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. 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. 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. 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. 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.

Background: A multitude of studies suggest an association between periodontal disease and adverse birth outcomes. Although the evidence is controversial, it is biologically plausible, and the key link maybe inflammation. Purpose: To correlate levels of periodontal disease as measured by conventional methods with PMN counts from an oral rinse in pregnant women. Methods: Sixty-three pregnant women were recruited. Periodontal examinations were carried out. Fifteen-second saline rinses were collected. ABTS, a colour changing redox agent was added to each rinse. The intensity of the colour reaction was measured by absorbance to count the oral PMNs. Results: A statistically significant difference in oral PMN counts was observed between those with periodontal disease and the healthy patients (P < .05). The sensitivity and specificity using the bleeding index was 0.94 and 0.76 respectively. Conclusions: The rinse assay can be used as a screening tool for periodontal disease and oral inflammation in pregnant women.

Background: A multitude of studies suggest an association between periodontal disease and adverse birth outcomes. Although the evidence is controversial, it is biologically plausible, and the key link maybe inflammation. Purpose: To correlate levels of periodontal disease as measured by conventional methods with PMN counts from an oral rinse in pregnant women. Methods: Sixty-three pregnant women were recruited. Periodontal examinations were carried out. Fifteen-second saline rinses were collected. ABTS, a colour changing redox agent was added to each rinse. The intensity of the colour reaction was measured by absorbance to count the oral PMNs. Results: A statistically significant difference in oral PMN counts was observed between those with periodontal disease and the healthy patients (P < .05). The sensitivity and specificity using the bleeding index was 0.94 and 0.76 respectively. Conclusions: The rinse assay can be used as a screening tool for periodontal disease and oral inflammation in pregnant women.

Breastfeeding initiation rates in the United States remain below the Healthy People 2010 goals. Research indicates patient interaction with health care providers may play an important role in womens ultimate feeding choice. This study sought to examine the impact of provider counseling regarding breastfeeding during the prenatal period on feeding outcome by evaluating: 1) if providers addressed womens concerns regarding breastfeeding; and 2) how providers responded to a womans feeding choice. We also sought to examine whether the type of counseling provided by providers regarding infant feeding is influenced by patient socio-demographics and stated feeding plans. This study is cross-sectional with convenience sampling of all English or Spanish speaking women on the postpartum floor at Yale-New Haven Hospital. A total of 130 women participated. Overall, 95.4% of women identified a concern they had about breastfeeding during the prenatal period, and one quarter of patients had their concerns about breastfeeding addressed. The majority of patients (74.6%) were asked about their feeding plans, and 50.5% were encouraged to breastfeed. Unlike the majority of studies that indicate young, African American, poorly educated, unmarried and low income women are less likely to receive counseling from providers to breastfeed, providers in our study area focused their efforts on this population. In multivariate analysis, neither having concerns addressed nor being encouraged to breastfeed were associated with increased likelihood of breastfeeding. Addressing patients concerns may be most relevant in the small subset of patients who make their feeding choice during pregnancy. Finally, women who were asked about their plans and had their concerns addressed (p=.010) or were encouraged to breastfeed (p=.040) were more likely to make their decision during pregnancy compared to before pregnancy than women whose providers did not discuss these issues. Likewise, mixed feeders were more likely to make their decision regarding infant feeding during rather than before pregnancy. This data suggests providers may be encouraging women to think more thoroughly about the possibility of breastfeeding, thus delaying their decision. In conclusion, many women are not being encouraged to breastfeed or having their concerns about breastfeeding addressed. All women would benefit from prenatal discussion of these topics; however, the effect may be most profound in women who make their decision regarding feeding during pregnancy.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2000. / Bibliography: leaves 109-116.

published_or_final_version / Public Health / Master / Master of Public Health

Background: Medical tourism is arising in Asian countries and in Hong Kong, the maternal tourism is evolving due to the influx of non-entitled pregnant women from mainland China for deliveries. The visitors were attracted not only by the technical advancement of Hong Kong healthcare system, but its special administrative background which grants the babies with a permanent resident identity as well as the citizenship benefits regardless to their parental status. Besides, the parents could avoid penalties from the "One Child Policy" in China. With the limited healthcare resources, non-local mothers started to compete with the local mothers for obstetric services. The community raised their concerns in developing of maternity tourism and verbalised their demands in protecting local rights and equity to resources. Aims and Objectives: There are limited published researches available on maternal tourism or the specific situation faced by Hong Kong. By analysing grey literature, this paper would like to suggest the impact exerted on the healthcare system by the influx of non-eligible mothers with a medical tourism framework. Results: The impact of non-local-mother deliveries on healthcare system were discussed in the areas of governance, delivery, financing, human resources and regulation. Future research could be done on assessing the priorities in the framework components and the direction, effectiveness of the management strategies for non-entitled deliveries. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences