L’exposition au régime occidental (Western diet, WD) pendant les périodes critiques du développement est considérée comme un facteur majeur dans l’apparition de l’obésité, notamment morbide, dont le traitement de référence lorsque toutes les autres stratégies (e.g. régime) ont échoué reste la chirurgie bariatrique. Mais la lourdeur de la procédure, associée à certains risques et échecs, justifie le développement de thérapies alternatives. Pour cela, il est essentiel de bien connaître les phénotypes neurocognitifs régulant le comportement alimentaire. L’objectif de cette thèse était d’étudier la dynamique neuro-comportementale hédonique et cognitive d’individus jeunes adultes ayant été exposés au WD soit pendant la période périnatale (projet SLK), soit à l’adolescence (projet HOS), à la fois sur le miniporc (SLK+HOS) et chez l’Homme (HOS). Pour le projet HOS, les tests ont été menés sur des individus normopondéraux (humain et porc), obèses (porc), puis après une perte de poids induite par une restriction calorique associée ou non à un bypass gastrique (porc). Nous avons utilisé des approches psycho-comportementales (tests, questionnaires) et de l’imagerie cérébrale (TEP, SPECT, IRMf). Chez le miniporc, l’exposition périnatale au WD confère un phénotype cérébral « obèse » et augmente la susceptibilité des descendants au stress, tandis que l’exposition à l’adolescence induit un phénotype cérébral évoquant les troubles addictifs tout en altérant la mémoire de travail. L’étude pilote humaine a permis d’identifier les aires cérébrales recrutées en situation de choix alimentaire posant un dilemme, en particulier le cortex cingulaire et le fusiforme-occipital. L’obésité provoque des attitudes anxio-dépressives associées au grignotage. La perte de poids rétablit un comportement normal et montre une régulation attentionnelle cérébrale en réponse au sucre. Une modulation neuronale par les hormones digestives et/ou le microbiote est fortement soupçonnée. Les analyses physiologiques, histologiques et métabolomiques programmées en perspective de ce travail de thèse devraient apporter des réponses précieuses pour comprendre comment l’axe microbiote-intestin-cerveau est impliqué dans ces modulations neurocognitives induites par le régime et les variations de poids. / The Western diet (WD) exposure during critical developmental periods is considered as a major factor in the development of obesity, notably morbid obesity, of which the reference treatment when all other strategies (e.g. diet) have failed remains the bariatric surgery. But the invasiveness of this procedure, associated with non-negligible risks and failures, justifies the development of alternative therapies. To this aim, it is essential to understand the brain phenotypes regulating eating behavior. The objective of this thesis was to study the hedonic and cognitive neuro-behavioral dynamics in young adults who had been exposed to WD either during the perinatal period (SLK project), during adolescence (HOS project), both in minipig (SLK + HOS) and humans (HOS). For the HOS project, tests were performed on normal-weight subjects (human and pig), obese subjects (pig), and then after weight loss induced by calorie restriction with or without a gastric bypass (pig). We used psycho-behavioral approaches (tests, questionnaires) and brain imaging (PET, SPECT, fMRI). In the minipig, perinatal exposure to WD induced an "obese" cerebral phenotype and increases offspring susceptibility to stress, whereas exposure in adolescents induces an addiction-type cerebral phenotype and alters working memory. The human pilot study allowed to identify brain areas recruited in a food-choice situation involving dilemma, particularly the cingulate cortex and fusiform-occipital. Obesity causes anxio-depressive symptoms associated with snacking. Weight loss restores normal behavior and induced attentional brain regulation in response to sugar. Neuronal modulation by digestive hormones and/or microbiota is strongly suspected. Additional physiological, histological, and metabolomic analyzes should provide valuable answers to understand how the microbiota-gut-brain axis is involved in neurocognitive modulations induced by diet and weight variations.

L’objectif principal de cette thèse était de caractériser et d’analyser la présence sociale dans la / les transition(s) de femmes brésiliennes de classes aisées à la maternité, au Brésil, en France, au Portugal et en Suèdedans des années récentes. L'objectif final était de contribuer à la déconstruction du modèle hégémonique de la «bonne maternité» au Brésil, établi à partir des expériences de femmes brésiliennes blanches de la classe moyenne.en. En tant que stratégie méthodologique, elle a mis l’accent sur les expériences de présence des mères brésiliennes, en utilisant la communication par ordinateur et trois méthodes en parallèle: une recherche documentaire de rapports de travail de recherches sur la santé périnatale et les politiques familiales des institutions nationales et internationales, des entretiens biographiques et enregistrement des journaux quotidiens; les trois méthodes sont articulés dans une perspective phénoménologique. Ainsi, à partir de mon travail de terrain, j’ai cherché, comme une dérive en spirale, comment certaines rhétoriques morales associées aux normes de genre, de classe et de race sont reproduites par des mères privilégiées en transition maternelle. Au-delà de ce processus de reproduction de la représentation hégémonique de la maternité, j’ai également constaté des hésitations et des mises en oeuvre éthique de ces femmes vis-à-vis des mères marginalisées telles que les femmes racialisées, célibataires et pauvres. Enfin, cette thèse développe la manière dont l’éthique du care découle des relations parentales quotidiennes et aussi comment l'intensification de la présence sociale est importante pour la promotion de cette éthique au-delà du travail genré. / The main objective of this thesis was characterizing and analysing social presence in the transition(s) of Brazilian women from privileged classes to motherhood, in Brazil, France, Portugal and Sweden, inrecent years. As a final goal, it intended to contribute to de-construct the hegemonic model of ―good motherhood in Brazil, which is established from the experiences of middle-class white Brazilian wom-en. As methodological strategy, it focused on Brazilian mothers‘ experiences of presences, using Computer-Mediated Communication and three methods in parallel: a documentary research on official re-ports of perinatal health and family policies, biographical interviews and recording of daily diaries, articulated through a phenomenological perspective. Therefore, in my fieldwork I searched, in a spiral drift-ing, how certain moral rhetorics associated to gender, class and racial norms are reproduced by privileged mothers in maternal transitions. Beyond of this process of reproducing hegemonic representation of motherhood, I also found generating hesitations and ethical enactment among these women towards marginalized mothers such as racialized, single and poor ones. Finally, this thesis discusses how care ethics raise from daily parental relationships and how improving responsive social presence is quite significant for the promotion of such ethics beyond of feminine care work.

<p>These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.</p><p>The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. </p><p>The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. </p><p>The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.</p><p>A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia. </p>

Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively. Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss. Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type. We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage. Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative. / On the day of the public defence of the doctoral thesis the status of article III was In Press and article IV was In Press.

Hyaluronan is an important component of the lung extracellular matrix, with a high capacity for water immobilization, but information on perinatal changes in the lung hyaluronan concentration and their association with changes in the lung water content is limited. In this study, conducted both in rabbit pups and in human infants, we investigated changes in the hyaluronan concentration and distribution in the lung and in the lung water content after preterm or term birth, and changes produced by common antenatal and postnatal pathological conditions and treatments. In rabbit pups, we found a gradual decrease in lung hyaluronan concentration and in the intensity of alveolar hyaluronan staining with advancing gestational age at birth in late gestation, but no further changes during the first 7-9 days of life. The lung water content was uniformly high before birth, but decreased significantly after preterm delivery or at birth at term. Postnatal exposure of newborn preterm or term rabbit pups to hyperoxia for 4-9 days resulted in an increase in both lung hyaluronan concentration and lung water content. This was accompanied by more intense hyaluronan staining, mainly in the alveolar walls. Antenatal exposure of rabbit pups to betamethasone or terbutaline resulted in a lower lung hyaluronan concentration at preterm birth, associated with less intense hyaluronan staining in alveolar walls, without altering the lung water content. Betamethasone exposure had a maximal effect at 25 days of gestation (term = 31 days), decreasing thereafter with advancing gestation, while terbutaline exposure resulted in a gradually increasing effect during late gestation, with a maximum at 29 days. In deceased infants born at a gestational age of &lt; 32 weeks, the lung hyaluronan concentration at death was most strongly associated with the gestational age at birth. It also covaried with sex, antenatal steroid administration, intrauterine bleeding, mode of delivery, birth weight, IRDS, and surfactant treatment. In infants born at a gestational age of &gt; 33 weeks there was a weaker association between lung hyaluronan concentration and gestational age. In this group, the lung hyaluronan concentration was associated with administration of a high concentration of oxygen, and covaried with maximal ventilatory pressure, and lung water content.

These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed. The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications. The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA. The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found. A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.

PURPOSE: To describe 1) smoking cessation (SC) interventions by Family Practice Nurses (FPN) during prenatal visits, and 2) the predictors and barriers of FPN-provided SC counselling for pregnant women. DESIGN: Non-experimental, descriptive, correlational design. Onetime, cross-sectional questionnaire using a previously validated questionnaire, modified and converted to electronic format. METHODS: Descriptive and multivariable analysis. Predictors investigated included nurses’ age, beliefs about their role in SC, self-efficacy to provide effective counselling, SC training, and interest in updating SC knowledge. PARTICIPANTS: Eighty-nine members of the Ontario Family Practice Nurses’ interest group (18% response rate) working in primary care settings across Ontario. RESULTS: Nearly one quarter (21.5%) of respondents never offer SC counselling to pregnant women. Nurses with higher levels of self-efficacy were more likely to provide SC counselling. Nurses are less likely to provide concrete assistance in the quitting process or arrange follow-up. The most commonly cited barriers included lack of time and cost of medication. CONCLUSIONS: FPNs are not consistently providing evidence-based SC interventions for pregnant women. Training to enhance self-efficacy may increase the frequency, efficiency and quality of FPN-provided SC interventions.

This study was undertaken to investigate the relationship between Natural Killer cells and HLA-G at the placental barrier in HIV-I infected pregnant women and to establish the significance, if any, to in utero infection. Fifty-five HIV -I infected pregnant women were recruited into the study after consent was obtained. Blood samples were collected from both mothers and babies for viral loads and CD4+ cell counts. Placental samples were obtained from pregnancies at delivery and examined by immunoperoxidase immunohistochemistry methods using monoclonal antibodies to p24 antigens and Natural Killer (CD56+) cells. HLA-G expression was quantified using real-time polymerase chain reaction. Analysis of viral loads and CD4+ cell counts were undertaken in categories. No significant association was observed between the viral load of mothers and their CD4+ cell counts. Eighteen percent of the women in this study population had 5 log viral loads with a transmission rate of 0.27(95% Cl, 0.15 - O. 39). Maternal viraemia was significantly associated with transmission of infection to babies (p = 0.047). The odds ratio indicated that for every 1 log increase in maternal viral load the babies were 3.1 times more likely to acquire the infection (Exp (B) = 3.137 (95%CI, 1.015-9.696). Furthermore, the study found that a higher number of female babies were infected than males. Although not statistically significant the odds ratio indicated that female babies were 3.1 times more likely to become infected than males (Exp (B) = 3.110 (95%CI, 0.819-11.808). We report here the results of immunohistochemistry for p24 antigens and NK (CD56+) cells and compare them to the immunological responses of both mothers and babies at birth. HIV-1 antigens were detected in 94.5% of all placentas by immunohistochemistry. Infiltration of CD56+ was found in 98% of placental tissue. The analysis revealed that the presence of p24 antigens in placental tissue was not influenced by maternal viral load or CD4+ cell counts. Lower median NK cell values were observed in placentas of mothers with infected babies as compared with the uninfected cluster. Although not statistically significant, the risk of vertical transmission was increased 3.4 times more in placentas which had lower NK cell values. According to the odds ratio, babies CD4+ counts were affected by every 1 log increase in mother's viral load. Overall, maternal viral load emerged as a strong predictor for risk of infection from infected mothers to their infants. Our analysis indicated that female babies were 3.7 times more likely to acquire the infection than males. Using data obtained from real-time PCR we investigated the relationship between maternal viral load and the quantity of HLA-G expression (p = 0.045; 95%CI 1.029- 11.499). Logistic regression models revealed that mother's viral load was the strongest risk factor for vertical transmission. No statistically significant correlation was noted with HLA-G and viral transmission. However, the odds ratio indicated that the risk of infection increased by 1.3 with every 1 fold increase in HLA-G expression. An analysis of mother-to-child transmission rates by gender revealed that the odds ratio for transmission was 3.4 times more in female babies than in males. We then investigated the relationship between maternal viraemia and HLA-G expression. A positive correlation between maternal viral load and placental HLA-G was observed (p = 0.038). When gender susceptibility to HLA-G expression was explored a statistically significant association was observed in placental tissue of mothers with infected and uninfected male babies and HLA-G expression (p = 0.013). To conclude, the analysis found that HLA-G was up regulated 3.95 times more in placental tissue of mothers with infected babies than in mothers with uninfected babies. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

The thesis objectives were to a) create environmental health indicators (EHIs) of the use and risk of crop farming pesticides; b) conduct an epidemiological study of the association between the pesticide EHIs and health outcomes, in rural crop farming areas of Manitoba. Pesticide indicators included the average annualized percent of Census Consolidated Subdivision land acreage where any pesticides, herbicides, fungicides, or insecticides were applied as well as an indicator of pesticide risk. In multilevel models, the use of insecticides was significantly associated with perinatal conditions (males: OR=1.08, p=0.005; females: OR=1.07, p=0.01), congenital anomalies in males (OR=1.04, p=0.04), and eye disorders (males: OR=1.03, p<0.001; females: OR=1.02, p=0.012). Eye disorders in males were also significantly associated with the use of any pesticide (OR=1.001, p<0.001) and pesticide risk (OR=1.06, p<0.001). Regular pesticide use in crop farming, especially insecticides, may be adversely affecting the health of the rural residents of Southern Manitoba.

PURPOSE: To describe 1) smoking cessation (SC) interventions by Family Practice Nurses (FPN) during prenatal visits, and 2) the predictors and barriers of FPN-provided SC counselling for pregnant women. DESIGN: Non-experimental, descriptive, correlational design. Onetime, cross-sectional questionnaire using a previously validated questionnaire, modified and converted to electronic format. METHODS: Descriptive and multivariable analysis. Predictors investigated included nurses’ age, beliefs about their role in SC, self-efficacy to provide effective counselling, SC training, and interest in updating SC knowledge. PARTICIPANTS: Eighty-nine members of the Ontario Family Practice Nurses’ interest group (18% response rate) working in primary care settings across Ontario. RESULTS: Nearly one quarter (21.5%) of respondents never offer SC counselling to pregnant women. Nurses with higher levels of self-efficacy were more likely to provide SC counselling. Nurses are less likely to provide concrete assistance in the quitting process or arrange follow-up. The most commonly cited barriers included lack of time and cost of medication. CONCLUSIONS: FPNs are not consistently providing evidence-based SC interventions for pregnant women. Training to enhance self-efficacy may increase the frequency, efficiency and quality of FPN-provided SC interventions.