The focus of this study is to understand why, despite high uptake of antenatal care, women in Uganda continue to deliver without skilled birth attendants. A critical gap in our knowledge is an understanding of the decisions women make during pregnancy and childbirth that determine the services they seek. Using a focused ethnography, we explored cultural knowledge and perceptions related to pregnancy and childbirth in Kabarole district. Interviews and focus group discussions were conducted with women that had recently given birth, their husbands/partners, biomedical and traditional health workers, and older women. HIV was identified as an important reason for seeking antenatal care. Other services used during pregnancy, biomedical and traditional, were accessed based on a complex array of beliefs and advice given to women. Thaddeus and Maines Three Delays Model provided a framework for analysis of barriers to skilled attendance at birth, which include distance, support from partners, and quality of health services.

Progesterone is unequivocally required for the establishment and maintenance of pregnancy in all mammals studied. Its known functions are complex and encompass global changes in gene expression. Therefore, studies were conducted to characterize the effects of progesterone on expression of genes for endometrial factors having roles in conceptus growth, implantation and establishment of pregnancy. The first study characterized the effect of an artificially induced early increase in circulating progesterone on conceptus growth and development and regulation of expression of galectin-15 (LGALS15), a recently identified protein secreted by the ovine uterine luminal epithelium (LE). Exogenous progesterone beginning on Day 1.5 post-mating accelerated conceptus development on Days 9 and 12. On Day 12 the conceptus was functionally and morphologically advanced to produce greater quantities of interferon tau (IFNT) than blastocysts from control ewes. Further, the endometrium responded to early progesterone and IFNT with early expression of cathepsin L (CTSL), radical S-adenosyl methionine domain containing 2 (RSAD2), and LGALS15 within the endometrium. The second study identifed structural changes within the luminal epithelium which could alter the flux of factors into and out of the uterine lumen to maintain appropriate fetal/maternal communication. In this study, progesterone reduced quantities of proteins associated with both tight and adherens junctions during the elongation period. IFNT subsequently increased these proteins after conceptus elongation. The third and fourth studies identified progesterone-regulated genes which have been implicated as having importance to implantation in sheep, mouse, and human. WNT signaling was transiently downregulated by progesterone, while members of several growth factor families are upregulated including insulin-like growth factor binding proteins (IGFBPs) 1 and 3, hepatocyte growth factor (HGF) and fibroblast growth factor 7 (FGF7), which may enhance conceptus growth. Collectively, these studies assess the role of progesterone in altering gene uterine expression to establish a favorable environment for conceptus development. The long-term goals of these studies are to establish biomarkers of receptivity to conceptus development and implantation, enhance our understanding of gene and pathway regulation in early pregnancy loss, and identify genes which may be targeted in therapeutic strategies to improve reproductive success in humans and animals.

As a woman with a spinal cord injury who uses a wheelchair, my thesis is an autoethnography that is based largely on the journals I have written in over the last twenty years, and in particular the journals I kept while I was pregnant and giving birth to my two children. Disability is a pervasive ideology that informs many of our cultural ideas of self and other, what constitutes acceptable and celebratory bodies, political stances, public policy, and language. Much of the literature that examines the female bodily experience excludes the stories and experiences of women with disabilities. Because the body with disabilities is often seen for what it can not do, taking on the role of mother can give the body a different value, status, and worth. I feel that my experiences as a woman with a disability experiencing pregnancy and childbirth offers insights and understanding into what it is already known about womens bodies. I display multiple levels of personal and cultural consciousness while connecting to the larger understandings of the culture of pregnancy, childbirth, and disability

An animal model has implicated elevated levels of tissue factor (TF), and resultant hypercoagulability and inflammation, as key factors in recurrent pregnancy loss (RPL) and has demonstrated that pravastatin is effective in treating this condition. In this study, we have re-evaluated the contraindication of statins during pregnancy. Evaluation has shown that while animal testing (at maternally toxic doses) and case reports of birth defects have led to the contraindication of statins during pregnancy, our controlled study, similar to previously published controlled studies, has failed to demonstrate increased fetal risks. As well, we demonstrated that transfer of pravastatin across the placenta is likely limited. While short term suspension of therapy during gestation is considered safe, extended time without therapy is detrimental to cardiovascular health. Coupled with a trend of elevated TF levels in women with RPL, reconsideration of the contraindication of statins is warranted based on appropriate risk: benefit assessment.

An animal model has implicated elevated levels of tissue factor (TF), and resultant hypercoagulability and inflammation, as key factors in recurrent pregnancy loss (RPL) and has demonstrated that pravastatin is effective in treating this condition. In this study, we have re-evaluated the contraindication of statins during pregnancy. Evaluation has shown that while animal testing (at maternally toxic doses) and case reports of birth defects have led to the contraindication of statins during pregnancy, our controlled study, similar to previously published controlled studies, has failed to demonstrate increased fetal risks. As well, we demonstrated that transfer of pravastatin across the placenta is likely limited. While short term suspension of therapy during gestation is considered safe, extended time without therapy is detrimental to cardiovascular health. Coupled with a trend of elevated TF levels in women with RPL, reconsideration of the contraindication of statins is warranted based on appropriate risk: benefit assessment.

Pregnancy is often portrayed as a happy time for the woman and her family. In reality, many women struggle with negative emotions and moods that can have deleterious effects on the mother, the fetus, and the growing family. Depression is an increasing, worldwide problem, with women in their childbearing years and those of low socioeconomic status the most vulnerable. <p>This study explores depression, as determined by the Edinburgh Postnatal Depression Scale (EPDS), in a high-risk sample of pregnant women enrolled in two prenatal programs in Saskatoon, Saskatchewan, Canada. A prevention and population health approach has been used to identify potential determinants and implications of antenatal depression. The data analyzed in this study were from the first cross-sectional portion of a longitudinal, epidemiological study of depression in pregnancy into the postpartum. Women were invited to participate in the study at their first prenatal visit. Data were collected by program staff. <p>The prevalence of depression in this sample of 402 high-risk women was 29.5%, which is similar to other studies of inner-city, low income, and minority women elsewhere in the world. In the final model, antenatal depression was associated with a history of depression, moods going up and down, current smoking status, high levels of stressors, and social support.<p>Factor analysis of the EPDS revealed three underlying factors: Anxiety, Depression, and Self-harm thoughts. The anxiety factor explained most of the variance in the overall EPDS scores in this sample of women. A history of problems with mood fluctuations was significantly associated with anxiety and depression subscales and self-harm. Significantly more women aged 21 and under experienced anxiety, and more Aboriginal women experienced depressive symptoms and self-harm thoughts. Twenty percent of women reported self-harm thoughts in the preceding seven days. Depressed, Aboriginal, and single women, and women who use alcohol were most at risk for self-harm thoughts. <p>The level of depressive symptoms in this sample of women represents a significant public and mental health problem in women already challenged by inequities in their life circumstances. We need to develop public health policy that will support screening and identification of women with depression. Interventions at the primary, secondary, and tertiary levels of prevention can help to improve the health of women struggling with antenatal depression, promote the optimal intrauterine environment for their unborn children, and reduce the intergenerational transmission of depression.

The dangerous health effects of smoking during pregnancy and during the postpartum period are well-established, yet a significant proportion of pregnant women continue to smoke despite being aware of the health risks and wanting to quit. While many risks factors for continued smoking or relapse have been identified, these factors are largely demographic and difficult to change. The purpose of the present study was to identify and measure the psychological factors that predict smoking cessation intentions and behaviours among pregnant women, during pregnancy and the postpartum period, who are either currently smoking or have recently quit. Pregnant smokers (N= 56) were asked to complete a series of questionnaires designed to access their reasoning at the three levels outlined by the Reasons Model and their feelings of autonomy and competence, and partner support in quitting smoking as indicated by Self-Determination Theory. Participants were also asked to complete a number of other questionnaires and a short, semi-structured interview to assess other factors potentially related to smoking behaviour. Participants were then re-contacted twice after their baby was born, at approximately two months and four months postpartum. At both times, participants were asked to again complete the questionnaire package and a short semi-structured interview. It was hypothesized that Reasons Model and Self-Determination Theory would predict both current and future intentions to quit smoking, and smoking behaviour, respectively. It was also hypothesized that those with direct experience with quitting smoking or reducing their smoking behaviour during pregnancy and postpartum (multigravida) would be more accurate in predicting their intentions to quit smoking and smoking behaviour than would those who were pregnant for the first time (primagravida). The results indicated some support for the ability of the two models to predict intentions to quit and smoking behaviour, though was limited by the small sample size. Further, level of direct experience emerged as a significant factor in participants’ ability to predict their intentions and behaviour regarding smoking. The current study suggests that both the Reasons Model and Self-Determination Theory are important tools for assessing and developing interventions for helping women to make positive changes in their smoking behaviour during pregnancy and postpartum.

Objective: To describe the worldwide experience of Bacillus anthracis infection reported in pregnant and postpartum women. Data Sources: Studies were identified through MEDLINE, WEB OF SCIENCE, EMBASE, and GLOBAL HEALTH databases from inception until April 2012. The keywords [(“anthrax” or “anthracis”) and (“pregna*” or “matern*” or “post partum” or “postpartum” or “puerperal” or “lact*” or “breastfed*” or “fetal” or “fetus” or “neonate” or “newborn” or “abort*” or “uterus”)] were used. In addition, all references from selected articles were reviewed, hand searches were conducted and relevant authors were contacted. Methods of Study Selection: The inclusion criteria were: 1) published articles referring to women diagnosed with an anthrax infection during pregnancy or within six months postpartum, 2) any article type reporting patient-specific data, 3) articles in any language, and 4) non-duplicate cases. Non-English articles were professionally translated. Duplicate reports, unpublished reports and review articles depicting previously identified cases were excluded. Tabulation, Integration and Results: Two authors independently reviewed articles for inclusion. The primary search of the 4 databases yielded 800 articles and the secondary cross-reference search revealed 146 articles. Seven articles from these searches met inclusion criteria. By contacting the lead author of the largest systematic review of inhalation anthrax to date, 6 additional articles, published before the databases’ inception, were identified that met inclusion criteria. In total, 19 cases of anthrax infection were found, 16 in pregnant women and 3 in postpartum women. Conclusions: Based on these case reports, anthrax infection in pregnant and postpartum women is associated with high rates of maternal and fetal death. Evidence of possible maternal-fetal transmission of B. anthracis was identified in early case reports. Transmission of B. anthracis through breast milk has not been reported. This review provides important insight to guide anthrax treatment and prophylaxis recommendations for pregnant and postpartum women.

Background: The incidence of Hypertensive Disorders in Pregnancy (HDP) is increasing in the US and is linked to serious long and short-term health problems for both mother and fetus. Vitamin D has been shown to have direct influence on molecular pathways involved in pregnancy. However a link between vitamin D status and HDP in Pregnant women has not been established. Objectives: The purpose of this study is to determine (1) the association between vitamin D deficiency and the occurrence of (HDP) and (2) whether non-Hispanic Black women (NHB) are at greater risk for HDP due to low vitamin D status. Methods: Pregnant females in the National Health and Nutrition Examination Survey (NHANES) study from 2001 to 2006 were used in this study. Participant’s response to interview questions and laboratory results were taken into account to determine HDP status. Logistic regression was used to determine the association between vitamin D status and HDP. Results: Pregnant women with low vitamin D status (25(OH)D < 20ng/ml) were 1.123 (95%CI: 0.808-1.56) times more likely to have HDP compared to women who were vitamin D sufficient. This association was not significant. NHB women did not show a significant increased risk for HDP. Conclusions: Low vitamin D status during pregnancy may lead to an increased risk for Hypertensive Disorders in Pregnancy. However more research on larger sample size is needed to determine the true extent of the association of vitamin D status with HDP in the general population and that of non-Hispanic Black women.

The dangerous health effects of smoking during pregnancy and during the postpartum period are well-established, yet a significant proportion of pregnant women continue to smoke despite being aware of the health risks and wanting to quit. While many risks factors for continued smoking or relapse have been identified, these factors are largely demographic and difficult to change. The purpose of the present study was to identify and measure the psychological factors that predict smoking cessation intentions and behaviours among pregnant women, during pregnancy and the postpartum period, who are either currently smoking or have recently quit. Pregnant smokers (N= 56) were asked to complete a series of questionnaires designed to access their reasoning at the three levels outlined by the Reasons Model and their feelings of autonomy and competence, and partner support in quitting smoking as indicated by Self-Determination Theory. Participants were also asked to complete a number of other questionnaires and a short, semi-structured interview to assess other factors potentially related to smoking behaviour. Participants were then re-contacted twice after their baby was born, at approximately two months and four months postpartum. At both times, participants were asked to again complete the questionnaire package and a short semi-structured interview. It was hypothesized that Reasons Model and Self-Determination Theory would predict both current and future intentions to quit smoking, and smoking behaviour, respectively. It was also hypothesized that those with direct experience with quitting smoking or reducing their smoking behaviour during pregnancy and postpartum (multigravida) would be more accurate in predicting their intentions to quit smoking and smoking behaviour than would those who were pregnant for the first time (primagravida). The results indicated some support for the ability of the two models to predict intentions to quit and smoking behaviour, though was limited by the small sample size. Further, level of direct experience emerged as a significant factor in participants’ ability to predict their intentions and behaviour regarding smoking. The current study suggests that both the Reasons Model and Self-Determination Theory are important tools for assessing and developing interventions for helping women to make positive changes in their smoking behaviour during pregnancy and postpartum.