Introduction This was a secondary data analysis of a prospective cohort of women enrolled in a phase III microbicide trial between October 2005 and August 2008. The study aimed to assess the pregnancy incidence rates and factors associated with pregnancy in women using barrier method and hormonal contraception, enrolled in the trial. Methods A total of 2508 participants were enrolled in the trial and followed up for up to 12 months. Of these 2437 were included in the pregnancy incidence analysis and 2171 participants were included in the multivariate analysis. Data on the main exposure, contraception, were collected by structured interview. The main outcome of interest was pregnancy, which was measured by detection of human chorionic gonadotrophin in urine using Quick Vue® test and confirmed by laboratory based testing. The incidence rate of pregnancy was calculated as number of pregnancies per 100 women years of follow up. Kaplan Meier Survival analysis was used to determine average time to first pregnancy. Univariate and multivariate analyses were conducted using Cox regression models to asses the factors associated with incident pregnancies. Data was analysed using Stata® version 10. Results A total of 2248 women years of follow up were recorded. A total of 238 pregnancies occurred resulting in pregnancy incidence of 11 per 100 women-years of follow up (95% CI: 9.32 to 12.02). The incidence of pregnancy increased with time in the study; 98 per 100 women years of follow up (95% CI: 85.09 to 112.35) in the last 3 months compared to 2 per 100 women-years of follow up (95% CI: 0.94 to 2.92) in the first 3 months of follow up. Older age and hormonal contraception use were significantly associated with a decreased risk of pregnancy. Women 35 years and older were 49% less likely to fall pregnant compared to those who were younger than 25 years, adjusted hazard ratio (AHR) 0.51(95% CI: 0.30 to 0.88, p=0.016). Women who used hormonal contraception had a reduced risk of falling pregnant AHR 0.66(95% CI: 0.46 to 0.94, p=0.02). There was no difference between the two types of hormonal contraception (injectable vs oral) with respect to pregnancy risk. Conclusion: The incidence of pregnancy increased with time in the study. Women who used hormonal contraception and who were older were less at risk of pregnancy. There was no significant difference in pregnancy risk by type of hormonal contraception (i.e. oral contraception vs injectable contraception) used.

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No description available.

Introduction: Maternal smoking is a risk factor for childhood overweight and obesity. However, the mechanisms underlying this association are largely unknown. Smoking is associated with changes in the composition of the maternal microbiome and there is now considerable evidence to suggest that the infant microbiome may play an important role in the development of obesity. Therefore we hypothesized that fetal and neonatal exposure to nicotine, the major addictive component of cigarettes, would result in dysbiosis, an alteration in the composition of the microbiome, in postnatal life. Methods: Nulliparous female Wistar rats were randomized to receive daily injections of saline (N=20) or nicotine bitartate (1.0 mg/kg/d; N=20) from 2 weeks prior to mating until weaning. We assessed markers of inflammation, gut permeability, and the composition of the gut microbiota in the offspring. Results: At the phyla level, exposure to nicotine resulted in alterations in the proportion of both Firmicutes and Bacteriodetes at 26 weeks of age. There were significant changes in a number of operational taxonomic units (OTUs) at 3, 12 and 26 weeks of age. Of note, a number of OTUs for Firmicute Clostridia Clostridiales Lachnospiraceae and Firmicute Clostridia Clostridiales Ruminococcus were decreased in the nicotine-exposed offspring which may suggest increased energy extraction in these animals. Although there was evidence of altered gene expression in pathways regulating inflammation and development, these did not result in increased inflammation or aberrant gut development Conclusion: Maternal nicotine-exposure resulted in dysbiosis in the gut of the offspring; an effect that persisted into adulthood. Since dysbiosis has been associated with increased weight gain and adiposity, these data suggest that alterations in the gut microbiome as a result of maternal nicotine-exposure may explain, in part, the increased risk of obesity in children born to mothers who smoke. / Thesis / Master of Health Sciences (MSc)

The occurrence of pre-existing type 1 and type 2 diabetes in pregnancy has been on the rise, parallel with the current “diabetes pandemic” (Albrecht et al., 2010; Coton et al., 2016; Feig et al., 2014; The Lancet, 2011). Currently, pre-existing diabetes affects up to 2.4% of pregnancies around the world (Deputy et al., 2018; Fadl & Simmons, 2016; Lopez-de-Andres et al., 2020; Tutino et al., 2014; Wahabi et al., 2017). Importantly, women with type 1 and type 2 diabetes are at a high risk of experiencing perinatal complications. Perinatal complications range from neonatal hypoglycemia to fetal and infant death (Feig et al., 2014; Kishida et al., 1989). The risk of complications is related to maternal glycemia; maintaining tight glycemic control within the recommended ranges for pregnancy is associated with a reduced risk of adverse outcomes (Feig et al., 2018; Inkster et al., 2006; Tennant et al., 2014). To achieve this, women experience a heavy burden of diabetes self-management during pregnancy. Little is known regarding the predictors of glycemic control during pregnancies complicated by type 1 and type 2 diabetes and their relationship with self-management factors, such as self-efficacy. Furthermore, the impact of these factors in combination with women’s pregnancy experiences has not been explored. The objective of this thesis was to explore how self-management and support experiences help explain glycemic control among women with pre-existing diabetes in pregnancy. There were four overarching questions: (a) What are the predictors of glycemic control during pregnancy among women with pre-existing diabetes? (b) What is the experience of managing diabetes during pregnancy? (c) What are the diabetes self-management education and support needs during pregnancy among women with pre-existing diabetes? (d) How do the self-management and support experiences of women with pre-existing diabetes in pregnancy help explain their glycemic control? The results of this sandwich thesis aim to answer these questions. The findings showed that women achieved tight glycemic control during pregnancy as they were motivated by the worry of complications for their unborn child. Fear related to complications, feeling unsupported by the healthcare team and a lack of connection with other mothers with diabetes contributed to compromised mental health. Future research should explore the development, implementation and evaluation of interventions to increase mental health support, peer support and support from the healthcare team for this vulnerable population. / Thesis / Doctor of Philosophy (PhD) / Expectant mothers with type 1 and type 2 diabetes have a high risk of complications related to their glucose levels during pregnancy. The relationship between glucose control, mothers’ self-confidence in managing diabetes and their experiences during pregnancy is not well understood. This study explored the factors that affect glucose control and their relationship with the support needs during pregnancy of mothers with type 1 and type 2 diabetes.

Thesis (Ed.D.)--Boston University

Thesis (M.S.)--Boston University

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Rationale & Background: During pregnancy, cardiometabolic adaptations occur to sustain fetal growth. Disruptions in maternal cardiometabolic status may arise related to maternal adiposity, dietary deficiencies or excesses, or sedentary behaviours in pregnancy. Clinically, maternal cardiometabolic dysfunction is associated with adverse health outcomes in both mothers and their offspring. We aimed to determine: 1) the contribution of maternal adiposity, diet and physical activity to maternal cardiometabolic status in early pregnancy using biomarkers of lipid and glucose profiles; 2) whether maternal adiposity measured by 4-site sum of skinfold thickness (SFT) or bioelectrical impedance analysis (BIA) yielded similar strength of association with cardiometabolic status. Study Design: Maternal blood samples, anthropometric and body adiposity, dietary and physical activity measures were collected from a subset of pregnant women in early pregnancy (12-17 wk gestation) prior to randomization to the Be Healthy in Pregnancy RCT. Blood samples were analyzed for fasting glucose, insulin, triglycerides, leptin, adiponectin, and C-reactive protein (CRP). Maternal adiposity was assessed by pre- pregnancy body mass index (pBMI) and two indirect quantitative measures of % body fat (BIA and 4-site SFT). Results: Of the 91 subjects (mean age= 31 ± 4 y), 46.2% were overweight/obese by pBMI. For both SFT and BIA, % body fat was positively associated with fasting glucose, insulin, triglyceride, leptin, and CRP concentrations, and negatively associated with adiponectin concentration, although the strength of the associations was greater for SFT than BIA. After adjustment for confounders, maternal adiposity remained significantly associated with all cardiometabolic biomarkers, except for adiponectin and CRP. Dietary polyunsaturated: saturated fat ratio, energy expenditure, high activity level, age, ethnicity and parity were significantly associated with some of the biomarkers. Conclusion: Maternal adiposity was predominantly associated with leptin, insulin, and glucose status in early pregnancy although dietary fat, energy, activity level, age, ethnicity and parity were also significantly associated with some biomarkers. Body fat estimated by SFT or BIA are generally comparable for use as a screening tool for cardiometabolic dysfunction in early pregnancy. In the clinical setting, BIA may be more easily adopted as it is faster and requires fewer technical skills by the operator than SFT measures. / Thesis / Master of Science (MSc)