This thesis examines the changing nature of women's pregnancy experiences as progression through the various stages of pregnancy occurs. Ten women are followed through their pregnancies, in order to capture their diverse and dynamic psycho-social experiences. The aim of the research is to highlight the significance of certain psycho-social issues related to the pregnancy experience (both positive and negative) which have been raised by the women themselves during the course of their pregnancies. The analysis has been carried out using the women's own descriptions. The main psycho-social issues that have been analysed are considered under the rubric of the dynamic self, in the form of: identification with the pregnancy; the assessment of risk during pregnancy; and finally, images of the self and baby during pregnancy. The thesis focuses in-depth on the dynamism and complexity of women's feelings during pregnancy. In particular, it looks at the concept of being obstetrically 'at risk' by analysing women's contradictory and changing accounts of their feelings and concerns. The research also contributes to the understandings of the identities and preoccupations of pregnant women. The design of the study is longitudinal and biographic. The women kept personal documents in the form of diaries during their pregnancies, and also participated in four unstructured in-depth interviews (three taking place during pregnancy, the fourth taking place after birth). The methodological approach taken is based on a feminist research perspective, which emphasises the value of qualitative methods of investigation. The thesis explores the role of the researcher by examining the location of the researcher in relation to both the participants and the research area. The individual experiential accounts of pregnancy provided by the women are explored in detail using a feminist interpretative style of analysis (Stanley and Wise, 1993).

Teenage pregnancy is an important health and social problem in South Africa. Despite declining trends of fertility rates in last two decades, the pregnancy among school girls remains steadily high in South Africa. Teenage pregnancy had negative impacts on various aspects of socio-economic well being of school girls. Aim: To determine the proportion of teenage pregnancy among high school girls and to identify the possible factors that influence teenage pregnancy in Mthatha region during the year 2009. Materials & Methods: This is an observational cross sectional, analytic study of teenage pregnancy conducted among high school teenage girls in the Mthatha region of South Africa. Result: A total of 1150 teenage girls from 15 to 19 years of ages responded from seven high schools in the Mthatha region of South Africa. In total 113 (10%) of teenage high school girls were currently mothers or had previously been pregnant. The proportions of those who had ever been pregnant increased significantly with age. The risk of falling pregnant among public high school teenage girls had two times higher compared to private high school teenage girls. Condoms were the most common method of contraception whereas the oral pills were the least common in practice. About half of teenage girls who had ever been pregnant had an abortion and of this one-third had had a backstreet/illegal abortion. The frequency of substance use was significantly higher among teenage girls who had ever been pregnant. A significant correlation was found between low socio-economic status, public schools and teenage pregnancy in this study. Conclusion: Teenage pregnancy is common among high school girls from 15 to 19 years of age in the Mthatha Region, South Africa. Poor socio-economic family conditions, lack of contraceptive use, early sexual maturation, risky behaviour, lack of knowledge about sexuality and reproductive health, multiple sexual partners and substance use were the common contributing factors of teenage pregnancy.

A number of studies have investigated the natural history of asthma in pregnancy. Most of the data suggests that the course of asthma for a given patient is unpredictable. Turner, et al.7 summarize the data from all of the English-language literature of studies on the effect of pregnancy on astha. Of 1054 cases examined, 49% of the asthma conditions remained unchanged, 22% got worst and 29% became better.7 Theophylline has been used safely during pregnancy. A review of the literature by O'Brien, showed that no teratogenic effects were associated with the use of theophylline in 117 cases and aminophylline in 76 cases examined.39,40 Blood concentration in newborns have been found to be similar to concentrations in the mothers.41,42,43 Problems developed because theophylline clearance may be altered during pregnancy and necessitate dosage adjustments and careful drug level monitoring.44 RATIONALE FOR STUDY Campbell, et al.45 developed a caffeine urinary metabolic ratio, in which they were able to demonstrate a correlation between changes in metabolic rations and clearance. The change in the metabolic ration explained the alteration in clearance and determined the specific Cytochrome P-450 system involved. Various physiologic changes occurring during pregnancy can cause changes in drug disposition. Pharmacokinetic parameters that need to be considered are plasma protein binding capacity, absorption, drug metabolizing enzyme activity, renal excretory function and volume of distribution.44,46,47 This study was developed to determine if changes in theophylline disposition during pregnancy were due to changes in drug metabolizing enzyme activity. A urinary test was designed to investigate the ratios of unchanged theophylline and theophylline metabolites to monitor changes in the various Cytochrome P-450 isoenzyme systems. Changes in the ratios could provide a noninvasive procedure to assess the effect of modulating agents or conditions (such as pregnancy) on theophylline metabolizing enzyme activity.

Background: : Few investigators have evaluated the association between early pregnancy social support and depression; however, increased social support may improve mental health during pregnancy. Our objective is to examine whether in early pregnancy there is an association between social support and maternal depression among women in Peru. Methods: : 2,062 pregnant women participated in structured interviews. Early pregnancy social support was measured using the Social Support Questionnaire (SSQ-6). We evaluated the number of individuals that participants could turn to in different situations (Social Support Number Score; SSQN) and their satisfaction with support received (Social Support Satisfaction Score; SSQS). Median SSQN and SSQS characterized participants according to high and low levels of support. SSQN family vs. non-family support were also evaluated separately. Antepartum depression was assessed using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: : 39.6% of women reported high SSQN and 45.5% reported high SSQS. Approximately 25% had antepartum depression. Women with high SSQN had 22% lower odds of antepartum depression (OR = 0.78; 95%CI: 0.63–0.97). Similarly, women with high SSQS scores had 45% lower odds of antepartum depression (OR = 0.55; 95%CI: 0.45–0.68). Women with high SSQN non-family scores had 30% lower odds antepartum depression compared to those with low SSQN non-family scores (OR = 0.70; 95%CI: 0.57–0.86). The association between SSQN family scores and antepartum depression did not reach statistical significance. Conclusion: : Increased social support may improve maternal mental health during pregnancy and this association should be assessed in longitudinal studies. / This research was supported by awards from the National Institutes of Health ( NIH ), National Institute of Minority Health and Health Disparities ( T37-MD-001449 ) and Eunice Kennedy Shriver National Institute of Child Health and Human Development ( R01-HD-059835 ). The NIH had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. / Revisión por pares

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Science in Medicine in Epidemiology and Biostatistics Johannesburg, 2002. / To systematically evaluate the efficacy of double dose of sulfadoxine-pyremithamine (SP/SP) treatment in pregnancy in malaria endemic areas. Methods - The relevant articles were retrieved by a computerized search of Medline, Cochrane Review, Pub Med and Google with the following key words, sulfadoxine-pyrimethamine, intermittent, pregnancy, Quasi- experimental studies and Randomised Control Trials. Three reviewers identified only 2 papers meeting the inclusion criteria set for the study. Systematic quantitative review was performed. / IT2018

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This research explores the influence of pregnancy loss and coping strategies employed while connecting to the fetus in a subsequent pregnancy following a late term loss. Nine participants were interviewed using a qualitative, phenomenological methodology to determine participant's experience. Four themes emerged within the data: (1) support network – participants acknowledged who was there for them and who was not, (2) emotional ups and downs – participants reported the emotional ups and downs from loss to the subsequent pregnancy to delivery and after birth, and how they connected during this process (3) coping – participants describe coping strategies used throughout their experience, and (4) moving forward – participants reported their process of finding their new normal and how this event changed their perspective on life. Limitations, future research and clinical implications were all identified and discussed. / Master of Science

Maternal obesity is an increasing concern in the obstetric population. It confers increased morbidity and mortality to the mother and offspring during pregnancy and delivery as well as potential long-term increase in risk of ill health to the offspring. There are currently few effective interventions and no pharmacological therapies. Potential mechanisms to account for ill health in obese non-pregnant individuals include excess inflammation, both systemically and within specific tissues such as adipose, as well as alterations in metabolic regulation including hyperglycaemia, reduced sensitivity to insulin and altered adipokine expression. In healthy pregnancy, there are significant adaptations to maternal metabolism, including the development of profound systemic insulin resistance. We hypothesize that there exists an interaction between the metabolic adaptations of pregnancy and those occurring in obesity which could provide a physiologically plausible mechanism which could contribute to the pathogenesis of adverse outcomes associated with obese pregnancies. In this thesis, we sought to understand and define the metabolic adaptations to pregnancy in severely obese women. Anthropometric characteristics are described in a longitudinal case-control study of apparently healthy obese (BMI > 40kg/m2) pregnant women. Systemic adipokine and pro- inflammatory cytokine profiles were measuring using ELISA. Indices of insulin sensitivity were assessed at three time points in pregnancy. In a cohort study of healthy pregnant women in the third trimester, transcript levels of adipokines and inflammatory cytokines in paired subcutaneous and omental adipose tissue biopsies were quantified and correlated these transcript levels with booking body mass index (BMI). Obese pregnant women gained less weight in pregnancy compared to lean women, but had significantly elevated fasting third trimester glucose, as well as elevated blood pressure and fasting insulin resistance throughout pregnancy. Fasting leptin was elevated throughout pregnancy in obese compared with lean pregnancy women; however, in the third trimester there was no correlation between adipose tissue leptin mRNA levels and BMI. Transcript levels of IL-6 were positively correlated with BMI in subcutaneous but not omental adipose tissue; no other positive correlations with BMI were shown. Hyperinsulinaemic euglycaemic clamps with concomitant use of stable isotope tracers were carried out in a case-control study of healthy obese pregnant women to characterise in detail whole body insulin sensitivity, endogenous glucose production and rate of lipolysis. In contrast to the original hypothesis, by the third trimester, there were few differences between lean and obese pregnant women in whole body glucose disposal (WGD) and endogenous glucose production. Compared with non-pregnant women, lean pregnant women demonstrated approximately 60% decrement in WGD; in contrast, obese non-pregnant women were already significantly insulin resistant but did not develop further insulin resistance in response to pregnancy. 3-Tesla (3T) Magnetic Resonance Imaging (MRI) and 1H-Magnetic Resonance Spectroscopy (1H-MRS)was used to assess abdominal fat distribution, hepatic and skeletal muscle lipid content in a case-control study of healthy pregnant women in the third trimester. As expected, obese pregnant women have greater adipose accumulation in both subcutaneous and intra-abdominal adipose depots and greater lipid accumulation in skeletal muscle. However, hepatic lipid content was low in both groups and there were no significant differences between lean and obese pregnant women. This was not expected as both groups are profoundly insulin resistant at this at this gestation, and in non-pregnant individuals, insulin resistance at this level would be expected to drive hepatic lipid accumulation, and may point to a pregnancyspecific hepato-protective mechanism. In conclusion, in this thesis, it has been shown that while obese women are insulin resistant with an adverse metabolic profile, that there does not appear to be the expected worsening of this profile in response to pregnancy and that by the end of pregnancy, lean women have a similar phenotype. Instead, while lean women are exposed to this environment only towards the end of pregnancy, obese women and their offspring are exposed throughout gestation, including key periods of fetal development in early pregnancy. This prolonged exposure may account for the excess pathologies in such pregnancies, potentially by exhausting what physiological reserve such women have pre-pregnancy. Potential therapies must therefore be optimally timed to improve the metabolic profile of obese women in early pregnancy, without hindering the required adaptations of the third trimester.