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1
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.
2
Ruby, Jeannine Alberts. "Nonobstetric laparoscopy versus laparotomy during pregnancy maternal and fetal outcomes /." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-153253/.
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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.
4
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.
5
Patek, Kyla J. "Posterior fossa anomalies diagnosed with fetal MRI: Associated anomalies and neurodevelopmental outcomes." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1305892532.
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Aḥmad, ʿĀʾishah. "The association between fetal position at the onset of labour and birth outcomes." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3723/.
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Fetal position throughout labour exerts considerable influence on labour and delivery, with a mal-positioned fetus during active labour known to contribute towards fetal and maternal morbidity. In response there is a move towards promoting the Left Occipito-Anterior (LOA) position at labour onset as optimal. It is thought that the LOA position encourages anterior rotation thus reducing the likelihood of mal-rotation. A systematic review was undertaken which highlighted an absence of scientific evidence. A prospective cohort study was therefore conducted with 1250 nulliparous women who were scanned to accurately determine fetal position, specifically the LOA position at the onset of labour and the association with delivery mode and other birth outcomes was examined. The LOA position at the onset of labour was not associated with mode of delivery, nor were any of the other positions (p=0.39). Pain relief, labour duration, augmentation, and Apgar scores did not show any association with the LOA or other positions. The only association found was that women with a fetus in the posterior position were more likely to use pethidine (p=0.008). This study has shown that the LOA fetal position at labour onset was not associated with improved outcomes and therefore should not be promoted as optimum.
7
Bennini, Junior João Renato 1978. "Gastrosquise = ultrassonografia na estimativa do peso fetal e predição de desfechos perinatais = Gastroschisis: ultrasonography for fetal weight estimation and prediction of perinatal outcomes." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312556.
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Orientadores: Cleisson Fábio Andrioli Peralta, Ricardo BariniTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-24T09:18:09Z (GMT). No. of bitstreams: 1 BenniniJunior_JoaoRenato_D.pdf: 3747485 bytes, checksum: 5e1bebb4894e53ecc9d1bb5c186b29c1 (MD5) Previous issue date: 2014
Resumo: Introdução: A literatura é controversa sobre o papel de parâmetros ultrassonográficos pré-natais na predição do risco de morbidade e mortalidade perinatais nos casos de gastrosquise. O peso ao nascimento é descrito como um importante fator prognóstico e estudos relatam que fórmulas ultrassonográficas criadas especificamente para esses casos apresentam melhor desempenho na estimativa do peso fetal, mas não há consenso sobre qual a melhor. Objetivos: Avaliar o papel de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais em casos de gastrosquise. Criar uma nova fórmula ultrassonográfica para estimativa de peso fetal que não utilize medidas abdominais e compará-la à outras fórmulas com parâmetros ultrassonográficos bidimensionais (US2D) e tridimensionais (US3D) quando aplicadas em fetos com gastrosquise. Métodos: Para avaliar o desempenho de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais foi realizado um estudo de coorte retrospectiva envolvendo fetos com o diagnóstico de gastrosquise isolada. Para criar e validar a nova fórmula US2D foram utilizados dados referentes à gestantes e fetos normais coletados em um estudo prévio publicado pelo nosso grupo. Foi realizado um estudo retrospectivo transversal envolvendo fetos com gastrosquise, para comparar a nova fórmula US2D com diferentes fórmulas US2D e US3D já publicadas. Os sujeitos foram selecionados entre aqueles acompanhados na Divisão de Obstetrícia do CAISM / UNICAMP. O tamanho da amostra foi estimado em 56 pacientes para avaliar o desempenho de parâmetros ultrassonográficos pré-natais na predição de desfechos perinatais e 27 pacientes para comparar as fórmulas de estimativa de peso fetal. Os dados maternos, gestacionais e pós-natais foram descritos como freqüências relativas e absolutas, média ± desvio padrão (DP), mediana e limites. A normalidade dos dados contínuos foi testada utilizando-se o teste de Kolmogorov¿Smirnov. Testes t de amostras independentes e testes de qui-quadrado foram utilizados na comparação de dados contínuos e categóricos, respectivamente. Análises de regressão polinominal até o terceiro grau foram consideradas para criar a nova fórmula US2D de estimativa do peso fetal sem medidas abdominais. Cálculo do erro percentual médio ± DP, testes t unilaterais, testes t de amostras pareadas com correção de Bonferroni e testes de variância para amostras pareadas foram usados para avaliar e comparar a acurácia e precisão das fórmulas. A associação entre dados contínuos foi testada utilizando-se os coeficientes de correlação de Pearson ou Spearman e regressão logística univariada, conforme indicado. Valores de p < 0,05 foram considerados significativos. Resultados: Foram incluídos 44 casos de fetos com gastrosquise para avaliar a predição de desfechos perinatais por meio de parâmetros ultrassonográficos pré-natais. A presença de dilatação de alças intestinais intra-abdominais (DAI) fetais aumentou o risco de complicacões intestinais pós-natais e a presença de restrição de crescimento fetal (RCF) diminuiu o risco deste mesmo desfecho. Nenhum outro parâmetro ultrassonográfico pré-natal pode significativamente predizer os desfechos perinatais avaliados. Foram usados os dados referentes aos mesmos grupos de 150 fetos normais e 60 fetos normais do estudo prévio para respectivamente criar e validar a nova fórmula US2D, que foi a seguinte: peso fetal estimado (PFE) = 623.324 + 0.165 x DBP x CC x CF2 (DP: 12,25%). Na comparação entre as fórmulas US2D e entre as fórmulas US2D e US3D, foram utilizados 44 e 28 fetos com gastrosquise isolada, respectivamente. O melhor desempenho na estimativa do peso de fetos com gastrosquise foi obtido com o modelo US2D proposto por Siemer e colaboradores. Conclusões: Em fetos com gastrosquise o achado de DAI múltipla associa-se a complicações intestinais pós-natais e a presença de RCF possui um efeito protetor para este mesmo desfecho. A nova fórmula US2D sem medidas abdominais não melhorou a estimativa do peso ao nascimento dos fetos com gastrosquise da nossa população em relação às outras fórmulas US2D e US3D avaliadas. Na nossa amostra de pacientes com gastrosquise o modelo S2D de Siemer e colaboradores apresentou o melhor desempenho na estimativa de peso
Abstract: Background: The role of prenatal ultrasonographic parameters for the predicition of perinatal outcomes in fetuses with gastroschisis is still controversial. Birthweight is described as a prognostic factor and some studies report that ultrasonographic formulas especifically created for these cases have a better performance for fetal weight estimation, but there is no consensus about which is the best one. Objectives: To evaluate prenatal ultrasonographic parameters as predictors of adverse perinatal outcomes in fetuses with gastroschisis. To create a new birthweight predicting ultrasonographic model without abdominal measurements and compare this new formula with other two-dimensional (2DUS) and three-dimensional (3DUS) fetalweight predicting models already published when aplied to fetuses with gastroschisis. Methods: To evaluate the performance of prenatal ultrasonographic parameters as predictors of perinatal outcomes in fetuses with gastroschisis a retrospective cohort study was done. To create and validate the new 2DUS formula the same data from normal fetuses colected in a previous study of our group was used. A retrospective cross-sectional study encompassing fetuses with gastroschisis was carried out to compare the new 2DUS formula with other 2DUS and 3DUS formulas already published. The patients were selected among those followed at the Division of Obstetrics of the Center for Integral Assistance to Women¿s Health of the State University of Campinas (UNICAMP). The sample size was estimated in 56 patients to evaluate prenatal ultrasonographic predictors and perinatal outcomes and 27 patients to compare the fetal weigth estimating formulas. Maternal, pregnancy and postnatal data were described as absolute and percentual frequencies, mean ± standard deviation (SD), median and range. Continuous data were tested for their normal distribution using the Kolmogorov¿Smirnov test. Independent samples t tests and chi-square tests were used in the assessment of continuous and categorical variables, when appropriate. Polynomial stepwise regression analyses up to the third order were considered to generate a new 2DUS weight-predicting model without abdominal measurements. Calculation of the mean percentage error ± SD, one-sample t tests, paired samples t-tests with Bonferroni adjustment and correlated variance tests for paired samples were used to compare the performances of the formulas. The potential association between continuous data was tested by means of Pearson or Spearman¿s Correlation Coefficient and univariate logistic regression, as indicated. A two-tailed p-value of less than 0.05 was considered statistically significant. Results: Forty-four fetuses were included to evaluate the ultrasonographic prental parameters as predictors of perinatal outcomes. The presence of fetal multiple intra-abdominal bowel dilation (IBD) was associated with increased incidence of intestinal complications and the presence of fetal growth restriction (FGR) had a protective effect over this outcome. No other prenatal ultrasographic parameter could significantly predict the perinatal outcomes evaluated. It was used the same data from our previous study on 150 normal fetuses and 60 normal fetuses to respectively generate and validate the new 2DUS formula, that was: estimated fetal weight = 623.324 + 0.165 x BPD x HC x FDL2 (SD: 12.25). In the comparison between the 2DUS formulas and between the 2DUS and 3DUS formulas it was included 44 and 28 fetuses, respectively. The best performance for weight prediction in fetuses with gastroschisis was achieved using the model created by Siemer et al. Conclusions: In fetuses with gastroschisis the findings of multiple IBD increases the risk of postnatal bowel complications and the presence of FGR decreases the risk of this outcome. The new 2DUS formula without abdominal measurements did not improve fetal weight estimation in fetuses with gastroschisis of our population when compared to other 2DUS and 3DUS formulas evaluated. The 2DUS weight estimating model of Siemer et al had the best performance for this purpose
Doutorado
Saúde Materna e Perinatal
Doutor em Ciências da Saúde
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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.
9
Gunn, J. K. L., C. B. Rosales, K. E. Center, A. V. Nunez, S. J. Gibson, and J. E. Ehiri. "The effects of prenatal cannabis exposure on fetal development and pregnancy outcomes: a protocol." BMJ, 2015. http://hdl.handle.net/10150/617200.
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UA Open Access Publishing FundIntroduction: The effects of exposure to marijuana in utero on fetal development are not clear. Given that the recent legislation on cannabis in the US is likely to result in increased use, there is a need to assess the effects of prenatal cannabis exposure on fetal development and pregnancy outcomes. The objective of this review is to assess the effects of prenatal exposure to cannabis on pregnancy outcomes (including maternal and child outcomes). Methods and analyses: Major databases will be searched from inception to the latest issue, with the aim of identifying studies that reported the effects of prenatal exposure to cannabis on fetal development and pregnancy outcomes. Two investigators will independently review all titles and abstracts to identify potential articles. Discrepancies will be resolved by repeated review, discussion and consensus. Study quality assessment will be undertaken, using standard protocols. To qualify for inclusion, studies must report at least one maternal or neonatal outcome post partum. Cross-sectional, case–control, cohort and randomised controlled trials published in English will be included. In order to rule out the effects of other drugs that may affect fetal development and pregnancy outcomes, studies will only be included if they report outcomes of prenatal exposure to cannabis while excluding other illicit substances. Data from eligible studies will be extracted, and data analysis will include a systematic review and critical appraisal of evidence, and meta-analysis if data permit. Meta-analysis will be conducted if three or more studies report comparable statistics on the same outcome. Ethics and dissemination: The review which will result from this protocol has not already been conducted. Preparation of the review will follow the procedures stated in this protocol, and will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethical approval of data will not be required since the review will use data that are already available in the public domain through published articles and other reports.
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Ndovie, Lughano. "Maternal and fetal outcomes of induction of labour using oral misoprostol at New Somerset Hospital." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28074.
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Introduction: Induction of labour is commonly performed in clinical practice. Increasing rates of induction of labour worldwide has led to debate on whether elective induction improves the outcomes or simply leads to increased complications and healthcare costs. Maternal and neonatal complications and increased caesarean section (CS) rates associated with induction of labour are related to a variety of factors influencing the methods of induction. Misoprostol has been the drug of choice for induction of labour in developing countries for almost a decade. Different misoprostol regimens are used for induction of labour in different health facilities. New Somerset Hospital uses the standard protocol for induction of labour using misoprostol that the Western Cape Government adopted. This protocol has however not been audited. The main objective of the study was to determine the maternal and fetal outcomes of inductions of labour performed at New Somerset Hospital. Methods: This was a retrospective study conducted at New Somerset Hospital. We reviewed a random sample of medical records of patients who underwent induction of labour from 01 January 2014 to 31 December 2014. Ethics committee approval was granted by the Human Research Ethics Committee of the Faculty of Health Sciences of UCT. A total of 88 folders were sampled from 1029 women who had induction of labour. Results: There were a total of 6514 deliveries in 2014 of which 1029 had induction of labour, giving an induction rate of 15.8%. A total of 86 patients were included in the study. The mean age of the patients was 28.9 years (SD±6.586) with an age range of 16 to 44 years. The average gestational age at the time of induction of labour was 39.5 weeks with a range 35 to 42.6 weeks and 14.0% of the patients were HIV positive. The three main indications of induction of labour were hypertension in pregnancy (40.7%), prolonged pregnancy (27.9%) and pre-labour rupture of membranes (8.1%). Overall, 50 patients (58.1%) had vaginal delivery and 36 patients (41.9%) had caesarean delivery. There was a significant association between mode of delivery and time to delivery. Patients who delivered within 24 hours of commencement of induction of labour were more likely to have had a vaginal delivery (p = 0.005). The three main indications for caesarean delivery were fetal heart rate changes (n=30; 72.0%) followed by failed induction of labour (n=9; 21.0%) and cephalopelvic disproportion (n=3; 7.0 %). In terms of maternal outcomes, 2 patients (2.3%) had hyperstimulation of the uterus, 6 patients (7.0%) had postpartum hemorrhage, 8 patients (9.3%) had vaginal tears and 5 patients (5.9%) had an episiotomy performed during delivery. The mean birth weight was 3262.1g (SD±503.77) with a range of 1925 to 4515 grams. At five minutes the means Apgar score was 9.8(SD ± 0.62) with range of 6 to 10. A total of 38 babies (44.3%) had meconium stained liquor documented at delivery, three babies (3.4%) required neonatal resuscitation upon delivery. There were 10 (11.6%) babies that were admitted to NICU. Conclusion: In this study we found that the prevalence of induction of labour was 15.8%. Hypertension in pregnancy, prolonged pregnancy and pre-labour rupture of membranes are the three common indications for induction of labour. Successful vaginal delivery was achieved in 51.0% of the study population. The caesarean delivery rate was high, mostly due to CTG changes The current induction of labour protocol using oral misoprostol is associated with acceptable maternal and fetal outcomes.
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Garza, Puentes Andrea de la. "Fatty Acids in Obese Pregnancies: Maternal and Child Outcomes." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/457689.
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Maternal obesity has implications on the health of future generations by early life programming. The mother is usually the main source of nutrients for the fetus and neonate, hence her nutritional status is crucial for child development. Fatty acids (FAs), especially long chain polyunsaturated fatty acids (LC-PUFAs), are key nutrients in fetal growth and development. Since these nutrients are known to be altered by conditions such as obesity, maternal obesity could impair fetal/neonatal FA supply, and consequently child outcomes.
This thesis presents 4 manuscripts about the influence of maternal pre-pregnancy weight on FA quality and concentrations, along with the implications on maternal and child outcomes. We studied mother-child pairs selected from the total participants in the observational PREOBE cohort study and divided them into 4 groups according to maternal pre-pregnancy body mass index (BMI) and gestational diabetes status; 1) normal-weight, overweight, obese and gestational diabetic.
We investigated if FADS and ELOVL genetic variants were associated with pre-pregnancy BMI or affected PUFA levels in plasma of pregnant women. We found that minor allele carriers of FADS1 and FADS2 SNPs had an increased risk for obesity and that the effects of genotype on plasma FA concentrations differed by maternal pre-pregnancy weight status. Enzymatic activity and FA levels were reduced in normal-weight women who were minor allele carriers of FADS SNPs; these reductions were not significant in overweight/obese participants. This suggests that women with a BMI>25 are less affected by FADS genetic variants in this regard. In the presence of FADS2 and ELOVL2 SNPs, overweight/obese women showed higher n-3 LC-PUFA production indexes in plasma than those women in the normal-weight group, but this was not enough to obtain a higher n3 LC-PUFA concentration.
We also analyzed the differences in colostrum PUFA composition according to maternal pre-gestational BMI and FADS genotype. A high maternal pre-pregnancy BMI was associated with altered FA levels in colostrum, nevertheless FADS genotypes modulated these results. Minor allele carriers resulted with decreased enzymatic activity and PUFA levels only in normal-weight individuals, making their FA levels similar to those of overweight/obese women. Therefore, FADS genetic variation in overweight/obese women had a different impact, possibly improving their FA status. We also found that dietary intake of DHA in late pregnancy influenced colostrum levels of DHA, thus a high intake of this FA could be a recommendation to improve breast milk composition.
Prior to FA analysis in the infants, we validated cheek cells and capillary blood as less invasive alternatives to traditional plasma sampling for FA analysis. We determined the impact of maternal BMI and/or infant feeding practice in infant FA concentrations, and analyzed if these FAs associated with cognitive performance. Maternal pre-pregnancy BMI altered the infant FA behavior in evolution, feeding practice and cognition. In general, FA concentrations decreased towards the 3 years of life, except for the SFAs, n6:n3 and LC-n6:n3 ratios which were increased. Exclusive breastfeeding seemed to rise crucial FAs (e.g. DHA) in infants at 6 months of age, and cognitive performance was found improved in infants with high levels of PUFAs (e.g. DHA, AA) until 1.5 years of age (e.g. n3 PUFAs).
These results are a contribution to the scientific evidence of the importance of a healthy pre-pregnancy weight, and identify groups of women who could benefit from an adequate FA intake to pursue better infant outcomes. We therefore should promote a healthy weight and diet in women before, during and after pregnancy to have beneficial effect in children, and consequently prevent some nutrition-related issues through their life.La obesidad materna tiene implicaciones en la salud de futuras generaciones debido a la programación fetal. Los ácidos grasos (AGs), especialmente poliinsaturados de cadena larga (AGPICL), intervienen en el crecimiento y desarrollo fetal. Dado a que la obesidad puede alterar la concentración de estos AGs, la salud del feto y neonato se compromete. Esta tesis presenta 4 manuscritos sobre el peso materno pre-gestacional en los AGs y sus implicaciones en madre e hijo. Se incluyeron participantes del estudio observacional PREOBE donde se dividen en 4 grupos según el índice de masa corporal (IMC) materno pre-gestacional y estado de diabetes gestacional; 1)normopeso, 2)sobrepeso, 3) obesidad, 4) diabetes gestacional. Se muestra que el alto peso en las mujeres embarazadas altera el comportamiento de los genotipos de las enzimas que intervienen en el metabolismo de los AGs (FADS y ELOVL) y, consecuentemente, afectan los niveles de AGs tanto en plasma como leche materna. Para examinar el perfil de AGs en el niño, primero se validaron la mucosa bucal y sangre capilar como métodos confiables y menos invasivos que la extracción de plasma. Al analizar los AGs del infante, se determina que el IMC materno pre-gestacional altera los niveles de AGs en el niño y cómo éstos se comportan respecto a la evolución, lactancia y cognición. Los resultados de esta tesis aportan evidencia científica sobre la importancia de un peso materno pre- gestacional adecuado; e identifican grupos de mujeres que pueden verse beneficiadas con una apropiada ingesta de AGs con la finalidad de promover el óptimo desarrollo del niño. Por tanto, se debe promover un peso y una dieta adecuada en las mujeres antes, durante y después del embarazo para beneficiar al niño y, consecuentemente, prevenir condiciones adversas en el curso de vida.
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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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El-Halabi, Dima. "Oxidative and nitrative stress biomarkers in amniotic fluid and their association with fetal growth and pregnancy outcomes." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101119.
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The study objectives were to: (1) assess fetal exposure to oxidative stress by measuring amniotic fluid concentrations of nitric oxide (NO), thiobarbituric acid--reactive substances (TBARS), and ferric reducing antioxidant power (FRAP) and (2) establish whether these concentrations were associated with infant birth weight, gestational age, or oxidative stress-related conditions arising during pregnancy. Frozen amniotic fluid samples were obtained from 654 mothers undergoing amniocentesis for genetic testing during second trimester in Montreal, QC, Canada. Maternal and neonatal characteristics were collected from medical charts and questionnaires and exclusion criteria were applied. ANOVAs and multivariate regression analyses showed that NO, which differed among pre-term, term, and post-term groups, was a positive predictor of gestational age. TBARS were highly correlated with sample storage and were not associated with pregnancy outcome parameters. FRAP positively predicted gender-corrected birth-weight-for-gestational-age. Our study shows that markers of oxidative and nitrative stress in-utero are associated with pregnancy outcomes.
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Jahan, Saulat. "Gestational and Pregestational Diabetes in the Eastern Mediterranean Region: A Meta-analysis of Maternal and Fetal Outcomes." ScholarWorks, 2014. http://scholarworks.waldenu.edu/hodgkinson/21.
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Pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) are associated with adverse pregnancy outcomes including increased caesarean section rates, macrosomia, and perinatal mortality. Despite the high prevalence of GDM and PGDM in the Eastern Mediterranean Region (EMR), most of the published studies examining the association between GDM/PGDM and adverse pregnancy outcomes have small sample sizes, low statistical power, and few adverse outcomes with conflicting results. The purpose of this study was to determine the association of GDM/PGDM with adverse pregnancy outcomes among women in the EMR, by using a meta-analysis research design. Following the conceptual model of the epidemiologic triangle, the research questions for this study tested whether an association existed between GDM/PGDM and delivery by cesarean section, macrosomia, and perinatal mortality among women in the EMR. A random effects model was used for merging the weighted average of the odds ratios in the 33 primary studies. Pooling of the data showed that, in the EMR, odds of undergoing caesarean section, of having a macrosomic baby, and of perinatal death among women with GDM/PGDM were higher than those without GDM/PGDM. This study contributes to social change by providing a better picture of magnitude and severity of GDM/PGDM, in creating awareness of the seriousness of the problem, and in helping inform public health interventions in the EMR. Women with GDM/PGDM receiving proper health care can have decreased adverse outcomes which, in turn, results in healthy mothers and children forming a healthy family and leading to a healthy, productive community.
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Paramasivam, Gowrishankar. "Ultrasound assessment of fetal cardiac function and risk of adverse obstetric and neonatal outcomes in term fetuses." Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/48187.
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Aim: To measure fetal cardiac output prior to labour and assess the risk of adverse obstetric and neonatal outcome in singleton pregnancies with appropriately grown for gestational age (AGA) fetuses at term. Methods: This was a prospective observational study conducted at Queen Charlotte’s and Chelsea Hospital, London UK. Fetal cardiac output and fetal cerebroplacental ratio (CPR) was measured within 72 hours before birth in 200 nulliparous women having singleton pregnancies with AGA fetuses. Scan details were not available to the clinicians and delivery was managed per the local protocol and guidelines. Obstetric and neonatal outcomes were obtained from case notes and correlated with the ultrasound findings. Results: Delivery was vaginal in 129 (64.5%) cases and by caesarean section in 71 (35.5%), including 34 (17.0%) for fetal distress and 37 (18.5%) for failure to progress. Fetuses delivered by caesarean section for fetal distress, compared to the remaining fetuses, had a lower median left cardiac output(LCO) (152.3 vs. 191.7 mL/min/kg; p=0.003), higher difference in the median ratio between the right to left cardiac output (RCO to LCO ratio) 1.925 vs. 1.340; p=0.002) and lower CPR (1.222 vs. 1.607; p < 0.0001). In screening for emergency caesarean section for fetal distress, for a 10% false positive rate, the detection rate with the RCO to LCO ratio was higher that with the LCO (41% vs. 29%) and with the CPR (41% vs. 27%). Similarly, the positive predictive value for the RCO to LCO ratio (45%) was higher than LCO (37%) and the CPR (35%). Conclusion: In AGA fetuses at term that develop intrapartum distress, there is evidence of prelabour redistribution of the cardiac output. The RCO to LCO ratio is superior to the LCO and CPR in predicting intrapartum fetal distress. Such assessments may be useful in stratifying patients for the intensity of monitoring during labour.
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O'Donnell, Kieran J. "Maternal prenatal stress and fetal programming : long term biobehavioural outcomes in the child and potential placental mechanisms." Thesis, Imperial College London, 2010. http://hdl.handle.net/10044/1/6350.
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Mounting evidence suggests prenatal stress can affect child development. Clinical studies of this concept, termed fetal programming, focus predominantly on early childhood. Also, little is known about the mechanisms underlying how maternal stress is transmitted to the fetus. This thesis will test if maternal anxiety during pregnancy is associated with (1) behavioural outcomes from childhood to early adolescence, (2) cortisol output in adolescence and (3) an altered placental phenotype. For Studies 1 and 2 participants were drawn from the Avon Longitudinal Study of Parents and Children (ALSPAC). Psychometric data from 9,871 mother child pairs (5,098 males, 4,773 females) were analysed using latent growth curve analysis. A subsample of the ALSPAC children aged 15 years (n = 899) provided saliva samples on three days at waking, +35mins, after school and before bed, for later cortisol analysis. For Study 3 a new cohort of women (n= 73) was recruited. Maternal psychometric data was collected one day prior to elective caesarean section, and the placenta collected after delivery. Study 1 showed that maternal prenatal anxiety was associated with conduct and emotional problems, and symptoms of ADHD at age 13 years, after allowing for a range of confounders, including postnatal anxiety. There were marked sex differences in the developing patterns. Saliva cortisol demonstrated a marked diurnal profile with a clear sex difference at age 15. Higher maternal prenatal anxiety was associated with a reduced cortisol awakening response. High levels of maternal prenatal anxiety were associated with reduced placental expression and activity of the cortisol metabolising enzyme 11β-Hydroxy steroid dehydrogenase 2 (11β-HSD2) and also with reduced placental weight. This thesis provides evidence that maternal prenatal anxiety can affect behavioural and neuroendocrine outcomes in adolescence. It also provides preliminary evidence that maternal anxiety is associated with alterations in the function of the placenta, which may underlie some aspects of fetal programming. These findings have public health implications. Increasing awareness about the lasting effects of prenatal anxiety may ultimately benefit mothers, the care they receive and their families.
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Adegoke, Korede K. "The Effects of Maternal Folate on Fetal Brain and Body Size among Smoking Mothers." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6793.
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The adverse effects of maternal smoking on infant mortality and morbidity has been well documented in the literature. Maternal tobacco use is causally associated with fetal growth restriction and correlates negatively with folate intake and metabolism. Studies have examined the association between smoking and folate levels during pregnancy, but very few have assessed this relationship using objective and accurate measures of both variables. Furthermore, despite evidence of a causal association between smoking in pregnancy and intrauterine growth restriction, and a plausible relationship between tobacco use and low maternal folate which is required for optimal fetal growth, no experimental study has investigated the potential benefit of folic acid in mitigating the adverse effects of maternal smoking on fetal outcomes.
The objectives of this study were to investigate the relationship between maternal smoking and folate levels and examine the efficacy of higher-strength folic acid supplementation, in combination with enrollment in a smoking cessation program, in promoting fetal body and brain growth. Our hypothesis was that women who smoke during pregnancy have lower peri-conceptional folic acid reserves than non-smoker pregnant women and that folic acid reserves will decrease with increasing cotinine level. Additionally, smoker pregnant women on higher-strength folic acid (4mg daily) in combination with smoking cessation programs will experience faster fetal brain growth and have infants with larger body size at birth compared to smokers on the standard dose of folic acid (0.8mg daily).
Participants were pregnant women (smokers and non-smokers) who received antenatal care between 2010-2014 at the Genesis Clinic of Tampa, a community health center affiliated with the Department of Obstetrics and Gynecology of the University of South Florida (USF). They were aged 18-44 years and had a gestational age of less than 21 weeks at study enrollment. To determine the peri-conceptional folic acid reserves in smoking versus nonsmoking women during pregnancy and associated sociodemographic factors, baseline (crosssectional) data from a double-blinded randomized controlled trial were analyzed using Tobit regression models (n=496). Smoking information was assessed using salivary cotinine, a sensitive and specific tobacco use biomarker. Folate reserve was measured using red blood cell folate. To investigate the efficacy of higher-strength folic acid on fetal body and brain size, baseline and follow-up data from pregnant smokers enrolled in the randomized controlled trial were utilized (n=345). All primary analyses of the clinical trial data were conducted on a modified intention-to-treat basis and included participants who completed the trial with an observed endpoint, irrespective of compliance to protocol. Multilevel modeling, linear regression, and log-binomial regression analyses were conducted.
A significant inverse association between salivary cotinine level and periconceptional red blood cell folate concentration was found among pregnant women in the early to midpregnancy period. Smokers on high-dose folate during pregnancy had infants with a 140.38g higher birth weight than infants of their counterparts on standard dose folate (P =0.047). Mothers who received higher strength folate had a 31.0% lower risk of having babies with SGA compared to their mothers on the standard-dose (adjusted relative risk-ARR=0.69, 95% CI: 0.46–1.03; (P =0.073)). High-dose folate had no significant effect on the intrauterine rate of growth in head circumference, and head circumference and brain weight at birth in our trial sample. However, the brain-body ratio of infants of mothers who received high-dose treatment was 0.33 percentage-point lower than that for infants of mothers who received the standard dose of folate (P =0.044).
Higher strength folic acid supplementation in pregnant women who smoke might be a cost-effective and safe option to improve birth outcomes and reduce low birth weight and SGA associated infant morbidity and mortality. Future studies with larger sample sizes and diverse populations are indicated to confirm or refute the results of this study. Randomized controlled trials starting during the preconception period and with follow-up until delivery are warranted, to identify the most folate-sensitive period of fetal growth and determine the optimal dose of folic acid supplement. Further research investigating several pathways through which the effects of prenatal smoking on adverse birth outcomes can be mitigated is needed.
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Howard, Philip Hamilton. "Income inequality, air toxics and variation in adverse birth outcomes in Missouri counties /." free to MU campus, to others for purchase, 2002. http://wwwlib.umi.com/cr/mo/fullcit?p3052180.
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Grjibovski, Andrej. "Socio-demographic determinants of pregnancy outcomes and infant growth in transitional Russia /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-226-8/.
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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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Araya, Winta Negusse. "Knowledge and Practice of Reproductive Health among Mothers and their Impact on Fetal Birth Outcomes: A Case of Eritrea." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4627.
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Maternal mortality is a huge concern globally leading to more than a quarter of a million deaths every year. Similarly, an estimated 4 million neonates die every year worldwide, contributing to the majority of deaths of under-5 children. The majority of these deaths take place in under-developed countries, and specifically, in the sub-Saharan Africa region. It is evidenced that maternal ill-health and death contribute to the majority of child deaths. Reducing the death of children under 5 years by two thirds and also improving maternal health/reducing maternal death by three quarters between the years 1990 and 2015 are two of the eight aims of the Millennium Development Goals (MDGs), MDG-4 and MDG-5 respectively. The report on maternal health services in Eritrea, a nation in the sub-Saharan Africa, shows a low utilization of antenatal care, family planning services, and postnatal care. Furthermore, there is insufficient use of skilled assistance at delivery. The purpose of this study was to explore the reproductive health knowledge and practice of women aged 18-49 and the impact of these on infant birth outcomes. Participants were all living in the Central Zone of Eritrea. This study proposed that knowledge of reproductive health is one of the key factors contributing to the health of women in the reproductive age group, and thereby reduction of maternal and child deaths and morbidities. An exploratory cross-sectional study design was implemented in this study using an investigator-designed questionnaire. Data were collected from participants intending to assess awareness on the domains of reproductive health including knowledge of family planning, sexually transmitted diseases (STDs), antenatal and postnatal care, importance of vaccinations, and identification of pregnancy/labor danger signs. Data on the most recent birth outcome that took place in the past five years were collected to investigate any existing associations. Findings showed that a majority of participants recognized danger signs and where to seek help in case of complications related to pregnancy and childbirth. Participants also stated the importance of child vaccination, identified STDs and family planning methods as well. Further, the majority also acknowledged the importance of antenatal care (ANC) and postnatal care by skilled personnel. However, a large percentage did not start ANC visits until after the first trimester. Also, a large number of participants did not know when fetal anomalies were most likely to occur or when conception can happen in relation to the menstrual cycle. Looking at birth outcomes, marital status and educational status showed a significant relationship with birth weight, while educational status was further a significant predictor of maturity of fetus at birth. Overall, these findings indicate the need for increased efforts in providing adequate reproductive health education, especially in certain target areas, so that women are better equipped with the necessary basic reproductive health information. This will hopefully contribute to the betterment of maternal health, further leading to a desired birth outcome.
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Tasset, Julia L. "A Systematic Review of Vitamin D Deficiency in Pregnancy in India and its Impact on Maternal and Fetal Outcomes." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1397235209.
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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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Chang, Shih-Chen. "Characteristics of inner-city pregnant African-American adolescents impact of nutrition on maternal health, fetal bone development and adverse birth outcomes /." Available to US Hopkins community, 2002. http://wwwlib.umi.com/dissertations/dlnow/3080635.
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Mavukani, M. P. "Maternal and fetal outcomes of pregnant women on antiretroviral (ARV) therapy at Dr George Mukhari hospital :a case-controlled clinical study." Thesis, University of Limpopo (Medunsa Campus), 2009. http://hdl.handle.net/10386/274.
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Thesis (M Med.(Obstetrics & Gynecology))--University of Limpopo,2009.OBJECTIVE: The objectives of the study were: 1) To determine the pattern of toxicity/side-effects among women using Highly Active Antiretroviral Therapy (HAART) in the perinatal period in comparison with women who were treated with intra- partum prophylaxis of nevirapine at the time of delivery. 2) To evaluate the effects of either approach of therapy on maternal and fetal outcomes. METHODOLOGY: STUDY DESIGN The department of Obstetrics and Gynaecology has begun to administer HAART to pregnant women identified for ARV programme. These women were counseled and recruited prospectively for the study. The study involved comparison of pregnancy outcomes between women identified for HAART and those who were HIV infected but who only required intra-partum prophylaxis in labour to prevent mother-to-child transmission of HIV with nevirapine.
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Ofori, Samuel N. "Isolated oligohydramnios in low-risk pregnancy- a prospective study of the maternal, placental and fetal aetiological factors and associated perinatal outcomes." Thesis, University of Portsmouth, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.516884.
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Background: There is an unsubstantiated conviction among clinicians that a significant reduction In amniotic fluid volume is a poor prognostic sign for pregnancy, even when it is an isolated finding. This belief has led to the inculcation of serial ultrasound assessments of amniotic fluid volume into the antenatal assessment of fetal well being with the aim of improving perinatal outcomes by closer monitoring and earlier delivery. In reality, there is no strong evidence base for this practice, while there are significant risks associated with premature delivery. There may also be cost and resource implications for the practice. Objective: The aim of this thesis was to investigate whether isolated oligohydramnios is significantly associated with adverse pregnancy outcomes in otherwise uncomplicated pregnancies, and to investigate the underlying associated maternal, fetal and placental aetiological factors. Materials and Methods: Amniotic fluid volumes were measured using ultrasound in 3328 low-risk pregnancies between 19 and 41 weeks. These were otherwise uncomplicated pregnancies recruited at the antenatal booking visit following a normal 1st trimester screening result (a negative 11-14 week combined nuchal translucency ultrasound and maternal serum-biochemistry fetal structural and chromosomal abnormality screening test). Maternal characteristics (age, parity, ethnicity, socioeconomic status, weight, smoking and alcohol consumption) during the course of the pregnancy, Placental characteristics (site, position and maturity), and Fetal renal blood flow parameters were also studied and analysed for possible associations. Results: Isolated oligohydramnios occurred more frequently with advancing maternal age and lower parity. However, maternal ethnicity, weight and socioeconomic status did not have any direct influence on the occurrence of isolated oligohydramnios and neither did the maternal life style factors studied. Increasing placental maturity was significantly associated with significantly reduced amniotic fluid but neither the placental site nor location was. There was a significant association between oligohydramnios and poor perinatal outcome as judged by meconium staining of amniotic fluid during labour, emergency Caesarean delivery for fetal compromise, an increased requirement for neonatal resuscitation and endotracheal intubation. In the population of pregnancies studied, there was no significant correlation between isolated oligohydramnios and a suspicious or pathological cardiotocogram during labour. However, a low birth weight less than 2500 g at birth, admission to the neonatal intensive care unit, a prolonged length of neonatal intensive care unit stay, and perinatal deaths were all significantly associated with oligohydramnios. No association was seen with either a low Apgar score or a low fetal arterial cord blood pH. Conclusion: This study showed that an isolated reduction in amniotic fluid volume even in an otherwise uncomplicated pregnancy is significantly associated with a poor perinatal outcome, and can therefore not be safely ignored. This finding justifies the continued assessment of amniotic fluid volumes.
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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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Myers, Patricia D. "The Association of Maternal Pregnancy Complications and Sudden Infant Death Syndrome." [Tampa, Fla.] : University of South Florida, 2003. http://purl.fcla.edu/fcla/etd/SFE0000068.
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Olsson, Thomas. "Does a pint a day affect your child’s pay? : Prenatal alcohol exposure and child outcomes, Evidence from a policy experiment." Thesis, Uppsala universitet, Nationalekonomiska institutionen, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7658.
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In this thesis I evaluate the impact of an experiment with free sales of strong beer in two Swedish counties that took place in the 1960s. I do this by studying adult earnings of persons in utero during the experiment. My data includes date and place of birth and allows me to evaluate the impact of the experiment using a difference-in differences methodology, comparing earnings across cohorts and counties. Since the availability of alcohol increased most heavily for persons under the age of 21, and male fetuses are less physiologically robust than female fetuses, I choose to study persons born by mothers younger than 21 separately and also estimate the impact of the experiment separately for men and women. I find that persons born by mothers under the age of 21 during the experiment have lower average earnings than persons born before the experiment, and that the impact is larger on men. My results indicate that the experiment has led to adverse effects on adult earnings, probably caused by the prenatal alcohol exposure’s negative impact on fetal development. This means that alcohol consumption have long-term consequences that represent large costs to society. Since these costs are generally disregarded when evaluating the cost of alcohol consumption, society’s cost of alcohol is probably higher than usually estimated.
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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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Arroyo, Juan Pablo. "Exploring Potential Risk Factors of Fetal Origins of Diabetes| Maternal Stressors during Pregnancy and Birth Outcomes among Women in a Hospital in the Municipality of Caguas, Puerto Rico." Thesis, University of South Florida, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1543402.
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Puerto Rico has the highest prevalence of type 2 diabetes, low birth-weight, and the second highest prevalence of preterm-birth in all the U.S. and its non-incorporated territories. These conditions are related. Birth-weight at both ends of the spectrum and preterm-birth are associated with an increased risk for developing type 2 diabetes and immune-inflammatory dysregulations. Maternal psychosocial stressors during pregnancy have also been recognized as potential risk factors for type 2 diabetes, and have been consistently associated with preterm-birth and low birth-weight across populations. Current evidence points toward epigenetic fetal metabolic-programming as the mechanism that underlies the increased risk for the previously mentioned morbidities. However, the particular psychosocial stressors that may contribute to the high prevalence of low birth-weight and preterm-birth in the population of Puerto Rico have not been well studied.
The present study assesses the relationships between particular psychosocial stressors, socioeconomic status, food insecurity, and birth outcomes. The results of this study show that low-risk pregnancy women were more likely to have babies with a higher ponderal index if they were exposed to stressors during gestation months 5, 6, and 7, or if exposed to "relationship stress" at any time during pregnancy. Women exposed to "financial difficulties" at any time during pregnancy were more likely to deliver babies at an earlier gestational age. Differences in birth outcomes between the exposed and non-exposed women were independent of maternal anthropometric measurements, maternal age at birth, number of previous births, and sex of the baby. Significant differences in birth outcomes were found between categories of father's self-identified and identified by others ethnicity, but sample size within categories was small. Although mothers with children at home had higher levels of food insecurity, and the level of food insecurity was correlated with higher levels of stress, no birth outcome measure was associated with food insecurity.
Some results are atypical in comparison with other populations, and therefore these findings may contribute to the understanding of population differences in the relationship between maternal stress during pregnancy and birth outcomes. The relatively small sample size and strict exclusion criteria of this study may limit the generalizability of the findings. Epidemiological similarities between Puerto Rico and other populations, and the possibility of a higher ponderal index increasing the risk for type 2 diabetes in the population of Puerto Rico need to be examined in future research.
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Zabihi, Sheller. "Fetal Outcome in Experimental Diabetic Pregnancy." Doctoral thesis, Uppsala University, Department of Medical Cell Biology, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8739.
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Women with pregestational diabetes have a 2-5 fold increased risk of giving birth to malformed babies compared with non-diabetic women. Diabetes-induced oxidative stress in maternal and embryonic tissues has been implicated in the teratogenic process. The malformations are likely to be induced before the seventh week of pregnancy, when the yolk sac is partly responsible for the transfer of metabolites to the embryo, and the uterine blood flow to the implantation site determines the net amount of nutrients available to the conceptus. We aimed to evaluate the effect on embryogenesis caused by a diabetes-induced disturbance in yolk sac morphology, uterine blood flow or altered maternal antioxidative status in conjunction with a varied severity of the maternal diabetic state.
We investigated to which extent maternal diabetes with or without folic acid (FA) supplementation affects mRNA levels and protein distribution of ROS scavenging enzymes (SOD, CAT, GPX), vascular endothelial growth factor-A (Vegf-A), folate binding protein-1 (Folbp-1), and apoptosis associated proteins (Bax, Bcl-2, Caspase-3) in the yolk sacs of rat embryos on gestational days 10 and 11. We found that maternal diabetes impairs, and that FA supplementation restores, yolk sac vessel morphology, and that maternal diabetes is associated with increased apoptotic rate in embryos and yolk sacs, as well as impaired SOD gene expression. We assessed uterine blood flow with a laser-Doppler-flow-meter and found increased blood flow to implantation sites of diabetic rats compared with controls. Furthermore, resorbed and malformed offspring showed increased and decreased blood flow to their implantation sites, respectively. In mice with genetically altered CuZnSOD levels, maternal diabetes increased embryonic dysmorphogenesis irrespective of CuZnSOD expression. We thus found the maternal diabetic state to be a major determinant of diabetic embryopathy and that the CuZnSOD status exerts a partial protection for the embryo in diabetic pregnancy.
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Schwab, Bettina. "Fetale Echokardiographie und postnatales Outcome." Diss., lmu, 2006. http://nbn-resolving.de/urn:nbn:de:bvb:19-63435.
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McConnell, B. A. "Neurodevelopmental outcome and prenatal Doppler performance." Thesis, Queen's University Belfast, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390885.
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Bachin, Imelda. "Predictors of fetal maturity and perinatal outcome at different gestations." Thesis, Imperial College London, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.509795.
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Farmer, George. "Intravenous glucose tolerance in pregnancy : maternal correlates and fetal outcome." Thesis, University of Aberdeen, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.254868.
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To study maternal glucose tolerance in pregnancy and its effects on the fetus, a rapid 25g intravenous glucose tolerance test was performed at about 32 weeks gestation in a group of randomly selected women. Full glucose tolerance data was available in 815 cases. The results were withheld from the patients and their obstetricians and paediatricians, and no treatment or advice was offered. Fasting plasma glucose and indices of glucose disposal were distributed unimodally with no evidence of a separate pathological group towards the diabetic end of the distributions. Glucose disposal rate was not, however, signficantly associated with the fasting plasma glucose, suggesting that glucose intolerance associated with elevation of the fasting plasma glucose might be a more clearly defined entity. New reference standards for fasting plasma glucose in pregnancy, which differ from those currently in use, are presented. The major determinants of relatively impaired maternal glucose tolerance in pregnancy were maternal age and obesity. Nonetheless, many cases of relative glucose intolerance occurred in the absence of any preexisting clinical indication. Significant association were found between maternal glucose metabolism and various measures of neonatal size and morbidity, including the incidence of congenital malformations and the occurrence of perinatal asphyxia in post-term infants. These effects were graded through much of the range of maternal glucose tolerance and not of predictive value in individual cases. The available evidence did not indicate that these relationships were mediated by fetal hyperinsulinism. It is concluded that the adverse consequences of impaired glucose disposal with normal fasting plasma glucose in pregnancy do not justify exhaustive measures to identify the condition. Screening for glucose intolerance during pregnancy should seek to identify those cases in which glucose intolerance is associated with elevation of fasting plasma glucose.
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Propp, Ute. "Geburtsverlauf und Fetal Outcome bei Kindern mit einem Geburtsgewicht >= 4000 g." Diss., lmu, 2004. http://nbn-resolving.de/urn:nbn:de:bvb:19-22043.
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Goddard, Kalanithi Lucy Emily. "Placental Localization and Perinatal Outcome." Yale University, 2008. http://ymtdl.med.yale.edu/theses/available/etd-08132007-124118/.
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This retrospective case-control study was designed to investigate the relationship between placental localization and intrauterine growth restriction (IUGR). Pregnant women with an anatomic survey from January 1, 2000, to December 31, 2005, and delivery of the pregnancy at Yale-New Haven Hospital (YNHH) were identified using clinical and billing records. Multiple gestation, fetal anomaly, and incomplete medical information were reasons for exclusion. Cases (N=69) were consecutive pregnancies with evidence of IUGR (estimated fetal weight <10th percentile for gestational age) at last follow-up ultrasound. Randomly selected controls (N=258) from the same time period had no evidence of IUGR. Maternal, ultrasound, delivery, and perinatal data were collected by retrospective medical record review, and IUGR cases and non-IUGR controls were compared using the Students t-test, Wilcoxon test, Chi-square analysis, Fishers exact test, and ANOVA. Placental location was determined from the anatomic survey record (obtained at 18.4 ± 1.2 weeks gestation in the IUGR group and 18.2 ± 1.0 weeks gestation in the control group; P=0.18). Multivariate logistic regression with adjustment for confounders was used to investigate the association between IUGR and placental localization. Consistent with known predictors of IUGR, the IUGR group had a higher proportion of black women (36.4% vs. 19.8%, P=0.03), chronic hypertension (26.0% vs. 3.5%, P<0.001), and hypertensive disorders of pregnancy (36.2% vs. 5.0%, P<0.001). Mean birth weights of IUGR and non-IUGR pregnancies differed by 2 kilograms (3244 ± 625 grams vs. 1277 ± 637 grams, P<0.001). IUGR infants were more likely to receive antenatal steroids, deliver preterm, deliver by cesarean section, and be admitted to neonatal intensive care. In both IUGR and non-IUGR pregnancies, the placenta was most commonly anterior or posterior. Unilateral placentas were three times more common in the IUGR group than in the non-IUGR group (17.4% vs. 5.0%, P=0.01). IUGR pregnancies were over four times as likely as control subjects to have unilaterally-located placentas compared to anterior placentas (OR 4.8, 95% confidence interval, 1.9-11.7). Adjusting for ethnicity, chronic hypertension, and hypertensive disorders of pregnancy did not affect this finding (OR 4.6, 95% confidence interval 1.6-13.5). In conclusion, we compared a group of 69 IUGR pregnancies to 258 non-IUGR controls and found intrauterine growth restriction to be associated with unilateral placentation.
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Peterson, Alexander. "The Fecal Incontinence Quality of Life Scale (FIQL) : improving outcomes measurement." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/61085.
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The Fecal Incontinence Quality of Life scale (FIQL) is a patient reported outcome measure (PROM) that is used to measure the effect that fecal incontinence has on quality of life, and has previously demonstrated high reliability and validity. It measures four domains of quality of life: lifestyle, coping/behavior, depression/self-perception, and embarrassment. Despite its wide use, previous studies have not applied rigorous modern methods to evaluate the FIQL's psychometric properties at the item and test level.
This thesis used a cohort of prospectively recruited patients from an elective surgical registry and applied methods from classical test theory (CTT), exploratory factor analysis (EFA), item response theory (IRT), and differential item and test functioning (DIF) to identify strengths and weaknesses in the FIQL. Specifically, this thesis aims to 1) confirm the reliability of the instrument, 2) describe the domains of quality of life measured by the instrument, 3) identify high and low quality items, and 4) determine whether one's score on the FIQL is influenced by gender or surgical procedure.
Out of 317 completed questionnaires from 880 total eligible patients, 236 were included for analysis. Reliability for all four domains was high as measured by Cronbach's α. Exploratory factor analysis failed to identify the four domains the FIQL claims to measure. Individual items demonstrated high discrimination but most had low difficulty. Items 2c, 2l, 3a, and 3h failed to demonstrate good separation between response categories. Five item pairs demonstrated local item dependence, most from question 3. Only item 2g demonstrated differential item functioning, based on gender. Differential test functioning was minimal.
The FIQL demonstrated a high degree of reliability, and the lifestyle domain can be used as is or with minor improvements. The FIQL can be improved by making response options consistent, distributing items from different domains evenly throughout the instrument, adding items with higher difficulty and better response separation, and removing items 2c, 2l, 3a, and 3h. Further research is needed before the FIQL can be used confidently as a stand-alone measure of fecal incontinence-related quality of life.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Elliott, Catherine. "Perinatal outcome in mothers with heart disease attending the combined Obstetric and Cardiology Clinic at Groote Schuur Hospital." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13115.
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Includes bibliographical references.ith the advances made in the management of cardiac conditions, much importance has been placed on the maternal outcome in pregnancies complicated by heart disease. However, to enable attending clinicians to provide suitable counseling and manage the pregnancy appropriately, the potential complications arising in the fetus and neonate also require attention. Adverse neonatal and perinatal outcome is more common in pregnant women with cardiac disease. Analysis of the available data pertaining to the South African population is important, as this population’s profile, like that of Africa, differs from that of industrialized countries. The relevance of maternal heart disease is highlighted by the National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) in South Africa ( http://www.doh.gov.za/docs/reports/2012/Report_on_Confidential_Enquiries_into_ Maternal_Deaths_in_South_Africa ). Objectives To describe the perinatal outcome in women with heart disease and to determine whether there is an associated adverse outcome related to babies born to mothers with heart disease. Methods 82 patients were collected serially over 18 months. Neonatal outcome was recorded. Adverse neonatal outcome was defined as perinatal mortality, admission to NICU and the need for delivery room resuscitation. Results Perinatal mortality rate in this cohort was good, and better than the rate in the general population from whence this cohort came, but was linked to a high rate of obstetric intervention. The rate of adverse neonatal outcome is better than the rate in industrialized countries. Conclusion Perinatal outcome is good when mothers with heart disease are managed in a multidisciplinary clinic.
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Bique, Osman Nafissa. "The impact of maternal morbidity on fetal growth and pregnancy outcome in Mozambique /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-3971-3/.
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Masuku, David Sifiso. "Maternal and fetal outcome of subsequent pregnancy in patients with documented peripartum cardiomyopathy." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29669.
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AIM: Subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have a high risk of heart failure relapse. We report on outcome of SSPs in PPCM patients in South Africa. METHODS AND RESULTS: Of the 18 PPCM patients with a SSP, 3 patients died within 6-months follow-up. Overall relapse rate, left ventricular ejection fraction (LVEF) <50% or death after at least 6 months follow-up, was 30%, with 16% (3/18) mortality. Persistently reduced LVEF (<50%) before entering SSP was present in 44% of patients, while full recovery (LVEF≥ 50%) was present in 85%. Persistently reduced LVEF before SSP was associated with a higher mortality (27% vs 0%) and a lower rate of full recovery at follow-up. Patients obtaining standard therapy for heart failure and bromocriptine immediately after delivery displayed significantly better LVEF at follow-up and a higher rate of full recovery, with no patient dying, compared with patients obtaining standard therapy for heart failure alone. CONCLUSION: Full recovery of LVEF before SSP was associated with lower mortality and better cardiac function at follow-up. Addition of bromocriptine to standard therapy for heart failure immediately after delivery was safe and appeared to be associated with better outcome of SSP in our patients.
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Oullette, Margaret Dolliver. "Effect of alcohol ingestion on zinc status and pregnancy outcome in rats /." The Ohio State University, 1985. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487259580263148.
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Cruz, Lemini Mónica Cristina. "Fetal cardiovascular dysfunction in intrauterine growth restriction as a predictive marker of perinatal outcome and cardiovascular disease in childhood." Doctoral thesis, Universitat de Barcelona, 2013. http://hdl.handle.net/10803/134221.
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Most risk factors leading to cardiovascular disease are already present in childhood and the importance of early identification of pediatric cardiovascular risk factors is now well recognized. Hypertension in the child has been associated with substantial long-term health risks and considered an indication for lifestyle modifications. Current clinical guidelines contemplate screening for hypertension in children over 3 years of age, in order to provide strategies for promoting cardiovascular health, which can be integrated into comprehensive pediatric care. Interventions in the IUGR group could go from blood pressure monitoring before 3 years of age, recommending lack of exposure to other risk factors (secondary smoking, obesity), surveillance of catch-up growth or administration of hypotensors and specially, promoting exercise and physical activity. A recent randomized trial in a large cohort of children suggest that the inverse association of fetal growth with arterial wall thickness in childhood can be prevented by dietary ω-3 fatty acid supplementation over the first 5 years of life. IUGR is not listed among those conditions presumed to increase cardiovascular risk, in current guidelines. Considering IUGR affects 5-10% of all newborns, the findings of this study would affect thousands of children per year. Currently, there are no prenatal parameters described that may aid in selecting those fetuses with later hypertension and arterial remodeling that may benefit for early screening in infancy and other preventive measures or interventions.
Both fetal and child cardiovascular evaluations have proven to be reliable techniques for describing changes in IUGR; cardiovascular dysfunction has been found subclinically and may have implications for cardiovascular risk in future life. The main aim of this work was to evaluate cardiovascular function parameters in IUGR fetuses as predictors of perinatal and postnatal cardiovascular outcome. In order to do this, we looked to validate the reproducibility of measurements and techniques not previously described in IUGR fetuses (studies 1 and 2), to evaluate whether fetal cardiovascular parameters could help us predict perinatal outcome (study 3) and finally to assess the value of fetal echocardiography for prediction of postnatal cardiovascular risk factors, specifically hypertension and arterial remodeling (study 4). This thesis confirms previous studies showing fetal cardiac dysfunction can be documented by fetal echocardiography; it validates different methods for evaluating cardiac function in the fetus and demonstrates the predictive value of these parameters for perinatal and postnatal cardiovascular outcome. Our first study demonstrates for the first time the validity of M-mode to assess longitudinal axis motion in IUGR. It further confirms previous research that IUGR fetuses have a significant decrease in longitudinal myocardial motion, as part of the fetal cardiovascular adaptation to placental insufficiency. In our second study, both TDI and 2D-derived strain analysis demonstrated to be feasible and reproducible to evaluate deformation parameters in the fetal heart. Our third study evaluated the independent and combined contribution of fetal cardiovascular parameters to the prediction of early-onset IUGR perinatal mortality. The study suggests an algorithm illustrating the chances of perinatal death against gestational age and DV, which might help clinical decisions in the management of early-onset IUGR fetuses.
The fourth study provides, for the first time, evidence that fetal echocardiographic parameters are strongly associated to postnatal hypertension and arterial remodeling, which are recognized cardiovascular risk factors and surrogates for early-onset cardiovascular disease. It supports that a fetal cardiovascular score is strongly associated with the presence of postnatal hypertension and arterial remodeling at 6 months of age in IUGR. Echocardiographic parameters demonstrated a far better performance than perinatal factors and fetoplacental Doppler used for establishing the severity of IUGR.Los fetos con restricción del crecimiento intrauterino (RCIU) presentan remodelamiento cardiovascular el cual persiste en la infancia y se ha asociado a enfermedades cardiovasculares en el adulto. La hipertensión en la infancia se ha demostrado como un factor de riesgo cardiovascular para la enfermedad adulta. Un seguimiento estricto junto con intervenciones en la dieta se ha demostrado mejora la salud cardiovascular en estos niños, sin embargo no todas las restricciones del crecimiento tienen hipertensión en la infancia. El objetivo principal de esta tesis es definir los parámetros con mayor utilidad de la ecocardiografía fetal para predecir hipertensión y remodelamiento arterial en infantes de 6 meses de edad con restricción del crecimiento intrauterino. Para esto, se realizó un estudio de cohorte incluyendo fetos con RCIU y controles, seguidos desde vida prenatal hasta los 6 meses de edad. La evaluación prenatal consistió en una ecocardiografía funcional completa. A los 6 meses de edad estos niños fueron evaluados para hipertensión y remodelamiento arterial. Posteriormente se realizó la construcción de un score cardiovascular para determinar desde vida prenatal aquellos niños con mayor riesgo a presentar hipertensión en vida postnatal y que pudieran requerir vigilancia o intervenciones.
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Challis, Kenneth. "Monitoring pregnancy for improved perinatal outcome in Mozambique /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-406-2/.
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Higgins, Lucy. "Assessing and quantifying placental dysfunction in relation to pregnancy outcome in pregnancies complicated by reduced fetal movements." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/assessing-and-quantifying-placental-dysfunction-in-relation-to-pregnancy-outcome-in-pregnancies-complicated-by-reduced-fetal-movements(49311fd8-8b13-4741-8e60-e150be8765ee).html.
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Currently there is no test to accurately predict stillbirth. It is proposed that better identification of placental disease in utero may aid stillbirth prediction and prevention. Pregnancies complicated by reduced fetal movement (RFM) have increased risk of stillbirth. We hypothesised that RFM is a symptom of placental dysfunction associated with adverse pregnancy outcome (APO) and that this placental abnormality can be detected antenatally and used to identify fetuses at highest-risk of APO. We tested this hypothesis by: 1) comparison of ex vivo placental structure and function between APO RFM pregnancies and their normal outcome RFM counterparts, 2) comparison of in utero estimates of placental size, vascularity, vascular and endocrine functions obtained from placental ultrasound, Doppler waveform analysis and maternal circulating placentally-derived hormone concentrations, to their ex vivo correlates and 3) examination of the predictive potential of placental biomarkers at the time of RFM.Ex vivo placentas from APO RFM pregnancies, compared to normal outcome RFM counterparts, were smaller (diameter, area, weight and volume, p<0.0001), less vascular (vessel number and density, p≤0.002), with arteries that were less responsive to sodium nitroprusside (p<0.05), and with aberrant endocrine function (reduced tissue content and/or release of human chorionic gonadotrophin (hCG), human placental lactogen (hPL) and soluble fms-like Tyrosine Kinase-1 (sFlt-1), p<0.03). Placental volume (PV) ex vivo correlated with sonographic estimated PV (p<0.004), hPL, hCG and placental growth factor (PlGF) concentrations in the maternal circulation (p<0.03). Ex vivo villous vessel number and density correlated with Doppler impedance at the umbilical artery free-loop (UAD-F, p=0.02) and intraplacental arteries (p<0.0001) respectively, whilst UAD-F impedance correlated with arterial thromboxane sensitivity (p<0.04). Examination of placental structure and function at the time of presentation with RFM identified 15 independently-predictive biomarkers. Three potential predictive models, incorporating measures of placental size (PlGF), endocrine function (sFlt-1), arterial thromboxane sensitivity and villous vascularity (UAD-F), were proposed. Using these models, sensitivity for APO was improved from 8.9% with baseline care (assessment of fetal size and gestation) to up to 37.5% at a fixed specificity of 99% (p<0.05). This series of studies shows that antenatal placental examination is possible and improves identification of pregnancies at highest risk of stillbirth in a high-risk population by up to 29%. Therefore such tests merit further development to prospectively assess their ability to predict and prevent stillbirth itself.
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Zemba, Jillian. "Utilizing sonography to image fetal hands and determine its relationship with birth outcome measures." Connect to resource, 2009. http://hdl.handle.net/1811/37040.
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Lu, YongPing [Verfasser]. "Maternal and fetal metabolomic signatures in regard to birth outcome and gestational disease / YongPing Lu." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2018. http://d-nb.info/1176636332/34.
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Swarts, Elfriede. "The outcome of prenatal sonographic diagnosis of fetal talipes in the Cape Town Metro district." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27550.
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Background: Talipes equinovarus, also termed club foot, is a congenital deformity of the ankle joint. Despite its prevalence of approximately 1 per 1000 live births, fetal talipes is relatively poorly studied since the introduction of percutaneous tendo Achilles tenotomies. Objectives: To document the associations, outcomes and prognosis of patients with antenatally diagnosed fetal talipes. The study aims to examine the association between, and prevalence of, fetal talipes and other abnormalities, structural and chromosomal, as well as the outcome in relation to postnatal surgery. The accuracy of prenatal ultrasound in diagnosing fetal talipes is also examined. Methods: A retrospective observational study was made of all cases presenting to the Fetal Medicine Unit between 1 January 2009 and 31 December 2014. All the identified cases were analysed to identify isolated talipes, associated abnormalities, and chromosomal abnormalities. The pregnancy outcomes were determined using the Astraia database as well as maternity records. When the outcome resulted in a live infant, these infants were followed up using the files at the referral hospital to determine the treatment method used and the number requiring surgery. Results: There were 155 cases, all referred to the Fetal Medicine Unit. Antenatal data included 75 who had other structural abnormalities and 75 who had isolated talipes. In five of the cases were no sufficient data could be found. Twenty-five cases were lost to follow-up, and 12 cases had no clubfoot at birth. Only one was labelled as having positional clubfoot. There were 91 live births. Of the cases of talipes with associated abnormalities, 21.19% were live births (excluding ENND). All terminations of pregnancy as well as 90.9% of intrauterine fetal deaths were complex talipes, and 94.52% of the cases of isolated talipes were live births. The most common associated abnormalities were of the central nervous system. Seventeen of the live births were lost to follow-up. Of the cases of isolated talipes, 53.19% had tenotomies and Ponseti treatment. The false positive rate of detecting fetal talipes on ultrasound was 7.74%. Conclusion: The study made it evident that complex talipes is associated with a poor pregnancy outcome defined as pregnancy loss, where isolated talipes is usually associated with a good pregnancy outcome. Ultrasound is a good diagnostic tool when diagnosing talipes antenatally but cannot diagnose the severity of the clubfoot. False negatives were not studied. The introduction of tenotomy can make a difference in the outcome of clubfoot in comparison with previous studies where tenotomies were not performed. Medical professionals need to address the importance of counselling, and a multidisciplinary team should be involved in cases involving prenatal counselling.
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Garcia, Luciana de Freitas. "Gastrosquise fetal isolada: relação entre dilatação intestinal e resultados perinatais adversos." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-06022012-174407/.
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Objetivos: Este estudo foi desenvolvido para avaliar o diâmetro transverso da alça intestinal exteriorizada como fator preditor de resultado adverso, nas gestações com gastrosquise fetal isolada. Métodos: Estudo retrospectivo envolvendo 94 gestações únicas. Foi realizada a medida do diâmetro transverso da alça intestinal (DTA) herniada, por meio da ultrassonografia antenatal, até 3 semanas antes do parto. Foi considerado resultado perinatal adverso: óbito intra-útero, óbito neonatal e complicações intestinais. Resultados: a última medida ultrassonográfica do DTA foi realizada com 35,6 ± 1,6 semanas e o tempo médio do intervalo entre a última medida e o parto foi de 6,2 ± 5,0 dias. Ocorreram 10 (10,6%) casos de óbitos intraútero e neonatal; foram observadas complicações intestinais em 8 (8,5%) casos. DTA 15, 20, 25 e 30 mm foram identificadas em 87, 46, 13 e 4% das gestações com prognóstico favorável, respectivamente. O DTA 25 mm apresentou valores de sensibilidade de 38%, e, valores preditivo positivo e preditivo negativo de 38% e 87%, na predição de resultados adversos. Para o DTA 30 mm, os valores foram: 19, 50 e 85%. A área sob a curva ROC do valor observado/esperado do DTA para cada idade gestacional foi de 0,67, sendo o melhor ponto-de-corte em 1,39; e, seus valores preditivos foram semelhantes aos do DTA 25 mm. Dilatação intestinal esteve significantemente associada com baixa taxa de fechamento primário da parede abdominal, longo período para iniciar a dieta via oral e internação hospitalar prolongada. Conclusões: Dilatação intestinal demonstrada até 3 semanas antes do parto é preditora de complicações intestinais e está associado a baixa taxa de fechamento primário da parede abdominal, longo período para iniciar a dieta via oral e de internação hospitalarObjectives: Evaluate bowel diameter as a predictor of adverse outcome in isolated fetal gastroschisis. Methods: Retrospective study involving 94 singleton pregnancies. Ultrasound measurements of herniated bowel transverse diameter (BTD) were performed up to 3 weeks before delivery. Adverse outcome was intrauterine/ neonatal death and/or bowel complications. Results: Last BTD was recorded at 35,6 ± 1,6 weeks and mean interval to delivery was 6,2 ± 5,0 days. Intrauterine/ neonatal death occurred in 10 (10,6%) cases; bowel complications were observed in 8 (8,5%). BTD 15, 20, 25 and 30mm were found in 87, 46, 13 and 4% of pregnancies with a favorable outcome, respectively. BTD 25 mm sensitivity was 38%, positive and negative predictive values, 38% and 87%. For BTD 30 mm, the values were: 19, 50 and 85%. Observed/expected BTD ROC curve showed an area of 0,67, with best cut-off at 1,39; prediction values were similar to those for BTD 25 mm. Bowel dilatation was also significantly associated with lower rate of primary surgical closure, longer period to full oral feeding and prolonged hospital stay. Conclusions: Bowel dilatation demonstrated up to 3 weeks before delivery is a predictor of intestinal complications and is associated with lower rate of primary surgical closure, longer period to achieve full oral feeding and hospital stay