Medicine and Health Sciences Commons^™

A Call For Better Care: The Impact Of Postnatal Contact Services On Women’S Parenting Confidence And Experiences Of Postpartum Care In Queensland, Australia, Yvette D. Miller, Aimée C C. Dane, Rachel Thompson

Dartmouth Scholarship

BackgroundUniversal postnatal contact services are provided in several Australian states, but their impact on women’s postnatal care experience has not been evaluated. Furthermore, there is lack of evidence or consensus about the optimal type and amount of postpartum care after hospital discharge for maternal outcomes. This study aimed to assess the impact of providing Universal Postnatal Contact Service (UPNCS) funding to public birthing facilities in Queensland, Australia on women’s postna

Ideas For A Healthy Baby--Reducing Disparities In Use Of Publicly Reported Quality Data: Study Protocol For A Randomized Controlled Trial, Sarah L. Goff, Penelope S. Pekow, Katharine O. White, Tara Lagu, Kathleen M. Mazor, Peter K. Lindenauer

Peter Lindenauer MD

BACKGROUND: Publicly reported performance on quality measures is intended to enable patients to make more informed choices. Despite the growing availability of these reports, patients' use remains limited and disparities exist. Low health literacy and numeracy are two barriers that may contribute to these disparities. Patient navigators have helped patients overcome barriers such as these in other areas, such as cancer care and may prove useful for overcoming barriers to using publicly reported quality data. METHODS/DESIGN: The goals of this study are: to determine the efficacy of a patient navigator intervention to assist low-income pregnant women in the use of …

Rural Heterosexual Female Adolescents' Decision-Making About Sexual Intercourse And Pregnancy In Ontario, Paulina Ezer

Electronic Thesis and Dissertation Repository

Rural areas in Ontario tend to have higher rates of adolescent pregnancy. A constructivist grounded theory methodology was used to gain an in-depth understanding of rural female adolescents’ decision-making process regarding sexual intercourse and their reproductive health, and how they view rural factors and circumstances influencing this process. The adolescent sexual decision-making process that emerged from the analysis involved prioritizing four influences that affect and are affected by the rural context: personal values and circumstances, family values and expectations, friends’ influences, and community influences. Findings will improve our understanding of how rural female adolescents make choices regarding their reproductive health. …

Food Choices And Practices During Pregnancy Of Immigrant Women With High-Risk Pregnancies In Canada: A Pilot Study, Gina M A. Higginbottom, Helen Vallianatos, Joan Forgeron, Donna Gibbons, Fabiana Mamede, Rubina Barolia

School of Nursing & Midwifery

Background: Immigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.
Methods: This four-phase study employed a case study design allowing for multiple means of data collection …

Implementation Of Evidence-Based Antenatal Care In Mozambique: A Cluster Randomized Controlled Trial: Study Protocol, Leonardo Chavane, Mario Merialdi, Ana Pilar Betrán, Jennifer Requejo-Harris, Eduardo Bergel, Alicia Aleman, Mercedes Colomar, Maria Luisa Cafferata, Alicia Carbonell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of …

Sexual And Reproductive Health And Rights Of Aymara Women In The Intercultural Health System In Chile / Salud Y Derechos Sexuales Y Reproductivos De Las Mujeres Aymara En El Sistema De Salud Intercultural De Chile, Ariela Schnyer

Independent Study Project (ISP) Collection

This investigation seeks to understand how Aymara women navigate their sexual and reproductive health and rights (SRHR) in Chile’s intercultural health care model. Indigenous communities have their own practices that complicate the provision of sexual and reproductive health by requiring health care providers to be aware of two different worldviews and how they may conflict, as well as what is necessary to provide respectful care. However, an ethnically and culturally pertinent framework is vital to actually assuring successful SRHR provision, whose tenants include autonomous choice and care free of discrimination, coercion or violence. These interactions were investigated through semi-structured interviews …

Perspectives From Community-Based Doulas And Mothers: Neighborhood Context And Pregnancy, Dara D. Mendez, Jessica Burke, Jennifer Jones, Cynthia Salter

Journal of Health Disparities Research and Practice

Objectives: Limited research explores the potential pathways by which neighborhoods influence pregnancy or how community members conceptualize and interpret how neighborhood contexts and living environments influence pregnancy and birth.

Study Design: We applied participatory Concept Mapping and a series of focused discussions with community-based doulas and mothers.

Methods: We collaborated with a community-based doula program to investigate how mothers and community doulas perceived the neighborhood to influence reproductive health. We conducted a series of focused discussions including ‘Brainstorming’ to uncover key themes related to how neighborhood context influenced pregnancy, ‘Sorting and Rating’ of key themes in association with pregnancy and …

Rationale, Design, And Method Of The Diabetes & Women’S Health Study – A Study Of Long-Term Health Implications Of Glucose Intolerance In Pregnancy And Their Determinants, Cuilin Zhang, Frank B. Hu, Sjurdur F. Olsen, Allan Vaag, Robert Gore-Langton, Jorge E. Chavarro, Wei Bao, Edwina Yeung, Katherine Bowers, Louise Groth Grunnet, Seth Sherman, Michele Kiely, Marin Strøm, Susanne Hansen, Aiyi Liu, James Mills, Ruzong Fan

Publications and Research

Women who develop gestational diabetes mellitus or impaired glucose tolerance during pregnancy are at substantially increased risk for type 2 diabetes and comorbidities after pregnancy. Little is known about the role of genetic factors and their interactions with environmental factors in determining the transition from gestational diabetes mellitus to overt type 2 diabetes mellitus. These critical data gaps served as the impetus for this Diabetes & Women’s Health study with the overall goal of investigating genetic factors and their interactions with risk factors amenable to clinical or public health interventions in relation to the transition of gestational diabetes mellitus to …

Dog Ownership During Pregnancy, Maternal Activity, And Obesity: A Cross-Sectional Study, Carri Westgarth, Jihong Liu, Jon Heron, Andrew R. Ness, Peter Bundred, Rosalind M. Gaskell, Alexander J. German, Sandra Mccune, Susan Dawson

Jihong Liu

The Avon Longitudinal Study of Parents and Children (ALSPAC) is an observational study of 14273 UK pregnant singleton mothers in 1990/1991. We examined outcomes of self report of strenuous activity (hours per week) at 18 and 32 weeks of gestation, hours spent in leisure-time physical activities and types, and pre-pregnancy body mass index (BMI); overweight status was defined as pre-pregnancy BMI$25 and obesity BMI$30. Pet ownership and activity data were reported for 11,466 mothers. Twenty-five percent of mothers owned at least one dog. There was a positive relationship between participation in activity at least once a week and dog ownership …

African-Born Women’S Birth Experiences In Worcester, Ma, Marianne Sarkis, Anneke Kat, Maya Baum, Bernadine Mayhungu

Local Knowledge: Worcester Area Community-Based Research

How do African Immigrant women interact with the Worcester healthcare system during pregnancy?

This study follows stories told by mostly Ghanaian women living in Worcester in order to understand their challenges in the maternal healthcare system. The researchers seek to understand cultural differences, socio-economic standing and communication challenges that have led to these women having one of the highest infant mortality rates in Worcester. The authors found that their interviews with healthcare providers shed the most light on what discrepancies exist between how the health care providers understand how this population experiences birth opposed to how these women experience birth …

Intimate Partner Violence After Disclosure Of Hiv Test Results Among Pregnant Women In Harare, Zimbabwe, Simukai Shamu, Christina Zarowsky, Tamara Shefer, Marleen Temmerman, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: HIV status disclosure is a central strategy in HIV prevention and treatment but in high prevalence settings women test disproportionately and most often during pregnancy. This study reports intimate partner violence (IPV) following disclosure of HIV test results by pregnant women.

Methods: In this cross sectional study we interviewed 1951 postnatal women who tested positive and negative for HIV about IPV experiences following HIV test disclosure, using an adapted WHO questionnaire. Multivariate regression models assessed factors associated with IPV after disclosure and controlled for factors such as previous IPV and other known behavioural factors associated with IPV.

Results: Over …

Safety Of Topiramate For Treating Migraines., Michael J. Marmura

Department of Jefferson Headache Center papers and presentations

INTRODUCTION: Migraine is a very common medical disorder characterized by attacks of moderate-severe headache, nausea and disability. Topiramate is an effective, popular prophylactic migraine treatment, which is approved for use in adults and adolescents. Due to its multiple mechanisms of action, topiramate has multiple potential safety issues, including systemic and CNS adverse events, which may complicate therapy.

AREAS COVERED: This review evaluates common adverse events as seen in the pivotal trials of topiramate for migraine as well as those observed in postmarketing studies. These include weight loss, metabolic acidosis, renal calculi, acute angle closure glaucoma, visual distortions and cognitive slowing. …

Psychosocial Factors Affecting Pregnant Hispanic Women, Marushka L. Silveira

Doctoral Dissertations

Prenatal psychosocial stress, anxiety, and depression are common, with higher rates among Hispanic women. While evidence supports an adverse effect of psychosocial factors on glucose intolerance and oral health, studies during pregnancy are sparse, particularly among Hispanic women. Therefore, we examined correlates of psychosocial factors and their associations with glucose intolerance and oral health among pregnant women. The first project examined correlates of high stress among 1,426 pregnant Hispanic participants in Proyecto Buena Salud, a prospective cohort study. Cohen’s Perceived Stress Scale was administered in early, mid- and late pregnancy. Using multivariable logistic regression, we found that increasing age, pre-pregnancy …

Prevalence And Evolution Of Intimate Partner Violence Before And During Pregnancy: A Cross-Sectional Study, An-Sofie Van Parys, Ellen Deschepper, Kristien Michielsen, Marleen Temmerman, Hans Verstraelen

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) before and during pregnancy is associated with a broad range of adverse health outcomes. Describing the extent and the evolution of IPV is a crucial step in developing interventions to reduce the health impact of IPV. The objectives are to study the prevalence of psychological abuse, as well as physical & sexual violence, and to provide insight into the evolution of IPV 12 months before and during pregnancy.

Methods: Between June 2010 and October 2012, a cross-sectional study was conducted in 11 antenatal care clinics in Belgium. Consenting pregnant women were asked to complete a …

Placental Fkbp5 Genetic And Epigenetic Variation Is Associated With Infant Neurobehavioral Outcomes In The Richs Cohort, Alison G. Paquette, Barry M. Lester, Devin C. Koestler, Corina Lesseur, David A. Armstrong, Carmen J. Marsit

Dartmouth Scholarship

Adverse maternal environments can lead to increased fetal exposure to maternal cortisol, which can cause infant neurobehavioral deficits. The placenta regulates fetal cortisol exposure and response, and placental DNA methylation can influence this function. FK506 binding protein (FKBP5) is a negative regulator of cortisol response, FKBP5 methylation has been linked to brain morphology and mental disorder risk, and genetic variation of FKBP5 was associated with post-traumatic stress disorder in adults. We hypothesized that placental FKBP5 methylation and genetic variation contribute to gene expression control, and are associated with infant neurodevelopmental outcomes assessed using the Neonatal Intensive Care Unit (NICU) Network …

Implantation Failure In Female Kiss1-/- Mice Is Independent Of Their Hypogonadic State And Can Be Partially Rescued By Leukemia Inhibitory Factor., Michele Calder, Yee-Ming Chan, Renju Raj, Macarena Pampillo, Adrienne Elbert, Michelle Noonan, Carolina Gillio-Meina, Claudia Caligioni, Nathalie G Bérubé, Moshmi Bhattacharya, Andrew J Watson, Stephanie B Seminara, Andy V Babwah

Obstetrics & Gynaecology Publications

The hypothalamic kisspeptin signaling system is a major positive regulator of the reproductive neuroendocrine axis, and loss of Kiss1 in the mouse results in infertility, a condition generally attributed to its hypogonadotropic hypogonadism. We demonstrate that in Kiss1(-/-) female mice, acute replacement of gonadotropins and estradiol restores ovulation, mating, and fertilization; however, these mice are still unable to achieve pregnancy because embryos fail to implant. Progesterone treatment did not overcome this defect. Kiss1(+/-) embryos transferred to a wild-type female mouse can successfully implant, demonstrating the defect is due to maternal factors. Kisspeptin and its receptor are expressed in the mouse …

Novel Synergistic Protective Efficacy Of Atovaquone And Diclazuril On Fetal-Maternal Toxoplasmosis, Helieh S. Oz

Internal Medicine Faculty Publications

Over 1 billion people globally are estimated to be infected with Toxoplasma gondii with severe or unknown consequences and no safe and effective therapies are available against congenital or persistent chronic infection. We propose that atovaquone and diclazuril synergistically protect against fetal-maternal toxoplasmosis.

METHODS: Programmed pregnant mice were treated with atovaquone and diclazuril monotherapy, or combined (atovaquone + diclazuril) therapy and infected with tachyzoites (0, 300, 600) and the course of infection was studied.

RESULTS: Infected dams with low dose (300) developed moderate toxoplasmosis complications and treatments were similarly effective with minor differences between monotherapies. In contrast, major differences were …

Preconception Care For Women With Pregestational Diabetes: Information For The Family Nurse Practitioner, Kathryn Conover Morrill

Student Works

Purpose: The purpose of this article is to evaluate present literature and guidelines regarding preconception care for women with type I diabetes mellitus (T1DM) or type II diabetes mellitus (T2DM) and familiarize the family nurse practitioner (FNP) with current clinical recommendations. Data Sources: The guidelines reviewed include the Clinical Practice Recommendations from the American Diabetes Association 2013, the American College of Obstetricians and Gynecologists pregestational diabetes mellitus guideline reaffirmed in 2010, and the National Institute for Health and Clinical Excellence on how to manage diabetes and its complications from preconception to the postnatal period 2008. Conclusions: Guidelines were established based …

Pregnancy Anxiety And Prenatal Cortisol Trajectories, Heidi S. Kane, Christine Dunkel Schetter, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Pregnancy anxiety is a potent predictor of adverse birth and infant outcomes. The goal of the current study was to examine one potential mechanism whereby these effects may occur by testing associations between pregnancy anxiety and maternal salivary cortisol on 4 occasions during pregnancy in a sample of 448 women. Higher mean levels of pregnancy anxiety over the course of pregnancy predicted steeper increases in cortisol trajectories compared to lower pregnancy anxiety. Significant differences between cortisol trajectories emerged between 30 to 31 weeks of gestation. Results remained significant when adjusted for state anxiety and perceived stress. Neither changes in pregnancy …

Challenge Of Morbid Obesity In Obstetric Anesthesia, Ahmed Abdel-Raouf Metwally, Ashraf Magdy Eskandr, Ashraf Mohamed Mostafa, Noha Abd Allah Afify

Menoufia Medical Journal

Objectives To discuss the pathophysiology of morbid obesity in pregnant ladies and the anesthetic management of morbidly obese parturients. Background The association between obesity and pregnancy can result in further limitation of parturient physiological reserve. Indeed, maternal obesity is associated with an increased risk of delivery and postpartum complications. Conclusion Complete understanding of the physiology, pathophysiology, comorbidies and their implications for anesthesia and analgesia in morbidly obese parturients should lead to improvement of safety and anesthetic care. 2- Reviews and Meta-Analyses. Objective To determine the anesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery. Data analysis was …

The Influence Of Maternal Contexts On Infant Outcomes, Secondary Analysis Of Wpcr Data 2000-2010, Mary Roseanne Butler

Theses and Dissertations

Congenital heart defects (CHD) are the most prevalent birth defect in the world and occur in approximately 6-8 of every 1,000 live births (Hoffman & Kaplan, 2002). CHD continues to be one of the leading causes of infant morbidity and mortality today. Five to ten percent of all cases of CHD can be attributed to a chromosomal abnormality, 3%-5% are linked to single gene defects, and approximately 2% are a result of known environmental factors (Clark, 2001). With only 10%-15% of the causes of CHD are understood, the remaining 85%-90% of all CHD cases, the etiologies remain unknown. The purpose …

Cancer Diagnosis During Pregnancy: Evaluating The Challenges Faced By Oncologists, Shannon Kaye Mulligan

Dissertations & Theses (Open Access)

Cancer during pregnancy is occurring more often than in the past, and it is estimated that cancer is diagnosed in approximately 1/1000 pregnancies. A consensus exists that management of these patients should prioritize survival of the mother and minimize teratogenic effects to the fetus, and utilize a multidisciplinary approach, involving medical oncology, surgical oncology, radiation oncology, radiology, and a maternal fetal medicine specialist. In spite of this consensus, there is not a standardized approach for treating cancer in women diagnosed during pregnancy. Due to the relative infrequency of this situation in the oncologic setting, the aims of this study were …

Feasibility Of Oral Prenatal Probiotics Against Maternal Group B Streptococcus Vaginal And Rectal Colonization, Lisa Hanson, Leona Vandevusse, Megan Duster, Simone Warrack, Nasia Safdar

College of Nursing Faculty Research and Publications

Objective

To examine the effect of an oral prenatal probiotic on group B Streptococcus (GBS) colonization and to demonstrate the feasibility of a larger randomized controlled trial.

Design

This pilot study was an open‐label, two‐group quasi‐experiment.

Setting

An urban central city nurse‐midwifery and wellness center serving a diverse population.

Participants

Ten pregnant participants received the oral probiotic (Florajen3) taken once daily, and 10 participants served as controls.

Methods

A questionnaire on dietary practices, vaginal cleansing, sexual history, and symptoms and GBS colony count samples were taken at 28‐, 32‐, and 36‐weeks gestation.

Results

Participants in the probiotic group reported no …

Why 'Down Under' Is A Cut Above: A Comparison Of Rates Of And Reasons For Caesarean Section In England And Australia, Samantha J. Prosser, Yvette D. Miller, Rachel Thompson, Maggie Redshaw

Dartmouth Scholarship

Background: Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point.

Methods: We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467).

Women’S Understanding Of The Effects Of Obesity On Pregnancy, Rachel A. Daniel

Senior Honors Theses

Obesity is a serious issue and is becoming a significant problem around the world. Obesity in general causes and complicates many health problems. As obesity increases in the population at large, the incidence of obesity in pregnancy continues to increase. Obesity during pregnancy has been linked in numerous studies to multiple complications, and the issues and risks have been clearly established. Also becoming pregnant or having multiple pregnancies increases the likelihood of developing obesity. Obese women of childbearing age many times do not even know these risks exist. There is a need to educate these women before they become pregnant, …

Methamphetamine: The Effect On The Child From Womb, Birth And Beyond, Chiara L. Keune

Graduate Research - Criminal Justice

Globally the use of methamphetamine surpasses that of heroin and cocaine combined. As a drug that facilitates weight loss and provides the user with increased energy, it is particularly appealing to women. This raises concerns about its use by pregnant women. This poster highlights what is known about the effects of methamphetamine by pregnant women on the unborn child, and on the long term consequences for the children of these women.

2009 H1n1 And Seasonal Influenza Immunization Among Pregnant Women: A Comparison Of Different Sources Of Immunization Information, Bonny Specker, Betty Wey, Jill Fuller, Marie-Noel Sandoval, Maureen Durkin, Nancy Dole, Emmanuel B. Walter

Ethel Austin Martin Program Publications

Validity of prenatal immunization data from different sources has not been assessed. We evaluated prenatal 2009 H1N1 and seasonal influenza (FLU) data obtained from state immunization information systems (IIS), medical record abstraction (MRA), and participant recall using medical care logs (NCS-MCL). 2009 H1N1 and FLU data were obtained from IIS and MRA for 325 pregnant women participating in the National Children's Study at three locations (SD/MN, NC, WI). Women recalled immunizations at first pregnancy visit and at 16-17 and 36 weeks' gestation (NCS-MCL). The proportion of women with vaccine information obtainable from each data source was determined, and proportions immunized …

Depression Is More Prevalent Throughout Pregnancy And The First Six Months Postpartum In Women Low In Religious Commitment And Social Support, Andrea D. Clements, Tifani A. Fletcher, Beth A. Bailey

ETSU Faculty Works

Abstract available through the Annals of Behavioral Medicine.

Genetic Risk Of Progression To Type 2 Diabetes And Response To Intensive Lifestyle Or Metformin In Prediabetic Women With And Without A History Of Gestational Diabetes Mellitus., Shannon D Sullivan, Kathleen A. Jablonski, Jose C Florez, Dana Dabelea, Paul W Franks, Sam Dagogo-Jack, Catherine Kim, William C Knowler, Costas A Christophi, Robert Ratner, Diabetes Prevention Program Research Group.

GW Biostatistics Center

OBJECTIVE The Diabetes Prevention Program (DPP) trial investigated rates of progression to diabetes among adults with prediabetes randomized to treatment with placebo, metformin, or intensive lifestyle intervention. Among women in the DPP, diabetes risk reduction with metformin was greater in women with prior gestational diabetes mellitus (GDM) compared with women without GDM but with one or more previous live births.

RESEARCH DESIGN AND METHODS We asked if genetic variability could account for these differences by comparing β-cell function and genetic risk scores (GRS), calculated from 34 diabetes-associated loci, between women with and without histories of GDM.

RESULTS β-Cell function was …

Selling Life To Abortion-Seekers: A Content Analysis Of Passive And Active Persuasion In Crisis Pregnancy Center Marketing, Alexander Kocman

Masters Theses

For supporters of the pro-life cause, crisis pregnancy centers (or CPC's) have become the "darlings of the movement," according to the New York Times (Belluck, 2013), offering women with unplanned pregnancies free advice, information, classes, childcare, and needed supplies. For abortion advocates, such establishments are intended to seduce vulnerable abortion-seekers into a situation where they will be counseled out of an abortion and possibly even proselytized. Yet for as much controversy as exists in the news media, medical community, and legal realm about CPC's, there is an unsettling lack of understanding of how--and why--CPC's market themselves the way they do. …