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1
Shub, Alexis. "Periodontal disease and adverse pregnancy outcomes." University of Western Australia. School of Women's and Infants' Health, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0184.
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[Truncated abstract] Periodontal disease is a common and underdiagnosed disease in humans that may have adverse effects on pregnancy outcomes. The aim of this thesis was to investigate the effects of periodontal disease in pregnancy by means of two observational human studies and the development of animal models of fetal and uterine exposure to periodontopathic bacteria and lipopolysaccharide. I performed a prospective study examining the rates of preterm birth, small for gestational age neonates and neonatal inflammation in 277 women who had undergone a detailed antenatal periodontal examination and oral health questionnaire. Periodontal disease was associated with small for gestational age neonates, and increased CRP levels in umbilical cord blood, but no effect was seen on the rate of preterm birth. Maternal oral health symptoms predicted both periodontal disease and newborn biometry. In a retrospective case control study, I examined the role of periodontal disease in perinatal mortality. Participants included 53 women who had experienced a perinatal loss for which no cause could be found after thorough investigation, and 111 control women. Women who had experienced a perinatal loss were more than twice as likely as controls to have periodontal disease. The incidence of periodontal disease was even higher in women in whom the perinatal loss was due to extreme prematurity. In contrast to my prospective study, risks to the pregnancy could not be predicted by maternal oral health behaviours or oral health symptoms. In order to better understand the mechanisms regulating the associations described in the human studies, two animal models were developed; one to investigate acute exposure and the second to investigate long-term exposure to periodontal pathogens. The first study examined the effects of administration of a bolus of periodontopathic bacteria and lipopolysaccharide to the pregnant sheep. Injection of bacteria and lipopolysaccharide in the amniotic fluid of the pregnant preterm sheep caused a high rate of fetal lethality, disturbance of fetal acid base status and inflammation of the fetus and membranes. Given the circumstances of exposure to periodontopathic pathogens in human periodontal disease, a model investigating long-term exposure to periodontopathic lipopolysaccharide on pregnancy outcomes was developed. ... Overall, I have demonstrated that maternal periodontal disease is associated with adverse pregnancy outcomes including fetal growth restriction and possibly perinatal loss. Mechanisms regulating these effects are likely to be mediated by fetal adaptations to intrauterine inflammation resulting in altered fetal development, growth or survival. Randomised controlled trials that are currently in progress will provide further information on the effects of periodontal disease in human pregnancy, and the efficacy of treatment to reduce these adverse outcomes.
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Janssen, Patti Alice. "Domestic violence and adverse pregnancy outcomes /." Thesis, Connect to this title online; UW restricted, 2001. http://hdl.handle.net/1773/10912.
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Price, Tabitha. "Periodontal Disease and Adverse Pregnancy Outcomes: Treatment Recommendations for the Pregnant Patient." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/2530.
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Gaudet, Laura. "Macrosomia and Related Adverse Pregnancy Outcomes: The Role of Maternal Obesity." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/22802.
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Fetal overgrowth is associated with adverse outcomes for offspring and with maternal obesity. Results from a systematic review and meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birthweight ≥4000g (OR 2.17, 95% CI 1.92, 2.45), birthweight ≥4500g (OR 2.77, 95% CI 2.22, 3.45) and birthweight ≥90%ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). A retrospective cohort study revealed that mothers whose infants are macrosomic are more likely to require induction of labour (OR 1.42, 95% CI 1.10-1.98) and delivery by Cesarean section (OR 1.45, 95% CI 1.04-2.01), particularly for maternal indications (OR 3.7, 95% CI 1.47-9.34), if they are obese. Infants from these pregnancies are significantly more likely to require neonatal resuscitation in the form of free flow oxygen (OR 1.57, 95% CI 1.03, 2.42) than macrosomic infants of non-obese mothers. Thus, co-existing maternal obesity and macrosomia increases the risk of adverse pregnancy outcomes.
5
Allen, Rebecca Emma. "Prediction and prevention of preeclampsia and other adverse pregnancy outcomes." Thesis, Queen Mary, University of London, 2018. http://qmro.qmul.ac.uk/xmlui/handle/123456789/33944.
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Aim To assess current methods of prediction of adverse pregnancy outcomes, develop a prediction model and assess diet and life style in preventing preeclampsia. Methods Meta-analyses performed to assess the role of abnormal 1st trimester biomarker levels in predicting PE and the predictive accuracy of 2nd trimester UAD indices for stillbirth. A prospective observational study was performed to assess the efficacy of maternal characteristics, biomarkers, arteriography and UADs for predicting adverse pregnancy outcomes. Previously published 1st trimester PE prediction models were validated using data collected from the observational study. A systematic review on the effect of diet and life style based metabolic risk modifying interventions on PE was performed. Results The review of biomarkers found that abnormal levels were particularIy associated with early onset PE. The stillbirth review demonstrated a three-four fold increased risk of still birth with abnormal UAD. 1045 women were included for analysis in the prospective observational study. Our models' detection rate (false positive rate of 15%) was 72% for PE; 48% PIH; 30 % SGA < 10th centile; 57% SGA < 5th centile and 67% stillbirth. In the validation study the observed discrimination ability in the derivation studies ranged from 0.70 to 0.954. When validated against the study cohort, the AUC varied importantly, ranging from 0.504 to 0.833. Dietary interventions were shown to reduce the risk of PE by 33%, with no reduction in risk with mixed interventions or fatty acid supplementation. Conclusion The high heterogeneity of studies in the systematic reviews makes it difficult to draw firm conclusions regarding the use of biomarkers or UADs in screening for pregnancy complications. Our prospective study showed a role for haemodynamics as part of routine 1st trimester screening for assessing the risk of hypertensive disease in pregnancy.
6
Potdar, Neelam. "Maternal caffeine consumption and its relationship to adverse pregnancy outcomes." Thesis, University of Leicester, 2010. http://hdl.handle.net/2381/8325.
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There are conflicting reports about the association of maternal caffeine intake with adverse pregnancy outcomes, specifically fetal growth restriction (FGR). Differences in study design and exposure definition have been partly responsible. In order to study the association between maternal caffeine consumption and FGR, I prospectively quantified caffeine intake in pregnancy from all known sources, assessed caffeine metabolism in pregnancy and used serial ultrasound growth scans to identify FGR fetus. In a prospective study of 1340 pregnant women in Leicestershire, UK, I quantified total caffeine intake from 4-weeks prior and throughout pregnancy using a validated caffeine assessment tool. Caffeine half-life (used here as proxy for clearance) was determined by measuring caffeine in saliva after a caffeine challenge. The primary outcome measure was FGR, which was determined by customised birth weight centile calculator and in a subgroup by serial ultrasound growth scan. Mean caffeine consumption decreased in the 1st and then increased in the 3rd trimester. Caffeine consumption throughout pregnancy was associated with an increased risk of FGR: OR = 1.2 (95% CI, 0.9 to 1.6) for 100-199 mg/day, OR = 1.5 (1.1 to 2.1) for 200- 299 mg/day, and OR = 1.4 (1.0 to 2.0) for over 300 mg/day compared to < 100 mg/day (Ptrend< 0.001). There was some evidence that the effect of caffeine on FGR was strongest in women with faster caffeine clearance (P = 0.06). On comparing outcome measure of FGR as defined by serial ultrasound growth scans in pregnancy and customised centile calculator, there was a moderate degree of agreement between the two methods (κ = 0.38, CI 0.26, 0.49). Caffeine consumption during pregnancy is associated with an increased risk of FGR and this effect is continuous throughout pregnancy. This effect was observed from four weeks before pregnancy and was statistically significant in the first trimester. A public health recommendation for pregnant women would be to reduce or limit the caffeine intake to a maximum of 2 cups of tea/coffee per day. Future research is required to study the mechanistic effect of caffeine on trophoblastic tissue.
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Giakoumelou, Sevasti. "The role of Chlamydia trachomatis infection in adverse pregnancy outcomes." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/29574.
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Chlamydia trachomatis (Ct), the most common sexually transmitted bacterium, has been associated with adverse pregnancy outcomes including controversial data on miscarriage, intrauterine growth restriction and low birth weight, however the causative mechanisms are unknown. A successful pregnancy requires normal endometrial stromal cell (ESC) decidualisation and trophoblast invasion, processes that involve chemokine action and lead to successful implantation. My objectives were to determine whether Ct infection impacts upon ESC decidualisation and chemokine secretion on human primary ESC invitro, to investigate the role of Ct infection in pregnancy in-vivo using a murine model of pregnancy and to investigate the role of Ct in miscarriage in a statistically powered case control study. A novel finding is that Ct can infect and proliferate in ESC, resulting in suboptimal decidualisation as measured by decidualisation marker prolactin’s reduced mRNA and protein levels in infected ESC. Furthermore, the altered secreted chemokine profile of decidualised ESC suggests an attenuated innate immune response from infected ESC. Focusing on chemokines C-X-C motif chemokine 12 (CXCL12) and CXCL16, important for trophoblast invasion, decreased mRNA and protein concentrations were detected in infected decidualised cells. From the in-vivo mouse model of past Ct infection in pregnancy, it was demonstrated that Ct infection did neither affect the fertility of the mice, pregnancy or resorption numbers in C3H mice nor alter embryonic and placental weight on e12 embryos. However, Ct infection caused reduction of embryo and placenta weight on e14 embryos. Finally, preliminary data from the case control study indicate that past Ct infection is not associated with miscarriage. Our in house PGP3 ELISA that detects past Ct infection was more sensitive than a commercially available MOMP ELISA. My data suggests that Ct infection affects pregnancy during the implantation stage by impairing decidualisation and altering chemokine secretion predisposing for adverse pregnancy outcomes that include growth restriction during later gestation.
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Cheong-See, Fi. "Predictors for adverse maternal and fetal outcomes in high risk pregnancy." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/25811.
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This thesis aims to undertake health technology assessments in high risk pregnancies through the following objectives: 1. In women with pre-eclampsia, a) To evaluate the association of maternal genotype and severe pre-eclampsia b) To assess the accuracy of tests in predicting adverse pregnancy outcomes c) To develop composite outcomes for reporting in trials on late onset pre-eclampsia 2. In women with multiple pregnancy, a) To study the association between chorionicity and stillbirth b) To identify the optimal timing of delivery in monochorionic and dichorionic twin pregnancies 3. In the field of prediction research in obstetrics a) To provide an overview of the existing prognostic models and their qualities b) To evaluate the methodological challenges and potential solutions in developing a prognostic model for complications in pre-eclampsia Methods The following research methodologies were used: Delphi survey, systematic reviews and meta-analyses. Results 1. a) Maternal genotype and severe pre-eclampsia: 57 studies evaluated 50 genotypes; increased risk of severe pre-eclampsia with thromobophilic genes. b) Accuracy of tests in predicting pre-eclampsia complications: 37 studies evaluated 13 tests. No single test showed high sensitivity and specificity. c) Delphi survey of 18/20 obstetricians and 18/24 neonatologists identified clinically important maternal and neonatal outcomes and maternal and neonatal composite outcomes were developed. 2. Prospective risk of stillbirth and neonatal deaths in uncomplicated monochorionic and dichorionic twin pregnancies: 32 studies were included. In dichorionic twin pregnancies, the risk of stillbirths was balanced against neonatal death at 37 weeks' gestation. In monochorionic pregnancies, there was a trend towards increase in stillbirths after 36 weeks but this was not significant. 3. a) From 177 studies included, 263 obstetric prediction models were developed for 40 different outcomes, most commonly pre-eclampsia, preterm delivery, mode of delivery and small for gestational age neonates. b) The obstetric prognostic model challenge of dealing with treatment paradox was explored and seven potential solutions proposed by expert consensus. Conclusion I have identified the strength of association for genes associated with complications in pre-eclampsia, components for composite outcomes for reporting in studies on pre-eclampsia, and the optimal timing of delivery for twin pregnancies. My work has highlighted the gaps in prediction research in obstetrics and the limitations of individual tests in pre-eclampsia.
9
Nilsson, Emma. "Genetic epidemiological studies of adverse pregnancy outcomes and the role of schizophrenia /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-590-9/.
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Wright, Erica, and n/a. "Gestational diabetes : a management approach to identify increased risk of an adverse pregnancy outcome." University of Canberra. Nursing, 1997. http://erl.canberra.edu.au./public/adt-AUC20061110.171500.
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Gestational diabetes (GDM) is a potentially serious disorder requiring timely
diagnosis and management to prevent adverse maternal and fetal outcomes.
Of increasing concern today, when treating the woman with GDM, is the need
to provide every woman with an intensive management plan to optimise the
likelihood of favourable pregnancy outcomes. Early identification of those
women with GDM who require insulin therapy in addition to diet therapy would
be beneficial in the planning and standardisation of clinical management
protocols, to enhance pregnancy outcomes and increase cost benefits with
improved allocation of resources.
The aim of this study was to evaluate the ability of the fasting plasma glucose
level (FPG) at diagnosis to predict an increased risk to the fetus and the need
for insulin therapy in a pregnancy complicated by GDM.
A prospective longitudinal study design and recruitment by convenience sample
was used. Data were obtained from 327 women and their babies. Diagnosis of
GDM was made by a 75 gram oral glucose tolerance test (OGTT) using
Australasian Diabetes in Pregnancy Society (ADIPS) criteria with the exception
of seven women diagnosed on a blood glucose level >11.1mmol/l. Following
consent of the women data were collected by a self report questionnaire and
the medical record system at three points; at first intervention, following delivery
and at the postpartum OGTT. Demographic, social, medical, maternal and
neonatal outcome data were collected. The management protocol was similar
for all of the women. Following nutritional intervention any woman who could
not meet the glycemic targets of <= 5mmol/l fasting and/or <= 6.5mmol/l two hours
postprandial was commenced on insulin therapy.
The women had a mean age of 32 years, body mass index (BMI) of 25.7 and
parity of 2 (range 1-12). Diagnosis was made at an average of 30 weeks and
70 women required insulin therapy with a mean dose of 34 IU per day,
commencing at a mean of 31 weeks gestation. Mean birthweight was 3400G.
Of the babies 12% were >4000G. Congenital abnormalities occurred in 3%,
neonatal morbidities in 2% and there was 1 death in utero.
Logistic regression analysis found the following significant associations:
Increasing maternal BMI was related to increasing FPG levels at diagnosis and
the requirement of higher insulin doses. There was a negative linear
relationship to weight gain. Ethnicity was associated with maternal BMI and
ethnicity with BMI was associated with birthweight in the specific ethnic group.
BMI with insulin therapy as a covariate and the FPG value at OGTT were
predictive of persistent glucose intolerance in 14% of women postpartum.
Each value of the OGTT was a significant predictor of the need for insulin
therapy as a function of the week of gestation. The FPG level was the
statistical model of best fit. A 50% probability for requiring insulin was reached
with a FPG at diagnosis of 4.0 mmol/l if tested at 10 weeks gestation, 5.1mmol/l
at 20 weeks and 6.1 mmol/l at 30 weeks (p<.001).
These results support the substantive research aim of the study. The model
has the power to predict the probability (risk) of requiring insulin therapy based
on the maternal FPG level at the OGTT according to the week of gestation.
The study results demonstrate that glucose intolerance is linked to a number of
adverse maternal and fetal outcomes in a continuous and graded fashion. The
degree of reversibility of maternal and fetal risk through therapeutic
interventions such as nutrition therapy, blood glucose monitoring, exercise and
active patient participation aimed at improving glucose tolerance is unknown.
Therefore, the rationale for, and feasibility of, new treatment strategies such as
the application of this statistical model as a management approach require
large scale randomised intervention studies, oriented toward measuring
maternal and fetal outcomes amongst different populations.
11
Magnusson, Linda L. "Parental exposures and occurrence of adverse pregnancy outcomes and childhood atopic diseases /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-673-5/.
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Clausson, Britt. "Risk factors and adverse pregnancy outcomes in small-for-gestational-age births." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2000. http://publications.uu.se/theses/91-554-4858-5/.
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Steele, Larry Lee. "Occupational exposures and adverse pregnancy outcomes among a cohort of female veterinarians /." The Ohio State University, 1992. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487760357821299.
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Jourdain, Angela Rosa. "Racial Disparities, Fragmentation of Care, and Adverse Outcomes Associated with Ectopic Pregnancy." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7673.
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Ectopic pregnancy (EP) is a rare condition that occurs in 1% of all pregnancies. However, women of lower socioeconomic status (SES) and ethnic minority groups are at greater risk of adverse outcomes associated with EP than White women. The purpose of this study was to examine data from the 2014 National Inpatient Sample to identify predictors of complications from EP in 2,626 females ages 15-44 in the United States. The theoretical framework used to guide this study was the theory of fundamental causes to explain why the association between SES and mortality has persisted despite progressive advances in the diseases and risk factors that are believed to explain it. Independent t-tests were conducted to determine whether significant differences in patient outcomes existed between EP participants who required one medical intervention during hospitalization and those with two or more medical interventions. Multiple linear regression analyses were used to examine the association between race, primary expected payer, income, number of procedure codes on record, number of diagnoses on record, and length of stay. The key findings were that for every increase in number of procedures (β = 0.13, p <.001) the length of stay also increased by 0.13 units; for every increase in number of diagnoses (β = 0.37, p <.001) length of stay increased by .37 units, and within the Black racial/ethnicity (β = 0.05, p < .05) length of stay increased by 0.05 units. Finally, for females within a higher income quartile of $45,000 or more (β = .08, p < .001), length of stay decreased by -0.08 units. Positive social change implications may include assistance to public health professionals in identifying individual factors that place women at increased risk for EP and the ability to increase EP prevention activity in populations that may be more susceptible to the condition and complications.
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Magadi, Monica Akinyi. "The determinants of poor maternal health care and adverse pregnancy outcomes in Kenya." Thesis, University of Southampton, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310540.
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Teixeira, Cláudia Sofia Morais. "Metabolic syndrome in pregnancy as a predictor of adverse obstetric and neonatal outcomes." Master's thesis, Instituto de Ciências Biomédicas Abel Salazar, 2008. http://hdl.handle.net/10216/20993.
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Malaba, Thokozile Rosemary. "Antiretroviral therapy use during pregnancy and adverse birth outcomes in South African women." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25352.
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Background Studies suggest antiretroviral therapy (ART) use during pregnancy may be associated with adverse pregnancy outcomes. Given the large numbers of pregnancies exposed to ART, better understandings of potential associations with commonly used ART regimens and adverse pregnancy outcomes is critical. With the number of women on ART initiated before conception rapidly increasing, understanding how current recommended regimens and timing of ART initiation may influence pregnancy outcomes is critically important. Methods This mini-dissertation presents a research protocol (Section A), literature view (Section B) and journalformatted manuscript (Section C) for a study of ART use and birth outcomes among HIV-infected women and a comparator cohort of HIV-uninfected women. Pregnant women seeking care at the Gugulethu MOU, a primary-level antenatal care facility in Cape Town, South Africa were enrolled between March 2013 and August 2015. Pregnancy dating was based on research ultrasound, or last menstrual period/clinical exam where ultrasound was unavailable. Women were followed from their 1st antenatal visit through delivery. Analyses compared birth outcomes (preterm (PTD), low birthweight (LBW) and small for gestational age (SGA) deliveries) between HIV-infected and uninfected women; and between women on ART initiated before conception versus those initiating ART during pregnancy. Results In 1554 women with live singleton births (mean birthweight, 3079g; 21% preterm; 13% LBW; 12% SGA), a higher prevalence of PTD (22% vs 13%, p=0.001) and LBW (14% vs 9%, p=0.030) were observed in the HIV-infected compared to HIV-uninfected women. Adverse birth outcomes (PTD, LBW and SGA) did not vary systematically among the HIV-infected women regardless of ART initiation timing (initiated ART before conception or initiated ART to during pregnancy). The absence of associations between the adverse birth outcomes and timing of ART initiation persisted after adjusting for maternal age, parity, height, CD4 cell count and viral load at 1st visit. Conclusions Levels of adverse birth outcomes, in particular PTD, remain high among HIV-infected women, however our findings from a routine care cohort demonstrate that the timing of initiation of widely used regimens before conception or during pregnancy do not appear to be associated with an increased risk in adverse pregnancy outcomes.
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Teixeira, Cláudia Sofia Morais. "Metabolic syndrome in pregnancy as a predictor of adverse obstetric and neonatal outcomes." Dissertação, Instituto de Ciências Biomédicas Abel Salazar, 2008. http://hdl.handle.net/10216/20993.
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Onyebuchi, Chinyere. "Effects of Neighborhood Membership and Hypertensive Disorders in Pregnancy on Adverse Birth Outcomes." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6935.
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Infant mortality (IM) rates in the United States remains high. The higher rates of IM among specific groups in the United States is believed to be fueled by the high rates of adverse birth outcomes including low birthweight (LBW) and preterm births (PTB) among these groups. Adverse birth outcomes have also been linked to the presence of hypertensive disorders during pregnancy. The purpose of this cross-sectional study was to explore the association between hypertensive disorders during pregnancy and adverse birth outcomes and the impact of the residential neighborhood of expectant mothers on this association. The life course health development theory guided the framework for this study. Study data were obtained from the 2010 New York City birth records and the 2010 US Census. Descriptive statistics and logistic regression analysis were used to address the 3 research hypotheses of the study. The study found that prepregnancy hypertension (HTN) (AOR: 2.84 & 3.25), gestational HTN (AOR: 2.28 & 3.33) and eclampsia (AOR: 4.41 & 6.70) were significantly associated with PTB and LBW respectively. Neighborhood segregation was not significant for PTB (AOR: 1.01) or LBW (AOR: 1.03). Neighborhood poverty was significant for PTB (AOR: 0.86) but not for LBW (AOR: 1.05). Neighborhood segregation and poverty had significant moderating effects on the prepregnancy HTN (p = 0.00), gestational HTN (p = 0.00), eclampsia (p = 0.00) and PTB and LBW association. Results from this study can help to address disparities in birth outcomes among women of differing races and ethnicities and thereby contribute to positive social change.
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Watson-Jones, Deborah Lindsay. "Impact of syphilis on outcome of pregnancy and evaluation of syphilis screening strategies for the reduction of adverse pregnancy outcomes in Mwanza, Tanzania." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246851.
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Chukwuemeka, Scholarstica Chinwe. "Adverse Foetal Outcomes in Gestational Diabetes: A Systematic Review and Meta-analysis." University of the Western Cape, 2020. http://hdl.handle.net/11394/7920.
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Magister Pharmaceuticae - MPharm<br>Gestational diabetes mellitus (GDM) is a condition that affects pregnant women and is one of the most common complications related to pregnancy. According to the World health organisation (WHO), the usual window for diagnosing GDM is between 24 and 28 weeks of gestation and the primary aim of diagnosing gestational diabetes is to identify women and infants at risk of short- or longer-term adverse outcomes. Recent results from the hyperglycaemia and adverse pregnancy outcome (HAPO) study have suggested that even mild levels of hyperglycaemia can have adverse effects on foetal outcomes but there are uncertainties about the prevalence of these outcomes in GDM diagnosed according to the latest WHO 2013 guideline and/or IADPSG 2010 criteria in diverse populations. GDM prevalence has been studied by different researchers, but the prevalence of adverse foetal outcomes in GDM diagnosed based on the latest WHO 2013 guideline and/or IADPSG 2010 criteria have not yet been explored except for the data published by the HAPO study. Due to the lack of sufficient knowledge on foetal outcomes in GDM, this study was conducted to review the evidence on the prevalence of adverse foetal outcomes in GDM diagnosed according to WHO 2013 guideline and/or the IADPSG 2010 criteria. Different databases including PubMed, Science Direct, Google Scholar and CINAHL as well as bibliographic citations were searched using a well-formulated search strategy to find the relevant observational studies (prospective/retrospective cohort and case-control) using explicit inclusion and exclusion criteria. The following search terms were used, “gestational diabetes”, “pregnancy”, “adverse fetal outcomes” and “adverse foetal outcomes”. The findings of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the obtained data analysed using MetaXL ® version 5.3. This review was registered online on PROSPERO, the International prospective register of systematic reviews (registration number: CRD42020155061). Fifteen studies with 88,831 pregnant women (range: 83-25,543 participants) from 12 countries around the world were identified, with a wide variation in the prevalence of foetal outcomes in GDM using the stipulated criteria. These studies were unevenly distributed geographically as six of them were conducted in Asia, four in Europe, four in North America, one in Australia and none in Africa, Antarctica and South America. A meta-analysis found that the overall prevalence of foetal outcomes ranged from 1% (perinatal mortality) to 11% ( large for gestational age). The finding is limited due to the paucity of data on the prevalence of foetal outcomes in GDM. However, more studies using these criteria in low- and middle- income countries (LMICs) are needed by health care providers, to inform practice and allocate resources for control of GDM and its adverse foetal outcomes in diverse settings and ethnic groups, especially in LMICs.
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Wong, Matthew Roy. "Methodological and ethical issues in the study of maternal smoking and adverse pregnancy outcomes." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0015/MQ49778.pdf.
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Dummer, Trevor J. B. "Investigating adverse pregnancy outcomes in Cumbria, 1950-93 : an integrated geographical and statistical analysis." Thesis, University of Newcastle Upon Tyne, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246623.
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Tennant, Peter William George. "Pre-pregnancy obesity, pre-existing diabetes, and the risks of serious adverse fetal outcomes." Thesis, University of Newcastle upon Tyne, 2016. http://hdl.handle.net/10443/3447.
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The epidemics of obesity and diabetes are two of the leading threats to health in the 21st century. Maternal obesity complicates a large and increasing minority of pregnancies, and pre-existing diabetes is one of the most common maternal chronic health complications of pregnancy. This Doctoral Statement presents a portfolio of six published articles that draw on the North of England’s long-standing population-based registries of maternal and perinatal health to investigate the effects of pre-pregnancy obesity and diabetes on a range of serious adverse pregnancy outcomes. The first two articles examined a cohort of pregnant women who delivered in five of the region’s hospitals during 2003-2005 to explore the associations between maternal body mass index and the risks of, 1) congenital anomaly and 2) fetal and infant death. The next three examined a cohort of pregnant women with pre-existing diabetes who delivered during 1996-2008 to explore the effects of the condition on, 1) congenital anomaly, 2) birth weight, and 3) fetal and infant death. The final article examined women with pre-existing diabetes who had delivered two successive pregnancies to explore the influences of recurrent adverse pregnancy outcome. Maternal pre-pregnancy obesity and diabetes were both associated with increased risks of congenital anomaly, stillbirth, and infant death, with stronger effects for diabetes than obesity. In diabetes, peri-conception glycaemic control was strongly associated with birthweight and the risks of congenital anomaly, stillbirth, and infant death, and previous adverse outcome was associated with a doubled risk in the second pregnancy. For each article I provide a contemporary analysis of its contribution to the literature and critique of the methodology. The wider relevance of the research is also considered by discussing the evidence for causality, potential mechanisms, and implications for public health. Finally, I reflect on my individual contributions and my development towards an independent epidemiologist.
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Wong, Tang. "The Risk Stratification of Women with Gestational Diabetes: Can we predict adverse pregnancy outcomes?" Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20831.
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Background: Risk informed models of care are critical to addressing the workload for diabetes services with the rising prevalence of Gestational Diabetes (GDM) Aim: To explore the effect of glycaemic, weight and non-glycaemic/weight related factors on the risk of adverse pregnancy outcomes Methods: Data was obtained from 11,011 singleton pregnancies at Bankstown-Lidcombe Hospital from 2010-2015. Outcomes included the incidence of pre-eclampsia, prematurity, induction of labour, caesarean section, low birthweight, SGA (<10thcentile), macrosomia, LGA (>90thcentile), Apgar scores and neonatal ICU admissions. Birthweight centiles were calculated using the customised calculator. Outcomes were assessed in women in fasting glucose 5.1-5.4mmol/L (IADPSG-GDM) compared to normal glucose tolerant women (NGT) and ADIPS1998-GDM versus NGT women. In another dataset of 3095 singleton GDM pregnancies from 1992-2013, outcomes were assessed in women with GWG below, according to or above the Institute of Medicine (IOM) targets. Modifying these targets was evaluated. Risk prediction models and calculators for adverse pregnancy outcomes were formulated to integrate non-glycaemic and non-weight related variables. Results: Women with fasting glucose between 5.1-5.4mmol/L were at a two-fold risk of LGA compared to women with NGT, thus supporting the new IADPSG criteria change. Treatment of GDM reduced maternal GWG and attenuated the risk of LGA Excessive GWG above IOM, resulted in increased rates of LGA, macrosomia and caesarean section. Modifying the IOM weight gain targets did not attenuate adverse outcomes. Finally, a number of non-glycaemic factors were associated with adverse pregnancy outcomes in GDM and were integrated into a risk prediction model. This thesis also presents a proposed risk informed model of care. Conclusion: A combination of glycaemic, weight gain and non-glycaemic/non-weight related factors could be used to predict the risk of adverse outcomes in GDM pregnancies.
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Rowell, Tiffany A. "Examining the Impact of Pregnant Black Women's Adverse Childhood Experiences through Maternal Health and Birth Outcomes." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1587137374251612.
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Christopher, Kenneth E. "The Effects of Hurricane and Tornado Disasters on Pregnancy Outcomes." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3436.
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Maternal prenatal exposure to hurricanes and tornadoes could contribute to an increased risk for adverse birth outcomes. Little is known about the effects of Hurricane Katrina of August 2005, on pregnancy outcomes in Mississippi. Additionally, little is known about the influence of the April 2011 Alabama tornado disaster on births in that state. The purpose of this study was to bridge this knowledge gap by examining the relationship between maternal prenatal exposure to these storms and adverse infant health outcomes. The theoretical framework guiding this retrospective, cross-sectional study was the life course approach. Data for this investigation included 2,000 records drawn from the Linked Infant Births and Deaths registers. Chi-square and logistic regression analyses were performed. Results indicated hurricane exposure was not a predictor of preterm birth (OR = .723, 95% CI = [.452, 1.16]; p = 1.76) or low birth weight (OR = .608, 95% CI = [.329-1.13]; p = .113). However, an association was observed between tornado exposure and preterm birth (OR = 1.68, 95% CI = [1.19-2.39]; p = < 0.05) and low birthweight (OR = 1.91, 95% CI = [1.27-2.87]; p = < 0.05). Findings suggest pregnant women are vulnerable to natural disaster storms, and are at risk for adverse pregnancy outcomes. The implications for social change include informing preparedness efforts to reduce vulnerability to increased pregnancy risk factors and adverse birth outcomes, consequential to hurricane and tornado disasters.
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Fitton, Catherine Alexandra. "Identifying adverse outcomes in neonates and children following in utero exposure to medication." Thesis, University of Aberdeen, 2019. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=240861.
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Introduction: Many medications have an unproven safety profile for use during pregnancy, leading to issues when chronic diseases, such as hypertension and depression, present during pregnancy. The focus of this research programme is to determine whether in utero exposure to antihypertensive and antidepressant medication is associated with increased risk of adverse events at birth, and up to 27 months of age in the child. Methods: Two systematic reviews were performed to identify current published literature and knowledge gaps. Following this, using Scottish healthcare data, a cohort of 268,711 children born 2010-2014 were identified. Following cleaning of the data, multiple imputation was used to account for missing values. Poisson, linear and multinomial regressions were performed to identify the relationship between in utero medication exposure and child outcomes. Results: In utero antihypertensive exposure was associated with preterm birth, low birth weight, small for gestational age, but not developmental issues. However, untreated hypertension was associated with low birth weight, preterm birth, and small for gestational age. In utero antidepressant exposure was associated with preterm birth, low birth weight, small for gestational age, preeclampsia, having a special needs indicator at 10 days and 6-8 weeks post-birth, developmental issues at 27 months Conclusions: This research programme identified several adverse outcomes following in utero exposure to antihypertensive and antidepressant medication.
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Olsson, David. "Adverse effects of exposure to air pollutants during fetal development and early life : with focus on pre-eclampsia, preterm delivery, and childhood asthma." Doctoral thesis, Umeå universitet, Yrkes- och miljömedicin, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-93962.
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Background Air pollution exposure has been shown to have adverse effects on several health outcomes, and numerous studies have reported associations with cardiovascular morbidity, respiratory disease, and mortality. Over the last decade, an increasing number of studies have investigated possible associations with pregnancy outcomes, including preterm delivery. High levels of vehicle exhaust in residential neighborhoods have been associated with respiratory effects, including childhood asthma, and preterm birth is also associated with childhood asthma. The first aim of this thesis was to investigate possible associations between air pollution exposure and pregnancy outcomes – primarily preterm delivery but also small for gestational age (SGA) and pre-eclampsia – in a large Swedish population (Papers I–III). The second aim was to study any association between exposure to high levels of vehicle exhaust during pregnancy and infancy and prescribed asthma medication in childhood (Paper IV). Methods The study cohorts were constructed by matching other individual data to the Swedish Medical Birth Register. In the first two studies, air pollution data from monitoring stations were used, and in the third and fourth studies traffic intensity and dispersion model data were used.Preterm delivery was defined as giving birth before 37 weeks of gestation. SGA was defined as having a birth weight below the 10th percentile for a given duration of gestation. Pre-eclampsia was defined as having any of the ICD-10 diagnosis codes O11 (pre-existing hypertension with pre-eclampsia), O13 (gestational hypertension without significant proteinuria), O14 (gestational hypertension with significant proteinuria), or O15 (eclampsia). Childhood asthma medication was defined as having been prescribed asthma medication between the ages of five and six years. Results We observed an association between ozone exposure during the first trimester and preterm delivery. First trimester ozone exposure was also associated with pre-eclampsia. The modeled concentration of nitrogen oxides at the home address was associated with pre-eclampsia, but critical time windows were not possible to investigate due to high correlations between time windows. We did not observe any association between air pollution exposure and SGA. High levels of vehicle exhaust at the home address, estimated by nitrogen oxides and traffic intensity, were associated with a lower risk of asthma medication. Conclusion Air pollution exposure during pregnancy was associated with preterm delivery and pre-eclampsia. We did not observe any association between air pollution levels and intrauterine growth measured as SGA. No harmful effect of air pollution exposure during pregnancy or infancy on the risk of being prescribed asthma medication between five and six years of age was observed.
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Huang, Pinchia. "Implications of False-Positive Trisomy 18 or 21 Screening Test Results in Predicting Adverse Pregnancy Outcomes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1247627814.
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Kaambo, Eveline. "The frequency and characterization of streptococci in aerobic vaginitis (AV) and its association with pregnancy outcomes." Thesis, University of the Western Cape, 2014. http://hdl.handle.net/11394/4660.
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Philosophiae Doctor - PhD<br>The aim of the study was to detect the prevalence of AV and its associated bacteria with preterm delivery in the Western Cape, South Africa. Furthermore, it sought particularly to examine and investigate the predictive value of GBS and E. faecalis for preterm delivery (PTD). It also aimed to establish other factors which may predict adverse pregnancy outcomes. Three hundred and one pregnant women were recruited from four different antenatal in the Western Cape, South Africa. The study conformed with the Declaration of Helsinki (2013). Maternal data was collected from a questionnaire and maternal medical records. Vaginal and rectal swabs were collected and microscopically examined for AV, followed by culture characterization of GBS and E. faecalis. Antimicrobial susceptibility testing was also performed. In this study, AV was detected in 79 (26.2%) of the 301 pregnant women, and GBS and E. faecalis isolated from 50 (16.6%) and 21 (7.0%) respectively. GBS serotype V was the predominant serotype, followed by serotype III. Pulse field gel electrophoresis (PFGE) profile analysis for both GBS and E. faecalis yielded a total of 24 restrictions profiles for GBS and 16 for E. faecalis. Multivariable analysis revealed that parity, gravidity, vaginal discharge, urinary tract infection, and smoking were significantly associated with PTD. The results from the study provides improved guidelines maternal screening of pregnant women. The early detection of AV-related bacteria may significantly reduce maternal and neonatal morbidity.
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Richardson, Liana Janine Earp Jo Anne L. "The social structural context of pregnancy and adverse birth outcomes the role of race, place, and time /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2855.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2009.<br>Title from electronic title page (viewed Jun. 4, 2010). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Gillings School of Global Public Health Health Behavior and Health Education." Discipline: Health Behavior and Health Education; Department/School: Public Health.
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Quansah, Reginald. "Occupational determinants of adverse pregnancy outcomes : work in healthcare and exposure to welding fumes and metal dust." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/676/.
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The goal of this thesis is to (i) systematically review all epidemiologic studies reporting on the relationship between occupational exposures and adverse pregnancy outcomes among nurses and physicians, (ii) compare the risk of adverse pregnancy outcomes between singleton newborns of nurses, midwives, and physicians and those of women in other occupations (reference groups) and (iii) investigate the risk of adverse pregnancy outcomes among parents exposed to welding fumes or metal dust. Data were obtained from all epidemiologic studies reporting on the relation between occupational exposures and adverse pregnancy outcomes among nurses and physicians, the 1990–2006 Finnish Medical Birth Register, and the Finnish Prenatal Environment and Health Study (FPEHS). Occupational exposure to anaesthetic gases was associated with spontaneous abortion and congenital malformation among nurses and physicians. Chemotherapy agents were associated with spontaneous abortion among nurses. There was moderate to substantial heterogeneity in the studied relations. In the FHCPS, singleton newborns of nurses have increased risk of low birth weight, post-term delivery, and small-for-gestational-age compared to those of teachers (reference group). Maternal employment as a midwife was not related to adverse pregnancy outcomes. The risk of high birth weight and post-term delivery were lower among singleton newborns of the physicians compared to those of other upper-level employees (reference group), but the risk of SGA and LGA did not differ between the newborns of physicians and those of the reference group. In the FPEHS, paternal exposure to welding fumes only was related to small-for-gestational-age. Maternal exposure to metal dust only was related to low birth weight and pre-term delivery and the joint effect of welding fumes and metal dust was related to small-for-gestational age. In conclusion, maternal employment as a nurses and parental occupational exposure to welding fumes or metal dust may increase the risk of adverse pregnancy outcomes.
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Mohammednur, Mohammedmekin Mohammedseid. "Adverse pregnancy outcomes among HIV-positive pregnant women treated with efavirenz-containing antiretroviral drugs: a retrospective cohort study in the Cape Flats." Thesis, University of the Western Cape, 2017. http://hdl.handle.net/11394/6185.
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Doctor Pharmaceuticae - Dpharm<br>The use of efavirenz (EFV) in the first trimester of pregnancy
remains controversial. In South Africa, the use of EFV-containing antiretroviral
therapy (ART) as part of a Fixed Dose Combination (FDC) during the first
trimester of pregnancy started in April, 2013. Literature to date has reported
conflicting outcomes following the use of EFV-containing ART during the first
trimester of pregnancy. The objectives of the study were to determine the
prevalence of adverse pregnancy outcomes among HIV-positive pregnant women
treated with EFV-containing ART and compare these results with those of pregnant
women treated with NVP-containing ART and HIV-negative pregnant women in
resource-limited settings. In addition, the study also aimed to determine the effect
of the time of initiation of ART on the prevalence of adverse pregnancy outcomes.
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Ban, Lu. "Maternal perinatal mental illnesses and adverse pregnancy outcomes : population-based studies using data from United Kingdom primary care." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/12877/.
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Background: Perinatal mental illness, especially depression, is a leading cause of maternal morbidity and mortality in high-income countries. In the United Kingdom (UK), mental illness commonly presents to and is treated at primary care level; however there are no up-to-date estimates of the burden of different mental illnesses in women in and around pregnancy. The potential impact of mental illness with or without psychotropic medication on the risk of non-live pregnancy outcomes is unclear. In this context, the safety of psychotropic drugs, especially antidepressants, remains controversial. Aim and objectives: To estimate the clinical burden of depression, anxiety and serious mental illness (defined as bipolar disorder, schizophrenia and other related psychotic disorders) presenting to and/or being treated in UK primary care, and to investigate the effects on pregnancy outcomes while trying to differentiate the effects of psychotropic medication from mental illness itself. Methods: Women aged 15-45 years from 1990 to 2009 were identified from The Health Improvement Network, a UK primary care database. Coding of mental illness diagnoses and psychotropic drug prescriptions were examined by separately assessing the proportions of women with recordings of diagnoses, symptoms, and drug prescriptions over the study period. Three separate studies were then carried out. A cross-sectional study was firstly conducted to estimate the prevalence and diagnostic overlap of mental illnesses before, during and after pregnancy and the variation by maternal age, socioeconomic status and other maternal factors. The second study examined the risks of non-live pregnancy outcomes (defined as perinatal death, miscarriage, and termination) in women with no history of depression and anxiety, a diagnosis of such illness prior to pregnancy, illness during pregnancy or illness during pregnancy with use of medication (stratified by medication type). Multinomial logistic regression models were used to compare risks of non-live outcomes across these groups, adjusting for important socio-demographic and lifestyle characteristics. The third study examined the risks of major and system-specific congenital anomalies in children born to women with depression or anxiety that was untreated or treated with psychotropic medication. Logistic regression with a generalised estimating equation was used to compare risks of major congenital anomalies in children exposed and unexposed to psychotropic medication during the first trimester of pregnancy, adjusting for important socio-demographic, lifestyle and chronic comorbidity in the mother. Results: There were 344,042 women who had one or more singleton pregnancies identified between age 15 and 45 from 1990 to 2009. Recording of mental illness and prescriptions of psychotropic drugs increased considerably over the study period. There was high prevalence and overlap of different maternal mental illnesses, especially depression and anxiety, during and after pregnancy, and the prevalence was generally highest in younger, socioeconomically deprived women who had smoked before childbirth, were outside the normal range of BMI and had other chronic medical conditions, such as diabetes. Socioeconomic deprivation was associated with increased risk of all mental illnesses, although the impact of deprivation was more marked in older women. Those aged 35-45 in the most deprived group had 2.63 times the odds of antenatal depression (95% confidence interval [CI] 2.22-3.13) compared with the least deprived; in women aged 15-25 the increased odds associated with deprivation was more modest (odds ratio [OR]=1.35, 95%CI 1.07-1.70). Similar patterns were found for anxiety and serious mental illness. Women with antenatal exposure to antidepressant or anti-anxiety drugs showed the greatest increased risks for non-live pregnancy outcomes, relative to those with no history of depression or anxiety, although women with prior (but currently un-medicated) illness also showed modest increased risks. Compared with un-medicated antenatal morbidity, there was weak evidence of an excess risk in women taking tricyclic antidepressants (TCAs), and stronger evidence for other medications. The absolute risks of major and system-specific congenital anomalies were small in the general population (269 per 10,000 children for major congenital anomalies). Compared with un-medicated antenatal depression or anxiety (278 per 10,000 children for major congenital anomalies), the use of antidepressants during early pregnancy was associated with excess risks, especially for selective serotonin reuptake inhibitors (SSRIs) (290 per 10,000 children for major congenital anomalies). Compared with children born to women with no depression or anxiety, there was an increased risk of heart anomalies in children with antenatal exposure to SSRIs (adjusted OR=1.25, 95% 95%CI 1.02-1.53), particularly in those exposed to paroxetine (adjusted OR=1.89, 95%CI 1.24-2.88). Children exposed to sertraline and escitalopram also had similar increased risks, although fewer women were exposed to these drugs. No increased risks of major congenital anomalies were found in children exposed to TCAs or benzodiazepines; however, the risks of right ventricular outflow tract anomalies were notably higher for all drug classes. Conclusion: Strong socioeconomic inequalities in perinatal mental illnesses occur and persist with increasing maternal age. Women with depression or anxiety have higher risks of miscarriage, perinatal death and therapeutic terminations than women without these diagnoses and the risks are even higher if prescribed psychotropic medication during early pregnancy than if not. There is also an increased risk of congenital heart anomalies in children exposed to paroxetine and other SSRIs during the first trimester compared with those who are unexposed, although the absolute risk is small. There could be other associated factors also related to depression, anxiety or use of medications, which yet unlikely fully explain the observed excess risks. Whilst medicated depression or anxiety could be a marker of more severe illness than un-medicated ones, my findings indicate there may be some specific drug effects Targeting detection and effective interventions to women at risk of mental illness during pregnancy may reduce inequity and avoid substantial psychiatric morbidity, and subsequently reduce the need for further psychotropic treatment. GPs and other health care professionals should take a cautious approach when managing mental illness in pregnant women. The findings in this thesis provide vital information for this purpose, namely helping communicate the magnitude of risk of major congenital anomalies to women with the use of different psychotropic drugs in the context of the baseline risk in the general population.
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Chico, R. M. "Intermittent preventive treatment of malaria in pregnancy and infectious causes of adverse birth outcomes in sub-Saharan Africa." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2018. http://researchonline.lshtm.ac.uk/4646716/.
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Background: The World Health Organization recommends intermittent preventive treatment of malaria in pregnancy (IPTp) using sulphadoxine-pyrimethamine (SP) during antenatal visits in moderate to high transmission areas. In some areas of Africa, recent efforts to control and eliminate malaria have yielded historic reductions in transmission intensity that have occurred alongside concomitant increases in parasite resistance to SP, compromising the efficacy of IPTp. Nevertheless, IPTp-SP continues to have beneficial effect on birth outcomes, and there is a suspicion that SP may protect against adverse birth outcomes attributable to curable sexually transmitted and reproductive tract infections (STIs/RTIs). This doctoral thesis explores five research questions related to IPTp with methods noted in parentheses. Research questions and methods: 1. In the context of declining malaria transmission, is there a threshold of malaria transmission intensity below which IPTp-SP may no longer protect against the incidence of low birth weight? (Methods: systematic review, meta-analysis, and meta-regression analysis) 2. In the context of declining parasite sensitivity to SP, is there a threshold of the Plasmodium falciparum resistance to SP defined by the prevalence of dhps mutation at codon A581G above which IPTp-SP may no longer protect against the incidence of low birth weight? (Methods: systematic review and meta-analysis) 3. In the context of declining malaria transmission and parasite sensitivity to SP, might protection conferred by IPTp-SP be explained partially by an effect against malaria infection as well as STIs/RTIs? (Methods: descriptive analysis and multivariate logistic regression) 4. In the context of pregnant women attending antenatal care in sub-Saharan Africa, what is the prevalence of malaria infection and curable STIs/RTIs? (Methods: systematic review and meta-analysis) 5. In the context of a high dual burden of malaria infection and curable STIs/RTIs amongst pregnant women in sub-Saharan Africa, would azithromycin be an efficacious drug to be included as part of IPTp? (Methods: systematic review and selected meta-analysis) Results: Evidence suggests that IPTp-SP protects against low birth weight in all gravidae regardless of transmission intensity. This protection persists among primi- and secundigravidae irrespective of the prevalence of the A581G mutation. Protection appears to wane, however, as there is no evidence of protective effect against low birth weight amongst multigravidae where the prevalence of A581G is >10.1%. Despite this finding, data from Zambia suggests that the protective effect of IPTp-SP may safeguard pregnancies against more than just the effects of malaria infection; women who received more doses of IPTp-SP during pregnancy were protected against adverse birth outcomes attributable to co-infection with malaria and several curable STIs/RTIs. Meta-analysis of data from pregnant women attending antenatal care facilities in sub-Saharan Africa suggests that malaria infection and curable STIs/RTIs amongst pregnant women attending antenatal care facilities in sub-Saharan Africa is very high and, when considered collectively, curable STIs/RTIs may be more prevalent than malaria infection during pregnancy. A potential response to this dual burden of disease in pregnancy is to explore combination therapies that address malaria and curable STIs/RTIs jointly and more effectively than IPTp-SP. Research presented in this thesis suggests that curable STIs/RTIs are sensitive to azithromycin and that policymakers need additional evidence to consider adding azithromycin to IPTp regimens. Conclusions: Despite evidence of parasite resistance, IPTp-SP remains protective against the effects of malaria infection in most pregnant women, even where transmission intensities are very low, and may also reduce the burden of curable STIs/RTIs. However, this protection is likely sub-optimal and, given the high prevalence of malaria and curable STIs/RTIs among pregnant women in sub-Saharan Africa, alternative therapies that include azithromycin merit investigation in clinical trials with robust microbiological components.
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Tessier, Daniel. "Maternal Obesity Induces a Pro-Inflammatory Uterine Immune Response Associated with Altered Utero-Placental Development and Adverse Fetal Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32451.
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Obese pregnant women have increased risk of a number of pregnancy complications, including poor maternal health, fetal growth restriction (FGR) and fetal demise. The success of pregnancy is dependent on precise regulation of the immune response within the utero-placental environment. Rats as a model for human related pregnancy complications are beginning to be widely used because of the similarities between these species in terms of trophoblast invasion and spiral artery remodeling. However our knowledge of immune cells and cytokine localization in the rat utero-placental tissue relating to these processes is limited. Therefore our first aim was to characterize the immune cell populations, such as uterine natural killer (uNK) cells, neutrophils and macrophages in the rat utero-placental unit at two crucial gestational ages relevant to trophoblast invasion and spiral artery remodeling, gestational day (GD) 15 and GD18. In addition, we characterized the cytokine distribution of TNFα, IFNγ and IL-10 in the utero-placental tissue at both above mentioned gestational ages. Our study has demonstrated co-localization of TNFα and IFNγ with uNK cells in the perivascular region of the spiral arteries in the rat mesometrial triangle. Neutrophils were localized at the maternal fetal interface and in the spiral artery lumen of the rat mesometrial triangle at both gestational ages. TNFα and IL-10 demonstrated a temporal change in the localization from GD15 to GD18 which coincides with the leading edge of trophoblast invasion into the mesometrial triangle. The results of the current study furthers our knowledge of the localization and temporal expression of uterine immune cells and relevant cytokines, and provides a base to research the function of these immune cells and cytokines during rat pregnancy as a model to study human pregnancy and complications related to immune functions.
Since obesity is associated with a peripheral and systemic pro-inflammatory state in humans, our second objective was to investigate whether maternal obesity could alter the utero-placental and systemic immune response in the rats. To characterize maternal obesity induced changes in uterine immune state we used pregnant rats fed a control diet (normal weight; CD) or a high fat diet (obese; HFD) at GD15 and GD18. We performed immunohistochemistry to localize TNFα and IL-10, and quantified the levels of TNFα, IL-1β and IL-10 in the uterine tissue by immunoassay. To assess the systemic immune state, circulating levels of pro-inflammatory cytokine MCP-1 were assessed by immunoassay. We demonstrated an increased concentration of the pro-inflammatory marker TNFα and a reduced anti-inflammatory IL-10-positive cell distribution in the rat mesometrial triangle in response to a HFD. In addition increased circulating MCP-1 was observed in the HFD-fed dams at both gestation ages. HFD induced obesity in our rat model leads to an increase in uterine and systemic pro-inflammatory markers. These markers have demonstrated the potential to alter utero-placental development.
Pregnancy complications such as FGR and fetal demise have been shown to be associated with impaired placental development as a result of altered trophoblast invasion and aberrant maternal spiral artery remodeling. Therefore, our third aim was to compare these parameters between the CD-fed rats and HFD-fed rats at GD15 and GD18. Early trophoblast invasion was increased by approximately 2-fold in HFD-fed dams with a concomitant increase in the expression of matrix metalloproteinase-9 protein, a mediator of tissue remodeling and invasion. By late gestation reduced trophoblast invasion was observed in HFD-fed dams. Furthermore, we also observed in late gestation significantly higher levels of smooth muscle actin surrounding the uterine spiral arteries of HFD-fed dams, suggesting impaired spiral artery remodeling. We also determined the impact of human serum from obese mothers on trophoblast invasion. We compared the invasion of HTR-8/SVneo cells treated with pooled first-trimester serum from obese women with or without fetal growth restriction vs. cells treated with serum from normal-weight women with or without fetal growth restriction. First-trimester serum from obese pregnant women reduced invasion of the trophoblast cell line HTR8/SVneo compared to serum from normal-weight pregnant women. Taken together, the results of this study suggest that maternal obesity can negatively influence crucial utero-placental development processes resulting in the poor pregnancy outcomes and increased fetal demise.
To summarize, the HFD increased the pro-inflammatory marker TNFα which was associated with altered trophoblast invasion profiles and impaired vascular remodeling. These disturbances in utero-placental development were also associated with decreased birth weights (indication of FGR) and increased rates of stillbirths in our obese rat model.
In conclusion, we have made progress in defining the influence of maternal obesity (HFD) on utero-placental development. The importance of these studies is evident since FGR represents a leading cause of perinatal morbidity and mortality. Furthermore, FGR fetuses have an increased risk of becoming obese in their lifetime as a result of fetal programming, therefore resulting in the propagation of a transgenerational obesity cycle. Therefore by understanding the mechanisms by which maternal obesity influences utero-placental development leading to FGR, we may be able to impact short term morbidity and prevent the programming of obesity in future generations. In addition, characterization of maternal obesity’s influence on utero-placental development will also help in the search for therapeutics or intervention strategies to help optimize fetal growth and improve pregnancy outcomes in obese women.
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Pastrakuljic, Aleksandra. "The role of the placenta in adverse fetal outcomes associated with maternal cocaine use and cigarette smoking in pregnancy." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/nq49966.pdf.
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Buie, Mary Elizabeth. "An Examination of the Impact of Preconception Health on Adverse Pregnancy Outcomes through the Theoretical Lens of Reciprocal Determinism." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3021.
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Statement of Purpose
The purpose of this study is to examine the impact of preconception health on adverse pregnancy outcomes through the theoretical lens of reciprocal determinism. Thus, this study aims to develop a preconception health conceptual framework that accounts for the interactive relationships among behavior, the environment, and the person.
Rationale for the Study
Women may not recognize a pregnancy until the first or second missed menstrual cycle, a full four to eight weeks or more after conception. Once a woman realizes the possibility of a pregnancy, it takes further time to confirm the pregnancy with a home pregnancy kit or a visit to the health care provider. In that time period, the woman may have unknowingly exposed her embryo to nutritional deficiencies, over-the-counter drugs, tobacco, alcohol, or other toxins. Because nearly half of all pregnancies are unintended, yielding about three million unintended pregnancies in the U.S. annually, there is a need to shift care to an earlier period in a woman's life cycle with greater potential to prevent birth defects and other adverse pregnancy outcomes, also known as preconception care.
The preconception health movement began with the rationale that many adverse pregnancy outcomes are determined prior to prenatal care initiation. Thus, in addition to prenatal care, the need for preconception health arose. The empirical literature makes a strong case for the benefit of individual preconception health components and their effects on adverse pregnancy outcomes. However, the actual effectiveness of collective preconception health in reducing adverse pregnancy outcomes has not yet been demonstrated. In an effort to evaluate the impact of preconception health on maternal morbidity, infant morbidity, and infant mortality, this study examined the reciprocal relationships between environmental, personal, and preconception behavioral factors and their associations with adverse pregnancy outcomes.
Methods
A secondary data analysis was conducted using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2005-2008 to test a preconception framework. Project 1 examined all variables in the preconception framework among the following states: Maine, New Jersey, Ohio, and Utah. Project 2 examined all variables except of two among all PRAMS-participating states. All of the variables in the proposed framework were derived from questions in the PRAMS survey or from PRAMS-linked birth certificate data. The research questions posed in this study were resolved through the path analyses of reduced and full iterations of the preconception framework in Projects 1 and 2.
Results
In Project 1, list-wise deletion of missing data resulted in a decrease from the original 27,933 participants to 12,239 participants. In Project 2, this action resulted in a decrease from the original 200,008 participants to 128,551 participants. The analysis of the reduced frameworks for both projects revealed extremely low R-squared values (1.1% or less). Subsequent analyses examining the full framework in Projects 1 and 2, as well as an additional post hoc analysis with supplementary PRAMS variables, resulted in R-squared values of 13.1%, 11.4%, and 30.5%, respectively.
Implications
This study examined the impact of preconception health behaviors on adverse pregnancy outcomes through the theoretical lens of reciprocal determinism. Preconception health behaviors alone accounted for a negligible portion of the variance associated with adverse pregnancy outcomes. As hypothesized, preconception health behaviors work in concert with environmental factors, personal influences, prenatal and natal factors. Significant predictors supported in the literature included lower socioeconomic status, pregnancy intention, pregnancy history, older maternal age, black maternal race, Hispanic ethnicity, overweight maternal BMI, tobacco use prior to pregnancy, maternal complications, hospitalization during pregnancy, later prenatal care initiation, fewer prenatal care visits, plurality, and cesarean section. Even so, there is a large portion of the variance in adverse pregnancy outcomes that is not accounted for, and further examination is required.
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Escouto, Daniele Crist?v?o. "Evaluation of the fullPIERS model and PLGF as predictors of adverse outcomes in women with hypertensive disorders of pregnancy." Pontif?cia Universidade Cat?lica do Rio Grande do Sul, 2018. http://tede2.pucrs.br/tede2/handle/tede/8270.
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Previous issue date: 2018-03-19<br>Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES<br>Introdu??o ? A distin??o adequada dos casos de alto risco para eventos graves nas doen?as hipertensivas gestacionais, n?o apenas pr?-ecl?mpsia, ? um desafio cl?nico. O modelo fullPIERS ? uma ferramenta simples e de baixo custo que utiliza vari?veis cl?nicas para estratificar a probabilidade de eventos adversos em gestantes com pr?-ecl?mpsia. O fator de crescimento placent?rio (PlGF) ? um biomarcador com concentra??es reduzidas no plasma de mulheres com pr?-ecl?mpsia e com crescente emprego na avalia??o de gestantes com suspeita de pr?-ecl?mpsia.
Objetivos ? O objetivo deste estudo ? estimar a acur?cia do modelo fullPIERS e do
biomarcador PlGF como preditores de desfechos adversos maternos em gestantes com doen?a hipertensiva gestacional.
M?todos ? Estudo de coorte prospectiva em um hospital terci?rio em Porto Alegre, Brasil, que incluiu gestantes admitidas com press?o arterial sist?lica ? 140 e/ou press?o arterial diast?lica ? 90 mmHg a partir da 20? semana de gesta??o. Os piores valores de vari?veis cl?nicas e laboratoriais dentro das primeiras 48 horas de admiss?o foram coletados. Desenvolvimento de eventos adversos foi acompanhado por um per?odo de 14 dias. Concentra??es plasm?ticas maternas de PlGF do momento da admiss?o foram mensuradas.
Resultados ? 405 gestantes foram inclu?das no estudo. Entre as 351 mulheres inclu?das na
an?lise do modelo fullPIERS, 20 (5%) desenvolveram pelo menos um evento adverso
materno dentro de 14 dias de interna??o. O modelo fullPIERS teve pouca capacidade
discriminativa para prever desfechos em 48 horas [AUC 0,639 (95% CI 0,458-0,819)]. A
acur?cia do modelo foi ainda mais baixa dentro de sete semanas da admiss?o [AUC 0,612
(95% CI 0,440-0,783)]; a capacidade discriminativa manteve-se similar dentro de 14 dias da
admiss?o [AUC 0,637 (95% CI 0,491-0,783)]. A calibra??o do modelo fullPIERS tamb?m foi
ruim: inclina??o 0,35 (95% CI 0,08-0,62) e intercepto 1,13 (95%CI -2,4-0,14). A an?lise do
PlGF incluiu 392 gestantes. PlGF <5? percentil esteve associados a eventos adversos maternos dentro de 48 horas em gestantes inclu?das antes de 35 semanas com sensibilidade de 0,80 (0,4-0,96), valor preditivo negativo (VPN) de 0,98 (0,9-0,99) e AUC ROC de 0,672 (IC 95% 0,5-0,9). PlGF <100 pg/mL apresentaram sensibilidade de 0,8 (0,4-0,96), especificidade de 0,6 (0,5-0,7) e VPN de 0,99 (0,94-0,99) em mulheres ap?s 37 semanas de gravidez. PlGF apresentou bom desempenho para prever parto at? 14 dias em gestantes inclu?das antes de 35 semanas. PlGF <5? percentil esteve associado a rec?m-nascido pequeno para idade gestacional (PIG) com sensibilidade de 0,75 (0,6-0,9), especificidade 0,65 (0,5-0,7), NPV de 0,87 (0,79-0,94) e AUC ROC 0,698 (0,6-0,79), em gestantes com <35 semanas, a acur?cia diminuiu com o aumento das idades gestacionais.
Conclus?es ? O modelo fullPIERS e a concentra??o de PLGF mostraram baixa acur?cia na
predi??o de desfechos adversos maternos em mulheres com doen?a hipertensiva gestacional, incluindo pr?-ecl?mpsia. O modelo fullPIERS teve desempenho inferior na nossa amostra quando comparado com o estudo que validou este teste. O PLGF parece ser um biomarcador para uso como ferramenta adicional na predi??o de parto dentro de 14 dias e rec?m-nascidos PIG, especialmente em gestantes antes da 35? semana gestacional.<br>Introduction - Singling out high-risk patients from the diverse hypertensive disorders of pregnancy, and not only preeclampsia, is a challenge for clinicians. The fullPIERS model is a simple and low-cost evaluation instrument using clinical variables to stratify the adverse outcomes probability of pregnant women with high-risk preeclampsia. Placental growth factor (PlGF) levels are reduced in preeclampsia and are increasingly being used as a biomarker in the assessment of this disease.
Objectives - The aim of the study is to evaluate the performance of the fullPIERS model and PlGF to predict adverse outcomes in women with hypertensive disorders of pregnancy.
Methods - A prospective cohort study carried out at a teaching hospital in Porto Alegre, Brazil enrolling pregnant women admitted with a systolic blood pressure ? 140 mmHg and/or a diastolic blood pressure ? 90 mmHg from the 20th week of gestation. First 48 hours of admission worst clinical and laboratory data were recorded and the development of adverse maternal and perinatal outcomes scrutinised up to 14 days. Admission maternal plasma PlGF concentrations were measured.
Results ? A total of 405 women were enrolled. From the 351 women included in the fullPIERS model analysis, 20 (5%) developed at least one of the combined maternal adverse outcomes. The fullPIERS model had poor outcomes discrimination at 48h [AUC 0.639 (95% CI 0.458-0.819)]. At the seventh admission day, the model?s accuracy was even lower [AUC 0.612 (95% CI 0.440-0.783)]; the model?s discriminative ability remained similar [AUC 0.637 (95% CI 0.491-0.783)] at 14 days. Calibration of the fullPIERS model was poor: slope - 0.35 (95% CI 0.08-0.62), intercept -1.13 (95%CI -2.4-0.14). PlGF analysis included 392 women. PlGF < 5th percentile predicted maternal adverse outcomes within 48h in women with gestation < 35 weeks with sensitivity of 0.80, NPV of 0.98 and AUC ROC of 0.672 (CI 95%0.5-0.9). The threshold of <100 pg/mL, had best accuracy in women after 37 weeks of pregnancy, sensitivity of 0.8, specificity of 0.6, negative predictive value of 0.99 and PPV of 0.04. PlGF had good performance to predict delivery within 14 days in women presenting before 35 weeks. PlGF <5th percentile predicted delivery of a SGA infant with sensitivity of 0.75, specificity 0.65, PPV of 0.45, NPV of 0.87, and AUC ROC 0.698, in women with gestation < 35 weeks, accuracy decreased at later gestational ages.
Conclusion - In conclusion, in our sample the fullPIERS model and PlGF were limited predictors of maternal adverse outcomes in pregnant women with hypertensive disorders of pregnancy, including preeclampsia. The performance of the fullPIERS model in our sample was inferior to that of the original cohort. PlGF as a biomarker appears to be an additional tool to predict delivery within 14 days and SGA newborn in women before 35 weeks gestation.
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MARIANI, JACOPO. "AIR POLLUTION EXPOSURE IN PREGNANCY: NASAL MICROBIOTA AND EXTRACELLULAR VESICLE COMMUNICATION AS POTENTIAL MECHANISM TO EXPLAIN ADVERSE BIRTH OUTCOMES." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/813004.
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ABSTRACT
BACKGROUND: Particulate matter (PM) exposure has been linked to the exacerbation of respiratory and cardiovascular conditions as well as to adverse effects on fetal growth. To link the cross-talk that might occur between respiratory system and placenta after PM exposure, it has been proposed a novel mechanism of cell to cell communication mediated by extracellular vesicles (EVs). EVs are involved in both biological and pathological processes including pregnancy state. As PM interacts firstly with the nares, bacterial nasal microbiota (bNM) is one of the first compartments hit by PM exposure. This interaction might lead to structural and functional modifications within the bNM, which could cause variations within the EVs signaling network, which might lead to an improper immune response to PM stimuli.
AIM: The main aim of the project was to identify how PM exposure might modify the homeostasis and composition of whole EV signaling network and bNM and the leading to a possible impact on newborn development.
Subject recruitment: 518 volunteer pregnant women were enrolled during the 11th week of pregnancy at the ‘Clinica Mangiagalli’-Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy. Among them, a group of subjects composed by 65 pregnant women, who agreed to participate to a more complex study protocol, was also identified.
Exposure assessment, EV and Microbiota measurement:
Exposure to PM concentrations was assessed using data obtained from FARM models for the whole population. In addition, individual exposure to short-term PM levels was retrieved through a personal sampler worn by the subgroup of 65 pregnant women. Plasmatic concentration and cellular origin of EVs were characterized by Nanoparticle tracking analysis (NTA) and flow cytometry, respectively. We investigated the bNM structure and characteristics of 65 pregnant women both at the enrolment (T0) and the following Monday during the cardiovascular screening (T1) through metabarcoding analysis of the V3–V4 regions of the 16s rRNA gene.
Statistical analysis:
Multivariable linear regression models were applied to test the associations between PM exposure (retrieved from both FARM models and personal sampler) and the majority of the collected outcomes such as maternal, foetal/newborns, and cardiovascular parameters as well as for bNM data.
On the other hand, to evaluate possible associations between PM concentrations and EV characteristics negative binomial regression models for count data with over-dispersion were performed.
In addition, multiple comparison method based on Benjamini-Hochberg False Discovery Rate (FDR) were applied for high number of comparisons.
RESULTS
In the whole population, PM10 exposure (measured at different time windows) resulted in decreased release of total amount of EVs, with the strongest effect related to concentration measured 13 weeks before the enrolment (13wks), whereas an inverse tendency was observed for exposure to PM2.5, although these associations were not significant. More reliable data on the finest fractions (PM1, PM2.5 and PM4) are given by personal sampler worn by a subgroup of women for a very short time period preceding the blood drawing (1.5 hours). As we considered this extremely acute effect, we observed a generalized increment in the EV count. Noteworthy, among the different analyzed EV subtypes, the levels of HERV-w+ EVs were the only to be increased by each tested PM10 time-lag. The same models applied on bNM data showed a reduction in terms of diversity (Shannon/Faith_pd ratio) and relative abundance of the genera Corynebacterium spp. and Staphylococcus spp. In addition, when the possible role of bNM as effect modifier between PM exposure and EVs release was investigated, we observed for the pregnant women with a balanced bNM an increment in terms of circulating EVs after daily PM stimuli.
Moreover, increments of the heart rate values were observed after exposure to both PM10 and PM2.5 levels measured the day before the cardiovascular screening (Day -1).
Focusing on newborn’s outcomes, decrements of the gestational age at birth were associated to PM concentrations measured throughout the gestation or during the 2nd trimester.
CONCLUSIONS: To our knowledge, this is the first exploring the role of bNM and the EV cross-talk in determining the effects of PM exposure levels on healthy pregnancies as well as on newborn outcomes. The results obtained so far might suggest a possible role exerted by both EV concentration and the bNM in pregnant women in mediating the effects of PM exposure.
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Pelzer, Elise Sarah. "Microbial colonisation of human follicular fluid and adverse in vitro fertilisation outcomes." Thesis, Queensland University of Technology, 2011. https://eprints.qut.edu.au/49122/1/Elise_Pelzer_Thesis.pdf.
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This study, investigating 263 women undergoing trans-vaginal oocyte retrieval for in vitro fertilisation (IVF) found that microorganisms colonising follicular fluid contributed to adverse IVF (pre-implantation) and pregnancy (post-implantation) outcomes including poor quality embryos, failed pregnancy and early pregnancy loss (< 37 weeks gestation). Some microorganisms also showed in vitro growth patterns in liquid media that appeared to be enhanced by the hormonal stimulation protocol used for oocyte retrieval. Elaborated cytokines within follicular fluid were also associated with adverse IVF outcomes.
This study is imperative because infertility affects 16% of the human population and the numbers of couples needing assistance continues to increase. Despite significant improvements in the technical aspects of assisted reproductive technologies (ART), the live birth rate has not increased proportionally. Overt genital tract infection has been associated with both infertility and adverse pregnancy outcomes (including miscarriage and preterm birth) as a direct result of the infection or the host response to it. Importantly, once inflammation had become established, medical treatment often failed to prevent these significant adverse outcomes. Current evaluations of fertility focus on the ovary as a site of steroid hormone production and ovulation. However, infertility as a result of subclinical colonisation of the ovary has not been reported. Furthermore, identification of the microorganisms present in follicular fluid and the local cytokine profile may provide clinicians with an early indication of the prognosis for IVF treatment in infertile couples, thus allowing antimicrobial treatment and/or counselling about possible IVF failure. During an IVF cycle, multiple oocytes undergo maturation in vivo in response to hormonal hyperstimulation. Oocytes for in vitro insemination are collected trans-vaginally. The follicular fluid that bathes the maturing oocyte in vivo, usually is discarded as part of the IVF procedure, but provides a unique opportunity to investigate microbial causes of adverse IVF outcomes. Some previous studies have identified follicular fluid markers that predict IVF pregnancy outcomes. However, there have not been any detailed microbiological studies of follicular fluid.
For this current study, paired follicular fluid and vaginal secretion samples were collected from women undergoing IVF cycles to determine whether microorganisms in follicular fluid were associated with adverse IVF outcomes. Microorganisms in follicular fluid were regarded as either "colonisers" or "contaminants"; colonisers, if they were unique to the follicular fluid sample, and contaminants if the same microorganisms were detected in the vaginal and follicular fluid samples indicating that the follicular fluid was merely contaminated during the oocyte retrieval process. Quite unexpectedly, by these criteria, we found that follicular fluid from approximately 30% of all subjects was colonised with bacteria. Fertile and infertile women with colonised follicular fluid had decreased embryo transfer rates and decreased pregnancy rates compared to women with contaminated follicular fluids. The observation that follicular fluid was not always sterile, but contained a diverse range of microorganisms, is novel. Many of the microorganisms we detected in follicular fluid are known opportunistic pathogens that have been detected in upper genital tract infections and are associated with adverse pregnancy outcomes. Bacteria were able to survive for at least 28 weeks in vitro, in cultures of follicular fluid. Within 10 days of establishing these in vitro cultures, several species (Lactobacillus spp., Bifidobacterium spp., Propionibacterium spp., Streptococcus spp. and Salmonella entericus) had formed biofilms. Biofilms play a major role in microbial pathogenicity and persistence. The propensity of microbial species to form biofilms in follicular fluid suggests that successful treatment of these infections with antimicrobials may be difficult.
Bifidobacterium spp. grew, in liquid media, only if concentrations of oestradiol and progesterone were similar to those achieved in vivo during an IVF cycle. In contrast, the growth of Streptococcus agalactiae and Escherichia coli was inhibited or abolished by the addition of these hormones to culture medium. These data suggest that the likelihood of microorganisms colonising follicular fluid and the species of bacteria involved is influenced by the stage of the menstrual cycle and, in the case of IVF, the nature and dose of steroid hormones administered for the maturation of multiple oocytes in vivo. Our findings indicate that the elevated levels of steroid hormones during an IVF cycle may influence the microbial growth within follicular fluid, suggesting that the treatment itself will impact on the microflora present in the female upper genital tract during pre-conception and early post-conception phases of the cycle.
The effect of the host immune response on colonising bacteria and on the outcomes of IVF also was investigated. White blood cells reportedly compose between 5% and 15% of the cell population in follicular fluid. The follicular membrane is semi-permeable and cells are actively recruited as part of the normal menstrual cycle and in response to microorganisms. A previous study investigated follicular fluid cytokines from infertile women and fertile oocyte donors undergoing IVF, and concluded that there were no significant differences in the cytokine concentrations between the two groups. However, other studies have reported differences in the follicular fluid cytokine levels associated with infertile women with endometriosis or polycystic ovary syndrome. In this study, elevated levels of interleukin (IL)-1 á, IL-1 â and vascular endothelial growth factor (VEGF) in vaginal fluid were associated with successful fertilisation, which may be useful marker for successful fertilisation outcomes for women trying to conceive naturally or prior to oocyte retrieval for IVF. Elevated levels of IL-6, IL-12p40, granulocyte colony stimulating factor (GCSF) and interferon-gamma (IFN ã) in follicular fluid were associated with successful embryo transfer.
Elevated levels of pro-inflammatory IL-18 and decreased levels of anti-inflammatory IL-10 were identified in follicular fluid from women with idiopathic infertility. Successful fertilisation and implantation is dependent on a controlled pro-inflammatory environment, involving active recruitment of pro-inflammatory mediators to the genital tract as part of the menstrual cycle and early pregnancy. However, ongoing pregnancy requires an enhanced anti-inflammatory environment to ensure that the maternal immune system does not reject the semi-allergenic foetus. The pro-inflammatory skew in the follicular fluid of women with idiopathic infertility, correlates with normal rates of fertilisation, embryo discard and embryo transfer, observed for this cohort, which were similar to the outcomes observed for fertile women. However, their pregnancy rate was reduced compared to fertile women. An altered local immune response in follicular fluid may provide a means of explaining infertility in this cohort, previously defined as 'idiopathic'.
This study has found that microorganisms colonising follicular fluid may have contributed to adverse IVF and pregnancy outcomes. Follicular fluid bathes the cumulus oocyte complex during the in vivo maturation process, and microorganisms in the fluid, their metabolic products or the local immune response to these microorganisms may result in damage to the oocytes, degradation of the cumulus or contamination of the IVF culture system. Previous studies that have discounted bacterial contamination of follicular fluid as a cause of adverse IVF outcomes failed to distinguish between bacteria that were introduced into the follicular fluid at the time of trans-vaginal oocyte retrieval and those that colonised the follicular fluid. Those bacteria that had colonised the fluid may have had time to form biofilms and to elicit a local immune response. Failure to draw this distinction has previously prevented consideration of bacterial colonisation of follicular fluid as a cause of adverse IVF outcomes.
Several observations arising from this study are of significance to IVF programs. Follicular fluid is not always sterile and colonisation of follicular fluid is a cause of adverse IVF and pregnancy outcomes. Hormonal stimulation associated with IVF may influence whether follicular fluid is colonised and enhance the growth of specific species of bacteria within follicular fluid. Bacteria in follicular fluid may form biofilms and literature has reported that this may influence their susceptibility to antibiotics. Monitoring the levels of selected cytokines within vaginal secretions may inform fertilisation outcomes. This study has identified novel factors contributing to adverse IVF outcomes and that are most likely to affect also natural conception outcomes. Early intervention, possibly using antimicrobial or immunological therapies may reduce the need for ART and improve reproductive health outcomes for all women.
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Matwejew, Elisabeth [Verfasser]. "MATERNAL SERUM BIOCHEMICAL MARKERS PP13, PAPP-A, PlGF AND ADAM12 11-13+6 WEEKS’ GESTATION AND ADVERSE PREGNANCY OUTCOMES / Elisabeth Matwejew." Kiel : Universitätsbibliothek Kiel, 2012. http://d-nb.info/1022376144/34.
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Thomas, Katherine Marks Wilder Rebecca S. "Nurse practitioners, physician assistants and certified nurse midwives' knowledge and behaviors regarding periodontal disease and its impact on adverse pregnancy outcomes." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1686.
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Thesis (M.S.)--University of North Carolina at Chapel Hill, 2008.<br>Title from electronic title page (viewed Sep. 16, 2008). "... in partial fulfillment of the requirements for the degree of Master of Science in Dental Hygiene Education in the Department of Dental Ecology, School of Dentistry." Discipline: Dental Ecology; Dental Hygiene Education; Department/School: Dentistry.
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Smith, Rachel B. "Assessment and validation of exposure to disinfection by-products during pregnancy, in an epidemiological study examining associated risk of adverse fetal growth outcomes." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/6357.
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Studies investigating exposure to disinfection by-products (DBPs) via chlorinated waters during pregnancy and adverse fetal growth outcomes have been limited by potential exposure measurement error, lack of exposure assessment validation and potential residual confounding. Factors driving DBP exposure are poorly understood, making it difficult to target resources appropriately in order to improve exposure assessment. These issues were investigated through DBP exposure assessment and validation for a new investigation of DBPs and fetal growth within the Born in Bradford (BiB) cohort study. Analysis of individual water use in the BiB cohort found that water consumption, showering, bathing and swimming varied by demographic and lifestyle factors. Sampling, analysis, and modelling of trihalomethanes (THMs) in tap water showed that THM concentrations exhibited clear seasonal variation, but spatial variability was limited across the study area. Various metrics of exposure to THMs during pregnancy were created, including ‘personalised’ semi-individual metrics. Analysis of these metrics revealed individual water use to be the main driver of THM exposure in this cohort, with spatial and temporal variability having little influence. Compared with a fully integrated THM exposure metric (incorporating ingestion, showering/bathing and swimming), metrics based only on THM concentrations or THM ingestion misclassified over 50% of women. A nested validation study was conducted using a 7-day water diary and urinary trichloroacetic acid (TCAA) biomarker. This found error in self-reported water use and TCAA ingestion estimates to vary by employment status - error being greater for employed women. Urinary TCAA was not correlated with TCAA in tap water, reinforcing that individual water use is the most influential driver of DBP exposure in this cohort. Recommendations for future research include improved individual water use assessment covering more activities and time-points in pregnancy, stratified analysis of questionnaire validation studies, and use of urinary TCAA as a main exposure measure in epidemiological studies.
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Stemmet, Megan. "Prevalence and characterization of Gardnerella vaginalis in pregnant mothers with a history of preterm delivery." Thesis, University of the Western Cape, 2012. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_4430_1373278573.
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<p>Risk factors such as intrauterine and vaginal infection put pregnant women at risk for delivering preterm. Bacterial vaginosis (BV) is a polymicrobial clinical syndrome commonly diagnosed in women of reproductive age, with women of African descent with low socioeconomic status and previous preterm delivery at high risk. Although frequently isolated from healthy women, <br>Gardnerella vaginalis has been most frequently associated with BV. There is limited data available on the prevalence of BV in Southern Africa<br>therefore, we embarked on a study to determine the <br>prevalence of BV and G. vaginalis in predominantly black communities in the Western Cape, in order to establish the role of G. vaginalis in BV. Women attending various Maternity and Obstetrics <br>units (MOU) in the Cape Peninsula with and without a history of pre-term delivery (PTD) were invited to participate in the study. Several factors were statistically associated with pregnancy history, <br>including location of study population, parity, smoking and presence of clinical symptoms. The presence of G. vaginalis was determined by culture in 51.7% of the preterm delivery group (PTDG) <br>and 44% of the full-term delivery group (FTDG) women. BV was detected in 31.13% of PTDG and 23.67% of FTDG by Gram stained analysis according to Nugent scoring criteria, with age and HIV <br>status posing as risk factors. When comparing PTDG and FTDG for an association between the presence of G. vaginalis and BV, a stronger association was observed in the PTDG but it was not statistically significant. In both PTDG and FTDG, G. vaginalis was isolated significantly more often in women diagnosed with BV at 24.5% (p <<br>0.05). Antibiogram studies revealed both Metronidazole and Clindamycin resistant strains of G. vaginalis. G. vaginalis Biotype 7 is specifically associated with BV, while Biotype 2 appears to be associated with BV in women with a history <br>of PTD. Accuracy of diagnostic tools were tested and it was determined that Nugent scoring is more sensitive in diagnosing BV (76.04%), but culture for G. vaginalis is more specific (83.21%). Although this study was limited in that we were unable to follow-up pregnancy outcomes, we were able to confirm the perceived role of G. vaginalis in BV. <br></p>
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Hegwood, Sunny Kay. "Maternal and Child Health Disparities among Native American Women in Oklahoma: A Secondary Analysis of Health Behaviors, Prior Well-Being, and Adverse Pregnancy Outcomes, 2004-2011." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/555996.
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Utilizing data from the Oklahoma Department of Health Pregnancy Risk Assessment Monitoring System (PRAMS) for the years 2004 through 2011, this study examines racial and ethnic differences in unhealthy maternal behaviors and the consequences of those actions on the health of both mother and child. The maternal behavior variables include smoking cigarettes, drinking alcohol, multivitamin use, and prenatal care utilization. The maternal health variables include gestational diabetes and hypertension. The labor and delivery outcome variables include placental issues, premature rupture of membranes (PROM), low birth weight, and child placement in an intensive care unit. This researcher hypothesized that minorities would engage in risky and unhealthy behaviors while pregnant more often than whites due to social disadvantages in the economic and educational realms. Furthermore, minorities would be more likely than whites to have unfavorable outcomes regarding labor, delivery, and health of the child due to lower socioeconomic status, poor maternal health, and underutilization of preventative care. The researcher finds that minority women seem to adhere to proper maternal health recommendations associated with personal choice, including smoking and drinking, though disparities are evident when compared to whites regarding behaviors associated with socioeconomic status, including prenatal care utilization and multivitamin use. African American women are more likely than whites to experience premature rupture of the membranes, have an underweight baby, and to place their baby in ICU, though less likely to experience placental issues. Native American women are less likely than whites to experience premature rupture of the membranes, have an underweight baby, and to place their baby in ICU, but more likely to experience placental issues. As expected, substantial changes have occurred in the maternal health and well-being of Oklahoma mothers over the course of the two PRAMS data collection phases.
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Debem, Henry Chukwunonso. "History of Pregnancy-Loss and Maternal Socioeconomic Factors as Predictors of Under-Five Child Mortality." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2721.
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Nigeria is one of the countries with the highest Under-5 Mortality rates (U5M) estimated at 117 deaths/1000 live births. Despite public health control initiatives, no significant improvement in U5M has been demonstrated. The purpose of the study was to determine whether history of Adverse Pregnancy Outcomes (APO) and maternal socioeconomic factors could predict the death of children before their fifth birthday, using the life course health development and fetal programming theories. The study population was women in their reproductive age (15- 49 years). The study was a secondary data analysis of the datasets obtained from three Nigeria Demographic and Health Surveys (2003, 2008, and 2013). Complex samples multivariate logistic regression was used to determine the associations among variables. The results showed that lower education level (p < 0.001), lower income level (p <0.05), rural residential setting (p< 0.01), and lower socioeconomic status index (p < 0.001) of women were statistically significant predictors of U5M. APO was not statistically associated with U5M (p > 0.05). This concludes that children of women with low socioeconomic factors and status index could be at higher risk of death within the first 5 years of their lives, and women with history of APO stand no greater risk of losing their under-5 children. The study would contribute to positive social change among women in Nigeria through early identification of women whose children may be at risk of U5M and provision of evidence-based advocacy to urge increased government and public attention to women and child welfare.
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McAuley, Kimberley. "Disinfection by-products and public health concerns." University of Western Australia. School of Population Health, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0070.
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Disinfection by-products (DBPs) are a major group of water contaminants and their role in causing adverse health outcomes, including adverse pregnancy outcomes, endocrine disruption, respiratory related adverse health outcomes and cancer has been subject to extensive epidemiological and toxicological research and review. Determination of safe exposure to DBPs, particularly within drinking water supplies, has been a topic of extensive debate, with a wide range of acceptable levels set across the industrialized world. The focus of the research in this thesis was on two of the main health outcomes associated with DBP exposure, namely adverse pregnancy outcomes and asthma related symptoms. To assess adverse pregnancy outcomes in Perth, an extensive classification quantification of the major DBPs in Perth drinking water was conducted. A registrybased prevalence study was carried out to assess birth defects in relation to high, medium and low DBP areas (defined by the water sampling and analysis). It was found that women living in high THM areas are 22% (odds ratio (OR) 1.22, 95% confidence interval (95% CI) 1.01-1.48) more likely of having a baby with any birth defect. High exposure was also strongly associated with an increased risk of having a baby with a cardiovascular defect (62% increased risk). Low birth weight and prematurity were also assessed; however these outcomes were not associated with an increased risk through an increase in exposure. Following on from this analysis, a population risk assessment model was developed for DBPs in high exposure environments. This involved a three step process: (i) Firstly a questionnaire-based validation and reliability study was used to assess water consumption patterns of a population of pregnant women in Perth. (ii) Secondly a prediction model for teratogenic burden of DBPs in Perth was developed, related to the exposure patterns of the population of pregnant women involved in the validation and reliability study. (iii) Finally, combining the information collected in (i) and (ii), along with the regression slope estimates for birth weight from the prevalence study (defined in Section 2.2.1), a dose-response model for THMs and birth weight was developed. Predictive simulations for birth weights at given THM levels were then conducted. It was estimated that pregnant women in Perth are exposed to between 0.3 4.10 µg/day ingested TTHM, and of this, the more toxic brominated forms accounted for between 0.27 3.69 µg/day. Based on a dose-response model used, birthweights calculated for the hypothetical exposures ranged from 3403.2g for the highest exposure to 3503.5g in the lowest exposure, which is a difference of over 100g. Although the resulting reduction in birth weight is not extreme, there is still a significant reduction in birth weight present as exposure to TTHMs increases. This is the first doseresponse model to be developed to assess an adverse pregnancy outcome based on pregnant women exposure data, and will be a useful tool for assessing varying exposures throughout not only Australia but also throughout the industrialised world, where DBP exposure is highly prevalent.
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Ibrahim, Ayman Hussein. "The thrombomodulin gene and its contribution to adverse pregnancy outcome." Thesis, University of Liverpool, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288113.
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