Theses and Dissertations from UMD

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Subject: search.filters.subject.Maternal and Child Health

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    EXAMINING THE IMPACT OF PRECONCEPTION AND EARLY PREGNANCY SERUM LEVELS OF MATERNAL VITAMIN D ON CLINICAL MARKERS OF IMPLANTATION AND PREECLAMPSIA
    (2023) Alkhalaf, Zeina; Thoma, Marie; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Vitamin D is a hormone rather than a vitamin, that is essential for overall health and wellbeing, including but not limited to the reproductive system. Although vitamin D is available through several sources, such as natural ultraviolet sunlight, food, and supplements, low circulating 25-hydroxyvitamin D (25(OH)D) levels of <30 ng/mL are common among pregnant women, with up to 69% of the US population suffering from the condition. Epidemiologic studies have suggested that low maternal serum 25(OH)D levels may be associated with adverse pregnancy outcomes, such as early pregnancy loss and preeclampsia, which may be initiated early in the pregnancy process during implantation and placentation. From a life course perspective, the periconception and early pregnancy period marks a critical time for establishing a healthy pregnancy. Implantation and placentation occur early in pregnancy and involve a complex process that relies on optimal endometrial receptivity and a host of hormonal and immunologic signaling events. Disruptions to this process may be indicated by early clinical markers of pregnancy complications (e.g., vaginal bleeding or subchorionic hemorrhage) and associated with later adverse outcomes (e.g., preeclampsia). In contrast, higher Human Chorionic Gonadotropin (hCG) levels, which have been linked to nausea and vomiting, may be markers of robust implantation and placentation. Therefore, I sought to investigate the preconception and early gestation maternal serum 25(OH)D levels on: (i) vaginal bleeding and subchorionic hemorrhage; (ii) nausea and vomiting; (iii) preeclampsia. In Aim 1, an analysis of medical record documentation of vaginal bleeding and subchorionic hemorrhage found that women who were persistently deficient/insufficient in maternal serum 25(OH)D at both preconception and 8-week gestation had 2.18 times higher (95% CI: 1.13, 4.20) odds of having subchorionic hemorrhage compared to women who remained sufficient across both time periods, even after adjustment for potential confounders. Additionally, an analysis of daily diaries showed women with deficient 25(OH)D levels had a higher odds (OR: 3.02, 95% CI: 1.13, 8.13) of moderate/heavy bleeding versus none compared to women with sufficient 25(OH)D levels based on self-reported daily diaries on vaginal bleeding at the start of pregnancy. In Aim 2, women with persistently deficient 25(OH)D levels at both preconception and early gestation had lower odds (OR: 0.34, 95% CI: 0.20, 0.60) of experiencing nausea and vomiting based on medical records. In comparison, women who increased their 25(OH)D levels early in pregnancy (i.e., were deficient/insufficient at preconception then became sufficient at 8-week gestation) had 1.71 (95% CI: 1.12, 2.61) times higher odds of nausea and vomiting compared to those who were persistently sufficient across both time periods. Based on self-reported nausea and vomiting symptoms from daily diaries, deficient 25(O)D was associated with lower odds (OR 0.65; 95% CI 0.40, 1.06) of both nausea and vomiting when comparing to sufficient 25(OH)D levels. In Aim 3, women who had deficient 25(OH)D at preconception had an increased risk (RR: 1.45, 95% CI: 0.64, 3.29) of preeclampsia (as identified from medical records), although results were insignificant. Linear spline models demonstrated that the risk of preeclampsia declined with each 1 ng/mL increase of 25(OH)D levels up to 40-45 ng/mL (RR: 0.97, 95% CI: (0.93, 1.00), but that levels beyond this threshold show an increase in the risk of preeclampsia for each 1 ng/mL increase in 25(OH)D (RR: 1.03; 95% CI: 1.00, 1.06). This research highlights the importance of exploring the maternal serum levels of 25(OH)D at both preconception and early gestation and how it may affect adverse pregnancy outcomes, such as vaginal bleeding, subchorionic hemorrhage, preeclampsia, and pregnancy outcomes that signify a robust implantation response, such as nausea and or vomiting. It further underscores the importance of assessing maternal serum 25(OH)D levels prior to critical time of implantation and placentation and potential biologic mechanisms that may lead to adverse pregnancy outcomes. Supporting healthy implantation and placentation is of utmost importance as this may guide the remainder of the health of the pregnancy, and any disruption to this process may increase the mother and infant’s risk of maternal morbidity and mortality (e.g., preeclampsia, vaginal bleeding, subchorionic hemorrhage). Future studies are needed with more diverse, larger sample sizes, and both paternal and maternal nutrition to further assess preconception nutritional risk factors on adverse and robust pregnancy outcomes. Accordingly, this research is vital as it may aid in identifying early factors that may reduce adverse maternal and infant health outcomes.
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    Examining Maternal Experiences of Food Insecurity on Birth and Early Childhood Outcomes
    (2020) De Silva, Dane André; Thoma, Marie E; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Food insecurity, or the inadequate access to nutritionally-acceptable food, has been increasingly recognized as a distal determinant of poor health outcomes. While 11.1% of U.S. households suffer from food insecurity, specific populations are disproportionately affected, including pregnant women and single mothers. From a life course perspective, growth trajectories may be influenced by both prenatal exposures and postpartum practices, such as breastfeeding. Since food insecurity is associated with stress and poor nutrition, when occurring during critical periods of development, the fetus may be programmed to have poor future health. Other research on developmental origins have identified patterns that exhibit sex differences, particularly around growth. Therefore, this investigation sought to examine maternal food insecurity on: (i) low birthweight and sex-specific differences; (ii) breastfeeding initiation and exclusive breastfeeding duration; and (iii) obesity at age two and sex-specific differences. In Aim 1, mothers experiencing prenatal food insecurity had a higher odds of delivering a low birthweight infant, though much of the association was explained by sociodemographic factors after adjustment (OR 1.10 [95%CI 0.98, 1.25]), with female infants showing OR 1.21 (95%CI 1.02, 1.43). For Aim 2, food insecurity did not appear to deter women from initiating breastfeeding (OR 1.41 [95%CI 0.58, 3.47]), and minimal differences in exclusive breastfeeding duration between food insecure and food secure women were found (TR 0.89 [95%CI 0.57, 1.39]). Finally, Aim 3 revealed that sociodemographic factors explained much of the association between maternal food insecurity and childhood obesity at 2 years (OR 1.15 [95%CI 0.75, 1.75]), though male offspring showed a stronger magnitude (OR 1.54 [95%CI 0.86, 2.74]). Maternal food insecurity is a multi-faceted exposure that is related to other covariates, which may interact in multiple ways to influence health outcomes through both biologic and behavioral pathways. This preliminary investigation highlights the importance of exploring exposures occurring during critical periods, including food insecurity, on birth and childhood outcomes, and how it may affect the later health of offspring differently by sex. Additional longitudinal data with accurate measures of food insecurity are needed to fully ascertain how it affects the health of mothers and children, and to identify possible mediating pathways.
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    DOMESTIC VIOLENCE EXPOSURE, MATERNAL EDUCATION, AND MATERNAL AUTONOMY AS PREDICTORS OF INDIAN WOMEN'S USE OF MATERNAL HEALTH SERVICES AND INFANT LOW BIRTH WEIGHT
    (2015) Duggal, Mili; Koblinsky, Sally A; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    India contributes disproportionately to the world's maternal mortality ratio and rate of infant low birth weight. Securing adequate antenatal care and delivery in a hospital or health facility are key strategies aimed at improving India's maternal and infant health outcomes. This study utilized the National Family Health Survey-3 (NFHS-3) to investigate predictors of Indian women's use of maternal health care services and delivery of a low birth weight infant. The ecological model of health was used to examine how the individual level factor of maternal education and the relationship level factors of women's domestic violence exposure and maternal autonomy were related to maternal and infant outcomes. Specifically, the study examined the role of physical violence, psychological violence, sexual violence, maternal education, and maternal autonomy in predicting women's receipt of adequate antenatal care, institutional delivery, and likelihood of delivering a low birth weight child. The study utilized NFHS-3 data from 2005-06 with a sample of 4,983 Indian women who gave birth in the previous year. This survey was the first to include a module addressing three different types of domestic violence exposure within the marital relationship. Findings revealed that 19% of women reported experiencing physical violence, 10% reported psychological violence, and 8% reported sexual violence in the previous year. Multivariate logistic regression analyses examined the association between the targeted maternal variables and women's use of maternity health services and infant low birth weight. Domestic violence emerged as a risk factor, with physical violence predicting less adequate antenatal care and higher likelihood of low infant birth weight. Psychological violence predicted lower likelihood of adequate antenatal care and institutional delivery, and sexual violence was associated with a lower likelihood of institutional delivery. In contrast, both maternal education and maternal autonomy emerged as protective factors. Maternal education was predictive of adequate antenatal care, institutional delivery, and lower likelihood of infant low birth weight, while maternal autonomy predicted institutional delivery and lower likelihood of delivering a low birth weight infant. Implications of the findings for policy makers, public health practitioners, and educators seeking to improve maternal and infant outcomes in India are discussed.