Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T10:05:11Z No. of bitstreams: 2 Dissertação - Carolina Leão de Moraes - 2016.pdf: 2471392 bytes, checksum: a44c5f84a2e4f1c1eba08208f748a84e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T10:05:48Z (GMT) No. of bitstreams: 2 Dissertação - Carolina Leão de Moraes - 2016.pdf: 2471392 bytes, checksum: a44c5f84a2e4f1c1eba08208f748a84e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-26T10:05:49Z (GMT). No. of bitstreams: 2 Dissertação - Carolina Leão de Moraes - 2016.pdf: 2471392 bytes, checksum: a44c5f84a2e4f1c1eba08208f748a84e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-11-12 / Introduction. Most causes of congenital anomaly (CA) remain still not elucidated; however it is known that genetic and environmental factors can increase the risk of developing these pathologies. The risk factors associated to pregnant women have been highlighted by its ability to influence conception results. Objective. Establish the clinical-epidemiological risk factors to CA. Methods. An observational, prospective, longitudinal, case-control study, performed between November 2014 and January 2016, in a fetal medicine service. The case population consisted of 223 pregnant women with fetuses carrying SA, and the control population consisted of 134 pregnant women without congenital structural anomalies. To evaluate the clinical and epidemiological data of pregnant women participating in the study, a questionnaire was applied for both groups before pre-natal visit. Later, after fetuses SA diagnosis, realized during ultrasonography evaluation, the groups were divided in case group and control group. Results. No significant differences were found in relation to age (p: 0.884), ethnicity (p: 0.887) and number of previous pregnancies (p: 0.139) between both evaluated groups. However, there were significant statistical differences between case group and control group regarding abortion history (OR: 2.05), previous children with CA (OR: 3.85), familiar CA history (OR: 6.03), consanguinity (OR: 4.43) and consumption of teratogenic substances during pregnancy (OR: 5.65). The most frequent SA were central nervous system (CNS) anomalies (30.94%), followed by genitourinary system (GUS) anomalies (23.80%) and by multiple congenital anomalies (MCA) (16.60%). The fetal gender most affected by structural anomalies was the male gender (52.12%). The most frequent final evolution of pregnancies with fetuses carrying SA was the birth (68.61%). Conclusion. The risk factors that influenced the congenital anomaly occurrence were: previous abortion, history of children with previous CA, familial history of CA, inbreeding and teratogenic substances use during pregnancy. / Introdução. A maioria das causas de anomalias congênitas (AC) ainda permanece não elucidada, no entanto, sabe-se que fatores genéticos e ambientais podem aumentar o risco de desenvolvimento destas patologias. Os fatores de risco associados às gestantes têm sido destacados por sua capacidade de influenciar nos resultados da concepção. Objetivo. Estabelecer os fatores de risco clínico-epidemiológicos para AC. Métodos. Estudo observacional, prospectivo, longitudinal, do tipo caso-controle, realizado entre novembro de 2014 a janeiro de 2016, em um serviço de medicina fetal. A população caso foi composta por 223 gestantes com fetos portadores de AE, e a população controle por 134 gestantes sem anormalidades congênitas estruturais. Para avaliar os dados clínicos e epidemiológicos das gestantes participantes da pesquisa, foi aplicado um questionário para ambos os grupos antes da consulta pré-natal. Posteriormente, após diagnóstico de AE fetal, realizado durante a avaliação ultrassonográfica, foram divididas em grupo caso e grupo-controle. Resultados. Não foram encontradas diferenças significativas em relação à idade (p: 0,884), etnia (p: 0,887) e número de gestações prévias (p: 0,139) entre os dois grupos avaliados. Entretanto, houve diferenças estatísticas entre o grupo caso e o grupo-controle quanto a antecedentes de abortos (OR: 2,05), filhos anteriores com AC (OR: 3,85), histórico de AC familiar (OR: 6,03), consanguinidade (OR: 4,43) e consumo de substâncias teratogênicas durante a gestação (OR: 5,65). As AE mais frequentes foram as anomalias do sistema nervoso central (SNC) (30,94%), seguida das anomalias do sistema gênitourinário (SGU) (23,80%) e das múltiplas anomalias congênitas (MAC) (16,60%). O sexo fetal mais acometido por anormalidades estruturais foi o sexo masculino (52,12%). A evolução final da gestação de fetos portadores de AE mais frequente foi o nascimento (68,61%). Conclusão. Os fatores de risco que influenciaram a ocorrência de anomalia congênita foram: abortamento prévio, antecedentes de filhos com AC prévia, história familiar pregressa de AC, consanguinidade e uso de substâncias teratogênicas durante a gestação.

Intrauterine Growth Restriction (IUGR) is evident in infants born with a reduced weight or length, and/or increased thinness for gestational age. IUGR is associated with altered postnatal growth and regulation, due to unknown mechanisms. Much clinical IUGR results from the reduced delivery of essential substrates (oxygen and nutrients) to the fetus, due to either maternal or placental limitations. Catch-up growth (accelerated rate of growth in absolute or fractional terms) occurs in the majority of IUGR infants, and returns an infant to their predetermined growth curve. IUGR is associated with increased risks of morbidity and mortality in the perinatal period, and with a reduced final adult stature and increased risk of adult onset diseases, particularly diabetes and cardiovascular disease. Catch-up growth after IUGR predicts improved health in terms of reduced hospital visits in infants and children, and an increased final adult stature but also predicts an increased risk of developing obesity, as well as diabetes and cardiovascular disease. The underlying mechanisms for catch-up growth may contribute to this range of outcomes in later life, but are poorly understood. Studies in IUGR infants have demonstrated increased absolute and/or fractional growth rates following birth, termed catch-up growth, in the presence of reduced or normal plasma concentrations of the thyroid hormones and major anabolic hormones (insulin and/or IGF-I). This suggests that increased sensitivity to, rather than increased production of insulin, IGF-I and thyroid hormone, causes catch-up growth following IUGR. We therefore hypothesised that placental restriction of fetal growth would reduce size at birth and increase postnatal growth and adiposity in association with increased metabolic sensitivity to insulin, IGFs and thyroid hormones. This study has shown that the placentally restricted (PR) lamb has a reduced size at birth in terms of soft and skeletal tissues, has increased rates of growth postnatally, and has increased adiposity by six weeks of age. We have also shown that PR of fetal growth in the sheep did not alter gestational age at delivery, but reduced survival rate. PR lambs demonstrated catch-up growth in most parameters by 30 days of age and increased adiposity at six weeks of age compared to the control lambs. Placental restriction increased insulin and IGF sensitivity of circulating free fatty acids, which in turn, predicts increased adiposity. Neonatal catch-up growth after fetal growth restriction was substantially predicted by both abundance of, and metabolic sensitivity to insulin, suggesting increased insulin action as an underlying cause. Catch-up growth occurs in the neonate despite reduced concentrations of fasting plasma IGFs, along with increased IGF sensitivity of free fatty acid metabolism and adiposity. Plasma TH concentrations predicted growth of soft and skeletal tissue in lambs during early postnatal life, particularly in those undergoing catch-up growth following PR. Therefore neonatal catch-up growth after IUGR is associated with increased sensitivity to both insulin and IGFs, particularly of circulating free fatty acids, and appears to occur to the extent allowed by the prevailing abundance of these hormones and of thyroid hormones. If this altered endocrine state persists, increased adiposity and its subsequent amplification may contribute to the development of obesity, and related adverse metabolic and cardiovascular outcomes in adult life. / Thesis (Ph.D.)--School of Molecular and Biomedical Science, 2004.

<p>Amniocentesis (AC) and chorionic villus sampling (CVS) are the principal methods for fetal karyotyping. The aim of this thesis was to evaluate psychological reactions and risks associated with the procedures.</p><p>A semi-randomised study was made on 321 women, where AC (147) and CVS (174) at 10-13 weeks’ gestation were done trans-abdominally. Spontaneous fetal loss occurred in 6.8% and 1.7% of the women in the AC and CVS groups, respectively. Repeat testing was required more often in the AC (19.0%) than in the CVS (5.2%) group.</p><p>A subgroup of 94 women answered a questionnaire prior to the procedure. Anxiety was stated as reason for invasive testing in 38% of the women. Mean scores according to the Hospital Anxiety and Depression Scale for anxiety and depression were low. Likewise, mean scores for the Impact of Event Scale, evaluating the psychological distress evoked by the procedure, were low. Yet, a number of women had higher scores, indicating a risk of clinical anxiety and depression or psychological distress. The women worried most about miscarriage, fetal injury by the procedure and waiting for the result.</p><p>Fetal, infant and maternal outcomes were evaluated in a cohort of 71 586 women aged 35 to 49 years old, with single births in Sweden during 1991 to 1996. Altogether, 21 748 were exposed to AC and 1984 to CVS. Women exposed to AC and CVS were compared with non-exposed. Outcomes were extracted from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register, and the Swedish Malformation Register. An increased risk of musculo-skeletal deformities, such as club foot (OR=1.45) and hip dislocation (OR=1.22), and respiratory disturbances such as neonatal pneumonia (OR=1.29), was found for infants born in the AC group. Risk increased with earlier gestation at the procedure. Fewer women in the AC group had a normal delivery and more had a Caesarean section. Complications related to the amniotic cavity and membranes (OR=1.15), hypotonic uterine dysfunction (OR=1.12) and instrumental vaginal deliveries (OR=1.11) were more common in the AC group. No significant differences were found for the CVS group.</p><p>CVS is the method of choice for prenatal karyotyping in the first trimester. AC should not be performed before 15 weeks’ gestation. Further research to develop methods to better identify women at increased risk of chromosomal abnormal pregnancies and to develop non-invasive tests for prenatal diagnosis is needed. Thereby, the number of women exposed to invasive procedures and the adverse effects caused by these procedures can be minimised.</p>

<p>This study aimed to explore the attitudes to HIV testing among a group of black, low socio-economic status pregnant women from Gugulethu, South Africa. The key research interest was to evaluate the attitudes and understandings of HIV/AIDS that underpin the decision to comply or not comply with prenatal HIV testing. Theories of health behaviour concur that the extent to which an individual will engage in a given health behaviour, such as HIV test compliance, will be a function of the extent to which a person believes she is personally susceptible to the particular illness and her evaluation of the severity of the consequences of contracting the disease.</p>

Amniocentesis (AC) and chorionic villus sampling (CVS) are the principal methods for fetal karyotyping. The aim of this thesis was to evaluate psychological reactions and risks associated with the procedures. A semi-randomised study was made on 321 women, where AC (147) and CVS (174) at 10-13 weeks’ gestation were done trans-abdominally. Spontaneous fetal loss occurred in 6.8% and 1.7% of the women in the AC and CVS groups, respectively. Repeat testing was required more often in the AC (19.0%) than in the CVS (5.2%) group. A subgroup of 94 women answered a questionnaire prior to the procedure. Anxiety was stated as reason for invasive testing in 38% of the women. Mean scores according to the Hospital Anxiety and Depression Scale for anxiety and depression were low. Likewise, mean scores for the Impact of Event Scale, evaluating the psychological distress evoked by the procedure, were low. Yet, a number of women had higher scores, indicating a risk of clinical anxiety and depression or psychological distress. The women worried most about miscarriage, fetal injury by the procedure and waiting for the result. Fetal, infant and maternal outcomes were evaluated in a cohort of 71 586 women aged 35 to 49 years old, with single births in Sweden during 1991 to 1996. Altogether, 21 748 were exposed to AC and 1984 to CVS. Women exposed to AC and CVS were compared with non-exposed. Outcomes were extracted from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register, and the Swedish Malformation Register. An increased risk of musculo-skeletal deformities, such as club foot (OR=1.45) and hip dislocation (OR=1.22), and respiratory disturbances such as neonatal pneumonia (OR=1.29), was found for infants born in the AC group. Risk increased with earlier gestation at the procedure. Fewer women in the AC group had a normal delivery and more had a Caesarean section. Complications related to the amniotic cavity and membranes (OR=1.15), hypotonic uterine dysfunction (OR=1.12) and instrumental vaginal deliveries (OR=1.11) were more common in the AC group. No significant differences were found for the CVS group. CVS is the method of choice for prenatal karyotyping in the first trimester. AC should not be performed before 15 weeks’ gestation. Further research to develop methods to better identify women at increased risk of chromosomal abnormal pregnancies and to develop non-invasive tests for prenatal diagnosis is needed. Thereby, the number of women exposed to invasive procedures and the adverse effects caused by these procedures can be minimised.

No description available.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The convergence of compelling evidence that transmission of HIV from a pregnant woman living with HIV to her foetus can be significantly interrupted due to advances in antiretroviral and obstetrical interventions, and worrisome epidemiologic data documenting a rise in HIV infection among Canadian women, spurred the development in Canada and world wide of policies and programmes aimed at increasing the number of pregnant women who are tested for HIV. Responding to innovative therapy reducing perinatal HIV transmission risk by increasing the number of pregnant women who agree to test for HIV is clearly an important prevention objective. However, the process must be accomplished in a way that is of most benefit to the pregnant woman herself and in a way that does not compromise a pregnant woman's rights to the established Canadian principles of HIV counselling and testing. / Working with pregnant women in Ontario, the province with the highest level of HIV infection among Canadian women, this thesis articulates and interprets their experiences of prenatal HIV counselling and testing and details their perspectives on best practices. The pregnant women's evidence-based recommendations for the re-design of prenatal HIV testing programmes are provided. These unique data have important utility for federal and provincial policy makers as HIV counselling and testing policies and programmes that encompass and are grounded in pregnant womens' experiences and perspectives are likely to be maximally acceptable and thereby increase the number of pregnant women who can be apprised of prophylactic treatment to take care of their own health needs as well as those of their unborn children. / In order for pregnant women to increase control over their own health and that of their unborn children, there is clear value in all pregnant women being afforded the opportunity to know their HIV status. However, the voices of the women in this study suggest that the autonomy rights of pregnant women may well be at risk in a programme in which the current emphasis is on potential HIV infection of the foetus rather than on potential or actual infection of the pregnant woman.

<p>This study aimed to explore the attitudes to HIV testing among a group of black, low socio-economic status pregnant women from Gugulethu, South Africa. The key research interest was to evaluate the attitudes and understandings of HIV/AIDS that underpin the decision to comply or not comply with prenatal HIV testing. Theories of health behaviour concur that the extent to which an individual will engage in a given health behaviour, such as HIV test compliance, will be a function of the extent to which a person believes she is personally susceptible to the particular illness and her evaluation of the severity of the consequences of contracting the disease.</p>

Thesis (M.D.)-University of Natal, Durban, 1979.