Screening pregnant women for substance use appears unworthy of debate given the harmful impacts on the fetus, pregnancy outcomes, the woman herself and her offspring to adulthood. However while screening is routine for conditions such as impaired glucose control, obstetric care providers are often reluctant to intervene with substance use, citing knowledge deficits and a lack of effective screening tools. General negativity about the value of intervention and stereotypical views of substance users have also been identified. This study examined existing screening tools and investigated the World Health Organization’s ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) Version 3.0, focussed on tobacco, alcohol and cannabis, the substances most used in the targetted public hospital clinics. The ASSIST Version 3.0’s performance in pregnancy was assessed using a two-pronged harm categorization: risk to the fetus and risk to the woman as an individual user. For the latter, levels of risk concordant with cut-offs for the general population were utilized. The ASSIST Version 3.0 performed only moderately well versus established self-report tools: the Revised Fagerstrom Tolerance Questionnaire (RTQ) for tobacco, the T-ACE for alcohol, and the Timeline FollowBack (TLFB) for cannabis. Most participants used tobacco (98 of 104); predominance of tobacco use was likely linked to the recognized difficulty in stopping, despite cessation of other substances. Kappa analyses of Specific Substance Involvement Scores (SSIS) on ASSIST Version 3.0 for tobacco did not support changing cut-offs for the woman as an individual user; however, ROC curves delineated an SSIS of 4 as indicative of fetal risk for both alcohol and cannabis. As all 98 tobacco users were ‘high risk’ users, a cut-off indicative of fetal risk for tobacco could not be determined but may be feasible by further research with first trimester women. Identifying tobacco use with an established tobacco-specific tool should be the first screening for pregnant women. If tobacco use is identified, screening for other substance use can be initiated and there may be a place for the ASSIST Version 3.0 in that context. Obstetric care providers need to then be willing and competent to address identified use, whilst avoiding unhelpful stereotyping. / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2010

The purpose of this review is to provide an overview of the current state of knowledge regarding the experience of intimate partner violence (IPV) during pregnancy. Pregnancy IPV is a significant problem worldwide, with rates varying significantly by country and maternal risk factors. Pregnancy IPV is associated with adverse newborn outcomes, including low birth weight and preterm birth. Many mechanisms for how IPV may impact birth outcomes have been proposed and include direct health, mental health, and behavioral effects, which all may interact. Screening for IPV during pregnancy is essential, yet due to time constraints and few clear recommendations for assessment, many prenatal providers do not routinely inquire about IPV, or even believe they should. More training is needed to assist health care providers in identifying and managing pregnancy IPV, with additional research needed to inform effective interventions to reduce the rates of pregnancy IPV and resultant outcomes.

The primary objective of this study was to evaluate the associations between psychosocial stressors, urine sugar levels, and subsequent birth outcomes, specifically high birth weight babies and Caesarean section births. In a prospective cohort study, 506 Black and White women of childbearing age were followed for the duration of one pregnancy in Tuscaloosa and Mobile counties in Alabama from 1990 to 2001. Participants were interviewed twice throughout pregnancy, during the first and third trimesters, respectively, and birth outcome data were collected via medical chart reviews. Six percent (6.1%) of the women in the sample had a high birth weight baby, and 18.4% received a C-section during childbirth. Adjusted logistic regression results indicate that urine sugar levels are predictive of high-weight births, with women who have higher urine sugar levels were more than three times likely to birth a high weight baby compared with women who have no detectable urine sugar spill (OR 3.25; 95% CI 1.30, 8.10). In addition, the interaction of familial social support throughout pregnancy, physical or verbal abuse during the second and third trimesters, and ethnicity is significantly associated with increased risk of having a high birth weight baby. For C-section, single participants are over two times less likely to receive a C-section during childbirth compared with currently married participants (OR 0.46; 95% CI 0.21-1.00). Examining structural equation modeling results; pathways leading from urine sugar levels, physical or verbal abuse during the latter half of the pregnancy, and a mother's social support among White participants are indicative of high weight births (R² = 0.65). White abused women who receive their mother's social support are more likely to have a high birth weight baby compared with both White and Black women who are not abused and receive the same amount of social support. Recommendations to public health practitioners include primary prevention through promotion of familial support during pregnancy, secondary prevention through urine sugar screening at every prenatal visit, and direct intervention by identifying and inquiring about instances of suspected abuse during pregnancy.

This study examines the problems which are created by assisted reproductive techniques on the individuals and their decisions about the reproduction. In the study, the data of a field study which was conducted in 2010 is used in order to make the examination deeper and to give a qualitative and quantitative dimension to the theoretical framework. Through the sociological analysis of both controversial issues occurred by pre-natal reproductive technologies such as sex selection, abortion, PGD, IVF babies, disability, etc. and personal decisions which are impossible to be given independent from the social environment, providing a contribution to the development of sociology of reproduction is desired. In this study it is claimed that assisted reproductive techniques are power which will possibly get ahead of natural reproduction and reduce and even erase the biodiversity and coincidental characteristics of human reproduction, and increase the inequalities in the society. Thus this power may courage the reproduction of &lsquo / desirables&rsquo / and prevent &lsquo / undesirable&rsquo / ones from living and even insemination anymore. Another argumentation which is under discussion is the illusion of all these activities and problems were taking their sources from the own decisions of prospective parents. Reproductive biotechnology commerce hopes to people through its economy, cuts across all boundaries through the bounties of its technical abilities and by doing so it does not see a drawback in making people &lsquo / victims&rsquo / of their choices that regarded as &lsquo / rational and free&rsquo / which in fact mere &lsquo / irrational&rsquo / preferences. Thus in this thesis, the theoretical foundations and social results of this technology which extending up to the pre-natal processes are discussed to contribute a more democratic policies