The consumption of alcohol and smoking of cigarettes are both common practices in Australian society. With continued public health efforts exposure to both alcohol and nicotine during pregnancy has diminished, however little is known about exposure to these toxins in the postnatal period and the effect on the breastfed infant. To investigate the pattern of alcohol consumption and cigarette smoking in the postnatal period and the effect on breastfeeding outcomes, a longitudinal study was conducted in two public hospitals with maternity wards in Perth, Australia. Data for the Perth Infant Feeding Study (PIFSII) were collected from 587 mothers between mid-September 2002 and mid-July 2003. While in hospital participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital related and psychosocial factors. Further analysis of alcohol data was undertaken on the 1995 and 2001 National Health Survey (NHS) data sets to provide a national perspective. Alcohol and smoking related data were analysed and described using frequency distributions, means and medians. Univariate logistic regression was used to screen for potentially significant variables for subsequent incorporation in the multivariate analysis. Multivariate logistic regression analysis was employed to determine the effect of alcohol consumption and cigarette smoking on breastfeeding outcomes prenatally, antenatally and postnatally, after adjusting for factors identified in the literature as being associated with breastfeeding initiation and duration. The relationship between smoking status and breastfeeding duration was determined using survival analysis. / Analysis of the relationship between breastfeeding duration and the level of postpartum intake was investigated using a Cox hazards model with repeated measures for alcohol consumption. Results showed that: 1. PIFSII. During pregnancy approximately 32% of women stopped drinking alcohol. Thirty five percent of pregnant women continued to consume alcohol during their pregnancy with 82.2% of these women consuming two or fewer standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. 2. NHS. Sixteen point four percent and 1.3% of pregnant women from the 1995 and 2001 NHS, respectively were consuming more than that recommended in ‘Guideline 11’ from the National Health and Medical Research Council of Australia (ie >7 standard drinks/week). 3. NHS. Thirteen percent of lactating mothers from the 1995 NHS and 16.8% from the 2001 NHS were consuming seven or more standard drinks of alcohol in the reference week, thus exceeding the NHMRC recommended level. 4. PIFSII. After 6 months of follow up, women who consumed alcohol at levels of more than two standard drinks per day were almost twice as likely to discontinue breastfeeding earlier than women who drank below these levels (HR 1.9, 95% CI 1.1, 3.0). 5. PIFSII. With regard to smoking, 226 (39%) of mothers reported smoking pre- pregnancy. Mothers who smoked were more likely to have a partner who smoked, to have consumed alcohol prior to pregnancy and less likely to attend antenatal classes. / They were also less likely to know how they were going to feed their baby before conception and be more inclined to consider stopping breastfeeding before four months postpartum. 6. PIFSII. Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 weeks versus 11 weeks, 95% CI: 8.3-13.7). This effect remained even after adjustment for age, education, income, father’s smoking status, mother’s country of birth, intended duration of breastfeeding >6 months and birth weight (risk ratio HR 1.59, 95% CI 1.22 to 2.08). 7. PIFSII. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70, 95% CI 1.55 to 8.83; p<0.05). The results of the present study suggest a negative association between drinking alcohol in the postpartum period and breastfeeding outcomes. Similarly, smoking cigarettes before, during and after pregnancy negatively affects breastfeeding. There is a need for guidelines outlining the safe intake of alcohol during lactation and for the cessation of cigarette smoking in the prenatal and antenatal period.

This thesis weaves together disparate sources of theoretical knowledge with the lived experience of 11 women to illuminate the mysterious world of pre-natal relating - the foundation for postnatal life and the beginnings of the capacity to love. Love and supportive relationships can ameliorate stress and trauma post-birth, but do they operate prenatally, and if so how? This research clearly shows that mothers relate to their preborns and from the rich detail of their stories, the author proposes a schema that captures the complexity and changing nature of prenatal relating. The basic physiological and neurological structures are formed from conception, making the preborn vulnerable to the effects of direct and maternal experience. Preborns have extensive capacities that include the potential for interaction. These capacities and experiences affect infant development post birth. This evidence supports the author's initial hypothesis that prenatal stress is a significant factor in the attentional and behavioural problems of childhood, and challenges purely genetic explanations. 'Normal' life events have greater potency during pregnancy, making the transition to parenthood stressful even for many women in low risk situations. Feeling supported is essential for the health and well-being of the mother and preborn. This thesis reports a phenomenological and prospective study of 11 pregnant women as they lived the prenatal journey. From the interviews, it describes the development of the prenatal relationship and the range of stressful and supportive factors that should be considered in the creation of child and family friendly communities. / Master of Science (Hons)

Becoming a mother is a challenging time and for some women the lifestyle adjustment can be very stressful. In combination with the changes in family structure mothers are increasingly seeking professional support and assistance in the care of their infants and children. Child and family health services in NSW offer varying levels of professional support and education, including 24-hour residential care. The purpose of this study is to explore and describe the mothers' perceptions and experiences of residential admission to a Child and Family Health Unit - Karitane. This study is descriptive in nature. Sixteen English speaking mothers admitted to Karitane in 1998 took part in the study. Focus groups were the main source of data for the study. The focus groups were undirected, conversations recorded and written notes taken. Additional data were collected by a questionnaire to determine the demographic characteristics of the mothers. The mothers' indicators of depression were scored using the Edinburgh Postnatal Depression Scale (EPDS). Each mother completed the EPDS during the admission period and at the time of the focus and respective comparison was made. Data analysis revealed that the mothers' EDPS scores had decreased significantly at the time of the focus group meeting. The key concepts that emerged in the mothers' descriptions of their experiences were the importance of the development of the professional relationship, equity and access to parenting services, particularly for the partner, and the need for services to promote and provide realistic parenting education with an early intervention focus. The implications of the findings lend support to health care professionals in lobbying government for the necessary funds, in providing increased access to quality parenting services. / Master of Nursing (Hons)

The period of pregnancy and childbirth is an important and sensitive time for men’s upcoming parenthood. Research into fathers’ experiences of childbearing has received less attention compared to maternal experiences. The purpose of this thesis was to study the sources fathers use to obtain information about pregnancy and childbirth, fathers’ preference for the mode of birth of their baby, and fathers’ childbirth experience and their perception of postnatal care quality.In 2007, 1105 expectant fathers were enrolled in the study when their partner had reached the middle of pregnancy. The fathers were followed until one year after the birth of their baby. The fathers were living in the county of Västernorrland in Sweden and their babies were born in one of the three hospitals in the county. Data was analysed using descriptive and inferential statistics, and content analysis. An index was created from a combination of fathers’ experiences of postnatal care quality.iiiCommon sources of information about pregnancy and childbirth used by prospective fathers were the Internet, their partners and the midwife. Fathers who were expecting their first baby (OR 1.4; 1.2-1.7), had a high level of education (OR 1.3; 1.2-1.5) and fathers with previous experience of caesarean section (OR 1.3; 1.1-1.6) were the greatest users of the Internet. Of the prospective fathers 71 (6.4%) desired caesarean section for the birth of their baby. Previous negative birth experience (PR 8.6; 2.6-28.3) and the experience of caesarean section (PR 5.7; 2.8-11.9) were factors associated with the wish that the baby would be born by caesarean section. A desire to plan the day of the baby’s birth (PR 6.0; 1.5-24.1) was associated with a preference for caesarean section for the men who were expecting their first baby. Two months after the birth of the baby 604 (74%) of the fathers in this group had had a positive birth experience. A correlation with a less-positive birth experience was with emergency caesarean section (OR 7.5; 4.1-13.6), instrumental vaginal birth (OR 4.2; 2.3-8.0) and if the man was unhappy with the medical care which the partner received (OR; 4.6; 2.7-7.8). Positive experience of healthcare professionals’ knowledge and attitudes was related to a satisfactory birth experience. The deficiencies in the postnatal care were mainly related to deficiencies in the information on the baby’s care and needs, and fathers’ experiences of their partners’ inadequate check-ups and medical care. A year after the birth 488 (79%) of the fathers were satisfied with the overall postnatal care, although they had pointed to deficiencies in the provision. Deficiencies in the attitude of the staff (OR 5.01; 2.80-8.98) and the medical care and check-ups their partner received were associated with fathers’ dissatisfaction with the overall postnatal care (OR 2.13; 1.25-3.62).ivMost fathers in this study had a positive birth experience and were happy with the postnatal care. The thesis highlights, however, opportunities for improvements in intrapartum and postnatal care. Healthcare professionals should be informed regarding the information provided via the web and to discuss the information that expectant fathers receive about pregnancy and childbirth. Prospective fathers should be given the opportunity to discuss their preferences and attitudes to the mode of birth. In addition, professionals should provide supportive information and be present in the delivery room. The information about the newborn baby’s care and needs can be strengthened, both before and after birth.

Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain. Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms. Material and methods: The intervention group consisted of 155 obese (BMI &gt;30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program. Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained &lt;7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain &lt;7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain. Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain &lt;7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.

Selection for increased encephalization in humans necessitated extensive brain growth after birth. To estimate changes in rates of growth and corresponding shape changes during gestation and infancy, chord and arc distances were obtained from the frontal, parietal, and occipital bones of 44 human fetuses, neonates, and infants (one year old and younger). Rates of growth in chord and arc measurements were calculated and compared using linear regression of log-transformed variables, followed by ANCOVA. Curvature of bone lengths and widths were estimated by chord/arc indices. Fetal rates of cranial growth were significantly slower while the fetal frontal and occipital bones were significantly more curved than those of infants. Fetal rates of cranial growth decrease during the first six postnatal months, in conjunction with rapid changes in shape, except for parietal superior-inferior height where bossing of the bone is similar in fetuses and neonates.

Behavioral deficits caused by fetal-alcohol are well expressed in juvenile subjects but usually ameliorate with maturation. It suggests some kind of postnatal regeneration. The aim of the present study was to examine the potential correlation between behavioral recovery and the postnatal hippocampal development in the fetal-alcohol rats. This study included behavioral tests applied to juvenile and adult subjects, unbiased stereology to investigate changes in neuron numbers and hippocampal volumes, the postnatal tracing and analysis of the hippocampal principal neuron&rsquo / s morphology, investigation of age-dependent changes in the distribution of doublecortin-expressing neurons, and evaluation of synaptic development by assessing age-dependent changes in the regional immunoreactivity/expression of synaptophysin and PSD95. Rats have been exposed to ethanol throughout 7-21 gestation days with daily ethanol dose of 6g/kg delivered by intragastric intubation to the pregnant dams. The morphological characteristics were examined on postnatal days P1, P10, P30, P60, in hippocampal CA1, CA3, and DG subregions, in fetal-alcohol and control rats. Both, stereological and doublecortin-immunoreactivity data pointed towards a possibility of limited neurogenesis taking place during a protracted postnatal period not only in the germinal zones (SGZ and SVZ) but also in the hippocampal CA regions. Ethanol effect on postnatal hippocampal development was limited to marginally lower number of granular cells in DG on P30. It correlated with poorer cognitive performance in the fetal-alcohol group. The treatment effect on the morphology of hippocampal neurons was observed mainly in CA region at P1 and seemed to be attributed more to the intubation stress than the ethanol itself.

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Postnatal vascular growth is a complex process involving multiple cells types whose functionality is orchestrated by a variety of soluble extracellular growth factors, mechanical stimuli, and matrix derived cues. The central goal for this dissertation project was to elucidate the role of osteopontin, a non-collagenous extracellular matrix protein, in postnatal vascular growth. At the onset, we concluded that the current methods for measurement of vascularity in small animal models were lacking. To address this shortcoming, we pursued micro-CT imaging for analysis of three-dimensional blood vessel architecture. We were able to demonstrate that micro-CT imaging provides an objective, quantitative, and three-dimensional methodology for evaluation of vascular networks that has broad applicability to preclinical studies. Next, we sought to apply the developed imaging techniques, along with other complementary methodologies, to explore the role of osteopontin in postnatal vascular growth. Osteopontin was previously known to elicit survival, migration, and other relevant activities in multiple cell types involved in postnatal vascular growth. Therefore, we sought to determine the in vivo significance of osteopontin in this process. To do so, we compared wild type and Osteopontin-/- mice for (1) their ability to form collateral vessels and functionally recover following acute induction of hind limb ischemia and (2) their capacity for neovascularization, mineralization, remodeling, and the restoration of mechanical properties during fracture healing. Data suggested that OPN is a critical regulator of collateral vessel formation and that this effect is driven by its role in mediating monocyte/macrophage migration and functionality. Secondly, we found that the presence of osteopontin was essential for normal early callus formation, neovascularization, late stage callus remodeling, and restoration of biomechanical strength. Abnormal collagen organization was observed within the remodeling fractures of Osteopontin-/- mice, and we hypothesize that a unifying link between the vascular and bone defects may be related to deficient matrix organization and remodeling. In conclusion, the imaging techniques developed in this thesis provide a novel methodology for quantitative analysis of vascular structures in small animal models. Secondly, this project has yielded an improved understanding of the basic pathophysiological mechanisms that control postnatal blood vessel growth and bone fracture healing.

Thesis (Ph.D.(Paediatrics))--University of Pretoria, 2009. / Abstract in English and Afrikaans. Includes bibliographical references.