The purpose of this non-experimental descriptive study was to identify the cultural beliefs and practices surrounding pregnancy. The study aims at collecting data which will function as baseline information on cultural beliefs and practices surrounding pregnancy. The study was conducted in the city of Francistown, the second largest to the capital of Botswana situated in the north-east. A structured interview guide with both open and close-ended questions was used to collect data from 230 pregnant women who were 18 years of age and above and who were willing to participate. The data was processed on computer and a statistical software package known as Statistical Package for Social Sciences (SPSS) was used. The study revealed that pregnant women used a combination of care givers which either included a modem midwife and an elderly woman at church or a modem midwife and a traditional midwife. This is done in order to follow the traditional and cultural beliefs surrounding pregnancy and childbirth. The majority (92.2%) of the antenatal women in this study had primary and secondary education but still follow their cultural beliefs and practices, thus education does not appear to influence cultural beliefs and practices. The most common reasons cited for adhering to the beliefs and practices were that defiance was a taboo punishable by the ancestors. This study has highlighted the cultural beliefs and practices related to pregnancy. Further in-depth investigation into the impact of these cultural beliefs and practices is needed as it is imperative to determine their impact on pregnancy and its outcome. The limitation of the study was that data was only collected in one city and therefore the results cannot be generalised to the entire population.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Epidemiology and Biostatistics / Background: Malaria causes an overwhelmingly large number of cases and deaths around the globe every year, with over 90% of deaths occurring in sub-Saharan Africa. Namibia is among the sub Saharan countries that have malaria as a major public health problem, affecting most pregnant women and children in the northern regions. Insecticide treated net (ITN) distribution has been expanded in the northern regions since 2005, yet there is low ITN utilization. The associated factors for low ITN utilization are not well established. Objective: This study aimed to determine factors affecting the utilization of ITN among pregnant women in northern regions of Namibia. Specific objectives were to: (1) describe coverage of ITNs among pregnant women in terms of possession; (2) describe the utilization rate of ITN among pregnant women in northern regions; and (3) determine the association between various factors and utilization of ITN among pregnant women. The first study outcome measure was utilization of ITN, defined as an individual pregnant woman who had used an ITN the night before the survey day. The second outcome measure was coverage of ITNs, defined as possession of at least one ITN in each household, irrespective of whether or not it was being used. Methods: A cross sectional study design was used, using secondary data from a nationally representative survey which collected data on malaria interventions in regions of Namibia. The original survey collected data from a representative sample of 3000 households from 120 primary sampling units (PSUs) in nine regions country wide, using a stratified sampling method of two stages. This study targeted pregnant women in four northern regions, namely; Kavango, Ohangwena, Oshana and Omusati, in both rural and urban areas; who participated in the 2009 Namibia Malaria Indicator Survey (NMIS) from 4 April to 10 June 2009. A total of 83 pregnant women were included in the analysis out of 194 pregnant women who were interviewed during the 2009 survey. In the descriptive analyses, we described the demographic characteristics of pregnant women. In the analytic analyses, univariable and multivariable analysis (logistic regression) were conducted. Logistic regression was used to determine risk factors associated with ITN utilization. Results: The utilization of ITN was high (47%) for young women aged 15-24 years old. Overall, 67% of pregnant women aged 15-44 years old slept under bed nets the night prior the survey day. In the univariable analyses, being 35-44 years of age (OR 0.25; 95% CI: 0.07-0.89, p<0.02) and having information about malaria (OR 0.28, 95% CI: 0.09-0.85, p<0.03), were independently associated with ITN utilization. In the multivariate logistic regression model, none of the explanatory variables were significant at the 5% level. The study showed 98.8% overall coverage of ITNs among pregnant women in terms of possession. Conclusion: These findings have implications for malaria interventions in Namibia. While almost all the pregnant women recruited in the study possessed ITNs, a significant proportion did not utilize them. Older women were more likely to utilize ITNs. Interventions to improve utilization among pregnant women should target younger women below the age of 35. Women that had information on malaria were more likely to utilize ITN. Sensitising women about the epidemiology of malaria across Namibia could lead to improved utilization of ITNs. A national malaria strategic plan needs to incorporate targeted reproductive women’s education for malaria control in Namibia.

Problem: Primary HSV-2 infection during pregnancy is associated with adverse pregnancy outcomes. However the mechanisms underlying these outcomes remain largely unknown. In this study we developed and characterized a mouse model of primary HSV-2 infection during early pregnancy and examined its effects on pregnancy and fetal outcomes. Methods of Study: C57BL/6 female mice positive for vaginal plugs were infected intravaginally (IVAG) with 10^3/10^4/10^5 PFU/mouse of HSV-2 (333) or saline (control) on gestational day (GD) 5. For comparison, female mice in diestrus stage were infected with HSV-2 at the same doses. Survival, pathology scores and vaginal viral shedding were measured post-infection. Systemic viral dissemination was examined by real-time PCR. Vaginal tissue, implantation sites, placenta and fetuses were examined by histology. Maternal serum (GD 13) and amniotic fluid (GD 8) was collected for multiplex cytokine analysis. Results: The minimum viral inoculation dose for infection in pregnant mice was 10^3 PFU of HSV-2, compared to 100-fold higher dose required to infect diestrus mice (10^5 PFU). There was a dose-dependent increase in implantation failure and number of resorptions with increasing dose of viral inoculum in pregnant mice at GD 8. In the 10^3 PFU group, although vaginal viral shedding was observed in all mice, 75% survived the infection, while all the mice in 10^4 and 10^5 PFU groups succumbed to infection by GD 13-15. There was evidence of abnormal placental morphology and necrotic fetal tissues in HSV-2 infected, pregnant mice compared to controls. Presence of HSV-2 DNA was measured in the vaginal tract, uterus (mated non-pregnant mice), and implantations of infected mated mice. HSV-2 DNA was also present in the spleen of the GD 13 time point group. Conclusions: These results indicate a 100-fold increase in susceptibility to HSV-2 infection during early pregnancy. At higher inoculation doses, IVAG HSV-2 infection spread systemically resulting in poor pregnancy outcomes and maternal mortality, especially in later gestation. At lower inoculation dose, the infection was localized in the reproductive tract and implantation sites, resulting in increased inflammation and adverse outcomes. This model will help to understand pathological mechanisms underlying adverse outcomes following primary HSV-2 infection in pregnancy. / Thesis / Master of Science (MSc)

Indiana University-Purdue University Indianapolis (IUPUI) / The aim of this qualitative study was to explore the expectations and experiences first-time mothers have before, during, and after pregnancy. Semi-structured interviews were conducted with fifteen first-time mothers, who gave birth within eighteen months before the date of the interview, and an additional interview was included with a first-time pregnant woman in her third trimester (N=16). The method of analysis was based on grounded theory, including line-by-line coding, focused coding and memo writing. Several themes emerged in the process. Approximately 70 percent of the women in this study became pregnant unintentionally. All of them described a certain amount of anxiety and fear about giving birth and becoming a mother. The measures taken in regard to activities and nutrition to improve pregnancy outcome were described. The most disconcerting findings were how the birth went for many of the women and the subject of postpartum emotional difficulties. Another theme was the different factors that negatively influenced the experience of giving birth. All of the women wanted to give birth vaginally and without medication, but seven of the women had to have medical interventions during birth - were administered Pitocin, mechanically induced, or had C-sections - which influenced their postpartum mental and emotional state severely. The disappointment after complications and diversions from a birth plan were significant. Fifty percent of the participating women reported to have suffered from postpartum emotional disorders, and three of them did not seek any help. Feelings of failure and low self-value due to emotional difficulties were described several times and also appeared in relation with body image issues. Physical changes, during and after pregnancy, were another major theme among the women. Transitions in their relationships were also mentioned in the interviews. Concluding, self-stigmatization was a main thread throughout the interviews. These findings are analyzed in relation to existing literature and the implications for future research are being discussed.

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It has been noted that many pregnant women in East Tennessee are THC+ during routine urine drug screenings and/or at the time of delivery despite associations between poor fetal health outcomes both at delivery and neurodevelopmentally later in life. The purpose of this study is to assess beliefs and reasons for marijuana use during pregnancy, informational sources that influence beliefs, likelihood of use in future pregnancies, comfort level in talking with doctors, and associations with age, prior tobacco and/or prior marijuana use. Anonymous surveys consisting of 13 simple questions were distributed to female patients 18+ at three regional university-affiliated clinics. Of the 165 respondents, women less than 40 were three times more likely to perceive marijuana use while pregnant as safe and three times more likely to have used while pregnant. Patients with a history of both marijuana and tobacco use were more likely than any other category of respondents to perceive marijuana use during pregnancy as safe and to have plans to use in future pregnancies. The highest reasons for usage were nausea or vomiting (44%) and anxiety (44%). 45% of respondents felt comfortable talking with their doctors about marijuana use in pregnancy. Patients cited “family and friends (21%), “scientific articles “(21%), and “other” (24%) as sources of information on this subject. These results demonstrate an increased need for research and public information dissemination regarding marijuana use in pregnancy, as well as improving the physician-patient relationship to encourage evidence-based methods to relieve medical complaints during pregnancy.

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Maternal obesity is a key predictor of childhood obesity. It has been shown to cause changes in maternal adaptation to pregnancy that result in an adverse in utero environment, inducing increased risk of obesity and metabolic disease in the offspring. Perturbation of gut microbiota over the course of pregnancy has been implicated in maternal metabolic adaptations. We investigated how high-fat (HF) diet-induced obesity before and during pregnancy affects gut microbiota and maternal intestinal barrier function, and whether altered maternal gut adaptations to pregnancy influence placental development. Microbiota of HF mice was modified by diet, and further modulated by pregnancy. Changes in mucin-degrading and short chain fatty acid (SCFA) producing bacteria were found in microbiota from HF pregnant mice. SCFA receptor, GPR41, expression was reduced in the duodenum and jejunum of HF dams. Intestinal barrier function was impaired in HF pregnancies as indicated by increased paracellular intestinal permeability measured by passage of FITC-Dextran and increased concentration of bacterial lipopolysaccharide in the maternal serum, observations that were consistent with reduced gene expression of tight junction proteins in the small intestine of HF dams. Diet-induced maternal obesity altered gene expression of inflammatory and immune cell marker genes in different gut sections. However, no change in TNF and IL-6 in maternal serum suggested that HF diet-induced obesity was not associated with systemic maternal inflammation. Female placenta from HF pregnancies were smaller in size, as calculated by measuring the cross sectional area of the placenta, which may be regulated by increased apoptosis. Augmented placental inflammation was not observed in HF placentas. Changes in maternal intestinal adaptations appear to be modified by diet-induced obesity before and during pregnancy, in a manner that reduced maternal barrier function and increased intestinal immune cell markers but these changes appeared not be associated with placental pro-inflammatory status. / Thesis / Master of Science (MSc)

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