Browsing by Subject "Pregnancy"
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Item Abnormal Pap Smear in Pregnancy(2009-05-06) Fennell, Naomi2-7% of pregnant women in the United States will have an abnormal pap during pregnancy. An abnormal pap smear means that some of the cells that were brushed off the cervix during a pap smear appeared atypical, or abnormal, under the microscope. There are many causes of atypical cervical cells, but they are often from infection with the human papillomavirus (HPV). Cervical dysplasia (change in the cells of the cervix) is considered pre-cancerous because if left untreated it can progress to cervical cancer. Some abnormal pap results will lead to an exam called a colposcopy. Colposcopy is when a doctor uses a microscope to look at the cervix. This procedure is similar to a pelvic exam and usually takes about 15 minutes. The doctor will try to visualize any abnormal areas on the cervix and decide if the abnormal area(s) appear to be mild, moderate, or severe dysplasia. The doctor will then decide if a biopsy is required. Current recommendations suggest that pregnant women with cervical lesions that appear to be moderate or severe dysplasia by colposcopy should be biopsied.Item Aerobic exercise in pregnancy(2010-09-15) Huynh, TamThis pamphlet discusses aerobic exercise during pregnancy. Non-contact aerobic exercises that are done 2-3 times a week improve the mother physical fitness. There is not enough data to determine if there are adverse/beneficial effects on fetal outcome.Item Can pregnant mother’s smoking hookah affect the weight of her baby?(2012-04-10) Chiri, ChalaItem Conceiving pregnancy as narrative(s): transgressive maternities and disability in American reproductive politics(2014-06) McWhorter, Rachel Joyce"Conceptions of Pregnancy" explores narratives that articulate pregnancy beyond the bounds of "normative," American reproductive politics. By enlisting these narratives, and focusing on the narrative substance of pregnancy itself, I argue that pregnancy can be refigured as a significantly critical position by which to critique lingering ideas of the Enlightenment subject and embodiment. This dissertation covers select literary texts from the antebellum era through the 21st century that encounter significant historical contexts and, in response, re-shape pregnancy and maternity toward this radical end: slave women and transgressive motherhood in the wake of the Civil War; the "gaps in people's lacks" or marginalized "pregnancies of the southern US, spanning the years of the Great Depression through the Civil Rights era, with the particular regional and national strain of eugenic classism and racism that directed women's reproductive choices; and the Second Wave and Third Wave feminists' intersections with Critical Disability Studies in the late 20th and early 21st centuries at the site of pregnancy.Item Diabetes During Pregnancy(2012-09-24) Morcomb, ErinItem Do I Need Medication to Prevent Clots in Pregnancy?(2012-04-10) Borchert, KarenItem Doctor visits during pregnancy(2012-07-16) Malone, JessicaItem Examining the Variation in Child Vaccination Status by Maternal Vaccination and Birthing Place(2015-06) Fuchs, ErikaOutbreaks of vaccine-preventable illnesses have occurred in recent years in pockets of children who are not up-to-date on their vaccinations, particularly among those whose parents have chosen to delay or refuse vaccinations for their children. It is essential to identify the at-risk children and the characteristics of parents who choose to delay or refuse vaccinations for their children. Numerous studies have focused on the beliefs and attitudes of parents regarding childhood vaccination, but few have focused on the association of other preventive health behaviors with childhood vaccination. Clustering of these behaviors is an important question in social epidemiology and could help in understanding underlying belief systems that influence health behaviors. Mothers who refuse influenza vaccinations during pregnancy report similar attitudes and beliefs to those who refuse vaccinations for their children, yet few studies have investigated relationships between child vaccination and other health behaviors. Additionally, mothers who choose to deliver their babies in out-of-hospital settings, a small, but growing, population in Minnesota, also report similar attitudes and beliefs, though this research is in its infancy. The objective of this study was to examine the variation in infant vaccination by maternal vaccination in pregnancy and maternal attitudes and beliefs using data from the Minnesota Pregnancy Risk Assessment Monitoring System and the Minnesota Immunization Information Connection. An exploratory study of the relationship between out-of-hospital birth and vaccination is also included. If relationships exist between these factors, there may be an opportunity for targeted vaccination interventions in subgroups of pregnant women or new mothers.Item Immune suppressive molecules and regulatory T cells control host defense against listeria monocytogenes infection(2012-06) Rowe, Jared HamiltonThe mammalian immune response is an intricately regulated, dynamic process providing the host with protection from the vast number of pathogenic microorganisms. Herein, these studies identified the impacts of regulating host defense by immune suppressive mechanisms, following infection with the bacterial pathogen Listeria monocytogenes. These investigations identified that changes in the inflammatory signals present during Listeria infection resulted in drastically different outcomes in the priming of protective T cells, when these cells were stimulated by either the immune suppressive molcules Cytotoxic T Lymphocyte Antigen (CTLA)-4 or Program Death Ligand (PDL)-1. Due to these findings, whereby changes in the immunologic environment altered the function of suppressive molecules, we examined whether physiologic changes in the immune system would impact host defense to infection. The natural expansion of the immune suppressive regulatory T cell (Tregs), while essential for sustaining pregnancy, resulted in increased maternal susceptibility to Listeria infection. Morevoer, Listeria entry into the host cell cytoplasmic compartment was suffient to reduce Treg suppressive potency and fracture Treg-mediated maternal tolerance. Lastly, we identified that the expansion of Tregs during pregnancy was primed by fetal-specific antigens and resulted in a long-lived population of cells, which provide "regulatory" memory. This is the first demonstration of Tregs with the ability to re-expand following a secondary antigen challenge (either fetal or pathogen-derived) and should spark future investigation into the role of regulatory memory.Item Insulin-like growth factors and placental ischemia-induced hypertension in the pregnant rat.(2011-06) Bozadjieva, Nadejda IvanovaPreeclampsia is a gestational condition characterized by new onset hypertension and proteinuria and often results in fetal growth restriction. This pregnancy-specific condition occurs in ~8 percent of live birth pregnancies and is the leading cause of maternal and neonatal mortality and morbidity. Delivery is the primary therapeutic approach for preeclampsia; hence, the long-term goal of preeclampsia research is to determine what causes preeclampsia and to find treatments to alleviate maternal hypertension and extend pregnancy to improve fetal outcome. Chronic placental ischemia via the reduced uteroplacental perfusion pressure (RUPP) model, utilized in this project to mimic the preeclamptic condition during the third trimester in the pregnant rat, results in hypertension, intrauterine growth restriction and fetal loss. Insulin-like Growth Factors (IGF-1 and IGF-2) have been reported to play an important role in fetal development, and low plasma levels of IGF-1 have been associated with reduced endothelial function and have been closely linked with elevated blood pressure in non-pregnant subjects. The hypotheses tested in this project are that 1) placental ischemia induced by RUPP decreases circulating and placental levels of IGF-1 and IGF-2; and 2) administering exogenous IGF-1 in RUPP rats attenuates maternal hypertension, endothelial dysfunction, intrauterine growth restriction and fetal loss. The data show that chronic placental ischemia decreases circulating IGF-2 levels, but does not affect circulating IGF-1 or placental IGF-1, IGF-2 and IGF-1 receptor levels. Further, administering exogenous IGF-1 in RUPP rats during the third trimester attenuates blood pressure and decreases fetal loss, but does not improve endothelial function or fetal weight. Overall, these studies determined that the mechanisms that regulate IGF signaling are potential targets for improved therapies for treating maternal blood pressure in preeclampsia and gestational hypertension.Item Maternal fish oil supplementation during pregnancy and lactation(2011-08-03) Lobitz, MackenzieItem Minnesota Youth Poll: Youth's Views on Teenage Pregnancy and Parenthood(Minnesota Agricultural Experiment Station, 1983) University of Minnesota. Agricultural Experiment StationItem Model, tables, figures, and data supporting Computational model captures cardiac growth in hypertensive pregnancies and in the postpartum period(2024-02-16) Kaissar, Molly; Yoshida, Kyoko; kyoshida@umn.edu; Yoshida, Kyoko; University of Minnesota Pregnancy Research and Engineering GroupHeart growth in the pregnant patient helps maintain cardiovascular function while supporting the growing fetus. However, in some cases, the cardiovascular demand of pregnancy can trigger life-threatening conditions, including hypertensive disorders of pregnancy and peripartum cardiomyopathy. We previously developed a computational model that accounts for hormonal and hemodynamic interactions throughout pregnancy to uncover the mechanisms behind this heart growth. Here, we evaluated its breadth, applying it to normal and abnormal rat pregnancies and after delivery. This dataset includes supplemental data and tables that support our findings and accompany our manuscriptItem A pattern adaptation for body changes during pregnancy: a single case study.(2009-11) Sohn, MyungHeePregnant women experience dramatic body changes during their pregnancy. With the wide variety of body shapes and sizes, physical changes occur differently for every pregnant woman; thus, these variations lead to problems of comfort, fit, and sizing of ready-to-wear maternity apparel. Therefore, this study examined the changes in body measurements and shapes during pregnancy and analyzed the relationship between these changes and pattern measurements and shapes. A single case study method was used to observe one participant’s body measurement and body shape changes during pregnancy, and the relationship between these body changes and related pattern changes. Findings were analyzed by the changes in body measurements and body shapes and the relationship between the body changes and pattern changes. The entire pattern adjustment process represents the analysis of the relationship of body changes to pattern changes. The findings of this study suggest that consideration of body shape during apparel pattern development offers valuable information related to fit that goes beyond standard linear measurements. In addition, the results indicated that body measurements and patterns did not increase proportionally to each other. The pattern changes were not necessary due to body measurement or shape changes. The patterns were adjusted not only to accommodate body changes but also to maintain the garment style.Item Pregnancy Outcomes After Myomectomy In Infertile Women With Fibroids: A Systematic Review Of The Literature(2017-08) Okeke, EstherABSTRACT Objectives: To analyze the impact of abdominal myomectomy on pregnancy outcomes of infertile women with fibroids, and to conduct a comparative effectiveness study of abdominal and laparoscopic myomectomy. Study design: A systematic review of all relevant literature in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 2015 respectively. English language restriction was applied to searches. Results: Out of 352 articles identified by literature search, and subsequently reviewed, six articles met the study inclusion criteria, three case series on effectiveness studies and three studies (one RCT, one cohort, one case series) on comparativeness effectiveness studies. There was a very low quality of strength of evidence for effectiveness studies though they support the hypothesis that pregnancy outcomes are improved after abdominal myomectomy. Furthermore, the comparative effectiveness studies showed no statistical significant difference in pregnancy outcomes. Conclusion: There is need for further research to be conducted.Item Pregnant woman with Diabetes: Insulin injection vs Insulin pump(2010-07-21) Esse, AbdulrazakComparison of traditional insulin injection with insulin pump in pregnant women with type I diabetes mellitus. The outcome is evaluated by looking at both glycemic control and perinatal complications.Item Quantitative Pharmacological Approaches for Characterizing Lamotrigine Pharmacokinetics in Special Populations of Pregnancy, Postpartum and Breastfeeding Infants to Prospectively Optimize Dosing(2020-12) Karanam, AshwinLamotrigine (LTG) is one of the most prescribed antiseizure medications (ASMs) in women with epilepsy during pregnancy and postpartum. Pregnancy-related physiological changes are expected to alter LTG pharmacokinetics (PK) especially increases in apparent clearance (CL/F), leading to subtherapeutic concentrations and in-turn potential loss of efficacy and/or safety. This necessitates increases in LTG dose during pregnancy to maintain therapeutic LTG concentrations followed by a postpartum reduction in dose to prevent toxicity. In addition, infants born to mothers on LTG therapy are exposed to LTG via breastmilk, necessitating quantitative characterization of rate and extent of LTG exposure in infants and possible relationships with infant neurocognitive and developmental outcomes. Management of LTG therapy in pregnancy and postpartum is thus balancing seizures in mother while minimizing LTG exposure to fetus and infants. These special populations are understudied especially with respect to PK-pharmacodynamic (PK-PD) relationships. This dissertation work aims at characterizing changes to LTG PK in pregnancy, postpartum and in breastfeeding infants. In addition, this thesis explores feasibility of potential LTG dosing algorithms which maximizes exposure and safety during pregnancy. The long-term goal of this research work is to create robust evidence-based guidelines for dosing LTG in both pregnant women with epilepsy and their breastfeeding children.Investigations into CL/F changes in early pregnancy were performed in women with epilepsy maintained on LTG monotherapy who were planning to become pregnant. CL/F increased at the rate of 0.115 L/h for every gestational week with increases in CL/F observed as early as 5 weeks gestational age, often before women themselves know they are pregnant, and continue to increase through gestational week 13. The average increase in clearance by week 13 was approximately 1.6 times the preconception CL/F. Such rapid increases in LTG-CL would necessitate dose-adjustments relatively early in pregnancy. It was also identified that LTG-CL increased by 0.844 L/h for every 1 ng/ml of estradiol however gestational age was a more robust predictor of LTG-CL changes. This may potentially be due to gestational age reflecting additional factors, although neither was robust enough for clinical use owing to significant interpatient variability. We also identified a subpopulation of women who may not experience significance CL/F changes in early gestation however quantification of this group was limited by the small sample size. Our findings highlight the importance of planning and early detection of pregnancy and use of therapeutic drug monitoring (TDM) in this population. LTG CL/F changes in pregnancy and postpartum necessitate dose changes. However, there exists no consensus on dosing recommendations for these populations. Simulation based methods were used to understand the outcomes of LTG dosing changes and different regimens in pregnant women with epilepsy (PWWE) based on published data. We identified that without any dose changes women in the high CL/F change group could experience loss of efficacy as early as 8 weeks gestational age. At least two dose increases during pregnancy would be needed to prevent loss of efficacy. However, using the same two dose increase strategy in women with low CL/F change during gestation could possibly lead to toxic/unsafe LTG concentrations. These results show that a “one size fits all” philosophy does not work well for LTG dosing in PWWE based on current knowledge and reinforces the need for TDM. LTG CL/F was characterized in the largest cohort of PWWE and nonpregnant women with epilepsy (NPWWE) enrolled in the MONEAD study. During pregnancy, we identified two subpopulations of women that exhibited different rates of increase in LTG CL/F. The gestational age associated increase in CL/F displayed a 1.75-fold increase in pregnancy at the end gestation in a majority of the PWWE (91%) compared to no identifiable change in LTG CL/F in the remaining 9% closely reproducing a previous study performed in a smaller population. Clinical covariates available in the study failed to explain the difference in subpopulations. We anticipate genotypic variations in the activity or induction of UGT1A4 or polymorphisms in estrogen receptors could partly explain the varying degrees of enhanced CL/F between the two groups of pregnant women and may warrant further investigation. In the postpartum period, LTG CL/F reached baseline values by 3 weeks after birth necessitating dose tapering early in postpartum. After 3 weeks, the CL/F in postpartum PWWE was indistinguishable from NPWWE CL/F confirming that pregnancy related changes do not carry over to postpartum. Infant LTG exposure via breastmilk was quantified in breastfeeding infants exposed to LTG enrolled in the MONEAD study. Median infant LTG concentrations were approximately 28.9% of maternal concentrations with a range of 0.6-90.3% indicating significant infant exposure but also wide between infant variability pointing out the need to accurately characterize infant LTG PK. A physiology-based PK model (PBPK) methodology was utilized to incorporate mechanistic information of LTG disposition in both postpartum mother and infants to characterize LTG exposure with both models having predictions within 1.6-fold of observed levels. These models provide mechanistic understanding of LTG-CL changes in infants and predictions of infant exposures which can be used for exploring exposure-neurocognitive developmental relationships. This PBPK model serves as a framework for understanding PK and quantifying exposure of other commonly used drugs in these special populations and is not limited to the epilepsy therapeutic area. Overall, the studies presented in this thesis characterized the LTG PK in special underrepresented populations of women with epilepsy and their infants including pregnancy and postpartum and breastfed infants. The results of this thesis add robust evidence to inform clinical management of LTG therapy in PWWE.Item The Relationship Between Pregnancy and Domestic Violence in Mali(2020-04) Fate, Kassandra RThe purpose of this study is to assess the magnitude of the relationship between intimate partner violence (IPV) during pregnancy. The data from the Demographic and Health Surveys in Mali in 2006 and 2012 was used and was confined to the respondents selected for the domestic violence module. The association between experience of domestic violence ‘ever’ and ‘in the past year’ with selected factors were examined by logistic regression and adjusted for cluster weight and sample weight. The result revealed that in 2006, the risk and frequency of physical IPV increases by 16% and emotional IPV increases by 31% when the woman in the relationship is pregnant. This is no longer significant in 2012. Additional results found that the risk and frequency of IPV increases by an average of 41% when the last child was wanted later and increases by an average of 72% when the last child wasn’t wanted. Physical IPV tended to be more prevalent in lower wealth quintiles, while emotional IPV tended to be more prevalent in higher quintiles.Item The role of complement system activation in placental ischemia-induced hypertension(2013-10) Lillegard, Kathryn ElisabethPreeclampsia is a pregnancy-specific condition characterized by new-onset hypertension and proteinuria associated with placental ischemia. Because no cure exists besides parturition, preeclampsia remains a leading cause of maternal and perinatal death and morbidity. New management strategies are urgently needed to attenuate maternal symptoms and prolong gestation. Immune activity is normally heightened in pregnancy and has been shown to increase even further in preeclampsia, as evidenced by elevations in innate immune complement activation products, including C3a. Decreased circulating free vascular endothelial growth factor (VEGF) is a known contributor to preeclampsia and previous studies have demonstrated a link between VEGF and complement. We therefore hypothesized that complement activation is critical to placental ischemia-induced hypertension. To test this, we used the Reduced Utero-placental Perfusion Pressure (RUPP) model of placental ischemia in the rat to induce hypertension and explore the effects of inhibiting complement activation and antagonizing a specific complement receptor in this model. The data demonstrate that complement activation occurred following placental ischemia and administration of soluble complement receptor 1, an inhibitor of complement activation, successfully prevented complement activation and abrogated the hypertension without influencing circulating free VEGF concentrations. To determine the specific complement component responsible, we used a C3a receptor antagonist to inhibit C3a-mediated cellular responses that may be important in placental ischemia-induced hypertension. The C3a receptor antagonist attenuated the hypertension and improved placental efficiency and did not affect circulating free VEGF, suggesting complement may be important in hypertension apart from circulating free VEGF concentrations. Overall, these data suggest a potentially valuable role for specific complement inhibition in managing the symptoms of preeclampsia.