In females, critical hormonal shifts occur during puberty, menstruation, pregnancy, and <br/>menopause. The fluctuating ovarian hormone levels across a woman’s lifespan likely contribute <br/>to inflammatory responses driven by the immune system, which is regulated by a variety of <br/>physiological pathways and microbiological cues. Pregnancy in particular results in drastic <br/>changes in circulating hormone profiles, and involves a variety of physiological changes, <br/>including inflammatory responses of the immune system. There is evidence that these effects are <br/>mediated, in part, by the significant hormone fluctuations that characterize pregnancy and <br/>postpartum periods. This thesis highlights and synthesizes important physiological changes <br/>associated with pregnancy, and their potential implications on cognitive and brain aging in <br/>women. A tertiary model of cognition is presented depicting interactions between hormonal <br/>history, reproductive history, and immune functions. This research is important to create a better <br/>understanding of women’s health and enhance medical care for women throughout pregnancy <br/>and across reproductive hormone shifts across the lifespan.

Pregnancy is a specific time in a woman’s life filled with complex changes in health, including the oral cavity. During this time, dental and perinatal care teams can be influential in helping women initiate and maintain essential habits to improve health and prevent adverse outcomes. There is research evidence that dental providers are reluctant to treat dental problems during pregnancy. Barriers to practice identified by dentists include lack of education, time, financial constraints, and concern for the safety treating pregnant women. Factors that facilitate dental care for pregnant women include purposeful assessment, referrals from prenatal providers, and continuing education for dental team members.

Multiple organizations recommend the treatment of oral health conditions during pregnancy to promote health and prevent pregnancy complications. In order to promote community-based partnerships in a healthcare system, dentists are encouraged to develop an intentional plan to increase collaboration with other members of the women’s healthcare team. Prior to developing a system wide intervention to improve access to dental care during pregnancy, dental team members were surveyed to identify barriers and facilitators which promote or hinder care in their practice. The data acquired will be used to inform the design and implementation of an intervention to specifically meet the needs of patients and providers in that system.

The Healthy Pregnancy Summit is a collection of videos from a variety of specialists detailing how to have a healthy pregnancy and healthy child, based on the latest scientific and medical information. This project summarizes each presentation, and compares to the Healthy Child Guide, a document supplementary to the summit. Finally, this project analyzes the overall usefulness of the summit and each presentation, and suggests areas for improvement.

With recent reports indicating that there is a relatively low number of pregnant people vaccinated against COVID-19 in the United States (~30% per the Centers for Disease Control and Prevention, October, 2021), this study aims to understand the reasons for COVID-19 vaccine hesitancy among the pregnant population in the state of Arizona. Using a mixed-methods approach, this cross-sectional study employs both semi-structured qualitative interviews (n = 40) and a quantitative survey instrument (n = 400) to better understand the reasons for COVID-19 vaccine hesitancy among pregnant people, with data collected over the course of a few months. Descriptive statistics and logistic regression are employed to analyze the quantitative data and the semi-structured interviews are inductively coded to analyze themes across participant interviews. The results from this study are not only able to help better address disparities in COVID-19 vaccinations among pregnant people, but they also provide implications for vaccine hesitancy overall in order to develop interventions to address vaccine hesitancy. Future research is warranted to better understand regional differences in vaccine hesitancy and differences across populations.

Stress of transitioning to parenthood, hormonal fluctuations as well as physical changes, and complications during postpartum could be addressed at the routine postpartum follow-up visit to avoid long-term adverse effects. While emphasis on preconception and prenatal care has increased nationwide, attendance at this important visit is on the decline. The purpose of this project was to investigate how enhanced prenatal education and concurrent scheduling of a well-baby visit at four weeks, instead of the traditional six weeks, could increase adherence to recommended follow-up care at a federally qualified health clinic in the Southwestern United States.

The Theory of Reasoned Action guided the intervention while Rosswurum and Larrabee’s evidence-based practice model was used to develop the project. The pre-existing weekly prenatal education program was enhanced with information regarding the importance of a four-week postpartum follow-up visit. Front desk schedulers were educated to offer same day appointments for the postpartum care visit and one-month well-baby appointment. Data collection took place for three months after implementation of the project and was compared to adherence rates during the three months prior to the intervention. Providers and scheduling staff members participated in a short post-intervention interview. Prenatal education and convenience of concurrent scheduling increased the percentage of adherence to follow-up visits over a three-month period. Providers and clinic staff recommend continuing with the process changes to increase patient’s access to family centered care.

Maintaining good oral health during pregnancy is a significant contributor to healthy pregnancy outcomes. The physiological changes that happen during pregnancy can adversely affect women’s oral health and place her at risk for pregnancy outcomes such as miscarriage and preeclampsia. The unborn child’s health can also be affected by premature birth and low birth weight. Although professional organizations have evidence-based practice guidelines for both prenatal and dental providers, the evidence shows a gap between recommendations and practice. An oral health promotion project for pregnant women was implemented in a federally qualified community health center where there was a lack of adherence to the guidelines.

The purpose of this project was to implement established oral health screening guidelines for pregnant women and to increase dental visits among pregnant women. For this project, a two-item maternal oral health-screening tool (MOS) for the prenatal providers was added into the electronic health record to standardize and document oral health screening for pregnant women at their first prenatal visit. After three months of implementation, there was a significant increase in maternal oral health screening and referral. This project may be replicated at any prenatal setting to improve oral health during pregnancy.