Orientadores: Maria de Lurdes Zanolli, Roberto Teixeira Mendes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T12:51:00Z (GMT). No. of bitstreams: 1 Queiroz_PatriciaHelenaBreno_D.pdf: 2651235 bytes, checksum: 6f5fb1ee7f755286f20c3b8766b25740 (MD5) Previous issue date: 2014 / Resumo: Este trabalho teve como objetivo geral compreender a influência das avós de bebês, filhos de mães adolescentes, no exercício e duração do aleitamento materno nos primeiros seis meses de vida; buscando entender na perspectiva das avós e das mães adolescentes o papel que as avós desempenham na gestação e maternidade adolescente e as concepções destas mulheres acerca do estabelecer e vivenciar a amamentação. A pesquisa seguiu um delineamento de caráter exploratório e natureza qualitativa. As adolescentes e as avós dos bebês foram convidadas a participar da pesquisa, a partir do último trimestre de gestação e conceder mais quatro entrevistas orientadas por roteiro semiestruturado, no puerpério imediato, aos 30, 120 e 180 dias após o nascimento, entre 14 de fevereiro de 2012 e 14 de maio de 2013. O material produzido após a leitura das transcrições das entrevistas foi agrupado em categorias e subcategorias e interpretado utilizando-se da Análise de Conteúdo Temático. Participaram do estudo 25 duplas de adolescentes e suas mães ou sogras. Quando perguntadas durante o pré-natal se sabiam o que era aleitamento materno (AM), 05 adolescentes reconheceram o conceito e 13 só o fizeram após uma explicação. Durante a visita no pós-parto imediato, 22 "recém-mães" informaram que não foram orientadas sobre AM durante o pré-natal, mas todas indicaram a equipe de enfermagem do Alojamento Conjunto do hospital, como responsável pelas orientações sobre amamentação. Na visita de 30 dias, 15 jovens referiram terem frequentado o ambulatório de AM no puerpério mediato, o que foi considerado importante para adequar a técnica de amamentação; duas relataram não terem continuado a amamentação de seus bebês quando em suas casas; quatro não completaram 30 dias de AM e substituíram por fórmulas introduzidas sob a recomendação de profissionais de saúde (farmacêutico, enfermeiro, pediatra). Dez de 19 de adolescentes que mantiveram o AM até o quarto mês foram orientadas pelo pediatra para a introdução de alimentos complementares. Somente nove bebês foram amamentados exclusivamente por seis meses. As mães e sogras atuam na retaguarda porque precisam retornar às suas atividades cotidianas e as adolescentes assumem o cuidado do bebê e muitas vezes, o trabalho doméstico. Neste contexto, os papéis de mãe e avó são definidos e a avós respeitam as escolhas de suas filhas. Intervenções dirigidas tanto para as adolescentes quanto para as avós, durante o período perinatal podem ter um efeito prolongador na amamentação, principalmente em famílias de mulheres-avós trabalhadoras que vão além do papel de "mãe de família" e contribuem para a subsistência desta / Abstract: This study aimed to understand the influence of grandparents of babies, children of adolescent mothers, exercise and duration of breastfeeding in the first six months of life; seeking to understand the perspective of grandparents and teenage mothers the role that grandparents play in pregnancy and teen motherhood and the conceptions of these women about the experience and establish breastfeeding. The research followed an exploration of character design and qualitative nature. The teenagers and grandmothers invited to participate in the study, from the last trimester of pregnancy and give four interviews guided by semi-structured, postpartum, 30, 120 and 180 days after birth, between February 14 2012 and May 14, 2013. The research design followed an exploratory and qualitative nature. The teenagers and grandmothers invited to participate in the research, from the last trimester of pregnancy and grant four semi-structured interviews guided by, postpartum, 30, 120 and 180 days after birth, between February 14 2012 and May 14, 2013. The material produced after reading the transcripts of the interviews, clustered into categories and subcategories and interpreted using the Thematic Content Analysis. The study included 25 pairs of adolescents and their mothers or mothers in law. When asked during the prenatal whether they knew what breastfeeding (BF) was, 05 adolescents recognized the concept and only 13 did so after an explanation. During the visit in the immediate postpartum period, 22 "new mothers" reported that were not oriented on BF during the prenatal, but all indicated the nursing staff of the hospital rooming, as responsible for the hospital on the guidelines breastfeeding. In 30-day visit, 15 young people reported having attended the outpatient clinic mediate the puerperium, which was considered important to adequate breastfeeding technique; two reported not have continued breastfeeding their babies while in their homes; four did not complete 30 days of BF and replaced by formulas introduced on the recommendation of health professionals (pharmacist, nurse, pediatrician). Of the19 adolescent, 10 maintained their AM until the fourth month, told by the pediatrician for the introduction of complementary foods. Only nine babies were exclusively breastfed for six months. Mothers and mothers in law act in rearward backwards because they need to return to their daily activities and teenagers take care of the baby and often the housework. The roles of mother and grandmother defined and grandparents respected the choices of their daughters. Interventions aimed both to teens and to grandparents during the perinatal period can have an effect on prolonging breastfeeding, especially in families of working women-grandmothers who go beyond the role of "mother of the family" and contribute to the subsistence of this / Doutorado / Saude da Criança e do Adolescente / Doutora em Ciências

Orientador: José Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T18:48:20Z (GMT). No. of bitstreams: 1 Souza_RenatoTeixeira_M.pdf: 10640708 bytes, checksum: 93bc984ddc636a415fed23ea6ca3a333 (MD5) Previous issue date: 2015 / Resumo: Introdução: Mais de 15 milhões de bebês nascem prematuros anualmente no mundo, sendo a prematuridade a maior causa de óbitos no período neonatal. A prematuridade terapêutica tem papel importante nesse contexto, pois se estima que 20 a 40% dos partos prematuros ocorrem por indicação dos provedores de assistência obstétrica. Dessa forma, a redução dos partos prematuros terapêuticos adquire cada vez mais importância para o controle da taxa de prematuridade e da morbimortalidade neonatais. O conhecimento dos fatores relacionados ao parto prematuro terapêutico é ponto fundamental para atingir essa redução. Objetivos: Avaliar a ocorrência do parto prematuro terapêutico e seus fatores associados na população do Estudo Multicêntrico de Investigação em Prematuridade (EMIP). Métodos: Análise secundária do EMIP, um estudo brasileiro de caso-controle aninhado a um corte transversal multicêntrico. O estudo ocorreu em 20 hospitais de referência em 3 regiões do Brasil de abril de 2011 a julho de 2012 e realizou a vigilância de 33.740 partos nesse período. O principal desfecho a ser avaliado é a ocorrência de parto prematuro terapêutico, definido como o parto que ocorreu antes de 37 semanas e que foi indicado pela equipe de assistência devido uma condição materna ou fetal. O grupo controle foi composto pelas mulheres com parto a termo. Os partos prematuros foram categorizados, conforme recomendações da Organização Mundial da Saúde, em prematuro extremo, muito prematuros e pretermo moderado Uma quarta categoria de idade gestacional, contemplando apenas os prematuros tardios, também foi analisada. Variáveis relacionadas a características sociodemográficas, pôndero-estaturais e de estilo de vida maternos, características da assistência ao pré-natal e ao parto e sobre a presença de morbidade ou complicação durante a gravidez, parto ou puerpério foram avaliadas na análise de risco para parto prematuro terapêutico. Foi realizada uma análise bivariada para estimar o risco de parto prematuro terapêutico para cada e uma análise multivariada com regressão logística não condicional para obter os fatores independentemente associados ao desfecho. Resultados: O parto prematuro terapêutico foi responsável por 35,4% dos partos prematuros na amostra estudada. As síndromes hipertensivas, o descolamento prematuro de placenta e a diabetes foram as condições que mais frequentemente motivaram a resolução prematura da gravidez. A idade materna avançada, a hipertensão crônica, a obesidade e a gravidez múltipla foram as principais condições maternas relacionadas à ocorrência de parto prematuro terapêutico. Houve uma tentativa de tratamento da condição materna que motivou a resolução em mais de 50% dos casos e 74,5% das mulheres com parto entre 28 e 31 semanas receberam corticoterapia. A cesariana foi a via de parto mais frequente. A proporção de mortalidade neonatal, do Apgar do quinto minuto menor que sete e da admissão em unidade intensiva neonatal foi muito maior nos prematuros terapêuticos do que no termo, mesmo considerando os prematuros tardios. Conclusões: Os resultados do estudo corroboram com a crescente importância do parto prematuro terapêutico, devido sua prevalência e impacto nos resultados perinatais. A gravidez múltipla, idade materna avançada, a obesidade e a presença de morbidades pré-gestacionais são os fatores que requerem especial atenção nas estratégias de prevenção da prematuridade terapêutica / Abstract: Background: More than 15 million babies are born prematurely each year worldwide and its the leading cause of deaths in the neonatal period. Provider-initiated preterm birth (piPTB) plays an important role in this context because it is estimated that 20-40% of preterm births occur by indication of obstetric care providers. Thus, the reduction in piPTB rate acquires more importance to decrease the rate of prematurity and neonatal morbidity and mortality. Knowledge of the factors related to piPTB is a key factor to achieve this reduction. Objectives: To evaluate the occurrence of provider-initiated preterm birth and the associated factors in the Multicenter Study on Preterm Birth in Brazil (EMIP) population. Methods: Secondary analysis of EMIP, a Brazilian multicenter cross-sectional study plus a nested case-control. The study took place in 20 referral hospitals in 3 regions of Brazil from April 2011 to March 2012 and conducted surveillance of 33,740 deliveries in this period. The primary outcome to be evaluated is the occurrence of provider-initiated preterm birth, defined as birth that occurred before 37 weeks and was medically indicated due to maternal or foetal condition. The control group was composed of women with term delivery. Preterm birth was categorized into extremely premature, very premature and moderate preterm, according to the World Health Organization. Another category that includes only the late preterm was also evaluated. Maternal, socio-demographic, obstetrical, prenatal care, delivery and postnatal characteristics were assessed as factors associated with piPTB. A bivariate analysis to estimate the risk for piPTB and a multivariate analysis using unconditional logistic regression for the factors independently associated with piPTB was performed. Results: The therapeutic preterm labor accounted for 35.4% of premature births in the sample. Hypertensive disorders, placental abruption and diabetes were the main conditions related to pi-PTB indications. Advanced maternal age, chronic hypertension, obesity and multiple pregnancy were the main maternal conditions related to pi-PTB. There was an attempt to treat maternal condition that led to the resolution in over 50% of cases and 74.5% of women with birth between 28 and 31 weeks received corticosteroid therapy. Cesarean section was the most frequent mode of delivery. The proportion of neonatal mortality, Apgar score<7 at 5 minutes and NICU admission were much higher in provider-initiated preterm newborns than in term newborns, even considering the late preterms. Conclusions: The results of our study corroborate the increasing notability of provider-initiated preterm birth, due to its prevalence and impact on perinatal outcomes. Multiple pregnancies, advanced maternal age, obesity and the presence of pre-gestational morbidities are the main factors that require special attention in prematurity prevention strategies / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

Bakgrund: Under graviditet genomgår kvinnan fysiologiska, psykologiska och hormonella förändringar. Att drabbas av psykisk ohälsa i samband med graviditet och tiden efter barnets födelse är inte annorlunda än att drabbas av psykisk ohälsa under andra perioder i livet men psykisk ohälsa under den perinatala perioden kan påverka bindningen till barnet och barnets anknytning till sin mamma. Psykisk ohälsa kan leda till att kvinnor ifrågasätter sin modersroll och barn till mödrar med psykisk ohälsa kan påverkas negativt genom emotionella-, kognitiva- och beteendemässiga svårigheter som kan bli långvariga. Barnmorskan har i uppgift att upptäcka och identifiera kvinnor med risk för psykisk ohälsa, tidiga insatser är av vikt. Barnmorskan kan remittera kvinnan till adekvat vård inom och utanför professionen. Det är av vikt att barnmorskan skapar förtroendefulla relationer, vården ska ges med värdighet och vara personcentrerad samt möjliggöra kontinuitet. Dock visar forskning att kvinnor upplevt att bemötande och vård inte tillgodoses vilket leder till att den psykiska ohälsan inte uppmärksammas. Syfte: Att, utifrån barnmorskors erfarenheter och upplevelser, belysa vad som påverkar bemötandet och vården gentemot kvinnor i relation till psykisk ohälsa i samband med graviditet och tiden närmast efter barnets födelse, så kallad perinatal psykisk ohälsa. Metod: Litteraturöversikt med kvalitativa och kvantitativa artiklar som analyserades med integrativ metod. Resultat: Barnmorskor ansåg att relationsskapandet var viktigt i avseendet att främja den psykiska hälsan och för att identifiera psykisk ohälsa. Barnmorskorna upplevde inte att stödet alltid räckte till, varken för att skapa förtroendefull relation eller för att erbjuda lämplig vård till kvinnor som drabbats av psykisk ohälsa. Helhetsperspektivet var bristande, en del barnmorskor ansåg att perinatal psykisk ohälsa var deras ansvar, medan ansvarsrollen upplevdes som otydlig av andra barnmorskor. Barnmorskor tillfrågade inte kvinnor om den psykisk hälsan under graviditeten och de kände sig mer bekväma att prata om fysiska besvär och frågor specifikt riktade mot graviditeten och dess fortskridande. Det framkom också negativa attityder och stigma kopplade till psykisk ohälsa, och att vården och bemötandet påverkades av tidsbrist. Barnmorskor upplevde kompetensbrist och otydlighet gällande remittering, vilket bidrog till osäkerhet och oro. Det visade sig att flertalet barnmorskor hade kunskapsbrister angående perinatal psykisk ohälsa. Slutsats: Bemötande och vård påverkas av förtroendefulla relationer, kontinuitet och kunskapsbrist. Genom att synliggöra betydelsen av förtroendefulla relationer skulle det möjliggöra att barnmorskor skulle kunna förebygga perinatal psykisk ohälsa och därmed kunna skydda, kanske den viktigaste relationen i livet, mammans bindning till sitt barn och barnets anknytning till sin mamma. / Background: During pregnancy, the woman undergoes physiological, psychological, and hormonal changes. Suffering from mental illness in context to pregnancy; before, during and the time after child’s birth, is no different than suffering from mental illness during other periods in life. But mental illness during the perinatal period can have a negative impact on the attachment to the child and the child´s attachment to the mother. Mental illness can lead to women´s questioning their role as mothers and children of mothers with mental illness can be negatively affected by emotional, cognitive, and behavioral difficulties that can be long-lasting. The midwife has the task of discovering and identifying women at risk of mental illness and early intervention is important. The midwife can refer the woman to adequate care within and outside the profession. It is important that the midwife creates trusting relationships, enable continuity and the care must be given with dignity and be person-centered. However, research shows that women have experienced that treatment and care are not provided, which leads to perinatal mental illness not being noticed.  Purpose: To, based on midwife’s view´s and experience, shed light on what affect the treatment and care towards women in relation to mental illness in connection with pregnancy and the time immediately after the child´s birth, so-called perinatal mental illness. Method: Literature review with qualitative and quantitative articles that were analyzed with an integrative method. Results: Midwives considered that building a relationship was important in promoting mental health and in identifying mental illness. The midwives did not feel that their support was always sufficient, neither to create a trusting relationship nor to offer appropriate care to women who have suffered from mental illness. The holistic perspective was lacking, some midwives considered that perinatal mental illness was their responsibility, while the role of responsibility was perceived as unclear by other midwives. Midwives did not ask women about their mental health during pregnancy, and midwives felt more comfortable talking about physical ailment and issues specifically related to pregnancy and its progression. There were also negative attitudes and stigmas associated with perinatal mental illness, and that care and treatment were affected negatively by lack of time. Midwives experienced a lack of skills and uncertainty regarding referral, which contributed to doubt and concern. It turned out that most midwives had a lack of knowledge regarding perinatal mental illness. Conclusion: Treatment and care are affected by trusting relationships, continuity, and lack of knowledge. By highlighting the importance of trusting relationships, it would enable midwives to prevent perinatal mental illness and thus protect, perhaps the most important relationship in life, the mother´s attachment to her child and the child´s attachment to the mother.

In the U.S., Black mothers experience fetal and infant mortality at alarming rates when compared to White and Latina mothers (Gregory, Drake, & Martin, 2018). The intent of this study was to examine perinatal loss among Black American women and to expand understanding of how the Strong Black Woman (SBW) ideology influences bereavement. Data were gathered from (N=109) Black American bereaved mothers. It was predicted that endorsement of differing aspects of the SBW would moderate the relationship between perinatal grief and psychosocial outcomes (i.e., depression and post-traumatic growth). Regression analyses, alongside a bootstrapping procedure via PROCESS (Hayes, 2017), were used to evaluate the moderation models. Results yielded a model of perinatal bereavement among Black American mothers. In particular, reliance on spirituality moderated the relationship between perinatal grief and depression, while the obligation to manifest strength moderated the relation between perinatal grief and posttraumatic growth (PTG). Neither moderated moderation model was significant. The model provided significant implications for clinical practice and intervention.

Background: South Africa aims to end all preventable deaths of children under the age of five as part of their commitment to the Sustainable Development Goals. More than half of these mortalities occur in the neonatal period with perinatal asphyxia as one of the leading causes. This study investigated and identified the characteristics of perinatal asphyxia and its contributing factors at a district hospital in Cape Town. Methods: A retrospective descriptive case series was performed and included all suspected cases of perinatal asphyxia referred from Mitchells Plain District Hospital (MPH)) to a specialised centre in the years 2016-2018. A data collection tool was used to extract information. Data was processed with SPSS to produce descriptive statistics and to investigate associations between variables using the Chi-square tests. Results: The study included 29 cases of suspected perinatal asphyxia. Ten (34.5%) had abnormal amplitude Electroencephalograms (aEEG's) indicative of Hypoxic Ischaemic Encephalopathy (HIE) and four (13.8%) demised before day seven of life. Non-operative deliveries (p=0.005), lack of a doctor at the time of delivery (p=0.004) and neonatal chest compressions (p=0.044) were associated with abnormal aEEG's. Babies with Thompson score of equal to or more than 12 (p=0.006), neonatal seizures (p=0.036) and delayed arrival at referral hospital (p=0.005) were associated with abnormal aEEG findings. Mortality was associated with Thompson score ≥12 (p=0.007) and the need for neonatal intubation at delivery (p=0.016). Conclusions: Significant reversable factors were identified in the peri-and postpartum periods. More capacitated staff would have the greatest impact on outcomes. The profile of HIE is exceedingly complex and challenges the resources and services of district level of care. Therefore, these factors should be targeted for future development and investment to improve outcomes from district hospitals.

Bakgrund: Oplanerade prehospitala förlossningar kan ske i närvaro av ambulanspersonal, vilka är avsevärt mindre utbildade för förlossningar än barnmorskor men tvingas ändå handha samma situation. Detta kan vara en dramatisk och stressande upplevelse både för födande och ambulanspersonal. Syfte: Beskriva sjuksköterskors/ambulanssjuksköterskors upplevelser, tankar och känslor om prehospitala förlossningssituationer i sitt arbete. Metod: En kvalitativ intervjustudie med deskriptiv design. Elva semistrukturerade intervjuer analyserades med kvalitativ innehållsanalys. Resultat: Förlossningssituationer beskrevs som verkligt fantastiska, häftiga, spännande, som de roligaste körningarna och som en euforisk glädje att få se ett liv ta sin början, jämfört med alla liv som ambulanspersonal ser slockna. Förlossningskörningarna benämndes som skräckblandad förtjusning, nervöst och läskigt. Dels eftersom dessa var så ovanligt förekommande och ambulanspersonalen upplevde sig underutbildade för situationen, vilket gav känslor av obehag, kompetensbrist och skräck att inte kunna hantera en eventuellt kritisk situation. Dels då körningar involverande barn gav extra kraftigt adrenalinpåslag, skärpa, närvaro och fokus. Ytterligare försvårande faktorer upplevdes vara platsbristen i en ambulans, dålig arbetsställning, underbemanning, utrustnings- och resursbrist, språksvårigheter, kulturskillnader eller sjukt/missbildat/dött/oönskat barn. Bristen på erfarenhet och kunskap var dock det primära och mer förlossningshospitering önskades. Slutsats: Förlossningssituationer väcker mycket starka känslor hos sjuksköterskor/ambulanssjuksköterskor både på ett positivt och negativt sätt. Dessa upplevs som de roligaste, mest spännande och mest glädjebringande körningar samtidigt som stressande, pressande, adrenalinframkallande samt som annorlunda alla andra körningar. Förlossningskörningar sker så sällan att det är svårt att upprätthålla en god kunskapsnivå, varför en ökning av utbildning önskas. / Background: Unplanned prehospital births can occur in the presence of ambulance staff, who are considerably less educated for childbirth than midwives but are still forced to handle the same situation, a potentially dramatic and stressful experience for both patient and paramedic. Purpose: Describing paramedics' experiences, thoughts and feelings about prehospital birth situations. Method: A qualitative interview study with descriptive design. Eleven semi-structured interviews analyzed with qualitative content analysis. Results: Childbirth situations were described as amazing, exciting and the euphoric joy seeing a life begin, compared to all lives paramedics see end. Childbirth situations were called a "horrified delight". Partly, because these were so unusual and the paramedics felt under-educated, which gave feelings of discomfort, inadequacy and fear of being unable to handle a potentially critical situation. Partly, because missions involving children gave stronger adrenaline-rushes, sharpness and focus. Further aggravating factors were the compact ambulance, poor working posture, understaffing, equipment- and resource-shortages, language difficulties, cultural differences or sick/malformed/dead/unwanted children. However, the lack of experience and knowledge was the primary one where more practical experiences at the delivery ward was desired. Conclusion: Childbirth situations evoke very strong emotions among nurses/paramedics both in positive and negative ways. These are considered the most enjoyable and exciting missions as well as stressful, pressing, adrenaline-inducing and different from all other missions. Childbirth missions are so unusual that it is difficult to maintain a good level of knowledge, which is why an increase in education is desired.

L’exposition au régime maternel durant la période périnatale, induit des processus d’empreintes orientant à long terme le phénotype et la santé des individus. De plus, les orientations alimentaires, telles que celles concernant les protéines, évoluent quantitativement et qualitativement. Ces deux constats, encouragent la communauté scientifique à s’interroger sur les conséquences de ces variations de consommation en protéines sur les générations futures. Ce projet de thèse vise à évaluer chez la descendance femelle rat, les effets d’une alimentation maternelle variant par la teneur (riche versus normal) et la qualité (sources animales versus végétales) en protéines sur la modification des préférences alimentaires et sur les risques métaboliques.Deux études ont été réalisées chez le rat. Une première étude a évalué l’impact de l’excès de protéines à travers un régime hyperprotéique (HP) à base de protéines de lait pendant la gestation. Une seconde étude a évalué les effets d’un régime HP de source protéique spécifique (lait, pois ou dinde) pendant la gestation et d’un régime de source protéique spécifique (lait, pois ou dinde) pendant l’allaitement. Une fois sevrés et jusqu’à l’âge adulte (étude 1 : 15 semaines ; étude 2 : 10 semaines), les ratons femelles ont été soumis à des modèles de « dietary self-selection » (DSS) leur laissant la possibilité de choisir la composition en macronutriments, le niveau de consommation alimentaire et la source protéique (étude 2 uniquement). Indépendamment du régime maternel, ces deux études ont montré que lorsque les sources en macronutriments étaient séparées dans le modèle DSS, les ratons présentaient une hyperphagie liée à une consommation accrue de lipides au détriment des glucides.De plus, les résultats de la seconde étude ont montré que les ratons n’orientaient pas spécifiquement leur consommation de protéines vers la source protéique à laquelle ils avaient été exposés via le régime maternel périnatal. En revanche, les deux études ont montré que la consommation d’un régime HP pendant la gestation, quelle que soit la qualité des protéines le composant, induisait une augmentation de l’adiposité chez la descendance femelle adulte. Cette augmentation était majorée lorsque la descendance avait été soumise au régime de choix (DSS), leur permettant d’augmenter leur consommation de lipides au détriment des glucides.En conclusion, l’exposition périnatale à un régime HP de qualité variable en protéines augmente la sensibilité au surpoids chez la descendance femelle adulte rat. Nous avons évalué les relations entre ces données et : la sensibilité des voies centrales du contrôle de la prise alimentaire et de la récompense, la sensibilité des voies de contrôle du métabolisme énergétique périphérique et la composition et l’activité du microbiote de l’intestin.Ces travaux apportent un grand nombre de nouvelles données indiquant clairement qu’une alimentation équilibrée en quantité et en qualité de protéines pendant la grossesse, à travers le ratio protéines/glucides et le profil en acides aminés, pourrait jouer un rôle clé sur des paramètres phénotypiques de la descendance notamment lorsqu’elle est soumise à des choix alimentaires augmentés. / Abstract : Perinatal exposure to maternal diet induces programming processes of later individual phenotype and health. Additionally, food orientations like for protein, change in terms of quantity and quality. These observations enhance scientific community to evaluate consequences of protein consumption changes on future generations.This thesis project aims to determine the consequences of modifying protein quantity and quality in maternal diets on food preferences and metabolic risks in female rat offspring.Two studies were conducted in rats. The first study evaluated the impact of protein excess in the maternal diet during gestation, through a high-protein (HP) diet composed with cow milk protein. The second study evaluated effects of (i) a HP diet composed with different protein sources (cow milk, pea, or turkey) during gestation and (ii) these different protein sources (cow milk, pea, or turkey-derived) during lactation. From weaning to adulthood (study 1: 15 weeks after birth; study 2; 10 weeks after birth), female pups were subjected to “dietary self-selection” (DSS), which allowed them to choose their own macronutrient compositions, level of food intake and protein sources (second study only).Regardless of the maternal diet, these two studies showed that when DSS was composed with separate macronutrients, rats exhibited overfeeding and increased lipid intake coupled with a decreased carbohydrate intake. Moreover, the results of the second study indicated that rats did not orient their protein intake towards the maternal protein source to which they were exposed during perinatal period. Nevertheless, the two studies showed that the maternal HP diet during gestation caused an increased adiposity in female adult offspring, regardless of the maternal protein source. This increase was stronger when offspring were subjected to DSS condition, which allowed them to increase lipid intake and decrease carbohydrate intake.In conclusion, perinatal exposure to a HP diet varying in protein quantity and quality increases the risk of becoming overweight in female rat adult offspring. We assess the relationship between these data and the the sensitivity of central pathways of food intake and reward control, the sensitivity of energetic and peripheral metabolic pathways, and the gut microbiota composition and activity.This work provides new data indicating that a balanced diet in protein quantity and quality during gestation, through a protein/carbohydrate ratio and amino acid profile, could play a key role on offspring phenotypic parameters, especially when submitted to increased dietary options.

Thesis (Ph.D. (Psychology)) -- University of Limpopo, 2022 / The psychological impact of perinatal death in the form of bereavement has been widely researched especially from the western perspective. The aim of this study was to establish the help-seeking pathways by mothers bereaved through perinatal death from the African perspective. The qualitative research paradigm in particular the phenomenological approach was adopted for the study. Phenomenology is described as an approach that focuses on the study of the lived experiences of individuals within their world. The application of this approach included personal interviews of 20 mothers who have experienced perinatal death at Doctor George Mukhari hospital in Gauteng province. The aim was to establish the help-seeking pathways they adopted to relief their distress, in terms of how they managed their bereavement and the help that they sought to relief their emotional distress. The findings of the study indicated that mothers lacked knowledge about what precipitated the onset of sudden symptoms such as early rupture of membrane, bleeding, lack of foetal movement which finally led to perinatal death. This lack of knowledge led mothers to attribute the cause of perinatal death to various reasons and conclusions such as distance decay, bad roads that delayed their arrival timeously at the hospital for their babies to be saved. Some cited lack of sense of urgency from the medical personnel and shortage of staff, especially doctors. However, they perceived positive social support from their families, spouses and medical professionals as one of the factors that contributed to their level of calmness and ability to bear the pain of loss. However, participants sought alternative help to facilitate clear understanding about what could have caused their babies to die, also how to manage their grief and how to deal with their subsequent pregnancies. Most of the participants benefited from the various healing pathways they chose. There is a need for healthcare system and community support to be more responsive to the plight of bereaved mothers, in reducing the stigma and the self-blame by bereaved mothers by offering support through counseling center. The findings reaffirm that despite the great studies taken in reducing perinatal deaths, there is a need for collaboration between the modern healthcare system and the traditional healthcare practitioners. Furthermore, emphasis v is needed on the preventative measures and training of healthcare practitioners within the maternal and child healthcare system to further reduce the alarming increase of prenatal deaths

Introduction: Borderline personality disorder (BPD) is a severe psychiatric disorder characterized by emotion dysregulation, interpersonal dysfunction, and poor impulse control. Little research has investigated BPD in the context of major life events. The perinatal period (pregnancy until 12 months postpartum) is an important milestone that involves major role transitions and novel challenges. This thesis examined the associations between borderline personality features (BPF) and depressive and generalized anxiety symptoms in a sample of treatment-seeking perinatal women. Methods: 74 perinatal women were recruited from the Women’s Health Concerns Clinic (WHCC) at St. Joseph’s Healthcare Hamilton, Canada, and enrolled in the WHCC Registry study. Participants were sent online intake questionnaires to collect data about demographic, personality, and other psychosocial variables. They also completed three self-report mental health measures: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), the Edinburgh Postnatal Depression Scale (EPDS), and the Generalized Anxiety Disorder Scale (GAD-7). Logistic regression was used to determine whether a positive MSI-BPD screen (score ≥ 7) was associated with a higher likelihood of screening positive on the EPDS or GAD-7 (score ≥ 13). Results: A positive screen on the MSI-BPD was significantly associated with an almost eighteen-fold increase in the odds of screening positive on the EPDS in our treatment-seeking perinatal sample (OR 17.84, 95% CI[2.11, 218.80], p<0.05). A positive screen on the MSI-BPD was not associated with higher odds of screening positive on the GAD-7, rather only childhood trauma and a positive screen on the EPDS emerged as significant predictor variables. Our findings may reflect the greater symptomatic overlap observed between BPD and perinatal depression as well as the comparatively lower comorbidity observed between GAD and BPD in non-perinatal research. Conclusions and Future Directions: The use of self-report measures, low statistical power, and a treatment-seeking sample are limitations to consider when interpreting our findings. To our knowledge, this research study offers one of the first explorations into the relationship between BPD and generalized anxiety symptoms during the perinatal period. Future research should aim to better characterize perinatal BPD and investigate its relationship with other mental health conditions. / Thesis / Master of Science (MSc) / The perinatal period (pregnancy until 12 months postpartum) represents a time of heightened vulnerability to poor mental health. Prior research has mainly focused on perinatal depression and anxiety, while perinatal personality disorders have received comparably less attention. Borderline personality disorder (BPD) is a severe psychiatric disorder associated with diminished ability to regulate emotions, disturbances in self-image, troubled interpersonal relationships, and impulsive behaviour. This thesis investigated the relationship between self-reported borderline personality features (BPF) and depressive and generalized anxiety symptoms in a sample of perinatal women seeking treatment at a psychiatric clinic. We hope that this research sheds light on the nature of perinatal BPD, as well as its associations with other mental health conditions, to improve both immediate and multi-generational maternal and infant well-being.

Background: Perinatal depression disproportionately affects asylum seeking and refugee (AS&R) women, but they are less likely to receive support than other women. There is no published research which considers the assessment and support for symptoms of perinatal depression provided by midwives for AS&R women navigating England’s maternity services. Aim: To investigate how midwifery practice can be developed to support asylum seeking and refugee women with symptoms of perinatal depression. Methods: A post-colonial feminist inquiry consisting of a scoping survey (study one) and a qualitative research study (study two) using remote interviews with AS&R women and midwives. Qualitative data was analysed using reflexive thematic analysis. Findings: Study one demonstrated that midwives who care for AS&R women work within diverse roles and service structures across England. Study two identified that midwives lack the resources and support structures required to effectively recognise and support symptoms of perinatal depression in AS&R women. These factors were sometimes invisible to AS&R women, but still negatively affected their ability to effectively discuss perinatal depression with a midwife and access help for any symptoms. The lack of appropriate resources was harmful to both AS&R women and midwives. Conclusion: AS&R women and midwives who care for them navigate an inequitable maternity system in England. Midwives do not have the appropriate resources to provide a level of care which is equitable to women in the general maternity population. This leaves AS&R women’s perinatal mental health needs unrecognised and unmet, acting as a barrier to receiving effective support. / Mary Seacole research development scholarship