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Bowman A, Sullivan T, Makrides M, Flenady V, Shepherd E, Hawke K, Stuart-Butler D, Leane C, Middleton P. Lifestyle and sociodemographic risk factors for stillbirth by region of residence in South Australia: a retrospective cohort study. BMC Pregnancy Childbirth 2024; 24:368. [PMID: 38750442 PMCID: PMC11097586 DOI: 10.1186/s12884-024-06553-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Stillbirth rates remain a global priority and in Australia, progress has been slow. Risk factors of stillbirth are unique in Australia due to large areas of remoteness, and limited resource availability affecting the ability to identify areas of need and prevalence of factors associated with stillbirth. This retrospective cohort study describes lifestyle and sociodemographic factors associated with stillbirth in South Australia (SA), between 1998 and 2016. METHODS All restigered births in SA between 1998 ad 2016 are included. The primary outcome was stillbirth (birth with no signs of life ≥ 20 weeks gestation or ≥ 400 g if gestational age was not reported). Associations between stillbirth and lifestyle and sociodemographic factors were evaluated using multivariable logistic regression and described using adjusted odds ratios (aORs). RESULTS A total of 363,959 births (including 1767 stillbirths) were included. Inadequate antenatal care access (assessed against the Australian Pregnancy Care Guidelines) was associated with the highest odds of stillbirth (aOR 3.93, 95% confidence interval (CI) 3.41-4.52). Other factors with important associations with stillbirth were plant/machine operation (aOR, 1.99; 95% CI, 1.16-2.45), birthing person age ≥ 40 years (aOR, 1.92; 95% CI, 1.50-2.45), partner reported as a pensioner (aOR, 1.83; 95% CI, 1.12-2.99), Asian country of birth (aOR, 1.58; 95% CI, 1.19-2.10) and Aboriginal/Torres Strait Islander status (aOR, 1.50; 95% CI, 1.20-1.88). The odds of stillbirth were increased in regional/remote areas in association with inadequate antenatal care (aOR, 4.64; 95% CI, 2.98-7.23), birthing age 35-40 years (aOR, 1.92; 95% CI, 1.02-3.64), Aboriginal and/or Torres Strait Islander status (aOR, 1.90; 95% CI, 1.12-3.21), paternal occupations: tradesperson (aOR, 1.69; 95% CI, 1.17-6.16) and unemployment (aOR, 4.06; 95% CI, 1.41-11.73). CONCLUSION Factors identified as independently associated with stillbirth odds include factors that could be addressed through timely access to adequate antenatal care and are likely relevant throughout Australia. The identified factors should be the target of stillbirth prevention strategies/efforts. SThe stillbirth rate in Australia is a national concern. Reducing preventable stillbirths remains a global priority.
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Affiliation(s)
- Anneka Bowman
- Aboriginal Communities and Families Health Research Alliance (ACRA), Adelaide, Australia.
- South Australian Health and Medical Research Institute, North terrace, Adelaide, Australia.
- University of Adelaide, Adelaide, Australia.
- Centre for Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
| | - Thomas Sullivan
- South Australian Health and Medical Research Institute, North terrace, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, North terrace, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
| | - Vicki Flenady
- Centre for Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Emily Shepherd
- South Australian Health and Medical Research Institute, North terrace, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
| | - Karen Hawke
- Aboriginal Communities and Families Health Research Alliance (ACRA), Adelaide, Australia
- Flinders University, Adelaide, Australia
| | - Deanna Stuart-Butler
- Centre for Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Cathy Leane
- Aboriginal Health Division of the Women's and Children's Health Network, Adelaide, Australia
| | - Philippa Middleton
- Aboriginal Communities and Families Health Research Alliance (ACRA), Adelaide, Australia
- South Australian Health and Medical Research Institute, North terrace, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
- Centre for Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
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Yeshitila YG, Gold L, Riggs E, Abimanyi-Ochom J, Sweet L, Le HND. Trends and disparities in perinatal health outcomes among women from refugee backgrounds in Victoria, Australia: A population-based study. Midwifery 2024; 132:103980. [PMID: 38547597 DOI: 10.1016/j.midw.2024.103980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Women from refugee backgrounds generally experience poorer pregnancy-related outcomes compared to host populations. AIM To examine the trend and disparities in adverse perinatal outcomes among women of refugee background using population-based data from 2003 to 2017. METHODS A population-based cross-sectional study of 754,270 singleton births in Victoria compared mothers of refugee backgrounds with Australian-born mothers. Inferential statistics, including Pearson chi-square and binary logistic regression, were conducted. Multiple logistic regression was conducted to explore the relationship between adverse perinatal outcomes and the women's refugee status. FINDINGS Women of refugee background had higher odds of adverse neonatal and maternal outcomes, including stillbirth, neonatal death, low APGAR score, small for gestational age, postpartum haemorrhage, abnormal labour, perineal tear, and maternal admission to intensive care compared to Australian-born women. However, they had lower odds of neonatal admission to intensive care, pre-eclampsia, and maternal postnatal depression. The trend analysis showed limited signs of gaps closing over time in adverse perinatal outcomes. DISCUSSION AND CONCLUSION Refugee background was associated with unfavourable perinatal outcomes, highlighting the negative influence of refugee status on perinatal health. This evidences the need to address the unique healthcare requirements of this vulnerable population to enhance the well-being of mothers and newborns. Implementing targeted interventions and policies is crucial to meet the healthcare requirements of women of refugee backgrounds. Collaborative efforts between healthcare organisations, government agencies and non-governmental organisations are essential in establishing comprehensive support systems to assist refugee women throughout their perinatal journey.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia; School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia; Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Lisa Gold
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of General Practice, The University of Melbourne, Victoria, Melbourne, Australia
| | - Julie Abimanyi-Ochom
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Institute for Health Transformation, Victoria, Australia
| | - Ha N D Le
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
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Hearn F, Brown SJ, Szwarc J, Toke S, Alqas Alias M, Essa M, Hydari S, Baget A, Riggs E. Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:481. [PMID: 38673392 PMCID: PMC11049987 DOI: 10.3390/ijerph21040481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Listening to What Matters is an exploratory descriptive qualitative study that aimed to (1) understand how women of refugee background in Melbourne, Australia experienced access to health information and maternity and/or early parenting care during the COVID-19 pandemic and (2) whether pandemic health directives had an impact on structural inequities for women of refugee background who received maternity and/or early parenting care during the COVID-19 pandemic. Semi-structured interviews were conducted with 41 participants including 17 women of refugee background, who identified as belonging to the Karen, Assyrian Chaldean, Iraqi, Syrian, Afghan, Sudanese, or South Sudanese communities and 24 health and social care professionals who identified as providing pregnancy or early parenting care during the pandemic in the north western suburbs of Melbourne. Interviews with women were conducted in preferred languages by community researchers. Interviews with professionals were conducted in English by researchers. Reflexive thematic data analysis included constructivist positionality and a trauma and violence informed approach. The results reported in this paper include three themes, with four accompanying subthemes, as follows: theme (1), 'Structural inequities and the toll of the pandemic'; theme (2), 'Supportive infrastructure'; and theme (3), 'Cultural safety during the pandemic'. The results demonstrate that cumulative negative impacts such as unequal access to health information, family separation and isolation, inadequate household income, and mental and social health concerns had the potential to amplify pre-existing structural inequities for women of refugee background. Community engagement facilitated by bicultural workers, interpreters, and trusted care providers facilitated fast-paced, two-way communication that built capacity and health literacy for women who were unable to speak English and unfamiliar with the health care system and, improved experiences of care. More research is needed to understand how the intersectional cumulative impacts of structural inequities have affected maternal and neonatal health outcomes for women of refugee background during the pandemic, as well as any differences in maternal and neonatal health outcomes between Australian-born and refugee background women and babies.
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Affiliation(s)
- Fran Hearn
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Stephanie J. Brown
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of General Practice, University of Melbourne, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
| | - Josef Szwarc
- The Victorian Foundation for Survivors of Torture Inc., Brunswick, VIC 3056, Australia
| | - Shadow Toke
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of General Practice, University of Melbourne, Parkville, VIC 3052, Australia
| | - May Alqas Alias
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Maryaan Essa
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Shogoufa Hydari
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Ashay Baget
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of General Practice, University of Melbourne, Parkville, VIC 3052, Australia
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Davies-Tuck ML, Davey MA, Hodges RL, Wallace EM. Fetal surveillance from 39 weeks' gestation to reduce stillbirth in South Asian-born women. Am J Obstet Gynecol 2023; 229:286.e1-286.e9. [PMID: 36907532 DOI: 10.1016/j.ajog.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND In July 2017, the State of Victoria's largest maternity service implemented a new clinical guideline to reduce the rates of stillbirth at term for South Asian women. OBJECTIVE This study aimed to evaluate the impact of offering fetal surveillance from 39 weeks to South Asian-born women on rates of stillbirth and neonatal and obstetrical interventions. STUDY DESIGN This was a cohort study of all women receiving antenatal care at 3 large metropolitan university-affiliated teaching hospitals in Victoria, who gave birth in the term period between January 2016 and December 2020. Differences in rates of stillbirth, neonatal deaths, perinatal morbidities, and interventions after July 2017 were determined. Multigroup interrupted time-series analysis was used to assess changes in rates of stillbirth and induction of labor. RESULTS A total of 3506 South Asian-born women gave birth before, and 8532 after the change in practice. There was a 64% reduction in term stillbirth (95% confidence interval, 87% to 2%; P=.047) after the change in practice from 2.3 per 1000 births to 0.8 per 1000 births. The rates of early neonatal death (3.1/1000 vs 1.3/1000; P=.03) and special care nursery admission (16.5% vs 11.1%; P<.001) also decreased. There were no significant differences in admission to the neonatal intensive care unit, 5-minute Apgar score <7, or birthweight, or differences in the trends of induction of labor per month. CONCLUSION Fetal monitoring from 39 weeks may offer an alternative to routine earlier induction of labor to reduce the rates of stillbirth without causing an increase in neonatal morbidity and attenuating trends in obstetrical interventions.
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Affiliation(s)
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Ryan L Hodges
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Health, Clayton, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Department of Health and Human Services, Melbourne, Australia
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Barthasarathy K, Lam L. Perinatal outcomes among Indian-born mothers in Australia. BMC Pregnancy Childbirth 2023; 23:595. [PMID: 37605130 PMCID: PMC10440895 DOI: 10.1186/s12884-023-05897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To examine the incidence of adverse perinatal outcomes and the risk of adverse perinatal outcomes for Indian-born mothers compared to other mothers living and giving birth in Australia. DESIGN, SETTING AND PARTICIPANTS This retrospective cohort study was designed to investigate all births in Australia in 2012 and those in the Monash Health Birthing Outcomes System (BOS) 2014 to Indian-born mothers in Australia. Data sets were analysed involving descriptive statistics using Statistical Package for Social Sciences (SPSS vs. 23). RESULTS Indian-born mothers in Australia are at increased risk of induced labour, emergency caesarean section, very preterm birth (20-27 weeks), babies with low to very low birth weight, and low Apgar score (0-2) at 5 min, gestational diabetes, hypothyroidism, iron deficiency anaemia and vitamin B12 deficiencies compared to other mothers giving birth in Australia. This is despite a range of protective factors (25-34 years, married, nonsmokers, and a BMI < 30) that would normally be expected to reduce the risk of adverse perinatal outcomes for mothers giving birth in a developed country. CONCLUSION In the absence of many of the recognized maternal risk factors, Indian-born mothers continue to face increased risk of adverse perinatal outcomes, despite access to high quality maternity care in Australia. Recommendations arising from this study include the need for an intervention study to identify maternal risk factors for Indian-born mothers in mid to late pregnancy that contribute to the risk for very preterm birth and low birth weight.
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Affiliation(s)
| | - Louisa Lam
- School of Nursing, Midwifery and Paramedicine (VIC), Australian Catholic University, Sydney, VIC, Australia.
- Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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De Graaff E, Sadler L, Lakhdhir H, Simon‐Kumar R, Peiris‐John R, Burgess W, Okesene‐Gafa K, Cronin R, Mccowan L, Anderson N. Grouping women of South Asian ethnicity for pregnancy research in New Zealand. Aust N Z J Obstet Gynaecol 2023; 63:499-508. [PMID: 36285385 PMCID: PMC10952764 DOI: 10.1111/ajo.13626] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The New Zealand (NZ) Ministry of Health ethnicity data protocols recommend that people of South Asian (SAsian) ethnicity, other than Indian, are combined with people of Japanese and Korean ethnicity at the most commonly used level of aggregation in health research (level two). This may not work well for perinatal studies, as it has long been observed that women of Indian ethnicity have higher rates of adverse pregnancy outcomes, such as perinatal death. It is possible that women of other SAsian ethnicities share this risk. AIMS This study was performed to identify appropriate groupings of women of SAsian ethnicity for perinatal research. MATERIALS AND METHODS National maternity and neonatal data, and singleton birth records between 2008 and 2017 were linked using the Statistics NZ Integrated Data Infrastructure. Socio-demographic risk profiles and pregnancy outcomes were compared between 15 ethnic groups. Recommendations were made based on statistical analyses and cultural evaluation with members of the SAsian research community. RESULTS Similarities were observed between women of Indian, Fijian Indian, South African Indian, Sri Lankan, Bangladeshi and Pakistani ethnicities. A lower-risk profile was seen among Japanese and Korean mothers. Risk profiles of women of combined Indian-Māori, Indian-Pacific and Indian-New Zealand European ethnicity more closely represented their corresponding non-Indian ethnicities. CONCLUSIONS Based on these findings, we suggest a review of current NZ Ministry of Health ethnicity data protocols. We recommend that researchers understand the risk profiles of participants prior to aggregation of groups in research, to mitigate risks associated with masking differences.
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Affiliation(s)
- Esti De Graaff
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
| | - Lynn Sadler
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
- Te Toka Tumai Auckland, Te Whatu Ora HealthAucklandNew Zealand
| | - Heena Lakhdhir
- Counties Manukau District, Division of Women's Health, Te Whatu Ora ‐ HealthAucklandNew Zealand
| | - Rachel Simon‐Kumar
- The University of Auckland School of Population HealthAucklandNew Zealand
| | - Roshini Peiris‐John
- The University of Auckland Section of Epidemiology and BiostatisticsAucklandNew Zealand
| | - Wendy Burgess
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
| | - Karaponi Okesene‐Gafa
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
- Counties Manukau District, Division of Women's Health, Te Whatu Ora ‐ HealthAucklandNew Zealand
| | - Robin Cronin
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
- Counties Manukau District, Division of Women's Health, Te Whatu Ora ‐ HealthAucklandNew Zealand
| | - Lesley Mccowan
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
| | - Ngaire Anderson
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & GynaecologyAucklandNew Zealand
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de Graaff E, Sadler L, Lakhdhir H, Simon-Kumar R, Peiris-John R, Burgess W, Okesene-Gafa K, Cronin R, McCowan L, Anderson N. An in-depth analysis of perinatal related mortality among women of South Asian ethnicity in Aotearoa New Zealand. BMC Pregnancy Childbirth 2023; 23:535. [PMID: 37488505 PMCID: PMC10364368 DOI: 10.1186/s12884-023-05840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND International and national New Zealand (NZ) research has identified women of South Asian ethnicity at increased risk of perinatal mortality, in particular stillbirth, with calls for increased perinatal research among this ethnic group. We aimed to analyse differences in pregnancy outcomes and associated risk factors between South Asian, Māori, Pacific and NZ European women in Aotearoa NZ, with a focus on women of South Asian ethnicity, to ultimately understand the distinctive pathways leading to adverse events. METHODS Clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, while national maternity and neonatal data, and singleton birth records from the same decade, were linked using the Statistics NZ Integrated Data Infrastructure for all births. Pregnancy outcomes and risk factors for stillbirth and neonatal death were compared between ethnicities with adjustment for pre-specified risk factors. RESULTS Women of South Asian ethnicity were at increased risk of stillbirth (aOR 1.51, 95%CI 1.29-1.77), and neonatal death (aOR 1.51, 95%CI 1.17-1.92), compared with NZ European. The highest perinatal related mortality rates among South Asian women were between 20-23 weeks gestation (between 0.8 and 1.3/1,000 ongoing pregnancies; p < 0.01 compared with NZ European) and at term, although differences by ethnicity at term were not apparent until ≥ 41 weeks (p < 0.01). No major differences in commonly described risk factors for stillbirth and neonatal death were observed between ethnicities. Among perinatal deaths, South Asian women were overrepresented in a range of metabolic-related disorders, such as gestational diabetes, pre-existing thyroid disease, or maternal red blood cell disorders (all p < 0.05 compared with NZ European). CONCLUSIONS Consistent with previous reports, women of South Asian ethnicity in Aotearoa NZ were at increased risk of stillbirth and neonatal death compared with NZ European women, although only at extremely preterm (< 24 weeks) and post-term (≥ 41 weeks) gestations. While there were no major differences in established risk factors for stillbirth and neonatal death by ethnicity, metabolic-related factors were more common among South Asian women, which may contribute to adverse pregnancy outcomes in this ethnic group.
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Affiliation(s)
- Esti de Graaff
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Auckland, New Zealand.
| | - Lynn Sadler
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Auckland, New Zealand
- Te Toka Tumai Auckland, Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Heena Lakhdhir
- Counties Manukau District, Division of Women's Health, Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Rachel Simon-Kumar
- The University of Auckland School of Population Health, Auckland, New Zealand
| | - Roshini Peiris-John
- The University of Auckland Section of Epidemiology and Biostatistics, Auckland, New Zealand
| | - Wendy Burgess
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Auckland, New Zealand
| | - Karaponi Okesene-Gafa
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Auckland, New Zealand
- Counties Manukau District, Division of Women's Health, Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Robin Cronin
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Auckland, New Zealand
- Counties Manukau District, Division of Women's Health, Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Lesley McCowan
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Auckland, New Zealand
| | - Ngaire Anderson
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Auckland, New Zealand
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de Graaff E, Bartlett K, Sadler L, Lakhdhir H, Simon-Kumar R, Peiris-John R, Burgess W, Cronin R, McCowan L, Anderson N. Placental pathology findings in perinatal deaths from 28 weeks gestation in Aotearoa New Zealand. Placenta 2023; 138:97-108. [PMID: 37245428 DOI: 10.1016/j.placenta.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/24/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Women of South Asian ethnicity are overrepresented in adverse pregnancy outcome across high-income countries, including those related to placental dysfunction. It has been hypothesised that placental aging occurs at earlier gestation in South Asian pregnancies. We aimed to identify differences in placental pathology among perinatal deaths ≥28 weeks gestation, between South Asian, Māori and New Zealand (NZ) European women in Aotearoa NZ, with a focus on women of South Asian ethnicity. METHODS Placental pathology reports and clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, blinded, and analysed by an experienced perinatal pathologist using the Amsterdam Placental Workshop Group Consensus Statement criteria. RESULTS 790 of 1161 placental pathology reports, 346 preterm (28+0 to 36+6 weeks) and 444 term (≥37+0 weeks) deaths, met the inclusion criteria. Among preterm deaths, South Asian women had higher rates of maternal vascular malperfusion compared with Māori (aOR 4.16, 95%CI 1.55-11.15) and NZ European (aOR 2.60, 95%CI 1.10-6.16). Among term deaths, South Asian women had higher rates of abnormal villous morphology compared with Māori (aOR 2.19, 95%CI 1.04-4.62) and NZ European (aOR 2.12, 95%CI 1.14-3.94), mostly due to increased rates of chorangiosis (36.7%, compared to 23.3% and 21.7%, respectively). DISCUSSION Differences in placental pathology by ethnicity were observed among preterm and term perinatal deaths. While we suspect differing underlying causal pathways, these deaths may be associated with maternal diabetic and red blood cell disorders among South Asian women, leading to a hypoxic state in-utero.
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Affiliation(s)
- Esti de Graaff
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Kate Bartlett
- Auckland District Health Board LabPlus, Auckland City Hospital, Building 31, Gate 4 Grafton Road, Grafton, Auckland, 1148, New Zealand.
| | - Lynn Sadler
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand; Te Toka Tumai Auckland, Te Whatu Ora Health, 2 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Heena Lakhdhir
- Counties Manukau District, Division of Women's Health, Te Whatu Ora - Health, 100 Hospital Road, Ōtāhuhu, Auckland, 2025, New Zealand.
| | - Rachel Simon-Kumar
- The University of Auckland School of Population Health, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Roshini Peiris-John
- The University of Auckland Section of Epidemiology and Biostatistics, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Wendy Burgess
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Robin Cronin
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand; Counties Manukau District, Division of Women's Health, Te Whatu Ora - Health, 100 Hospital Road, Ōtāhuhu, Auckland, 2025, New Zealand.
| | - Lesley McCowan
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Ngaire Anderson
- The University of Auckland Faculty of Medical and Health Sciences, Obstetrics & Gynaecology, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
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Hearn MF, Biggs DL, Brown PS, Krastev MA, Szwarc MJ, Riggs APE. Finding our own ways of working together: reflections on implementing and facilitating a multidisciplinary and equity-oriented model of Group Pregnancy Care for women of refugee background. Midwifery 2023; 123:103709. [PMID: 37209583 DOI: 10.1016/j.midw.2023.103709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This paper explores professional staff experiences of implementing and facilitating a multidisciplinary equity-oriented model of Group Pregnancy Care for women of refugee background. This model was the first of its kind in Australia and one of the first worldwide. DESIGN AND SETTING This exploratory descriptive qualitative study reports the process evaluation findings from the formative evaluation of Group Pregnancy Care for women of refugee background. Data were collected in Melbourne, Australia between January and March 2021 via semi-structured interviews, and analysed using reflexive thematic analysis. PARTICIPANTS Purposive sampling was used to recruit twenty-three professional staff involved in the implementation, facilitation, or oversight of Group Pregnancy Care. FINDINGS This paper reports five themes: knowledge sharing, bicultural family mentors - the critical link, finding our own ways of working together, power dynamics at the intersection of community and clinical knowledge, and system capacity for change. KEY CONCLUSIONS The bicultural family mentor role contributes to the cultural safety of the group, and increases the confidence and competence of professional staff through cultural bridging. Multidisciplinary cross-sector teams that collaborate well can provide cohesive care. It is possible for hospital and community-based services to establish cross-sector equity-oriented partnerships. However, there are challenges sustaining partnerships in the absence of explicit funding to support collaboration, and in context of organisational and professional inflexibility. IMPLICATIONS FOR PRACTICE Investing in change is necessary to achieve health equity. Creating explicit funding pathways for the bicultural family mentor workforce, multidisciplinary collaboration, and cross-sector partnerships would strengthen service capacity to provide equity-oriented care. Working towards health equity also requires a commitment to continuing professional development for professional staff and organisations to increase knowledge and capacity.
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Affiliation(s)
- Ms Fran Hearn
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Dr Laura Biggs
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Professor Stephanie Brown
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia; University of Melbourne, Department of General Practice, Swanston St, Parkville, VIC, 3052, Australia; University of Melbourne, Department of Paediatrics, Swanston St, Parkville, VIC, 3052, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Ms Ann Krastev
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Mr Josef Szwarc
- The Victorian Foundation for Survivors of Torture Inc., Brunswick, VIC, 3056, Australia
| | - Associate Professor Elisha Riggs
- Murdoch Children's Research Institute, Intergenerational Health, 50 Flemington Rd, Parkville, VIC, 3052, Australia; University of Melbourne, Department of General Practice, Swanston St, Parkville, VIC, 3052, Australia
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South-Asian women's experiences of earlier additional, fetal monitoring to reduce stillbirth: An exploratory qualitative study. Women Birth 2023; 36:e213-e218. [PMID: 35902344 DOI: 10.1016/j.wombi.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND In an attempt to reduce the rates of stillbirth at term among South-Asian born women, Victoria's largest maternity service, Monash Health, implemented a new clinical guideline in 2017 that recommended additional earlier, twice weekly monitoring to assess fetal wellbeing from 39 weeks for South-Asian women. In acknowledging the importance of woman centred, culturally responsive care, this study aimed to understand South-Asian women's, experiences, of the additional earlier fetal monitoring. METHODS An exploratory qualitative study was conducted using semi-structured phone interviews six weeks postpartum, across June and July 2021, with South-Asian born women who underwent the earlier monitoring from 39 weeks. Women were asked questions regarding their understanding of the monitoring, their experiences of the monitoring process and any impact the monitoring or results had on their pregnancy, labour and birth. Interviews were recorded and transcribed verbatim. Data were analysed using a thematic approach and an inductive coding strategy. RESULTS Seventeen women from India, Sri Lanka, Pakistan and Afghanistan were interviewed. the main themes were i: gaining peace of mind, need for better communication, did the women really have a choice? and comparisons to maternity care in the country of origin. Women experienced positive reassurance of their baby's well-being from the monitoring and were happy with the earlier, extra care. However, women described receiving variable explanations of the purpose of the monitoring. Ineffective communication and logistical barriers were highlighted to negatively impact women's ability to engage in shared decision making and their overall experience of the earlier monitoring. CONCLUSIONS The additional monitoring is reported by these women to have an overall positive impact on their maternity care. Future work should explore the experiences of non-English speaking South-Asian women and those who declined monitoring.
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Pearson T, Due C, Obst K. Culturally and Linguistically Diverse Men's Grief Experiences Following Perinatal Death in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231153545. [PMID: 36689624 DOI: 10.1177/00302228231153545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To explore the grief experiences of men from culturally and linguistically diverse (CALD) backgrounds following perinatal death in Australia. Qualitative analysis of interview data using thematic analysis. Participants were health service providers (n = 6), and CALD community members (n = 10) who were either community leaders with experience working with CALD men following perinatal death in Australia (n = 6), or were CALD men who had lived experience of perinatal death (n = 4). Thematic analysis identified four themes related to CALD men's grief. These included the role of religion and rituals, grief as stoic, the partner- and family-centred nature of men's grief, and finally grief as ensuring and changeable over time. This research points to the strong need for CALD men's specific needs to be included in the development of policy and practice surrounding perinatal death.
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Affiliation(s)
- Thomas Pearson
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Kate Obst
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
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12
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Pearson T, Obst K, Due C. Culturally and linguistically diverse men's experiences of support following perinatal death: A qualitative study. J Clin Nurs 2022. [PMID: 35864732 DOI: 10.1111/jocn.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore culturally and linguistically diverse men's experiences of support after perinatal death, including barriers and facilitators to support and how healthcare providers, systems and policies can best support families. BACKGROUND Many groups of culturally and linguistically diverse families in Australia are at higher risk of experiencing perinatal death. Culturally sensitive bereavement services are essential; however, there has been no previous research specifically examining culturally and linguistically diverse men's experiences of support following perinatal death. DESIGN Individual semi-structured interviews were completed with healthcare providers, community leaders and culturally and linguistically diverse men who had experienced a perinatal death in Australia (n = 16). Data were analysed using Thematic Analysis and COREQ guidelines were followed. RESULTS Men's need for support following perinatal death was associated with stigma, and shaped by culturally-relevant religion and ritual, and connection to community and family. Significant barriers to men seeking and gaining support included challenges with self-advocacy and navigating the woman-centred nature of perinatal care in Australia. CONCLUSIONS Culturally and linguistically diverse men's specific needs should be included in the development of policy and practice surrounding perinatal death. While perinatal bereavement care guidelines acknowledge the importance of culturally informed care following perinatal death, there remains a lack of culturally specific supports available, particularly for culturally and linguistically diverse men. RELEVANCE TO CLINICAL PRACTICE Specific recommendations from this research include increasing community liaison officers or cultural consultants in hospitals and support organisations; providing culturally and linguistically diverse support groups; adopting family-centred and father-inclusive language in all perinatal death support services and ensuring clear communication and targeted assistance for culturally and linguistically diverse men to self-advocate for their baby and access to support. PATIENT OR PUBLIC CONTRIBUTION This study came out of consultation with community members and member checking of results was conducted to ensure adequate representation of participants' views.
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Affiliation(s)
- Thomas Pearson
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Kate Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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13
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Maternal Race and Stillbirth: Cohort Study and Systematic Review with Meta-Analysis. J Clin Med 2022; 11:jcm11123452. [PMID: 35743521 PMCID: PMC9224577 DOI: 10.3390/jcm11123452] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/10/2022] Open
Abstract
Accurate identification of independent predictors of stillbirth is needed to define preventive strategies. We aim to examine the independent contribution of maternal race in the risk of stillbirth after adjusting for maternal characteristics and medical history. There are two components to the study: first, prospective screening in 168,966 women with singleton pregnancies coordinated by the Fetal Medicine Foundation (FMF) and second, a systematic review and meta-analysis of studies reporting on race and stillbirth. In the FMF study, logistic regression analysis found that in black women, the risk of stillbirth, after adjustment for confounders, was higher than in white women (odds ratio 1.78, 95% confidence interval 1.50 to 2.11). The risk for other racial groups was not significantly different. The literature search identified 20 studies that provided data on over 6,500,000 pregnancies, but only 10 studies provided risks adjusted for some maternal characteristics; consequently, the majority of these studies did not provide accurate contribution of different racial groups to the prediction of stillbirth. It is concluded that in women of black origin, the risk of stillbirth, after adjustment for confounders, is about twofold higher than in white women. Consequently, closer surveillance should be granted for these women.
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Influence of Maternal Region of Birth on Placental Pathology of Babies Born Small. CHILDREN 2022; 9:children9030388. [PMID: 35327760 PMCID: PMC8947328 DOI: 10.3390/children9030388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
Background: Placental pathology is a common antecedent factor in infants born small for gestational age. Maternal region of birth can influence rates of SGA. Aims: To determine the association of maternal region of birth on placental pathology in babies that are born small, comparing a South Asian born population with Australia and New Zealand born women. Materials and methods: A retrospective cohort study was conducted at Monash Health, the largest public health service in Victoria. Mother-baby pairs above 34 weeks’ gestation and birth weight less than 10th centile born in 2016 were included. Placental pathology reports and medical records were reviewed. Statistical analyses of placental and selected neonatal outcomes data were performed. Results: Three hundred and eleven small for gestational age babies were included in this study, of which 171 were born to South Asian mothers and 140 to Australian and New Zealand mothers. There were no significant differences in gestational age at birth between the groups (38.7 (1.6) vs. 38.3 (1.7) weeks, p = 0.06). Placental pathology (macroscopic and microscopic) data comparisons showed no significant differences between the two groups (81% major abnormality in both groups). This was despite South Asian small for gestational age babies being less likely to require admission to a special care nursery or neonatal intensive care unit (35 vs. 41%, p = 0.05), or have a major congenital abnormality (2.3 vs. 4.3%, p = 0.04). Conclusion: In this observational study, maternal region of birth did not have an influence on placental pathology of babies born small, despite some differences in neonatal outcomes.
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O’ Sullivan C, Wilson E, Beckmann M. Five‐year trends in induction of labour in a large Australian metropolitan maternity service. Aust N Z J Obstet Gynaecol 2022; 62:407-412. [DOI: 10.1111/ajo.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caoimhe O’ Sullivan
- Obstetrics & Gynaecology Department Mater Misericordiae Ltd Brisbane Queensland Australia
| | - Erin Wilson
- Obstetrics & Gynaecology Department Mater Misericordiae Ltd Brisbane Queensland Australia
| | - Michael Beckmann
- Obstetrics & Gynaecology Department Mater Misericordiae Ltd Brisbane Queensland Australia
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Lin S, Zhang Y, Jiang L, Li J, Chai J, Pei L, Shang X. Interactive Effects of Maternal Vitamin D Status and Socio-Economic Status on the Risk of Spontaneous Abortion: Evidence from Henan Province, China. Nutrients 2022; 14:nu14020291. [PMID: 35057472 PMCID: PMC8780117 DOI: 10.3390/nu14020291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Maternal vitamin D deficiency might generate adverse reproductive outcomes, and socio-economic inequalities in micronutrient-related diseases have often been found. This study aimed to explore the interactive effects of maternal vitamin D status and socio-economic status (SES) on risk of spontaneous abortion. Methods: A population-based case–control study was conducted including 293 women with spontaneous abortion and 498 control women in December 2009 and January, 2010 in Henan Province, China. Information on pregnancy outcomes, maternal demographic, lifestyle and exposure factors and blood samples were collected at the same time. Vitamin D deficiency was defined as 25(OH)D < 20 ng/mL. SES index was constructed with principal component analysis by aggregating women’s and their husbands’ education level and occupation, and household income and expenditure. Interactive effects were assessed on a multiplicative scale with ratio of the odds ratio (ROR). Results: Compared to those with high SES and vitamin D sufficiency, women with vitamin D deficiency and low SES index had an increased risk of spontaneous abortion (aOR: 1.99; 95% CI: 1.23–3.23). The ROR was 2.06 (95% CI: 1.04–4.10), indicating a significant positive multiplicative interaction. Conclusions: Maternal low SES may strengthen the effect of vitamin D deficiency exposure on spontaneous abortion risk in this Chinese population.
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Affiliation(s)
- Shiqi Lin
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
| | - Yuan Zhang
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
| | - Lifang Jiang
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou 450002, China; (L.J.); (J.C.)
| | - Jiajia Li
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
| | - Jian Chai
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou 450002, China; (L.J.); (J.C.)
| | - Lijun Pei
- Institute of Population Research and China Center on Population Health and Development, Peking University, Beijing 100871, China; (S.L.); (Y.Z.); (J.L.)
- Correspondence: (L.P.); (X.S.)
| | - Xuejun Shang
- Department of Andrology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China
- Correspondence: (L.P.); (X.S.)
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17
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Fetal monitoring from 39 weeks' gestation to identify South Asian-born women at risk of perinatal compromise: a retrospective cohort study. Sci Rep 2021; 11:23352. [PMID: 34857850 PMCID: PMC8639724 DOI: 10.1038/s41598-021-02836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
To investigate whether earlier “post-term” monitoring of South Asian (SA) pregnancies from 39 weeks’ gestation with amniotic fluid index (AFI) and cardiotocography (CTG) detected suspected fetal compromise. Retrospective cohort study of all SA-born women at an Australian health service with uncomplicated, singleton pregnancies following the introduction of twice-weekly AFI and CTG monitoring from 39 weeks. Monitoring results, and their association with a perinatal compromise composite (including assisted delivery for fetal compromise, stillbirth, and NICU admission) were determined. 771 SA-born women had earlier monitoring, triggering delivery in 82 (10.6%). 31 (4%) had a non-reassuring antepartum CTG (abnormal fetal heart rate or variability, or decelerations) and 21 (2.7%) had an abnormal AFI (≤ 5 cm). Women with abnormal monitoring were 53% (95% CI 1.2–1.9) more likely to experience perinatal compromise and 83% (95% CI 1.2–2.9) more likely to experience intrapartum compromise than women with normal monitoring. Monitoring from 39 weeks identified possible fetal compromise earlier than it otherwise would have been, and triggered intervention in 10% of women. Without robust evidence to guide timing of birth in SA-born women to reduce rates of stillbirth, earlier monitoring provides an alternative to routine induction of labour.
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Grundy S, Lee P, Small K, Ahmed F. Maternal region of origin and Small for gestational age: a cross-sectional analysis of Victorian perinatal data. BMC Pregnancy Childbirth 2021; 21:409. [PMID: 34051749 PMCID: PMC8164792 DOI: 10.1186/s12884-021-03864-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Being born small for gestational age is a strong predictor of the short- and long-term health of the neonate, child, and adult. Variation in the rates of small for gestational age have been identified across population groups in high income countries, including Australia. Understanding the factors contributing to this variation may assist clinicians to reduce the morbidity and mortality associated with being born small. Victoria, in addition to New South Wales, accounts for the largest proportion of net overseas migration and births in Australia. The aim of this research was to analyse how migration was associated with small for gestational age in Victoria. Methods This was a cross sectional population health study of singleton births in Victoria from 2009 to 2018 (n = 708,475). The prevalence of being born small for gestational age (SGA; <10th centile) was determined for maternal region of origin groups. Multivariate logistic regression analysis was used to analyse the association between maternal region of origin and SGA. Results Maternal region of origin was an independent risk factor for SGA in Victoria (p < .001), with a prevalence of SGA for migrant women of 11.3% (n = 27,815) and 7.3% for Australian born women (n = 33,749). Women from the Americas (aOR1.24, 95%CI:1.14 to 1.36), North Africa, North East Africa, and the Middle East (aOR1.57, 95%CI:1.52 to 1.63); Southern Central Asia (aOR2.58, 95%CI:2.50 to 2.66); South East Asia (aOR2.02, 95%CI: 1.95 to 2.01); and sub-Saharan Africa (aOR1.80, 95%CI:1.69 to 1.92) were more likely to birth an SGA child in comparison to women born in Australia. Conclusions Victorian woman’s region of origin was an independent risk factor for SGA. Variation in the rates of SGA between maternal regions of origin suggests additional factors such as a woman’s pre-migration exposures, the context of the migration journey, settlement conditions and social environment post migration might impact the potential for SGA. These findings highlight the importance of intergenerational improvements to the wellbeing of migrant women and their children. Further research to identify modifiable elements that contribute to birthweight differences across population groups would help enable appropriate healthcare responses aimed at reducing the rate of being SGA.
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Affiliation(s)
- Sarah Grundy
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.
| | - Patricia Lee
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Kirsten Small
- School of Nursing and Midwifery, Griffith University, QLD, Gold Coast, Australia.,Transforming Maternity Care Collaborative, Griffith University, Gold Coast, QLD, Australia
| | - Faruk Ahmed
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
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19
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Dongarwar D, Maiyegun SO, Yusuf KK, Ibrahimi S, Ikedionwu CA, Salihu HM. Incidence and risk of stillbirth among various Asian-American subgroups. J Matern Fetal Neonatal Med 2021; 35:6638-6643. [PMID: 34024237 DOI: 10.1080/14767058.2021.1918669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND Striking racial/ethnic disparities exist in pregnancy outcomes among various racial/ethnic. OBJECTIVE To determine the incidence and risk factors associated with stillbirth in Asian-American women. STUDY DESIGN We conducted this retrospective cohort study using the United States Birth and Fetal Death data files 2014-2017. We used the fetuses-at-risk approach to generate stillbirth trends by gestational age among Non-Hispanic (NH)-White and Asian-American births during the study period. We calculated the adjusted risk of stillbirth for Asian-Americans, overall, and for each Asian-American subgroup: Asian Indians, Koreans, Chinese, Vietnamese, Japanese and Filipinos, with NH-Whites as the referent category. RESULTS Of the 715,297 births that occurred among Asian-Americans during the study period, stillbirth incidence rate was 3.86 per 1000 births. From the gestational age of 20 weeks through 41 weeks, the stillbirth rates were consistently lower among Asian-Americans compared to NH-Whites. Stillbirth incidence ranged from a low rate of 2.6 per 1000 births in Koreans to as high as 5.3 per 1000 births in Filipinos. After adjusting for potentially confounding characteristics, Asian-Americans were about half as likely to experience stillbirth compared to NH-White mothers [adjusted hazards ratio (AHR) = 0.57, 95% confidence interval (CI) = 0.51-0.64]. This intrauterine survival advantage was evident in all Asian-American subgroups. CONCLUSION The risk of stillbirth is twofold lower in Asian-Americans than in NH-Whites. It will be an important research agenda to determine reasons for the improved intrauterine survival among Asian-Americans in order to uncover clues for reducing the burden of stillbirth among other racial/ethnic minority women in the United States.
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Affiliation(s)
- Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Sitratullah O Maiyegun
- Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Korede K Yusuf
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Sahra Ibrahimi
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Chioma A Ikedionwu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, TX, USA.,Department of Family Medicine, Baylor College of Medicine, Houston, TX, USA
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20
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Warrilow KA, Gordon A, Andrews CJ, Boyle FM, Wojcieszek AM, Stuart Butler D, Ellwood D, Middleton PF, Cronin R, Flenady VJ. Australian women's perceptions and practice of sleep position in late pregnancy: An online survey. Women Birth 2021; 35:e111-e117. [PMID: 33867299 DOI: 10.1016/j.wombi.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Going-to-sleep in the supine position in later pregnancy (≥28 weeks) has been identified as a risk factor for stillbirth. Internationally, public awareness campaigns have been undertaken encouraging women to sleep on their side during late pregnancy. AIM This study aimed to identify sleep practices, attitudes and knowledge in pregnant women, to inform an Australian safe sleeping campaign. METHODS A web-based survey of pregnant women ≥28 weeks' gestation conducted from November 2017 to January 2018. The survey was adapted from international sleep surveys and disseminated via pregnancy websites and social media platforms. FINDINGS Three hundred and fifty-two women participated. Five (1.6%) reported going to sleep in the supine position. Most (87.8%) had received information on the importance of side-sleeping in pregnancy. Information was received from a variety of sources including maternity care providers (186; 66.2%) and the internet (177; 63.0%). Women were more likely to report going to sleep on their side if they had received advice to do so (OR 2.3; 95% CI 1.0-5.1). Thirteen (10.8%) reported receiving unsafe advice, including changing their going-to-sleep position to the supine position. DISCUSSION This indicates high level awareness and practice of safe late-pregnancy going-to-sleep position in participants. Opportunities remain for improvement in the information provided, and understanding needs of specific groups including Aboriginal and Torres Strait Islander women. CONCLUSION Findings suggest Australian women understand the importance of sleeping position in late pregnancy. Inconsistencies in information provided remain and may be addressed through public awareness campaigns targeting women and their care providers.
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Affiliation(s)
- K A Warrilow
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia.
| | - A Gordon
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia; Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - C J Andrews
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia
| | - F M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - A M Wojcieszek
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia
| | - D Stuart Butler
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia
| | - D Ellwood
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia; Griffith University, School of Medicine and Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - P F Middleton
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia; SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - R Cronin
- University of Auckland and Counties Manukau Health, Auckland, New Zealand
| | - V J Flenady
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), South Brisbane, Australia
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21
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Social and ethnic disparities in stillbirth and infant death in Denmark, 2005-2016. Sci Rep 2021; 11:8001. [PMID: 33846451 PMCID: PMC8041838 DOI: 10.1038/s41598-021-87084-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Ethnic disparity in stillbirth and infant death has been demonstrated in Europe. As the relation between migration and health change over time, this population based register study investigated the recent figures and explored if potential differences could be explained by the well-known educational and income inequalities in stillbirth and infant death using a novel approach. Stillbirth and infant mortality varied considerably according to country of origin, with only immigrants from China, Norway, and Poland having an overall lower risk than Danish women. Women of Pakistani, Turkish, and Somali origin had a particularly high risk of both outcomes. Women from recent high conflict areas displayed a pattern with increased stillbirth risk. An observed excess risks across generations was found, which is disturbing and rule out factors related to language barriers or newness. Differences in educational level and household income explained only part of the observed inequalities. Strengthening of the maternity care system to better understand and meet the needs of immigrant women seems needed to mitigate the disparities.
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Selvaratnam RJ, Rolnik DL, Davey MA, Wallace EM. Stillbirth: are we making more progress than we think? A retrospective cohort study. BJOG 2021; 128:1304-1312. [PMID: 33539656 DOI: 10.1111/1471-0528.16665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify how the changing stillbirth risk profile of women is affecting the interpretation of the stillbirth rate. DESIGN A retrospective, population-based cohort study from 1983 to 2018. SETTING Victoria, Australia. POPULATION A total of 2 419 923 births at ≥28 weeks of gestation. METHODS Changes in maternal characteristics over time were assessed. A multivariable logistic regression model was developed for stillbirth, based on maternal characteristics in 1983-1987, and used to calculate individual predictive probabilities of stillbirth from the regression equation. The number of expected stillbirths per year as a result of the change in maternal demographics was then calculated, assuming no changes in care and in the associations between maternal characteristics and stillbirth over time. MAIN OUTCOME MEASURE Stillbirth. RESULTS Compared with 1983-1987, there were more women in older age groups giving birth, more nulliparous women, more indigenous women and women born in Oceania, Asia and Africa, more multiple pregnancies and more women with pre-existing diabetes in 2014-2018. Despite this, the rate of stillbirth fell from 5.42 per 1000 births in 1983 to 1.72 per 1000 births in 2018 (P < 0.001). Applying the multivariable logistic regression equation, derived from the 1983-87 data, to each year, had there been no changes in care or in the associations between maternal characteristics and stillbirth, the rate of stillbirth would have increased by 12%, from 4.94 per 1000 in 1983 to 5.54 per 1000 in 2018, as a result of the change in maternal characteristics. CONCLUSIONS Population rates of stillbirth are falling faster than is generally appreciated. TWEETABLE ABSTRACT Population reductions in stillbirth have been underestimated as a result of changing maternal characteristics.
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Affiliation(s)
- R J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - D L Rolnik
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - M-A Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Health and Human Services, Victorian Government, Victoria, Australia
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Burger RJ, Temmink JD, Wertaschnigg D, Ganzevoort W, Reddy M, Davey MA, Wallace EM, Mol BW. Trends in singleton preterm birth in Victoria, 2007 to 2017: A consecutive cross-sectional study. Acta Obstet Gynecol Scand 2021; 100:1230-1238. [PMID: 33382080 PMCID: PMC8359202 DOI: 10.1111/aogs.14074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 01/01/2023]
Abstract
Introduction Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries preterm birth rates are increasing, largely as a result of increases in iatrogenic preterm birth, whereas in other countries rates are stable or even declining. The objective of the study is to describe trends in singleton preterm births in Victoria from 2007 to 2017 in relation to trends in perinatal mortality to identify opportunities for improvements in clinical care. Material and methods We conducted a consecutive cross‐sectional study in all women with a singleton pregnancy giving birth at ≥20 weeks of pregnancy in Victoria, Australia, between 2007 and 2017, inclusive. Rates of preterm birth and perinatal mortality were calculated and trends were analyzed in all pregnancies, in pregnancies complicated by fetal growth problems, hypertension, (pre)eclampsia or prelabor rupture of membranes (PROM), and in (low‐risk) pregnancies not complicated by any of these conditions. Results There were 811 534 singleton births between 2007 and 2017. Preterm birth increased from 5.9% (4074 births) to 6.4% (4893 births; P < .001), due to an increase in iatrogenic preterm birth from 2.5% (1730 births) to 3.6% (2730 births; P < .001). Comparable trends were seen in pregnancies complicated by fetal growth problems and hypertension and in pregnancies not complicated by small for gestational age (SGA), hypertension, (pre)eclampsia or PROM (all P < .001). In pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM the perinatal mortality rate from 20 weeks of gestation fell (13 to 12 per 1000 births; P < .001). In pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM there was no significant change in the perinatal mortality from 28 weeks and no decrease in the preterm weekly prospective stillbirth risk. Conclusions The singleton preterm birth rate in Victoria is increasing, driven by an increase in iatrogenic preterm birth, both in pregnancies complicated by SGA and hypertension, and in pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM. While perinatal mortality decreased in the pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM, no significant reduction in perinatal mortality from 28 weeks or in preterm weekly prospective stillbirth risk was noted in the pregnancies not complicated by any of these conditions.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Josephina D Temmink
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Dagmar Wertaschnigg
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Wessel Ganzevoort
- Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Ben-Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
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24
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Young NE, Davies‐Tuck M, Malhotra A. Influence of maternal region of birth on neonatal outcomes of babies born small. Acta Paediatr 2021; 110:158-165. [PMID: 32460365 DOI: 10.1111/apa.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 11/28/2022]
Abstract
AIM To compare neonatal outcomes of small for gestational age (SGA) infants born to South Asian (SA)-born women and Australian/New Zealand (ANZ)-born women. METHODS Retrospective cohort study at a hospital network in Australia. Maternal and neonatal data were collected for infants born SGA between 2013 and 2017 to SA- or ANZ-born women. Rates of perinatal mortality and neonatal morbidities were analysed between groups. RESULTS A total of 1018 SA and 959 ANZ SGA infants were included. SA SGA babies were older (median [IQR] 39 [38-40] weeks) and heavier (2590 [2310-2780] grams) compared to ANZ SGA babies (38 [37-40] weeks and 2480 [2059-2740] grams; P < .001 for both). After adjustment for differences in demographics, SA SGA babies were 1.5 times more likely to develop hypothermia (CI: 1.16-1.88, P = .001), but 60% less likely to be born with a major congenital malformation (CI: 0.24-0.67, P = .001) and 36% less likely to need gavage feeding (CI: 0.43-0.93, P = .02) compared to ANZ SGA babies. CONCLUSION Small for gestational age babies of SA-born women have different neonatal outcomes as compared to those born to ANZ-born women. Further research into influence of maternal region of birth on placental function, organogenesis and body composition of SGA babies is warranted.
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Affiliation(s)
| | - Miranda Davies‐Tuck
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
| | - Atul Malhotra
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
- Monash Newborn Monash Children’s Hospital Melbourne Vic. Australia
- Department of Paediatrics Monash University Melbourne Vic. Australia
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25
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A hospital-based cohort study of gender and gestational age-specific body fat percentage at birth. Pediatr Res 2021; 89:231-237. [PMID: 32289811 DOI: 10.1038/s41390-020-0879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Birthweight is the most commonly used proxy marker but does not adequately define true nutritional status. Modalities like DXA (dual energy x-ray absorptiometry) and TOtal Body Electric Conductivity (TOBEC) have been validated to assess body composition but their accuracy in neonates has not been established. The PEAPOD (COSMED, Rome Italy) has been validated as an accurate tool for measuring percentage body fat (%BF) in newborns. The study aim was to determine the gender-specific %BF percentiles at different gestations (35-41 weeks) for a healthy population of newborn infants. A secondary aim was to determine whether there is any relationship between %BF and neonatal condition at birth (cord gas measurement). METHODS %BF was measured using air displacement plethysmography (PEAPOD) within 6 h of birth. RESULTS There is an increase in the mean %BF with increasing gestation for female and males from 36 weeks' gestation in the 7667 infants who underwent assessment. Females have a higher %BF than their male equivalents. There was no correlation between %BF and cord pH. CONCLUSION Gender and gestation are both important in determining the quantiles and mean %BF at birth. There was no correlation between low cord pH and %BF. IMPACT Measuring the percentage body fat (PEAPOD) at birth is a useful marker of an infant's nutritional status. This is the largest hospital-based cohort of gestational age and gender-specific %BF in healthy newborns. The normative graphs from this study will help to accurately determine high-risk infants with low %BF so they can be monitored appropriately.
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26
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Stillbirth in Australia 1: The road to now: Two decades of stillbirth research and advocacy in Australia. Women Birth 2020; 33:506-513. [PMID: 33092699 DOI: 10.1016/j.wombi.2020.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022]
Abstract
Stillbirth is a major public health problem with an enormous mortality burden and psychosocial impact on parents, families and the wider community both globally and in Australia. In 2015, Australia's late gestation stillbirth rate was over 30% higher than that of the best-performing countries globally, highlighting the urgent need for action. We present an overview of the foundations which led to the establishment of Australia's NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) in 2017 and highlight key activities in the following areas: Opportunities to expand and improve collaborations between research teams; Supporting the conduct and development of innovative, high quality, collaborative research that incorporates a strong parent voice; Promoting effective translation of research into health policy and/or practice; and the Regional and global work of the Stillbirth CRE. We highlight the first-ever Senate Inquiry into Stillbirth in Australia in 2018. These events ultimately led to the development of a National Stillbirth Action and Implementation Plan for Australia with the aims of reducing stillbirth rates by 20% over the next five years, reducing the disparity in stillbirth rates between advantaged and disadvantaged communities, and improving care for all families who experience this loss.
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27
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Rumbold AR, Yelland J, Stuart-Butler D, Forbes M, Due C, Boyle FM, Middleton P. Addressing stillbirth inequities in Australia: Steps towards a better future. Women Birth 2020; 33:520-525. [PMID: 33092701 DOI: 10.1016/j.wombi.2020.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Persistent disparities in stillbirth risk and care are present in Australia. Eliminating these disparities is possible with a commitment to enhancing and scaling up models of culturally safe maternity care shown to be effective for Aboriginal and Torres Strait Islander women and those of migrant and refugee backgrounds. Campaigns to improve public awareness of stillbirth also play an important role in reducing stillbirth risk and consequences. To achieve reach and impact in communities at risk, messaging needs to be framed around the social and cultural context of women's lives. Here we describe important initiatives underway within the Stillbirth Centre of Research Excellence to develop a coordinated national approach to stillbirth prevention and care in communities that bear a disproportionate burden of stillbirth.
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Affiliation(s)
- Alice R Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Jane Yelland
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia; Department of General Practice, University of Melbourne, Australia
| | - Deanna Stuart-Butler
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia
| | - Madeline Forbes
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, Australia
| | - Frances M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia; Institute for Social Science Research, The University of Queensland, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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28
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Andrews CJ, Ellwood D, Middleton PF, Gordon A, Nicholl M, Homer CSE, Morris J, Gardener G, Coory M, Davies-Tuck M, Boyle FM, Callander E, Bauman A, Flenady VJ. Implementation and evaluation of a quality improvement initiative to reduce late gestation stillbirths in Australia: Safer Baby Bundle study protocol. BMC Pregnancy Childbirth 2020; 20:694. [PMID: 33187483 PMCID: PMC7664588 DOI: 10.1186/s12884-020-03401-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2015, the stillbirth rate after 28 weeks (late gestation) in Australia was 35% higher than countries with the lowest rates globally. Reductions in late gestation stillbirth rates have steadily improved in Australia. However, to amplify and sustain reductions, more needs to be done to reduce practice variation and address sub-optimal care. Implementing bundles for maternity care improvement in the UK have been associated with a 20% reduction in stillbirth rates. A similar approach is underway in Australia; the Safer Baby Bundle (SBB) with five elements: 1) supporting women to stop smoking in pregnancy, 2) improving detection and management of fetal growth restriction, 3) raising awareness and improving care for women with decreased fetal movements, 4) improving awareness of maternal safe going-to-sleep position in late pregnancy, 5) improving decision making about the timing of birth for women with risk factors for stillbirth. METHODS This is a mixed-methods study of maternity services across three Australian states; Queensland, Victoria and New South Wales. The study includes evaluation of 'targeted' implementer sites (combined total approximately 113,000 births annually, 50% of births in these states) and monitoring of key outcomes state-wide across all maternity services. Progressive implementation over 2.5 years, managed by state Departments of Health, commenced from mid-2019. This study will determine the impact of implementing the SBB on maternity services and perinatal outcomes, specifically for reducing late gestation stillbirth. Comprehensive process, impact, and outcome evaluations will be conducted using routinely collected perinatal data, pre- and post- implementation surveys, clinical audits, focus group discussions and interviews. Evaluations explore the views and experiences of clinicians embedding the SBB into routine practice as well as women's experience with care and the acceptability of the initiative. DISCUSSION This protocol describes the evaluation of the SBB initiative and will provide evidence for the value of a systematic, but pragmatic, approach to strategies to reduce the evidence-practice gaps across maternity services. We hypothesise successful implementation and uptake across three Australian states (amplified nationally) will be effective in reducing late gestation stillbirths to that of the best performing countries globally, equating to at least 150 lives saved annually. TRIAL REGISTRATION The Safer Baby Bundle Study was retrospectively registered on the ACTRN12619001777189 database, date assigned 16/12/2019.
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Affiliation(s)
- C J Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- Gold Coast University Hospital, and School of Medicine, Griffith University, Gold Coast, Australia
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - M Nicholl
- University of Sydney, Sydney, NSW, Australia
| | - C S E Homer
- Burnet Institute, Melbourne, Victoria, Australia
| | - J Morris
- University of Sydney, Sydney, NSW, Australia
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
| | - M Coory
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
| | - M Davies-Tuck
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - E Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A Bauman
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - V J Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Mater Health Services, Level 3 Aubigny Place, South Brisbane, QLD, 4101, Australia.
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Green B, Howat P, Hui L. The predicted clinical workload associated with early post-term surveillance and inductions of labour in south Asian women in a non-tertiary hospital setting. Aust N Z J Obstet Gynaecol 2020; 61:244-249. [PMID: 33135779 DOI: 10.1111/ajo.13268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stillbirth increases steeply after 42 weeks gestation; hence, induction of labour (IOL) is recommended after 41 weeks. Recent Victorian data demonstrate that term stillbirth risk rises at an earlier gestation in south Asian mothers (SAM). AIMS To determine the impact on a non-tertiary hospital in Melbourne, Australia, if post-dates IOL were recommended one week earlier at 40 + 3 for SAM; and to calculate the proportion of infants with birthweight < 3rd centile that were undelivered by 40 weeks in SAM and non-SAM, as these cases may represent undetected fetal growth restriction. MATERIALS AND METHODS Singleton births ≥ 37 weeks during 2017-18 were extracted from the hospital Birthing Outcomes System. Obstetric and neonatal outcomes for pregnancies that birthed after spontaneous onset of labour or IOL were analysed according to gestation and country of birth. RESULTS There were 5408 births included, and 24.9% were born to SAM (n = 1345). SAM women had a higher rate of IOL ≥ 37 weeks compared with non-SAM women (42.5% vs 35.0%, P < 0.001). If all SAM accepted an offer of IOL at 40 + 3, there would be an additional 80 term inductions over two years. There was no significant difference in babies < 3rd centile undelivered by 40 weeks in SAM compared with non-SAM (29.6% vs 37.7%, P = 0.42). CONCLUSIONS Earlier IOL for post-term SAM would only modestly increase the demand on birthing services, due to pre-existing high rates of IOL. Our current practices appear to capture the majority at highest risk of stillbirth in our SAM population.
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Affiliation(s)
- Brittany Green
- Department of Obstetrics and Gynaecology, The Northern Hospital, Melbourne, Victoria, Australia
| | - Paul Howat
- Department of Obstetrics and Gynaecology, The Northern Hospital, Melbourne, Victoria, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, The Northern Hospital, Melbourne, Victoria, Australia
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30
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Berman Y, Ibiebele I, Randall D, Torvaldsen S, Nippita TA, Bowen J, Baldwin HJ, Todd SM, Morris JM, Ford JB, Patterson JA. Rates of neonatal morbidity by maternal region of birth and gestational age in New South Wales, Australia 2003-2016. Acta Obstet Gynecol Scand 2020; 100:331-338. [PMID: 33007108 DOI: 10.1111/aogs.14012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Research suggests that neonatal morbidity differs by maternal region of birth at different gestational ages. This study aimed to determine the overall and gestation-specific risk of neonatal morbidity by maternal region of birth, after adjustment for maternal, infant and birth characteristics, for women giving birth in New South Wales, Australia, from 2003 to 2016. MATERIAL AND METHODS The study utilized a retrospective cohort study design using linked births, hospital and deaths data. Modified Poisson regression was used to determine risk with 95% confidence intervals (95% CI) of neonatal morbidity by maternal region of birth, overall and at each gestational age, compared with Australian or New Zealand-born women giving birth at 39 weeks. RESULTS There were 1 074 930 live singleton births ≥32 weeks' gestation that met the study inclusion criteria, and 44 394 of these were classified as morbid, giving a neonatal morbidity rate of 4.13 per 100 live births. The gestational age-specific neonatal morbidity rate declined from 32 weeks' gestation, reaching a minimum at 39 weeks in all maternal regions of birth. The unadjusted neonatal morbidity rate was highest in South Asian-born women at most gestations. Adjusted rates of neonatal morbidity between 32 and 44 weeks were significantly lower for babies born to East (adjusted relative risk [aRR] 0.65, 95% CI 0.62-0.68), South-east (aRR 0.76, 95% CI 0.73-0.79) and West Asian-born (aRR 0.93, 95% CI 0.88-0.98) mothers, and higher for babies of Oceanian-born (aRR 1.11, 95% CI 1.04-1.18) mothers, compared with Australian or New Zealand-born mothers. Babies of African, Oceanian, South Asian and West Asian-born women had a lower adjusted risk of neonatal morbidity than Australian or New Zealand-born women until 37 or 38 weeks' gestation, and thereafter an equal or higher risk in the term and post-term periods. CONCLUSIONS Maternal region of birth is an independent risk factor for neonatal morbidity in New South Wales.
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Affiliation(s)
- Ye'elah Berman
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, NSW, Australia
| | - Ibinabo Ibiebele
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Deborah Randall
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Siranda Torvaldsen
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tanya A Nippita
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Obstetrics and Gynecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Jennifer Bowen
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Neonatology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Heather J Baldwin
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Stephanie M Todd
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, NSW, Australia
| | - Jonathan M Morris
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Obstetrics and Gynecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Jane B Ford
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
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31
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Davies-Tuck M, Ruzic M, Davey MA, Hodges R, Nowotny B, Flenady V, Andrews C, Wallace EM. Understanding staff views and experiences of a clinical practice change to reduce stillbirth in South Asian women: A cross-sectional survey. Women Birth 2020; 34:e390-e395. [PMID: 32828713 DOI: 10.1016/j.wombi.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In July 2017, Victoria's largest maternity service implemented a new clinical practice guideline to reduce the rates of term stillbirth in women of South Asian background. AIM To capture the views and experiences of clinical staff following the implementation of the new clinical guideline. METHODS Cross sectional survey of clinical staff providing maternity care in August 2018, 12 months post implementation. Staff were asked to provide their agreement with ten statements assessing: perceived need for the guideline, implementation processes, guideline clarity, and clinical application. Open-ended questions provided opportunities to express concerns and offer suggestions for improvement. The frequency of responses to each question were tabulated. Open ended responses were grouped together to identify themes. FINDINGS A total of 120 staff completed the survey, most (n=89, 74%) of whom were midwives. Most staff thought the rationale (n=95, 79%), the criteria for whom they applied (83%, n=99), and the procedures and instructions within the guideline were clear (74%, n=89). Staff reported an increase in workload (72%, n=86) and expressed concerns related to rationale and evaluation of the guidelines, lack of education for both staff and pregnant South Asian women, increased workload and insufficient resources, patient safety and access to care. Challenges relating to shared decision making and communicating with women whose first language is not English were also identified. DISCUSSION This study has identified key barriers to and opportunities for improving implementation and highlighted additional challenges relating to new clinical guidelines which focus on culturally and linguistically diverse women.
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Affiliation(s)
- Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
| | - Mikayla Ruzic
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Benjamin Nowotny
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; Safer Care Victoria, Melbourne, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; Safer Care Victoria, Melbourne, Australia
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Burger RJ, Temmink S, Wertaschnigg D, Ganzevoort W, Reddy M, Davey MA, Wallace EM, Mol BW. Trends in preterm birth in twin pregnancies in Victoria, Australia, 2007-2017. Aust N Z J Obstet Gynaecol 2020; 61:55-62. [PMID: 32820556 DOI: 10.1111/ajo.13227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries, the preterm birth rate in women with a multiple pregnancy is increasing, mostly due to an increase in iatrogenic preterm birth. AIMS To investigate trends in preterm birth in twin pregnancies in Victoria, Australia, in relation to maternal and perinatal complications. MATERIALS AND METHODS We conducted a retrospective population-based cohort study in all women with a twin pregnancy who delivered at or after 20 weeks of gestation in the state of Victoria, Australia between 2007 and 2017. Annual spontaneous and iatrogenic preterm birth rates were calculated and trends analysed. Incidence of adverse pregnancy outcomes, maternal complications and risk factors for preterm birth were analysed. RESULTS We studied 12 757 women with a twin pregnancy. Between 2007 and 2017 the preterm birth rate increased from 641/1231 (52%) to 803/1158 (69%), mainly due to an increase in iatrogenic preterm birth from 342/1231 (28%) to 567/1158 (49%). This was irrespective of the presence of pregnancy complications. Our study showed neither a decrease in perinatal mortality from 28 weeks of gestation nor in preterm average weekly prospective stillbirth risk. CONCLUSION Preterm birth rates in twins in Victoria are increasing, mainly driven by an increase in iatrogenic preterm birth. This occurred both in complicated and non-complicated twin pregnancies, and has not been accompanied by reduction in perinatal mortality from 28 weeks.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Obstetrics, University of Amsterdam, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Sofieke Temmink
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Obstetrics, University of Amsterdam, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Dagmar Wertaschnigg
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Wessel Ganzevoort
- Department of Obstetrics, University of Amsterdam, Amsterdam UMC, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Melbourne, Australia
| | - Euan Morrison Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Melbourne, Australia
| | - Ben-Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Namachivayam SP, Carlin JB, Millar J, Alexander J, Edmunds S, Ganeshalingham A, Lew J, Erickson S, Butt W, Schlapbach LJ, Ganu S, Festa M, Egan JR, Williams G, Young J. Gestational Age and Risk of Mortality in Term-Born Critically Ill Neonates Admitted to PICUs in Australia and New Zealand. Crit Care Med 2020; 48:e648-e656. [PMID: 32697505 DOI: 10.1097/ccm.0000000000004409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Gestational age at birth is declining, probably because more deliveries are being induced. Gestational age is an important modifiable risk factor for neonatal mortality and morbidity. We aimed to investigate the association between gestational age and mortality in hospital for term-born neonates (≥ 37 wk') admitted to PICUs in Australia and New Zealand. DESIGN Observational multicenter cohort study. SETTING PICUs in Australia and New Zealand. PATIENTS Term-born neonates (≥ 37 wk) admitted to PICUs. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS:: We studied 5,073 infants born with a gestational age greater than or equal to 37 weeks and were less than 28 days old when admitted to a PICU in Australia or New Zealand between 2007 and 2016. The association between gestational age and mortality was estimated using a multivariable logistic regression model, adjusting for age, sex, indigenous status, Pediatric Index of Mortality version 2, and site. The median gestational age was 39.1 weeks (interquartile range, 38.2-40 wk) and mortality in hospital was 6.6%. Risk of mortality declined log-linearly with gestational age. The adjusted analysis showed a 20% (95% CI, 11-28%) relative reduction in mortality for each extra week of gestation beyond 37 weeks. The effect of gestation was stronger among those who received extracorporeal life support: each extra week of gestation was associated with a 44% (95% CI, 25-57%) relative reduction in mortality. Longer gestation was also associated with reduced length of stay in hospital: each week increase in gestation, the average length of stay decreased by 4% (95% CI, 2-6%). CONCLUSIONS Among neonates born at "term" who are admitted to a PICU, increasing gestational age at birth is associated with a substantial reduction in the risk of dying in hospital. The maturational influence on outcome was more strongly noted in the sickest neonates, such as those requiring extracorporeal life support. This information is important in view of the increasing proportion of planned births in both high- and low-/middle-income countries.
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Affiliation(s)
- Siva P Namachivayam
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - John B Carlin
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Johnny Millar
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
| | - Janet Alexander
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
| | - Sarah Edmunds
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
| | | | - Jamie Lew
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Simon Erickson
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Warwick Butt
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - Luregn J Schlapbach
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - Subodh Ganu
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Marino Festa
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Jonathan R Egan
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Gary Williams
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Janelle Young
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Dominiek C, Natasha D, Foureur M, Spear V, Amanda H. Exploring unwarranted clinical variation: The attitudes of midwives and obstetric medical staff regarding induction of labour and planned caesarean section. Women Birth 2020; 34:352-361. [PMID: 32674990 DOI: 10.1016/j.wombi.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Unexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section. AIM To map attitudes and knowledge of maternity care professionals regarding indications for planned birth, and assess inter-professional (midwifery versus medical) and intra-professional variation. METHODS A custom-created survey of medical and midwifery staff at eight Sydney hospitals. Staff were asked to rate their level of agreement with 45 "evidence-based" statements regarding caesareans and inductions on a five-point Likert scale. Responses were grouped by profession, and comparisons made of inter- and intra-professional responses. FINDINGS Total 275 respondents, 78% midwifery and 21% medical. Considerable inter- and intra-professional variation was noted, with midwives generally less likely to consider any of the planned birth indications "valid" compared to medical staff. Indications for induction with most variation in midwifery responses included maternal characteristics (age≥40, obesity, ethnicity) and fetal macrosomia; and for medical personnel in-vitro fertilisation, maternal request, and routine induction at 39 weeks gestation. Indications for caesarean with most variation in midwifery responses included previous lower segment caesarean section, previous shoulder dystocia, and uncomplicated breech; and for medical personnel uncomplicated dichorionic twins. Indications with most inter-professional variation were induction at 41+ weeks versus 42+ weeks and cesarean for previous lower segment caesarean section. DISCUSSION Both inter- and intra-professional variation in what were considered valid indications reflected inconsistency in underlying evidence and/or guidelines. CONCLUSION Greater focus on interdisciplinary education and consensus, as well as on shared decision-making with women, may be helpful in resolving these tensions.
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Affiliation(s)
- Coates Dominiek
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia.
| | - Donnolley Natasha
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, UNSW, Sydney, Australia.
| | - Maralyn Foureur
- Hunter New England Nursing and Midwifery Research Centre, Australia; University of Newcastle, Faculty of Health and Medicine, Australia.
| | - Virginia Spear
- Royal Hospital for Women, South Easters Sydney Local Health District, Australia
| | - Henry Amanda
- School of Women's and Children's Health, UNSW Medicine, UNSW, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia.
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Yelland J, Mensah F, Riggs E, McDonald E, Szwarc J, Dawson W, Vanpraag D, Casey S, East C, Biro MA, Teale G, Willey S, Brown SJ. Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: An interrupted time series design. PLoS Med 2020; 17:e1003089. [PMID: 32649668 PMCID: PMC7351141 DOI: 10.1371/journal.pmed.1003089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/16/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this 'whole-of-system' approach was to improve access to antenatal care. The objective of this paper is to report refugee women's access to hospital-based antenatal care over the period of health system reforms. METHODS AND FINDINGS The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks' gestation compared over time and to Australian-born women using logistic regression analyses. In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks' gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting. CONCLUSIONS Accurate ascertainment of 'harder-to-reach' populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.
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Affiliation(s)
- Jane Yelland
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Mensah
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ellie McDonald
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Wendy Dawson
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Dannielle Vanpraag
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Christine East
- School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Mercy Health and La Trobe University, Bundoora, Victoria, Australia
| | - Mary Anne Biro
- School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Glyn Teale
- Women’s and Children’s, Western Health, Sunshine, Victoria, Australia
| | - Sue Willey
- School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Stephanie J. Brown
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Profile of severely growth-restricted births undelivered at 40 weeks in Western Australia. Arch Gynecol Obstet 2020; 301:1383-1396. [PMID: 32318796 DOI: 10.1007/s00404-020-05537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the proportion of severely growth-restricted singleton births < 3rd percentile (proxy for severe fetal growth restriction; FGR) undelivered at 40 weeks (FGR_40), and compare maternal characteristics and outcomes of FGR_40 births and FGR births at 37-39 weeks' (FGR_37-39) to those not born small-for-gestational-age at term (Not SGA_37+). METHODS The annual rates of singleton FGR_40 births from 2006 to 2015 were calculated using data from linked Western Australian population health datasets. Using 2013-2015 data, maternal factors associated with FGR births were investigated using multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CI) while relative risks (RR) of birth outcomes between each group were calculated using Poisson regression. Neonatal adverse outcomes were identified using a published composite indicator (diagnoses, procedures and other factors). RESULTS The rate of singleton FGR_40 births decreased by 23.0% between 2006 and 2015. Factors strongly associated with FGR_40 and FGR_37-39 births compared to Not SGA_37+ births included the mother being primiparous (ORs 3.13: 95% CI 2.59-3.79; 1.69, 95% CI 1.47, 1.94, respectively) and ante-natal smoking (ORs 2.55, 95% CI 1.97, 3.32; 4.48, 95% CI 3.74, 5.36, respectively). FGR_40 and FGR_37-39 infants were more likely to have a neonatal adverse outcome (RRs 1.70, 95% CI 1.41, 2.06 and 2.46 95% CI 2.18, 2.46, respectively) compared to Not SGA 37+ infants. CONCLUSIONS Higher levels of poor perinatal outcomes among FGR births highlight the importance of appropriate management including fetal growth monitoring. Regular population-level monitoring of FGR_40 rates may lead to reduced numbers of poor outcomes.
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Mozooni M, Preen DB, Pennell CE. The influence of acculturation on the risk of stillbirth in migrant women residing in Western Australia. PLoS One 2020; 15:e0231106. [PMID: 32240255 PMCID: PMC7117748 DOI: 10.1371/journal.pone.0231106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/16/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate the influence of acculturation, demonstrated by age on arrival, length of residence, interpreter use and having an Australian-born partner, on disparities observed in the risk of stillbirth between migrant and Australian-born populations in Western Australia (WA). Methods A retrospective cohort study using linked administrative health data for all non-Indigenous births in WA from 2005–2013 was performed. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Adjusted odds ratios (aOR) for stillbirth in migrants from six ethnicities of white, Asian, Indian, African, Māori, and ‘other’, with different levels of acculturation, were compared with Australian-born women using multivariable logistic regression analysis and marital status, maternal age group, socioeconomic status, parity, plurality, previous stillbirth, any medical conditions, any pregnancy complications, sex of baby, and smoking during pregnancy as the covariates. Results From all births studied, 172,571 (66%) were to Australian-born women and 88,395 (34%) to migrant women. Women from African, Indian and Asian backgrounds who gave birth in the first two years after arrival in Australia experienced the highest risk of stillbirth (aOR 3.32; 95% CI 1.70–6.47, aOR 2.71; 95% CI 1.58–4.65, aOR 1.93; 95% CI 1.21–3.05 respectively) compared with Australian-born women. This association attenuated with an increase in the length of residence in Asian and Indian women, but the risk of stillbirth remained elevated in African women after five years of residence (aOR 1.96 [1.10–3.49]). Interpreter use and an Australian-born partner were associated with 56% and 20% lower odds of stillbirth in migrants (p<0.05), respectively. Conclusions Acculturation is a multidimensional process and may lower the risk of stillbirth through better communication and service utilisation and elevate such risk through increase in prevalence of smoking in pregnancy; the final outcome depends on how these factors are in play in a population. It is noteworthy that in women of African background risk of stillbirth remained elevated for longer periods after immigrating to Australia extending beyond five years. For migrants from Asian and Indian backgrounds, access to services, in the first two years of residence, may be more relevant. Enhanced understanding of barriers to accessing health services and factors influencing and influenced by acculturation may help developing interventions to reduce the burden of stillbirth in identified at-risk groups.
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Affiliation(s)
- Maryam Mozooni
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- * E-mail:
| | - David Brian Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Craig Edward Pennell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
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Mozooni M, Pennell CE, Preen DB. Healthcare factors associated with the risk of antepartum and intrapartum stillbirth in migrants in Western Australia (2005-2013): A retrospective cohort study. PLoS Med 2020; 17:e1003061. [PMID: 32182239 PMCID: PMC7077810 DOI: 10.1371/journal.pmed.1003061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Māori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Māori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Māori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.
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Affiliation(s)
- Maryam Mozooni
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Craig E. Pennell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - David B. Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Gurung A, Bajracharya K, Gurung R, Budhathoki SS, KC NP, Shrestha PR, KC A. The Association of Women's Empowerment with Stillbirths in Nepal. Matern Child Health J 2020; 24:15-21. [PMID: 31784858 PMCID: PMC7048701 DOI: 10.1007/s10995-019-02827-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women's ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women's empowerment is associated with stillbirths. METHODS Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women's empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted. RESULTS A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22-4.80). Education of mother (aOR 1.48; 0.94-2.33), age of husband (aOR 1.54; 0.86-2.76), household head (aOR 1.51; 0.88-2.59), poor wealth index (aOR 1.62; 0.98-2.68), middle wealth index (aOR 1.37; 0.76-2.47), decision making for healthcare (aOR 1.36; 0.84-2.21) and household purchases (aOR 1.01; 0.61-1.66) had no any significant association with stillbirths. CONCLUSIONS There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.
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Affiliation(s)
| | | | | | - Shyam Sundar Budhathoki
- Golden Community, Lalitpur, Nepal
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Naresh Pratap KC
- Golden Community, Lalitpur, Nepal
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
| | | | - Ashish KC
- Department of Women’s and Children’s Health, International Maternal and Child Health, University Hospital, 751 85 Uppsala, Sweden
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Cox AG, Narula S, Malhotra A, Fernando S, Wallace E, Davies-Tuck M. The influence of maternal ethnicity on neonatal respiratory outcome. Arch Dis Child Fetal Neonatal Ed 2020; 105:50-55. [PMID: 31123055 DOI: 10.1136/archdischild-2018-316418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Higher rates of neonatal morbidity and mortality at term combined with earlier spontaneous delivery have led to the hypothesis that babies born to South Asian born (SA-born) women may mature earlier and/or their placental function decreases earlier than babies born to Australian and New Zealand born (Aus/NZ-born) women. Whether babies born to SA-born women do better in the preterm period, however, has yet to be evaluated. In this study we investigated respiratory outcomes, indicative of functional maturity, of preterm babies born to SA-born women compared with those of Aus/NZ-born women to explore this hypothesis further. STUDY DESIGN AND SETTING This retrospective cohort study was conducted at Monash Health. PATIENTS Data were collected from neonatal and birth records of moderate-late preterm (32-36 weeks) infants born between 2012 and 2015 to SA-born and Aus/NZ-born women. OUTCOME MEASURES Rates of nursery admissions and neonatal respiratory outcomes were compared. RESULTS Babies born to Aus/NZ-born women were more likely to be admitted to a nursery (80%) compared with SA-born babies (72%, p=0.004). Babies born to SA-born mothers experienced significantly less hyaline membrane disease (7.8%), required less resuscitation at birth (28.6%) and were less likely to require ventilation (20%) than babies born to Aus/NZ-born mothers (18%, 42.2%, 34.6%; p<0.001). There was no difference in the duration of ventilation or length of stay in hospital. CONCLUSIONS Moderate-late preterm babies born to SA-born women appear to have earlier functional maturity, as indicated by respiratory outcomes, than Aus/NZ-born babies. Our findings support the hypothesis of earlier fetal maturation in SA-born women.
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Affiliation(s)
- Annie Georgina Cox
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Shagun Narula
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Atul Malhotra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| | - Shavi Fernando
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Euan Wallace
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Miranda Davies-Tuck
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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41
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Flenady V, Gardener G, Boyle FM, Callander E, Coory M, East C, Ellwood D, Gordon A, Groom KM, Middleton PF, Norman JE, Warrilow KA, Weller M, Wojcieszek AM, Crowther C. My Baby's Movements: a stepped wedge cluster randomised controlled trial to raise maternal awareness of fetal movements during pregnancy study protocol. BMC Pregnancy Childbirth 2019; 19:430. [PMID: 31752771 PMCID: PMC6873438 DOI: 10.1186/s12884-019-2575-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background Stillbirth is a devastating pregnancy outcome that has a profound and lasting impact on women and families. Globally, there are over 2.6 million stillbirths annually and progress in reducing these deaths has been slow. Maternal perception of decreased fetal movements (DFM) is strongly associated with stillbirth. However, maternal awareness of DFM and clinical management of women reporting DFM is often suboptimal. The My Baby’s Movements trial aims to evaluate an intervention package for maternity services including a mobile phone application for women and clinician education (MBM intervention) in reducing late gestation stillbirth rates. Methods/design This is a stepped wedge cluster randomised controlled trial with sequential introduction of the MBM intervention to 8 groups of 3–5 hospitals at four-monthly intervals over 3 years. The target population is women with a singleton pregnancy, without lethal fetal abnormality, attending for antenatal care and clinicians providing maternity care at 26 maternity services in Australia and New Zealand. The primary outcome is stillbirth from 28 weeks’ gestation. Secondary outcomes address: a) neonatal morbidity and mortality; b) maternal psychosocial outcomes and health-seeking behaviour; c) health services utilisation; d) women’s and clinicians’ knowledge of fetal movements; and e) cost. 256,700 births (average of 3170 per hospital) will detect a 30% reduction in stillbirth rates from 3/1000 births to 2/1000 births, assuming a significance level of 5%. Analysis will utilise generalised linear mixed models. Discussion Maternal perception of DFM is a marker of an at-risk pregnancy and commonly precedes a stillbirth. MBM offers a simple, inexpensive resource to reduce the number of stillborn babies, and families suffering the distressing consequences of such a loss. This large pragmatic trial will provide evidence on benefits and potential harms of raising awareness of DFM using a mobile phone app. Trial registration ACTRN12614000291684. Registered 19 March 2014. Version Protocol Version 6.1, February 2018.
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Affiliation(s)
- V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.
| | - G Gardener
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,Department of Maternal Fetal Medicine, Mater Misericordiae Limited, Brisbane, Australia
| | - F M Boyle
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - E Callander
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - M Coory
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - C East
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,School of Nursing and Midwifery, Monash University and Monash Women's Maternity Services, Clayton, Victoria, Australia.,School of Nursing & Midwifery, La Trobe University, Melbourne, Brazil
| | - D Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,School of Medicine, Griffith University, Gold Coast, Australia.,Gold Coast University Hospital, Southport, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - P F Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - K A Warrilow
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - M Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - A M Wojcieszek
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Level 3 Aubigny Place Mater Research, South Brisbane QLD, Brisbane, 4101, Australia
| | - C Crowther
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Berman Y, Ibiebele I, Patterson JA, Randall D, Ford JB, Nippita T, Morris JM, Davies‐Tuck ML, Torvaldsen S. Rates of stillbirth by maternal region of birth and gestational age in New South Wales, Australia 2004–2015. Aust N Z J Obstet Gynaecol 2019; 60:425-432. [DOI: 10.1111/ajo.13085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/17/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ye’elah Berman
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- NSW Biostatistics Training Program NSW Ministry of Health SydneyNew South WalesAustralia
| | - Ibinabo Ibiebele
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- Northern Sydney Local Health District Kolling Institute New South WalesAustralia
| | - Jillian A. Patterson
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- Northern Sydney Local Health District Kolling Institute New South WalesAustralia
| | - Deborah Randall
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- Northern Sydney Local Health District Kolling Institute New South WalesAustralia
| | - Jane B. Ford
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- Northern Sydney Local Health District Kolling Institute New South WalesAustralia
| | - Tanya Nippita
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- Northern Sydney Local Health District Kolling Institute New South WalesAustralia
- Department of Obstetrics and Gynaecology Royal North Shore Hospital Northern Sydney Local Health District Sydney New South WalesAustralia
| | - Jonathan M. Morris
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- Northern Sydney Local Health District Kolling Institute New South WalesAustralia
- Department of Obstetrics and Gynaecology Royal North Shore Hospital Northern Sydney Local Health District Sydney New South WalesAustralia
| | - Miranda L. Davies‐Tuck
- The Ritchie Centre Hudson Institute of Medical Research MelbourneVictoriaAustralia
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity VIC Department of Health Melbourne VictoriaAustralia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School Women and Babies Research St LeonardsNew South WalesAustralia
- Northern Sydney Local Health District Kolling Institute New South WalesAustralia
- School of Public Health and Community Medicine UNSW Sydney New South Wales Australia
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Choi SKY, Henry A, Hilder L, Gordon A, Jorm L, Chambers GM. Adverse perinatal outcomes in immigrants: A ten-year population-based observational study and assessment of growth charts. Paediatr Perinat Epidemiol 2019; 33:421-432. [PMID: 31476081 DOI: 10.1111/ppe.12583] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/16/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternity populations are becoming increasingly multiethnic. Conflicting findings exist regarding the risk of adverse perinatal outcomes among immigrant mothers from different world regions and which growth charts are most appropriate for identifying the risk of adverse outcomes. OBJECTIVE To evaluate whether infant mortality and morbidity, and the categorisation of infants as small for gestational age or large for gestational age (SGA or LGA) vary by maternal country of birth, and to assess whether the choice of growth chart alters the risk of adverse outcomes in infants categorised as SGA and LGA. METHODS A population cohort of 601 299 singleton infants born in Australia to immigrant mothers was compared with 1.7 million infants born to Australian-born mothers, 2004-2013. Infants were categorised as SGA and LGA according to a descriptive Australian population-based birthweight chart (Australia-2012 reference) and the prescriptive INTERGROWTH-21st growth standard. Propensity score reweighting was used for the analysis. RESULTS Compared to Australian-born infants, infants of mothers from Africa, Philippines, India, other Asia countries, and the Middle East had between 15.4% and 48.1% elevated risk for stillbirth, preterm delivery, or low Apgar score. The association between SGA and LGA and perinatal mortality varied markedly by growth chart and country of birth. Notably, SGA infants from African-born mothers had a relative risk of perinatal mortality of 6.1 (95% CI 4.3, 6.7) and 17.3 (95% CI 12.0, 25.0) by the descriptive and prescriptive charts, respectively. LGA infants born to Australian-born mothers were associated with a 10% elevated risk of perinatal mortality by the descriptive chart compared to a 15% risk reduction by the prescriptive chart. CONCLUSIONS Country-of-birth-specific variations are becoming increasingly important for providing ethnically appropriate and safe maternity care. Our findings highlight significant variations in risk of adverse perinatal outcomes in immigrant subgroups, and demonstrate how the choice of growth chart alters the quantification of risk associated with being born SGA or LGA.
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Affiliation(s)
- Stephanie K Y Choi
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amanda Henry
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia
| | - Lisa Hilder
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Adrienne Gordon
- Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Louisa Jorm
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Georgina M Chambers
- Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Walker RE, Choi TST, Quong S, Hodges R, Truby H, Kumar A. "It's not easy" - A qualitative study of lifestyle change during pregnancy. Women Birth 2019; 33:e363-e370. [PMID: 31587965 DOI: 10.1016/j.wombi.2019.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Maternal lifestyle in the months leading up to conception and throughout pregnancy has both immediate and transgenerational impacts on offspring health. AIM To explore how women's lifestyles change when they become pregnant, and their perspectives of the lifestyle advice they receive throughout pregnancy. METHODS A descriptive qualitative approach was used. Semi-structured interviews with 17 childbearing women (mean gestational age, 30.2 ± 2.0 weeks) recruited from a large hospital network in Victoria, Australia between July and October 2018 were transcribed and analysed using an inductive process of thematic analysis. FINDINGS Three themes and six sub-themes were identified. Lifestyle change during pregnancy was highly influenced by participants' preconception lifestyle, the physiological demands of pregnancy and the pressures of daily life. While participants proactively sought lifestyle advice from a range of sources, including the Internet, they were generally less proactive in seeking advice during routine maternity care visits. Participants appreciated the lifestyle advice they received from health professionals, including midwives, as part of their maternity care despite acknowledging that they often received it only if they asked. Overall, it seemed that the lifestyle advice received from health professionals was much less influential on maternal lifestyle behaviour change than the broader socio-ecological environment. CONCLUSION Childbearing women want lifestyle advice that supports positive lifestyle change during pregnancy and health professionals, including midwives, must be proactive as they provide it. Other factors that impact on childbearing women's capability and opportunity to make lifestyle change should be considered when providing advice that supports positive lifestyle behaviour change.
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Affiliation(s)
- Ruth E Walker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Level 1 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia.
| | - Tammie S T Choi
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Level 1 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
| | - Sara Quong
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Level 1 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia; Department of Nutrition and Dietetics, Monash Health, Clayton Road, Clayton, Victoria 3168, Australia
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton Road, Clayton, Victoria 3168, Australia
| | - Helen Truby
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Level 1 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
| | - Arunaz Kumar
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton Road, Clayton, Victoria 3168, Australia
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Yelland J, Riggs E, Szwarc J, Brown SJ. Ending preventable stillbirths among migrant and refugee populations. Med J Aust 2019; 210:488-489.e1. [DOI: 10.5694/mja2.50199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jane Yelland
- Intergenerational Health Research GroupMurdoch Children's Research Institute Melbourne VIC
- University of Melbourne Melbourne VIC
| | - Elisha Riggs
- Intergenerational Health Research GroupMurdoch Children's Research Institute Melbourne VIC
- University of Melbourne Melbourne VIC
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture Melbourne VIC
| | - Stephanie J Brown
- Intergenerational Health Research GroupMurdoch Children's Research Institute Melbourne VIC
- University of Melbourne Melbourne VIC
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Hogan R, Rossiter C, Catling C. Cultural empathy in midwifery students: Assessment of an education program. NURSE EDUCATION TODAY 2018; 70:103-108. [PMID: 30172985 DOI: 10.1016/j.nedt.2018.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/12/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The ability of midwives to provide empathic care that is culturally appropriate is critical for women to feel accepted by the midwives who support them. Australia is a culturally diverse society, yet there is evidence of poorer maternity outcomes for some women and infants, related to their cultural background. OBJECTIVES This study's objective was to evaluate the effectiveness of an education program for student midwives. The program was intended to increase the cultural empathy of future midwives, to help ensure greater cultural safety and optimal maternity outcomes across all sections of Australian society. DESIGN This quantitative study compared pre- and post-intervention measures of students' empathy. SETTING The health faculty of a large urban university in Australia. PARTICIPANTS Fifty-five students from all three years of an undergraduate midwifery program participated. METHODS The study examined students' scores on the Jefferson Scale of Empathy for health profession students, measured before and immediately after the education program, and again after four weeks. RESULTS The midwifery students had a high mean baseline score on the empathy scale. Scores increased significantly after the education program. Students with lower pre-test scores recorded significantly greater increases in their empathy levels than those who were more empathic initially. Empathy scores declined one month after the program, but remained higher than baseline levels. CONCLUSIONS Several studies have explored empathy levels amongst current and future health professionals. However, few studies of health professional students have evaluated the impact of specific education interventions addressing cultural empathy. This study found that midwifery students tended to have higher empathy scores than students in other health disciplines. The education workshop further increased participants' scores.
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Affiliation(s)
- Rosemarie Hogan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
| | - Chris Rossiter
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
| | - Christine Catling
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia.
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Antecedents of Abnormally Invasive Placenta in Primiparous Women: Risk Associated With Gynecologic Procedures. Obstet Gynecol 2018; 131:227-233. [PMID: 29324602 DOI: 10.1097/aog.0000000000002434] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association between prior invasive gynecologic procedures and the risk of subsequent abnormally invasive placenta (ie, placenta accreta, increta, and percreta). METHODS We conducted a population-based data linkage study including all primiparous women who delivered in New South Wales, Australia, between 2003 and 2012. Data were obtained from linked birth and hospital admissions with a minimum lookback period of 2 years. Prior procedures invasive of the uterus were considered including gynecologic laparoscopy with instrumentation of the uterus; hysteroscopy, including operative hysteroscopy; curettage, including suction curettage and surgical termination; and endometrial ablation. Modified Poisson regression was used to determine the association between the number of prior gynecologic procedures and risk of abnormally invasive placenta. RESULTS Eight hundred fifty-four cases of abnormally invasive placenta were identified among 380,775 deliveries included in the study (22.4/10,000). In total, 33,296 primiparous women had at least one prior procedure (8.7%). Among women with abnormally invasive placenta, 152 (17.8%) had undergone at least one procedure compared with 33,144 (8.7%) among women without abnormally invasive placenta (P<.01). After adjustment, the relative risk was 1.5 for one procedure (99% CI 1.1-1.9), 2.7 for two procedures (99% CI 1.7-4.4), and 5.1 for three or more procedures (99% CI 2.7-9.6). Abnormally invasive placenta was also positively associated with maternal age, socioeconomic advantage, mother being Australia-born, placenta previa, hypertension, multiple births, use of assisted reproductive technology, and female fetal sex. CONCLUSION Women with a history of prior invasive gynecologic procedures were more likely to develop abnormally invasive placenta. These insights may be used to inform management of pregnancies in women with a history of gynecologic procedures.
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Carr BL, Copnell B, McIntyre M. Differences in meconium stained amniotic fluid in an Australian population: A retrospective study. Women Birth 2018; 32:e259-e263. [PMID: 29954687 DOI: 10.1016/j.wombi.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meconium stained amniotic fluid commonly occurs postdates ( >40 weeks gestation) indicating fetal maturity. Previous literature indicates that different ethnicities mature at different rates. AIM To compare the rate of meconium stained amniotic fluid of Australian-born and non-Australian born women. METHODS A retrospective correlation study design was implemented, using data collected in the birth outcomes system at one tertiary hospital. Data was collected from all women who gave birth to a term (>/=37 weeks gestation), singleton, liveborn baby between January 1st to December 31st, 2014. Maternal country of birth was used for comparison. Categorical data was analyzed using Chi-Square test for Independence. Continuous variables were assessed for normality, and differences were compared using an Independent t-test or a Mann-Whitney U test. All tests were two-tailed and p<0.05 was considered statistically significant. RESULTS 3,041 women were included; 1131 Australian-born and 1910 non-Australian born. Meconium stained amniotic fluid occurred more frequently in non-Australian born women compared to Australian-born women (23.5% vs. 19.8 p=0.02). Their babies were significantly smaller (Mean=3265g, Standard Deviation 463.8 vs Mean=3442g, Standard Deviation 499.2, p<0.001), with no difference in gestational length (Mean=39.4, Standard Deviation 1.28 vs Mean=39.5, Standard Deviation 1.18, p=0.06). Increasing gestational age had the strongest association with meconium stained amniotic fluid; >/=42 weeks gestation occurring 3.52 (95% Confidence Interval: 2.00, 6.22, p=<0.001) more than <40 weeks gestation. CONCLUSION Maternity health services should record ethnicity and region of birth to provide individualised care as women born overseas often have poorer perinatal outcomes when compared to Australian-born women.
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Affiliation(s)
- Bethany L Carr
- Monash University, School of Nursing and Midwifery, McMahons Rd, Frankston 3199, VIC, Australia; Monash Medical Centre, Women's & Children's Program, 246 Clayton Rd, Clayton 3168, VIC, Australia.
| | - Beverley Copnell
- La Trobe University, School of Nursing and Midwifery Centre, Plenty Rd & Kingsbury Dve, Bundoora 3086, VIC, Australia
| | - Meredith McIntyre
- Monash University, School of Nursing and Midwifery, McMahons Rd, Frankston 3199, VIC, Australia
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