect of poor adherence. In conclusion, optimal use of prenatal multivitamins requires improvements in supplement tolerability, adherence, and pharmacokinetics which depend on supplement formulations, and individualized assessment and counseling.

Fetal alcohol spectrum disorder (FASD) is the leading non-genetic cause of brain damage. In an effort to reduce alcohol-exposed pregnancies, steps are needed to identify at risk women as early as possible so that appropriate intervention can occur. The objective of this dissertation was to examine screening methods validated in identifying pregnant women at risk for consuming alcohol and illicit drugs during pregnancy. A systematic review identified three main approaches including maternal self-report, use of standardized questionnaires and detection via biological markers. Since most screening tools were developed in alcoholic women, it was important to examine performance in problem drinkers. Alcohol screening tools (ASQ), currently the best method of predicting prenatal problem drinking, were not effective in a cohort representative of problem drinkers. ASQ performance improved minimally, using higher thresholds, but not enough to be used alone. Provider’s knowledge of complexities inherent in women under their care is an important component in screening. As illicit drug use is an important predictor of problem drinking, identifying maternal risk factors associated with substance use was necessary. Increased rates of STD’s, untreated psychiatric disorders, binge drinking and heavy smoking were all identified as predictors of prenatal methamphetamine (MA) use. These factors, combined with high rates of unplanned pregnancies have serious adverse implications for the fetus. The most widely used method to screen for illicit substance use is based on a practice-based approach that relies heavily on maternal self-report. Most providers do not ask about alcohol and substance use in the absence of a high index of suspicion due to the assumption that patient will deny use. But evidence suggests that maternal account can be accurate in a supportive environment. The last study examines the agreement between self-reported data, in comparison to illicit drug use based on positive hair test results. A reasonable agreement between the two approaches of identification demonstrates that maternal self-report can be reliable in women who are motivated enough to seek prenatal care. No single approach is sufficient to effectively identify at risk women. However, combining two or more methods will improve screening and help reduce the number of alcohol-exposed pregnancies.

Past research has demonstrated that there are numerous medical and psychological consequences when a woman with an eating disorder becomes pregnant. There has been a paucity of research, however, examining the attitudes towards pregnancy of women with body image issues/eating disorders and how these attitudes subsequently affect intentions to become pregnant. The present study examines intentions to become pregnant among a sample of women ranging in level of body image concerns using the Theory of Reasoned Action (TRA) as a framework (Ajzen and Fishbein, 1980). Two hundred and forty-two females from an introductory psychology class completed a questionnaire, including the Eating Disorder Inventory (Garner, 1991) and specific scales targeting the components of the TRA developed for the present study. As expected, all TRA precursors to intentions were positively correlated with intentions to become pregnant, while contrary to predictions, body image was not correlated with intentions. In partial support of the TRA, a multiple regression analysis revealed that, for all participants, the subjective norm of pregnancy and perceived benefits of pregnancy were predictive of intentions to become pregnant. Perceived costs of pregnancy, however, evidenced no ability to predict intentions to become pregnant. Although results failed to support the prediction that those with high body image concerns would indicate a lower intention to become pregnant, significant differences among those with high versus low body image concerns did emerge. Specifically, participants with high body image concerns reported greater perceived costs of pregnancy as well as a greater likelihood of engaging in weight control behaviours during pregnancy. Implications, as well as practical applications of these findings are discussed.

Purpose Two new scales, CORECTS and PUQE-24 are introduced and validated, and the safety and effectiveness of Proctofoam-HC® in pregnancy is demonstrated. Method 315 of Motherisk NVP patients provided information on five clinical parameters as well as PUQE scores. 28 patients visiting a proctologist were graded for the severity of anal conditions by a proctologist before administering CORECTS. Pre and postnatal interviews were conducted with 204 pregnant women prescribed Proctofoam-HC®. Results Strong correlations were found between the following: PUQE-24 scores and parameters of well-being, hospitalization, and multivitamin intake; bleeding and pain components of CORECTS and the proctologist’s grade.There was no significant difference between mean birth weight of Proctofoam-HC® treated and comparison groups. There was a significant reduction in all symptoms of hemorrhoids. Conclusion PUQE-24 and CORECTS are the first validated scales used to assess the severity of NVP and hemorrhoids. Proctofoam-HC® is safe and effective for use in pregnancy.

Purpose Two new scales, CORECTS and PUQE-24 are introduced and validated, and the safety and effectiveness of Proctofoam-HC® in pregnancy is demonstrated. Method 315 of Motherisk NVP patients provided information on five clinical parameters as well as PUQE scores. 28 patients visiting a proctologist were graded for the severity of anal conditions by a proctologist before administering CORECTS. Pre and postnatal interviews were conducted with 204 pregnant women prescribed Proctofoam-HC®. Results Strong correlations were found between the following: PUQE-24 scores and parameters of well-being, hospitalization, and multivitamin intake; bleeding and pain components of CORECTS and the proctologist’s grade.There was no significant difference between mean birth weight of Proctofoam-HC® treated and comparison groups. There was a significant reduction in all symptoms of hemorrhoids. Conclusion PUQE-24 and CORECTS are the first validated scales used to assess the severity of NVP and hemorrhoids. Proctofoam-HC® is safe and effective for use in pregnancy.

It is highly recommended for women to take multivitamin/mineral supplements during the periconceptional and prenatal periods. Studies have confirmed that taking prenatal multivitamins prevents maternal iron deficiency anemia, and reduces the risk for neural tube defects (NTDs). To date, research aimed at optimizing the use of multivitamins before and during pregnancy has been minimal. My thesis focused on two challenges of periconceptional and prenatal multivitamin supplementation. The first challenge was gastrointestinal (GI) adverse events such as nausea and constipation which may be attributed to iron content and tablet size. Pregnant women are highly susceptible to GI adverse events since 80% experience nausea and vomiting of pregnancy. A prospective, randomized, controlled, open-label study was conducted to investigate whether a low-iron, small-tablet prenatal multivitamin can reduce GI adverse events, and improve supplement tolerability and adherence, relative to a high-iron, small-tablet prenatal multivitamin. We determined that low iron dose did not produce a significant difference, while small tablet size could be considered an important factor. Moreover, our results confirmed that adherence was poor in pregnant women. We were prompted to identify determinants which could predict adherence to prenatal multivitamins. Our retrospective study determined that predictors of adherence are rooted in women’s prior experiences with multivitamin use. The second challenge we addressed was achieving adequate blood folate concentrations for prevention of NTDs. If adherence is poor, standard dosing of 0.4-1 mg folic acid may not produce the blood folate concentrations needed in women prior to conception. We investigated the pharmacokinetics of 5 mg folic acid. Our prospective, parallel, open-labeled study, comparing a single dose of 5 mg to 1.1 mg folic acid, confirmed that folic acid follows linear (proportional) pharmacokinetics. However, our prospective, randomized, controlled, open-labeled, multiple-dose study determined that repeated use of folic acid at these 2 doses followed non-linear pharmacokinetics. Nevertheless, our data confirmed that 5 mg folic acid can produce higher blood folate concentrations, with a faster rate, which can counter the effect of poor adherence. In conclusion, optimal use of prenatal multivitamins requires improvements in supplement tolerability, adherence, and pharmacokinetics which depend on supplement formulations, and individualized assessment and counseling.

Fetal alcohol spectrum disorder (FASD) is the leading non-genetic cause of brain damage. In an effort to reduce alcohol-exposed pregnancies, steps are needed to identify at risk women as early as possible so that appropriate intervention can occur. The objective of this dissertation was to examine screening methods validated in identifying pregnant women at risk for consuming alcohol and illicit drugs during pregnancy. A systematic review identified three main approaches including maternal self-report, use of standardized questionnaires and detection via biological markers. Since most screening tools were developed in alcoholic women, it was important to examine performance in problem drinkers. Alcohol screening tools (ASQ), currently the best method of predicting prenatal problem drinking, were not effective in a cohort representative of problem drinkers. ASQ performance improved minimally, using higher thresholds, but not enough to be used alone. Provider’s knowledge of complexities inherent in women under their care is an important component in screening. As illicit drug use is an important predictor of problem drinking, identifying maternal risk factors associated with substance use was necessary. Increased rates of STD’s, untreated psychiatric disorders, binge drinking and heavy smoking were all identified as predictors of prenatal methamphetamine (MA) use. These factors, combined with high rates of unplanned pregnancies have serious adverse implications for the fetus. The most widely used method to screen for illicit substance use is based on a practice-based approach that relies heavily on maternal self-report. Most providers do not ask about alcohol and substance use in the absence of a high index of suspicion due to the assumption that patient will deny use. But evidence suggests that maternal account can be accurate in a supportive environment. The last study examines the agreement between self-reported data, in comparison to illicit drug use based on positive hair test results. A reasonable agreement between the two approaches of identification demonstrates that maternal self-report can be reliable in women who are motivated enough to seek prenatal care. No single approach is sufficient to effectively identify at risk women. However, combining two or more methods will improve screening and help reduce the number of alcohol-exposed pregnancies.

Past research has demonstrated that there are numerous medical and psychological consequences when a woman with an eating disorder becomes pregnant. There has been a paucity of research, however, examining the attitudes towards pregnancy of women with body image issues/eating disorders and how these attitudes subsequently affect intentions to become pregnant. The present study examines intentions to become pregnant among a sample of women ranging in level of body image concerns using the Theory of Reasoned Action (TRA) as a framework (Ajzen and Fishbein, 1980). Two hundred and forty-two females from an introductory psychology class completed a questionnaire, including the Eating Disorder Inventory (Garner, 1991) and specific scales targeting the components of the TRA developed for the present study. As expected, all TRA precursors to intentions were positively correlated with intentions to become pregnant, while contrary to predictions, body image was not correlated with intentions. In partial support of the TRA, a multiple regression analysis revealed that, for all participants, the subjective norm of pregnancy and perceived benefits of pregnancy were predictive of intentions to become pregnant. Perceived costs of pregnancy, however, evidenced no ability to predict intentions to become pregnant. Although results failed to support the prediction that those with high body image concerns would indicate a lower intention to become pregnant, significant differences among those with high versus low body image concerns did emerge. Specifically, participants with high body image concerns reported greater perceived costs of pregnancy as well as a greater likelihood of engaging in weight control behaviours during pregnancy. Implications, as well as practical applications of these findings are discussed.

BAKGRUND: Folsyra och järn är två viktiga ämnen som under graviditeten har olika betydelser dels för mamman och dels för fostret. Brister på dessa ämnen kan således leda till skador av olika slag och därför rekommenderas ofta kosttillskott till gravida kvinnor. Kvinnornas matvanor kan påverka om de får i sig tillräcklig mängd av dessa ämnen. SYFTE: Syftet med denna studie var att se hur gravida förhåller sig till att ha en hälsosam kost under graviditeten samt inställningen till kosttillskott med järn och folsyra. Studien syftade till att undersöka eventuella hinder samt se användningen av järn och folsyra. METOD: Studien är av kvantitativ typ med en enkät som inför denna undersökning har modifierats, Health and Taste Attitude Scale. Enkäten består av 7 frågor och 21 påståenden varav 6 st är från HTAS och resterande tillagda. Deltagarna kommer från ett internetforum "Min Bebis" där enkäten skickades ut som ett personligt meddelande till 151 st, varav 44 st kom att delta. En beskrivande analys gjordes med medelvärde och standardavvikelse. RESULTAT: Denna studie hade en majoritet av blivande förstagångsföräldrar och visade på att fler gravida kvinnor tar kosttillskott med järn än folsyra. Det verkar finnas en bristande konsumtion på livsmedel rika på folsyra och järn däribland blodpudding, frukter och fullkornsprodukter. I resultatet framkommer att de flesta inte har tagit tillskott av folsyra innan graviditet. De gravida verkar ha en måttlig inställning till att äta hälsosamt under sin graviditet. / BACKGROUND: Folic acid and iron are two important substances during pregnancy which have different meanings for the mother and the child. Deficiencies of these substances can lead to damage, and therefore often recommended supplements to pregnant. Women´s diet can affect whether they get enough of those substances. AIM: The aim of this study was to see how the pregnancy is related to having a healthy diet and attitudes to food supplements with iron and folic. The study aimed to investigate possible barriers and ensure the use of iron and folic acid. METHOD: This study is quantitative using a questionnaire developed for this study. The questionnaire contained part of the Health and Taste Attitude Scale. The items were partly modified to suit the aim of the study. The questionnaire was send as a message to 151 pregnant women in the internet forum "MinBebis" and 44 were participating. RESULTS: Respondents in this study were mainly prospective first-time parents and the results showed that more pregnant women take supplements with iron than folic acid. There seems to be a low consumption of foods rich in folic acid and iron, example fruit and whole grains. The majority did not take supplements of folic before pregnancy. The pregnant women seem to have a moderate approach to eating healthy during their pregnancy.