Browsing by Subject "pregnancy"

Background Preeclampsia is a common and heterogeneous vascular syndrome of pregnancy. Its genetic risk profile is yet unknown and may vary between individuals and populations. The rs4606 3' UTR polymorphism of the Regulator of G-protein signaling 2 gene (RGS2) in the mother has been implicated in preeclampsia as well as in the development of chronic hypertension after preeclampsia. The RGS2 protein acts as an inhibitor of physiological vasoconstrictive pathways, and a low RGS2 level is associated with hypertension and obesity, two conditions that predispose to preeclampsia. We genotyped the rs4606 polymorphism in 1339 preeclamptic patients and in 697 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort to study the association of the variant with preeclampsia. Results No association between rs4606 and preeclampsia was detected in the analysis including all women. However, the polymorphism was associated with preeclampsia in a subgroup of overweight women (body mass index ≥ 25 kg/m2, and < 30 kg/m2) (dominant model; odds ratio, 1.64; 95% confidence interval, 1.10-2.42). Conclusions Our results suggest that RGS2 might be involved in the pathogenesis of preeclampsia particularly in overweight women and contribute to their increased risk for hypertension and other types of cardiovascular disease later in life.

Preeclampsia is a vascular pregnancy disorder characterized by new-onset hypertension and proteinuria and/or new-onset preeclampsia associated symptoms during the second half of pregnancy. The pathophysiology of the disorder is not fully understood, but incomplete placentation and maternal tolerance towards fetal tissue are known to play a part in the disease pathogenesis. Predisposing factors include nulliparity, obesity, diabetes, chronic hypertension and autoimmune diseases. Furthermore, women who have experienced preeclampsia are more susceptible to cardiovascular disease later in life. One established biomarker for preeclampsia is the increased concentration of the soluble Fms-like tyrosine kinase 1 (sFlt1) in the maternal serum. sFlt1 is frequently overexpressed in preeclampsia and it is linked with angiogenic imbalance and endothelial dysfunction, although its role in the disorder is not completely clear. Preeclampsia has a genetic background. There are protective and predisposing variants in and near the Fms related tyrosine kinase 1 gene (FLT1; coding for sFlt1) that have been associated with preeclampsia either in the mother or in the fetus. In this study, five genetic polymorphisms over a 2.3 kb region in the 3’ untranslated region of FLT1 were genotyped by Sanger sequencing and fragment analysis in altogether 1200 individuals consisting of case and control mother–child pairs of the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort. These polymorphisms were tested for association with various preeclampsia-related phenotypes by Fisher’s exact test. In the maternal genome, the minor alleles of rs17086497 and rs57760154 were associated with extreme hypertension (systolic blood pressure >180 mmHg) (p=0.004, OR=1.77) and obesity (p=0.023, OR=1.63). Homozygosity for these minor alleles was associated with pregnancy complications in general (p=0.026, OR=2.53) and the early-onset form of preeclampsia (p=0.004, OR=3.34). Additionally, the minor alleles of rs9554314, rs3138582 and rs149279513 were associated with extreme hypertension (p=0.045, OR=1.63) and obesity (p=0.023, OR=1.78). Moreover, a suggestive association to severe proteinuria (> 5 g/24h) was found in the maternal genome. In the fetal genome, significant negative associations were reached for rs17086497 and rs57760154 in terms of the serum concentration of sFlt1 in the preeclampsia group (p=0.008, OR=0.23). Overall, the results seem to link the studied region in the maternal genome to preeclampsia with severe features. This supports the idea of preeclampsia as a heterogeneous disorder with varying etiology and mechanisms and thus highlights the importance of differentiating between the various sub-phenotypes. For example, the association of the same allele in the fetal genome with lower maternal sFlt1 levels and in the maternal genome with severe symptoms of preeclampsia suggests that the sFlt1 level might not be a good measure in all patients. Additionally, the observed associations with extreme hypertension and obesity point to the possibility that this region might be relevant for the endothelial damage that is thought to be a central factor in creating the later-in-life disease susceptibility.

Both prenatal hyperglycaemia (caused by maternal diabetes mellitus) and neonatal hypoglycaemia pose a risk to the neurocognitive development of the child: Maternal diabetes mellitus in pregnancy has been reported to be associated with impairments in memory functions of the offspring up to adolescence. Also, an association has been reported between neonatal hypoglycaemia and neurodevelopmental impairments in childhood and adolescence. However, to our knowledge, the association of prenatal hyperglycaemia with memory impairments has not previously been studied in adulthood. As for the possible association of neonatal hypoglycaemia with memory impairments, it has not, to our knowledge, been studied at any age. Furthermore, the separate and combined sequelae of the two risk factors are yet to be directly compared. We hypothesized that the two risk factors, separately and combined, would still in middle age be associated with subtle memory impairments. We assessed memory functions in a follow-up study of a cohort born during 1971–1974 and prospectively studied from birth. The sample included participants exposed to prenatal hyperglycaemia (n = 22), neonatal hypoglycaemia (n = 14), or both (n = 7). It also included controls with no early risks (n = 40). We assessed the participants' memory functions comprehensively, including working memory and immediate and delayed recall of both verbal and visual material. We found an interaction of early risk with the type of digit span task, a measure of working memory: The differences between span task scores varied between the groups. However, no pairwise between-group differences were significant. Thus, the interaction was not specific to any particular groups and likely to be clinically irrelevant. The interaction was non-significant when gestational age and birth weight were controlled for. The early risks were unassociated with scores on other memory tasks. Against our hypotheses, our results suggest that prenatal hyperglycaemia, neonatal hypoglycaemia and their combination are relatively benign disorders, especially when not accompanied by other perinatal complications: The association of prenatal hyperglycaemia with neurocognitive impairments appears to be attenuated in adulthood, and neonatal hypoglycaemia appears to have few long-term sequelae.

This study assesses the key factors affecting the resilience of young single mothers in Arusha region, Tanzania. The average age of childbearing in Tanzania remains low. Many socioeconomic difficulties such as poverty, lack of education and sexual- and reproductive services have an impact why many Tanzanian girls give birth during adolescence. Young single mothers often face many challenges in coping with pregnancy and motherhood due to the discrimination they face. This research is based on 22 semi-structured interviews that were conducted with young single mothers, who had given birth between 15 and 20 years old in Arusha region, Tanzania. The data was collected during one month visit to Meru at the end of 2017. The interviews were conducted in two locations. Half of the interviews were conducted in the villages of south-east of Meru and half in two women´s shelters in Arusha town. The interviews were supported by participant observation and informal conversations. The data was transcribed and analysed through qualitative content analysis. This study focuses on assessing the main factors that affect the resilience of young mothers during pregnancy and motherhood. Resilience is assessed through reproductive resilience framework. The meaning of resources (capitals) in the lives of single mothers was also assessed. Moreover, the social discourses regarding gender, sexuality and motherhood were examined in order to gain understanding of how they impact the experience of young single mothers. The findings show that social support operates as a protective factor in building resilience for the young single mothers. However, the findings show that young single mothers struggle to receive support during pregnancy. This is mainly because the negative social discourses regarding girl’s sexuality and pregnancy outside wedlock in Tanzania. The results show that young mothers face strong discrimination during pregnancy, both from their families, friends and community, which operated as a constraining factor for resilience. The discrimination had profound impact on of the resilience of the young mothers during pregnancy, as it often disrupted family relations and sometimes led to separation of the girl from her family. The shame of unmarried pregnancy diminished the support networks the young mothers had. Furthermore, the findings show that young mothers are able to receive more support during motherhood from their families and communities. Young mothers would no longer receive discrimination or verbal abuse in their communities. The findings show that the role of motherhood in the community is highly respect and therefore the young mothers were accepted in the community as any mothers. Motherhood itself operated as both protective and constraining factor for resilience. Becoming mother decreased the shame of unmarried pregnancy and raised the young mothers in highly valued positions of mothers in their societies. Some young mothers had managed to renegotiate their place in the family after the pregnancy experience and were again accepted in their families. Regardless of the financial challenges that young motherhood brought to the informants the mothers who had managed to keep their social support relations were showing positive adjustment to motherhood. Most young mothers embraced their roles as mothers, because it brought them value and made them acceptable members in their communities after the negative pregnancy experiences.

Målet med denna undersökning var att ta reda på prevalensen för mardrömmar hos blivande föräldrar under graviditeten och att undersöka om det finns en skillnad mellan hur ofta blivande mammor och blivande pappor drömmer mardrömmar. Målet var också att undersöka ifall mardrömmar är kopplade till psykisk hälsa. De 1673 familjer som deltog i CHILD-SLEEP födelsekohortstudien svarade på frågeformulären då kvinnorna var i 32:a graviditetsveckan och vid senare tidpunkter efter att barnen fötts. I frågeformulären fanns bland annat frågor om den allmänna hälsan, sömnen och hur ofta deltagarna drömde mardrömmar. I studien framkom det att de gravida kvinnorna drömde mardrömmar oftare än vad vuxna i allmänhet gör, medan de blivande papporna inte gjorde det. 7,7 % av de gravida kvinnorna drömde ofta mardrömmar under graviditeten medan bara 1,3 % av de blivande papporna vid samma tidpunkt gjorde det. Logistiska regressionsanalyser utfördes för att ta reda på vilka riskfaktorer som var kopplade till mardrömmar. Det framkom att speciellt depressivitet, ångest och stress var riskfaktorer hos de blivande föräldrarna. Hos de gravida kvinnorna var insomni statistiskt signifikant kopplat till mardrömmar och hos papporna var specifikt insomningssvårigheter, att vakna under natten och en dålig sömnkvalitet kopplade till mardrömmar.

Raskauden aikana raudantarve lisääntyy, mikä altistaa raudanpuutteelle ja anemialle. Raudanpuuteanemian diagnostiikassa käytetään perusverenkuvasta erityisesti punasolujen kokoa ja kromisuutta kuvaavia punasoluindeksejä (MCV ja MCH). Ferritiini on yleisesti hyväksytty rautavarastojen mittari. Lisäksi diagnostiikassa voidaan käyttää liukoista transferriinireseptoria (TfR) ja transferriinin rautakyllästeisyyttä (Trfesat). Raskaus aiheuttaa elimistössä fysiologisia muutoksia, jotka voivat vaikuttaa myös raudanpuutteen diagnostiikassa käytettäviin laboratoriokokeisiin. Erityisesti TfR ja Trfesat -tulosten tulkinnasta raskauden aikana on vain vähän tutkimusnäyttöä, eikä niiden käyttöä rutiinisti suositella. Tutkimusaineisto kerättiin HUS Diagnostiikkakeskuksen laboratoriotulostietokannasta ja se koostuu tuhansista HUS-alueen potilaista vuosilta 2008–2021. Aineistosta poimittiin ne raskaana olevat, joilta oli mitattu jokin rautatutkimus ja heiltä tutkittiin anemian yleisyyttä raskauden aikana sekä anemian vaikutuksia raudanpuuteanemian diagnostiikassa käytettäviin parametreihin (MCV, ferritiini, TfR ja Trfesat) raskauskolmanneksittain. Saatuja tuloksia verrattiin verrokkiryhmään, jonka muodostivat fertiili-ikäiset (18–45 v.) naiset. Tilastolliset analyysit ja kuvaajat tehtiin R-kielellä. Anemian esiintyvyys lisääntyi siten, että toisella ja kolmannella raskauskolmanneksella suurempi osuus mitatuista hemoglobiinipitoisuuksista oli aneemisia (33 % ja 36 %) kuin ensimmäisellä raskauskolmanneksella (13 %). Myös matalat rautavarastot yleistyvät raskaana olevilla verrokkeihin nähden. Lisäksi MCV nousi raskauden aikana, mikä vaikeuttaa verenkuvan käyttöä raskausajan anemian diagnostiikassa. Ferritiinipitoisuus pieneni toisella ja kolmannella raskauskolmanneksella verrattuna ensimmäiseen, mikä kertoo rautavarastojen pienemisestä. TfR- ja Trfesat-pitoisuuksista ei voi tehdä luotettavia johtopäätöksiä tämän tutkielman perusteella. Tämä tutkielma toi lisää tietoa anemian osuudesta tehdyistä raskaudenaikaisista mittauksista HUS Diagnostiikkakeskuksen alueella. Saadut tulokset toivat myös tietoa siitä, mitä pitää tutkia lisää: TfR- ja Trfesat-arvojen muutoksista raskauden aikaan raudanpuutteen yhteydessä tarvitaan lisää tutkimusta laajemmalla aineistolla ja ferritiinin laskua raskauden aikana pitäisi selvittää lisää, jotta tiedetään, milloin lasku on fysiologista ja milloin patologista.

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.

Kardiotokografia on tavallisin menetelmä synnytyksen aikaisessa sikiön voinnin tarkkailussa. Se on herkkä mutta epätarkka tutkimusmenetelmä, joka antaa paljon vääriä positiivisia tuloksia, jolloin synnyttäjän ja sikiön riski altistua turhille toimenpiteille ja niiden komplikaatioille kasvaa. Laajemman tutkimuksen, jonka osa oma tutkimukseni on, tarkoituksena on selvittää KTG- rekisteröinnissä havaittavan saltatorisen eli korostuneen vaihtelun merkitystä. Tutkimuksesta saatavien tietojen perusteella voitaisiin paremmin kohdistaa toimenpiteitä oikeille synnyttäjille. Tutkimuspotilaat ovat vuosien 2011-2012 aikana Kätilöopiston sairaalassa synnyttäneitä, joiden tiedot on kerätty retrospektiivisesti sähköisestä potilastietojärjestelmästä. Omassa tutkimuksessani vertailin keräämäni 860 synnyttäjän aineiston tietoja Terveyden ja hyvinvoinnin laitoksen koko Suomen synnyttäjiä koskevaan tilastoon. Lisäksi vertasin, kuinka hyvin aineistoni synnyttäjät edustavat keskimääräistä Kätilöopiston sairaalan synnyttäjää ja kuinka aineistoni ensisynnyttäjät eroavat uudelleensynnyttäjistä. Tutkimukseni perusteella Kätilöopiston sairaalassa on enemmän ensisynnyttäjiä ja kivunlievityksenä käytetään muuta maata enemmän epiduraalipuudutusta. Uudelleen synnyttäneisyys vähentää kivunlievityksen tarvetta ja lyhentää synnytyksen kestoa. Lisäksi se vähentää synnytyksen käynnistämisen tarvetta ja toimenpidesynnytyksen vaaraa.