As a woman with a spinal cord injury who uses a wheelchair, my thesis is an autoethnography that is based largely on the journals I have written in over the last twenty years, and in particular the journals I kept while I was pregnant and giving birth to my two children. Disability is a pervasive ideology that informs many of our cultural ideas of self and other, what constitutes acceptable and celebratory bodies, political stances, public policy, and language. Much of the literature that examines the female bodily experience excludes the stories and experiences of women with disabilities. Because the body with disabilities is often seen for what it can not do, taking on the role of mother can give the body a different value, status, and worth. I feel that my experiences as a woman with a disability experiencing pregnancy and childbirth offers insights and understanding into what it is already known about womens bodies. I display multiple levels of personal and cultural consciousness while connecting to the larger understandings of the culture of pregnancy, childbirth, and disability

Pregnancy is often portrayed as a happy time for the woman and her family. In reality, many women struggle with negative emotions and moods that can have deleterious effects on the mother, the fetus, and the growing family. Depression is an increasing, worldwide problem, with women in their childbearing years and those of low socioeconomic status the most vulnerable. <p>This study explores depression, as determined by the Edinburgh Postnatal Depression Scale (EPDS), in a high-risk sample of pregnant women enrolled in two prenatal programs in Saskatoon, Saskatchewan, Canada. A prevention and population health approach has been used to identify potential determinants and implications of antenatal depression. The data analyzed in this study were from the first cross-sectional portion of a longitudinal, epidemiological study of depression in pregnancy into the postpartum. Women were invited to participate in the study at their first prenatal visit. Data were collected by program staff. <p>The prevalence of depression in this sample of 402 high-risk women was 29.5%, which is similar to other studies of inner-city, low income, and minority women elsewhere in the world. In the final model, antenatal depression was associated with a history of depression, moods going up and down, current smoking status, high levels of stressors, and social support.<p>Factor analysis of the EPDS revealed three underlying factors: Anxiety, Depression, and Self-harm thoughts. The anxiety factor explained most of the variance in the overall EPDS scores in this sample of women. A history of problems with mood fluctuations was significantly associated with anxiety and depression subscales and self-harm. Significantly more women aged 21 and under experienced anxiety, and more Aboriginal women experienced depressive symptoms and self-harm thoughts. Twenty percent of women reported self-harm thoughts in the preceding seven days. Depressed, Aboriginal, and single women, and women who use alcohol were most at risk for self-harm thoughts. <p>The level of depressive symptoms in this sample of women represents a significant public and mental health problem in women already challenged by inequities in their life circumstances. We need to develop public health policy that will support screening and identification of women with depression. Interventions at the primary, secondary, and tertiary levels of prevention can help to improve the health of women struggling with antenatal depression, promote the optimal intrauterine environment for their unborn children, and reduce the intergenerational transmission of depression.

Coordinated signals between the maternal endometrium and conceptus during the peri-implantation period are essential for the establishment and maintenance of pregnancy. In pigs, this involves estrogen secretion from conceptuses as the signal for maternal recognition of pregnancy. Pig conceptuses also secrete interferons (IFN) delta (IFND) and IFN gamma (IFNG). The uterine effects of pig IFNs are not known, although ruminant conceptuses secrete IFN tau (IFNT) for pregnancy recognition, and this increases the expression of IFN-stimulated genes (ISGs) in the endometrium. Therefore, studies were conducted to identify and characterize ISGs in the pig endometrium during pregnancy and to evaluate their regulation by estrogen and conceptus secretory proteins (CSPs) that contain IFNs. In the first study, four classical ISGs, including interferon regulatory factor 1 (IRF1) and signal transducer and activator of transcription 2 (STAT2), were detected in the pig endometrium and increased after Day 12 of pregnancy, specifically in stroma. IRF2, a transcriptional repressor of ISGs, increased in luminal epithelium (LE) by Day 12 of pregnancy. The increase of IRF2 was due to estrogen while the stromal increase of IRF1 was due to IFN-containing CSP infusion. In the second study, the ISG STAT1 increased in LE after Day 12 of pregnancy and estrogen resulted in a similar increase. After Day 15 of pregnancy, STAT1 increased in stroma. Infusion of IFN-containing CSPs resulted in a similar stromal increase. In the third study, the ISGs swine leukocyte antigen (SLA) class I and beta-2microglobulin (B2M) increased in LE between Days 5 and 9 of the estrous cycle and pregnancy and decreased between Days 15 and 20 of pregnancy. By Day 15 of pregnancy, SLAs and B2M increased in stroma where they remained through Day 40. Progesterone increased SLA and B2M in LE, and a progesterone receptor antagonist ablated the upregulation while infusion of IFN-containing CSP increased SLA and B2M in stroma. Collectively, these studies identify ISGs expressed in the pig endometrium during pregnancy. These genes may be involved in protecting the fetal semiallograft from immune rejection, limiting conceptus invasion through the uterine wall, and/or establishing a vascular supply to the conceptus. The interactions of estrogen, progesterone and IFNs to regulate cell-type specific expression of ISGs highlight the complex interplay between endometrium and conceptus for pregnancy recognition and implantation.

Endogenous retroviruses (ERVs) comprise a significant portion of the genome of all mammals and have been implicated in placental development in multiple species. The ovine genome contains approximately 27 copies of endogenous betaretroviruses (enJSRVs) that are related to the exogenous Jaagsiekte sheep retrovirus (JSRV), an oncogenic retrovirus tropic to the lung. The enJSRV loci are abundantly expressed in the female reproductive tract and the conceptus, and they are essential to conceptus development. Studies were conducted to determine: 1) the effect of exogenous progesterone administration on conceptus development after loss of enJSRV Env; 2) the specific enJSRV env expressed in the developing conceptus; and 3) if the uterus produces enJSRV viral particles that are capable of transducing the conceptus. Study One determined the effects of exogenous progesterone on development of the conceptus in which enJSRV Env was ablated. Despite rescuing conceptus survival, the conceptuses were morphologically fragile and had reduced binucleate cell (BNC) numbers. These results suggest that mononuclear trophectoderm cell (MTC) proliferation and differentiation is dependent on enJSRV Env, even in a uterine environment supported by exogenous progesterone. Study Two assessed the enJSRV loci transcribed in the ovine conceptus during elongation before (day 13) and after (day 18) onset of BNC differentiation. The most represented loci in both day 13 and day 18 conceptuses encoded truncated Env proteins that did not contain membrane-spanning domains. Conceptuses from both time points contained evidence of the transcription of full-length, biologically active enJSRV Env, as well as completely intact proviral loci with the ability to produce viral particles in vitro. Study Three utilized a transpecies embryo transfer experiment to determine if the intact enJSRVs loci could produce viral particles in vivo. The presence of enJSRV viral particles in the uterus was confirmed, as was their ability to transduce the conceptus. Collectively, these studies provide evidence of truncated Env proteins, intact biologically active Env proteins, and enJSRVs viral particles within the ovine uterus and conceptus that are necessary to stimulate proliferation and differentiation of MTCs even in a uterine environment supported by exogenous progesterone.

Progesterone is unequivocally required for the establishment and maintenance of pregnancy in all mammals studied. Its known functions are complex and encompass global changes in gene expression. Therefore, studies were conducted to characterize the effects of progesterone on expression of genes for endometrial factors having roles in conceptus growth, implantation and establishment of pregnancy. The first study characterized the effect of an artificially induced early increase in circulating progesterone on conceptus growth and development and regulation of expression of galectin-15 (LGALS15), a recently identified protein secreted by the ovine uterine luminal epithelium (LE). Exogenous progesterone beginning on Day 1.5 post-mating accelerated conceptus development on Days 9 and 12. On Day 12 the conceptus was functionally and morphologically advanced to produce greater quantities of interferon tau (IFNT) than blastocysts from control ewes. Further, the endometrium responded to early progesterone and IFNT with early expression of cathepsin L (CTSL), radical S-adenosyl methionine domain containing 2 (RSAD2), and LGALS15 within the endometrium. The second study identifed structural changes within the luminal epithelium which could alter the flux of factors into and out of the uterine lumen to maintain appropriate fetal/maternal communication. In this study, progesterone reduced quantities of proteins associated with both tight and adherens junctions during the elongation period. IFNT subsequently increased these proteins after conceptus elongation. The third and fourth studies identified progesterone-regulated genes which have been implicated as having importance to implantation in sheep, mouse, and human. WNT signaling was transiently downregulated by progesterone, while members of several growth factor families are upregulated including insulin-like growth factor binding proteins (IGFBPs) 1 and 3, hepatocyte growth factor (HGF) and fibroblast growth factor 7 (FGF7), which may enhance conceptus growth. Collectively, these studies assess the role of progesterone in altering gene uterine expression to establish a favorable environment for conceptus development. The long-term goals of these studies are to establish biomarkers of receptivity to conceptus development and implantation, enhance our understanding of gene and pathway regulation in early pregnancy loss, and identify genes which may be targeted in therapeutic strategies to improve reproductive success in humans and animals.

Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 53-59)f.

Thesis (M.Med.Sc.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 72-83).

Thesis (M.P.H.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 39-44).

Thesis (M.D.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 136-152).

Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009. / Full text also available online, Scroll down for electronic link.