Medicine and Health Sciences Commons^™

Black Midwives For Black Mothers: Ameliorating Racial Disparities In The Quality Of Maternal Healthcare, Kimberly Navarro

Theses and Dissertations

In the United States, maternal mortality represents a dire health crisis with a stark racial imbalance. Black women are two and a half to three times more likely to die from pregnancy and birth-related complications than their White counterparts. Racial disparities in maternal health can be explained by variations in the quality of maternal healthcare services that women tend to receive. Racial and ethnic minority women are more likely to receive inferior quality prenatal care (PNC), which brings to question the care model of traditional PNC and its adequacy in serving the healthcare needs of Black women. Since Black women …

Effects Of Provider Support And Psychosocial Stressors On Maternal Health-Promoting Behaviors, Mary Catherine Jessen

Theses and Dissertations

ABSTRACTEFFECTS OF PROVIDER SUPPORT AND PSYCHOSOCIAL STRESSORS ON MATERNAL HEALTH-PROMOTING BEHAVIORS

Despite technological and structural advances in the organization and delivery of health care services to pregnant women and infants, the U.S. ranks low on perinatal outcomes with profound disparities. Engagement in health-promoting behaviors during pregnancy is critical in improving birth outcomes. Women, particularly women of color, continue to experience unmet needs for emotional support with providers. Women of color experience being treated differently based on their race. The purpose of this study was to 1) examine the relationships between stress, provider support, and specific maternal health promoting behaviors (MHPB) …

Intersection Of Maternal Disability Status, Prescription Opioid Use Before And During Pregnancy, And Adverse Birth Outcomes, Chelsea Lynes Richard

Theses and Dissertations

Nationally, individuals with disability, like those with chronic health conditions, have higher rates of opioid use and misuse and are prescribed higher dosages than those without disability. Because opioid agonists and antagonists can cross the placenta rapidly, there is biological plausibility that they may have an impact on birth outcomes. Therefore, monitoring prescription opioid use, particularly among pregnant women, is of great public health importance. While evidence for the impact of opioid use on preterm birth and low birthweight are conflicting; findings are consistent that opioid use during pregnancy is associated with a higher risk of small for gestational age, …

Urate Genetic Assessment In Asian And Pacific Islander Subgroups Of Pregnant Women: Implications For Personalized Medicine And Means To Reduce Health Disparities, Ali Alghubayshi

Theses and Dissertations

Gout is one of the most common rheumatic conditions and appears to have a higher prevalence in certain populations. Risk factors for gout and its precursor, hyperuricemia, are also significant risk factors for preeclampsia, major pregnancy-related morbidity. A retrospective cross-sectional study was conducted on 1059 pregnant women from different populations whom 100% reported their ethnicities from the Asian, Native Hawaiian, and Pacific Islander populations. Numerous uric acid (UA) genes and clinical conditions were addressed, and all study details were reviewed and exempted by the University of Hawaii human Studies Program (Protocol Number: 2018-00225). In this project, we hypothesized that UA …

Physical Activity During Pregnancy And Birth Outcomes In South Carolina 2009-2015, Andrew Tyler Broadway

Theses and Dissertations

Physical activity is known to be beneficial to adults in general, including pregnant women, but the literature on physical activity and neonatal outcomes has been inconsistent. Few studies have differentiated between physical activity prior to pregnancy and during pregnancy to see whether the typical beneficial effect is not due to having a more active lifestyle in general. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a national cross-sectional surveillance system. Our data from SC PRAMS included 6391 respondents and was weighted to be representative of population of pregnant women that delivered in the state. We excluded births that were not …

Placental Eicosanoids And Sphingolipids In Preeclampsia, Daniel T. Reep

Theses and Dissertations

Placental dysfunction is implicated in the pathogenesis of preeclampsia. Chemical signals between the placenta and maternal circulation are a suspect cause of endothelial dysfunction and maternal hypertension. This study examined select lipid mediators of inflammation produced by the placenta. Patients were recruited from Virginia Commonwealth University’s pregnancy clinics and placentas were collected at delivery. Forty-eight-hour explant cultures of villous placental tissue were used to model lipid production. Electrospray ionization mass spectrometry was used to quantify concentrations of free lipids in the culture media. Bicinchoninic acid assays were performed to quantify protein in each culture for normalization of lipid data. After …

"To Conceive With Child Is The Earnest Desire If Not Of All, Yet Of Most Women": The Advancement Of Prenatal Care And Childbirth In Early Modern England: 1500-1770, Victoria E.C. Glover

Theses and Dissertations

This thesis analyzes medical manuals published in England between 1500 and 1770 to trace developing medical understandings and prescriptive approaches to conception, pregnancy, and childbirth. While there have been plenty of books written regarding social and religious changes in the reproductive process during the early modern era, there is a dearth of scholarly work focusing on the medical changes which took place in obstetrics over this period. Early modern England was a time of great change in the field of obstetrics as physicians incorporated newly-discovered knowledge about the male and female body, new fields and tools, and new or revived …

A Stakeholder Examination Of Gestational Weight Gain Guidelines, Melissa Kwitowski

Theses and Dissertations

Obesity is a significant health concern for women of childbearing age. More than 40% of women have a Body Mass Index (BMI) in the overweight or obese ranges at the time they conceive, posing significant health risks for both mother and child. Excessive weight gain during pregnancy is common and associated with numerous deleterious complications. The Institute of Medicine published gestational weight gain (GWG) guidelines based on prepregnancy BMI. However, more than 50% of women gain in excess of these recommendations. Further, many women report receiving minimal guidance from their healthcare providers regarding weight gain, nutrition, and physical activity during …

Influence Of Thyroid Disorders On Pregnancy Outcomes, Brittany Sullivan

Theses and Dissertations

Objective: The objective of this thesis is to investigate the effects of maternal thyroid dysfunction on maternal pregnancy outcomes.

Setting and Participants: The NICHD Consecutive Pregnancy data set contains information on a total of 114,679 pregnancies from 51,086 women who delivered ≥ 20 weeks of gestation. The data come from 20 different hospitals throughout the state of Utah and were collected between the years of 2002 to 2010.

Main Outcomes: Main outcomes of interest included: breech presentation, chorioamnionitis, gestational diabetes, gestational hypertension, hemorrhage, inductions, placental abruption, placental previa, preterm birth, premature rupture of membranes (PROM), preeclampsia, and …

Smoking Cessation In Pregnancy And Gestational Weight Gain In South Carolinian Mothers, 2009-2011, Laquenta Latreese Weldon

Theses and Dissertations

Purpose: To determine if smoking cessation during pregnancy is associated with excessive gestational weight gain (GWG).

Methods: Data came from the 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing population-based survey of live births in South Carolina (n=2,603). Participant smoking status was classified as nonsmoker (did not smoke before or during pregnancy), persistent smoker (smoked before and throughout pregnancy), or quitter (smoked before but quit during pregnancy). Multinomial logistic regression model was estimated to examine the association between smoking status and meeting the 2009 Institute of Medicine guidelines, while linear regression model was used for the continuous outcomes such …

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 …

The Comparative Effectiveness Of Group Prenatal Care On Women's Psychosocial Health, Emily Heberlein

Theses and Dissertations

Background: High rates of adverse birth outcomes persist in the United States despite increased access to individual prenatal care (IPNC). Psychosocial factors influence birth outcomes and affect infant and child development and maternal functioning. Group prenatal care (GPNC) combines individual physical assessments and facilitated group education and support. Studies of GPNC show promising results, including lowered preterm birth rates, but the GPNC psychosocial mechanisms influencing birth outcomes are unclear.

Methods: Surveys at study enrollment (N=248), late pregnancy, and six weeks postpartum assessed psychosocial effects of each PNC model. Multiple regression models and planned moderator analyses tested whether GPNC participants had …

Predictors Of Sexual Relationship Power, Communication And Sexual Decision Making Among Latino Couples, Yui Matsuda

Theses and Dissertations

Unintended pregnancy (UP) is increasing among Latinos in the United States. Unintended pregnancy contributes to many negative consequences for infants, mothers and families. Concurrently, various factors affect Latino couples’ sexual relationship power, communication and decision making about family planning, including sexual relationship power, relationship commitment, dyadic adjustment, individual background, and cultural characteristics. Previous research has not focused on understanding the factors that affect Latino couples’ sexual relationship power, communication and sexual decision making from each partner’s perspective. The purpose of this study was to examine the association between sexual relationship power, communication, and sexual decision making from each partner’s perspective …

The Association Between Prenatal Care Content And Quality With Preterm Birth And Maternal Postpartum Health Behaviors, Susan Cha

Theses and Dissertations

Background: Health policies that seek to improve pregnancy outcomes focus on increasing the availability and access to prenatal care (PNC) services based on studies that support an association between insufficient PNC and adverse birth outcomes. These studies employ PNC utilization indices that measure the adequacy of PNC use, but these indices fail to account for the content or specific components of PNC. Objectives: The purpose of this study was to utilize PRAMS and birth certificate data to evaluate the content and quality of PNC in Virginia, and its impact on preterm birth and maternal postpartum health behaviors. Methods: Data was …

The Effects Of Motivational Interviewing In Pregnancy On Knowledge And Retention Of Infant Oral Health Information, Andrew Zima

Theses and Dissertations

THE EFFECTS OF MOTIVATIONAL INTERVIEWING IN PREGNANCY ON KNOWLEDGE AND RETENTION OF INFANT ORAL HEALTH INFORMATION By Andrew D. Zima, Jr., B.S., M.S., D.D.S. A thesis submitted in partial fulfillment of the requirements for the degree of Masters of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Major Director: Tegwyn H. Brickhouse, D.D.S., Ph.D Associate Professor, Department of Pediatric Dentistry Purpose: The purpose was to examine the effect of motivational counseling in pregnancy with readiness and acceptance of infant oral health information. Methods: The study used a prospective cohort design to examine the effect of prenatal education …

Intimate Partner Violence And Pregnancy: Data From The Chicago Women's Health Risk Study, Anne Zehner

Theses and Dissertations

Background: Intimate partner violence (IPV) during pregnancy increases the risks of adverse outcomes for both mothers and their unborn children, including maternal and fetal death. However, more research is needed to determine if IPV increases in frequency or severity during pregnancy and to determine what the risk factors are for IPV during pregnancy. Objectives: To use data from the Chicago Women’s Health Risk Study to determine (1) if abuse is more prevalent during the pregnancy period, 2) if abuse during the pregnancy period increases in frequency or severity, 3) if pregnant women who are abused are at increased risk for …

Examination Of Birth Outcomes With Mode Of Delivery For Breech Presentation, Kelly Marie Arey

Theses and Dissertations

Introduction: Approximately 3% to 4% of all pregnancies at term will have a fetus with a breech presentation. Studies have shown that the US has almost completely abandoned vaginal delivery for breech presentation through the influence of the "Term Breech Trial" (TBT) which concluded that a policy of planned caesarian section would reduce perinatal mortality, late neonatal mortality, and serious neonatal morbidity by approximately two-thirds for term fetuses. However, the recommendations are still being challenged by others.Objectives: The purpose of the study was to describe who in Virginia is having a vaginal delivery for a breech presentation and to determine …

Lack Of Knowledge Of Mother-To-Child Transmission In Kenya Among Women Ages 15-49, Nisha Warrier

Theses and Dissertations

Purpose: The epidemic of mother-to-child transmission (MTCT) of HIV/AIDS in resource-poor countries is dramatic; it is responsible for nearly 90% of childhood infections. The primary purpose of analysis was to understand the distribution of factors and their association with lack of knowledge of MTCT in Kenya. In parallel, another aim was to identify the relationship between media, particularly frequency of radio exposure, and lack of knowledge.Methods: This study used the 2003 Kenya Demographic and Health Survey (DHS) collected for 8,195 women, ages 15-49. Descriptive analysis, univariate analysis, and logistic regression were completed on SPSS 14 software.Results: In the sample, 1151 …

Factors Associated With High Sexual Risk Behavior In Single Women, Thomas B. M. Leecost

Theses and Dissertations

Objective: This study was to identify factors associated with High Sexual Risk Behavior (HSRB) in single Afro American women seen in an Epidemiology/Sexual transmitted disease (EPID/STD) Clinic in Richmond, Virginia from January 2006 through April 2006.Method: Participants were 154 single women (no history of marriage) between the ages of 18-30 visiting the EPID/STD clinic for the first time.Demographic information was obtained from their records. A volunteer interview was given that contained 101 variables to evaluate for High Sexual Risk Behavior (HSRB). HSRB was defined to response 'yes' to the question, "During the past 3 months did you have sex with …

Predictors Of Primary Elective Cesarean Delivery Among Apparently Healthy Pregnant Women In Virginia, Brooke W. Rossheim

Theses and Dissertations

Objectives. The purpose of this cross-sectional study was to evaluate whether certain maternal variables were associated with the performance of a primary cesarean delivery rather than a spontaneous vaginal delivery among apparently healthy pregnant women in the Commonwealth of Virginia.Methods. This study utilized the 2004 Virginia Statistics File for Live Births which contained 103,830 records. From this dataset, the following groups of women were excluded: multiparous women, women who had had a previous delivery by any method, women with medical and obstetric problems, women with any labor and delivery complications, women with premature births and women with multiple gestations. The …

Predictors Of Induced Abortion Among Female Youth Center Users In Port-Au-Prince, Haiti, Rachel Barker

Theses and Dissertations

Objective: Induced abortions occur in every country in the world. However sixty percent of the world's women live in countries where abortion is illegal. 19 million pregnancies end in unsafe and/or illegal abortions. Annually, 68,000 women die from unsafe abortions. Legal or not, unsafe abortion is one of the great neglected problems of health care in developing countries like Haiti and is a serious concern to women during their reproductive lives. Methods: The data for this study was collected from youth centers (ages 15-24) and used to estimate percentage distributions of abortion ratios by selected characteristics of women, particularly age …

Predictors Of Early Onset Of Sexual Intercourse In Male And Female Residents Of The United States, Brianna Michele Magnusson

Theses and Dissertations

Abstract Purpose: The United States has the highest rate of teen pregnancy of any industrialized nation. Adolescents who have their first sexual intercourse at a young age are at increased risk for teen pregnancies and acquiring a sexually transmitted disease. This study examines predictors of early onset sexual intercourse in male and female residents of the United States. Methods: A nationally representative sample of N=7,643 females and N=4.928 males ages 15-44 was procured from the 2002 National Survey of Family Growth (NSFG), Cycle 6. Age at first sexual intercourse was used to define early onset of sexual debut(<18 years). Socio-demographic and behavioral characteristics of the respondents, demographic and selected reproductive characteristics of the respondent's parents were examined using multiple logistic regression modeling. Results: Non-fispanic black, being raised without both parents, having a mother less than 18 years old at the age of first birth and age difference between partners were significant predictors of early onset of sexual intercourse for both males and females. Maternal education less than high school was a significant protective factor for female respondents [OR=0.72 (95%CI=0.58- 0.90)] and paternal education completed high school only [OR=1.4 (95% CI=l. 1-1.7)] was a significant risk factor for male respondents. Conclusions: Racelethnicity, age difference between partners, not being raised by both parents, having a mother who had her first birth before the age of 18 and parental education are important predictor variables. Further study should be conducted to investigate the protective effect of lack of maternal education for female respondents. Intervention programs for teen pregnancy and sexually transmitted infection prevention should target these at risk groups.

Is Number Of Pregnancies A Risk Factor For Heart Attack In Women?, Pavan Kumar Irukulla

Theses and Dissertations

Background: Studies regarding number of pregnancies and coronary heart disease have shown inconsistent results. In the present study, we assessed the association between number of pregnancies and heart attack (HA) in women.Methods: Using data from NHANES III a cross sectional data analysis of 10634 women aged 17 and above was conducted. We considered socio-demographic factors and other potential risk factors including physical activity, smoking, alcohol, diabetes, hypertension, hypercholesterolemia, BMI, age, and family history of heart attack. We conducted Bivariate analysis to determine prevalence and crude odds ratios. Multivariate logistic regression analysis was used to adjust for confounding variables using SPSS. …