Pregnancy is a sensitive period in women’s lives; pregnant women encounter various physical changes and emotional challenges during pregnancy. The vision for Sweden’s eHealth initiative is to be the best in the world in using eHealth to make it easier for people to achieve a healthy wellbeing and equal welfare by 2025. However, there is a lack of empirical studies in the area, especially studies associated with both eHealth and pregnancy in a Swedish context. Therefore, the thesis intended to seek the factors that affect a pregnant woman to adopt an eHealth innovation by applying qualitative interviews. Eleven women were selected including both women who are currently pregnant and women who have experienced pregnancy in recent years. Semi-structed interviews were chosen to gain more in-depth insights of the challenges during pregnancy. The data analysis followed the framework of Unified theory of acceptance and use of technology (UTAUT). Rogers’ innovation diffusion theory was discussed in relation to the study as well. The results based on the date from the study showed that the real drive for pregnant women to adopt an eHealth innovation is the dissatisfaction with the current solution, namely prenatal care in the Swedish public health care system. Other moderating factors that affect their intention for adoption are relevant knowledge, expertise support and trialability. The results revealed that women with foreign background were more likely to be dissatisfied with prenatal care in Sweden, and that professionals’ involvement in using the innovation and the possibility of experimenting with it will increase the intention of innovation adoption. Age, experience, and personality were not supported in having an impact on innovation adoption in this study. The limitations of the study are transferability and confirmability, where credibility, dependability and authenticity are high in this study.

Thesis (M. A. (Nursing)) -- University of Limpopo, 2021 / Indigenous practices are performances that occur naturally in a region or a growing living environment. Most women believe in indigenous practices because of their cultures and social structure. In South Africa regardless of the availability and accessibility of maternal and child health services, 50% of women were found that they still consult traditional birth attendants as their first choice during pregnancy, labour, delivery, and postnatal care. The purpose of the study was to determine the indigenous practices of women during pregnancy, labour and puerperium amongst cultural groupings at selected hospitals in Limpopo Province, South Africa. A Convergent parallel mixed method design was used in the study to collect both qualitative and quantitative data at the same time. Non-probability purposive sampling was used to select 15 participants and Probability simple random sampling was used to select 125 women who were pregnant, in labour and puerperium using slovin’s formula. Data were collected through a semi-structured interview with a guide for qualitative strand and a self-administered structured questionnaire for quantitative srtand. Data were analysed qualitatively using tech’s open coding method and quantitatively using Statistical Package for the Social Sciences (SPSS) Version 25 with the assistance of the University of Limpopo’s Bio-statistician. The results of the study showed that most women use indigeneous practices for protection against witchcraft, fear of giving birth in caesarian section and many other reasons.THPs and church leaders are regarded as the most principled people in their community. Indigenous women are aware of the sign and symptoms during pregnancy, labour, and puerperium which may determine consultation to healthcare practitioners, but they choose THPs and church leaders. Most women still rely on their religious beliefs to assist during their labour. Pregnant women, those in labour and puerperium should be supported to practice their religious beliefs and practices. THPs and church leaders are obliged to teach their clients and ensure that they know the names and components of the traditional medicines and church rituals they use.The nursing education should include indigenous practices in the curriculum so, that healthcare practitioners know about the indigenous practices and can serve as assistance in the training and development of health practitioners who continuously care for women during pregnancy, labour, and puerperium and as a result, may reduce maternal and child morbidity and mortality in Limpopo Province, South Africa.

Introduction/background: Epidemics of infectious diseases (ID) are re-occurring now more often and spreads faster into many different parts of the world due to globalization. The increasing evidence of climate change and man-made events have shown impacts to increase the emergency and re-emerging of animal- borne IDs. Studies claims that background factors of these IDs are biological, environmental and human-lifestyle related changes. The pathogen Lassa fever virus (LASV) is a zoonotic organismthat circulates in rodent reservoirs, and the animal´s hosts are rodent species (rats) of the genus Mastomys natalensis. Mastomys natalensis is primarily the reservoir species of the animal-borne disease of Lassa fever (LF) which is most prevalent in west Africa, particularly in Nigeria. Lassa fever (LF) has limited information with under-documented cases, its health effect on pregnant women especially in Nigeria is within the rural areas of Edo, Ondo, Delta, Ebony, Bauchi, Taraba and Plateau states where maternal mortalities are higher.  Aim: The overarching aim of this thesis is to analyse and discuss the health effects of Lassa fever occurrence and outcomes on pregnant women in Nigeria, with emphasis on the maternal mortality and fatality during pregnancy. Method: A statistical and systematic review was performed from retrospective studies of case series, case-control, observational and cohort studies of patients in Nigeria (pregnant women with gestation ages of pregnancy from 2 weeks –32 weeks) that tested positive to LASV. Publication status and publication date was applied for the inclusion of respective studies by electronic searches via Web of Science, Google scholar, MEDLINE and PubMed. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines (PRISMA) was used to illustrate the flow of relevant articles in my study. R-commander and R-Studio software was used to analyze the data and to find the causal significant relationship between LF and maternal mortality using “Linear regression and linear model plot”. Result: The total number of full-text and Peer-view publications on Lassa fever virus cases was 1 609 articles. 94 articles out of the 1 609 articles were eligible for full text revision. Exclusion criteria finally yielded 6 studies that were relatively relevant to my study. However, 3 out of the 6 articles were statistically reviewed to know the influence of Lassa fever and the risk of maternal mortality during pregnancy.  Conclusion: Lassa fever occurrence have significantly shown potential increase in the severity of maternal mortality, and is predominant among pregnant women from 39 - 45 years old in Nigeria especially within the risk endemic areas of Ondo, Edo, Ebony and Bauchi states showing significant long-term diseases on LF affected pregnant women, such as encephalopathy, acute kidney dysfunction and acute kidney failure that leads to further health problems or complications like coma and sensorineural deafness.

Abstract in English, IsiZulu and Sepedi / Business Management / M. Com

Objetivo: Evaluar la asociación entre la calidad del sueño y la depresión perinatal en gestantes que cursan entre la semana de gestación 12 y la semana de gestación 36 en un centro materno infantil de Lima . Materiales y Métodos: Estudio transversal analítico en gestantes atendidas en un centro de atención primaria entre agosto y diciembre del año 2019 . Los datos se recogieron mediante una encuesta auto aplicada. Se empleó el Índice de calidad del sueño de Pittsburgh (PSQI) para la evaluación de la calidad de sueño. La evaluación de la depresión perinatal fue con la escala de Depresión Postnatal de Edimburgo (EPDS). Para el análisis multivariado se utilizó la regresión de Poisson con varianzas robustas a fin de calcular las razones de prevalencia crudas y ajustadas y sus respectivos intervalos de confianza. Resultados: Se incluyeron 200 participantes. La mediana de la edad fue de 26 años (RIQ :22-32) y 111 (55.5%) gestaciones fueron no planificadas. El 52% presento una mala calidad de sueño y el riesgo de depresión perinatal fue del 31.5%. La mala calidad de sueño se asoció con una frecuencia significativamente mayor de depresión perinatal. ( RPa de 4.8 para aquellas con mala calidad de sueño que merece atención médica presentaron , RPa de 6.6 para aquellas con mala calidad de sueño que merece atención y tratamiento médico). Conclusiones : Existe una asociación entre la mala calidad del sueño y la depresión perinatal en gestantes entre las semanas 12 y 36 de gestación. Se debe promover investigaciones operativas a fin de evaluar si intervenciones para mejorar la calidad del sueño podrían tener un impacto positivo en la reducción de la depresión perinatal. / Objective: Evaluate the association between sleep quality and perinatal depression in pregnant women between the 12th week of gestation and the 36th week of gestation in a maternal and child center in Lima. Materials and Methods: Analytical cross-sectional study in pregnant women cared for in a primary care center between August and December 2019. The data were collected through a self-administered survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The evaluation of perinatal depression was with the Edinburgh Postnatal Depression Scale (EPDS). For the multivariate analysis, Poisson regression with robust variances was used to calculate the crude and adjusted prevalence ratios and their respective confidence intervals. Results: The sample was composed of 200 participants. The median age was 26 years (IQR: 22-32) and 111 (55.5%) pregnancies were unplanned. 52% presented a poor quality of sleep and the risk of perinatal depression was 31.5%. Poor quality of sleep was associated with a significantly higher frequency of perinatal depression. (RPa of 4.8 for those with poor quality of sleep that deserves medical attention and RPa of 6.6 for those with poor quality of sleep that deserves medical attention and treatment). Conclusion: There is an association between poor sleep quality and perinatal depression in pregnant women between weeks 12 and 36 of gestation. Operational research should be promoted to assess whether interventions to improve sleep quality could have a positive impact on reducing perinatal depression. / Tesis

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Termination of pregnancy among young women is a public health issue, particularly in South Africa where high prevalence of pregnany terminations has lately been reported. It is estimated that 260000 terminations of pregnancy take place in South Africa every year. Studies in South Africa have reported that risk factors associated with termination of pregnancy such as financial problems, being poorly educated, being young, unemployed, dependent on parents, widowed or single and other relationship problems were most common. Approximately 1200 pregnancies were terminated in the District Hospital of Limpopo Province between 2017 and 2018. There is also an increased rate of unintended pregnancy among HIV positive women which suggest that women with HIV may be more likely to terminate pregnancy but chooses not to terminate due to fear of being judged. Therefore, the primary objective of this study was to investigate the risk factors associated with termination of pregnancy at a District Hospital in Limpopo Province. Methodology: A cross-sectional descriptive retrospective review study in which convenience sampling of the records of women who terminated pregnancies was used in this study. A self-constructed data extraction tool was used to extract the data from patients records. The tool covered variables such as the age of the women, educational status, marital status, year and month of termination of pregnancy, gestational age, parity, and gravidity, HIV status and circumstances leading to termination of pregnancy. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). The independent t-test was used for variables having two categories as it assesses whether the difference between means of two groups are statistically significant. This test was performed at the 95% confidence level. The p-value of less than 0.05 in the study results was used for statistical significant difference in means between the categories which were investigated. vi Results: The mean age was 27.9 years (standard error [Std. Err.] =0.37) and majority of women who terminated pregnancies were in the age group 20 – 24 years, single and had a secondary educational level. There was a statistical significance difference between age groups and the gestational age, parity and gravidity at p=0.004 and p<0.001 respectively. The proportion of women who were at gestational age of 1 to 8 weeks decreased with increasing maternal age from 22.4% in age ≤20 years to 13% in age group 30 – 34 years. There was again a statistical significance difference (p<0.001) in relation to number of pregnancies that have each resulted in the birth of an infant capable of survival (parity) and similarly to gravida. The prevalence of HIV amongst women who terminated pregnancy in the current study was found to be 21.3% and the risk of women who terminated pregnancies being HIV positive increased significantly with age as older women (age 20 years and above) were 6.5 times more likely to be HIV positive as compared to younger ones (p<001). Low educational level, gestational age of more than 13 weeks and parity of 1 – 2 were significantly associated with termination of pregnancy. The association of gravida of women who terminated pregnancies and HIV revealed that women who were in their second or third pregnancies (gravida) while HIV positive were 3.9 times more likely to terminate pregnancies as compared to those who were first pregnancy (p<0.001). Marital status was not significantly associated with termination of pregnancy. Conclusion: Termination of pregnancies among adolescents and youth is a major public health issue and the findings of this study highlight the need to address the structural socio-economic drivers of family planning which results in high number of termination of pregnancy amongst the youth. Structural interventions, such as increasing contraceptive use which may be useful for reducing the burden of unplanned pregnancies. These findings suggest the need for targeted interventions for women of child-bearing age to access reproductive health interventions to prevent unintended pregnancies and the associated risk of termination.

Bakgrund: Mäns våld mot kvinnor är en ständigt aktuell fråga. Våldet består av flera former såsom fysiskt, psykiskt, ekonomiskt, materiellt, sexuellt, digitalt och hedersrelaterat våld. Barnmorskan har ett ansvar i att ställa frågor om våld till gravida kvinnor för att identifiera de som lever under våldsutsatthet och kunna erbjuda stöd och förebygga fortsatt våldsutsatthet. Syfte: Syftet var att beskriva barnmorskors upplevelse av att ställa frågan om våldsutsatthet till gravida kvinnor på mödrahälsovården.  Metod: En kvalitativ design med enskilda intervjuer har genomförts med totalt tio barnmorskor från sex olika mödrahälsovårdscentraler i sydöstra Sverige. Analysen genomfördes via en induktiv tematisk innehållsanalys. Resultat: De främsta resultaten i studien presenteras i fyra tematiska kategorier; professionellt och etiskt förhållningssätt, barnmorskans behov av att definiera våld, barnmorskans upplevelse av barriärer och barnmorskans upplevelse av brister i vårdkedjan. Barnmorskorna beskrev att rutinen kring att ställa frågan om våld till gravida kvinnor på mödrahälsovården var angelägen och självklar, där rädsla för att möta ett medgivande på frågan inte hindrade barnmorskorna från att ställa den. Slutsats: Ett av studiens fynd är att gravida kvinnor med hög socioekonomisk status ansågs utgöra en barriär för att ställa frågor om våldsutsatthet. För att överkomma de barriärer som finns för att ställa frågan om våld är det viktigt att ständigt arbeta med de frågor som utgör en barriär för barnmorskorna. / Background: Men's violence against women is an ever-present issue. Violence consists in many forms, such as physical, psychological, economic, material, sexual, digital, and honor-related violence. The midwife has a responsibility to ask questions about violence to pregnant women to identify those who are exposed to domestic violence. Aim: This study aimed to describe midwives' experience of asking the question of exposure to violence to pregnant women in maternity care. Method: A qualitative design with individual interviews has been conducted with ten midwives from six different maternity health centers in southeastern Sweden. The analysis was conducted through an inductive thematic content analysis. Results: The study´s main results are presented in four thematic categories; professional and ethical approach, the midwife's need to define violence, the midwife's experience of barriers and the midwife's experience of shortcomings in the care chain. The midwives described that the routine around asking the question of violence to pregnant women at the maternal health care was urgent and self-evident, where fear of obtaining consent to the question did not prevent the midwives from asking it. Conclusion: One of the study's finding is that pregnant women with high socioeconomicstatus were considered a barrier to asking the question. To overcome the obstacles that exist to asking the question of violence, it is important to constantly work on the issues that constitute a barrier for the midwives.

Impaired intrauterine growth, inability of the fetus to achieve the required growth potential, contributes to a higher burden of neonatal morbidity and mortality. Intrauterine growth is an inferred process and small for gestational age is considered a rough estimate of impaired intrauterine growth that requires reliable gestational age data. Due to sparse data and measurement errors in gestational age, researchers rely on markers such as birth weight, birth length, and birth head circumference to infer fetal growth. While the etiology of impaired fetal growth is multifactorial, maternal anemia and undernutrition contribute substantially to impaired fetal growth and are prioritized in 2030 global nutrition goals by the World Health Assembly. Nutrition supplements such as lipid-based nutrient supplements, multiple micronutrients, and iron or folic acid during pregnancy are presumed to improve maternal anemia. But the effect of the supplements during pregnancy on fetal growth appears to be small to negligible, which has shifted the researcher’s focus to the pre-conception period. However, prior reviews on the preconception period have either synthesized the evidence from observational studies, or have explored outcomes such as congenital anomalies (e.g., neural tube defects), neurodevelopment disorders, or only birth weight. Hence the evidence from existing randomized controlled trials (RCTs) evaluating the effect of preconception nutrition supplements on maternal anemia and all markers of fetal growth including birth weight, birth length, and birth head circumference has not been systematically summarized and synthesized. We bridged this knowledge gap in the current dissertation (Aim 1). The Women First (WF) Preconception Nutrition Trial found that lipid-based nutrient supplementation started preconception or during pregnancy conferred greater benefits for birth weight and birth length among mothers who were anemic (Hemoglobin (Hb) < 12 g/dL) than among mothers who were non-anemic (Hb ≥ 12 g/dL) pre-pregnancy. However, by dichotomizing women into anemic and non-anemic women, we may miss high-risk women with specific Hb levels who may obtain greater benefits for intrauterine growth associated with the supplements. Assessing the effect of preconception nutrient supplements across a range of pre-pregnancy Hb levels will help us identify women with specific Hb cut-offs who may have the greatest potential to respond to the supplements (Aim 2). Additionally, there are major gaps in understanding the mechanisms of how nutrient supplements, consumed either before or during pregnancy, improve intrauterine growth. A better understanding of the underlying mechanisms would allow for fine-tuning of nutrition interventions for greater efficacy. Here, we examined whether Hb during pregnancy could be a potential mechanism through which nutrition supplements improve intrauterine growth (Aim 3). For Aim 1, we undertook a systematic review and meta-analysis of the RCTs evaluating the effect of preconception nutrition supplements on maternal hemoglobin and markers of intrauterine growth including birth weight, birth length, birth head circumference, and small for gestational age. Additionally, we examined preterm birth as an important perinatal outcome. We searched electronic databases including PubMed, Web of Science, Embase, CINAHL, and Cochrane Central. We computed pooled mean differences and risk ratios (RR) with 95% confidence intervals (CIs) using random-effect models. We employed I2 and Cochran’s Q test statistics to assess heterogeneity. We used the GRADE (grading of recommendations, assessment, development, and evaluations) tool to assess the quality of evidence. For Aim 2 and Aim 3, we leveraged the existing data from a large multi-country Women First (WF) Preconception Nutrition Trial conducted in Pakistan, India, Guatemala, and the Democratic Republic of Congo. Women in the WF trial were randomized to consume a lipid-based nutrient supplement (LNS) at least three months before and during pregnancy (Arm 1- preconception), only during pregnancy (Arm 2- during), or not at all (Arm 3 - control). The outcome was weight, length, and head circumference within 48 hours of birth expressed as Z-scores. For Aim 2, we analyzed the WF trial data on 2443 women-newborn dyads. For each site, we computed adjusted mean differences in these Z-scores between the randomized arms across six pre-pregnancy Hb categories (8-8.9, 9-9.9, 10-10.9, 11-11.9, 12-12.9, and ≥13g/dL) based on Hb distributions. We pooled site-specific effect measures using meta-analysis. For Aim 3, hemoglobin measured at 12 (n=2075) and 32 weeks of gestation (n=2157) was a mediator. We employed causal mediation analysis under a counterfactual approach to estimate direct and indirect effects. For Aim 1, we identified 20 eligible RCTs (n=27,659 women). Preconception nutrition supplements (iron and folic acid, multiple micronutrients, and a lipid-based nutrient supplement) increased maternal hemoglobin by 0.30g/dL ((0.03, 0.57); I2=79%). However, we did not find a significant effect of the supplements on birth weight (12.47gm ((-33.14, 58.08); I2=58%)), birth length (0.15cm (-0.26, 0.56); I2=68%; n=5), birth head circumference (-0.23cm (-0.88, 0.43); I2=84%), small for gestational age (RR: 0.91 (0.80,1.04); I2=31%), or preterm birth (RR: 0.93 (0.69,1.25); I2=57%). Overall, the quality of evidence was assessed as moderate and very low for maternal hemoglobin and three markers of intrauterine growth including birth weight, birth length, and birth head circumference, respectively. In Aim 2, we found that the effect of LNS on birth weight, length, and head circumference varied by pre-pregnancy Hb categories. Pooled mean differences in the Z-scores for birth length (0.60 (0.03, 1.23)), birth weight (0.50, (0.11, 0.89)), and birth head circumference ((0.26, (0.02, 0.51)) were greatest for Arm 1-preconception vs. Arm 3-control women with Hb 9-9.9g/dL. Women with Hb 10-10.9g/dL also benefited from preconception LNS. However, compared to controls, the effects of preconception LNS on birth weight, birth length, and birth head circumference attenuated for women with Hb 10-10.9g/dL. Compared to Arm 3-control, LNS during pregnancy (Arm 2) improved birth length, birth weight, and birth head circumference for women with Hb 8-10.9g/dL. Preconception LNS (Arm1) vs. LNS during pregnancy (Arm 2) improved the three markers of intrauterine growth only for women with Hb 9-9.9g/dL. Women with nearly normal (11-11.9 g/dL) and normal Hb (≥12g/dL) did not appreciably benefit from LNS, offered before and or during pregnancy. For Aim 3, Hb at 12 or 32 weeks of gestation did not mediate the relationship between the LNS and intrauterine growth. Indirect effects of preconception LNS (Arm 1) vs. Arm 3, mediated by Hb at 12 weeks, were 0.02 (-0.02, 0.01), 0.01 (-0.01, 0.02), and 0.01 (-0.01, 0.02) for length, weight, and head circumference Z-scores, respectively. The corresponding direct effects, not mediated by Hb, were 0.18 (0.09, 0.33), 0.12 (0.03, 0.23), and 0.06 (-0.03, 0.20), respectively. Site-specific and gestational age-adjusted data analyses both at 12 and 32 weeks of gestation confirmed the findings of negligible mediation by Hb during pregnancy. All types of preconception nutrition supplements studied to date appear to reduce maternal anemia. However, it is uncertain whether there are beneficial effects of preconception nutrition supplements on markers of intrauterine growth. Low quality of evidence from the RCTs examining the markers of intrauterine growth warrants future well-designed RCTs to produce solid scientific data, particularly on the benefits of a more comprehensive package of preconception nutrition supplements that include both macro- and micronutrients. The findings from the WF trial suggest that the benefits of preconception LNS on fetal growth are mainly confined to women with pre-pregnancy Hb 9-9.9g/dL. Compared to controls, women with Hb 10-10.9g/dL also benefited from preconception LNS, albeit the magnitude of effect on three markers of intrauterine growth was modest for women with Hb 10-10.9g/dL. However, LNS, started during pregnancy, appeared to improve markers of intrauterine growth for women with a wider range of Hb 8-10.9g/dL. Women with Hb ≥ 11g/dL did not benefit from LNS started either pre-conception or during pregnancy. These findings suggest that prioritizing women with specific pre-pregnancy Hb categories for targeted nutrition interventions may be advisable. This would target limited resources most efficiently in LMICs. Lastly, negligible mediation by Hb during pregnancy suggests that alternative pathways that potentially mediate the relationship between LNS and intrauterine growth need to be investigated.

Située dans le Nord-Est de la Colombie-Britannique, la formation de Montney est une zone d’exploitation gazière par fracturation hydraulique capable de rejeter des contaminants comme les éléments-traces, dont certains peuvent affecter la santé des femmes enceintes et leur enfant. Notre étude visait 1) l’évaluation de l’exposition de femmes enceintes de cette région à plusieurs éléments-traces à partir d’échantillons urinaires répétés, 2) la comparaison des concentrations à celles de populations de référence et 3) l’évaluation de la variabilité intra- et inter-individuelle dans les concentrations urinaires. 85 femmes enceintes participant à notre étude Exposures in the Peace River Valley (EXPERIVA) ont fourni 1 échantillon urinaire quotidien pendant 7 jours consécutifs. 20 éléments-traces y ont été analysés. Des statistiques descriptives ont été effectuées et la variabilité a été évaluée à l’aide du coefficient de corrélation intraclasse (CCI). Les concentrations urinaires médianes étaient supérieures à celles des populations de référence pour le baryum (2 fois), le cobalt (3 fois) et le strontium (2 fois). Durant la semaine, le 95e centile de référence était dépassé au moins 1 fois par de nombreuses participantes pour le baryum (58%), le cobalt (73%), le cuivre (29%), le manganèse (28%), le sélénium (38%), le strontium (60%) et le vanadium (100%). Les CCI variaient de 0.288 à 0.722 selon l’élément-trace. Nos résultats laissent supposer que les femmes enceintes de cette région peuvent être particulièrement exposées à certains éléments-traces (baryum, cobalt, cuivre, manganèse, sélénium, strontium et vanadium) et qu’un seul échantillon urinaire peut être insuffisant pour estimer adéquatement l’exposition à certains éléments-traces. / Located in Northeastern British-Columbia, the Montney formation is an important area of gas exploitation by hydraulic fracturing which can release contaminants like trace elements. Gestational exposure to these contaminants may lead to deleterious developmental effects. Our study aimed to assess gestational exposure to trace-elements in women living in this region through repeated urinary measurements, to compare these values to those from reference populations, and to evaluate inter- and intra-individual variability. 85 pregnant women participating in the Exposures in the Peace River Valley (EXPERIVA)study provided daily spot urine samples over 7 consecutive days. Samples were analyzed for 20 trace elements. Descriptive statistics were performed, and variability was evaluated through intraclass correlation coefficient (ICC) calculation for each trace element. When compared with those from North American populations, median urinary levels were higher in our population for barium (2 times), cobalt (3 times) and strontium (2 times). The 95th percentile of reference populations was exceeded at least 1 time by many participants during the week for barium (58%), cobalt (73%), copper (29%), manganese (28%), selenium (38%), strontium (60%) and vanadium (100%). ICCs varied from 0.288 to 0.722 depending on the trace element. Our results suggest that pregnant women living in this region may be more exposed to certain trace elements (barium, cobalt, copper, manganese, selenium, strontium, and vanadium), and that one urine spot sample could be insufficient to adequately estimate exposure to certain trace elements.

The Institute of Medicine (IOM) and National Research Council (NRC) established guidelines for weight gain during pregnancy to maximize positive health outcomes for mothers and their offspring. However, in the US, about half of all pregnant women exceed these recommendations. Excessive weight gain during pregnancy is associated with various negative outcome for mothers and their children. Research in recent years has begun to explore the relationship between both diet quality and ultra-processed food (UPF) intake during pregnancy with gestational weight gain (GWG). However, research is scarce, especially pertaining to UPF intake and GWG. Additionally, there is no research which explores these relationships among Latina women living within the US. The purpose of this study is to explore the relationships between prenatal diet quality, measured with the Healthy Eating Index-2020 (HEI), and intake of UPF, based on the Nova classification system, with the adequacy of GWG among a predominantly Latina sample of adult pregnant women living within the US. Additionally, the association between social determinants of health with diet quality and with UPF intake were also explored. The study is a secondary-data analysis of data from a longitudinal study. The sample analyzed includes 118 pregnant women between the ages of 18-45 years old (mean = 29.9, SD = 6.1). Mean pre-pregnancy body mass index (pBMI) for the total sample was 25.8 kg/m2 (overweight). 67% of the sample identified as Hispanic/Latina. Overall, 22% of the sample were classified with inadequate GWG; 17% with adequate GWG; and 61% with excessive GWG. The mean total HEI score for the sample was 54.1 out of 100, where higher scores reflect higher diet quality and adherence to the Dietary Guidelines for Americans. There was a statistically significant difference across GWG groups (inadequate/adequate/excessive) in mean total HEI scores (p < .05). The adequate GWG group had the highest total HEI scores and the excessive GWG group had the lowest total HEI scores. Variables that were found to be univariately associated with excessive gestational weight gain included: average total HEI score, pBMI, ethnicity; education; and income (p < .05). A 1-point increase in mean total HEI scores was associated with a 5% lower chance of excessive GWG (p = .02). However, after adjustment for covariates (maternal age; pBMI; income; education; race and ethnicity), the association between average total HEI score and excessive gestational weight gain was attenuated and no longer statistically significant. There was a statistically significant difference across GWG groups (inadequate, adequate, or excessive) in their scores of two HEI components: Greens and Beans (p < .01); and Seafood and Plant Proteins (p < .01). The adequate GWG group had the highest scores and the excessive GWG group had the lowest scores in these HEI components. In simple logistic regressions of excessive GWG versus adequate GWG on HEI components, the Greens and Beans scores and the Seafood and Plant Protein scores were significantly associated with excessive GWG. After adjustment, the Greens and Beans scores and Seafood and Plant Proteins scores indicated strong estimated negative associations with excessive GWG, OR = 0.61, 〖 χ〗_1^2= 8.07, p < 0.01 and OR = 0.60, 〖 χ〗_1^2= 7.84, p < 0.01, respectively. A higher score on these components was associated with a lower risk of excessive GWG. The mean percentage of energy intake from ultra-processed foods (PEI-UPF) was 51.2%. There was no statistically significant difference in the PEI-UPF across GWG groups (inadequate, adequate, or excessive) and the PEI-UPF was not associated with odds of excessive GWG. However, the adequate GWG group had the lowest intake of PEI-UPF (49.2%) and the excessive GWG group had the highest intake of PEI-UPF (52.1%). Social determinants of health were not associated with the mean PEI-UPF, but results suggested a positive relationship between social support and total HEI scores (p = .08). Deeper analysis of the social support measure revealed a statistically significant relationship between the appraisal subscale of social support and HEI scores, Β = 0.13, F(1, 102) = 7.11 (p = 0.009). Overall, dietary intake during pregnancy may influence the adequacy of gestational weight gain. Achieving recommended intake of greens and beans, as well as seafood and plant proteins, may play a particularly important role in reducing the risk for excessive gestational weight gain. In addition, greater levels of social support, particularly access to another person who can offer advice and guidance with personal problems, may enhance diet quality during pregnancy.