The relationships between stress, ascorbic acid status, and the adequacy of nutrient intake during the third trimester of pregnancy were studied. Adequacy of nutrient and ascorbic acid intake were measured by diet histories and 24 hour recalls. Plasma ascorbic acid and cortisol levels were determined. Stress was assessed by Spielberger State-Trait Anxiety Inventories (STAI) and Symptom Checklists (SCL). Factors which may affect stress were assessed by a General Background Information Questionnaire. All subjects had acceptable plasma ascorbic acid levels (0.48 - 1.64). A-State and A-Trait scores, X̄ = 1.55 and X̄ = 1.63 respectively, indicated the majority of subjects to be little stressed. There were positive significant correlations between age and cortisol, A-State and A-Trait measures of STAI, nutritional scores from diet histories and plasma cortisol. Significant negative correlations were obtained between month of pregnancy and plasma ascorbic acid levels, total ascorbic acid intake and A-State measurements of STAI, A-State measurements and income, A-State measurements and education, and A-State measurements and ascorbic intake as calculated from diet histories. There was no significant correlations between STAI, measurements and cortisol, plasma ascorbic acid and cortisol, and STAI measurements and plasma ascorbic acid. This study showed no conclusive evidence that ascorbic acid status or nutrient intake were affected by psychological stress. / Master of Science

This retrospective study was undertaken to determine the effect of nutritional counseling and assessment of underweight pregnant women enrolled in NIP program of the Virginia State Health Department on pregnancy outcomes, including biological, social and nutritional risk variables. A total sample of 2228 prenatal women enrolled in the program from 1988-1991 were subjects for this study. A NIP program tracking form was used to obtain all the information pertinent to this research. About half of the underweight women as measured by percent expected weight remained underweight at their last visit and only 44% of the underweight pregnant women had normal expected weight at their last visit. Women of the other ethnic group had the highest change in protein intake during their pregnancy indicating that these women showed remarkable improvement in their dietary intake. The incidence of low birth weight in this subject population was greater when compared with the state vital statistics. Black women appeared to be more vulnerable than white women or women of other ethnic group. No significant difference was seen in the incidence of preterm and low birth weight infants born to underweight women who remained underweight at their last visit and those who had improvement in their percent expected weight. Longer NIP participation was not positively correlated with pregnancy outcomes. But positive correlations with number of nutritional visits and when the prenatal care began, it is possible that nutrition intervention by the NIP nutritionists may have reduced the incidence of unfavorable pregnancy outcomes. / Master of Science

Height, skinfold, and circumference measurements were obtained from 29 normal weight and 17 overweight (>110% of desirable weight for height) healthy pregnant women every four weeks during their second trimester of pregnancy. The mean weight gain and food intake values were not significantly different for both groups. Measurements increased at a greater rate for the normal weight gravidas than for the overweight gravidas in almost every case. For both groups, increases in fat stores were greater in the central sites than in the peripheral sites. No clear relationship between age, prepregnant weight, and weight gain during the second trimester with the birthweight of the baby was found. The infant birthweights of both groups were at an optimal level ( >2500 grams) except for one (born to the mother 151% of her desirable weight for height). The similarity in results for the two groups is greatly due to there not being a large enough difference in prepregnant weights between the two groups. Nevertheless, the results do lend support to a 20 to 30 pound weight gain for an optimal outcome of pregnancy for healthy pregnant women with a wide range of prepregnancy weights. Those women 150% or more of their desirable weight for height may need to gain on the lower end of the spectrum due to their excess endogenous reserves and to possible harm to the fetus with large gains. / Master of Science

M.S.

該前瞻性研究對香港中國裔孕婦的25羥基維生素D（25（OH）D）的水平及其影響因素進行調查，并對25（OH）D與甲狀旁腺激素（PTH）、孕期肌肉酸痛、不良妊娠結局、孕期及産後骨質流失，以及嬰兒的骨骼發育等關係進行探索，力求建立適用于香港的中國孕婦的25（OH）D正常值。 / 共有237名單胎妊娠婦女以及62名多胎妊娠的婦女在2010年8月至2011年11月間參加本研究中的隊列研究，分別在參加研究時（<20 孕周）、24-28孕周、31-36孕周以及産後6-11周進行抽血測量血清25（OH）D以及PTH水平，同時填寫一份包括對每月攝取含維生素D的食物以及營養補充劑頻度、接受日照情況及喜好、以及肌肉不適等情況的問卷，并在24-28孕周進行75克口服葡萄糖耐量試驗。參與隊列研究的單胎孕婦在20周前、31-36孕周以及産後隨訪時接受用定量超聲測量非優勢手的橈骨遠端以及中指近掌指骨的骨質超聲速率（SoS）。在産後複查時，對其嬰兒左側腓骨中部的骨質SoS進行測量。記錄婦女各次檢查時的體重、抽血月份紫外線輻射強度的歷史記錄、以及妊娠結局。另外募集一批孕婦參加病例對照研究，比較患早產（PTB）、子癇前期（PET）、妊娠糖尿病 （GDM）以及胎兒生長受限（FGR）併發癥的婦女與對照組 （體重指數以及抽血時紫外線強度配對）的血清25（OH）D水平。 / 孕婦在孕期的平均25（OH）D水平在44.7 ± 12.6 至48.9 ± 17.1 nmol/l範圍，25（OH）D水平與體重指數、維生素D營養補充劑、抽血時紫外線強度以及個人對陽光的喜好情況有關，而與胎兒數量、孕次、孕周以及終止妊娠無關。 / 單胎妊娠的孕婦三個孕期的血清25（OH）D與PTH水平均負相關，但在多胎妊娠中，二者無明顯相關性。PTH在孕期以及産後的變化相對不受25（OH）D影響。孕婦25（OH）D的水平與孕婦肌肉酸痛癥狀、産後恢復、孕期及產褥期骨質流失以及嬰兒骨質無關。患早期PTB（< 34孕周）、PET或FGR的孕婦的血清25（OH）D比對照組低，但GDM患者的25（OH）D水平與對照組無差別。血清25（OH）D低於34.3 nmol/l者的早期早產以及子癇前期的風險增高，低於50 nmol/l者發生胎兒生長受限的風險增高。服用維生素D補充劑情況可能影響25（OH）D與FGR的關係。 / 總而言之，血清25（OH）D水平不足以全面完全反映孕期維生素D的情況，對預測不良妊娠結局的作用有限。 / This prospective study explored the maternal serum level of 25(OH)D in Chinese pregnant women in Hong Kong and the factors affecting 25(OH)D level. It also explored the correlation between maternal 25(OH)D with PTH level, maternal musculoskeletal complaints, adverse pregnancy outcome, maternal bone turnover during pregnancy and postpartum, and the bone development of the offspring, aiming to explore and establish a normal range of 25(OH)D level in pregnancy for the Hong Kong Chinese women. / A total of 237 women with singleton pregnancy and 62 women with multiple pregnancies were recruited for the cohort study from August, 2010 to November, 2011. Maternal blood samplings for 25(OH)D and PTH measurements were performed at recruitment, 24-28 weeks, 31-36 weeks of gestation, and 6-11 weeks postpartum respectively. A questionnaire which included the monthly dietary and supplement intake of vitamin D, questions about sunlight exposure, and musculoskeletal complaints was administered on each visit. A 75g oral glucose tolerance test (OGTT) was performed on cohort cases at 24-28 weeks of gestation. Measurements of the speed of sound (SoS) at the distal one third of the maternal radius and the proximal phalanx of the third finger of the non-dominant side were performed with quantitative ultrasonography (QUS) measurement during the visits at the first and third trimesters, and postnatal period. The SoS at the left mid-shaft tibia of the offspring was determined during the postnatal visit. Maternal characteristics, ultraviolet radiation (UVR) intensity at blood sampling, and pregnancy outcome, were also recorded. Cases with pregnancy complications were recruited for case-control studies, and maternal 25(OH)D level was examined with respect to preterm birth (PTB), preeclampsia (PET), gestational diabetes (GDM), and fetal growth restriction (FGR, birthweight below the 10th percentile of the customized estimated birthweight). The controls were matched for booking body mass index (BMI) and UVR intensity at blood sampling. / The mean 25(OH)D level in ranged from 44.7 ± 12.6 to 48.9 ± 17.1 nmol/l in the three trimesters, and was related to BMI, vitamin D supplementation, UVR intensity at blood sampling, and the acceptance of sunlight exposure, but not the number of fetus, parity, gestational age, or the completion of pregnancy. / Inverse correlation between PTH and 25(OH)D were observed in singleton, but not in multiple, pregnancy. The change in maternal PTH level is found to be relatively independent from that of 25(OH)D. There was no correlation between maternal 25(OH)D level with musculoskeletal complaints, postnatal recovery, bone turnover during and after pregnancy, or the bone density of the offspring. Maternal 25(OH)D level was lower in women with early PTB ( < 34 weeks), PET, and FGR, but not for GDM. A maternal 25(OH)D level of lower than 34.3nmol/l and 50 nmol/l was associated with increased risk of early PTB, PET, and FGR respectively. But the correlation between maternal 25(OH)D level with FGR might be affected by supplementation. / In conclusion, serum level of 25(OH)D is insufficient in reflecting maternal vitamin D status and metabolism in pregnancy, and is of limited use in predicting adverse pregnancy outcome. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Hu, Zhiyang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 201-223). / Abstracts and appendixes also in Chinese. / Thesis dedication --- p.i / Acknowledgments --- p.ii / Abstract --- p.v / Abstract (Chinese) --- p.viii / List of Abbreviation --- p.x / Table of contents --- p.xiii / List of Figures --- p.xxii / List of Tables --- p.xxiv / Chapter Chapter 1: --- Literature Review --- p.1 / Chapter 1.1 --- The synthesis and metabolism of vitamin D --- p.3 / Chapter 1.1.1 --- The synthesis of vitamin D --- p.3 / Chapter 1.1.2 --- The metabolism of vitamin D --- p.4 / Chapter 1.1.3 --- Vitamin D binding protein --- p.10 / Chapter 1.1.4 --- Factors related to 25(OH)D level --- p.11 / Chapter 1.2 --- Function of vitamin D --- p.13 / Chapter 1.2.1 --- Mechanism of vitamin D function --- p.13 / Chapter 1.2.2 --- Classic function --- p.14 / Chapter 1.2.3 --- Non-classic function --- p.16 / Chapter 1.2.3.1 --- Immune system --- p.17 / Chapter 1.2.3.2 --- Cardiovascular system --- p.18 / Chapter 1.2.3.3 --- Cell proliferation and differentiation --- p.18 / Chapter 1.2.3.4 --- Neurological system --- p.19 / Chapter 1.2.3.5 --- Reproductive system --- p.20 / Chapter 1.2.3.6 --- Fetal development --- p.21 / Chapter 1.3 --- The definition of vitamin D deficiency --- p.21 / Chapter 1.4 --- Vitamin D status and pregnancy --- p.24 / Chapter 1.4.1 --- Alteration in vitamin D metabolism during pregnancy --- p.24 / Chapter 1.4.2 --- Factors affecting maternal serum level of 25(OH)D --- p.25 / Chapter 1.4.3 --- Vitamin D and bone resorption during pregnancy and lactation --- p.27 / Chapter 1.4.3.1 --- Alteration of calcium metabolism, bone absorption and the role of vitamin D --- p.27 / Chapter 1.4.3.2 --- Measurement of bone density in pregnant women and babies --- p.33 / Chapter 1.4.4 --- Current studies on maternal vitamin D status and pregnancy outcome --- p.35 / Chapter 1.4.4.1 --- Birthweight --- p.35 / Chapter 1.4.4.2 --- Infection --- p.37 / Chapter 1.4.4.3 --- Preterm delivery --- p.39 / Chapter 1.4.4.4 --- Diabetes (DM) and gestational diabetes (GDM) --- p.39 / Chapter 1.4.4.5 --- Hypertension and preeclampsia --- p.41 / Chapter 1.4.4.6 --- Multiple pregnancy, muscular symptoms --- p.42 / Chapter 1.4.4.7 --- Vitamin D supplementation and pregnancy outcome --- p.44 / Chapter 1.5 --- Defining vitamin D deficiency in pregnancy --- p.45 / Chapter 1.6 --- Objective of the study --- p.46 / Chapter Chapter 2: --- Study design and methods --- p.48 / Chapter 2.1 --- Case recruitment and study design --- p.48 / Chapter 2.1.1 --- Longitudinal singleton study --- p.49 / Chapter 2.1.2 --- Cross-sectional study --- p.50 / Chapter 2.1.2.1 --- Preterm birth (PTB) --- p.51 / Chapter 2.1.2.2 --- Preeclampsia (PET) --- p.51 / Chapter 2.1.2.3 --- Gestational diabetes (GDM) --- p.52 / Chapter 2.1.3 --- Multiple pregnancy study --- p.52 / Chapter 2.2 --- Measurements --- p.53 / Chapter 2.2.1 --- Hormonal analysis of serum levels of 25(OH)D and PTH --- p.53 / Chapter 2.2.2 --- Calculation of monthly intake of vitamin D from diet --- p.55 / Chapter 2.2.3 --- SoS measurements --- p.56 / Chapter 2.2.4 --- Ultraviolet radiation strength assessment --- p.59 / Chapter 2.3 --- Statistical analysis --- p.60 / Chapter Chapter 3 --- Longitudinal Study on the Level of and Factors Affecting Vitamin D in Singleton Pregnancy --- p.62 / Chapter 3.1 --- Introduction --- p.62 / Chapter 3.2 --- Material and method --- p.63 / Chapter 3.3 --- Statistics --- p.64 / Chapter 3.4 --- Results --- p.65 / Chapter 3.4.1 --- Demographic data of the subjects --- p.65 / Chapter 3.4.2 --- Maternal levels of 25(OH)D and PTH, and the factors affecting their levels --- p.66 / Chapter 3.4.2.1 --- Distribution of 25(OH)D level and PTH level in the four visits --- p.66 / Chapter 3.4.2.2 --- Dietary intake of vitamin D and supplementation --- p.69 / Chapter 3.4.2.3 --- Seasonality and sunlight exposure --- p.73 / Chapter 3.4.2.4 --- Parity --- p.76 / Chapter 3.4.3 --- Changes of maternal levels of 25(OH)D and PTH in pregnancy --- p.78 / Chapter 3.4.4 --- Independent factors related to maternal 25(OH)D level in pregnancy --- p.79 / Chapter 3.4.5 --- Maternal and fetal 25(OH)D level at delivery --- p.80 / Chapter 3.4.6 --- Muscular symptoms and other complaints in pregnancy, pregnancy outcome, and their relationships with maternal 25(OH)D level --- p.81 / Chapter 3.4.7 --- Postnatal recovery and factors related to postnatal level of 25(OH)D and PTH --- p.86 / Chapter 3.4.7.1 --- Postnatal symptoms and relationship with 25(OH)D and PTH --- p.86 / Chapter 3.4.7.2 --- The postnatal level of 25(OH)D and PTH in women with different feeding mode --- p.88 / Chapter 3.4.7.3 --- Independent factors related to postnatal 25(OH)D and PTH level --- p.89 / Chapter 3.4.7.4 --- Factors related to the change of 25(OH)D and PTH after delivery --- p.90 / Chapter 3.4.8 --- Correlation between 25(OH)D with PTH in pregnancy and postnatal period --- p.91 / Chapter 3.5 --- Discussion --- p.92 / Chapter 3.5.1 --- 25(OH)D level in Chinese pregnant women --- p.92 / Chapter 3.5.2 --- Factors related to maternal 25(OH)D level --- p.93 / Chapter 3.5.2.1 --- Dietary and supplementation --- p.93 / Chapter 3.5.2.2 --- Seasonality and outdoor activity --- p.96 / Chapter 3.5.2.3 --- Gestational age --- p.98 / Chapter 3.5.2.4 --- Age and parity --- p.98 / Chapter 3.5.3 --- Relationship of 25(OH)D level in the cord blood with maternal 25(OH)D level --- p.99 / Chapter 3.5.4 --- 25(OH)D level and muscular complains in pregnancy --- p.100 / Chapter 3.5.5. --- Postnatal recovery and 25(OH)D level --- p.101 / Chapter 3.5.6 --- PTH level in pregnancy and postnatal period --- p.101 / Chapter 3.6 --- Conclusion --- p.102 / Chapter Chapter 4 --- Longitudinal Study on the Relationship between Maternal 25(OH)D level with Changes of Maternal Bone Density in Pregnancy and Lactation, and Factors Affecting Bone Density of newborn Infants --- p.105 / Chapter 4.1 --- Introduction --- p.105 / Chapter 4.2 --- Material and method --- p.106 / Chapter 4.3 --- Statistics --- p.108 / Chapter 4.4 --- Results --- p.108 / Chapter 4.4.1 --- Demographic data --- p.108 / Chapter 4.4.2 --- Maternal bone density and the changes in pregnancy and postnatal recovery --- p.109 / Chapter 4.4.2.1 --- Maternal bone density in the first trimester and related factors --- p.109 / Chapter 4.4.2.2 --- Maternal bone density in the three visits --- p.109 / Chapter 4.4.2.3 --- The change in maternal bone density in the three visits --- p.110 / Chapter 4.4.2.4 --- Diversity in the change of bone density in pregnant women --- p.112 / Chapter 4.4.3 --- Factors related to the changes in bone density --- p.114 / Chapter 4.4.3.1 --- Changes between the first and the third trimesters --- p.114 / Chapter 4.4.3.2 --- Change between the third trimester and postnatal visits --- p.116 / Chapter 4.4.4 --- The bone density in infants and related factors --- p.120 / Chapter 4.5 --- Discussion --- p.122 / Chapter 4.5.1 --- Maternal bone density changes in pregnancy and postnatal period --- p.122 / Chapter 4.5.2 --- Factors related to the maternal bone density changes in pregnancy and postnatal period --- p.124 / Chapter 4.5.2.1 --- Initial bone density, parity, and BMI --- p.125 / Chapter 4.5.2.2 --- 25(OH)D and PTH level --- p.126 / Chapter 4.5.2.3 --- Supplement --- p.127 / Chapter 4.5.2.4 --- Lactation --- p.128 / Chapter 4.5.2.5 --- Height --- p.129 / Chapter 4.5.3 --- Factors related to bone density of the infant. --- p.130 / Chapter 4.5.3.1 --- Maternal 25(OH)D level --- p.130 / Chapter 4.5.3.2 --- Gestational age and birthweight --- p.131 / Chapter 4.5.3.3 --- Maternal bone density change --- p.131 / Chapter 4.5.3.4 --- The gender of the offspring and feeding method --- p.132 / Chapter 4.6 --- Conclusion --- p.133 / Chapter Chapter 5 --- Maternal 25(OH)D Level in Multiple Pregnancy --- p.134 / Chapter 5.1 --- Introduction --- p.134 / Chapter 5.2 --- Material and method --- p.135 / Chapter 5.3 --- Statistics --- p.136 / Chapter 5.4 --- Results --- p.137 / Chapter 5.4.1 --- Demographic data of the subjects --- p.137 / Chapter 5.4.2 --- The level of 25(OH)D in multiple pregnancy and singleton pregnancy --- p.137 / Chapter 5.4.3 --- Supplementation in multiple pregnancy --- p.140 / Chapter 5.4.4 --- The change of maternal 25(OH)D and PTH levels in the three trimesters --- p.141 / Chapter 5.4.5 --- 25(OH)D level in cord blood and its correlation with 25(OH)D level of the sibling --- p.143 / Chapter 5.4.6 --- Correlation between 25(OH) with PTH in pregnancy --- p.143 / Chapter 5.5 --- Discussion --- p.144 / Chapter 5.5.1 --- 25(OH)D level in multiple pregnancy and singleton pregnancy --- p.144 / Chapter 5.5.2 --- Supplementation in multiple pregnancy --- p.146 / Chapter 5.5.3 --- Changes of maternal levels of 25(OH)D and PTH in the three trimesters in multiple pregnancy --- p.146 / Chapter 5.5.4 --- The PTH/25(OH) correlation --- p.147 / Chapter 5.6 --- Conclusion --- p.148 / Chapter Chapter 6 --- Maternal level of 25(OH)D in complicated pregnancy --- p.150 / Chapter 6.1 --- Introduction --- p.150 / Chapter 6.2 --- Method --- p.153 / Chapter 6.2.1 --- Preterm birth --- p.155 / Chapter 6.2.2 --- Preeclampsia --- p.155 / Chapter 6.2.3 --- Gestational diabetes --- p.156 / Chapter 6.2.4 --- Fetal growth restriction --- p.157 / Chapter 6.2.5 --- The association between 25(OH)D level with pregnancy complication --- p.158 / Chapter 6.3 --- Statistics --- p.159 / Chapter 6.4 --- Results --- p.160 / Chapter 6.4.1 --- Setting of the cutoff values of hypovitaminosis D --- p.160 / Chapter 6.4.2 --- Preterm birth --- p.160 / Chapter 6.4.3 --- Preeclampsia --- p.164 / Chapter 6.4.4 --- Gestational diabetes --- p.168 / Chapter 6.4.4.1 --- Case-control study --- p.168 / Chapter 6.4.4.2 --- Factors affecting OGTT results --- p.170 / Chapter 6.4.5 --- Fetal growth restriction --- p.173 / Chapter 6.5 --- Discussion --- p.179 / Chapter 6.5.1 --- Adjustment for confounders for case-control study --- p.179 / Chapter 6.5.2 --- PTB and 25(OH)D level --- p.181 / Chapter 6.5.3 --- PET and 25(OH)D level --- p.182 / Chapter 6.5.4 --- GDM and 25(OH)D level --- p.186 / Chapter 6.5.5 --- FGR and 25(OH)D level --- p.189 / Chapter 6.5.6 --- Defining vitamin D deficiency in pregnancy --- p.192 / Chapter 6.6 --- Conclusion --- p.195 / Chapter Chapter 7 --- Summary --- p.196 / References --- p.201 / Chapter Appendix 1 --- Antenatal questionnaire (English/Chinese) --- p.224 / Chapter Appendix 2 --- Postnatal questionnaire (English/Chinese) --- p.238

This study was undertaken to redress the scant knowledge regarding the chemistry and mode of action of pregnancy-related traditional medicines, or isihlambezo (Zulu), which are used by 60 to 80% of women in South Africa. The three selected plants are among the six most frequently cited species from the approximately 90 used by traditional healers. The purpose of the study was to identify components which could cause uterine contractions, those with nutritional value for the foetus and mother, and those with any toxic effects. Plant root extracts were purified via silica gel column chromatography and bioassays were carried out on the fractions, using isolated rat uterine tissue. Purified compounds were identified via spectral techniques, and some were characterised by comparison to authentic standards using HPLC, and others by matching their GC-MS spectra to library standards. Thirty-eight compounds were identified in total, the majority of these being novel to the species concerned. Those isolated from Combretum kraussii were 1 sitosterol, 2 combretastatin, 3 3',4-tri-O-methylellagic acid, 4 combretastatin B-1, 5 combretastatin A-1, 6 3,3'-di-O-ellagic acid lactone, 7a ellagic acid lactone, 7b ellagic acid, 8 and 9 a mixture of combretastatin B-1 and A-1 glucosides, 10 and 11 partly characterised glucosides of ellagic acid. Those isolated from Gunnera perpensa were 12 3',4-tri-methylellagic acid, 13 ellagic acid lactone, 14 1,1'-biphenyl-4,4'-diacetic acid, 15 p-hydroxybenzaldehyde, 16 Z-methyl lespedezate, 17 and 18 partly characterized higher glucosides of Z-methyllespedezate. Those isolated rom Rhoicissus tridentata were 19 (-)-epigallocatechin, 20 (+)-gallocatechin, 21 procyanidin B3, 22 procyanidin B4, 23 (+)-catechin hydrate, 24 (+)-mollisacacidin, 25 (+)-epicatechin, 26 fisetinidol-(4a-8) catechin, 27 (-)-fisetinidol, 28 fisetinidol-(4b-8)catechin, 29 gallic acid, 30 epicatechin-3-0-gallate, 31 partly characterized hydrogel of glucose, 32 sitosterol, 33 sitosterolin, 34 y-sitosterol, 35 oleanolic acid, 36 lupen-3-one, 37 20-epi-y-taraxastananol and 38 triacontanol. The compounds with the greatest in vitro uteroactivity were predominantly proanthocyanidins or phenolic glucosides. It is proposed that effects of phenolic glucosides could be due to the interaction of the sugar moiety as well as the phenolic moiety with the receptor site in muscle tissue. The corresponding phenolic aglycones isolated were only moderately uterotonic, or unreactive by comparison. Non-polar compounds such as sitosterol and sitosterolin showed minimal enhancement of the uterine response at low concentrations, and inhibition at higher concentrations. Aqueous root extracts of the plants were all found to be non-toxic according to cell-viability tests using monkey vero cells and human fibroblasts. Extracts are therefore considered safe for human consumption, although it is recommended that Rhoicissus tridentata be used with caution because it showed the lowest cell viability of the three species, and uterine hyperstimulation has been attributed to this species, as well as CNS depression and respiratory arrest. Ions which could be nutritionally beneficial in pregnancy, calcium, iron, and phospate, were present in low in aqueous extracts. Levels of calcium and potassium ions were considered to be too low to directly stimulate uterine muscle. Proanthocyanidins, combretastatins, ellagic acid derivatives and phytosterols, with health-promoting properties, were also identified. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

Thesis (MNutrition )ITE))--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: The primary objective was to determine whether pregnant women visiting primary health care clinics (PHCs) were aware of the nutritional supplementation programmes: Nutrition Supplementation Programme (NSP) food, folate-, iron- and vitamin A supplementation. The secondary objective was to determine whether pregnant women qualified for the NSP food-, folate- and iron supplementation. The third objective was to determine whether those who qualified received the prescribed NSP food-, folate-, and iron supplementation and whether they were compliant with these interventions. Design: A cross-sectional descriptive study was conducted at all PHCs hosting basic antenatal clinics in the Cape Town Metropolitan Area of the Western Cape Province, South Africa. Method: One hundred and fourteen pregnant women who met the inclusion criteria were included in the study using a non-random quota sampling strategy. Pregnant women were interviewed using a validated questionnaire. The mid upper arm circumference (MUAC) was measured and the symphysis-fundus (SF) measurement was obtained from the medical files to determine whether participants met the entry criteria for the NSP. Written informed consent was obtained from participants. Results: Fifty per cent of participants were between 12 and 24 weeks of gestation. Most of them (68%) had an MUAC of between 24,7 cm and 34,4 cm. Fifty (44%) of the participants had a sufficient SF measurement. Twenty-one (18%) of the participants indicated that they were aware of the vitamin A Programme, 56 (49%) were aware of the NSP food-supplementation and 79 (70%) knew about the folicand iron supplementation that pregnant women should receive from the clinic. Six (5%) participants qualified for the NSP with an MUAC of below 23 cm. Only one (17%) participant was registered with the NSP and received the food-supplementation. Seventy (61%) of the participants indicated that they received and used the iron- and folic supplements, of which 30 (43%) did not know why they needed to take these supplements. Conclusion: Folate- and iron supplementation appears to be reasonably successfully implemented in the Cape Town Metropolitan Area among pregnant women visiting PHCs. The NSP food-supplementation, however, appears to be unsuccessfully implemented and needs further attention. Resources could be appointed to inform pregnant women about the reasons for and importance of taking these supplements. / AFRIKAANSE OPSOMMING: Inleiding: Die hoofdoelstelling was om te bepaal of swanger vroue wat primêre gesondheidsorgklinieke (PGK’s) bywoon, bewus was van die voeding supplementasie programme: Voedsel Supplementasie Program (VSP) – voedselaanvulling, folaat-, yster- en vitamien A supplementasie. Die tweede doelstelling was om te bepaal of hierdie swanger vroue in aanmerking kom vir die VSP– voedselaanvulling, folaat- en yster supplementasie. Die derde doelstelling was om te bepaal of hierdie swanger vroue die voorgeskrewe VSP – voedselaanvulling, folaat- en yster supplementasie ontvang het en hierdie intervensies nagevolg het. Ontwerp: ʼn Deursnit beskrywende studie is gedoen en data is ingesamel van al die PGK’s wat voorgeboortelike klinieke huisves in die Kaapstadse metropolitaanse gebied, in die Wes-Kaapprovinsie, Suid-Afrika. Metode: Honderd en veertien swanger vroue wat aan die insluitingskriteria voldoen het, is volgens ʼn nie-ewekansige kwotastrategie uitgesoek om aan die studie deel te neem. Onderhoude is volgens ʼn bevestigde vraelys met swanger vroue gevoer. Die omtrek van die middelboarm is geneem en die symphysis-fundus-meting is van die mediese lêers verkry om te bepaal of deelnemers aan die insluitingskriteria vir die VSP voldoen. Deelnemers het ʼn vrywaringsvorm geteken voordat hulle aan die studie begin deelneem het. Resultate: Vyftig persent van die swanger vroue het ʼn gestasie-ouderdom van tussen 12 en 24 weke gehad. Die omtrek van die meeste vroue (68%) se middelboarm was tussen 24,7 cm en 34,4 cm. Vyftig (44%) van die vroue se symphysis-fundusmeting was voldoende. Een en twintig (18%) van die deelnemers het aangedui dat hulle van die Vitamien A-program bewus was, 56 (49%) was van die VSPvoedselaanvulling bewus en 79 (70%) van die deelnemers was bewus van die folaat- en yster supplementasie wat swanger vroue van die kliniek behoort te ontvang. Ses (5%) deelnemers, met ʼn middelboarm-omtrek van minder as 23 cm, het vir die VSP in aanmerking gekom. Slegs een (17%) deelnemer was geregistreer en het die voedselaanvulling ontvang. Sewentig (61%) van die deelnemers het aangedui dat hul wel yster- en folaat supplementasie ontvang en gebruik, waarvan 30 (43%) nie geweet het waarom hulle dié supplemente neem nie. Gevolgtrekking: Dit wil voorkom asof folaat- en yster supplementasie vir swanger vroue wat PGK’s in die Kaapstadse metropolitaanse gebied besoek, redelik suksesvol toegepas word. Daarteenoor word die VSP – voedselaanvulling onsuksesvol uitgevoer en behoort dit verdere aandag te geniet. Hulpbronne kan aangewys word om swanger vroue beter in te lig oor die doel en belangrikheid daarvan om hierdie supplemente te neem.

Made available in DSpace on 2016-06-07T17:12:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-22. Added 1 bitstream(s) on 2016-06-07T17:16:33Z : No. of bitstreams: 1 000864313.pdf: 5847541 bytes, checksum: 79d376f36de687b2301fef412b63caed (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: delinear, implementar e avaliar a efetividade de uma intervenção - inserção sistematizada da promoção da alimentação saudável e caminhada no lazer na atenção pré-natal rotineira realizada por médicos e enfermeiros em unidades de saúde da família - sobre cinco práticas alimentares e a realização de caminhada no lazer por gestantes. Métodos: estudo de intervenção controlado, não randomizado, no qual participaram 42 médicos/enfermeiros e uma amostra (n=353) de gestantes por eles assistidas em unidades de atenção primária à saúde da rede pública do município de Botucatu-SP, Brasil. O estudo foi dividido em duas etapas: avaliação das mudanças em conhecimentos e práticas dos profissionais e avaliação do impacto da intervenção sobre os comportamentos das gestantes por eles assistidas. Na primeira, foi delineada e implementada uma ação educativa (AE), com 16 horas, presenciais, dirigida a médicos e enfermeiros que assistem gestantes em 9 unidades de saúde da família, com o objetivo de ampliar/adequar seus conhecimentos sobre alimentação e atividade física na gestação e organizar o processo de trabalho para a inserção sistematizada no pré-natal da promoção de 5 práticas alimentares (3 frutas diariamente; 2 porções de hortaliças e 2 de feijão, pelo menos em 5 dias da semana; consumo esporádico (no máximo uma vez por semana) de refrigerante e/ou biscoito industrializado) e da orientação das gestantes para a realização de caminhada no lazer. A AE incluiu um curso de imersão (8hs) com todos os profissionais e 3 oficinas de trabalho em cada unidade de saúde. Os conhecimentos e práticas dos participantes (n=22), antes e após a intervenção, foram comparados aos de um grupo controle (n=20), formado pelos profissionais de 8 unidades básicas de saúde de modelo tradicional (UBS) situadas no mesmo município e que não foram envolvidas na intervenção. Nos dois grupos, os conhecimentos... / Objective: to design, implement and evaluate the effectiveness of an intervention - systematic insertion of promoting healthy eating and leisure-time walking during in routine prenatal care performed by doctors and nurses in family health care units - over five dietary practices and the realization of leisure-time walking at by pregnant women. Methods: this is a controlled intervention study, not randomized, in which took part 42 doctors/nurses and a sample (n=353) of pregnant women attended by those professionals in primary health care settings to public health care in the city of Botucatu-SP, Brazil. The study has been divided into two stages. The first one was the implementation and evaluation of an educational activity (EA), with 16 hours, by attendance, addressed to doctors and nurses who assist pregnant women in nine family health care units, in order to extend/adapt their knowledge of nutrition and physical activity during pregnancy and then introduce routinely and systematically in prenatal care the promotion of 5 dietary practices (3 fruit daily; 2 servings of vegetables and two servings of beans, at least 5 days a week; sporadic consumption (maximum once a week) of soda and / or industrialized cookie), and guidance of pregnant women to walking during leisure time. The knowledge and practices of the participants (n=22) before and after the EA, have been compared to a control group (n=20), formed by professionals of eight traditional health care units not involved in the educational activity. This knowledge has been evaluated in both groups with a self-applied questionnaire, elaborated for this research; practices (guidance for leisure-time walking and healthy eating) have been measured by interviews with pregnant women assisted by two professional groups, in their homes. We have generated two scores of knowledge (about walking and nutrition) and we have used ANOVA for repeated measures to assess changes before and after the ...

Orientador: Maria Antonieta de Barros Leite Carvalhães / Coorientador: Maria Helena D'Aquino Benício / Banca: Daniela Saes Sartorelli / Banca: Luiza Cristina Godim Domingues Dias / Banca: Paula Andrea Martins / Banca: Silvia Justina Papini / Resumo: Objetivo: delinear, implementar e avaliar a efetividade de uma intervenção - inserção sistematizada da promoção da alimentação saudável e caminhada no lazer na atenção pré-natal rotineira realizada por médicos e enfermeiros em unidades de saúde da família - sobre cinco práticas alimentares e a realização de caminhada no lazer por gestantes. Métodos: estudo de intervenção controlado, não randomizado, no qual participaram 42 médicos/enfermeiros e uma amostra (n=353) de gestantes por eles assistidas em unidades de atenção primária à saúde da rede pública do município de Botucatu-SP, Brasil. O estudo foi dividido em duas etapas: avaliação das mudanças em conhecimentos e práticas dos profissionais e avaliação do impacto da intervenção sobre os comportamentos das gestantes por eles assistidas. Na primeira, foi delineada e implementada uma ação educativa (AE), com 16 horas, presenciais, dirigida a médicos e enfermeiros que assistem gestantes em 9 unidades de saúde da família, com o objetivo de ampliar/adequar seus conhecimentos sobre alimentação e atividade física na gestação e organizar o processo de trabalho para a inserção sistematizada no pré-natal da promoção de 5 práticas alimentares (3 frutas diariamente; 2 porções de hortaliças e 2 de feijão, pelo menos em 5 dias da semana; consumo esporádico (no máximo uma vez por semana) de refrigerante e/ou biscoito industrializado) e da orientação das gestantes para a realização de caminhada no lazer. A AE incluiu um curso de imersão (8hs) com todos os profissionais e 3 oficinas de trabalho em cada unidade de saúde. Os conhecimentos e práticas dos participantes (n=22), antes e após a intervenção, foram comparados aos de um grupo controle (n=20), formado pelos profissionais de 8 unidades básicas de saúde de modelo tradicional (UBS) situadas no mesmo município e que não foram envolvidas na intervenção. Nos dois grupos, os conhecimentos... / Abstract: Objective: to design, implement and evaluate the effectiveness of an intervention - systematic insertion of promoting healthy eating and leisure-time walking during in routine prenatal care performed by doctors and nurses in family health care units - over five dietary practices and the realization of leisure-time walking at by pregnant women. Methods: this is a controlled intervention study, not randomized, in which took part 42 doctors/nurses and a sample (n=353) of pregnant women attended by those professionals in primary health care settings to public health care in the city of Botucatu-SP, Brazil. The study has been divided into two stages. The first one was the implementation and evaluation of an educational activity (EA), with 16 hours, by attendance, addressed to doctors and nurses who assist pregnant women in nine family health care units, in order to extend/adapt their knowledge of nutrition and physical activity during pregnancy and then introduce routinely and systematically in prenatal care the promotion of 5 dietary practices (3 fruit daily; 2 servings of vegetables and two servings of beans, at least 5 days a week; sporadic consumption (maximum once a week) of soda and / or industrialized cookie), and guidance of pregnant women to walking during leisure time. The knowledge and practices of the participants (n=22) before and after the EA, have been compared to a control group (n=20), formed by professionals of eight traditional health care units not involved in the educational activity. This knowledge has been evaluated in both groups with a self-applied questionnaire, elaborated for this research; practices (guidance for leisure-time walking and healthy eating) have been measured by interviews with pregnant women assisted by two professional groups, in their homes. We have generated two scores of knowledge (about walking and nutrition) and we have used ANOVA for repeated measures to assess changes before and after the ... / Doutor

This study was done with the objective of designing and applying a nutrition education program based on a test of improved practices for pregnant women and women of childbearing age in the rural communities of Ibarra canton: La Riconada and Cuambo. For this, information was collected on knowledge, attitudes, and practices (KAP) regarding the eating habits of pregnant women. These results were used to identify content and recommendations to reinforce and/or instruct about eating during pregnancy. Nutrition education was based on the methodology of the improved practices test, which consisted of testing the recommendations in families' homes before recommending them and recording information on their acceptability. The results indicate that pregnant women in the two communities don't eat all the food groups every day. They need to increase the consumption of foods rich in calcium and iron, as well as foods that supply energy, protein, and fats. The pregnant women don't eat additional foods to cover these recommendations during the pregnancy. Despite the knowledge they have and the lessons they received, there are women who don't eat greens, vegetables, and fruits because they don't like them, and those who do eat them don't meet the established nutritional recommendations. The women prefer to eat artificial drinks with unboiled water, and they do not look after personal hygiene. The test of improved practices has been useful for observing if they really put in practice the knowledge about eating during pregnancy, and at the same time it helped design the educational proposal that served as a guide to help improve eating practices of pregnant women in the two rural communities, considering their motivations and recommendations.