Medicine and Health Sciences Commons^™

Health Care Provider Knowledge And Routine Management Of Pre-Eclampsia In Pakistan, Sana Sheikh, Rahat Najam Qureshi, Asif Raza Khowaja, Rehana Salam, Marianne Vidler, Diane Sawchuck, Peter Von Dadelszen, Shujat Zaidi, Zulfiqar Bhutta

Department of Paediatrics and Child Health

Background: Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices.
Methods: We conducted a mixed method study in the districts of Hyderabad and Matiari …

Effect Of A Randomised Exclusive Breastfeeding Counselling Intervention Nested Into The Minimat Prenatal Nutrition Trial In Bangladesh, Ashraful Islam Khan, Iqbal Kabir, Hanna Eneroth, Shams El Arifeen, Eva-Charlotte Ekström, Edward A. Frongillo Jr., Lars Åke Persson

Faculty Publications

AIM: It is unknown whether maternal malnutrition reduces the effect of counselling on exclusive breastfeeding. This study evaluated the effect of breastfeeding counselling on the duration of exclusive breastfeeding, and whether the timing of prenatal food and different micronutrient supplements further prolonged this duration. METHODS: Pregnant women in Matlab, Bangladesh, were randomised to receive daily food supplements of 600 kcal at nine weeks of gestation or at the standard 20 weeks. They also were allocated to either 30 mg of iron and 400 μg folic acid, or the standard programme 60 mg of iron and folic acid or multiple micronutrients. …

Predictors Of Infant Age At Enrollment In Early Infant Diagnosis Services In Kenya., Kathy Goggin, Catherine Wexler, Niaman Nazir, Vincent S. Staggs, Brad Gautney, Vincent Okoth, Samoel A Khamadi, Andrea Ruff, Michael Sweat, An-Lin Cheng, Sarah Finocchario-Kessler

Manuscripts, Articles, Book Chapters and Other Papers

Despite the importance of early detection to signal lifesaving treatment initiation for HIV+ infants, early infant diagnosis (EID) services have received considerably less attention than other aspects of prevention of mother to child transmission care. This study draws on baseline data from an on-going cluster randomized study of an intervention to improve EID services at six government hospitals across Kenya. Two logistic regressions examined potential predictors of "on time" (infant ≤6 weeks of age) vs. "late" (≥7 weeks) and "on time" versus "very late" (≥12 weeks) EID engagement among 756 mother-infant pairs. A quarter of the infants failed to get …

Glucose Monitoring In Pregnancy Complicated By Diabetes., Aisha Sheikh, Abdul Jabbar

Department of Medicine

Diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Due to variations in insulin resistance throughout pregnancy there is a continuous need to implement Medical Nutrition Therapy (MNT), exercise and pharmacological treatments which have to be escalated. Self-monitoring of blood glucose (SMBG) is integral to the management of diabetes in pregnancy. Proper implementation of SMBG in pregnant women with diabetes requires patient education and understanding of its applications and limitations. Real-time results enable individuals to make informed daily self-care decisions regarding diet, exercise, and insulin. Retrospective analysis of SMBG data enables clinicians to develop individualized care plans, informing …

Baby, This World Is Cruel, Nytesia S. Ross

Journal of Multicultural Affairs

This poem is about a woman's fear of bringing a child into this world.

Trophoblast Major Histocompatibility Complex Class I Expression Is Associated With Immune-Mediated Rejection Of Bovine Fetuses Produced By Cloning, Heloisa M. Rutigliano, Aaron J. Thomas, Amanda Wilhelm, Benjamin R. Sessions, Brady A. Hicks, Donald H. Schlafer, Kenneth L. White, Christopher J. Davies

Animal, Dairy, and Veterinary Science Faculty Publications

Trophoblast cells from bovine somatic cell nuclear transfer (SCNT) conceptuses express major histocompatibility complex class I (MHC-I) proteins early in gestation, and this may be one cause of the significant first-trimester embryonic mortality observed in these pregnancies. MHC-I homozygous-compatible (n = 9), homozygous-incompatible (n = 8), and heterozygous-incompatible (n = 5) SCNT pregnancies were established. The control group consisted of eight pregnancies produced by artificial insemination. Uterine and placental samples were collected on Day 35 ± 1 of pregnancy, and expression of MHC-I, leukocyte markers, and cytokines were examined by immunohistochemistry. Trophoblast cells from all SCNT pregnancies expressed MHC-I, while …

Reproductive Health Knowledge Among African American Women Enrolled In A Clinic-Based Randomized Controlled Trial To Reduce Psychosocial And Behavioral Risk, Project Dc-Hope, Uba Backonja, Candace Robledo, Maeve Wallace, Katrina F. Flores, Michele Kiely

School of Medicine Publications

Background: Washington, DC, has among the highest rates of sexually transmitted infections and unintended pregnancy in the United States. Increasing women's reproductive health knowledge may help to address these reproductive health issues. This analysis assessed whether high-risk pregnant African American women in Washington, DC, who participated in an intervention to reduce behavioral and psychosocial risks had greater reproductive health knowledge than women receiving usual care.

Methods: Project DC-HOPE was a randomized, controlled trial that included pregnant African American women in Washington, DC, recruited during prenatal care (PNC). Women in the intervention group were provided reproductive health education and received tailored …

Preterm Birth And Air Pollution: Critical Windows Of Exposure For Women With Asthma, Pauline Mendola, Maeve Wallace, Beom Seuk Hwang, Danping Liu, Candace Robledo, Tuija Männistö

School of Medicine Publications

Background: Ambient air pollutants may increase preterm birth (PTB) risk, but critical exposure windows are uncertain. The interaction of asthma and pollutant exposure is rarely studied.

Objective: We sought to assess the interaction of maternal asthma and air pollutant exposures in relation to PTB risk.

Methods: Electronic medical records for 223,502 US deliveries were linked with modified Community Multiscale Air Quality model outputs. Logistic regression with generalized estimating equations estimated the odds ratio and 95% CIs for PTB on the basis of the interaction of maternal asthma and particulate matter with aerodynamic diameter of less than 2.5 microns and particulate …

Gestational Hormone Profiles Predict Human Maternal Behavior At 1-Year Postpartum, Laura M. Glynn, Elyssia Poggi Davis, Curt A. Sandman, Wendy A. Goldberg

Psychology Faculty Articles and Research

In many non-human species, including primates, gestational reproductive hormones play an essential role in the onset of maternal motivation and behaviors. We investigated the associations between prepartum estradiol and progesterone and maternal behavior at 1-year postpartum in 177 women. Blood was obtained at five gestational time points and an index of quality of maternal care was determined using a well-validated mother-child interaction protocol. Women who exhibited higher quality maternal care at 1-year postpartum were characterized by unique gestational profiles of estradiol, progesterone and the estrogen to progesterone ratio; specifically by slower accelerations and levels of these hormone trajectories beginning in …

Violence Against Pregnant Women With Disabilities, Ari K. Mwachofi

Journal of Health Disparities Research and Practice

Background

Each year, violence is perpetrated against 1.5 million US women, of whom 324,000 are pregnant. Violence in pregnancy has adverse effects on maternal and infant health. Although there are 4.7 million childbearing age women with disabilities, and their pregnancy rates are growing, there is very little information about violence against pregnant women with disabilities.

Objectives

The study questions are: Are there differences in pre- and in-pregnancy violence experiences of women with and without disabilities? Is disability a significant predictor of pre- and in-pregnancy violence against women?

Methods

The study uses data from the 2009 Pregnancy Risk Assessment Monitoring System …

Sangar & Nasira, Sangar, Nasira, Tsos

TSOS Interview Gallery

Sangar and his family are from Iran but are originally Turkish. In Iran they faced a psychological war and many problems that stemmed from discrimination. He points out how many are oppressed or discriminated against, but he and his family were singled out for their ethnicity. There was no hope for a bright future, and they decided to flee the country for the benefit of their children.

They fled to Greece through Turkey and had many issues with human traffickers, robbery, a treacherous journey across the sea, and problems in Moria refugee camp where his wife couldn’t get the care …

‘Essential But Not Always Available When Needed’ – An Interview Study Of Physicians’ Experiences And Views Regarding Use Of Obstetric Ultrasound In Tanzania, Annika Åhman, Hussein Kidanto, Matilda Ngarina, Kristina Edvardsson, Rhonda Small, Ingrid Mogren

Faculty of Health Sciences, East Africa

Background The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries.

Objective We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management.

Design A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis.

Results Use of obstetric ultrasound in the management of …

Important Strategies For Effective Family Planning Counseling, Savera Aziz Ali, Minaz Mawani, Gulshan Bano, Sumera Aziz Ali

School of Nursing & Midwifery

No abstract provided.

Air Pollution Exposure And Preeclampsia Among Us Women With And Without Asthma, Pauline Mendola, Maeve Wallace, Danping Liu, Candace Robledo, Tuija Männistö, Katherine Grantz

School of Medicine Publications

Maternal asthma and air pollutants have been independently associated with preeclampsia but rarely studied together. Our objective was to comprehensively evaluate preeclampsia risk based on the interaction of maternal asthma and air pollutants. Preeclampsia and asthma diagnoses, demographic and clinical data came from electronic medical records for 210,508 singleton deliveries. Modified Community Multiscale Air Quality models estimated preconception, first and second trimester and whole pregnancy exposure to: particulate matter (PM)<2.5 and <10µm, ozone, nitrogen oxides (NOx), sulfur dioxide (SO2) and carbon monoxide (CO); PM2.5 constituents; volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs). Asthma-pollutant interaction adjusted relative risks (RR) and 95% confidence intervals (CI) for preeclampsia were calculated by interquartile range for criteria pollutants and high exposure (≥75th percentile) for PAHs and VOCs. Asthmatics had higher risk associated with first trimester NOx and SO2 and whole pregnancy elemental carbon (EC) exposure than non-asthmatics, but only EC significantly increased risk (RR=1.11, CI:1.03-1.21). Asthmatics also had a 10% increased risk associated with second trimester CO. Significant interactions were observed for nearly all VOCs and asthmatics had higher risk during all time windows for benzene, ethylbenzene, m-xylene, o-xylene, p-xylene and toluene while most PAHs did not increase risk.

Health Care Seeking Behaviours In Pregnancy In Rural Sindh, Pakistan: A Qualitative Study, Rahat Najam Qureshi, Sana Sheikh, Asif Raza Khowaja, Zahra Hoodbhoy, Shujaat Zaidi, Diane Sawchuck, Marianne Vidler, Zulfiqar A. Bhutta, Peter Von Dadeslzen

Department of Paediatrics and Child Health

Background: Pakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour. It is essential to identify the barriers and facilitators that women and families encounter, when deciding to seek maternal care services. This study aimed to understand health-seeking patterns of pregnant women in rural Sindh, Pakistan.
Methods: A qualitative study was undertaken in rural Sindh, Pakistan as part of a large multi-country study in 2012. Thirty three focus group discussions and 26 in-depth interviews were conducted with mothers [n=173], male decision-makers [n=64], Lady Health Workers [n=64], Lady Health Supervisors [n=10], Women Medical Officers [n=9] and Traditional Birth …

Ramadan & Pregnancy, Omar Rizvi

Celebration of Learning

Fasting during Ramadan, the ninth month of the Muslim calendar, is one of the five pillars of Islam and is fard (obligatory) for all Muslims physically and mentally capable of doing so. In the Qur’an, it is made abundantly clear that religion and its acts of worship are not meant to pose undue difficulty or hardship (Qur’an 22:78, 5:6, 2:185). My paper explores the Islamic definitions for “unnecessary difficulty” and “physically capable” specifically in regards to pregnant women. At what point does fasting incur significant, if any, damage to the fetus that it should prevent the mother from participating in …

Perceptions Of The Role Of The Man In Family Planning, During Pregnancy And Childbirth: A Qualitative Study With Fifteen Nepali Men, Magdalena Mattebo, Bharati Sharma, Erica Dahlkvist, Eleonor Molinder, Kerstin Erlandsson

Journal of Asian Midwives (JAM)

Introduction: In Nepal, by tradition, family life and marriage are generally controlled by patriarchal norms, sanctions, values and gender differences. Women in Nepal have limited possibilities to make decisions regarding their sexual and reproductive health, as the husbands and other elders in the family make most of the decisions regarding family planning, pregnancy and childbirth.
Aim: To describe the perceptions of Nepali men regarding the role of the man with respect to family planning, pregnancy and childbirth.
Methods: A qualitative study was conducted with 15 Nepali men in both urban and rural areas. The material was analyzed through inductive …

Heavy Expectations: Reading Pregnancy In The Victorian Novel, Livia Arndal Woods

Dissertations, Theses, and Capstone Projects

This dissertation articulates the tendency of Victorian novels to make legible only the pregnant bodies of immodest characters who transgress gendered ideologies while the pregnant bodies of modest characters tend to go undescribed. Tracing the medicalization of pregnancy and childbirth over the course of the long nineteenth century, my chapters demonstrate the function of moralizing narrative conventions in the representation of pregnancy in mid-Victorian novels, of a self-conscious use of free indirect diagnosis in high-Victorian fiction, and a shift at the fin-de-siècle from pregnancy as a signifier of morality to a symptom of unstable minds. The novels I read closely …

Assessment Of Micronutrient Status In Pregnant Malawian Women Before And After Treatment For Moderate Malnutrition, Cambria M. Glosz

Master's Theses

Background: Multiple micronutrient deficiencies are prevalent in pregnant women in developing countries and can result in adverse effects to both the mother and infant. Multiple micronutrient supplements or supplementary foods may be a way to combat micronutrient deficiencies.

Objective: To assess change in micronutrient and protein levels in moderately malnourished pregnant Malawian women after receiving one of three nutritional interventions.

Methods: Serum retinol, 25-hydroxyvitamin D, ferritin, vitamin B₁₂, folate, zinc, albumin and C-reactive protein concentrations were measured in pregnant women with MUAC >20.6 cm and

Results: Baseline micronutrient concentrations indicated high rates of deficiency …

Human Papillomavirus And Its Impact On Vulnerable Populations, Harpriya Kaur

Theses & Dissertations

Human papillomavirus (HPV) is the most common sexually transmitted infection. The infection is higher in certain racial/ethnic groups and those who are immunocompromised including pregnant women. Because immune system is suppressed during pregnancy, women are at higher risk of various types of infection including HPV, a known risk factor for pregnancy complications. However, its role in adverse pregnancy outcomes is unclear. Another high risk population is Northern Plain American Indian. In the Northern Plains region, American Indian women have significantly higher rate of HPV infection than white counterparts and are infected with different types of HPVs than the general population. …

Examining The High Rate Of Infant Mortality Among Minorities In Norristown, Pa, Wendy Kaye

Graduate Theses & Dissertations

Background: According to the Centers for Disease Control (CDC) (2016), infant mortality is defined as “the death of a baby before his or her first birthday”. The statistics provided by the CDC (2016) state that 23,440 infants died in the US in 2013. Racial and ethnic minorities experience higher rates of infant mortality than White people. In Norristown, PA, between 2008 and 2012, the rate of infant death for African Americans was 25 percent, versus 15 percent for their Caucasian counterparts.

Purpose: The purpose of this paper is to examine the reasons for high infant mortality, with the goal of …

Ssri Use In Pregnancy And Congenital Heart Defects: A Meta-Analysis Of Population Based Cohort Studies, Elizabeth A. Kowalik

Senior Honors Projects

The American College of Obstetricians and Gynecologists estimate that 10-23% of pregnant women in the US face depression at some point during their pregnancy. However, no clear recommendations regarding the treatment of depression in pregnancy are available. Antidepressants are commonly used during pregnancy without clear evidence of their safety. A study of 1,106,757 women in 47 states found that 89,980 (8.1%) had taken an antidepressant at some point during their pregnancy. The Centers for Disease Control and Prevention (CDC) found that 298 (4.5%) of 6582 women in 10 states between the years of 1998 and 2005 had taken an antidepressant …

Psychological And Sociocultural Influences Of Current And Historical Intimate Partner Violence In Pregnancy, Cindy D. Phillips

Electronic Theses and Dissertations

The Centers for Disease Control and Prevention (CDC) estimates that 1.5 million women are victims of intimate partner violence (IPV) each year, and 324,000 of these women are pregnant (2013). Research on the predictability of certain factors and their relationship to current and historical IPV is limited. In order to better understand IPV as it related to a sample of 1,016 Appalachian pregnant women selected for the Tennessee Interventions for Pregnant Smokers (TIPS), it was important to evaluate various influences that may predict the prevalence of IPV in this population when compared to the State of Tennessee and the U.S. …

Preeclampsia: The Roles Of Acute Inflammation And Intrauterine Stress, Nicholas Parchim

Dissertations and Theses (Open Access)

Preeclampsia (PE) is a severe, acute disease of pregnancy affecting approximately 8% of pregnant women after week 20 of gestation. PE is characterized by hypertension and renal damage reflected by proteinuria and has significant morbidity to both mother and fetus. Maternal symptoms range from headaches, nausea, edema, to visual changes, but once maternal symptoms present, damage to the fetus has begun. Mothers who progress untreated through the disease can also experience a condition called eclampsia characterized by seizure, coma, and, ultimately, death. PE-affected newborns experience features similar to prematurity—abnormal lung and renal development, intrauterine growth retardation (IUGR), and, possibly, fetal …

The Effects Of Iron Deficiency Anemia And Iron Supplementation In Pregnancy, Anna J. Cox

Senior Honors Theses

Iron deficiency anemia (IDA) is a condition that occurs in both underdeveloped and developed countries worldwide. This disorder is diagnosed in an individual who presents the common signs and symptoms of anemia along with consistently low clinical markers of stored iron. Iron deficiency (ID) usually precedes a diagnosis of IDA as the insufficient amount of iron often goes undetected until one’s quality of life is diminished. Certain populations, such as women who are pregnant or of reproductive age, are particularly at risk for ID and the development of IDA. During pregnancy, the recommended dietary allowance (RDA) for iron is greater …

Pregnancy And Childbirth Practices Among Immigrant Women From India: “Have A Healthy Baby”, Rama Cousik, M. Gail Hickey

The Qualitative Report

In India, practices relating to pregnancy, childbirth and child development have been rooted in cultural beliefs and traditions that are based on knowledge contained in ancient Indian texts. Many Indians residing across the globe continue to observe these practices. Some may find it challenging to do so when they are residing abroad, away from familiar surroundings and separated from their extended families. A small body of research exists that shows that migrant Indian women do observe traditional maternal practices based on cultural beliefs, but there is a need to learn more about how this knowledge is acquired, disseminated and preserved. …

Neonatal Abstinence Syndrome: Pharmacologic Strategies For The Mother And Infant., Walter K. Kraft, Megan W. Stover, Jonathan M. Davis

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet …

The Relationship Between Religiosity And Health-Promoting Behaviors In Pregnant Women At Pregnancy Resource Centers, Natalie Cyphers, Andrea D. Clements, Jody L. Ralph

ETSU Faculty Works

Abstract available through the Annals of Behavioral Medicine.

Toward Earlier Inclusion Of Pregnant And Postpartum Women In Tuberculosis Drug Trials: Consensus Statements From An International Expert Panel., Amita Gupta, Jyoti S. Mathad, Susan M. Abdel-Rahman, Jessica D. Albano, Radu Botgros, Vikki Brown, Renee S. Browning, Liza Dawson, Kelly E. Dooley, Devasena Gnanashanmugam, Beatriz Grinsztejn, Sonia Hernandez-Diaz, Patrick Jean-Philippe, Peter Kim, Anne D. Lyerly, Mark Mirochnick, Lynne M. Mofenson, Grace Montepiedra, Jeanna Piper, Leyla Sahin, Radojka Savic, Betsy Smith, Hans Spiegel, Soumya Swaminathan, D Heather Watts, Amina White

Manuscripts, Articles, Book Chapters and Other Papers

Tuberculosis is a major cause of morbidity and mortality in women of childbearing age (15-44 years). Despite increased tuberculosis risk during pregnancy, optimal clinical treatment remains unclear: safety, tolerability, and pharmacokinetic data for many tuberculosis drugs are lacking, and trials of promising new tuberculosis drugs exclude pregnant women. To advance inclusion of pregnant and postpartum women in tuberculosis drug trials, the US National Institutes of Health convened an international expert panel. Discussions generated consensus statements (>75% agreement among panelists) identifying high-priority research areas during pregnancy, including: (1) preventing progression of latent tuberculosis infection, especially in women coinfected with human …

Smoking Characteristics And Psychiatric Comorbidities Of Pregnant Smokers: An Analysis Of Quit4baby Randomized Controlled Trial, Shawn Chiang, Lorien C. Abroms, Jennifer M. Schindler-Ruwisch, Leah E. Leavitt

GW Research Days 2016 - 2020

Background: Text messaging or short message service (SMS) programs have been shown to be effective in helping adult smokers quit smoking (Abroms et al., 2014). However, to our knowledge, no prior research has examined psychiatric comorbidities associated with smoking in the text messaging context. The risk of smoking has been shown to increase as a function of the number of psychiatric illnesses with which a person is diagnosed (Aubin, Rollema, Svensson, & Winterer, 2012). The current study examined this association and other correlates of smoking-psychiatric comorbidity in a sample of U.S. pregnant smokers enrolled in Quit4Baby, a smoking cessation text …