Saudi Cultural Missions Theses & Dissertations
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Item Restricted Exploring the Barriers to Physical Activity During Pregnancy in Saudi Arabia: A Systematic Review(Swansea University, 2024-09-30) Alhussain, Maha; Ikpeme, MoBackground: Engaging in regular physical activity (PA) during pregnancy is crucial for improving maternal and fetal health outcomes. Activities range from light exercises, like walking, to more structured moderate-intensity activities. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend pregnant women engage in at least 150 minutes of moderate-intensity PA per week, yet global adherence rates, particularly in Saudi Arabia, remain low due to various barriers. Methods: A comprehensive literature search was conducted across six databases, including Embase, Web of Science, Medline, PubMed, ASSIA, and APA PsycInfo. The review focused on studies addressing barriers to PA among pregnant women in Saudi Arabia. The SPICE framework guided the search strategy, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess study quality. Results: Out of 1,138 studies identified, five were included in the final review. Key barriers identified included sociodemographic factors such as age, education, and number of pregnancies. Cultural beliefs and lack of knowledge were significant barriers, with many women believing exercise could harm their pregnancies. Social influences, particularly family discouragement, and environmental factors, such as lack of access to safe exercise facilities, further hindered PA. Additionally, women cited fatigue, lack of time, and motivation as major personal barriers to engaging in regular exercise during pregnancy. Conclusion: The review identified several barriers that prevent pregnant women in Saudi Arabia from engaging in regular PA. Cultural beliefs, social norms, and limited knowledge about the benefits of PA contribute to these challenges. Environmental factors and personal barriers like fatigue and time constraints also play a significant role in reducing PA levels during pregnancy. Addressing these barriers through education and access to resources may help improve PA participation rates and enhance maternal health outcomes.9 0Item Restricted The role of IDO1 In the Vascular remodeling During Pregnancy(Drexel University, 2024-07) Ghaban, Dema; Muller, AlexanderAbstract Role of IDO1 in the vascular remodeling during pregnancy Dema Ghaban Alexander Muller, Ph.D. During gestation, the trophoectoderm, the outer layer of the blastocyst, engages with the uterine wall to form the placenta, a temporary organ at the maternal-fetal vascular interface. To increase blood flow through the placenta, uterine spiral arteries transform into large, dilated, low-resistance vessels in which the endothelial layer has been replaced by infiltrating extravillous trophoblasts that invade the uterine myometrium. While it has been widely assumed that these invasive trophoblasts drive the spiral artery remodeling (SAR) process, careful temporal analysis has established that SAR initiation occurs prior to trophoblast arrival. Rather, it is decidual immune cells that are implicated in causing the disorganization of vascular cells and separation of smooth muscle layers characteristic of early-stage SAR. Mouse studies have shown that uterine natural killer (uNK) cells, which expand rapidly in the decidua at mid-gestation, are required for SAR to proceed normally and that this activity is dependent on the inflammatory cytokine interferon-gamma (IFNγ). It therefore has been clearly established that inflammation plays a fundamental role in this complex, physiological process, but thus far a detailed understanding of the specific factors involved downstream of IFNγ has remained elusive. Addressing the unresolved role of inflammation in the reshaping the vasculature at this key stage of gestation has been the core focus of my research project. To better understand how the inflammatory microenvironment established by decidual immune cells promotes SAR, it is important to have an assay that quantifiably assesses the remodeling process. To this end, I describe the development of a method whereby sections of mid-gestation mouse embryos are prepared for comparative assessment of SAR initiation based on confocal microscopy-based immunofluorescence quantification of staining for smooth muscle alpha actin (SMA) within individual arterial vessels (Chapter 2). This technique provides a reproducible and objectively quantifiable methodology for monitoring this initial stage of the SAR process for any perturbations that might result from modifications to the inflammatory microenvironment. Trophoblasts must next migrate to the spiral arteries for SAR to proceed, and I further describe the use methods for assessing trophoblast invasiveness as a later aspect of the SAR process using both in vitro human cell and in vivo mouse-based experimental models (Chapter 3). The tryptophan-catabolizing enzyme indoleamine 2,3-dioxygenase (IDO1) is an IFNγ-inducible protein that is highly expressed in the placenta at mid-gestation. Through its well-established capacity to promote T cell tolerance, IDO1 has gained widespread recognition as a mechanism for protecting hemi-allogeneic fetus from maternal immunity. More recently, our laboratory has determined that a specific myeloid subpopulation that protects neovasculature from IFNγ due to IDO1 mediated activation of the integrated stress response through general control non-derepressible 2 (GCN2) that results in elevated production of interleukin 6 (IL6). Research studies have reported that IDO1 deficiency can induce symptoms akin to preeclampsia in both mice and humans. While these findings suggest a role of IDO1 in decidual vascularization during pregnancy, this has yet to be explored. Altered expression of IL6 and its receptor in decidua have likewise been reported in cases of sporadic miscarriage and in vitro assays have identified IL6 as a potential factor driving trophoblast invasion. Based on our findings in settings of pathological neovascularization, I have investigated the hypothesis that the initiation of SAR similarly runs through IFNγ/IDO1/IL6. In line with previous reports, vessel wall SMA remained significantly elevated in mice lacking IFNγ, and consistent with our hypothesis lack of either IDO1 or GCN2 resulted in a similar retention of SMA. However, in contrast to IDO1 or GCN2 deficiency which only partially attenuated SMA loss, IL6 deficiency blocked SMA loss almost completely, suggesting that IDO1 is not the sole input driving IL6 in this context. IFNγ expression was unaffected in mice lacking IDO1, GCN2 or IL6 despite the defects in vessel wall remodeling observed in these mice while IL6 expression was impaired in mice lacking IFNγ, IDO1 or GCN2 consistent with IFNγ being an upstream driver and IL6 a downstream effector in the SAR process. In addition to these effects on the vessel wall, IL6 was confirmed to promote trophoblast migration in vitro and loss of IFNγ, IDO1, GCN2 or IL6 all compromised trophoblast invasiveness in vivo. Thus, two key features of the SAR process, vessel wall remodeling and trophoblast invasion are subject to control by this inflammatory pathway. These data provide important elucidation of mechanism by which inflammation controls SAR an suggest potential pathways for interventional therapy to mitigate the effects when this process goes awry.17 0Item Restricted ANTENATAL EXERCISE AND ITS ASSOCIATED FACTORS AMONG SAUDI PREGNANT WOMEN(George Mason University, 2024) Alhajiri, Donna Nassir; Oh, Kyeung MiBackground: Regular physical exercise during pregnancy can help reduce the risk of complications for both the mother and the fetus. Globally, women’s exercise during pregnancy is low and decreases as pregnancy progresses. In Saudi Arabia, women’s antenatal exercise practices are understudied. There is an increase in women’s obesity and pregnancy-related weight gain, a lack of health counseling, and a lack of antenatal exercise guidelines. There is a need to explore the level of antenatal exercise and its associated factors. The findings can be used to develop culturally appropriate antenatal exercise education and counseling programs for Saudi pregnant women. Purpose of the study: To assess antenatal exercise adherence to the American College of Obstetrics and Gynecology (ACOG) exercise during pregnancy guidelines and its associated factors among Saudi pregnant women. Method: This is an exploratory, cross-sectional, and descriptive study. Data was collected using a self-reported questionnaire. The target population of this study was Saudi pregnant women. A convenient sampling method was used to include women 18 to 45 years old, living in the eastern province with a single, alive fetus and a normal pregnancy, naturally conceived, and who can read and write in Arabic. Exclusion criteria were women with a high-risk pregnancy, a medical problem except for diabetes mellitus, a psychological condition, or a mental or physical disability. In an exploratory manner, facilitators, and barriers as independent variables on intrapersonal, interpersonal, environmental, organizational, and policy levels were included to assess their associations with antenatal exercise. Descriptive statistics were used to describe the study sample’s characteristics, women’s levels of knowledge, attitude, and adherence to the ACOG antenatal exercise guidelines, in addition to antenatal exercise facilitators, and barriers on intrapersonal, interpersonal, environmental, organizational, and policy levels. Bivariate relationships between antenatal exercise and its associated factors were assessed using the independent t-tests and Chi-square tests. Finally, the associations of demographic characteristics, women’s knowledge, attitude, antenatal exercise facilitators, and barriers on intrapersonal, interpersonal, environmental, organizational, and policy levels factors with antenatal exercise were assessed using logistic regression analyses after assessing the assumptions. Statistical significance was tested at p ˂0.05.61 0Item Restricted Factors Associated with Physical Activity Before and During Pregnancy: Analysis of 2016-2019 PRAM Data(University of Alabama, 2024-02-27) Abutalib, Nuha; Wilkewrson, AmandaPregnant women are encouraged to engage in 150 minutes of physical activity (PA) each week during pregnancy. However, studies show that a significantly low number of women engage in PA during pregnancy. The current study sought to explore the association between intrapersonal and interpersonal factors and engagement in PA before and during pregnancy among women in Alabama and Rhode Island from 2016 to 2019. A cross-sectional study was completed using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2019 during the most recent survey phase (Phase 8) for the states of Alabama and Rhode Island. Pregnant women who were told by a healthcare provider that they could not engage in PA were excluded from the analysis. A Chi-Square test of independence, point biserial correlation, and a multivariable logistic regression model were used to determine the association between selected intrapersonal and interpersonal variables and PA three months before and during the third trimester of pregnancy. Only 14.6% of the sample met PA guidelines before pregnancy, and only 8.8% of the total sample met the guidelines during pregnancy. Significant univariate associations were found between race, ethnicity, pre-pregnancy BMI, and state of residence and meeting the PA before pregnancy, and maternal age, education level, pre-pregnancy BMI, source of health insurance, and household income and meeting the PA guidelines during pregnancy. There was no significant relationship between interpersonal factors and meeting the PA guidelines before pregnancy, but WIC participation and marital status were significantly associated with meeting the PA guidelines during pregnancy. In the multivariable regression model, maternal race, maternal ethnicity, pre-pregnancy BMI, and state of residence were all significantly associated with meeting the PA guidelines three months before pregnancy. However, pre-pregnancy BMI was the only variable significantly associated with meeting the PA guidelines during pregnancy in the multivariable logistic regression model. No significant interactions were observed between intrapersonal and interpersonal factors and meeting PA guidelines before or during pregnancy. The study's findings support the need for education, awareness programs, and strategies provided by health education specialists and healthcare providers to encourage engagement in PA before and during pregnancy.20 0Item Restricted Saudi Women's Knowledge and Awareness of the Risk of Venous Thromboembolism During Pregnancy and the Puerperium and the Practice of ‘Lying-in’: A Mixed Methods Study(University of Newcastle, 2024-02-02) Alshammari, Afrah; Foureur, Maralyn; McLaughlin, Karen; Newnham, LizBackground: Venous thromboembolism (VTE) refers to blood clots in the veins including Deep Vein Thrombosis (blood clots in deep veins, usually in the leg or pelvis), and Pulmonary Embolism (when a piece of blood clot is dislodged and flows through the bloodstream to the lung causing a blockage in the lung). During pregnancy, the human body undergoes physiological and anatomical changes that increase the risk of VTE. Prolonged periods of immobility such as during postpartum ‘lying-in’ may increase this risk. Aim: To assess Saudi women’s awareness of the risks of VTE during pregnancy and the puerperium in Al-Jouf, KSA and in Australia, and to explore Saudi women’s cultural practice of ‘lying-in’ after the birth of the baby. Design: Two separate studies using a mix of methods. A qualitative descriptive study using semi structured interviews with pregnant and postnatal women in Al-Jouf and, a quantitative cross-sectional study with a survey including two validated tools to compare Saudi Arabian pregnant and postnatal women’s awareness of the risk of VTE and postnatal practices of ‘lying-in’ in Al-Jouf and in Australia. Results: interviews were conducted with 15 pregnant and postnatal women in Al-Jouf. Analysis of the individual interview data led to the creation of two main themes, ‘40 days rest is expected’ and ‘pregnancy and blood clots? No way!’. These two main themes illustrated the participants’ knowledge and awareness of the risk of VTE, as well as their experiences with lying-in during the postpartum period. Women justified their lying-in practice due to customs and a lack of knowledge about any risks of this practice. Some women had prior awareness of blood clotting due to factors such as a personal or a neighbour’s experience of VTE, or face-to-face health education, or through the internet. Most participants confirmed their lack of awareness of the risk of VTE during pregnancy and the postpartum period, as well as their desire for health education to improve understanding. Analysis of the survey data from 380 Saudi women in Al-Jouf and 85 Saudi women in Australia confirmed the lack of awareness/knowledge of the risk of VTE associated with pregnancy and the puerperium. The practice of ‘lying-in’ was more common amongst Saudi women in Al-Jouf than in Australia, due to the lack of family in Australia to provide support. Awareness of the risk of VTE during pregnancy and the postpartum period was higher amongst Saudi women in Australia, possibly due to exposure to a different health system which emphasises education about the risks. Conclusions: pregnant and postnatal women are at risk of VTE, and certain cultural practices, such as lying in bed during the postpartum period may further increase this risk. Therefore, it is crucial to raise awareness among Saudi Arabian women about the potential risk of VTE during pregnancy and after giving birth. Health education to encourage women to engage in physical activity during this period may mitigate the risk of VTE.87 0Item Restricted Dentists' Education, Knowledge, Attitudes and Behavior concerning the Effects of Pregnant Patients' Oral Health on Pregnancy Outcomes: A National Survey(Saudi Digital Library, 2021-12-08) Khuraybah, Abad; Boynton, James; Majewski, Robert; Salzmann, Larry; Inglehar, Inglehart; Inglehart, Marita RObjectives: Since 1996, there is empirical evidence that pregnant patients’ oral health and pregnancy outcomes are related. The objectives were to assess general dentists’ education, knowledge and professional behavior related to treating pregnant patients’ oral health and how COVID -19 affected dentists’ professional behavior related to the relationship between oral health and pregnancy outcomes Methods: 2,500 surveys were mailed to members of the American Dental Association; 96 were undeliverable and 253 were completed (Response rate: 10.52%). Results: About half of the respondents (50.2%) agreed/strongly agreed that they were well educated about treating pregnant patients in dental school. However, only about a third (34%) were satisfied with this education. The majority knew that periodontal disease was associated with preterm delivery (71.8%) and infants’ birth weight (69.3%), and that pregnant patients can safely undergo basic dental treatment (90%), tooth extractions (82.8%) and root canal treatment (90.3%). The majority delivered fillings (78.4%), periodontal treatment (69.2%) and root canal therapy (66.2%) to pregnant patients. Nearly all dentists delivered routine examinations and cleanings (94%) to these patients and discussed the importance of oral health during pregnancy (91.6%). A total of 38.6% was concerned about legal risks and 38.6% believed there were no guidelines for treating pregnant patients. COVID did not change treatment patterns for the majority of respondents. The better their dental school education was, the more knowledge they had about pregnant patients’ oral health care (r=0.19;p<0.001) and the more likely they were to deliver this care (r=0.30;p<0.001). Conclusions: Increasing educational efforts in dental school and continuing education about the effects of pregnant patients’ oral health on pregnancy outcomes is needed to improve related knowledge and professional behavior.30 0