Tesi: "Pregnancy Complications"

1

Benton, Samantha Jayne. "Angiogenic factors in placentally-mediated pregnancy complications". Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/50014.

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Placentally-mediated pregnancy complications include pre-eclampsia, intrauterine growth restriction (IUGR), placental abruption and some causes of stillbirth. These complications are believed to arise from abnormal placental development in early gestation that leads to compromised placental function in later pregnancy which can adversely affect both mother and fetus. It is a priority in obstetrics to identify these pregnancies early and accurately so that appropriate monitoring and intervention can optimise outcomes for these mothers and babies. Novel biomarkers such as angiogenic factors in the maternal circulation may improve the prediction and/or diagnosis of these complications by adding to the information gained from tools already used in clinical practice. In this thesis, I investigated angiogenic factors in 1) the diagnosis of pre-eclampsia using new clinical immunoassays, 2) the prediction of placentally-mediated complications in a high-risk pregnancy cohort and 3) the diagnosis of placental IUGR in pregnancies with small for gestational age (SGA) fetuses. Additionally, I investigated the association between levels of circulating angiogenic factors and the presence of histopathological lesions of dysfunction in the placenta after delivery. I found that angiogenic factors, particularly low circulating placental growth factor (PlGF), had high sensitivity and specificity in the diagnosis of pre-eclampsia but all markers had poor performance as predictive markers for placentally-mediated complications. In pregnancies with SGA fetuses, low maternal PlGF discriminated between fetuses with placental IUGR (defined by the presence of histological lesions of placental dysfunction) from constitutionally small fetuses (no pathological lesions present) with high sensitivity and high negative predictive value. Additionally, low maternal PlGF in the second trimester was associated with the presence of lesions of placental dysfunction in pregnancies at high-risk for placentally-mediated complications. Low maternal PlGF was also associated with lesions of placental dysfunction as well as altered placental morphology in pregnancies with SGA fetuses. Taken together, these findings suggest that PlGF may be an antenatal marker of placental dysfunction and may provide a novel clinical tool to identify pregnancies with placental dysfunction. This work improves our understanding of angiogenic factors in placentally-mediated complications and contributes to the growing body of evidence supporting their integration in clinical practice.
Medicine, Faculty of
Obstetrics and Gynaecology, Department of
Graduate

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2

ElMoursi, Mohamed Saad Elsayed. "Quantification of placental dysfunction in pregnancy complications". Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/17262/.

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Background The pathogenetic mechanisms behind placental dysfunction-related complications like preeclampsia and intrauterine growth restriction have remained perplexing till now, in part because of lack of well-defined structural and functional molecular characterisation. There is growing evidence that links trophoblast debris and the existence of syncytial nuclear aggregates (SNA) to the pathogenesis of gestational diseases. Characterisation and quantification of structural and functional parameters of placental dysfunction may give researchers a clearer picture of the mechanisms underlying the development of high risk pregnancy. Methods Placental samples were obtained from normal term pregnancies, preterm controls, as well as from pregnancies complicated by preeclampsia (PET), intrauterine growth restriction (IUGR) and PET-IUGR. Formalin-fixed, paraffin-embedded sections were visualised with H&E, stained using immunohistochemistry (IHC) and digitally scanned. Using stereological methodology, volumes of placental SNAs, trophoblasts, villi and capillaries were measured. Three dimensional (3D) volume reconstructions of terminal placental villi with SNAs and fibrinoid degenerations were created. IHC-labelled slides were analysed by image analysis algorithms. Differential expression of placental genes and miRNAs, hypothesised to regulate cell death in placental dysfunction, were quantified using RT-qPCR. BeWo cell lines were carried out for in vitro validation of the effects miRNAs regulating programmed cell death (PCD) using flow cytometry and western blotting. Results Specific morphometric patterns of villous, trophoblasts, SNA and capillary volumes were demonstrated with characteristic higher SNAs and lower capillary volumes in PET placentae with reciprocal patterns in IUGR placentae showing a negative correlation pattern between nuclear aggregates and capillary volumes. Image analysis of immune-labelled slides showed a higher autophagy marker expression in PET and a positive correlation to SNAs as well as a balanced reciprocal expression patterns with apoptosis. Moreover, miR-204 transfected BeWo cells showed a similar balanced reciprocal regulation of autophagy and apoptosis expressions. Conclusion We have demonstrated that applying stereology-based and image analysis on digitised placental sections can be useful in quantifying and dissecting structural and functional patterns in normal and abnormal placental function. 3D reconstruction model are a novel approach towards placental characterisation in normal and complicated pregnancies. The study also showed that miR-204 plays a vital role in the regulation of placental autophagy and apoptosis, critical in the pathophysiology of placental dysfunction.

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3

Rodie, Vanessa Angela. "Metabolic complications of pregnancy and cardiovascular disease risk". Thesis, University of Glasgow, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.421118.

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4

Demetriou, Charalambos. "Investigating genetic factors associated with complications of pregnancy". Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/30728.

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This PhD project sets out to investigate the role of genetic factors associated with fetal growth restriction and recurrent miscarriage (RM), two of the most common complications of pregnancy. This work studied large cohorts of patients collected from specialist clinics in West London with the aim of better understanding their underlying molecular aetiology. The first part of this project focused on the paternally expressed, maternally imprinted gene, IGF2, which is a key growth hormone critical for in utero growth in mice. Its role in human fetal growth has remained ambiguous, as it has only been studied in term tissues. mRNA expression levels of IGF2 and other genes were investigated in 260 chorionic villus samples collected at 11-13 weeks' gestation. Transcript levels of IGF2 revealed a significant positive correlation with birth weight (P=0.009). Critically, small for gestational age neonates had significantly lower IGF2 levels than appropriate for gestational age neonates (P=3.6x10-7). Next a study was undertaken to investigate a potential role for disturbed imprinting in products of conception (POC). This work first involved a detailed analysis of the POC DNA to establish levels of maternal cell contamination. POCs could then be more accurately evaluated to investigate the status of known imprinted genes. Interestingly, in a number of POCs, known maternally expressed genes were found to be paternally expressed and vice versa. This suggested that some miscarriages might be associated with or even caused by abnormal imprinting. Two approaches were then used to study genetic factors associated with RM. The first involved a genetic association study with a placental anti-coagulant protein Annexin A5 that contains four nucleotide substitutions (M2 haplotype) in its promoter. Patient and control haplotypes were determined and compared in 500 White European pairs that had RMs and 250 control trios. Carriers of the M2 haplotype were found to exhibit higher RM risk than non-carriers, which was in agreement with previous studies. However, this is only true for the patients who suffered with early miscarriages. The second study involved analysis of a single family where the patient had experienced a total of 29 miscarriages but had no successful pregnancies. Next-generation exome sequencing was carried on family members to search for a potential rare genetic variant gene causative of the RM phenotype. Two candidate genes with potentially damaging mutations were investigated in more depth by sequencing them in cohorts of Asian RM patients (n=100) and White European RM patients (n=120). In one of the genes, three novel variants and one very rare SNP, which were all predicted to be damaging by different prediction programs, were identified in a total of four Asian patients. Future studies to further investigate these potential mutations, involves functional analysis of each variant such as site-directed mutagenesis and protein-protein interactions.

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5

Bayingana, Claude. "The prevalence of members of the "red complex" in pregnant women as revealed by PCR and BANA hydrolysis". Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria called red complex (Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes which can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother&rsquo
s immune system to infection by these periodontopathogens, brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the prevalence of red complex, using BANA and PCR in subginginval plaque samples from pregnant women. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending a Mitchells Plain ante-natal clinic. Plaque samples were analyzed by the enzymatic BANA-test for detection of the presence of red complex and DNA was extracted and analyzed using 16 rDNA-Polymerase Chain Reaction (PCR).

Seventy-nine percent of pregnant women showed gingival index scores of &ge
1 of which 74.24% harboured by at least one of the members of the red complex. P.gingivalis was the most prevalent of the three members of the red complex. Findings of this study confirmed a need for dental preventive measures in pregnant women and microbial monitoring of suspected periodontopathogenes. This could be achieved by joint cooperation between Maternity Obstetric Units (MOU), Dentistry and oral microbiology departments. The results of this study revealed that although PCR is more sensitive than BANA in detecting members of the red complex, BANA showed a better association with the indices used to diagnose periodontal disease.

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6

Björklund, Anders. "Hypoglycaemia in pregnancy : hypoglycaemic clamp studies during and after pregnancy in women with IDDM /". Stockholm, 1998. http://diss.kib.ki.se/search/diss.se.cfm?19980605bjor.

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7

Wilkerson, Diana Sue. "Perinatal complications as predictors of infantile autism". Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/833467.

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This study investigated the impact of perinatal complications on the developing child and the relationship of those complications to the development of autism in an individual. The biological mothers of autistic children (N = 183) completed the Maternal Perinatal Scale, a maternal selfreport which surveys complications of pregnancy and medical conditions of the mother. Archival data on normals (N = 209), obtained during previous perinatal investigations, was utilized as a control group.Previous research in this area has been limited, with no definitive conclusions. All previous investigators have declined to state that events identified in previous research were definitely related to the development of autism.An overall multivariate test was performed to determine if significant differences existed between the autistic and normal subjects. Following this exploration of the data, previously identified complications were entered into a stepwise discriminant analysis in the order of theirtheoretical importance to determine the extent of their contribution to autism. Following this analysis, medical conditions of the mothers (items 27-47 as included on the MPS) were entered into the stepwise analysis to determine their contribution, if any, to autism in the sample.The results of this analysis revealed that the two groups differed significantly on three of the ten factors of the MPS. The overall multivariate test was highly significant and revealed that the groups differed on Factor 2 (Gestational Age), Factor 4 (Maternal Morphology), and Factor 8 (Intrauterine Stress). Moreover, five of the six previously identified items were found to be significant. These were: prescriptions raken during pregnancy, length of labor, viral infection,, abnormal presentation at delivery, and low birthweight. Three of the maternal medical conditions examined were also highly significant and contributed to separation between groups. These were: urinary infection, high temperatures, and depression. These were items which have not been identified in previous investigations.Based on discriminant analysis of the 10 factors of the MPS, 65% of the cases were correctly grouped. The MPS would be a useful clinical tool in identification of those children who are at risk for development of autism.
Department of Educational Psychology

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8

Walker, Kate Frances. "Late pregnancy complications in women of advanced maternal age". Thesis, University of Nottingham, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.718852.

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The age of childbearing is rising in women living in industrialised nations. Advanced maternal age is associated with a small increased risk of term antepartum stillbirth. Labour induction would likely reduce stillbirth, but might also increase Caesarean delivery, already high for older women. The aim of this thesis was to design and conduct a randomised controlled trial of induction of labour at 39 weeks versus expectant management for nulliparous women aged over 35 years. In total 619 women participated and the trial showed that induction of labour has no adverse short-term effects on maternal or neonatal outcomes. In particular, it does not increase caesarean section rate. A cost-utility analysis of the trial was performed and demonstrated that induction of labour is associated with a small gain in QALYs and is not more expensive than expectant management. One key secondary outcome of the trial was maternal satisfaction. There is a lack of a robust validated tool for evaluating labour experience in the UK therefore a study of 350 women was performed to validate a Swedish instrument (Childbirth Experience Questionnaire) in the UK. This study demonstrates that the Childbirth Experience Questionnaire is a valid and reliable measure of childbirth experience in the UK population. A study examining the causes of 2850 cases of antepartum stillbirth in women of advanced maternal age using anonymised national data found that stillbirths in women over 35 years old are more likely to be due to major congenital anomalies, mechanical causes, maternal disorders or associated obstetric factors than women less than 35. In 2013, a systematic review of randomised controlled trials of induction of labour versus expectant management at term found that a policy of induction was associated with a 17% reduction in the risk of caesarean section. An IPD meta-analysis of induction of labour versus expectant management at term in women with intact membranes by subgroups of maternal age has shown that induction in women of advanced maternal age has no statistically significant effect on caesarean section rates.

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9

Syngelaki, Argyro. "Screening for pregnancy complications at 11-13 weeks' gestation". Thesis, Manchester Metropolitan University, 2015. http://e-space.mmu.ac.uk/595938/.

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Background: The current approach to prenatal care, which was established more than 80 years ago, is characterised by a high concentration of visits in the third-trimester of pregnancy which implies that firstly, most complications occur at this late stage of pregnancy and secondly, most adverse outcomes are unpredictable during the first or even the second trimester. Objectives: The objective of this thesis is to provide evidence that most pregnancy complications are predictable as early as 12 weeks’ gestation. The pregnancy complications examined include fetal aneuploidies, fetal structural defects, preeclampsia, preterm birth, gestational diabetes mellitus and fetal macrosomia. Methods: I have critically examined fourteen articles reporting on screening for pregnancy complications at 11-13 weeks’ gestation, where more than 90,000 singleton pregnancies were prospectively assessed at 11-13 weeks’ gestation as part of a routine prenatal visit for screening for trisomy 21. We recorded a series of maternal characteristics and history, measured maternal weight and height, performed a detailed ultrasound examination of the fetus, measured maternal uterine artery Doppler pulsatility index and maternal mean arterial pressure and collected blood for analysis of biomarkers for prospective or retrospective analysis. All data were prospectively entered into our data base as well as the pregnancy outcomes as soon as they became available. Ethical approval was obtained for these studies. Multivariate regression analysis was used to define the contribution of each maternal characteristic and history in predicting each adverse outcome and those with a significant contribution formed an algorithm to estimate the background risk (a priori risk) for each one of these complications. The potential value of biophysical and biochemical markers in improving the performance of the a priori risk in predicting adverse pregnancy outcomes, was evaluated. Results: First trimester effective screening for adverse pregnancy outcomes was provided by a combination of maternal factors and biophysical or biochemical markers. The developed predictive models could correctly identify the vast majority of aneuploidies, early preeclampsia and more than half of the cases of spontaneous preterm birth and gestational diabetes. First trimester prediction of fetal macrosomia was less effective compared with other complications. First trimester examination of fetal anatomy was feasible resulting in a high detection of fetal non-chromosomal defects, including more than half of fetal cardiac defects. Conclusions: Assessment of the mother and fetus at 11-13 weeks’ gestation can provide effective early identification of the high risk group of pregnancies with fetal and maternal adverse outcomes.

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10

Chaudhry, Shazia Hira. "The Association of Homocysteine with Placenta-Mediated Pregnancy Complications". Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39425.

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Background: Preeclampsia, small for gestational age (SGA), placental abruption, and fetal death are pregnancy complications linked to the utero-placental vasculature with serious consequences for maternal and infant well-being. Elevated homocysteine, a marker of cardiovascular disease risk, is postulated to play a role in placenta-mediated complications, but epidemiologic studies have reported inconsistent findings. The two primary objectives of this thesis were to 1: comprehensively investigate the association of homocysteine with placenta-mediated complications and examine modifying effects of pre-specified factors on this association, and 2: comprehensively investigate determinants of maternal homocysteine during pregnancy. Methods: A systematic review and meta-analysis of prospective studies was conducted to address thesis objective 1. The Ottawa and Kingston (OaK) Birth Cohort, a prospective cohort study that recruited pregnant women between 2002 and 2009, was used to address thesis objectives 1 and 2. Homocysteine concentration was measured between 12 and 20 weeks gestation. Analyses based on the OaK Birth Cohort consisted of multivariable regressions using restricted cubic splines to model associations with continuously distributed variables. Results: Objective 1: In an analysis of 7587 participants, a significant association between homocysteine concentration and a composite outcome of any placenta-mediated complication was observed (odds ratio (OR) for a 5 µmol/L increase: 1.63, 95% Confidence Interval (CI) 1.23-2.16) and SGA (OR 1.76, 95% CI 1.25-2.46), with potential modifying effects of the methylene tetrahydrofolate reductase (MTHFR) 677C>T variant (SGA) and high-risk pregnancy (preeclampsia). In the systematic review identifying 30 prospective cohort or nested case-control studies, a random effects meta-analysis of pooled mean differences in homocysteine between cases and controls in 28 studies revealed significantly higher means for SGA: 0.35 µmol/L (95% CI 0.19 to 0.51, I2=33%); and preeclampsia: 0.87 µmol/L (95% CI 0.52 to 1.21, I2=92%). Significant sources of heterogeneity were study region (SGA and preeclampsia), adjusting for covariates (preeclampsia), folate status (preeclampsia), and severity (preeclampsia). Objective 2: In 7587 OaK participants, factors related to favourable health status were associated with lower maternal homocysteine concentrations. Folic acid supplementation during pregnancy of >1 mg/day did not substantially increase serum folate concentration. Conclusion: This thesis suggests an independent effect of slightly higher homocysteine concentration in the early to mid-second trimester on the risk of any placenta-mediated complication, SGA, and preeclampsia. Modifying effects explain some of the variability in previous studies. Favourable preconception health status was associated with lower maternal homocysteine.

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11

Nevin, James. "Pregnancy-associated cervical cancer". Thesis, University of Cape Town, 1991. http://hdl.handle.net/11427/26272.

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12

Linné, Yvonne. "Factors affecting weight development after pregnancy - the SPAWN (Stockholm Pregnancy And Women's Nutrition) study /". Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-405-4/.

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13

Nilsson, Emma. "Genetic epidemiological studies of adverse pregnancy outcomes and the role of schizophrenia /". Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-590-9/.

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14

Matte, Susan Marie. "HOW PREGNANT DIABETIC WOMEN VIEW THEIR PREGNANCIES". Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/275243.

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15

Chambers, Andrea Suzanne. "Relaxation During Pregnancy to Reduce Stress and Anxiety and Their Associated Complications". Diss., The University of Arizona, 2007. http://hdl.handle.net/10150/195435.

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Stress and anxiety during pregnancy predict perinatal complications over the course of pregnancy and labor as well as premature birth and low infant birth weight. The current study examined whether relaxation training provided to women at the beginning of the 2nd trimester could reduce stress and anxiety and assessed the impact of the intervention on perinatal complications, premature delivery, and infant outcomes at birth. Twenty-six moderately anxious pregnant women between 14 and 20 weeks gestation participated in the treatment study. Women completed a baseline laboratory assessment that involved questionnaires and a psychophysiological assessment. They were randomized to receive either six weeks of relaxation training or a list of tips for reducing stress (control). Women repeated the laboratory tasks post-treatment (Time 2) and again between 34 and 36 weeks gestation (Time 3). The treatment condition did not lead to greater mood change than the control condition at either Time 2 or 3. Several analyses, however, suggest relaxation training has the potential for reducing negative mood and complications over the course of pregnancy. Moderator analyses also revealed the treatment more efficacious for those with greater physiological flexibility.

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16

Shub, Alexis. "Periodontal disease and adverse pregnancy outcomes". University of Western Australia. School of Women's and Infants' Health, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0184.

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[Truncated abstract] Periodontal disease is a common and underdiagnosed disease in humans that may have adverse effects on pregnancy outcomes. The aim of this thesis was to investigate the effects of periodontal disease in pregnancy by means of two observational human studies and the development of animal models of fetal and uterine exposure to periodontopathic bacteria and lipopolysaccharide. I performed a prospective study examining the rates of preterm birth, small for gestational age neonates and neonatal inflammation in 277 women who had undergone a detailed antenatal periodontal examination and oral health questionnaire. Periodontal disease was associated with small for gestational age neonates, and increased CRP levels in umbilical cord blood, but no effect was seen on the rate of preterm birth. Maternal oral health symptoms predicted both periodontal disease and newborn biometry. In a retrospective case control study, I examined the role of periodontal disease in perinatal mortality. Participants included 53 women who had experienced a perinatal loss for which no cause could be found after thorough investigation, and 111 control women. Women who had experienced a perinatal loss were more than twice as likely as controls to have periodontal disease. The incidence of periodontal disease was even higher in women in whom the perinatal loss was due to extreme prematurity. In contrast to my prospective study, risks to the pregnancy could not be predicted by maternal oral health behaviours or oral health symptoms. In order to better understand the mechanisms regulating the associations described in the human studies, two animal models were developed; one to investigate acute exposure and the second to investigate long-term exposure to periodontal pathogens. The first study examined the effects of administration of a bolus of periodontopathic bacteria and lipopolysaccharide to the pregnant sheep. Injection of bacteria and lipopolysaccharide in the amniotic fluid of the pregnant preterm sheep caused a high rate of fetal lethality, disturbance of fetal acid base status and inflammation of the fetus and membranes. Given the circumstances of exposure to periodontopathic pathogens in human periodontal disease, a model investigating long-term exposure to periodontopathic lipopolysaccharide on pregnancy outcomes was developed. ... Overall, I have demonstrated that maternal periodontal disease is associated with adverse pregnancy outcomes including fetal growth restriction and possibly perinatal loss. Mechanisms regulating these effects are likely to be mediated by fetal adaptations to intrauterine inflammation resulting in altered fetal development, growth or survival. Randomised controlled trials that are currently in progress will provide further information on the effects of periodontal disease in human pregnancy, and the efficacy of treatment to reduce these adverse outcomes.

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17

Tong, Stephen. "Investigation of novel endocrine markers of early pregnancy and later pregnancy health". Monash University, Dept. of Obstetrics and Gynaecology, 2004. http://arrow.monash.edu.au/hdl/1959.1/9689.

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18

Ives, Angela Denise. "Breast cancer and pregnancy : how does a concurrent or subsequent pregnancy affect breast cancer diagnosis, management and outcomes?" University of Western Australia. School of Surgery, 2010. http://theses.library.uwa.edu.au/adt-WU2010.0038.

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[Truncated abstract] A diagnosis of breast cancer is a life-changing event for any woman. For young women and their families it can be devastating. Women aged less than 45 years make up 20% of new cases of breast cancer diagnosed annually in Australia. With the trend for women to delay pregnancy, young women diagnosed with breast cancer may want at least the option to become pregnant after diagnosis and treatment but little is known about how pregnancy affects breast cancer or how breast cancer affects pregnancy. The aims of this thesis were to investigate how concurrent and subsequent pregnancy affects the development and outcomes of breast cancer and how breast cancer affects a concurrent or subsequent pregnancy. This study describes two groups of women identified from the entire Western Australian population less than 45 years of age when diagnosed with: 1. Gestational breast cancer, defined as breast cancer diagnosed while a woman is pregnant or in the first twelve months after completion of a pregnancy; and 2. Breast cancer who subsequently conceive. This study focused on three main areas; patterns of care and outcomes for women diagnosed with gestational breast cancer and those women diagnosed with breast cancer who subsequently conceived; the imaging and pathological characteristics of gestational breast cancer; and lastly the psychosocial issues associated with gestational breast cancer. ... This result was statistically significant. In an age and staged matched case control study lymph node negativity did not purvey a survival advantage for women diagnosed with gestational breast cancer as it did for the non- gestational breast cancer controls. Women diagnosed with breast cancer who have good prognosis tumours need not necessarily wait two years to become pregnant. In an age matched case control study women diagnosed with gestational breast cancer were more likely to have extensive insitu carcinoma, higher mitotic rates and tumours with medullary like features than their age matched controls. In a Cox's proportional hazards regression model which included pathological characteristics, there was no significant difference in survival for women diagnosed with gestational breast cancer were compared to women diagnosed with non-gestational breast cancers. The psychosocial issues for women diagnosed with gestational breast cancer are similar to other young women diagnosed with breast cancer but the effect on the 9 lives of women dealing with pregnancy and breast cancer simultaneously was much greater. The issues of breast cancer and pregnancy are complex at both a physical and psychological level. Much more research is needed to understand the mechanisms of how pregnancy affects breast cancer and its spread. Women who are pregnant when diagnosed with breast cancer or who consider pregnancy after their diagnosis need unbiased support from those around them. Survival is important but other survivorship issues may be just as important. To translate these findings into clinical practice and offer directions for future research eleven recommendations are proposed.

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Porter, Charlene. "Immunological, molecular and proteomic evaluation of pregnancy associated conditions using human placental models". Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=167960.

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Haemolytic Disease of the Foetus and Newborn (HDFN) and Foetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) are the most clinically relevant alloimmune disorders of pregnancy caused by maternal alloimmunisation to paternally derived foetal red blood cell (RhD) and platelet antigens (HPA-1a) respectively. Recombinant Fc-modified antibodies have been designed as inert potential biotherapeutics to compete with maternal alloantibodies and reduce foetal mortality. Fc-modified anti-D (Fog1G1 Δnab) and anti-HPA-1a (B2G1Δnab & B2G1Δnac) have been evaluated for their materno-foetal transport capacity using human placental models. For future in vivo efficacy, Fc-modified antibodies should transport at similar rates to wild-type antibodies (Fog1G1 and B2G1). The placental perfusion model showed that the Δnab mutation appeared to lower the transport capability of anti-D and anti-HPA-1a across the placenta. In a Human Umbilical Endothelial Vein Cell (HUVEC-c) cell culture model, transport of HPA-1a was favoured in a basal to apical direction and was statistically significant at hours 12 and 24 (p=0.002 & p=0.010 respectively). The relative order of transport was B2G1Δnac > B2G1 > B2G1Δnab implying the Δnac mutation enhances transport across the foetal endothelium. Since approximately 40% of RhD negative women give birth to RhD negative babies, these women currently receive anti-D prophylaxis unnecessarily. Foetal DNA was successfully extracted from maternal plasma and genotyped for foetal RhD status using Real-Time PCR. Foetal genotyping results revealed 96% and 98% concordance with cord blood serology for maternal blood samples taken at booking (~16 weeks) and at 28 weeks gestation respectively. Two-dimensional Difference in Gel Electrophoresis (2-D DiGE) was used to evaluate the normal placental proteome of syncytiotrophoblast membrane particles (STBMs) generated from placental perfusion. Eleven differentially expressed protein species were identified when comparing different STBM samples. Future work aims to compare the normal placental proteome with the proteome of placentas from complicated pregnancies (e.g. PE, IUGR, PTL and Trisomies 13, 18 and 21) to discover potential biomarkers for screening.

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20

Hamel, Lois C. "Planning for a Healthier Birth and Beyond: Strategies Women Use to Manage Gestational Diabetes". Fogler Library, University of Maine, 2003. http://www.library.umaine.edu/theses/pdf/HamelLC2003.pdf.

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21

Zetterström, Karin. "Chronic Hypertension and Pregnancy : Epidemiological Aspects on Maternal and Perinatal Complications". Doctoral thesis, Uppsala University, Department of Women's and Children's Health, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.

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These studies were undertaken to investigate risks of maternal and perinatal complications in pregnant women with chronic hypertensive disease, and to investigate future risk of preeclampsia in women born small for gestational age (SGA). Population based cohort studies using the Swedish Medical Birth Register from different years were performed.

The maternal complications mild and severe preeclampsia, gestational diabetes and abruptio placenta were studied in a population of 681 515 women, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics as age, parity, BMI, ethnicity and smoking habits. Chronic hypertensive women wore found to have significantly increased risks of all complications.

The perinatal complication SGA was studied in a population of 560 188, with a prevalence of 0,5% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the secondary complications mild and severe preeclampsia. Chronic hypertensive women were found to suffer a significantly increased risk of giving birth to an offspring that is SGA.

The perinatal complication fetal/infant mortality was studied in a population of 1 222 952 with a prevalence of 0,6% for chronic hypertension. Risk estimates were adjusted for differences in maternal characteristics and for the complications mild and severe preeclampsia, gestational diabetes, abruptio placenta and offspring being SGA In the analysis an effect modification by gender was included. Chronic hypertensive women were found to have a significantly increased risk for stillbirth and neonatal death in male, but not in female, offspring. Thus a clear gender difference in mortality was revealed. The risk of mortality of offspring was mediated by severe preeclampsia, abruptio placenta and offspring being SGA. Mild preeclampsia and gestational diabetes did not affect the risk. No increased risk of post neonatal mortality was found.

A generation study was performed in 118 634 girls of which 5.8% were born SGA. Their future risk for mild and severe preeclampsia in first pregnancy was analysed. Risk estimates were adjusted for age, smoking, BMI and for preeclampsia in the mothers while pregnant with the study population. Women who were born SGA were shown to have a significantly increased risk for severe preeclampsia, but not for mild preeclampsia.

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Zetterström, Karin. "Chronic hypertension and pregnancy : epidemiological aspects on maternal and perinatal complications /". Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7755.

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23

Aye, Christina. "The influence of pregnancy complications on fetal and neonatal cardiovascular development". Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:e3353669-2a87-4e68-9905-a4beb1d7fb9c.

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It is becoming increasingly clear that exposure to pregnancy complications such as hypertensive disorders of pregnancy and premature birth (birth before 37 weeks gestation) have a long term and specific effect on future cardiovascular disease development and risk in the offspring. Those born to a preeclamptic pregnancy have been shown to have double the risk of stroke in adulthood and studies have consistently shown an increase in blood pressure in these individuals. Higher blood pressure has also been observed in those born preterm in addition to specific cardiac modifications in young adulthood. Through detailed cardiovascular phenotyping, this thesis investigates the effects of exposure to in utero maternal hypertension and/or a preterm birth on offspring cardiovascular development in the antenatal and early postnatal period in a newly established cohort of infants. A stratified recruitment strategy was employed in order to recruit similar numbers of mother and infant dyads from hypertensive and normotensive pregnancies across a range of gestations. Nomograms for fetal ventricular volume and mass using two dimensional echocardiography were created. These were then used, along with postnatal normative data, to create trajectories of offspring cardiovascular development from 15 weeks postmenstrual age through to three months post birth in order to overlay datasets from babies born preterm. It was demonstrated that premature infants have similar in utero cardiac development to controls but post birth they undergo disproportionate cardiac hypertrophy which is associated with a degree of diastolic impairment. Preterm infants at birth had a unique ventricular shape, but these changes had attenuated by three months of age. Exposure to in utero maternal hypertension also appeared to have a deleterious effect and on further investigation, postnatal ventricular hypertrophy was also observed when analysis was restricted to term born infants exposed to this pregnancy complication. Additionally, offspring born to a hypertensive pregnancy demonstrated an increased microvascular density loss over the first three months of life. This was associated with a reduction in vasculogenic potential in their human umbilical vein endothelial cells and also increased levels of maternal anti-angiogenic biomarkers at birth. Again, there was a trend to suggest maternal hypertension and prematurity may have an additive effect. These microvascular changes were not, however, correlated with cardiac hypertrophy in the whole cohort over the same period, but, intriguingly, when subgroup analysis was performed, increased microvascular density loss was correlated with increased left ventricular mass indexed to body size at three months of age in term born infants but not in the preterm group. It was then shown that preterm offspring had reduced heart rate variability measures at birth suggesting autonomic dysfunction. This was, however, not correlated with any previously demonstrated cardiovascular developmental changes in the early postnatal period. Offspring exposed to maternal hypertension and those born small for gestational age did not demonstrate any difference in heart rate variability at birth compared to controls. The results from my thesis point towards the perinatal and early postnatal period as being a critical window for cardiovascular development. As up to 8% of pregnancies are affected by hypertensive disorders of pregnancy and approximately 10% of all births are preterm, understanding the mechanisms behind these findings and their relevance to long term cardiovascular disease in this population is of great public health interest. Modification of clinical care and discovery of novel targets for disease prevention during this potentially tractable period will be of future interest.

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24

Bakun, O. V., e D. Ashish. "THE INFLUENCE OF PYELONEPHRITIS COMPLICATIONS ON COURSE OF PREGNANCY AND LABOR". Thesis, Буковинський державний медичний університет, 2014. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/9600.

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Pyelonephritis - nonspecific, infectious-inflammatory process with primary and primary lesion interstitial tissue walls and renal tubules, with subsequent involvement of glomerular and vascular system. Different pathological conditions, which provoked acute stage of chronical pyelonephritis among pregnant women has been analized. Among: anomalies of kidney development, glomerulonephritis, hypertonic disease, preeclampsia and oth. According retrospective investigation of case history of women of postpartum period which have complicated pyelonephritis of Chernivtsi region has been received such characteristics: general amount of cases of nephrological complicated diseases during 2010-2013 consists 87; ratio of these diseases consists: pyelonephritis - 78,16%, glomerulonephritis - 9,1% and oth. - 12,74%. Most part of all background conditions, which contributes development of acute stage of chronical pyelonephritis compound anomalies of kidney development (51%), among them the most - single left kidney (34%). Different groups of exciters of chronical pyelonephritis during pregnancy has been analized: Ar. Piogenes, Streptococcus spp., E. coli, Candida albicans, St. aureus, Enterobacter aerogenus, S. Haemolyticus, S. epidermidis. Negative results of bacteriological examination of urine after finishing course of antibioticotherapy has been founded efficacy of antibioticotherapy in pregnant women with complicated pyelonephritis. The disappearance or significant reduction in the severity of the clinical manifestations of the disease: negative Pasternatsky symptom, disappearance of pain in the lumbar region, the normalization of body temperature and reduce the intensity of other general clinical symptoms.
Кафедра акушерства та гінекології

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25

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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26

Noftall, Alice. "The experience of men whose partners are hospitalized for high-risk pregnancies : a phenomenological study /". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0016/MQ55532.pdf.

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27

Yatich, Nelly J. "The effect of malaria and intestinal helminth coinfection on birth outcomes in Ghana". Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008r/yatich.pdf.

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28

KAZAMA, SHARON WONG. "THE EFFECTS OF STRESS AND MARITAL INTIMACY ON PREGNANCY AND BIRTH COMPLICATIONS". Diss., The University of Arizona, 1987. http://hdl.handle.net/10150/184150.

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The present prospective longitudinal investigation examined the relationship of life event stress and marital intimacy to pregnancy and birth complications (N = 65). As expected, marital intimacy had a significant buffering effect on stress, but had no relationship with pregnancy and birth complications. In addition, stress levels were not related to pregnancy outcome. Social desirability and conflict resolution on the intimacy measure, as well as ethnicity were significantly related to pregnancy and birth complications. Particular attention is focused on social desirability and its implications for future social support research.

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29

Gebremedhin, Amanuel Tesfay. "Effects of interpregnancy interval on pregnancy complications in a high-income country". Thesis, Curtin University, 2021. http://hdl.handle.net/20.500.11937/85548.

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Using a high-quality, population-based cohort spanning over 35 years in WA, we found insufficient evidence to suggest that short intervals increase the risk of hypertensive disorders of pregnancy (HDPs) and gestational diabetes. However, long intervals (>24 months) were associated with an increased risk of HDPs. Findings from this thesis suggest that optimal intervals vary by maternal age and previous pregnancy complications at birth prior to the interval and challenge the applicability of the current birth spacing recommendations, including WHO, to high-income settings such as Australia.

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30

Okong, Pius. "Maternal morbidity in Uganda : studies on life-threatening pregnancy complications in low-income settings /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-127-X/.

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31

Öhman, Inger. "Newer antiepileptic drugs in women of child-bearing age : pharmacokinetic studies during pregnancy, breastfeeding, and contraception /". Stockholm, 2006. http://diss.kib.ki.se/2006/91-7357-046-X/.

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32

Laresgoiti, Servitje Estibalitz. "Effect of Stress, Emotional Lability and Depression on the Development of Pregnancy Complications". Thesis, Walden University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3591710.

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Chronic stress and other emotional factors may have relevant impacts on pregnancy outcomes because they are related to neuroendocrine changes that lead to alterations in immunomodulation during pregnancy. In this quantitative prospective cross-sectional study, the relationship of emotional lability, depression, and stress during pregnancy and the development of preterm labor, preeclampsia, placental abruption, and low birth weight for gestational age babies was examined. Additionally, social support scores were compared to levels of stress/anxiety, depression, and emotional lability in pregnant women. Two hundred and forty two pregnant women who received prenatal services at the National Institute of Perinatology in Mexico City were evaluated during the 2^nd or 3^rd trimester of pregnancy and followed until pregnancy termination. Logistic regression analyses showed that being single significantly predicted preeclampsia and preterm birth, and the presence of social support significantly decreased the likelihood of preterm birth development. In the logistic regression model, family income significantly predicted the development of abruptio placentae. MANCOVA results revealed a significant difference among the social support categories on the combined dependent variables (stress/anxiety, depression, and emotional lability). The ANCOVA reported significant differences between social support scores, and stress/anxiety and depression scores. ANCOVA also showed significant differences between the number of pregnancies and stress scores. A 2X2 factorial analysis of variance showed a significant main effect of stress and depression on newborn weight. By promoting awareness of the importance of emotional factors during pregnancy among healthcare workers and pregnant women, this study contributed to positive social change.

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33

Laresgoiti, Servitje Servitje Estibalitz. "Effect of Stress, Emotional Lability and Depression on the Development of Pregnancy Complications". ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1074.

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Abstract (sommario):

Chronic stress and other emotional factors may have relevant impacts on pregnancy outcomes because they are related to neuroendocrine changes that lead to alterations in immunomodulation during pregnancy. In this quantitative prospective cross-sectional study, the relationship of emotional lability, depression, and stress during pregnancy and the development of preterm labor, preeclampsia, placental abruption, and low birth weight for gestational age babies was examined. Additionally, social support scores were compared to levels of stress/anxiety, depression, and emotional lability in pregnant women. Two hundred and forty two pregnant women who received prenatal services at the National Institute of Perinatology in Mexico City were evaluated during the 2nd or 3rd trimester of pregnancy and followed until pregnancy termination. Logistic regression analyses showed that being single significantly predicted preeclampsia and preterm birth, and the presence of social support significantly decreased the likelihood of preterm birth development. In the logistic regression model, family income significantly predicted the development of abruptio placentae. MANCOVA results revealed a significant difference among the social support categories on the combined dependent variables (stress/anxiety, depression, and emotional lability). The ANCOVA reported significant differences between social support scores, and stress/anxiety and depression scores. ANCOVA also showed significant differences between the number of pregnancies and stress scores. A 2X2 factorial analysis of variance showed a significant main effect of stress and depression on newborn weight. By promoting awareness of the importance of emotional factors during pregnancy among healthcare workers and pregnant women, this study contributed to positive social change.

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34

Didrickson, Susanna. "Facing Uncertainty on Two Fronts: The Experience of Being Pregnant While One's Husband is Deployed". Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/578608.

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This qualitative descriptive study investigated the unique and specific impact of being pregnant while one's husband was deployed to a combat zone. Three specific aims were used to address the study objectives 1) Describe the experience of being pregnant while one's husband is deployed 2) Describe the women's experiences with health-care providers 3) Describe the types of support women sought or had access to during pregnancy. Participants were 16 women who had been pregnant while their husbands were deployed for greater than 30 days from 2004-2014, with no prior personal history of being deployed. Participants completed demographic questionnaires on their pregnancy course, and their husband's military and deployment history. Semi-structured telephone interviews were conducted with each participant individually. Content and matrix analysis were utilized to explore the study aims. The Stress and Coping Model by Lazarus and Folkman (1984) provided the theoretical framework for this study. Communication was an important part of receiving support from the husband and daily communication (n=4, 25%) was associated with more problem-based coping (75%) and feelings of emotional support from the husband (38%). Six participants stated a history of preterm labor or birth, and most of those participants used emotion-based coping predominantly (57%). Participants who perceived that their husbands experienced significant danger were more likely to use emotion-based coping (56%). Participants overall had more positive interactions with certified nurse midwives (76%) and civilian obstetric physicians (77%), and reported more negative interactions with military obstetric providers (87%). Primiparous participants reported that 61% of all experiences with providers were positive while multiparous participants were more likely to have negative (66%) or mixed (6%) experiences. Support systems sought or accessed were different for officer and enlisted wives as well as for different ages. The wives of enlisted soldiers were more likely to not participate, or have an unfavorable view (52%) of the FRGs. Whereas, the wives of officers felt more support and involvement (69%). Wives who were 29-years-old or less sought out more support from friends/co-workers (33%) than the 30-years-old or older group (19%). The 30-years-old or older group was more likely to have sought support from family (50%) versus the 29-years-old or younger group (40%). The difference in support sought or accessed from the FRG between the two age groups was much less significant (28% for ≤ 29-years old versus 31% for ≥ 30-years old). The findings from this study could be adapted to create a screening tool that would alert providers to those pregnant women who might need specific resources or social support.

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35

Hill, S. Kristian. "Maternal perinatal events as predictors of sensory-motor functioning in normal children". Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1117100.

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The relationship between perinatal complications and sensory-motor functions was examined. Information from the Maternal Perinatal Scale (MPS) was used to predict factor scores of the Dean Sensory-Motor Battery (DSMB). Participants were 187 normal nonreferred children who were administered the DSMB while their mothers completed the MPS. Using MPS items as predictors, separate stepwise regression analyses for each DSMB factor found that 11 - 16% of variance could be accounted for in sensory-motor performance. At least three MPS items significantly contributed to the prediction of each DSMB factor. Predictors of Sensory and Simple Motor functions (DSMB Factor I) included maternal bleeding during pregnancy, delay between membrane rupture (water break) and onset of labor, and evidence of hypoxia. Evidence of hypoxia, maternal bleeding during pregnancy, and delay between water break and labor onset were predictive of Motor and Complex Sensory functions (DSMB Factor II). In addition, gender of the child joined maternal bleeding during pregnancy, amount of swelling during pregnancy, and mother's height in predicting Subcortical Motor functions (DSMB Factor III). Additional analyses using a canonical correlation confirmed the results of the regression analyses. A linear composite of sensory and motor variables was primarily defined by DSMB factors I and II. The linear composite of perinatal information was defined primarily by the same items that emerged as significant predictors of sensorymotor functions in the regression analyses. Most notably, a redundancy analysis indicated that about 20% of variance in DSMB factor scores could be accounted for by a linear composite of perinatal information. In general, sensory-motor performance decreased as severity of perinatal complications increased. Results were discussed in terms of the implications of using a normal non-referred population. More importantly, the present data suggested the possibility that 1) the relationship between perinatal complications and sensory-motor functions may exist on a continuum rather than the dichotomous diagnosis/no diagnosis, and 2) the synergistic influence of multiple perinatal complications may contribute to the manifestation of clinically significant behaviors. The role of sensory-motor functions as a foundation for more complex behaviors is also discussed.
Department of Educational Psychology

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36

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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37

Vääräsmäki, M. (Marja). "Care and outcome of Finnish diabetic pregnancy". Doctoral thesis, University of Oulu, 2001. http://urn.fi/urn:isbn:951426469X.

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Abstract The aim of this study was to evaluate the treatment, course and outcome of pregnancy in Finland using two cohorts of diabetic women. The clinical cohort consisted of data from all 210 women with Type 1 diabetes and their 296 pregnancies managed between 1986 and 1995 in the two northernmost provinces of Finland. The register-based study population included all 1442 mothers with a singleton birth who had insulin treatment during pregnancy in 1991-1995 according to the Medical Birth Register. Of these mothers, 954 (66%) had pre-existing diabetes. Insulin-treated diabetes complicated 4.5/1000 births in Finland in 1991-1995, the prevalence of Type 1 diabetes being 2.9/1000 in the whole country and 3.3/1000 in Northern Finland. In the 1990's the care of these women shifted from tertiary level only to include the secondary level hospitals as well, and was more often carried out on an out-patient basis. This care policy in association with the self-monitoring of blood glucose levels contributed to an obvious improvement in glycaemic control during pregnancy. Despite that, the high proportion (73%) of women entering pregnancy with unsatisfactory glycaemic control did not decrease during the study period. Retinopathy complicated 134 (45.3%) diabetic pregnancies, while clinical nephropathy was found in 23 (7.8%) cases. Although retinopathy was more often aggravated during the first pregnancy, the occurrence of retinopathy or its severe form was not increased at the beginning of consecutive pregnancies. Of the mothers, 50 (16.9%) had pre-eclampsia during pregnancy, and in 28% of these cases it was classified as superimposed. It was found more often among primiparous than multiparous (25.6% vs. 11.0%, respectively), and its occurrence rose with the severity of diabetes. In both cohorts, the rates of preterm deliveries, Caesarean sections and large for gestational age (LGA) infants were significantly (p < 0.001) higher in Type 1 diabetic pregnancies than in the background population. The rates of congenital anomalies (CA) were 540-629/10000 in two study populations, both being 2-3-fold as compared to the background population. Cardiac malformations were most common, with anomalies in the genitourinary tract and the musculoskeletal organs being next in frequency. Sixty-three percent of malformed infants were boys. Though pregnancy itself was not found to worsen the prognosis of diabetes, at least in the short term, pregnancy in diabetic women still remains a high risk state with an increased rate of prematurity, operative deliveries, CAs and peri- and neonatal mortality. In order to decrease the mortality rate in diabetic births, attention should be directed at both the prevention of CA and at identifying the foetuses at risk for intrauterine death. The postneonatal mortality rate is also high, reflecting a shift in the deaths from the early neonatal period to a later age. Therefore, a combined mortality, including induced abortions, stillborns and infant deaths, would give a more realistic idea of the outcomes in diabetic pregnancies.

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38

Toivo, Aini-Kaarin. "Perceptions and experiences of pregnant women towards HIV voluntary antenatal counselling and testing in Oshakati Hospital, Namibia". Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&amp.

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This study focused on perceptions and experiences of pregnant women who opted in against those who opted out of voluntary antenatal HIV counseling and testing. The pregnant women's perceptions and experiences were assessed in order to gain insight into their views towards voluntary antenatal counseling and testing.

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39

Fritz, Kathleen Gary. "Development of a urinary metabolic ratio that reflects systemic theophylline elimination during pregnancy". Scholarly Commons, 1993. https://scholarlycommons.pacific.edu/uop_etds/2245.

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A number of studies have investigated the natural history of asthma in pregnancy. Most of the data suggests that the course of asthma for a given patient is unpredictable. Turner, et al.7 summarize the data from all of the English-language literature of studies on the effect of pregnancy on astha. Of 1054 cases examined, 49% of the asthma conditions remained unchanged, 22% got worst and 29% became better.7 Theophylline has been used safely during pregnancy. A review of the literature by O'Brien, showed that no teratogenic effects were associated with the use of theophylline in 117 cases and aminophylline in 76 cases examined.39,40 Blood concentration in newborns have been found to be similar to concentrations in the mothers.41,42,43 Problems developed because theophylline clearance may be altered during pregnancy and necessitate dosage adjustments and careful drug level monitoring.44 RATIONALE FOR STUDY Campbell, et al.45 developed a caffeine urinary metabolic ratio, in which they were able to demonstrate a correlation between changes in metabolic rations and clearance. The change in the metabolic ration explained the alteration in clearance and determined the specific Cytochrome P-450 system involved. Various physiologic changes occurring during pregnancy can cause changes in drug disposition. Pharmacokinetic parameters that need to be considered are plasma protein binding capacity, absorption, drug metabolizing enzyme activity, renal excretory function and volume of distribution.44,46,47 This study was developed to determine if changes in theophylline disposition during pregnancy were due to changes in drug metabolizing enzyme activity. A urinary test was designed to investigate the ratios of unchanged theophylline and theophylline metabolites to monitor changes in the various Cytochrome P-450 isoenzyme systems. Changes in the ratios could provide a noninvasive procedure to assess the effect of modulating agents or conditions (such as pregnancy) on theophylline metabolizing enzyme activity.

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40

Mathai, Elizabeth. "Genital and urinary tract infections in pregnancy in southern India : diagnosis, management and impact on perinatal outcome /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-129-6/.

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41

林勇行 e Yung-hang Lam. "Sonographic features of fetuses with homozygous [alpha]-thalassaemia-1during early pregnancy". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2001. http://hub.hku.hk/bib/B31981744.

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42

Edwards, Lisa J. "Maternal undernutrition and fetal blood pressure and the hypothalamo-pituitary adrenal axis in the late gestation fetal sheep". Title page, table of contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phe2654.pdf.

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Includes bibliographical references (leaves 228-257). Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.

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43

Ojodun, Olumide. "The prevalence of hypertensive complications of pregnancy in Dora Nginza Hospital, Port Elizabeth, Eastern Cape". Thesis, Stellenbosch : Stellenbosch University, 2010. http://hdl.handle.net/10019.1/20451.

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Research report (MMed) -- Stellenbosch University, 2010.
Bibliography
ENGLISH ABSTRACT: BACKGROUND: Hypertension and its complications is responsible for a significant proportion of maternal and neonatal morbidity and mortality worldwide. In Dora Nginza Hospital, clinical experience has shown that hypertension and its complications are common but despite this assumption, the overall prevalence of complications, social and demographic characteristics and various forms of presentations of hypertension in pregnancy is still largely unknown. OBJECTIVES: To determine the prevalence of complications, risk factors, social and demographic characteristics of hypertensive complications of pregnancy in Dora Nginza Hospital. STUDY DESIGN: The study is a retrospective descriptive study performed on medical records. The study was carried out by looking at records of patients admitted with hypertension in pregnancy over a 2 year period (2007-2008). MS Excel was used to capture the data and STATISTICA version 9 was used for data analysis. SETTING: Dora Nginza hospital, Port Elizabeth Hospitals Complex. MAIN OUTCOME MEASURES: The incidence, risk factors, maternal complications, perinatal outcome. RESULTS: A total of 22,711 deliveries were recorded in Dora Nginza hospital over the two year period (2007-2008). 1520 cases were complicated by hypertension giving an incidence of hypertension as 6.69% (66.9 per 1000 deliveries). The incidence of pre eclampsia is 35.40% and chronic hypertension 2.80%. Maternal complications occurred in 40.29% of the hypertensive women. Maternal deaths occurred in 0.79% (790 per 100000 deliveries) accounting for 38.71% of the total maternal deaths in the facility. Poor neonatal outcome was recorded in 5.90% of these women. The 2.30% stillbirths represent 3.30% of all fetal deaths in the facility for the study period. Prominent risk factors are age, race, low socioeconomic status, smoking and BMI CONCLUSION: Hypertensive disorders of pregnancy in Dora Nginza hospital is common and is an important cause of maternal and perinatal morbidity and mortality. Improved socioeconomic status, quality obstetric services which include early booking, proper antenatal care, early referral and proper documentation can minimise the effect of hypertension on pregnancy.
AFRIKAANSE OPSOMMING: geen opsomming

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44

Poles, A. "Glycoprotein estimation and analysis of genes associated with inherited platelet disorders and complications of pregnancy". Thesis, University of the West of England, Bristol, 2013. http://eprints.uwe.ac.uk/22243/.

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The archetypical inherited platelet (PLT) disorders are Glanzmann’s Thrombasthenia (GT) and Bernard Soulier Syndrome (BSS) and both are autosomal recessive disorders. GT results from mutations in the ITGB3 and/or ITGA2B genes that encode the GPIIb/IIIa complex, while BSS results from mutations in the genes (GPIba, GPIbb and GPIX) that encode the GPIb/IX/V complex. GT and BSS patients have a mild bleeding tendency which is in contrast with patients with another inherited PLT disorder known as congenital amegakaryocytic thrombocytopenia (CAMT). CAMT is associated with mutations in the MPL gene that encodes the thrombopoietin receptor (TPOr), and develop pancytopenia which requires stem cell transplantation. The GPIIb/IIIa and GPIb/IX/V complexes are also the carrier molecules for the majority of Human Platelet Antigens (HPAs). Alloimunisation against HPA is important in foetal maternal alloimmune thrombocytopenia (FMAIT) where the mother becomes immunized against an antigen that the foetus has inherited from the father. In the GT patients, seven novel mutations were identified. One homozygous mutation in the ITGA2B gene resulted in a frameshift and premature stop codon, two heterozygous missense mutations were identified in the same patient and lastly a homozygous missense mutation was identified in a patient that also possessed a novel intronic mutation in the ITGB3 gene. A further two novel homozygous missense mutations were also detected in the ITGB3 gene. In the BSS patients five novel mutations were identified in the GPIba, GPIbb and GPIX genes. There were three single base deletions resulting in premature stop codons, one missense mutation in the leader sequence of the GPIbb gene, and a further heterozygous missense mutation also in the GPIbb gene. Five of seventeen suspected CAMT patients possessed mutations in the MPL gene. Three novel mutations were identified; one missense mutation resulting in a premature stop codon, one mutation in intron 11 and a homozygous missense mutation. Gene analysis provided confirmatory diagnosis and correlated with disease progression. In the FMAIT case, maternal antibodies reactive only with paternal platelets were localized to GPIIb/IIIa by crossmatch using the MAIPA assay. A mutation was detected in exon 23 of ITGA2B in the father and the three children. This mutation predicts a valine to leucine amino acid substitution (V740L) in the mature protein. Recombinant GPIIb glycoprotein mutated to contain the novel mutation and expressed in HEK293 cells was specifically recognised by maternal antibodies. The mutation was not detected either in the mother or a cohort of one hundred volunteer platelet apheresis donors. Evidence from these patient cohorts indicated that misdiagnosis is not uncommon and this highlights the need for confirmatory diagnosis based on immunophenotyping and gene analysis. This was emphasised in the cohort of CAMT patients, that had variously been incorrectly diagnosed with FMAIT, Immune Thrombocytopenic Purpura and Aplastic Anaemia. Gene analysis of the ITGA2B gene permitted definition of the V740L mutation that defines a new low frequency antigen implicated in two cases of FMAIT in a single family.

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45

Chalana, Vikram. "Deformable models for segmentation of medical ultrasound images /". Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/8025.

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46

Rogal, Shari. "The Effects of Posttraumatic Stress Disorder on Pregnancy Outcomes". Yale University, 2006. http://ymtdl.med.yale.edu/theses/available/etd-06282006-141433/.

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The purpose of this study was to determine the effect of posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, on the occurrence of low birthweight (<2500 grams) and preterm delivery (<37 weeks gestational age). A cohort of 1362 women was recruited from prenatal care visits and screened for depression, panic disorder, posttraumatic stress disorder, and substance use. Current episodes of PTSD were assessed using the MINI International Neuropsychiatric Interview. Pregnancy outcomes were abstracted from hospital records after delivery, and the data were analyzed using logistic regression. Two hundred sixty two women (33%) were lost to follow-up due to unavailable medical records, leaving 1100 women in the final analyses. Among these 1100 women, 31 (3%) were found to have PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorders, and prior preterm delivery were significantly associated with PTSD in the sample, while age, language spoken, and race were not. Low birthweight (LBW) was present in 6.5% of sampled women and was not significantly associated with a diagnosis of PTSD in pregnancy when adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder OR= 1.82 (CI=1.01, 3.29). Preterm delivery occurred in 7.0% of those without and 16.1% of those with PTSD (p=0.055). Because prior preterm delivery data were not available for 33% of women with PTSD, this variable was included only in secondary analyses. However, the association between PTSD and preterm delivery depended on this variable, with OR= 2.82 (0.95, 8.38) before controlling for prior preterm delivery and OR=3.35 (1.04, 10.85) after controlling for prior preterm delivery. These data suggest that a possible association of PTSD and preterm delivery was limited by the low rates of PTSD in this cohort and the inability to control for all confounders. Taken together, these findings provide limited support for the hypothesized association between PTSD and preterm delivery and no support for an association of PTSD with LBW.

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47

Spadafore, Lori. "Relationship between perinatal complications and attention deficit hyperactivity disorder and other behavioral characteristics". Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1115716.

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The present study was undertaken to determine the relationship between perinatal complications and subsequent development of Attention Deficit Hyperactivity Disorder (ADHD) and other behavioral characteristics. The biological mothers of 74 children diagnosed with ADHD and 77 children displaying no characteristics of the disorder completed the Maternal Perinatal Scale (MPS), the Behavior Assessment System for Children-Parent Rating Scales (BASC-PRS), and a demographic survey. In addition, the biological mothers of 120 children with no characteristics of ADHD or any other behavior disorders completed only the MPS so that exploratory factor analysis of the MPS could be completed.Following factor analysis, stepwise discriminant analysis of the resulting five factors was utilized to explore the nature of the relationship between such perinatal factors and ADHD. Results of this analysis indicated that emotional factors, or the amount of stress encountered during pregnancy and the degree to was planned, were the items that maximized the separation between the ADHD and Non-ADHD groups. Additional discrimination between the groups was attributed to the extent of insult or trauma to the developing fetus and the outcome of prior pregnancies. ADHD children were also found to have experienced twice as many behavioral, social, or medical problems, and were more likely to reach developmental milestones with delays.Stepwise discriminant analysis also revealed the Attention Problems and Hyperactivity scales of the BASC-PRS were most significant in differentiating between the ADHD and Non-ADHD subjects. Using the BASC-PRS resulted in approximately 90% of the total sample being correctly classified as ADHD or NonADHD. Canonical correlation analysis indicated that emotional factors and the general health of both the mother and the developing fetus were the best predictors of later behavioral patterns reported on the BASC-PRS.
Department of Educational Psychology

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Janssen, Anna. "Investigating a role for imprinted genes in pregnancy complications and the possible influence of maternal lifestyle". Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/80617/.

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Imprinted genes, displaying monoallelic parent of origin specific expression, are known to regulate fetal growth and placental development. Work in animal models also suggests that imprinted genes regulate placental hormone signalling to the mother, which is required for induction of maternal adaptation to pregnancy. Aberrant placental imprinted gene expression may therefore have a causative role in pregnancies characterised by abnormal fetal growth and/or inadequate maternal adaptation to pregnancy. Given these important functions, identifying environmental stimuli responsible for perturbed imprinted gene expression is also of interest. This thesis examined human placental expression of the imprinted genes PHLDA2, CDKN1C, PEG3 and PEG10 in three independent cohorts, including pregnancies complicated by fetal growth restriction, fetal overgrowth, preeclampsia, gestational diabetes and maternal mood disorders. Placental imprinted gene expression was also analysed in relation to placental hormone (hPL and PGH) gene expression and in relation to maternal lifestyle factors. The effect of maternal diet on placental imprinted gene expression was further explored in a mouse model to provide evidence for a cause or effect relationship. Placental PHLDA2 expression was significantly increased in growth-restricted pregnancies, supporting a role for PHLDA2 in the negative regulation of fetal growth. In contrast, placental PEG10 expression was positively associated with fetal growth. This study did not support a role for PEG3 in the control of fetal growth, but did suggest a role in maternal adaptation to pregnancy with aberrant gene expression observed in pregnancies complicated by maternal depression. Finally, this study provided evidence that PHLDA2, CDKN1C, PEG3 and PEG10 expression is responsive to environmental stimuli, particularly maternal diet, in both human pregnancies and in a mouse model. Thus, this thesis highlights the importance of imprinted genes in achieving a successful pregnancy for both mother and fetus and the possible role of maternal lifestyle in influencing this.

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Reep, Daniel T. "Placental Eicosanoids and Sphingolipids in Preeclampsia". VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5553.

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Placental dysfunction is implicated in the pathogenesis of preeclampsia. Chemical signals between the placenta and maternal circulation are a suspect cause of endothelial dysfunction and maternal hypertension. This study examined select lipid mediators of inflammation produced by the placenta. Patients were recruited from Virginia Commonwealth University’s pregnancy clinics and placentas were collected at delivery. Forty-eight-hour explant cultures of villous placental tissue were used to model lipid production. Electrospray ionization mass spectrometry was used to quantify concentrations of free lipids in the culture media. Bicinchoninic acid assays were performed to quantify protein in each culture for normalization of lipid data. After analysis, it was found that severity of preeclampsia was correlated with a unique lipid profile. Pro-inflammatory hydroxyeicosatetraenoic acids and sphingolipids were elevated. Aspirin usage in patients who developed preeclampsia was found to attenuate accumulation of isoprostane oxidative stress markers and thromboxane production while preserving omega-3-fatty acid and increasing prostacyclin levels.

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Abdel, Azim Hatem Hamdy. "Breast cancer in young women: impact of pregnancy on biology and outcome". Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209357.

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In this work, we found that proliferation-related prognostic gene signatures could aid treatment decision-making independent of age. This is clinically relevant for the younger breast cancer population given the potential long-term side effects of adjuvant systemic chemotherapy and hence the need to identify patients who are less likely to benefit adjuvant chemotherapy. In addition, it was clear that young age at diagnosis adds extra biological complexity, which is independent of differences in breast cancer subtype distribution. This includes enrichment with known breast cancer targets like RANKL. Whilst these results require further validation, either experimentally or in other clinical data sets, it suggests that separate therapeutic approaches may need to be specifically designed in order to improve outcomes for breast cancer arising in young women. In this regard, and based on our results and supportive evidence from other studies, we initiated a proof-of-concept prospective phase II neoadjuvant study investigating the role of denosumab, a RANKL inhibitor on modulating tumor biology in young premenopausal breast cancer patients.

We found that diagnosis during pregnancy does not significantly influence the classic pathological features or the prevalence of breast cancer subtypes. We also did not find obvious differences in the distribution of PIK3CA mutations. However, we found that tumors diagnosed during pregnancy have activated serotonin receptor signaling and high expression of potential breast cancer targets; of particular interest IGF1, and PDL1. Such differences appeared to be reflected in the normal pregnant breast underscoring the potential role of the pregnant breast microenvironment on the tumor transcriptome. We were not able to associate these genes with prognosis, which could be partly due to lack of statistical power. Of note, we cannot confirm whether any of these aberrations are key drivers of the biology of tumors diagnosed during pregnancy. Nevertheless, this remains the first study to look into the biology of this relatively rare disease and hence we believe it would serve as a very valuable resource for future research in this field. We are planning to perform targeted gene sequencing to further refine our understanding of the potential effect of pregnancy on the biology of these tumors.

In the last part of this work addressing the safety of pregnancy following breast cancer diagnosis, we identified that available studies suffered major limitations related to study design including selection bias and lack of information on patients with history of an ER-positive disease. This has resulted in advising against pregnancy in women with prior history of breast cancer. Our subsequent study has robustly addressed most of the limitations in older studies and clearly showed that pregnancy following breast cancer is safe even in women with a history of ER-positive disease. Hence, this study would provide a very important resource for the oncology community, which would aid adequate fertility counseling for young breast cancer survivors. This work is currently serving as the basis for a new prospective study by the IBCSG to test the safety of early interruption of tamoxifen in young women with early breast cancer seeking subsequent pregnancy.

Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished

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Tesi sul tema "Pregnancy Complications"

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