Indiana University-Purdue University Indianapolis (IUPUI) / The opioid crisis has resulted in an unprecedented number of neonates born with prenatal opioid exposure; however, the long-term effects of opioid exposure on offspring behavior and neurodevelopment remain relatively unknown. I developed a translational mouse model of prenatal methadone exposure (PME) that resembles the typical pattern of opioid use by pregnant women who first use oxycodone then switch to methadone maintenance pharmacotherapy, and subsequently become pregnant while maintained on methadone. PME produced substantial impairments in offspring growth, sensorimotor milestone acquisition, and activity in an open field. Furthermore, these behavioral alterations were associated with significant disruptions in the primary motor cortex (M1). Notably, layer 5 pyramidal neurons of the M1 displayed significantly increased voltage sag which is primarily mediated by HCN1 channels. Interestingly, the α2-adrenergic receptor, a known modulator of HCN1 channels, displayed significantly increased expression in the M1 of PME animals. The locomotor activity in an open field was significantly reduced following in vivo pharmacological activation of the α2-adrenergic receptor with clonidine in PME offspring suggesting this may be therapeutic target for the hyperactivity associated with prenatal exposure to opioids. Previous work has also described an association between prenatal opioid exposure and alterations in opioid reward-related behavior; however, the effect of PME on alcohol reward remains undetermined. Given the widespread accessibility and usage, alcohol represents the most likely addictive substance the growing population of opioid exposed neonates will encounter as they age. I discovered that PME disrupts conditioned preference for alcohol, enhances the locomotor stimulating effects of alcohol, and increases alcohol consumption in a sex-dependent manner. This alcohol-reward phenotype in PME offspring was associated with altered excitatory neurotransmission and disrupted cannabinoid-mediated long-term depression (CB-LTD) in the dorsolateral striatum, an important substrate involved in compulsive drug use. Further work is required to determine the specific inputs at which CB-LTD is disrupted and if restoring this form of plasticity in PME animals prevents the enhanced alcohol addiction phenotype. / 2023-03-02

Résumé of Thesis (Sc. D.)--University of Michigan, 1940. / Reproduced from type-written copy. Bibliography: leaf 6. Also issued in print.

Résumé of Thesis (Sc. D.)--University of Michigan, 1940. / Reproduced from type-written copy. eContent provider-neutral record in process. Description based on print version record. Bibliography: leaf 6.

Thesis (Ph.D.)--University of California, San Francisco, 2004. / Bibliography: leaves 207-238. Also available online.

Thesis (M.S.)--West Virginia University, 2000. / Title from document title page. Document formatted into pages; contains vi, 57 p. Vita. Includes abstract. Includes bibliographical references (p. 38-42).

Thesis (D.S.)--Harvard School of Public Health. / Photocopy of typescript. Boston, Mass. : Harvard School of Medicine, 1977. -- 29 cm. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 284-289).

The feto-placental unit synthesises a variety of proteins and hormones which are secreted into the maternal circulation and amniotic fluid from early pregnancy. In pregnancies where the fetus has an autosomal trisomy, the normal concentration profiles of these markers in maternal serum and amniotic fluid are disturbed. These marker changes can be used to estimate the risk that a pregnancy is affected by Down's syndrome (or Trisomy 18) and thus allow the parents to make an informed decision regarding prenatal diagnosis by invasive testing. However, the factors which give rise to the varying patterns of marker concentrations in chromosomally abnormal pregnancies are poorly understood. The aim of this project was to investigate the underlying causes of abnormal marker concentrations in Down's syndrome, Trisomy 13, and Trisomy 18 pregnancies. The results of this investigation indicate that in Down's syndrome pregnancies, maternal serum levels of placental products reflect those found in the placenta; intact hCG, FβhCG and SP1 levels were elevated while PAPP-A and placental ALP levels were little changed. This suggests that transport of these proteins from the placenta into the maternal circulation is not affected but there is altered synthesis of hCG subunits and SP1. Hepatic synthesis of AFP does not appear to be altered in Down's syndrome pregnancies, but increased placental and reduced maternal serum levels of AFP point to a possible placental transport defect specific to AFP. Similarly reduced GGT levels in fetal intestine and in corresponding amniotic fluid from Down's syndrome pregnancies suggest that amniotic fluid GGT activity is of fetal intestinal origin since GGT activity was elevated in fetal liver and placental from the same series of Down's syndrome pregnancies.

Background: It is well accepted that gestational weight gain (GWG) outside of the Institute of Medicine recommendations is a modifiable risk factor for pregnancy complications, regardless of a woman’s pre-pregnancy body mass index. Objectives: Given that not all prenatal healthcare providers (HCPs) are aware of these guidelines nor discuss them with their patients, this thesis sought to examine counselling practices and evaluate a pilot knowledge translation tool for the improvement of such counselling. Methods: 1) A literature review was conducted to assess current prenatal GWG counselling practices between patients and HCPs; 2) an electronic survey was conducted to determine patients’ perceptions of GWG counselling and whether certain patient characteristics increase chances of counselling; 3) a quasi-experimental study was implemented to evaluate the Canadian Obesity Network’s 5As of Healthy Pregnancy Weight Gain tool. Results: GWG counselling was often infrequent and inaccurate. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity and those categorized with overweight/obesity were more likely to receive GWG advice. The 5As of Healthy Pregnancy Weight Gain Tool is effective at initiating Ask and Advise components of HCP-mediated GWG counselling, but work is still needed to improve all other components of the 5As (Assess, Agree, Assist). Conclusions: Weight gain counselling is an essential component of prenatal healthcare, but discussions between HCPs and patients is inconsistent. Future steps include the development of GWG knowledge translation tools and improving GWG education for HCPs.

D.Cur / One of the most important factors relating to antenatal care provisions as One of the most important componentscomponents of P rimary Health Carecomponents of Prima ry Health C are (PHC ) is that the provisio forfor all pregnant women for whom these provisions afor all pregnant women for whom these provisions related to the a vailability, afforda bility, accepta bility, effectiveness, efficiency , equityrelated to the availability, utilization of the antenatal care clinics by pregnant women. TheThe White Paper on the Trans foThe White Paper on the Trans formation of The White Paper on services be madeservices be ma de accessib le for all the po pulation grou ps in South A frica. Thisservices thethe health services should be equally accessible in thethe health services should be equally accessible in WhiteWhite Paper states tha t all citizens shou ld have equ al access toWhite Paper states that all citizens should entitled. The right of access to health care means that: " Health professionals are obliged to facilitate access. The following constitute access to health care: " Functional services, of sufficient quality; " Physical, economic and information access; " Respect for ethics and culture, including language; " Scientifically appropriated and high quality care; and " Recognition of the needs of vulnerable groups. IfIf the curriculum for the training ofIf the curriculum for the training of primary health careIf the curriculum itit should reflect community needs more accura tely and the teaching sho uldit should reflect community moremore emphasis on community and oumore emphasis on community and outcome-bmore emphasis undertundertaundertakenundertaken to explore and describe the factors that influence the accessibility of carecare services in the then Central Region of the then Northern Prcare services in the then Central strategies to address such factors. TheThe aim of this study was to expThe aim of this study was to explore and desThe aim of this accessibilityaccessibility of antenatalaccessibility of antenatal care clinics in the rural areas. The researcher descrip tivedescriptive and contextualdescriptive and contextual design to approachdescriptive and contextual obtained th rough interview s withobtained through interviews with postpartum women, clinic and hospitalobtained withwith nurses fromwith nurses from thewith nurses from the Maternal and Child Health (MCH) Office in ofof Heaof Healof Health and Welfare. The second phase entailed the development of strategies addressingaddressing thoaddressing those factors addressing those factors that influence the accessibility data obtained in phase one of this study as well as from the literature. TheThe results of this research show that several personal anThe results of this research show that several byby both health care us ers and health care providersby both health c are users and h ealth care provid ers haveby thethe antenatal care clinics. The principal factors are: adolescent pregnancy,the antenatal care clinics. humanhuman and materialhuman and material resources, thehuman and material resources, the considerable thethe long waiting hours, paucity of community ithe long waiting hours, paucity of community involvemethe relatingrelating to the organization of health care activities at the clinic, andrelating to the organization of and safety at the clinics. RecommRecommendationsRecommendations evolving from this study are that the Health Department should moremore nurse s and mater ial resources, the clinicmore nurses and material resources, the clinic should be organised nnursesnurses shounurses should be given in-service education in primary health care (PHC), including antenatalantenatal care services, on a regular basis in order to equip themantenatal care services, on a clinics.clinics. Security of the clinic en vironment should be imp roved to ensu re the safety o f both personnel and patients on a twenty-four hourpersonnel and patients on a twenty-four hour basis. Antenatal more accessible to all the communities.

Non-genetic maternal influences on prenatal development have a significant effect on the development of early life behavior. This study assessed the behavioral effect of elevated prenatal progesterone on postnatal emotional reactivity, or underlying fear and stress, in embryos of Northern bobwhite quail (Colinus virginianus). Test groups of progesterone treated eggs, vehicle treated, and no injection were exposed to three measures of emotional reactivity at 48 and 96 hours after hatch: an open field, an emergence test, and a tonic immobility test. Heightened levels of emotional reactivity in the tonic immobility emergence tasks, and decreased levels of emotional reactivity in the open field suggest that elevated prenatal progesterone modifies post natal emotional reactivity up to 96 hours of age.