The purpose of this study is to see if all the special circumstances, extra classes, and parenting aspects of a treatment program are effective for pregnant substance abusing women. This study also explored the factors that contributed to the perceived satisfaction and effectiveness of the clients enrolled in a drug and alcohol treatment program.

Orientador: Maria Terezinha Serrão Peraçoli / Coorientador: Leandro Gustavo de Oliveira / Banca: Alessandra Pontillo / Banca: Francisco Lázaro Pereira de Souza / Resumo: A pré-eclâmpsia (PE) é uma síndrome específica da gravidez, caracterizada por hipertensão arterial e proteinúria, identificadas após a 20a semana de gestação. Essa patologia está associada com hiperuricemia, valores séricos elevados de citocinas inflamatórias, ativação de leucócitos e estresse oxidativo. Cristais de ácido úrico podem ativar um complexo intracelular denominado inflamassoma, uma estrutura multi-proteica importante para o processamento e liberação das citocinas inflamatórias interleucina-1 beta (IL-1β) e IL-18. Este estudo investigou, em gestantes portadoras de PE, o estado de ativação de monócitos, tanto endógeno como estimulado por urato monossódico (MSU), por meio da expressão gênica dos inflamassomas NLRP1 e NLRP3, bem como a associação destes complexos com a expressão de citocinas inflamatórias por estas células. Monócitos foram obtidos do sangue periférico de 23 gestantes pré-eclâmpticas e 23 gestantes normotensas (GN) no terceiro trimestre de gestação e de 23 mulheres saudáveis, não grávidas (MNG) e cultivados na presença ou ausência de 50 μg/mL de MSU por 18 h. A presença do inflamassoma foi avaliada por meio da expressão gênica de NLRP1, NLRP3, caspase-1, IL-1β, IL-18 e TNF-α por RT-qPCR em células não estimuladas (expressão endógena) ou após estímulo com MSU (expressão estimulada). A concentração das citocinas foi avaliada pelo método de ELISA. Os resultados foram analisados por meio de testes não-paramétricos com nível de significância de 5%. Em gestantes pré-eclâmpticas, a expressão gênica de NLRP1, NLRP3, caspase-1, IL-1β e TNF-α em monócitos estimulados ou não com MSU, foi significativamente maior do que nos grupos GN e MNG. Além disso, observou-se maior expressão endógena de IL-18 em gestantes com PE em comparação às gestantes normotensas, enquanto a expressão estimulada da citocina foi maior no grupo PE em relação aos grupos GN e... / Abstract: Preeclampsia (PE) is a specific syndrome of pregnancy, characterized by hypertension and proteinuria, identified after the 20th week of pregnancy. This pathology is associated with hyperuricemia, elevated serum levels of inflammatory cytokines, leukocyte activation and oxidative stress. Uric acid crystals may activate an intracellular complex called inflammasome, a multi-protein structure which is important for processing and release of inflammatory cytokines such as interleukin-1 beta (IL-1β) and IL-18. This study investigated, in pregnant women with PE, the state of monocyte activation both endogenous and stimulated with monosodium urate (MSU), by gene expression of NLRP1 and NLRP3 inflammassomes as well as their association with inflammatory cytokines expression by these cells. Monocytes were obtained from peripheral blood of 23 preeclamptic pregnant women, 23 normotensive pregnant women (NT) in the third trimester of pregnancy and 23 healthy non-pregnant women (NP), and cultured in the presence or absence of 50 μg/mL of MSU for 18 h. Inflammasome activation was evaluated by the gene expression of NLRP1, NLRP3, caspase-1, IL-1β, IL-18 and TNF-α by RT-qPCR in unstimulated monocytes (endogenous expression), or after cell stimulation with MSU (stimulated expression). The concentration of cytokines was assessed by enzyme-linked immunosorbent assay (ELISA). The results were analyzed using non-parametric tests at 5% significance level. In preeclamptic pregnant women, gene expression of NLRP1, NLRP3, caspase-1, IL-1β and TNF-α by monocytes, stimulated or not with MSU, was significantly higher than in NT and NP groups. In addition, there was a higher endogenous expression of IL-18 in pregnant women with PE compared with NT pregnant women, while the stimulated cytokine expression was higher in the PE group than in the other two groups studied. Stimulation of monocytes from preeclamptic and non-pregnant women with MSU induced increased ... / Mestre

Orientador: Cátia Regina Branco da Fonseca / Resumo: A Doença Periodontal na gestação desencadeia uma resposta imunológica exacerbada com altas concentrações locais e sistêmicas de marcadores inflamatórios. Objetivo: Investigar a repercussão da Doença Periodontal (DP) na gestante e suas complicações na gestação e no momento do parto, bem como desfechos negativos para o recém-nascido (RN) (infecção, prematuridade, baixo peso, restrição de crescimento fetal). Método: Estudo de coorte retrospectiva, a partir de registros de prontuários médicos de 142 gestantes atendidas em serviço de pré-natal de risco habitual entre 2012-2014, com avaliação odontológica para DP. Foram analisadas variáveis maternas gestacionais, do parto e do recém-nascido. Os RN foram estratificados em dois grupos: filhos de mães com DP (subdividido para Doença Periodontal grave -DPG) e, filhos de mães sem DP. Cada desfecho foi ajustado por um modelo de regressão logística múltipla, com significância se p<0,05, considerando todos os potenciais confundidores. Resultados: Observou-se entre as mulheres com diagnóstico de DPG o aumento de chance de vulvovaginite 3,45 vezes maior (OR=3,45; p=0,050) e de RPM 5,59 vezes maior (OR=5,59; p=0,017). Nos recém-nascidos, a chance de haver restrição de crescimento fetal foi 11,53 vezes maior nas gestantes com DPG (OR = 11,53; p=0,041). Conclusão: A Doença Periodontal aumentou a chance para desfechos neonatais e maternos negativos, sendo estes o recém-nascido nascer com restrição de crescimento fetal e a gestante apresentar vul... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Periodontal Disease on pregnancy triggers an intense immunological response with high levels of local and systemic concentration of stress biomarkers. Objective: To investigate the repercussion of periodontal disease (PD) on the pregnant woman and complications during pregnancy and delivery as well, negative outcomes for the newborn (infection, prematurity, low weight, fetal growth restriction). Method: Retrospective cohort study, based on records of medical records of 142 pregnant women attended at prenatal service at usual risk between 2012-2014, with odontological evaluation for PD. Gestational maternal, labor and newborn variables were analyzed. The newborns were stratified into two groups: newborns mothers with PD (subdivided for severe periodontal disease - SPD) and newborns mothers without PD. Each outcome was adjusted by a multiple logistic regression model, with significance if p <0.05, considering all potential confounders. Results: Was increased among women exposed the SPD the odds of vulvovaginitis was 3.45 times higher (OR = 3.45; p=0.050) and of PMR was 5.59 times higher (OR=5.59; p=0.017). In the newborn of mothers exposed the SPD, the increase in odds of the fetal growth restriction was 11.53 times higher (OR=11.53; p= 0.041). Conclusion: Periodontal disease increased the chance for neonatal and maternal negative outcomes, such as fetal growth restriction in the newborn and vulvovaginitis and premature rupture of the membrane in the pregnant woman in the p... (Complete abstract click electronic access below) / Mestre

Orientador: Marilza Vieira Cunha Rudge / Resumo: Adaptação transcultural e validação do Pregnancy Sexual Response Inventory (PSRI) para o espanhol em gestantes chilenas. Introdução: A gestação é marco especial na vida da mulher, ocorrem mudanças físicas e psicológicas que comumente impactam no bem-estar geral. Podem ser observadas modificações sexuais no período gestacional, fator que pode afetar negativamente a qualidade de vida. O Inventário de Resposta Sexual à Gravidez (PSRI) é ferramenta clínica com entrevista breve e semiestruturada para avaliar o impacto da gravidez na sexualidade, no entanto, atualmente não há tradução em espanhol do questionário PSRI. Objetivo: Traduzir, adaptar culturalmente e validar para língua espanhola (Chile) o PSRI em gestantes chilenas. Método: Estudo de corte transversal, internacional desenvolvido no Chile. Incialmente, o questionário PSRI foi validado na língua espanhola para gestantes chilenas. Posteriormente o PSRI validado foi aplicado com a finalidade de avaliar a qualidade sexual das gestantes em diferentes trimestres. Foi analisado “por domínio" e a pontuação "geral" que variam de 0 (pior) até 100 (o melhor) e a pontuação final em categorização dividida em quartis da seguinte forma: 0 <25 como "muito ruim", 25 <50 como "ruim", 50 <75 como "bom" e 75-100 como "excelente". Análise de dados: A distribuição dos escores do questionário PSRI foi avaliada pela média (desvio padrão [DP]); a confiabilidade foi avaliada pelo coeficiente alfa de Cronbach, que avaliou a consistência interna. A... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cross-cultural adaptation and validation of the questionnaire Pregnancy Sexual Response Inventory (PSRI) to Spanish version for Chilean pregnant women. Introduction: Gestation is a particular moment in women's lives, there are physical and psychological changes that commonly affect the general well-being. Sexual changes can be observed in the gestational period, a factor that can negatively affect the quality of life. The Pregnancy Sexual Response Inventory (PSRI) is a clinical tool with brief and semi-structured interview to assess the impact of pregnancy on sexuality, however, there is currently no Spanish translation of the PSRI questionnaire. Objective: To translate, culturally adapt and validate the Spanish language (Chile) the PSRI in Chilean pregnant women. Method: Cross-sectional, international study developed in Chile. Initially, the PSRI questionnaire in the Spanish language for pregnant women in Chile was validated. Subsequently the validated PSRI was applied with the purpose of evaluating the sexual quality of the pregnant women in different quarters. It was analyzed by "domain" and the "general" score ranging from 0 (worst) to 100 (the best) and the final score in categorization divided into quartiles as follows: 0<25 as "very bad," 25 <50 as “bad,” 50 <75 as "good" and 75-100 as "excellent". Data analysis: The distribution of PSRI scores was assessed by the mean (standard deviation [SD]); the reliability was evaluated by Cronbach's alpha coefficient, to analyze ... (Complete abstract click electronic access below) / Mestre

Bakgrund: Förlossningsrädsla klassificeras som lätt rädsla eller oro, måttlig rädsla samt svår eller intensiv förlossningsrädsla. Prevalensen av svår förlossningsrädsla hos gravida kvinnor uppskattas till 14 procent ur ett globalt perspektiv. Förlossningsrädsla kan ge konsekvenser i form av att kvinnor väljer att inte föda fler barn och eller att det går ofrivilligt lång tid mellan graviditeterna samt att kvinnorna kan uppleva mer smärta under en förlossning. Syfte: Syftet med den här metasyntesen är att beskriva upplevelser och rädslor hos förlossningsrädda kvinnor under graviditet och förlossning. Metod: Kvalitativ metasyntes med meta-ethnografi som analysmetod. Datainsamling har utförts i databaserna PubMed, Cinahl, Web of Science och PsycINFO. Totalt ingår 15 artiklar i metasyntesens resultat och dessa valdes ut efter kvalitetsgranskning. Resultat: Fyra huvudteman identifierades, Beskrivning av förlossningsrädsla, Rädsla för sin egen hälsa och det okontrollerbara, Rädslor i samband med möten i vården och Rädslor för barnets hälsa. Även sex underteman identifierades, Det oförutsägbara, Att inte ha kontroll, Den fysiska hälsan, Smärta, Möten med barnmorska och annan vårdpersonal och Interventioner. Slutsats: Resultatet visar att de vanligaste rädslorna som förlossningsrädda kvinnor har under graviditet och förlossning är rädsla för bristningar, smärta och att barnet ska skadas. De förlossningsrädda kvinnorna uppger även att de är rädda för att inte erhålla tillräckligt med stöd från barnmorskan. Klinisk tillämpbarhet: Den här metasyntesen visar att det är av stor vikt att identifiera och hjälpa förlossningsrädda kvinnor i ett tidigt stadie under graviditet för att kunna främja deras hälsa och förebygga förlossningsrädsla. För att hjälpa dessa kvinnor kan barnmorskan förslagsvis erbjuda föräldrautbildning för kvinnor som känner oro eller rädsla inför sin förlossning. Denna utbildning skulle kunna innehålla studiebesök på en förlossningsavdelning samt information om de vanligaste rädslorna och åtgärder som vidtas om komplikationer skulle uppstå. / Background: Fear of childbirth can be classified as low fear or worry, moderate fear and severe fear of childbirth. The prevalence of severe fear of childbirth among pregnant women is estimated to be 14 percent globally. Consequences of fear of childbirth is not wanting to have another child, involuntarily long time between pregnancies and more pain during labour. Method: Qualitative meta- synthesis with meta-ethnographic analysis method. Databases that was used to find the articles were PubMed, Cinahl, Web of Science and PsycINFO. Totally 15 articles are included in the meta-synthesis after a quality review. Results: Four main themes were identified Description of fear of childbirth, Fear of their own health and the uncontrollable, Fear associated with meetings with healthcare and Fear of the health of the child. Also six subtopics were identified, The unpredictable, Not having control, The physical health, Pain, Encounters with midwives and other healthcare professionals and interventions. Conclusion: The results showed that the most common fear among pregnant women with fear of childbirth were fear of tearing, pain and the health of the baby. The women with fear of childbirth is also afraid of encounter a midwife who would give inadequate support. Clinical implications: This meta-synthesis shows it is of huge importance to identify fear of childbirth in early pregnancy to promote health and reduce fear of childbirth. To help these women, the midwife may propose parental education for women who feel anxious or afraid of childbirth. This training could include study visits to a maternity ward as well as information on the most common fears and measures taken if complications should occur.

<p>Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation.</p><p>After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea. </p><p>We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry. </p><p>We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. </p><p>Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.</p>

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 223-241).

Thesis (Ph. D.)--Oregon State University, 2007. / Printout. Includes bibliographical references (leaves 124-140). Also available on the World Wide Web.

Introduction: Generally, pregnancy is considered to be a positive period in life in Iranian culture. For the parents, it is important to have a healthy pregnancy and, as a result, a healthy child. A sufficient birth weight of the infant represents one of the crucial conditions of a healthy development of a child during infancy as well as later in life. Ongoing research has been carried out regarding various medical factors related to birth weight, but there is a gap in knowledge about psychosocial factors such as social support, coping, self-esteem, stress and mother’s mental health, and various socio-demographic factors including domestic violence, which may lead to adverse pregnancy outcomes such as low birth weight. This thesis aims to provide knowledge to fill this gap. Methods: A cross-sectional survey was conducted in Tehran, Iran, including 600 young mothers who had delivered in Akbarabadi hospital, one of the main gynaecological hospitals affiliated with Tehran University of Medical Sciences. The investigation included a self-developed socio-demographic form, the Social Support Questionnaire, the Ways of Coping Checklist, Rosenberg’s Self-Esteem Scale, the General Health Questionnaire-12, and a Life Event Checklist. Results: We could not find a significant association between birth weight and mother’s level of education, and there was no substantial relationship between general mental health and birth weight. Verbal abuse was reported by 26.0% of the young mothers, 4.8% reported physical abuse, 5.5% reported sexual abuse, and 1.3% reported all three types of abuse. The abuse-index was significantly negatively associated with satisfaction with social support and with self-esteem. The higher the abuse-index, by trend, the lower was the infants’ birth weight. Weight before pregnancy, current weight, weight gain during pregnancy, and the number of prenatal care visits were significantly positively associated with the weight of the newborn. Mothers who reported having a history of a low birth-weight (LBW) child or were physically abused during pregnancy had infants with significant lower birth weight. The more the pregnant women were satisfied with their social support and the more often they used positive reappraisal as a way of coping, the higher was their infants’ birth weight. The higher the self-esteem, the less often they used escape avoidance and confrontive coping. Conclusion: The results suggest the importance of relationships between a healthy pregnancy and psychosocial as well as socio-demographic factors. Providing pregnant women with social support is a key component for a healthy pregnancy, especially when faced with stressful situations. The number of people available for support did not provide a significant buffering effect on domestic violence (DV), but the perceived quality of social support did. Higher education in the mother and husband, and women’s employment represented protective conditions against the occurrence of DV. Women who reported physical abuse during pregnancy had infants with lower birth weight. Satisfaction with social support and use of positive reappraisal were significantly associated with higher birth weight.

<p>Tobacco smoking remains one of the leading causes of death worldwide. Despite all the efforts made by governments, researchers and communities to educate women about the dangerous effects of tobacco smoke and nicotine, smoking during pregnancy continues to be a common habit and accounts for a significant percentage of fetal morbidity and mortality. The offspring is, as a result, exposed to nicotine through the blood and the milk of the mother. Nicotine is therefore expected to interact with the developing fetus and the offspring of mothers who smoke or use Nicotine Replacement therapy for smoking cessation, resulting in the interference with normal fetal lung development. Maternal cigarette smoke or nicotine exposure produces adverse effects in the lungs of offspring, these include / intrauterine growth retardation, low birth weight, premature birth, reduced pulmonary function at birth, and a high occurrence of respiratory illnesses after birth. The main objectives of this study were to determine: 1) the effects of maternal nicotine exposure during gestation and lactation on lung development in the offspring, 2) if there is evidence of premature aging of the lungs of the lungs of the nicotine exposed offspring, and 3) whether tomato juice can have protective effects on the fetal lung development and function in the offspring. From the study, it was established that maternal nicotine exposure had no significant effect on the growth parameters of the offspring. However, it results in the late onset of gradual parenchymal damage which resembles premature aging. The study also found that the consumption of tomato juice may have protective effects on the premature aging of the lungs of the offspring.</p>