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The intent of this research project was to discover the barriers that exist in this community when a woman attempts to access prenatal care. A concern for the well being of the children in the community and a belief in the importance of early intervention to enhance outcomes inspired the idea for this project.

Thesis (M. A. (Clinical Psychology)) University of Limpopo, 2017 / The study investigated the prevalence of Obsessive-Compulsive Disorder (OCD) symptoms and their relationship with pregnancy-related anxiety, prenatal depression and clinical anger among African pregnant women. The sample consisted of 206 pregnant women attending their antenatal check-ups at the Mankweng, Nobody and Rethabile clinics, and Mankweng hospital in the Capricorn District, Limpopo Province. When correlational analysis was conducted, the patient characteristics of age, having undergone a medical check-up, and having previously delivered a live baby generally did not correlate with any of the main scales measuring OCD, namely, perinatal depression, pregnancy-related anxiety and clinical anger (p > 0.05). Findings from the study indicated that almost 81% of the pregnant women could be classified as obsessive-compulsive disordered, when using the Foa et al. (2002) cut-off score of 21. Furthermore, findings from the regression analyses indicated that higher age, the number of gestation weeks, having previously experienced pregnancy-related complications, perinatal depression, pregnancy-related anxiety and clinical anger were variably positive predictors of OCI-R measured OCD symptoms. The predictors are specific to each of the symptoms. It can be concluded from the study that there is a relationship between OCD symptoms and all the independent variables used. / National Research Foundation

Bakgrund: Depressiva symtom (DS) är vanligt förekommande under graviditeten samtidigt som den fysiska aktivitetsnivån tenderar att minska under graviditeten. Få studier har undersökt sambandet mellan fysisk aktivitet (FA) och DS hos gravida kvinnor i Sverige. Syfte: Att kartlägga fysiska aktivitetsnivå och förekomst av DS hos gravida kvinnor i Sverige. Undersöka om det finns samband mellan dessa variabler och om det finns skillnad i DS mellan de som uppnår rekommendationerna för FA och de som inte gör det. Metod: En kvantitativ tvärsnittsstudie som undersökte FA med The International Physical Activity Short Form och DS med Edinburgh Postnatal Depression Scale (EPDS). 86 gravida kvinnor inkluderades i studien. Resultat: Totalt 72% av deltagarna uppnådde rekommendationerna för FA. 29% av deltagarna var fysiskt aktiva på en låg nivå, 47% på en måttlig nivå och 24% på en hög nivå. 21% av deltagarna hade DS enligt EPDS. Det fanns inget signifikant samband mellan FA och poäng på EPDS. Det förekom ingen signifikant skillnad i poäng på EPDS mellan de som uppnådde rekommendationerna för FA och de som inte gjorde det. Konklusion: Majoriteten av deltagarna uppnådde rekommendationerna för FA. Ungefär en femtedel av deltagarna fick över 12 poäng på EPDS vilket indikerar ett behov för utredning av eventuell depression. Det fanns inget samband mellan FA och poäng på EPDS. Ingen signifikant skillnad mellan grupperna kunde påvisas. Vidare forskning behövs för att studera FA som behandling vid DS under graviditet. / Background:Depressive symptoms (DS) are common during pregnancy and physical activity (PA) tend to decrease during pregnancy. Few studies have examined the relationship between PA and DS in pregnant women in Sweden. Purpose:Examine the physical activity level and presence of DS in pregnant women in Sweden. Examine the relationship between these variables and the difference in DS between those who fulfilled the recommendations for PA and those who did not. Methods:A quantitative cross-sectional study investigating PA with The International Physical Activity Short Form and DS with the Edinburgh Postnatal Depression Scale (EPDS). 86 pregnant women were included in the study. Results:A total of 72% of the participants achieved the recommendations for PA. 29% were physically active at a low level, 47% at a moderate level and 24% at a high level. 21% of the participants had DS according to EPDS. There was no significant association between PA and points on EPDS. There was no significant difference in points on EPDS between those who achieved the recommendations for PA and those who did not. Conclusion:The majority of the participants achieved the recommendations for PA. About one-fifth of the participants received more than 12 points on EPDS, indicating a need for an investigation of possible depression. There was no association between FA and points on EPDS. No significant difference between the groups was detected. Further research is needed to study PA as a treatment for DS during pregnancy.

Endocrine disrupting chemicals (EDCs) are emerging contaminants that can interfere with the hormone system and may cause cancers, birth defects and reproductive system disorders. Prevalence of endocrine-related dysfunction and disease has increased steadily over the past decades. Although accumulating data suggest that these diseases have fetal origins, associations of EDC exposure during pregnancy and adverse health effects on both mothers and fetuses have not been thoroughly evaluated, particularly at multiple points in time. We firstly developed an analytical method for quantification of 28 EDCs (9 phthalates, 8 bisphenols, 5 parabens, 5 benzophenones and triclosan) in urine samples using ultra high performance liquid chromatography coupled with triple quadrupole mass spectrometer. The method was applied to measure targeted compounds in a total of 5220 urine samples collected from 951 pregnant women at three trimesters and 1501 pregnant women at one or two trimesters in Wuhan, China between 2014 and 2015. Based on the quantification results, exposure patterns and health risks of 28 EDCs on participants were evaluated and discussed in detail below. Among these samples, bisphenol A (BPA), bisphenol S (BPS), bisphenol F (BPF), methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), 4-hydroxybenzophenone (4-OH-BP), 2,4-dihydroxybenzophenone (BP-1), 2-hydroxy-4-methoxybenzophenone (BP-3), triclosan, mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono(2-ethylhexyl) phthalate (MEHHP), monobenzyl phthalate (MBzP), mono-n-butyl phthalate (MnBP), monoisobutyl phthalate (MiBP) were determined with detection rates exceeding 50%, in which BPA, BP-3, MeP and MnBP were the predominant compounds. We found the U-shaped trends of urinary concentrations of phthalate metabolites over trimesters. Parabens, benzophenones and triclosan displayed a downward trend over three visits. We also found the levels of targeted compounds varied by exposure-related factors, such as sampling seasons, physical activities, computer using time and decoration information. In addition, multiple EDCs were mostly determined at low doses over trimesters, indicating that real-world exposure of pollutants were dominated by low-dose mixtures. We then evaluated the combined health hazards induced by EDC exposure via calculating the estimated daily intakes on the basis of average urinary concentrations at three trimesters. It was found that 24.9% of participants had potential health risks caused by exposure to phthalate mixtures. The most frequency of cumulative risks occurred in women who were exposed to a high dose of one specific phthalate, di-n-butyl phthalate (DnBP) or di(2-ethylhexyl) phthalate (DEHP). We also evaluated the cumulative health risks of BPA and its alternatives and found that about 1.6% of participants were at risks induced by bisphenol exposure. Combined health hazards were mainly driven by one specific bisphenol (BPS or BPA). Our findings suggested that regional interventions of DnBP, DEHP, BPA and BPS in application and production should be tighten and/or taken. Considering the low-dose effects of BPA, we further investigated the associations of BPA and three major natural estrogens, including estrone (E1), estradiol (E2) and estriol (E3), at three trimesters of pregnancy. We observed non-monotonic dose-response relationships of BPA to E1, E2 and E3 over trimesters even when BPA concentrations were below the current safety thresholds. In the gender-stratified models, we found significant negative relationships (β < 0, p < 0.05) between BPA and E2 among mothers with male fetuses in the first trimester. However, we found that no significant relationship between BPA and E2 among mothers with female fetuses over three trimesters. Significant non-monotonic associations (from significant negative to positive associations) between BPA and E3 were observed among mothers with female fetuses in the second trimester. The above mentioned findings suggested the gender-specific and trimester-specific effects of BPA on estrogens. Our findings also indicated that the current tolerance daily intake value maybe not safe enough to evaluate the potential health risks induced by BPA exposure. We next investigated the effects of maternal exposure to phthalates on both mothers and fetuses. Associations of phthalate exposure with the risks of gestational diabetes mellitus (GDM) and plasma glucose levels were evaluated based on a nested case-control study design. It was found that the levels of phthalate metabolites in women with GDM were significantly higher than those without GDM. Meanwhile, positive associations between urinary concentrations of phthalate metabolites and the risks of GDM were obvious, indicating that phthalate exposure may be a risk factor for GDM. In addition, phthalate levels were related to the increased plasma glucose levels after 75 g oral glucose tolerance test. Our findings suggested that phthalates might disturb the glucose homeostasis and increase GDM risks. Furthermore, we assessed the trimester-specific and gender-specific effects of DEHP exposure on fetal growth, birth size and postnatal growth at 6, 12 and 24 months. We found that among male offspring, 1st-trimester DEHP was negatively related to fetal growth (β < 0, p < 0.05), but positively related to 24-month body mass index (BMI). 2nd-trimester DEHP was negatively related to fetal growth, birth weight and birth length, but positively related to the weight gain rates from birth to 12 months old. 3rd-trimester DEHP was positively (β > 0, p < 0.05) associated with birth weight, BMI at 6 and 12 months. However, among females, 1st-trimester DEHP was associated with increased birth length, while 2nd-trimester DEHP was negatively associated with BMI at 6 and 12 months. A negative association between DEHP and weight gain rates at 6 months was noted among females. Our findings indicated the second trimester maybe the sensitive window of DEHP exposure for offspring growth since 2nd-trimester DEHP levels were related to the decreased fetal growth, decreased birth size, but increased weight gain rates in early childhood age among male offspring. To investigate the mechanism underlying the associations of DEHP exposure with glucose and lipid metabolism, we investigated the biotransformation of DEHP and the disturbed metabolisms induced by MEHP, the putative toxic metabolite of DEHP, in human normal liver cell L02 using metabolomics and lipidomics. We found that MEHP was the major metabolite of DEHP. Decreased uptake of glucose and accumulation of glucose in liver cells were obvious after MEHP exposure. Phospholipid remodeling, incomplete fatty acid β-oxidation, inhibition of purine metabolism and glycolysis, and increased oxidative stress were noted in MEHP-exposed L02 cells, which were related to insulin resistance. In this work, we measured 28 EDCs in a total of 5220 urine samples provided by 951 pregnant women (three trimesters) and 1501 pregnant women (one or two trimesters) and then evaluated the exposure levels, exposure patterns (variations, variability and correlations), health risks and health effects of these compounds on pregnant women and fetuses. Our data suggested that participants had potential health risks induced by exposure to phthalates or bisphenols. Phthalate exposure was related with the increased plasma glucose levels and risks of GDM. Prenatal DEHP exposure may induce the intrauterine growth restriction and catch-up growth among males, which supported the evidence of fetal origin. To explore the underlying mechanisms of MEHP on glucose and lipid metabolic disorders, we exposed the human normal hepatic L02 cells with MEHP, and applied metabolomic and lipidomic approaches for finding potential biomarkers and disturbed pathways. We found that MEHP exposure inhibited glucose uptake, caused phospholipid remodeling and increased oxidative stress in L02. These findings suggest that the usage of products containing EDCs, particularly phthalates, in pregnant women should be limited in China, intervention of BPS should be considered, and threshold values of BPA are called for reevaluation.

PhD (Advanced Nursing Science) / Department of Advanced Nursing Science / See the attached abstract below

Bakgrund: Det finns samband mellan den gravida kvinnans förväntningar inför förlossning och förlossningsupplevelsen. Trots tidigare förlossningserfarenhet tycks omföderskor förvånansvärt nog inte ha mer realistiska förväntningar inför förlossning än vad förstföderskor har. Syfte: Att synliggöra tvåföderskors förväntningar inför kommande förlossning. Metod: En kvalitativ metod med hermeneutisk textanalys inspirerad av Gadamer användes. Nio tvåföderskor i åldrarna 26-33 år intervjuades med hjälp av en halvstrukturerad intervjuguide. Resultat: De analyserade intervjutexterna mynnade ut i fyra huvudteman: Blandade känslor – förväntningar formas av första förlossningsupplevelsen, Partnern – en stöttepelare för vissa, Barnmorskan som vägledare genom förlossningen och ”Go with the flow” – förväntningar på kontroll under förlossning. I resultatet framgår att det finns en uppfattning hos kvinnorna om att den första förlossningsupplevelsen har stor inverkan på förväntningarna inför kommande förlossning, på gott och ont. Det finns en rädsla hos kvinnorna att det förväntas av dem att de på grund av sin tidigare förlossningserfarenhet redan ”kan”, vilket leder till oro. Konklusion: Tvåföderskorna har överlag positiva förväntningar inför sin kommande förlossning. Trots positiva förväntningar ges uttryck för en oro om att barnmorskan förväntar sig att de på grund av sin tidigare förlossningserfarenhet redan ”kan”. Tvåföderskor är således i behov av barnmorskans individuella och professionella stöd. / Background: There is a connection between the pregnant woman's expectations of childbirth and the actual childbirth experience. Aim: To illustrate multiparous women’s expectations of their forthcoming childbirth. Method: This study used a qualitative method with hermeneutic text analysis inspired by Gadamer. Nine multiparous women aged 26-33 years were interviewed using a semi-structured interview guide. Results: Analysis of the interviews revealed four main themes: Mixed emotions – expectations are formed by the first childbirth experience, The partner – for some, an important source of support, The midwife as a guide through childbirth and “Go with the flow” - expectations of control during childbirth. Results showed that the women held the opinion that the first childbirth experience has a major impact on their expectations for future childbirth, both good and bad. There was a concern amongst the women that because of their previous childbirth experience, they would be expected to "know what to do". Conclusion: Women generally have positive expectations of childbirth. Given the concern of these multiparous women that they may be considered as experienced in childbirth, it is clear that the midwife should be prepared to offer professional support to multiparous women based on their individual needs.

Thesis (L.L.M.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Law, 2014. / The non-consensual destruction of a nasciturus is a disturbing societal phenomenon that negatively permeates the lived realities of pregnant women with positive maternal intention. These women choose to experience a full term gestation and they choose to give birth to a live and healthy infant. At some point during their gestation they are non-consensually deprived of their choices through active third party violence by commission or passive third party negligence by omission. These women have no legal recourse for their loss, because in South African law, the non-consensual destruction of a nasciturus is not a crime. The nasciturus is not recognised as a victim separate from the pregnant woman despite the manner in which the pregnant woman freely chooses to interpret her pregnancy. The consensual destruction of a nasciturus enjoys legal protection in South African law by virtue of the provisions contained in the Choice on Termination of Pregnancy Act 92 of 1996. The choice to terminate a pregnancy is therefore legally recognised in South African law, whereas the choice to continue a pregnancy is not legally recognised. Argument is advanced in this dissertation for the legal recognition of the choice to continue a pregnancy by criminalising non-consensual nascitural destruction through the creation of a Choice on Continuation of Pregnancy Act. Non-Consensual nascitural destruction occurs as a result of violence against pregnant women as well as in situations of medical negligence. Empirical data is provided to demonstrate how non-consensual nascitural destruction can occur in medical settings where negligence is suspected. The inherent human need to safeguard and protect the nasciturus has been in existence since time immemorial. Despite this need, in South African law, legal subjectivity, and the ability to be recognised as a separate victim of crime, remain contingent upon a live birth. Evidence suggests that the requirement of live birth in law developed as an evidentiary mechanism and not as a substantive rule of law. Its relevance in circumstances of non-consensual nascitural destruction is doubtful at best. The law in South Africa has failed to take cognisance of the psychosomatic dimensions of personhood and argument is advanced in favour of a nuanced and constitutionally sensitive approach to matters of moral as well as legal personhood. Authentic female autonomy and reproductive freedom requires a re-evaluation of the paradigms that surround nascitural safeguarding and protection, and a transformative approach to constitutional interpretation. The establishment of a legislative scheme to criminalise the nonconsensual destruction of a nasciturus is proposed. Within this legislative scheme certain precautions and fortifications are suggested in order to avoid any potential erosion of the rights of pregnant women who have negative maternal intention. It is demonstrated that it is in fact possible for pregnant women with positive maternal intention and pregnant women with negative maternal intention to both enjoy legal protection without encroaching upon one another’s constitutional rights to reproductive freedom, bodily autonomy and privacy. It is contended that achieving the aforementioned is the final barrier to authentic female reproductive freedom in South Africa.

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