Human pre-implantation embryos display a high prevalence of aneuploidy and chromosomal mosaicism, unique from any other species. The decreasing incidence of aneuploidy observed between the cleavage and blastocyst stages of preimplantation embryo development infers a degree of 'self-correction' following activation of the embryonic genome. However, contrary to the previous assumption that only euploid embryos should be considered 'normal', new evidence has confirmed that mosaic embryos can result in the birth of healthy babies. Thus, aneuploidy should be viewed as an intrinsic feature of human pre-implantation embryo development, which presents a novel challenge at implantation. The endometrium must implement both positive and negative selection, in order to limit maternal investment to only viable embryos. The ability of the endometrium to act as a 'biosensor' of embryo quality has been well documented yet there is little direct evidence for the key regulators of this process. For the first time, we demonstrate a biological context for embryo biosensoring. Firstly, we discover novel embryo-secreted proteases that are enhanced at the blastocyst stage and relate to implantation outcome upon embryo transfer. Secondly, we identify corresponding protease-sensitive receptors in the endometrium, heightened during the window of implantation. By demonstrating the cleavage and de-activation of endometrial toll-like receptor 4 (TLR4) by embryo conditioned medium, we link successful implantation to a diminished inflammatory response. Furthermore, we demonstrate that TLR4 levels in the endometrium constitute a selectivity checkpoint, which is supressed in women suffering from recurrent miscarriage (RM).

The desire for, and provision of, cross border reproductive services (CBRS) (i.e. gamete donation and surrogacy) is a growing international phenomenon. CBRS describes the travel by infertile patients from one country or jurisdiction where access to treatment is limited or unavailable to another country or jurisdiction to seek infertility treatment. There are numerous reasons for CBRS and it is an under- researched and undertheorised area of health research. The aim of this thesis was to explore patients’ motivations for and experiences of CBRS. This study provided themes on the decision making process of CBRS patients and contextualised them within a partial trans-Theoretical Model. Data regarding CBRS were collected from 26 international participants by means of asynchronous email in-depth semi-structured interviews via two international infertility networks. SPSS was used to analyse the quantitative data whereas NVivo 10 software aided the systematic thematic coding method within an Interpretative Grounded Theory. Participants’ motivations for and experiences of CBRS are complex. Seven stages of patients’ infertility journeys emerged: 1. Pre-contemplation: participants had no awareness of their own infertility; 2. Contemplation: participants became aware of their infertility and treatment at home and / or CBRS; 3. Preparation: participants researched CBRS using internet/infertility networks; 4. Action: participants took specific steps to initiate CBRS; 5: Maintenance: participants’ expectations and experiences were important to whether or not they would continue with CBRS; 6: Exit: some participants successfully built their family. Others’ overall experience was negative, their expectations were not met and they decided to quit treatment; 7: Re-engagement: some participants re-engaged with infertility treatment; some participants re-considered their decision regarding infertility treatment either at home or CBRS. A partial Trans-Theoretical Model could explain some of the decision-making process in seeking CBRS. Future research is needed to explore the implications of CBRS for patients, donors, offspring and healthcare systems.

No description available.

Purpose. To describe women's postpartum experiences with mother-baby togetherness in hospital, and the concordance of their experiences with the recommendations from Health Canada (2000a) on family-centred maternity and newborn care (FCMNC). Design. Descriptive study based on secondary analysis of a telephone survey conducted at one week and six weeks postnatally. Five elements reported by women were examined: the timing of first physical contact, physical proximity during the first few hours, transfer together to postnatal unit, rooming-in, and combined mother-baby care. Setting. Four maternity units in Ottawa (Ontario, Canada) including two level I units, one level II and one level III unit. A proportionate sample was drawn from each unit. The overall response rate to both interviews was 88.3%. Participants. Women (N = 552) who returned home with their babies within the first postnatal week, between October 2000 and March 2001. Findings. While in hospital, 95.8% of mothers and babies were separated. Combined care was reported by 84.7% of women and rooming-in by only 33.9% of women. Only 8.8% of women experienced all five FCMNC recommended practices. Practices varied between the units (p < .001). Women who had a caesarean birth were more likely to be separated from their infants than those who had a vaginal birth. Routine procedures performed in the nursery was the most frequently reported reason (55.8%) for the first separation of mothers and babies. Conclusion. Few women reported receiving care based on the FCMNC recommendations about mother-baby togetherness. Hospital practices varied considerably. It is recommended that healthy newborns receive care at their mothers' bedside. Further research is recommended to study the relationship between unit policy, actual practices, nurses' beliefs and women's preferences about the elements of mother-baby togetherness.

Neonatal weight measurements are used as a key indicator of breastfeeding adequacy. The purpose of this study was to explore non-feeding factors that might be related to newborn weight loss. The relationship between the intravenous (IV) fluids women receive during parturition (the act of giving birth including time in labour or prior to a cesarean section) and their newborn's weight loss during the first 72 hours postpartum was the primary interest. Three hypotheses guided the thesis. Specifically, the hypotheses stated that in the first 72 hours postpartum, there is a positive association between: (a) the amount of IV fluid given to a woman during parturition and the amount of weight her infant loses; (b) the amount of IV fluid given to a woman during parturition and the amount her infant eliminates; and (c) the amount an infant eliminates and the infant's weight loss. In an effort to clarify patterns of weight loss, a systematic review was completed to determine reference weight loss, and the results are reported in this thesis. Additionally, the issue of who should consent for neonates in lactation and breastfeeding research studies was raised during the ethics review, and the results of an examination of the underpinning principles for such consent are presented in this thesis. A prospective observational cohort study was conducted to explore associations between maternal fluids during parturition, neonatal output, and newborn weight loss. During labour or before a cesarean section, maternal IV and oral fluids were recorded. Participants weighed their newborns every 12 hours for 72 hours, then weight was measured daily from Day 4 to Day 14. Parents weighed all output (i.e. diapers) in the first 72 hours. Results of the systematic review show that the 7% maximum allowable weight loss recommended in four clinical practice guidelines appears to be based on mean weight loss and does not account for standard deviation. Although we determined patterns of weight loss, causes of weight loss and implications for morbidity and mortality were not established. Completing the systematic review clarified assumptions about how birth weight is used as the baseline for calculating weight loss and how clinical decisions are based on the percentage of loss from birth weight. The three hypotheses were supported. At 60 hours postpartum (point of maximum weight loss), mean loss was 237.2 grams (SD 98; n = 96, range 70-467 grams) and the percentage lost was 6.57 (SD 2.51; n = 96, range 1.83-13.06%). There was a positive relationship between maternal IV fluids from admission to birth and neonatal weight loss in grams (r(83) = .199, p = .035). Mean neonatal output for the first 24 hours was 83.04 grams (SD 47.81; n = 107, range 0-314 grams). There was a positive relationship between maternal IV fluids given in the final 2 hours before birth and neonatal output at 24 hours (r(17) = .426, p = .044) which explained 18% of the variability in weight loss. On Day 1, there was a positive relationship between output and weight loss (r(96) = .341, P < .0001) which explained 12% of the variability in weight loss. When groups, based on maternal fluids, were compared (≤1200 mls [n = 21] versus> 1200 [n =53]), newborns lost 5.51% versus 6.93% (p = 0.03). A hierarchical regression analysis indicated gestational age and birth weight were additional predictors of weight loss. It appears neonates experience diuresis in the first 24 hours with a related weight loss. Overall, the results indicate that maternal IV fluids before birth are related to weight loss in the early postpartum period. It appears neonate's experience varying degrees of diuresis, and consequent weight loss, in the first 24 hours is a correction. Clinicians (e.g. nurses, lactation consultants, and physicians working with breastfeeding women) should reconsider using birth weight as baseline when assessing newborn weight loss. These findings support using weight measured at 24 hours postpartum as the baseline for assessing newborn weight loss.

Human epidemiological and experimental animal studies show that a poor intra-uterine environment induced by restricted maternal diet during pregnancy leads to persistent alterations in the metabolism and physiology of the offspring and an altered susceptibility to chronic disease in adult life such as cardiovascular disease and metabolic syndrome. This phenomenon has been termed fetal programming. In rats, maternal protein restriction (MPR) during pregnancy alters the expression of specific genes involved in lipid and carbohydrate homeostasis such as glucocorticoid receptor (GR) and peroxisomal proliferator-activated receptor–alpha (PPARα). Evidence is accumulating which indicates that persistent changes in the expression of GR and PPARα are mediated by changes in the epigenetic regulation of these genes within the offspring. Epigenetics refers to processes that stably alter gene activity without altering DNA sequence. DNA methylation and histone modification are the most significant epigenetic modifications. However the mechanism by which alterations in maternal diet can induce the altered epigenetic regulation of genes such as GR or PPARα is currently unknown. The aim therefore of this project was to investigate the role of the DNA methyltransferase1 (Dnmt1). Dnmt1 is essential for the maintenance of DNA methylation patterns in the induction of the altered epigenetic regulation of genes in response to maternal diet. We initially investigated the effect of MPR on Dnmt1 mRNA expression in heart, brain and spleen from control and protein restriction (PR) offspring on PN34. We found that MPR altered the expression of Dnmt1 and the de novo DNA methyltransferases Dnmt3a, and 3b in a tissue specific manner. The effect of MPR on the expression and methylation of GR and PPARα was also tissue specific. However, in most tissues examined there was not a simple inverse relationship between GR or PPARα expression and methylation or with levels of Dnmt1 expression. To assess how widespread the changes in gene expression induced by MPR are, microarray analysis was conducted in E8 embryos from control and PR fed dams and results were validated by RT-PCR. Results showed that only relatively small subsets of genes were affected by MPR or global dietary restriction (UN). Gene ontology analysis also revealed that similar pathways were altered under condition of both maternal PR and UN and interestingly one of the pathways altered by both maternal PR and UN was chromatin modification. In both PR and UN embryos on E8 a decrease in Dnmt1, Dnmt3a and 3b expression was observed as well as a decrease in the histone methyltransferases EZH2, Suv39H1 and the HDAC Sirt1 in the embryos from PR dams compared to controls. Alterations in the expression of the DNA and histone methyltransferases in response to MPR were accompanied by changes in DNA methylation and histone modification at the GR promoter as early as E14.

Empirical data on critical obstetrical dimensions of the pelvis combined with observations of occupationally-related muscular lesions on the skeleton can be used to test the hypothesis that constricted pelvic dimensions and/or patterns of hard labor contribute to early mortality for some women. These data, combined with ethnographic information, allow for a more holistic approach to understanding the quality (how well) and quantity (how long) of life in past populations. The enduring history of populations in the American Southwest offers a unique opportunity to examine long-term patterns of health and lifestyle. Data on the relationships among reproduction, occupational stress, and mortality from eight skeletal samples (n = 188) representing Ancestral Pueblo (Anasazi) peoples reveal that women worked hard and that many presented compromised pelvic shape. These contracted pelves may have contributed to early death for some young women although many older women were found to have compromised pelvic dimensions as well. This suggests that while maternal mortality may have been a factor in the early deaths of reproductive age women, examination of women's lifestyle and stresses must be used to understand the myriad of stressors beyond pregnancy and parturition that contributed to young women's mortality. When skeletal data are combined with ethnographic information of birth process, corn grinding and other facets of reproduction and work, the complex relationships between pregnancy and parturition, workload and cultural practices, and the incidence of early death for young women are uncovered. Utilizing this biocultural approach to women's reproductive health will, contributes to a better understanding of the combined effects of reproduction and work patterns on women's bodies and women's lives in the past as well as the present.

No description available.

Abstract Aim: To map first-time mothers experiences of breastfeeding support provided by maternal health care, birth center and BB. Method: A quantitative survey with a cross-sectional design. The criterias to be included was first-time mothers who breastfed or wished to breastfeed and gave birth to a full-term child in the last two years. Data were collected through a web survey published on Facebook. A comfort selection was chosen and data were analyzed with descriptive statistics. Comparisons were made between two age groups Results: A total of 197 first time mothers were answered in the survey. Group 1 consisted of first-time mothers aged 21-30 years and Group 2 consisted of first-time mothers aged 31-42 years. The breastfeeding support included written, verbal and practical guidance. Positive and negative factors in breastfeeding support were identified. Both differences but mainly similarities were identified among first-time mothers’ experiences of breastfeeding support. It was 70,3% of the entire population who wanted more information about breastfeeding. A difference was that Group 2 generally estimated lower breastfeeding support compared with Group 1. Conclusion: The breastfeeding support was estimated quite low by both age groups. Almost half of the first-time mothers considered themselves to receive the best breastfeeding support from sources other than maternal health care, childbirth and BB. This indicates that the breastfeeding support that first-time mothers received was insufficient. First-time mothers requested more information about breastfeeding. High attendance of the midwife and individual guidance were positive factors.   Keywords: breastfeeding, experiences, midwives, mothers, support.

Progestins are synthetic progestogens that prevent pregnancy by thickening the mucous of the cervix to prevent sperm entry and by disrupting implantation via alteration of the timing of endometrial changes occurring during a normal menstrual cycle. Various hormonal birth control methods utilize progestins, with some of the most effective types of birth control methods being long-acting reversible contraceptives. These include hormonal injections such as depot medroxyprogesterone acetate (DMPA), hormonal implants such as Nexplanon, and hormone-releasing intrauterine devices (IUDs) such as Mirena. Although there have been many studies on the safety and effectiveness of these methods, fewer studies have examined how these hormonal methods may impact the bacterial environment of the vagina, better known as the vaginal microbiome. The health of the vagina relies heavily on the bacteria composing the microbiome. Changes in species composition correlate with higher risk of sexually transmitted infections (STIs) and adverse pregnancy outcomes. When women select their preferred hormonal contraceptive method, they should know if it will impact their vaginal microbiome and increase susceptibility to disease. Twenty-one patients enrolled in this study, with one patient initiating DMPA, 14 initiating levonorgestrel (LNG) IUD, and 6 initiating the etonogestrel subdermal implant (ESI). At initiation, 3 months post initiation, and 6 months post initiation, no differences were seen in the vaginal microbiomes of each of the women enrolled in the study. Some differences in the vaginal microbiota of postpartum women and those who were not postpartum were seen. More specifically, enrichment of three families, Lachnospiraceae, Ruminococcaceae, and Erysipelotrichaceae, was seen in women who were more than 12 weeks postpartum, but the effects of those differences remain unclear. Although our sample size was small, the lack of changes in the vaginal microbiome in women initiating long-acting progestin contraception is reassuring; further study in this area is needed.