Browsing by Subject "raskaus"

Objectives. In previous research, prenatal stress has been associated not only with preterm birth and low birth weight but also with child temperamental characteristics and emotional development. There has been some variation in study methods and results across studies, study samples have been rather small, and the relationship between prenatal stress and child temperament is still not fully understood. Timing of prenatal stress has also been emphasized, but there have been only few studies of its effects on child temperament. This longitudinal study aimed to determine whether maternal prenatal stress is associated with mother- and father-rated temperament of 6-month-old infants. The study also assessed whether timing of prenatal stress or concurrent parental stress influence the associations. Methods. This study is a part of a broader, multidisciplinary Prediction and Prevention of Pre-eclampsia (PREDO) -project. The current study sample consisted of 2197 children and their parents, who were recruited from maternity clinics at weeks 12 + 0 to 13 + 6 of gestation. Mothers filled a stress-self-report questionnaire (the Perceived Stress Scale) biweekly throughout pregnancy, a total of 14 times. Mothers (n = 2197) and their spouses (n = 1235) rated temperamental characteristics of their about 6-month-old child with the Revised Infant Behaviour Questionnaire. The associations between prenatal stress and infant temperament were analyzed using linear regression, controlling for multiple perinatal and sociodemographic confounders and for concurrent levels of maternal and paternal stress. The mediation effect of maternal concurrent stress was analyzed using the Sobel test and the moderation effect using the one-way ANOVA. Results and conclusions. Higher maternal prenatal stress predicted both mother- and father-rated higher negative affectivity and lower orientating regulation, but not extraversion in 6-month-old infants. Mid- to late pregnancy stress had the strongest associations to these traits. Maternal postnatal stress moderated and partly mediated the association to negative affectivity and mediated the association to orientating regulation. Prenatal stress was significantly associated with negative affectivity only in the group of mothers who experienced lower prenatal stress. Nevertheless, even after controlling for concurrent maternal/paternal stress, the association between prenatal stress and both mother- and father-rated negative affectivity remained significant, but the association to orientating regulation remained significant only as father-rated. The results are in line with the fetal programming hypothesis and add to the growing body of literature about the importance of prenatal environmental factors in infant temperament development.

Humans all over the world are selecting food items from a larger pool of potentially edible foods and are creating prohibitions and preferences for certain foods. These are called food beliefs and they are an important part of the local culture. Reasoning to them often lies in health or social respect. Many food beliefs still exist in Africa and pregnant and breastfeeding women and children are often the target of these beliefs. Under the suboptimal nutritional status or food insecurity the possible food beliefs might considerably affect the nutritional status and health of these vulnerable groups. Malnutrition is still a major problem in Africa and other developing countries. The aim of this thesis was to study whether and what types of food beliefs concerning pregnant and breastfeeding women can be found in the rural area of the Zambezia province, Mozambique. Furthermore, the aim was to evaluate their possible significance on nutritional status. Five group interviews in three villages and 10 individual interviews in two villages were done. Interviewees were women of 12 to 78 years of age and all together 27 women were interviewed. Interpretation, sensitivity of the topic and the inexperience of the interviewer caused challenges in conducting the interviews. Because of this the method was altered and changed from group interview to individual interview during the study. Food beliefs differed between villages and within villages but some common characteristics can be found. There are several food beliefs concerning pregnant and breastfeeding women in the study area. Pregnant women were advised not to eat protein rich foods such meat and fish but were recommended to eat vegetables, fruits and cereal foods during pregnancy. Eggs were both recommended and forbidden during pregnancy. In addition, there was an intentional habit for pregnant women to eat less cassava porridge or less food in general („eating down?). During breastfeeding nothing was forbidden in general but coconut and vegetables were recommended. Most of the reasonings were related to the health of a mother and a child. The reasonings can be divided into the following groups: enhances breast milk production, causes stomach pain, maintains fitness and prevents stomach growth, mother will be strong and healthy and she?ll get vitamins, the child?s appearance changes, child will be strong and healthy, child?s behaviour changes, causes miscarriage, causes easy or difficult delivery. Food beliefs were partly mixed with education from health authorities. Almost all women said that they do follow these beliefs. Few women expressed their concerns about following the beliefs on recommended foods since food availability makes it sometimes difficult. Food belief that forbids good protein sources from pregnant women can increase the risk of protein deficiency. Eating down increases the risk of having not enough energy during pregnancy. The recommended foods are mainly nutritious and likely promote health. It can be stated that when starting a research in a foreign culture, it is necessary to have a flexible research method. It is be very important that the method can be adjusted during the study. The conclusion of this thesis was that individual interviews would have been the most suitable method when studying food beliefs in this area. Individual interviews should have only one interviewer, interviewee and interpreter if needed. All should be the same sex and the age group. From the health and nutrition viewpoint it is vital to be aware of the food beliefs in the society under investigation and to study these specifically in the area because these can vary markedly even in the same village or community.

Background: Pregnancy-related subarachnoid hemorrhage (pSAH) is rare, but it causes high mortality and morbidity. Nevertheless, data on pSAH are limited. The objectives here were to examine the incidence trends, causes, risk factors, and outcomes of pSAH in a nationwide population-based cohort study in Finland covering 30 years. Methods: We performed a retrospective population-based cohort study and nested case-control study in Finland for the period 1987-2016 (SIPP-FIN). The Medical Birth Register was linked to the Hospital Discharge Register to identify women with incident stroke during pregnancy or puerperium. A subcohort of women with SAH is included in this analysis. The temporal connection of SAH to pregnancy and clinical details were verified from patient records. Results: The unadjusted incidence of pSAH was 3.21 (95%CI 2.46-4.13) per 100,000 deliveries. No significant increase occurred in the incidence throughout the study period. However, the age of the mother had a significant increasing effect on the incidence. In total, 77% of patients suffered an aneurysmal pSAH, resulting in death in 16.3% of women and with only 68.2% achieving good recovery (Modified Ranking Scale 0-2) at three months. Patients with non-aneurysmal pSAH recovered well. The significant risk factors for pSAH were smoking (OR 3.27 (1.56-6.86)), pre-pregnancy hypertension (OR 12.72 (1.39-116.46)), and pre-eclampsia/eclampsia (OR 3.88 (1.00-15.05)). Conclusions: The incidence of pSAH has not changed substantially over time in Finland. The majority of pSAH cases were aneurysmal and women with aneurysm had considerable mortality and morbidity. Counselling of pregnant women about smoking cessation and monitoring of blood pressure and symptoms of pre-eclampsia are important interventions to prevent pSAH.

Lääkintäoikeudellinen tutkimus tarkastelee tärkeimpiä potilasoikeusnormeja, -käsitteitä ja -periaatteita. Tutkimuksen lähtökohtana on potilaslain 2 luvun potilaan oikeudet. Erityisesti 3 §:n hyvän hoidon ja kohtelun säännös on joustava normi, jonka merkitys täsmentyy jatkuvasti lainsoveltajien käytännön ratkaisutoiminnassa. Potilasoikeuksia koskevia säännöksiä on myös mm. perustuslaissa, potilasvahinkolaissa, ammattihenkilölaissa, terveydenhuoltolaissa sekä kansainvälisissä ihmisoikeussopimuksissa. Potilaan oikeuksia määrittävät lisäksi terveydenhuollon ammattilaisten eettiset ohjeet ja lääkintäoikeuden oikeusperiaatteet. Tutkimuksen erityiskysymyksenä on synnyttäjäpotilaan oikeudet. Tarkoituksena on selvittää, millaisen sisällön hyvän hoidon ja kohtelun säännös saa tuomioistuinkäytännön, yleisen laillisuusvalvonnan, terveydenhuollon ammatinharjoittamisvalvonnan sekä potilasvahinkolautakunnan ratkaisuissa. Potilasoikeuksia koskeva ratkaisukäytäntö osoittaa laadultaan hyvän hoidon toteutuvan lääketieteellisesti perustellulla, ammattitaitoisella ja huolellisella hoidolla. Potilaan oikeuteen hyvään hoitoon kuuluu yhtä oleellisena osana hyvän kohtelun vaatimus, johon sisältyy sellaisia elementtejä kuin yhteisymmärryksessä toteutettu hoito, potilaan itsemääräämisoikeus, kuin oikeus riittävään informointiin, oikeus kieltäytyä toimenpiteistä, yksityisyyden turvaaminen, huolelliset potilasasiakirjamerkinnät sekä hoiva ja ihmisarvoinen kohtelu. Ratkaisujen perusteluissa synnyttäjän hyvä kohtelu tarkoitti myös inhimillistä ja arvostavaa kohtaamista, vakaumuksen kunnioittamista, ystävällistä tukemista ja opastamista, pelon ja kivun tehokasta hoitamista sekä yksilöllisyyden huomioimista. Ihmisarvon, itsemääräämisoikeuden ja integriteetin käsitteet lain tasoisina säännöksinä ovat parantaneet potilaan asemaa. Euroopan ihmisoikeustuomioistuimen oikeuskäytäntö on syventänyt näiden arvojen merkitystä ja korostanut erityisesti potilaan subjektiivisen kokemuksen merkitystä kohtelustaan. Raskaana olevien ja synnyttävien naisten sekä vastasyntyneiden kohtelun arvioinnissa tuli huomioitavaksi heidän kuulumisensa haavoittuvaan ryhmään. Eettiset periaatteet ovat osa lääkintäoikeuden laintulkintaa, ja ihmisoikeuksien vahvistuminen on nähtävissä potilaan oikeuksia koskevan lainsäädännön kehityksessä sekä lain soveltamiskäytännöissä.

Goals: According to Developmental Origins of Health and Disease hypothesis, maternal prenatal factors are associated with offsprings’ health and susceptibility for non-communicable disease. In previous studies, maternal cortisol and sleep difficulty have been separately associated with multiple negative outcomes for the offspring. However, little is known about the association of maternal sleep difficulty and cortisol during pregnancy. The goal of this thesis is to examine the association of sleep difficulty and maternal diurnal cortisol during early pregnancy. Methods: The study sample (N=310) comes from the prospective pregnancy cohort study “The InTraUterine sampling in early pregnancy” (ITU). Sleep difficulty was assessed with Pittsburgh Sleep Quality Index at early pregnancy on average 18.20 (sd=1.73) weeks gestation (between 12.43–21.86 weeks gestation). Salivary cortisol was measured seven times a day for one day: upon waking, 15 minutes after awakening, 30 minutes after awakening, at 10 a. m., at noon, at 17 p. m., and at bedtime. Salivary cortisol samples were collected between gestation weeks 12–20, on average at 18.88 weeks’ gestation (sd=1.48). General linear model and mixed design analysis of variance were used to study the association of sleep difficulty and diurnal salivary cortisol. Anxiety and depression symptoms, maternal age and education were included as covariates in general linear model analyses. Results: The total number of different kinds of sleep difficulties was not associated with salivary cortisol upon waking or at bedtime or cortisol awakening response, mean diurnal cortisol concentration, diurnal cortisol slope or diurnal cortisol change. Some specific types of sleep difficulties were associated with diurnal cortisol. Namely, greater sleep latency was associated with higher awakening cortisol and higher mean cortisol concentration. Daytime dysfunction was associated with lower awakening cortisol level and sleep disturbance (physical symptoms, that disturb sleep) was associated with flatter diurnal cortisol slope. Conclusions: Even though the total number of different kinds of sleep difficulties was not associated with diurnal cortisol, the results of this thesis suggest a possible association between specific type of maternal sleep difficulties and diurnal cortisol during early pregnancy. Longitudinal study protocols are needed to identify the possible causal mechanism between possible associations of specific sleep difficulties with cortisol during pregnancy. To examine biological fetal programming mechanisms, follow up on offspring birth weight, cognitive development and mental health should be included in these studies.