Medicine and Health Sciences Commons^™

Metabolomic Biomarkers For Hypertensive Disease Of Pregnancy, Akasham Rajagopaul

Electronic Thesis and Dissertation Repository

Hypertensive disease of pregnancy (HDP) is a serious cardiometabolic pregnancy complication. Early onset HDP (EO-HDP) is more severe but rare, whereas late onset HDP (LO-HDP) is milder but common. Current disease markers, including placental growth factor (PlGF), are reasonable predictors of EO-HDP but poor predictors of LO-HDP. We sought to assess the performance of metabolomic biomarkers in HDP through a scoping review and primary analysis of plasma from symptomatic patients. Review of 31 studies indicated better prediction of all HDP and EO-HDP than LO-HDP using metabolomic biomarkers. Due to substantial heterogeneity in reported metabolites, no set of reliable biomarkers have …

In Utero Magnetic Resonance Relaxometry For Fetal Tissue Development, Simran Sethi

Electronic Thesis and Dissertation Repository

Fetal life is a significant period of human development because organ systems that sustain life outside the uterus begin to develop during this time. A necessary process that begins during fetal life is myelination, which is the process by which myelin, a lipid-rich substance, is wrapped around neurons in the brain to increase the speed of action potential transmission. Since myelination is critical for the normal function of the central nervous system, fetal myelin assessment is important for understanding neurodevelopment and neurodegeneration, such as intrauterine growth restriction (IUGR).

Magnetic resonance imaging (MRI) is an excellent tool for visualizing fetal anatomy …

Role Of Decorin At The Fetal-Maternal Interface, Chidambra D. Halari

Electronic Thesis and Dissertation Repository

The human placenta is an invasive tumor-like structure, this invasion being physiological. A subset of placental trophoblast called extra-villous trophoblast invades the uterine decidua and remodels uterine arteries into low-resistance, high-flow tubes to permit adequate flow of maternal blood to nourish the fetus. A poor extra-villous trophoblast invasion and uterine arterial remodeling can lead to fetal growth restriction and a serious pregnancy-associated maternal disease preeclampsia. Decorin, a leucine-rich proteoglycan produced by uterine decidual cells restrains multiple trophoblast functions: self-renewal and differentiation of trophoblast stem cells, migration, invasion, proliferation and endovascular differentiation. Additionally, decidual overproduction of decorin was associated with preeclampsia, …

Investigating The Impact Of The Covid-19 Pandemic On Maternal Perceived Stress, Postpartum Depressive Symptoms, And Pregnancy Outcomes In London, Ontario: A One Health Approach, Mei Yuan

Electronic Thesis and Dissertation Repository

The 2019 novel-coronavirus (COVID-19) may have increased feelings of stress and worry in pregnant women. This study investigated the impact of the pandemic on perceived stress and postpartum depressive symptoms, with potential implications for pregnancy outcomes. Women (n=44) who recently gave birth completed questionnaires at 6 weeks postpartum that assessed stress, social support, depressive symptoms, and COVID-19 impact. In summary, 31.8% of participants had high levels of perceived stress, 36.4% had possible postpartum depression, and perceived social support was significantly negatively associated with depressive symptoms. No significant associations were observed between different biological and socio-environmental factors and perceived stress or …

Perspectives Of Canadian Midwives On Nutrition For Pregnancy, Yvana T. Sawaya

Electronic Thesis and Dissertation Repository

Limited data exists on Canadian midwives’ experiences with nutrition for pregnancy. An anonymous e-survey was distributed via midwifery associations’ e-newsletters, social media, and clinics’ public e-mail addresses to explore Canadian midwives’ nutrition attitudes, education, and recommendations.

Almost all (99.4%) of the 161 respondents provided nutrition advice to pregnant women and almost two-thirds (63.7%) received nutrition training. Midwives had positive attitudes towards nutrition (median=5 on scale where 1=very unimportant and 5=very important) and their comfort levels in advising on nutrition topics ranged from moderate to high. An average of 85.3% of their recommendations aligned with Health Canada pregnancy guidelines and relevant …

The Effects Of Maternal Delta-9-Tetrahydrocannabinol And Cannabidiol Exposure On Fetal Heart Development In Mice, Gregory Robinson

Electronic Thesis and Dissertation Repository

Up to 22.6% of pregnant women consume cannabis during pregnancy despite the uncertainty of teratogenicity of the main ingredients in cannabis, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). This study tested the hypothesis that gestational THC and CBD exposure leads to heart abnormalities. Daily, oral THC exposure induced heart abnormalities in 68% of offspring with three main phenotypes including thickened semilunar valves, ventricular myocardial hypertrophy and hypoplastic coronary arteries in fetuses, and postnatal cardiac dysfunction. Altered gene expression of key cardiogenic regulators, increased proliferation, and reduced epicardial epithelial-to-mesenchymal-transition were demonstrated implicating potential mechanisms responsible for these abnormalities. Also, maternal CBD exposure resulted …

Quantifying Mid-Pregnancy Placental Metabolism In Guinea Pigs Fed A Lifelong Western Diet, Mary-Ellen E.T Empey

Electronic Thesis and Dissertation Repository

Maternal consumption of a Western diet (WD) has been linked to alterations in fetoplacental metabolic programming and risk for the exposed fetus to develop obesity, cardiovascular disease, and type II diabetes mellitus. It may also cause oxidative damage to the placental mitochondria. This thesis investigated the metabolic effects of a WD on placentae using a guinea pig model of pregnancy and hyperpolarized ¹³C MRI for metabolic quantification. It was hypothesized that placental glycolytic metabolism would increase, and placental oxidative metabolism would decrease in WD-fed sows. Control diet- and WD-fed, pregnant sows underwent metabolic MRI at 33 days gestation and …

The Association Between Maternal Obesity And Fetal Size For Gestational Age In Singletons And Twins, Shohi Prajapati

Electronic Thesis and Dissertation Repository

Maternal obesity and multiple births have adverse effects on fetal growth; prevalence of both are increasing in Canada. We explored associations between maternal obesity and infant size for gestational age using data from a London perinatal database. Birthweight for gestational age was assessed using standards published by Robertson (2002) to classify Small for Gestational Age (SGA) and Large for Gestational Age (LGA) in 30396 singletons and 1346 twins. Associations were estimated using logistic regression for singletons and the GEE extension of logistic regression for twins. Increased maternal pre-pregnancy BMI was statistically significantly associated with decreased odds of SGA in singletons …

Use Of Psychotropic Medications Among Pregnant Women With Bipolar Disorder: Patterns, Determinants, And Impact On Perinatal Outcomes, Misbah Salim

Electronic Thesis and Dissertation Repository

Navigating psychotropic treatment use for bipolar disorder (BD) in pregnancy is challenging as it is, but it is even more difficult with use of multiple medications across various drug classes for treatment, given the absence of evidence of their safe use. This retrospective cohort study assessed prescription patterns, patient characteristics associated with these patterns, risk of adverse outcomes, and rates of readmission in women with BD who were prescribed antipsychotic, antidepressant, or combination treatment during pregnancy, relative to untreated women. An estimated 25% of women were prescribed psychotropic drugs during pregnancy. Women with past suicide attempts and those with recurrence(s) …

Incidence, Characteristics, And Outcomes Of Acute Kidney Injury Treated With Dialysis During Pregnancy And The Postpartum Period, Ainslie M. Hildebrand

Electronic Thesis and Dissertation Repository

Pregnancy-related acute kidney injury (AKI) may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective cohort study of all consecutive pregnancies between 1997 and 2011 in Ontario and describe the incidence, characteristics, and outcomes of AKI treated with dialysis (AKI-D) during pregnancy or within 12 weeks postpartum. Of 1,918,789 pregnancies, 188 were complicated by AKI-D (incidence proportion: 1 per 10,000, 95% confidence interval 0.8 to 1.1). Eight women died (4.3% versus 0.01% in the general population) and seven (3.9%) survivors remained dialysis-dependent four months after delivery. The presence of AKI-D was …

Antenatal Depressive Symptoms And Antidepressant Use In Pregnancy, Jerry Yu-Hsiang Chen

Electronic Thesis and Dissertation Repository

Review of the current literature reveals inconsistent findings on potential associations between antidepressant use during pregnancy and adverse fetal and child health and development. This study aims to examine the effect of antenatal SSRI exposure on several neonatal (preterm birth, small- and large-for-gestational age, Apgar score, and neonatal intensive care unit admission) and child developmental outcomes (measured by Ages and Stages Questionnaire) while controlling for confounding by indication. Data were obtained from the Prenatal Health Project, a longitudinal cohort study of 2,357 women in London, Ontario. Results from univariable analysis discovered that infants exposed to in utero SSRIs were more …

Maternal Fat Intake During Pregnancy And Breastfeeding Initiation, Rachel Man

Electronic Thesis and Dissertation Repository

Introduction: Breast milk provides health benefits for both mother and child. Prominent reasons for not initiating breastfeeding include lactation problems and perceived insufficient milk supply. Animal studies have shown that a high fat diet is associated with negative changes in the lactation process, while omega-3 supplementation appears to have positive effects. Hypothesis: 1. High maternal fat intake during pregnancy is associated with breastfeeding non-initiation. 2. Long-chain omega-3 fatty acid intake (EPA+DHA) is associated with breastfeeding initiation. 3. Maternal EPA+DHA intake modifies the relationship between total fat intake during pregnancy and breastfeeding initiation. Materials and Methods: The data for this study …

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. …

Prenatal Programming Of Hepatic Glucose And Cholesterol Regulation In Male Rat Offspring By Chronic Intermittent Hypoxia, Waseem Iqbal

Electronic Thesis and Dissertation Repository

Obstructive sleep apnea (OSA) is a chronic disorder involving repetitive interruptions in breathing during sleep. Sufferers of OSA are exposed to chronic intermittent hypoxia (CIH), characterized by cyclical reductions in oxygen availability. A number of studies have established a link between OSA and various cardiovascular and metabolic comorbidities in adulthood, including hypertension, obesity, and type II diabetes. While the consequences of OSA in adults have been well described, the cross-generational impact of this condition and potential effects on fetal development are not known. Epidemiological and animal studies have demonstrated that physiological insults during pregnancy lead to diminished growth of offspring …

Population-Based Placental Weight Ratio Distributions And Determinants Of Placental Weight Ratios, Erin M. Macdonald

Electronic Thesis and Dissertation Repository

The placental weight ratio (PWR) is a common proxy for the balance between fetal and placental growth, and is defined as the placental weight over the birth weight. The objectives were (1a) to establish PWR distributions by gestational age for the overall population and (1b) for small, average and large for gestational age infants (SGA, AGA, LGA) and (2) to determine what pregnancy related conditions were associated with the PWR. The data were obtained using a hospital based retrospective cohort. Nonparametric quantile regression was used for the first and multinomial logistic regression for the second objective. The results show how …

Ginseng Extract Treatment Influences On Preimplantation Development In Vitro, And Pregnancy And Post-Partum Development In The Mouse, Danyka D. Belanger

Electronic Thesis and Dissertation Repository

Ginseng is one of the most commonly consumed herbal medicines in the world. Consumption is highest in females, thus my purpose was to define the concentration responsive effects of North American alcoholic and aqueous ginseng extracts on preimplantation development in vitro and on pregnancy and post-partum development in the mouse. 2-cell embryos from female mice were cultured with 5 different concentrations of both extracts, ginsenosides Rb1, Rg1 and Re, a combinatorial ginsenoside solution and a polysaccharide fraction. Embryonic development and recovery from treatment was assessed. To investigate in vivo effects of ginseng extracts, females were gavaged with 50 mg/kg and …