Thesis (M.Sc.)--Memorial University of Newfoundland, 2005. / Restricted until October 2006. Bibliography: leaves 103-113.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: South Africa’s poor maternal health indicators have resulted from weak maternal health services delivery, including access to quality family planning, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and new-borns. Maternal deaths and disabilities remain a major public health problem in developing countries and maternal mortality is the health indicator which shows the greatest gap between the rich and poor countries. There are global achievements which are substantial reduction in global maternal mortality and an increase in the proportion of childbirths occurring in health facilities. On annual basis there are maternal health outcomes which occurs and these include an estimated 139 million births, an estimated 289 000 women die during pregnancy, childbirth or soon after and lastly an estimate 2.6 million will have stillbirths and 2.9 million infants will die in the first month of life. The purpose of the study was to determine the factors driving maternal health services utilization in rural areas of Limpopo Province. Methodology: The current study was done at Hlogotlou area in Sekhukhune district of Limpopo province and it used a quantitative research approach, that was descriptive cross-sectional study to determine the factors driving maternal health services utilization. The structured questionnaire was used to describe the knowledge levels of pregnant women on utilizing the antenatal services and to describe the utilization of prenatal services by pregnant women. The sampling method was random. The total number of 450 pregnant women participated in the study and all of them were analysed. Data were analysed using STATA version 12 and descriptive statistics were used to describe the data wherein categorical variables, frequencies and percentages were reported. Differences between groups (teenagers, adolescents, adults) were analysed using univariate logistic regression. Results: A total of 450 pregnant women were interviewed majority of women were in the age group 21-25 years, single, unemployed had a secondary educational level. Socio-economic status was assessed using a household wealth index and majority of the pregnant women in the current study were in the medium socio-economic status at 66.4% and majority of the women were using social grants 67.8%. Majority of women get information pertaining to antenatal care from televisions followed by those who v received information from leaflets, radio and those who did not receive information from anywhere at 37.1%, 23.1%, 22.7% and 16.9% respectively. There was a statistical significance difference between those who initiated first antenatal care visit before 12 weeks and after 12 weeks at p-value=0.007. Majority of pregnant women who used televisions as source of information for maternal health care, majority of them were found to be initiating antenatal care after 12 weeks at as compared to those who used radio and leaflets or newspapers as they initiated antenatal care before 12 weeks. Majority of pregnant women in the current study were aware of the antenatal care services rendered at the clinics and they were aware of the fact that antenatal care services rendered at the clinics could assist in detecting the complications related to pregnancies and also reported that these services could reduce the maternal and neonatal morbidity including maternal mortality. There was an understanding of the importance of antenatal care amongst the pregnant women. The predictors of utilization of maternal health services were young age, lower educational level pregnant women who were not married were pregnant women who were in the low socio-economic status. The young pregnant women were 2.2 times more likely to plan their pregnancies and 1.8 times more likely to discuss their pregnancies with their partners or spouses. Pregnant women who were married at a young age were 0.4 times less likely to lack the knowledge about existing for antenatal care at the clinics. Pregnant women with lower educational level were 6.8 times more likely to lack the knowledge about existing for antenatal care at the clinics. Pregnant women who were not married were 2.1 times more likely to go for the first antenatal care booking in the first trimester (1-12 weeks). Pregnant women who were in the low socio-economic status were 1.4 times more likely to lack the knowledge about existing for antenatal care at the clinics and 1.3 times more likely to report that barriers to accessing antenatal care services was either culture, religion or language barrier. Conclusion: The findings of this study highlight the need to address the structural socio-economic drivers of maternal health care utilizations in rural areas of Limpopo Province, South Africa. Timely entry to antenatal care was low in the study area. In order to improve the situation, it is important to provide community-based information, education and vi communication on antenatal care and its right time of commencement. In addition, empowering women and implementing the proclamation designed for the age at marriage should be mandatory up to the local level. Our findings suggested that policies enhancing improved education could benefit health awareness. Key concepts Antenatal care, maternal health care services, pregnant women, utilization.

Thesis (MPH.) -- University of Limpopo, 2022 / The burden of labour and delivery-related complications are health problems that are life-threatening for the fetus and pregnant women. Mokopane hospital in Waterberg of Limpopo Province reports many maternal health complications. There has not been an investigation into the burden of delivery complications and therefore this study aims to investigate the burden of labour and delivery complication experienced by women giving birth at Mokopane hospital of Limpopo province. Purpose: of this study was to explore the burden of labour and delivery-related complications among pregnant women at Mokopane hospital of Limpopo province. Methods: A cross-sectional, retrospective descriptive study was conducted. The study followed a quantitative approach and the researcher completed a questionnaire using clinical records from all delivery files of mothers delivered at maternity between January 2017 to December 2019 Mokopane hospital. Findings: The major finding of this study was the majority of women were at a low risk of pregnancy (69%) followed by a high risk of pregnancy (24%). The study further revealed that (73.7%) of women at Mokopane hospital were delivered through the normal virginal procedure and (25.8%) delivered through Caesarean section. Moreover, about 86% of the mothers were normal after delivery whilst 14% were sick or had complications. Conclusion: This study, therefore, recommends that educational programs about labour and delivery-related complications and related programs should be prioritised for pregnant women. KEY CONCEPTS The burden: Is the intensity or severity of disease and its possible impact on daily life (Gidron 2013). In the context of this study, the burden will refer to the death and loss of health due to labour and delivery-related complications among pregnant women at Mokopane hospital of Limpopo Province. Labour: This is the process of rhythmic uterine contractions which results in cervical dilatation, a descent of the presenting part; and delivery of the fetus, placenta, and membrane. (Anthony & Van Der Spuy, 2002; Clark, Van de Velde, & Fernando, 2016). In the context of this study, labour will be defined as a physiologic process during which the fetus, membranes, umbilical cord, and placenta are expelled from the uterus. Delivery related complication: Is an acute condition arising from a direct cause of maternal death, such as antepartum or postpartum haemorrhage, obstructed labour, postpartum sepsis, a complication of abortion, pre-eclampsia or eclampsia, ectopic pregnancy and ruptured uterus, or indirect causes such as anaemia, malaria and tuberculosis. (WHO, 2018). In the context of this study, delivery related complications will include amongst others severe antenatal bleeding, Postpartum haemorrhage, nonconvulsive hypertensive disorder of pregnancy (pre-eclampsia), Eclampsia: preeclampsia plus convulsions, Convulsions, Prolonged labour, Premature rupture of the membranes, Retained placenta. Pregnant women: Is a woman who is in the period from conception to birth in which the egg is fertilised by a sperm and then implanted in the lining of the uterus then develops into the placenta and embryo, and later into a foetus (Martin, 2015). In the context of this study, a pregnant woman will be described as a woman who is carrying a developing embryo or fetus within her body.

Mistreatment experienced by women delivering in healthcare institutions is a concerning pattern reproduced and normalized in health systems globally, causing widespread harm. Women’s reports and observations of childbirth practices in institutions have revealed that disturbing proportions of deliveries are characterized by indignity, humiliation, and neglect. The enormity of the problem constitutes a social catastrophe, as potentially hundreds of thousands are affected daily at a profoundly important moment of personal, family, and social life. Growing global concern has elicited research on mistreatment’s prevalence and characteristics, with limited attention to developing explanatory theory. The observed patterns indicate that mistreatment is systemic; therefore, social theory is required to understand why mistreatment persists, despite official norms that prohibit mistreatment and promulgate respectful care. Diane Vaughan’s normalization of organizational deviance theory from organizational sociology, emerged from studies of how things go wrong in organizations. The theory posits that organizational structures and processes are distorted due to resource scarcity combined with production pressures resulting in normalized organizational deviance in daily micro-level transactions. Furthermore, regulatory systems are unable to capture and mitigate the problem. Vaughan’s multi-level framework provided an opportunity for analogical cross-case comparison to elaborate theory on mistreatment as normalized organizational deviance.To elaborate the theory, the Tanzanian public health system in the period of 2010-2015 was selected as a case because it was the site of a seminal study to measure the prevalence of mistreatment, explore its causes, and develop and test interventions to reduce its occurrence. My participation in designing and conducting this study provided understanding of the phenomenon which formed the foundation of this dissertation. Novel theory was first elaborated through a systematic review of literature on maternal health care and the government health system in Tanzania. A broad Scopus search identified 4,068 articles published on the health system and maternal health in Tanzania of which 122 were selected. Data was extracted using a framework based on the theory and reviews of mistreatment in healthcare. Relationships and patterns emerged through comparative analysis across concepts and system levels and then were compared with Vaughan’s theory and additional organizational theories, resulting in a nascent theory. A qualitative theory-driven approach was then applied to verify and expand the nascent theory using qualitative exploratory data from the study in Tanzania described above. The data included eight focus group discussions and 37 in-depth interviews involving 91 individuals representing community and health system stakeholders. Data were analyzed deductively and inductively using the theory’s framework while allowing for emergent constructs. Analysis based on the literature review revealed that normalized scarcity at the macro-level combined with production pressures that emphasized biomedical care and imbalanced power-dependence on limited financial sources altered values, structures, and processes in the health system. Meso-level actors strove to achieve production goals with limited autonomy and insufficient resources, resulting in workarounds and informal rationing. Biomedical care was prioritized, and emotion work was rationed in provider interactions with women, which many women experienced as disrespect. The nascent theory developed through literature review was largely supported by the qualitative data, while providing further nuance and elucidating new components. Moral distress, which occurs when one knows the right thing to do but is prevented from taking the right action due to institutional constraints, emerged as an important systems effect of organizational dysfunction. In addition, the qualitative data revealed that managers coped with dual roles as both managers and providers and that the service interaction includes families, not solely providers, women, and newborns. The challenges in the regulatory environment also were clarified, highlighting that monitoring and observing mistreatment was hindered due to structural secrecy and the nature of mistreatment. The nascent theory revealed the importance of emotional labor and emotion work in understanding mistreatment. Emotional labor has been widely acknowledged as an important aspect of healthcare provision, especially for a positive patient experience; yet there has been limited attention to emotion work as the underlying effort required to provide respectful maternity care and prevent mistreatment. Qualitative data from the exploratory formative research were further analyzed to explore the characteristics of emotion work. 22 interviews and 3 focus groups with 44 maternity providers from different levels of care provision in two districts were analyzed using thematic analysis combined with affinity diagramming. Six key themes were identified that provide a deeper understanding of the emotion work required of maternity providers, including 1) expected to love and care for patients; 2) controlling emotions; 3) managing patient expectations in the face of system shortages; 4) providers are human beings too; 5) nurses are perceived as harsh; and 6) limited system support for emotion work. The themes and corresponding sub-themes highlight that the nature of childbirth care, the context, and gender norms influence the ability to exert emotion work and thus provide respectful care. Emotion work was expected but good performance was unacknowledged by the system. Additional resources are required, not only to ensure the most basic of resources to provide quality of care, but to ensure sufficient organizational support to address the emotional demands of providers. Systems need to acknowledge the extra effort required for emotion work and support and train providers to provide this care, as well as help them to manage difficult emotions that they experience due to the nature of their work. Analogical comparison with another case of organizational deviance enabled a novel approach to elaborate theory. Normalization of organizational deviance proved useful for understanding mistreatment. This theory and others from organizational sociology that explore why things go wrong in organizations may be relevant for other areas of persistent systems failure and underperformance. Further theory testing in different contexts and types of health systems is needed to understand the generalizability of the nascent theory and advance its development. In addition, many of the constructs, such as emotional labor and moral distress, have not been widely applied in low- and middle-income settings and require deeper study. This theory reveals the systemic factors driving mistreatment and can guide the identification of system leverage points to transform health systems towards ensuring a respectful experience during childbirth for women and their newborns. Ensuring that adequate resources are provided to achieve targets is essential, but organizational support to address the emotional demands of providers must also be provided. These changes will ease the burden among providers and managers struggling to provide care in under-resourced health systems. The extra effort required for emotion work should be acknowledged and appropriate training provided, as well as support for providers to manage the difficult emotions that they experience due to the nature of their work. The findings may also have implications beyond childbirth, as the theory highlights the conditions that may lead to burnout and poor mental health among providers, an ongoing problem worldwide that was exacerbated by the COVID-19 pandemic.

Birthweight is powerful predictor of infant growth and survival. Premature birth and intrauterine growth retardation of birthweight. Maternal environment is important underlying determinant of birthweight. Common lifestyle risk factors include maternal under-nutrition, smoking, alcohol and social factors and stress. The Winelands/West Coast region has high rates of low birthweight. In addition, alcohol abuse and smoking are major problems in this area. The aim of this quantitative case-control study was to determine the epidemiology of low birthweight, related to lifestyle behaviours in pregnant women, with particular attention to lifestyle factors such as alcohol, smoking, and stress-related factors.

該前瞻性研究對香港中國裔孕婦的25羥基維生素D（25（OH）D）的水平及其影響因素進行調查，并對25（OH）D與甲狀旁腺激素（PTH）、孕期肌肉酸痛、不良妊娠結局、孕期及産後骨質流失，以及嬰兒的骨骼發育等關係進行探索，力求建立適用于香港的中國孕婦的25（OH）D正常值。 / 共有237名單胎妊娠婦女以及62名多胎妊娠的婦女在2010年8月至2011年11月間參加本研究中的隊列研究，分別在參加研究時（<20 孕周）、24-28孕周、31-36孕周以及産後6-11周進行抽血測量血清25（OH）D以及PTH水平，同時填寫一份包括對每月攝取含維生素D的食物以及營養補充劑頻度、接受日照情況及喜好、以及肌肉不適等情況的問卷，并在24-28孕周進行75克口服葡萄糖耐量試驗。參與隊列研究的單胎孕婦在20周前、31-36孕周以及産後隨訪時接受用定量超聲測量非優勢手的橈骨遠端以及中指近掌指骨的骨質超聲速率（SoS）。在産後複查時，對其嬰兒左側腓骨中部的骨質SoS進行測量。記錄婦女各次檢查時的體重、抽血月份紫外線輻射強度的歷史記錄、以及妊娠結局。另外募集一批孕婦參加病例對照研究，比較患早產（PTB）、子癇前期（PET）、妊娠糖尿病 （GDM）以及胎兒生長受限（FGR）併發癥的婦女與對照組 （體重指數以及抽血時紫外線強度配對）的血清25（OH）D水平。 / 孕婦在孕期的平均25（OH）D水平在44.7 ± 12.6 至48.9 ± 17.1 nmol/l範圍，25（OH）D水平與體重指數、維生素D營養補充劑、抽血時紫外線強度以及個人對陽光的喜好情況有關，而與胎兒數量、孕次、孕周以及終止妊娠無關。 / 單胎妊娠的孕婦三個孕期的血清25（OH）D與PTH水平均負相關，但在多胎妊娠中，二者無明顯相關性。PTH在孕期以及産後的變化相對不受25（OH）D影響。孕婦25（OH）D的水平與孕婦肌肉酸痛癥狀、産後恢復、孕期及產褥期骨質流失以及嬰兒骨質無關。患早期PTB（< 34孕周）、PET或FGR的孕婦的血清25（OH）D比對照組低，但GDM患者的25（OH）D水平與對照組無差別。血清25（OH）D低於34.3 nmol/l者的早期早產以及子癇前期的風險增高，低於50 nmol/l者發生胎兒生長受限的風險增高。服用維生素D補充劑情況可能影響25（OH）D與FGR的關係。 / 總而言之，血清25（OH）D水平不足以全面完全反映孕期維生素D的情況，對預測不良妊娠結局的作用有限。 / This prospective study explored the maternal serum level of 25(OH)D in Chinese pregnant women in Hong Kong and the factors affecting 25(OH)D level. It also explored the correlation between maternal 25(OH)D with PTH level, maternal musculoskeletal complaints, adverse pregnancy outcome, maternal bone turnover during pregnancy and postpartum, and the bone development of the offspring, aiming to explore and establish a normal range of 25(OH)D level in pregnancy for the Hong Kong Chinese women. / A total of 237 women with singleton pregnancy and 62 women with multiple pregnancies were recruited for the cohort study from August, 2010 to November, 2011. Maternal blood samplings for 25(OH)D and PTH measurements were performed at recruitment, 24-28 weeks, 31-36 weeks of gestation, and 6-11 weeks postpartum respectively. A questionnaire which included the monthly dietary and supplement intake of vitamin D, questions about sunlight exposure, and musculoskeletal complaints was administered on each visit. A 75g oral glucose tolerance test (OGTT) was performed on cohort cases at 24-28 weeks of gestation. Measurements of the speed of sound (SoS) at the distal one third of the maternal radius and the proximal phalanx of the third finger of the non-dominant side were performed with quantitative ultrasonography (QUS) measurement during the visits at the first and third trimesters, and postnatal period. The SoS at the left mid-shaft tibia of the offspring was determined during the postnatal visit. Maternal characteristics, ultraviolet radiation (UVR) intensity at blood sampling, and pregnancy outcome, were also recorded. Cases with pregnancy complications were recruited for case-control studies, and maternal 25(OH)D level was examined with respect to preterm birth (PTB), preeclampsia (PET), gestational diabetes (GDM), and fetal growth restriction (FGR, birthweight below the 10th percentile of the customized estimated birthweight). The controls were matched for booking body mass index (BMI) and UVR intensity at blood sampling. / The mean 25(OH)D level in ranged from 44.7 ± 12.6 to 48.9 ± 17.1 nmol/l in the three trimesters, and was related to BMI, vitamin D supplementation, UVR intensity at blood sampling, and the acceptance of sunlight exposure, but not the number of fetus, parity, gestational age, or the completion of pregnancy. / Inverse correlation between PTH and 25(OH)D were observed in singleton, but not in multiple, pregnancy. The change in maternal PTH level is found to be relatively independent from that of 25(OH)D. There was no correlation between maternal 25(OH)D level with musculoskeletal complaints, postnatal recovery, bone turnover during and after pregnancy, or the bone density of the offspring. Maternal 25(OH)D level was lower in women with early PTB ( < 34 weeks), PET, and FGR, but not for GDM. A maternal 25(OH)D level of lower than 34.3nmol/l and 50 nmol/l was associated with increased risk of early PTB, PET, and FGR respectively. But the correlation between maternal 25(OH)D level with FGR might be affected by supplementation. / In conclusion, serum level of 25(OH)D is insufficient in reflecting maternal vitamin D status and metabolism in pregnancy, and is of limited use in predicting adverse pregnancy outcome. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Hu, Zhiyang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 201-223). / Abstracts and appendixes also in Chinese. / Thesis dedication --- p.i / Acknowledgments --- p.ii / Abstract --- p.v / Abstract (Chinese) --- p.viii / List of Abbreviation --- p.x / Table of contents --- p.xiii / List of Figures --- p.xxii / List of Tables --- p.xxiv / Chapter Chapter 1: --- Literature Review --- p.1 / Chapter 1.1 --- The synthesis and metabolism of vitamin D --- p.3 / Chapter 1.1.1 --- The synthesis of vitamin D --- p.3 / Chapter 1.1.2 --- The metabolism of vitamin D --- p.4 / Chapter 1.1.3 --- Vitamin D binding protein --- p.10 / Chapter 1.1.4 --- Factors related to 25(OH)D level --- p.11 / Chapter 1.2 --- Function of vitamin D --- p.13 / Chapter 1.2.1 --- Mechanism of vitamin D function --- p.13 / Chapter 1.2.2 --- Classic function --- p.14 / Chapter 1.2.3 --- Non-classic function --- p.16 / Chapter 1.2.3.1 --- Immune system --- p.17 / Chapter 1.2.3.2 --- Cardiovascular system --- p.18 / Chapter 1.2.3.3 --- Cell proliferation and differentiation --- p.18 / Chapter 1.2.3.4 --- Neurological system --- p.19 / Chapter 1.2.3.5 --- Reproductive system --- p.20 / Chapter 1.2.3.6 --- Fetal development --- p.21 / Chapter 1.3 --- The definition of vitamin D deficiency --- p.21 / Chapter 1.4 --- Vitamin D status and pregnancy --- p.24 / Chapter 1.4.1 --- Alteration in vitamin D metabolism during pregnancy --- p.24 / Chapter 1.4.2 --- Factors affecting maternal serum level of 25(OH)D --- p.25 / Chapter 1.4.3 --- Vitamin D and bone resorption during pregnancy and lactation --- p.27 / Chapter 1.4.3.1 --- Alteration of calcium metabolism, bone absorption and the role of vitamin D --- p.27 / Chapter 1.4.3.2 --- Measurement of bone density in pregnant women and babies --- p.33 / Chapter 1.4.4 --- Current studies on maternal vitamin D status and pregnancy outcome --- p.35 / Chapter 1.4.4.1 --- Birthweight --- p.35 / Chapter 1.4.4.2 --- Infection --- p.37 / Chapter 1.4.4.3 --- Preterm delivery --- p.39 / Chapter 1.4.4.4 --- Diabetes (DM) and gestational diabetes (GDM) --- p.39 / Chapter 1.4.4.5 --- Hypertension and preeclampsia --- p.41 / Chapter 1.4.4.6 --- Multiple pregnancy, muscular symptoms --- p.42 / Chapter 1.4.4.7 --- Vitamin D supplementation and pregnancy outcome --- p.44 / Chapter 1.5 --- Defining vitamin D deficiency in pregnancy --- p.45 / Chapter 1.6 --- Objective of the study --- p.46 / Chapter Chapter 2: --- Study design and methods --- p.48 / Chapter 2.1 --- Case recruitment and study design --- p.48 / Chapter 2.1.1 --- Longitudinal singleton study --- p.49 / Chapter 2.1.2 --- Cross-sectional study --- p.50 / Chapter 2.1.2.1 --- Preterm birth (PTB) --- p.51 / Chapter 2.1.2.2 --- Preeclampsia (PET) --- p.51 / Chapter 2.1.2.3 --- Gestational diabetes (GDM) --- p.52 / Chapter 2.1.3 --- Multiple pregnancy study --- p.52 / Chapter 2.2 --- Measurements --- p.53 / Chapter 2.2.1 --- Hormonal analysis of serum levels of 25(OH)D and PTH --- p.53 / Chapter 2.2.2 --- Calculation of monthly intake of vitamin D from diet --- p.55 / Chapter 2.2.3 --- SoS measurements --- p.56 / Chapter 2.2.4 --- Ultraviolet radiation strength assessment --- p.59 / Chapter 2.3 --- Statistical analysis --- p.60 / Chapter Chapter 3 --- Longitudinal Study on the Level of and Factors Affecting Vitamin D in Singleton Pregnancy --- p.62 / Chapter 3.1 --- Introduction --- p.62 / Chapter 3.2 --- Material and method --- p.63 / Chapter 3.3 --- Statistics --- p.64 / Chapter 3.4 --- Results --- p.65 / Chapter 3.4.1 --- Demographic data of the subjects --- p.65 / Chapter 3.4.2 --- Maternal levels of 25(OH)D and PTH, and the factors affecting their levels --- p.66 / Chapter 3.4.2.1 --- Distribution of 25(OH)D level and PTH level in the four visits --- p.66 / Chapter 3.4.2.2 --- Dietary intake of vitamin D and supplementation --- p.69 / Chapter 3.4.2.3 --- Seasonality and sunlight exposure --- p.73 / Chapter 3.4.2.4 --- Parity --- p.76 / Chapter 3.4.3 --- Changes of maternal levels of 25(OH)D and PTH in pregnancy --- p.78 / Chapter 3.4.4 --- Independent factors related to maternal 25(OH)D level in pregnancy --- p.79 / Chapter 3.4.5 --- Maternal and fetal 25(OH)D level at delivery --- p.80 / Chapter 3.4.6 --- Muscular symptoms and other complaints in pregnancy, pregnancy outcome, and their relationships with maternal 25(OH)D level --- p.81 / Chapter 3.4.7 --- Postnatal recovery and factors related to postnatal level of 25(OH)D and PTH --- p.86 / Chapter 3.4.7.1 --- Postnatal symptoms and relationship with 25(OH)D and PTH --- p.86 / Chapter 3.4.7.2 --- The postnatal level of 25(OH)D and PTH in women with different feeding mode --- p.88 / Chapter 3.4.7.3 --- Independent factors related to postnatal 25(OH)D and PTH level --- p.89 / Chapter 3.4.7.4 --- Factors related to the change of 25(OH)D and PTH after delivery --- p.90 / Chapter 3.4.8 --- Correlation between 25(OH)D with PTH in pregnancy and postnatal period --- p.91 / Chapter 3.5 --- Discussion --- p.92 / Chapter 3.5.1 --- 25(OH)D level in Chinese pregnant women --- p.92 / Chapter 3.5.2 --- Factors related to maternal 25(OH)D level --- p.93 / Chapter 3.5.2.1 --- Dietary and supplementation --- p.93 / Chapter 3.5.2.2 --- Seasonality and outdoor activity --- p.96 / Chapter 3.5.2.3 --- Gestational age --- p.98 / Chapter 3.5.2.4 --- Age and parity --- p.98 / Chapter 3.5.3 --- Relationship of 25(OH)D level in the cord blood with maternal 25(OH)D level --- p.99 / Chapter 3.5.4 --- 25(OH)D level and muscular complains in pregnancy --- p.100 / Chapter 3.5.5. --- Postnatal recovery and 25(OH)D level --- p.101 / Chapter 3.5.6 --- PTH level in pregnancy and postnatal period --- p.101 / Chapter 3.6 --- Conclusion --- p.102 / Chapter Chapter 4 --- Longitudinal Study on the Relationship between Maternal 25(OH)D level with Changes of Maternal Bone Density in Pregnancy and Lactation, and Factors Affecting Bone Density of newborn Infants --- p.105 / Chapter 4.1 --- Introduction --- p.105 / Chapter 4.2 --- Material and method --- p.106 / Chapter 4.3 --- Statistics --- p.108 / Chapter 4.4 --- Results --- p.108 / Chapter 4.4.1 --- Demographic data --- p.108 / Chapter 4.4.2 --- Maternal bone density and the changes in pregnancy and postnatal recovery --- p.109 / Chapter 4.4.2.1 --- Maternal bone density in the first trimester and related factors --- p.109 / Chapter 4.4.2.2 --- Maternal bone density in the three visits --- p.109 / Chapter 4.4.2.3 --- The change in maternal bone density in the three visits --- p.110 / Chapter 4.4.2.4 --- Diversity in the change of bone density in pregnant women --- p.112 / Chapter 4.4.3 --- Factors related to the changes in bone density --- p.114 / Chapter 4.4.3.1 --- Changes between the first and the third trimesters --- p.114 / Chapter 4.4.3.2 --- Change between the third trimester and postnatal visits --- p.116 / Chapter 4.4.4 --- The bone density in infants and related factors --- p.120 / Chapter 4.5 --- Discussion --- p.122 / Chapter 4.5.1 --- Maternal bone density changes in pregnancy and postnatal period --- p.122 / Chapter 4.5.2 --- Factors related to the maternal bone density changes in pregnancy and postnatal period --- p.124 / Chapter 4.5.2.1 --- Initial bone density, parity, and BMI --- p.125 / Chapter 4.5.2.2 --- 25(OH)D and PTH level --- p.126 / Chapter 4.5.2.3 --- Supplement --- p.127 / Chapter 4.5.2.4 --- Lactation --- p.128 / Chapter 4.5.2.5 --- Height --- p.129 / Chapter 4.5.3 --- Factors related to bone density of the infant. --- p.130 / Chapter 4.5.3.1 --- Maternal 25(OH)D level --- p.130 / Chapter 4.5.3.2 --- Gestational age and birthweight --- p.131 / Chapter 4.5.3.3 --- Maternal bone density change --- p.131 / Chapter 4.5.3.4 --- The gender of the offspring and feeding method --- p.132 / Chapter 4.6 --- Conclusion --- p.133 / Chapter Chapter 5 --- Maternal 25(OH)D Level in Multiple Pregnancy --- p.134 / Chapter 5.1 --- Introduction --- p.134 / Chapter 5.2 --- Material and method --- p.135 / Chapter 5.3 --- Statistics --- p.136 / Chapter 5.4 --- Results --- p.137 / Chapter 5.4.1 --- Demographic data of the subjects --- p.137 / Chapter 5.4.2 --- The level of 25(OH)D in multiple pregnancy and singleton pregnancy --- p.137 / Chapter 5.4.3 --- Supplementation in multiple pregnancy --- p.140 / Chapter 5.4.4 --- The change of maternal 25(OH)D and PTH levels in the three trimesters --- p.141 / Chapter 5.4.5 --- 25(OH)D level in cord blood and its correlation with 25(OH)D level of the sibling --- p.143 / Chapter 5.4.6 --- Correlation between 25(OH) with PTH in pregnancy --- p.143 / Chapter 5.5 --- Discussion --- p.144 / Chapter 5.5.1 --- 25(OH)D level in multiple pregnancy and singleton pregnancy --- p.144 / Chapter 5.5.2 --- Supplementation in multiple pregnancy --- p.146 / Chapter 5.5.3 --- Changes of maternal levels of 25(OH)D and PTH in the three trimesters in multiple pregnancy --- p.146 / Chapter 5.5.4 --- The PTH/25(OH) correlation --- p.147 / Chapter 5.6 --- Conclusion --- p.148 / Chapter Chapter 6 --- Maternal level of 25(OH)D in complicated pregnancy --- p.150 / Chapter 6.1 --- Introduction --- p.150 / Chapter 6.2 --- Method --- p.153 / Chapter 6.2.1 --- Preterm birth --- p.155 / Chapter 6.2.2 --- Preeclampsia --- p.155 / Chapter 6.2.3 --- Gestational diabetes --- p.156 / Chapter 6.2.4 --- Fetal growth restriction --- p.157 / Chapter 6.2.5 --- The association between 25(OH)D level with pregnancy complication --- p.158 / Chapter 6.3 --- Statistics --- p.159 / Chapter 6.4 --- Results --- p.160 / Chapter 6.4.1 --- Setting of the cutoff values of hypovitaminosis D --- p.160 / Chapter 6.4.2 --- Preterm birth --- p.160 / Chapter 6.4.3 --- Preeclampsia --- p.164 / Chapter 6.4.4 --- Gestational diabetes --- p.168 / Chapter 6.4.4.1 --- Case-control study --- p.168 / Chapter 6.4.4.2 --- Factors affecting OGTT results --- p.170 / Chapter 6.4.5 --- Fetal growth restriction --- p.173 / Chapter 6.5 --- Discussion --- p.179 / Chapter 6.5.1 --- Adjustment for confounders for case-control study --- p.179 / Chapter 6.5.2 --- PTB and 25(OH)D level --- p.181 / Chapter 6.5.3 --- PET and 25(OH)D level --- p.182 / Chapter 6.5.4 --- GDM and 25(OH)D level --- p.186 / Chapter 6.5.5 --- FGR and 25(OH)D level --- p.189 / Chapter 6.5.6 --- Defining vitamin D deficiency in pregnancy --- p.192 / Chapter 6.6 --- Conclusion --- p.195 / Chapter Chapter 7 --- Summary --- p.196 / References --- p.201 / Chapter Appendix 1 --- Antenatal questionnaire (English/Chinese) --- p.224 / Chapter Appendix 2 --- Postnatal questionnaire (English/Chinese) --- p.238

Birthweight is powerful predictor of infant growth and survival. Premature birth and intrauterine growth retardation of birthweight. Maternal environment is important underlying determinant of birthweight. Common lifestyle risk factors include maternal under-nutrition, smoking, alcohol and social factors and stress. The Winelands/West Coast region has high rates of low birthweight. In addition, alcohol abuse and smoking are major problems in this area. The aim of this quantitative case-control study was to determine the epidemiology of low birthweight, related to lifestyle behaviours in pregnant women, with particular attention to lifestyle factors such as alcohol, smoking, and stress-related factors. / Master of Public Health - MPH

Birthweight is powerful predictor of infant growth and survival. Premature birth and intrauterine growth retardation of birthweight. Maternal environment is important underlying determinant of birthweight. Common lifestyle risk factors include maternal under-nutrition, smoking, alcohol and social factors and stress. The Winelands/West Coast region has high rates of low birthweight. In addition, alcohol abuse and smoking are major problems in this area. The aim of this quantitative case-control study was to determine the epidemiology of low birthweight, related to lifestyle behaviours in pregnant women, with particular attention to lifestyle factors such as alcohol, smoking, and stress-related factors.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The availability and provision of good antenatal care services ensure early detection and prompt management of any complication or disease that may adversely affect pregnancy outcome. To ensure high quality care, an ongoing health education and empowerment of pregnant women with pregnancy related information, need to be provided by midwives throughout pregnancy. The purpose of this study, therefore, was to explore the pregnant women`s experiences and perceptions regarding health education given during the antenatal period. The objectives set were to - explore the content of the health education given to pregnant women by midwives during the antenatal period - determine whether the health education offered by midwives is understood by pregnant women - determine whether information regarding Health Education during antenatal period is applicable and is used by pregnant women. A qualitative approach with an explorative descriptive design was applied for the purpose of this study. The population included pregnant women who attended an antenatal clinic for the second time in 2012. Ten pregnant women were selected purposively who consented to participate in the study. The trustworthiness of this study was assured by using Lincoln and Guba`s criteria of credibility, transferability, dependability and confirmability. A pretest was done with one participant not included in the actual study. Ethics approval was obtained from the Ethics Committee of the Faculty of Medicine and Health Sciences at Stellenbosch University, reference: S12/05/136. Informed written consent was obtained from each participant which included a recording of the interview. Data was collected through semi-structured interviews using an interview guide and a tape recorder. The researcher approached two women per day for five days. A total of ten (10) pregnant women were interviewed until data saturation reached. The use of Tesch's eight steps of data analysis was used to analyse the transcribed data as described in De Vos et al. (2004:331). Findings revealed that health education was given to pregnant women at the institution under study but with minimum explanations. The midwives were perceived as supportive and regarded as a source of information and self-care agents. Antenatal attendance was regarded as important by participants. Participants indicated that their unborn babies were monitored by the midwives in order to detect abnormalities early. However, midwives emphasised non-pregnancy related complications specifically HIV/AIDS and neglected to give basic antenatal care, such as antenatal exercises, personal hygiene and diet. Language was found to be a barrier and contributed to a lack of information. Recommendations include basic antenatal aspects to be covered in the health education, such as emphasis on personal hygiene, exercises, diet and avoidance of harmful sociocultural practices. With the implementation of appropriate teaching principles language, age and involvement of influential people during health education should be considered. In conclusion, to reduce maternal morbidity and mortality rates and promoting self-care reliance, antenatal care services should be accessible to facilitate ongoing health education by midwives throughout pregnancy. / AFRIKAANSE OPSOMMING: Die beskikbaarheid en voorsiening van goeie voorgeboortesorgdienste verseker die vroeë en vinnige bestuur van enige komplikasie of siekte wat swangerskap-uitkomste nadelig mag beïnvloed. Om hoë gehalte sorg te verseker, moet gesondheidsvoorligting en bemagtiging van swangervroue rakende swangerskap inligting deurlopend deur vroedvroue verskaf word. Die doel van hierdie studie was om vervolgens die swangervrou se ervaringe en persepsies ten opsigte van gesondheidsopvoeding gedurende die voorgeboortelike stadium te ondersoek. .Die doelwitte soos gestel was om: - die inhoud van die gesondheidsvoorligting wat deur vroedvroue gedurende die voorgeboorte periode aan swangervroue verskaf word, te ondersoek - te bepaal of die gesondheidsvoorligting wat verskaf word deur vroedvroue deur swangervroue verstaan word - vas te stel of die ligting aan swangervroue gepas is en te bepaal of dit toegepas word deur swangervroue. ’n Kwalitatiewe benadering met ’n beskrywende ontwerp is vir die doel van hierdie studie toegepas. Die populasie het swangervroue ingesluit wat ’n voorgeboortekliniek vir die tweede keer gedurende 2012 besoek het. Tien vrouens is doelgerig geselekteer wat daartoe ingestem het om aan die navorsing deel te neem. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. ’n Loodsondersoek was met een deelnemer wat nie in die werklike studie ingesluit was nie, gedoen. Etiese goedkeuring is verkry van die Etiese Komitee van die Fakulteit van Geneeskunde en Gesondheidswetenskappe aan die Universiteit van Stellenbosch, verwysing: S12/05/136. Ingeligte skriftelike toestemming is verkry van elke deelnemer wat ook ’n opname van die onderhoud ingesluit het. Data is ingesamel deur van semi-gestruktureerde onderhoude gebruik te maak met behulp van ’n onderhoudsgids en ’n bandopnemer. Die gebruik van Tesch se ag stappe van data-analise is gebruik om die getranskribeerde data te analiseer (De Vos et al., 2004:331). Bevindinge het getoon dat gesondheidsvoorligting wel aan swangervroue by die inrigting onder die soeklig met die minimum verduidelikings verskaf is. Die vroedvroue is as ondersteunend en as ’n bron van inligting, asook as selfsorgagente waargeneem. Voorgeboorte bywoning is as belangrik deur deelnemers gesien. Deelnemers het aangedui dat hulle ongebore babas gemonitor is deur vroedvroue om abnormaliteite vroeg op te spoor. Nietemin, vroedvroue het nie-verwante swangerskap komplikasies, spesifiek MIV/VIGS beklemtoon en het nagelaat om aandag te gee aan basiese voorgeboortesorg soos voorgeboorte oefeninge, persoonlike higiëne en dieet. Daar is bevind dat taal ’n hindernis is en dat dit bygedra het tot ’n gebrek aan inligting. Aanbevelings sluit in basiese voorgeboorte aspekte wat gedek moet word in gesondheidsvoorligting, soos die beklemtoning van persoonlike higiëne, oefeninge, dieet en die vermyding van nadelige sosio-kulturele praktyke. Met die implimentering van doeltreffende onderrigbeginsels moet taal, ouderdom en die betrokkenheid van invloedryke mense gedurende gesondheidsvoorligting in ag geneem word. Ten slotte, om moeder-morbiditeit en-mortaliteitsyfers te verminder en selfsorgvertroue te bevorder, behoort voorgeboortesorgdienste toeganklik te wees, sodat vroedvroue volgehoue gesondheidsvoorligting tydens swangerskap kan fasiliteer.

No description available.