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Wong GP, Hartmann S, Simmons DG, Ellis S, Nonn O, Cannon P, Nguyen TV, Nguyen A, Bartho LA, Tong S, Hannan NJ, Kaitu'u-Lino TJ. Trophoblast Side-Population Markers are Dysregulated in Preeclampsia and Fetal Growth Restriction. Stem Cell Rev Rep 2024:10.1007/s12015-024-10764-w. [PMID: 39028417 DOI: 10.1007/s12015-024-10764-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
Dysregulated progenitor cell populations may contribute to poor placental development and placental insufficiency pathogenesis. Side-population cells possess progenitor properties. Recent human trophoblast side-population isolation identified enrichment of 8 specific genes (CXCL8, ELL2, GATA6, HK2, HLA-DPB1, INTS6, SERPINE3 and UPP1) (Gamage et al. 2020, Stem Cell Rev Rep). We characterised these trophoblast side-population markers in human placenta and in placental insufficiency disorders: preeclampsia and fetal growth restriction (FGR). Trophoblast side-population markers localised to mononuclear trophoblasts lining the placental villous basement membrane in preterm control, preeclamptic and FGR placental sections (n = 3, panel of 3 markers/serial section). Analysis of single-cell transcriptomics of an organoid human trophoblast stem cell (hTSC) to extravillous trophoblast (EVT) differentiation model (Shannon et al. 2022, Development) identified that all side-population genes were enriched in mononuclear trophoblast and trophoblasts committed to differentiation under hTSC culture conditions. In vitro validation via 96 h time course hTSC differentiation to EVTs or syncytiotrophoblasts (n = 5) demonstrated ELL2 and HK2 increased with differentiation (p < 0.0024, p < 0.0039 respectively). CXCL8 and HLA-DPB1 were downregulated (p < 0.030, p < 0.011 respectively). GATA6 and INTS6 increased with EVT differentiation only, and UPP1 reduced with syncytialisation. SERPINE3 was undetectable. Trophoblast side-population marker mRNA was measured in human placentas (< 34-weeks' gestation; n = 78 preeclampsia, n = 30 FGR, and n = 18 gestation-matched controls). ELL2, HK2 and CXCL8 were elevated in preeclamptic (p = 0.0006, p < 0.0001, p = 0.0335 respectively) and FGR placentas (p = 0.0065, p < 0.0001, p = 0.0001 respectively) versus controls. Placental GATA6 was reduced in pregnancies with preeclampsia and FGR (p = 0.0014, p = 0.0146 respectively). Placental INTS6 was reduced with FGR only (p < 0.0001). This study identified the localisation of a unique trophoblast subset enriched for side-population markers. Aberrant expression of some side-population markers may indicate disruptions to unique trophoblast subtypes in placental insufficiency.
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Affiliation(s)
- Georgia P Wong
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia.
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
| | - Sunhild Hartmann
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - David G Simmons
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Sarah Ellis
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, 3084, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Olivia Nonn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Ping Cannon
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Tuong-Vi Nguyen
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anna Nguyen
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Lucy A Bartho
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Natalie J Hannan
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Tu'uhevaha J Kaitu'u-Lino
- The Department of Obstetrics, Gynaecology and Newborn Health, Mercy Hospital for Women, University of Melbourne, 163 Studley Road, Heidelberg, Victoria, 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Stoke R, Crawford K, Jardine L, Kumar S. Maternal perception of decreased fetal movements is independent of infant size. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:79-86. [PMID: 38237047 DOI: 10.1002/uog.27587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Fetal movements are often used as a surrogate for fetal wellbeing. Previous research suggests a link between maternal perception of decreased fetal movements (DFM) and small-for-gestational-age (SGA) infants. The aim of this study was to investigate the association between maternal presentation with DFM and birth-weight centile categories at a large Australian perinatal center. METHODS This was a retrospective study of non-anomalous singleton infants born at ≥ 28 + 0 weeks' gestation between January 2016 and October 2020 at the Mater Mothers' Hospital in Brisbane, Australia. The primary outcome was the rate of DFM according to birth-weight centile category. Maternal demographic characteristics included age, body mass index, ethnicity, parity, medical conditions and previous stillbirth. The association between DFM and birth-weight centile was evaluated using adjusted multinomial regression models. Robust standard errors were used to account for clustering at the patient level. Wald tests and Akaike's and Bayesian information criteria were used to evaluate models. RESULTS Over the 5-year study period, 45 042 women met the inclusion criteria. Of these, 6690 (14.9%) women presented with DFM. Of the DFM cohort, 80.9% (5411/6690) had only one presentation with DFM, and 19.1% (1279/6690) had two or more presentations. The overall stillbirth rate was similar in women with DFM (0.1% (8/6690)) and those without DFM (0.1% (50/38 352)). There was no association between DFM (either single or multiple) and infant birth-weight centile. CONCLUSIONS This study suggests that presentation with DFM is not associated with infant size. Clinicians should consider additional risk factors and the overall clinical context when deciding appropriate management. DFM is not necessarily an indication for an immediate or urgent ultrasound scan to assess fetal size. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Stoke
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - K Crawford
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
| | - L Jardine
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, South Brisbane, Queensland, Australia
- Centre for Maternal and Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
- NHMRC Stillbirth Centre for Research Excellence, Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
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Ahmed MA, Bailey HD, Pereira G, White SW, Wong K, Marriott R, Hare MJL, McNamara BJ, Shepherd CCJ. Shoulder dystocia in babies born to Aboriginal mothers with diabetes: a population-based cohort study, 1998-2015. BMC Pregnancy Childbirth 2024; 24:395. [PMID: 38816708 PMCID: PMC11137982 DOI: 10.1186/s12884-024-06484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/05/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Australian Aboriginal and Torres Strait Islander women with diabetes in pregnancy (DIP) are more likely to have glycaemic levels above the target range, and their babies are thus at higher risk of excessive fetal growth. Shoulder dystocia, defined by failure of spontaneous birth of fetal shoulder after birth of the head requiring obstetric maneuvers, is an obstetric emergency that is strongly associated with DIP and fetal size. The aim of this study was to investigate the epidemiology of shoulder dystocia in Aboriginal babies born to mothers with DIP. METHODS Stratifying by Aboriginal status, characteristics of births complicated by shoulder dystocia in women with and without DIP were compared and incidence and time-trends of shoulder dystocia were described. Compliance with guidelines aiming at preventing shoulder dystocia in women with DIP were compared. Post-logistic regression estimation was used to calculate the population attributable fractions (PAFs) for shoulder dystocia associated with DIP and to estimate probabilities of shoulder dystocia in babies born to mothers with DIP at birthweights > 3 kg. RESULTS Rates of shoulder dystocia from vaginal births in Aboriginal babies born to mothers with DIP were double that of their non-Aboriginal counterparts (6.3% vs 3.2%, p < 0.001), with no improvement over time. Aboriginal mothers with diabetes whose pregnancies were complicated by shoulder dystocia were more likely to have a history of shoulder dystocia (13.1% vs 6.3%, p = 0.032). Rates of guideline-recommended elective caesarean section in pregnancies with diabetes and birthweight > 4.5 kg were lower in the Aboriginal women (28.6% vs 43.1%, p = 0.004). PAFs indicated that 13.4% (95% CI: 9.7%-16.9%) of shoulder dystocia cases in Aboriginal (2.7% (95% CI: 2.1%-3.4%) in non-Aboriginal) women were attributable to DIP. Probability of shoulder dystocia among babies born to Aboriginal mothers with DIP was higher at birthweights > 3 kg. CONCLUSIONS Aboriginal mothers with DIP had a higher risk of shoulder dystocia and a stronger association between birthweight and shoulder dystocia. Many cases were recurrent. These factors should be considered in clinical practice and when counselling women.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, Perth, Australia.
- School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - Helen D Bailey
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
| | - Matthew J L Hare
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Barwon South West Public Health Unit, Barwon Health, Geelong, Victoria, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
- Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
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McLean MA, Klimos C, Lequertier B, Keedle H, Elgbeili G, Kildea S, King S, Dahlen HG. Model of perinatal care but not prenatal stress exposure is associated with birthweight and gestational age at Birth: The Australian birth in the time of COVID (BITTOC) study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100981. [PMID: 38739983 DOI: 10.1016/j.srhc.2024.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/24/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The present study aimed to understand, relative to standard care, whether continuity of care models (private midwifery, continuity of care with a private doctor, continuity of care with a public midwife), and women's experience of maternity care provision, during the perinatal period buffered the association between prenatal maternal stress (PNMS) and infant birth outcomes (gestational age [GA], birth weight [BW] and birth weight for gestational age [BW for GA]). METHODS 2207 women who were pregnant in Australia while COVID-19 restrictions were in place reported on their COVID-19 related objective hardship and subjective distress during pregnancy and provided information on their model of maternity care. Infant birth outcomes (BW, GA) were reported on at 2-months postpartum. RESULTS Multiple linear regressions showed no relationship between PNMS and infant BW, GA or BW for GA, and neither experienced continuity of care, nor model of maternity care moderated this relationship. However, compared with all other models of care, women enrolled in private midwifery care reported the highest levels of experienced continuity of care and birthed infants at higher GA. BW and BW for GA were higher in private midwifery care, relative to standard care. CONCLUSION Enrollment in continuous models of perinatal care may be a better predictor of infant birth outcomes than degree of PNMS exposure. These results highlight the possibility that increased, continuous support to women during pregnancy may play an important role in ensuring positive infant birth outcomes during future pandemics.
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Affiliation(s)
- Mia A McLean
- School of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand; BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Chloé Klimos
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Belinda Lequertier
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | | | - Sue Kildea
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Suzanne King
- Douglas Institute Research Centre, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia.
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Jones AS, Deitch J, Yates C, Hamblin PS, Teale G, Kevat D, Lee IL. Antenatal health and perinatal outcomes of Pacific Islander women in Australia with and without gestational diabetes: A ten-year retrospective cohort study. Aust N Z J Obstet Gynaecol 2024. [PMID: 38661099 DOI: 10.1111/ajo.13826] [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: 12/14/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Pacific Islander (PI) women in Australia have an increased risk of gestational diabetes (GDM); however, their perinatal outcomes are poorly understood. AIM The aim was to determine the maternal characteristics and perinatal outcomes of PI women with and without GDM compared to Australian/European (AE)-born women. METHODS A retrospective analysis of perinatal outcomes of singleton deliveries >20 weeks' gestation between 1 January 2011 and 31 December 2020 was conducted at a tertiary provider (Melbourne, Australia). Antenatal details and birth outcomes were extracted from the Birth Outcome Systems database. t-Tests and χ2, univariate and multivariable logistic regression analyses assessed the relationship between ethnicity and outcomes. RESULTS Of 52,795 consecutive births, 24,860 AE women (13.3% with GDM) and 1207 PI-born women (20.1% with GDM) were compared. PI women had significantly greater pre-pregnancy body mass index (BMI) and significantly lower rates of smoking and nulliparity. PI women with GDM had higher rates of pre-eclampsia (P < 0.001), large-for-gestational age (LGA) neonates (P = 0.037) and neonatal hypoglycaemia (P = 0.017) but lower rates of small-for-gestational age neonates (P = 0.034). Neonatal intensive care unit (NICU)/special care nursery requirements did not increase. After having adjusted for covariates, PI women's risk of LGA neonates (adjusted odds ratio (aOR): 1.06, 95% confidence interval (CI): 0.86-1.31) was attenuated; however, risk of pre-eclampsia (aOR: 1.49, 95% CI: 1.01-2.21) and neonatal hypoglycaemia (aOR: 1.40, 95% CI: 1.01-1.96) still increased. They were less likely to require a primary caesarean section (aOR: 0.86, 95% CI: 0.73-0.99). CONCLUSION PI women have higher BMI and GDM rates, contributing to an increased likelihood of adverse perinatal outcomes. BMI is a modifiable risk factor that could be addressed prenatally.
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Affiliation(s)
- Annabel S Jones
- Department of Endocrinology and Diabetes, Western Health, St Albans, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
| | - Jessica Deitch
- Department of Endocrinology and Diabetes, Western Health, St Albans, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
| | - Christopher Yates
- Department of Endocrinology and Diabetes, Western Health, St Albans, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Shane Hamblin
- Department of Endocrinology and Diabetes, Western Health, St Albans, Victoria, Australia
| | - Glyn Teale
- Women's and Children's Division, Western Health, St Albans, Victoria, Australia
| | - Dev Kevat
- Department of Endocrinology and Diabetes, Western Health, St Albans, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
- Women's and Children's Division, Western Health, St Albans, Victoria, Australia
| | - I-Lynn Lee
- Department of Endocrinology and Diabetes, Western Health, St Albans, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
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Triggs T, Crawford K, Hong J, Clifton V, Kumar S. The influence of birthweight on mortality and severe neonatal morbidity in late preterm and term infants: an Australian cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:101054. [PMID: 38590781 PMCID: PMC10999727 DOI: 10.1016/j.lanwpc.2024.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/10/2024]
Abstract
Background The aim of this study was to detail incidence rates and relative risks for severe adverse perinatal outcomes by birthweight centile categories in a large Australian cohort of late preterm and term infants. Methods This was a retrospective cohort study of singleton infants (≥34+0 weeks gestation) between 2000 and 2018 in Queensland, Australia. Study outcomes were perinatal mortality, severe neurological morbidity, and other severe morbidity. Categorical outcomes were compared using Chi-squared tests. Continuous outcomes were compared using t-tests. Multinomial logistic regression investigated the effect of birthweight centile on study outcomes. Findings The final cohort comprised 991,042 infants. Perinatal mortality occurred in 1944 infants (0.19%). The incidence and risk of perinatal mortality increased as birthweight decreased, peaking for infants <1st centile (perinatal mortality rate 13.2/1000 births, adjusted Relative Risk Ratio (aRRR) of 12.96 (95% CI 10.14, 16.57) for stillbirth and aRRR 7.55 (95% CI 3.78, 15.08) for neonatal death). Severe neurological morbidity occurred in 7311 infants (0.74%), with the highest rate (19.6/1000 live births) in <1st centile cohort. There were 75,243 cases of severe morbidity (7.59% livebirths), with the peak incidence occurring in the <1st centile category (12.3% livebirths). The majority of adverse outcomes occurred in infants with birthweights between 10 and 90th centile. Almost 2 in 3 stillbirths, and approximately 3 in 4 cases of neonatal death, severe neurological morbidity or other severe morbidity occurred within this birthweight range. Interpretation Although the incidence and risk of perinatal mortality, severe neurological morbidity and severe morbidity increased at the extremes of birthweight centiles, the majority of these outcomes occurred in infants that were apparently "appropriately grown" (i.e., birthweight 10th-90th centile). Funding National Health and Medical Research Council, Mater Foundation, Royal Australian College of Obstetricians and Gynaecologists Women's Health Foundation - Norman Beischer Clinical Research Scholarship, Cerebral Palsy Alliance, University of Queensland Research Scholarship.
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Affiliation(s)
- Tegan Triggs
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - Kylie Crawford
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jesrine Hong
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Vicki Clifton
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
- NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Fotheringham P, Safi N, Li Z, Anazodo A, Remond M, Hayen A, Currow D, Roder D, Hamad N, Nicholl M, Gordon A, Frawley J, Sullivan EA. Pregnancy-associated gynecological cancer in New South Wales, Australia 1994-2013: A population-based historical cohort study. Acta Obstet Gynecol Scand 2024; 103:729-739. [PMID: 36915236 PMCID: PMC10993344 DOI: 10.1111/aogs.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/12/2022] [Accepted: 01/25/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Pregnancy-associated gynecological cancer (PAGC) refers to cancers of the ovary, uterus, fallopian tube, cervix, vagina, and vulva diagnosed during pregnancy or within 12 months postpartum. We aimed to describe the incidence of, and perinatal outcomes associated with, invasive pregnancy-associated gynecological cancer. MATERIAL AND METHODS We conducted a population-based historical cohort study using linked data from New South Wales, Australia. We included all women who gave birth between 1994 and 2013, with a follow-up period extending to September 30, 2018. Three groups were analyzed: a gestational PAGC group (women diagnosed during pregnancy), a postpartum PAGC group (women diagnosed within 1 year of giving birth), and a control group (women with control diagnosis during pregnancy or within 1 year of giving birth). We used generalized estimation equations to compare perinatal outcomes between study groups. RESULTS There were 1 786 137 deliveries during the study period; 70 women were diagnosed with gestational PAGC and 191 with postpartum PAGC. The incidence of PAGC was 14.6/100 000 deliveries and did not change during the study period. Women with gestational PAGC (adjusted odds ratio [aAOR] 6.81, 95% confidence interval [CI] 2.97-15.62) and with postpartum PAGC (aOR 2.65, 95% CI 1.25-5.61) had significantly increased odds of a severe maternal morbidity outcome compared with the control group. Babies born to women with gestational PAGC were more likely to be born preterm (aOR 3.11, 95% CI 1.47-6.59) and were at increased odds of severe neonatal complications (aOR 3.47, 95% CI 1.45-8.31) compared with babies born to women without PAC. CONCLUSIONS The incidence of PAGC has not increased over time perhaps reflecting, in part, the effectiveness of cervical screening and early impacts of human papillomavirus vaccination programs in Australia. The higher rate of preterm birth among the gestational PAGC group is associated with adverse outcomes in babies born to these women.
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Affiliation(s)
- Penelope Fotheringham
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew South WalesAustralia
| | - Nadom Safi
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew South WalesAustralia
| | - Zhouyang Li
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew South WalesAustralia
| | - Antoinette Anazodo
- Nelune Comprehensive Cancer CentrePrince of Wales HospitalRandwickNew South WalesAustralia
| | - Marc Remond
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew South WalesAustralia
| | - Andrew Hayen
- School of Public HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - David Currow
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - David Roder
- Population Health, Beat Cancer ProjectUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Nada Hamad
- The Kinghorn Cancer CentreDarlinghurstNew South WalesAustralia
| | - Michael Nicholl
- Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Adrienne Gordon
- Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Jane Frawley
- School of Public HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Elizabeth A. Sullivan
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew South WalesAustralia
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Deitch JM, Lee IL, Yates CJ, Kathpal E, Lawton P, Shahid I, Hamblin PS, Dutta D, Krishnamurthy B, Said JM, Steele C, Teale GR, Kevat D. Simplified gestational diabetes screening with a triaging fasting plasma glucose reduces the burden of oral glucose tolerance tests during pregnancy - A large tertiary comparative cohort study. Diabetes Res Clin Pract 2024; 209:111120. [PMID: 38307138 DOI: 10.1016/j.diabres.2024.111120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
AIMS The study aimed to evaluate the impact of a simplified screeningapproach for gestational diabetes (GDM) compared to conventional screening on OGTT rates, GDM prevalence, and perinatal outcomes. METHOD A retrospective comparative cohort study included singleton births from 20 weeks' gestation. Pregnancies without diagnostic glucose results from 13 weeks' gestation or incomplete screenings were excluded. Simplified screening consisted of a triaging fasting plasma glucose (FPG), where only those with FPG levels between 4.7 and 5.0 mmol/L proceeded to the 2hr 75 g oral glucose tolerance test (OGTT).The study period was divided into conventional screening (1st January 2019-30th June 2020) and simplified screening (1st January 2021-31st December 2021). RESULTS Out of 15,138 pregnancies, 12,035 met the inclusion criteria: 7385 underwent conventional and 4650 underwent simplified screening. In the simplified group, 82.9 % avoided an OGTT. The simplified screening group also had a lower GDM prevalence compared to the conventional group ((18.7 % vs. 21.7 %, p < 0.001). Perinatal outcomes, including the rate of large-for-gestational-age infants, were similar between the groups. CONCLUSION The simplified GDM screening strategy for significantly reduced OGTTs by over 80% without impacting perinatal outcomes. It suggests that prospective studies are necessary to further evaluate this approach.
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Affiliation(s)
- Jessica M Deitch
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - I-Lynn Lee
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - Christopher J Yates
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Esha Kathpal
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia
| | - Paul Lawton
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia
| | - Ibrahim Shahid
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia
| | - Peter S Hamblin
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Deepak Dutta
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia
| | | | - Joanne M Said
- Department of Obstetrics & Gynaecology, Western Health, St Albans, Victoria, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Parkville, Victoria, Australia; Department of Maternal Fetal Medicine, Western Health, St Albans, Victoria, Australia
| | - Cheryl Steele
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia
| | - Glyn R Teale
- Department of Obstetrics & Gynaecology, Western Health, St Albans, Victoria, Australia
| | - Dev Kevat
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Obstetric Medicine, Western Health, St Albans, Victoria, Australia
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9
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Hong J, Crawford K, Jarrett K, Triggs T, Kumar S. Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants - an Australian population-based cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:101011. [PMID: 38292653 PMCID: PMC10825608 DOI: 10.1016/j.lanwpc.2024.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
Background The aim of this study was to ascertain risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity related to the 5-min Apgar score in early term (37+0-38+6 weeks), full term (39+0-40+6 weeks), late term (41+0-41+6 weeks), and post term (≥42+0 weeks) infants. Methods This was a retrospective cohort study of 941,221 term singleton births between 2000 and 2018 in Queensland, Australia. Apgar scores at 5-min were categorized into five groups: Apgar 0 or 1, 2 or 3, 4-6, 7 or 8 and 9 or 10. Gestational age was stratified into 4 groups: Early term, full term, late term and post term. Three specific neonatal study outcomes were considered: 1) Neonatal mortality 2) Severe neurological morbidity and 3) Severe non-neurological morbidity. Poisson multivariable regression models were used to determine relative risk ratios for the effect of gestational age and Apgar scores on these severe neonatal outcomes. We hypothesized that a low Apgar score of <4 was significantly associated with increased risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity. Findings Of the study cohort, 0.04% (345/941,221) were neonatal deaths, 0.70% (6627/941,221) were infants with severe neurological morbidity and 4.3% (40,693/941,221) had severe non-neurological morbidity. Infants with Apgar score <4 were more likely to birth at late term and post term gestations and have birthweights <3rd and <10th percentiles. The adjusted relative risk ratios (aRRR) for neonatal mortality and severe neurological morbidity were highest in the Apgar 0 or 1 cohort. For infants in the Apgar 0 or 1 group, neonatal mortality increased incrementally with advancing term gestation: early term (aRRR 860.16, 95% CI 560.96, 1318.94, p < 0.001); full term (aRRR 1835.77, 95% CI 1279.48, 2633.91, p < 0.001); late term (aRRR 1693.61, 95% CI 859.65, 3336.6, p < 0.001) and post term (aRRR 2231.59, 95% CI 272.23, 18293.07, p < 0.001) whilst severe neurological morbidity decreased as gestation progressed: early term (aRRR 158.48, 95% CI 118.74, 211.51, p < 0.001); full term (aRRR 112.99, 95% CI 90.56, 140.98, p < 0.001); late term (aRRR 87.94, 95% CI 67.09, 115.27, p < 0.001) and post term (aRRR 52.07, 95% CI 15.17, 178.70, p < 0.001). Severe non-neurological morbidity was greatest in the full term, Apgar 2-3 cohort (aRRR 7.36, 95% CI 6.2, 8.74, p < 0.001). Interpretation A 5-min Apgar score of <4 was prognostic of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in infants born >37 weeks' gestation with the risk greatest in the early term cohort. Funding National Health and Medical Research Council and Mater Foundation.
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Affiliation(s)
- Jesrine Hong
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Kylie Crawford
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Kate Jarrett
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - Tegan Triggs
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
- NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
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10
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Galbally M, Watson SJ, Newnham J, White S, Watkins A, Lewis AJ. The Relationship Between Early Term Birth and the Risk of Later Childhood Mental Disorders Within a Pregnancy Cohort. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01643-5. [PMID: 38165581 DOI: 10.1007/s10578-023-01643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/04/2024]
Abstract
This study examines whether gestational age, birth weight, and early term birth is associated with childhood mental disorders in 342 pregnant women recruited at less than 20 weeks gestation and were then followed up until 4 years postpartum, including 93 children born at early term. Women were assessed at recruitment using the Structured Clinical Interview for DSM. At 4 years of age their children were assessed using the Preschool Age Psychiatric Assessment (PAPA) and the Child Behavior Checklist (CBCL). This study found earlier birth predicted an increased risk for anxiety disorders and demonstrated a significant interaction between gestational age and lower birthweight. The risk for ADHD increased with lower gestational age independent of birthweight. In contrast, gestational age was not associated with Oppositional Defiant Disorder, Conduct Disorder, internalizing or externalizing symptoms. These findings highlight the important differences in the association of early term birth and vulnerability for specific mental disorders.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.
- Health Futures Institute, Murdoch University, Perth, Australia.
| | - Stuart J Watson
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
- Health Futures Institute, Murdoch University, Perth, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - Scott White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | | | - Andrew J Lewis
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
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11
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Galbally M, Watson SJ, Boyce P, Howard L, Herrman H. Perinatal depression: The use of the Edinburgh Postnatal Depression Scale to derive clinical subtypes. Aust N Z J Psychiatry 2024; 58:37-48. [PMID: 37649275 DOI: 10.1177/00048674231193640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Predicting the course and complications of perinatal depression through the identification of clinical subtypes has been previously undertaken using the Edinburgh Postnatal Depression Scale and has the potential to improve the precision of care and improve outcomes for women and their children. METHODS Edinburgh Postnatal Depression Scale scores were collected twice in pregnancy and twice in the postpartum in a sample of 360 women who met diagnostic criteria for perinatal depression using the Structured Clinical Interview for DSM disorder. These data were used to compare with previous, though conflicting, evidence from cross-sectional studies and extend this by undertaking longitudinal measurement invariance modelling to test the structural validity across the perinatal period. Latent profile and transition modelling was used to identify distinct subtypes of women and assess the utility of these subtypes and transition profiles to predict clinically meaningful outcomes. RESULTS Although our data supported one of the previously reported three-factor Edinburgh Postnatal Depression Scale structures used to compute subfactor totals for depressed mood, anxiety and anhedonia at both early pregnancy and 6 months postpartum, there was little value in using these Edinburgh Postnatal Depression Scale subfactor scores to identify subtypes predictive of clinically meaningful postpartum symptom subtypes, or of general health, pregnancy and neonatal outcomes. CONCLUSION Our study does not support the use of the Edinburgh Postnatal Depression Scale to distinguish perinatal depressive subtypes for the purposes of predicting course and complications associated with perinatal depression. However, the results give guidance on alternative ways to study the value of personalised management in improved outcomes for women living with or at risk for perinatal depression.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Stuart J Watson
- School of Clinical Sciences, Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Philip Boyce
- Specialty of Psychiatry, Faculty of Medicine and Health and The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Louise Howard
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Helen Herrman
- Orygen Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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12
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Manno JM, Marzan MB, Rolnik DL, Potenza S, Pritchard N, Said JM, Palmer KR, Whitehead CL, Sheehan PM, Ford J, Mol BW, Walker SP, Hui L. Reduction in spontaneous and iatrogenic preterm births in twin pregnancies during COVID-19 lockdown in Melbourne, Australia: a multicenter cohort study. BMC Pregnancy Childbirth 2023; 23:846. [PMID: 38082241 PMCID: PMC10712149 DOI: 10.1186/s12884-023-06137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Melbourne, Australia, recorded one of the longest and most stringent pandemic lockdowns in 2020, which was associated with an increase in preterm stillbirths among singleton pregnancies. Twin pregnancies may be particularly susceptible to the impacts of pandemic disruptions to maternity care due to their higher background risk of adverse perinatal outcomes. METHODS Multicenter retrospective cohort study of all twin pregnancies birthing in public maternity hospitals in Melbourne. Multivariable log-binomial regression models were used to compare perinatal outcomes between a pre-pandemic group to women in whom weeks 20+0 to 40+0 of gestation occurred entirely during one of two lockdown-exposure periods: exposure 1 from 22 March 2020 to 21 March 2021 and exposure 2 from 22 March 2021 to 27 March 2022. RESULTS Total preterm births < 37 weeks were significantly lower in exposure 1 compared with the pre-pandemic period (63.1% vs 68.3%; adjusted risk ratio 0.92 95% CI 0.87-0.98, p = 0.01). This was mainly driven by fewer spontaneous preterm births (18.9% vs 20.3%; adjusted risk ratio 0.95 95% CI 0.90-0.99, p = 0.04). There were also lower rates of preterm birth < 34 weeks (19.9% vs 23.0%, adjusted risk ratio 0.93 95% CI 0.89-0.98 p = 0.01) and total iatrogenic births for fetal compromise (13.4% vs 20.4%; adjusted risk ratio 0.94 95% CI 0.89-0.98, p = 0.01). There were fewer special care nursery admissions (38.5% vs 43.4%; adjusted risk ratio 0.91 95% CI 0.87-0.95, p < 0.001) but no significant changes in stillbirth (1.5% vs 1.6%; adjusted risk ratio 1.00 95% CI 0.99-1.01, p = 0.82). Compared with the pre-pandemic period, there were more preterm births < 28 weeks and neonatal intensive care unit admissions in exposure 2. CONCLUSIONS Melbourne's first lockdown-exposure period was associated with lower preterm births in twins without significant differences in adverse newborn outcomes. Our findings provide insights into the influences on preterm birth and the optimal timing of delivery for twins.
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Affiliation(s)
- Juliana M Manno
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Melvin B Marzan
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Stephanie Potenza
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Natasha Pritchard
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Joanne M Said
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Maternal-Fetal Medicine Department, Joan Kirner Women's and Children's Hospital, Western Health, St Albans, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Clare L Whitehead
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Australia
| | - Penelope M Sheehan
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Eastern Health, Box Hill, Australia
| | - Jolyon Ford
- Department of Obstetrics and Gynaecology, Peninsula Health, Frankston, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Parkville, Australia.
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Heidelberg, Australia.
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Australia.
- Department of Obstetrics and Gynaecology, The Northern Hospital, Northern Health, Epping, Australia.
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13
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Mnatzaganian G, Taylor M, He F, Yuen N, McIntyre HD, Woodward M, Ma L, Huxley RR. Differences in neonatal adverse outcomes among women with gestational diabetes mellitus managed by diet or medication: a propensity score matched analysis of a population-based sample. Gynecol Endocrinol 2023; 39:2250005. [PMID: 37608764 DOI: 10.1080/09513590.2023.2250005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Neonatal outcomes in women with and without medically managed gestational diabetes mellitus (GDM) were compared after accounting for differences in maternal baseline characteristics using a propensity score (PS) analysis. METHODS Women without preexisting diabetes, delivering singletons during 2010-2017 in a large hospital, were eligible for inclusion. Using nearest-neighbour PS matching, women with non-pharmacological managed GDM were matched with women whose GDM was medically managed. A conditional logistic regression consequently compared the neonatal adverse outcomes between the groups after adjusting for gestational age, induction of labor, birth type, and number of ultrasounds conducted during the pregnancy. RESULTS Of the overall 10028 births, GDM was diagnosed in 930 (9.3%), of whom 710 (76.3%) were successfully matched. The conditional regressions found higher risk of neonatal adverse outcomes in neonates of women with non-pharmacological managed GDM compared to neonates of women with medically managed GDM. These included a higher risk of hypoglycemia (odds ratio (OR) 1.56, 95% confidence interval (CI) 1.03-2.38, p = 0.037), hypothermia (OR 2.29, 95%CI 1.05-5.00, p = 0.037), and birth injuries (OR 3.50, 95%CI 1.62-7.58, p = 0.001), and a higher risk of being small for gestational age (OR 2.06, 95%CI 1.01-4.18, p = 0.046) and being admitted to a special care unit (OR 2.04, 95%CI 1.29-3.21, p = 0.002). CONCLUSIONS The increased neonatal morbidity associated with non-medicated GDM identified in our study may indicate that diet and lifestyle changes alone are not sufficient to achieve glycaemic control in some women with GDM. Our findings indicate that gestational diabetes management approach is independently associated with neonatal outcomes.
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Affiliation(s)
- George Mnatzaganian
- Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Marietta Taylor
- Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Fan He
- Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Nicola Yuen
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - H David McIntyre
- Obstetric Medicine, Mater Health Services, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Rachel R Huxley
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
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14
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McLean A, Barr E, Tabuai G, Murphy HR, Maple-Brown L. Continuous Glucose Monitoring Metrics in High-Risk Pregnant Women with Type 2 Diabetes. Diabetes Technol Ther 2023; 25:836-844. [PMID: 37902969 DOI: 10.1089/dia.2023.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Objective: To describe glucose metrics in a high-risk population of women with type 2 diabetes (T2DM) in pregnancy and to explore the associations with neonatal outcomes. Research Design and Methods: Prospective observational study of 57 women. Continuous glucose monitoring (CGM) trajectories were determined from metrics collected in early and late gestation using the first and last two (mean 16 and 35) weeks of Freestyle Libre data. Logistic regression was used to examine associations of CGM metrics with neonatal hypoglycemia (glucose <2.6 mmol/L requiring intravenous dextrose) and large for gestational age (LGA) (>90th percentile for gestational age and sex). Pregnancy-specific target glucose range was 3.5-7.8 mmol/L (63-140 mg/dL). Results: Forty-one women used CGM for 15 weeks (mean age 33 years, 73% Aboriginal or Torres Strait Islander, 32% living remotely). There was limited change in average metrics from early to late pregnancy. For the subgroup with sensor use >50% (n = 29), mean time in range (TIR) increased by 9%, time above range reduced by 12%, average glucose reduced by 1 mmol/L, and time below range increased by 3%. Neonatal hypoglycemia was associated with most CGM metrics, HbA1c and CGM targets, particularly those from late pregnancy. LGA was associated with hyperglycemic metrics from early pregnancy. Each 1% increase TIR was associated with a 4%-5% reduction in risk of neonatal complications. Conclusion: In this high-risk group of women with T2DM, CGM metrics only improved during pregnancy in those with greater sensor use and were associated with LGA in early pregnancy and neonatal hypoglycemia throughout. Culturally appropriate health care strategies are critical for successful use of CGM technology.
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Affiliation(s)
- Anna McLean
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Endocrinology Department, Cairns Hospital, Cairns, Australia
| | - Elizabeth Barr
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Georgina Tabuai
- Endocrinology Department, Cairns Hospital, Cairns, Australia
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Endocrinology Department, Royal Darwin Hospital, Darwin, Australia
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15
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Doyle MA. Seasonal patterns in newborns' health: Quantifying the roles of climate, communicable disease, economic and social factors. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101287. [PMID: 37549490 DOI: 10.1016/j.ehb.2023.101287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
Poor health at birth can have long-term consequences for children's development. This paper analyses an important factor associated with health at birth: the time of year that the baby is born, and hence seasonal risks they were exposed to in utero. There are multiple potential explanations for seasonality in newborns' health. Most previous research has examined these in isolation. We therefore do not know which explanations are most important - and hence which policy interventions would most effectively reduce the resulting early-life inequalities. In this paper, I use administrative data to estimate and compare the magnitudes of several seasonal risks, seeking to identify the most important drivers of seasonality in the Northern Territory of Australia, a large territory spanning tropical and arid climates and where newborn health varies dramatically with the seasons. I find that the most important explanations are heat exposure and disease prevalence. Seasonality in food prices and road accessibility have smaller effects on some outcomes. Seasonal fertility patterns, rainfall and humidity do not have statistically significant effects. I conclude that interventions that protect pregnant women from seasonal disease and heat exposure would likely improve newborn health in the Northern Territory, with potential long-term benefits for child development. It is likely that similar impacts would apply in other locations with tropical and arid climates, and that, without action, climate change will accentuate these risks.
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Affiliation(s)
- Mary-Alice Doyle
- Department of Social Policy, London School of Economics, Houghton Street, WC2A 2AE, United Kingdom.
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16
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Crawford K, Hong J, Kumar S. Mediation analysis quantifying the magnitude of stillbirth risk attributable to small for gestational age infants. Am J Obstet Gynecol MFM 2023; 5:101187. [PMID: 37832646 DOI: 10.1016/j.ajogmf.2023.101187] [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: 09/26/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Many risk factors for stillbirth are linked to placental dysfunction, which leads to suboptimal intrauterine growth and small for gestational age infants. Such infants also have an increased risk for stillbirth. OBJECTIVE This study aimed to investigate the effect of known causal risk factors for stillbirth, and to identify those that have a large proportion of their risk mediated through small for gestational age birth. STUDY DESIGN This retrospective cohort study used data from all births in the state of Queensland, Australia between 2000 and 2018. The total effects of exposures on the odds of stillbirth were determined using multivariable, clustered logistic regression models. Mediation analysis was performed using a counterfactual approach to determine the indirect effect and percentage of effect mediated through small for gestational age. For risk factors significantly mediated through small for gestational age, the relative risks of stillbirth were compared between small for gestational age and appropriate for gestational age infants. We also investigated the proportion of risk mediated via small for gestational age for late stillbirths (≥28 weeks). RESULTS The initial data set consisted of 1,105,612 births. After exclusions, the final study cohort constituted 925,053 births. Small for gestational age births occurred in 9.9% (91,859/925,053) of the study cohort. Stillbirths occurred in 0.5% of all births (4234/925,053) and 1.5% of small for gestational age births (1414/91,859). Births at ≥28 weeks occurred in 99.4% (919,650/925,053) of the study cohort and in 98.9% (90,804/91,859) of all small for gestational age births. Of the ≥28-week births, stillbirths occurred in 0.2% (2156/919,650) of all births and 0.8% (677/90,804) of the small for gestational age births. Overall, increased odds of stillbirth were significantly mediated through small for gestational age for age <20 years, low socioeconomic status, Indigenous ethnicity, birth in sub-Saharan and North Africa or the Middle East, smoking, nulliparity, multiple pregnancy, assisted conception, previous stillbirth, preeclampsia, and renal disease. Preeclampsia had the largest proportion mediated through small for gestational age (66.7%), followed by nulliparity (61.6%), smoking (29.4%), North-African or Middle Eastern ethnicity (27.6%), multiple pregnancy (26.3%), low socioeconomic status (25.8%), and Indigenous status (18.7%). Sensitivity analysis showed that for late stillbirths, the portions mediated through small for gestational age remained very similar for many of the risk factors. CONCLUSION Although small for gestational age is an important mediator between many pregnancy risk factors and stillbirth, mitigating the risk of small for gestational age is likely to be of value only when it is a major contributor in the pathway to fetal demise.
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Affiliation(s)
- Kylie Crawford
- Mater Research Institute, University of Queensland, Brisbane, Australia (Drs Crawford, Hong, and Kumar); University of Queensland Mayne Medical School, University of Queensland, Brisbane, Australia (Drs Crawford, Hong, and Kumar); School of Public Health, University of Queensland, Brisbane, Australia (Dr Crawford)
| | - Jesrine Hong
- Mater Research Institute, University of Queensland, Brisbane, Australia (Drs Crawford, Hong, and Kumar); University of Queensland Mayne Medical School, University of Queensland, Brisbane, Australia (Drs Crawford, Hong, and Kumar); Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia (Dr Hong)
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Brisbane, Australia (Drs Crawford, Hong, and Kumar); University of Queensland Mayne Medical School, University of Queensland, Brisbane, Australia (Drs Crawford, Hong, and Kumar); National Health and Medical Research Council, Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Australia (Dr Kumar).
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17
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Ahmed MA, Bailey HD, Pereira G, White SW, Hare MJ, Wong K, Marriott R, Shepherd CC. Overweight/obesity and other predictors of gestational diabetes among Aboriginal and non-Aboriginal women in Western Australia. Prev Med Rep 2023; 36:102444. [PMID: 37840590 PMCID: PMC10568432 DOI: 10.1016/j.pmedr.2023.102444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Abstract
This population-based study investigated the association of BMI and other predictors with gestational diabetes mellitus (GDM) among Australian Aboriginal and non-Aboriginal mothers. We conducted a state-wide retrospective cohort study that included all singleton births in Western Australia (n = 134,552) between 2012 and 2015 using population health datasets linked by the Western Australian Data Linkage Branch. Associations between GDM and its predictors were estimated as adjusted relative risks (aRRs) from multivariable generalised linear models. Adjusted ratio of relative risks (aRRRs) compared RRs in Aboriginal and non-Aboriginal mothers. Adjusted population attributable fractions estimated the contribution of overweight/obesity to GDM burden, and adjusted predicted probabilities for GDM were plotted against BMI levels. The following predictors had stronger associations with GDM in Aboriginal, compared to non-Aboriginal, mothers: maternal obesity (aRR [95% CI] 3.16 [2.54-3.93]; aRRR 1.57 [1.26-1.94]), previous LGA (aRR 1.70 [1.37-2.12]; aRRR 1.41 [1.13-1.76]) and previous macrosomia (birthweight ≥ 4 kg) (aRR 1.55 [1.24-1.94]; aRRR 1.53 [1.22-1.91]). 46.1% (95% CI: 36.6-54.1) of GDM cases in Aboriginal women (23.3% in non-Aboriginal mothers, 95% CI: 21.6-25.1) were attributed to overweight/obesity. Compared to non-Aboriginal mothers, adjusted GDM probabilities were higher at all BMI levels and showed greater increase with BMI. Overweight/obesity is a key driver of GDM among Aboriginal women. Association between BMI and GDM is stronger in Aboriginal, compared to non-Aboriginal, women especially at higher BMI.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Helen D. Bailey
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Scott W. White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Matthew J.L. Hare
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Carrington C.J. Shepherd
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
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18
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Thirugnanasundralingam K, Davies-Tuck M, Rolnik DL, Reddy M, Mol BW, Hodges R, Palmer KR. Effect of telehealth-integrated antenatal care on pregnancy outcomes in Australia: an interrupted time-series analysis. Lancet Digit Health 2023; 5:e798-e811. [PMID: 37890903 DOI: 10.1016/s2589-7500(23)00151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, rapid integration of telehealth into antenatal care occurred to support ongoing maternity care. A programme of this scale had not been previously implemented. We evaluated whether telehealth-integrated antenatal care in an Australian public health system could achieve pregnancy outcomes comparable to those of conventional care to assess its safety and efficacy. METHODS Routinely collected data for individuals who gave birth at Monash Health (Melbourne, VIC, Australia) during a conventional care period (Jan 1, 2018, to March 22, 2020) and telehealth-integrated period (April 20, 2020, to April 25, 2021) were analysed. We included all births that occurred at 20 weeks' gestation or later or with a birthweight of at least 400 g (if duration of gestation was unknown). We excluded multiple births, births for which private antenatal care was received, and births to individuals transferred from other hospitals or who had no antenatal care. Baseline demographics, telehealth uptake, and pregnancy complications (related to pre-eclampsia, fetal growth restriction [FGR], gestational diabetes, stillbirth, neonatal intensive care [NICU] admission, and preterm birth [<37 weeks' gestation]) were compared using comparative statistics and an interrupted time-series analysis. Results were stratified by care stream, with high-risk models consisting of obstetric specialist-led care, and all other streams categorised as low-risk models. The impact of the integrated period on outcomes was also assessed with stratification by parity. FINDINGS 17 873 births occurred in the conventional period and 8131 in the integrated period. Compared with the conventional period, women giving birth during the integrated period were slightly older (30·63 years vs 30·88 years) and had slightly higher BMI (25·52 kg/m2vs 26·14 kg/m2), and more Australian-born women gave birth during the integrated period (37·37% vs 39·79%). There were no significant differences in smoking status or parity between the two groups. 107 (0·08%) of 129 514 antenatal consultations in the conventional period and 34 444 (45·94%) of 74 982 in the integrated period were delivered by telehealth. No significant differences between the conventional and integrated periods were seen in median gestational age at pre-eclampsia diagnosis (low-risk models 37·4 weeks in the conventional period vs 37·1 weeks in the integrated period, difference -0·3 weeks [-0·7 to 0·1]; high-risk models 35·5 weeks vs 36·3 weeks, difference 0·3 weeks [-0·3 to 1·1]), incidence of FGR below the 3rd birthweight percentile (low-risk models 1·62% vs 1·74%, difference 0·12 percentage points [-0·26 to 0·50]; high-risk 4·04% vs 4·13%, difference 0·089 percentage points [-1·08 to 1·26]), and incidence of preterm birth (low-risk models 4·99% vs 5·01%, difference 0·02% [-0·62 to 0·66]; high-risk models 15·76% vs 14·43%, difference -1·33% [-3·42 to 0·77]). Parity did not affect these findings. Interrupted time-series analysis showed a significant reduction in induction of labour for singletons with suspected FGR among women in low-risk models during the integrated period (-0·04% change per week [95% CI -0·07 to -0·01], p=0·0040), and NICU admission declined after telehealth integration (low-risk models -0·02% change per week [-0·03 to -0·003], p=0·018; high-risk models -0·10% change per week, -0·19 to -0·001; p=0·047). No significant differences in stillbirth rates were observed. The proportion of women diagnosed with gestational diabetes was significantly higher in the integrated period compared with the conventional period for both low-risk care models (22·28% vs 25·13%, difference 2·85 percentage points [1·60 to 4·11]) and high-risk care models (28·70% vs 34·02%, difference 5·32 percentage points [2·57 to 8·07]). However overall, when compared with the conventional period, there was no significant difference in proportion of women with gestational diabetes requiring insulin therapy (low-risk models 8·08% vs 7·73%, difference -0·35 percentage points [-1·13 vs 0·44]; high-risk models 14·81% vs 15·71%, difference 0·89 percentage points [-1·23 to 3·02]), or proportion of women with gestational diabetes who gave birth to a baby with macrosomia in the integrated period (low-risk models 3·16% vs 2·33%, difference -0·83 percentage points [-1·77 to 0·12]; high-risk models 5·58% vs 4·81%, difference -0·77 percentage points [-3·06 to 1·52]). INTERPRETATION Telehealth-integrated antenatal care replaced around 46% of in-person consultations without compromising pregnancy outcomes. It might be associated with a reduction in labour induction for suspected FGR, particularly for women in low-risk models, without compromising FGR detection or perinatal morbidity. These findings support the ongoing use of telehealth in providing flexible antenatal care. FUNDING None.
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Affiliation(s)
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia; Monash Women's, Monash Health, Melbourne, VIC, Australia.
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19
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Santana Dos Santos IK, Borges Dos Santos Pereira D, Cumpian Silva J, de Oliveira Gallo C, de Oliveira MH, Pereira de Vasconcelos LC, Conde WL. Frequency of anthropometric implausible values estimated from different methodologies: a systematic review and meta-analysis. Nutr Rev 2023:nuad142. [PMID: 37903374 DOI: 10.1093/nutrit/nuad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
CONTEXT Poor anthropometric data quality affect the prevalence of malnutrition and could harm public policy planning. OBJECTIVE This systematic review and meta-analysis was designed to identify different methods to evaluate and clean anthropometric data, and to calculate the frequency of implausible values for weight and height obtained from these methodologies. DATA SOURCES Studies about anthropometric data quality and/or anthropometric data cleaning were searched for in the MEDLINE, LILACS, SciELO, Embase, Scopus, Web of Science, and Google Scholar databases in October 2020 and updated in January 2023. In addition, references of included studies were searched for the identification of potentially eligible studies. DATA EXTRACTION Paired researchers selected studies, extracted data, and critically appraised the selected publications. DATA ANALYSIS Meta-analysis of the frequency of implausible values and 95% confidence interval (CI) was estimated. Heterogeneity (I2) and publication bias were examined by meta-regression and funnel plot, respectively. RESULTS In the qualitative synthesis, 123 reports from 104 studies were included, and in the quantitative synthesis, 23 studies of weight and 14 studies of height were included. The study reports were published between 1980 and 2022. The frequency of implausible values for weight was 0.55% (95%CI, 0.29-0.91) and for height was 1.20% (95%CI, 0.44-2.33). Heterogeneity was not affected by the methodological quality score of the studies and publication bias was discarded. CONCLUSIONS Height had twice the frequency of implausible values compared with weight. Using a set of indicators of quality to evaluate anthropometric data is better than using indicators singly. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020208977.
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Affiliation(s)
- Iolanda Karla Santana Dos Santos
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, São Paulo, Brasil
- Fundação Universidade Federal do ABC, Santo André, São Paulo, Brasil
| | | | | | | | | | | | - Wolney Lisbôa Conde
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, São Paulo, Brasil
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20
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Ahmed MA, Bailey HD, Pereira G, White SW, Wong K, McNamara BJ, Rheeder P, Marriott R, Shepherd CCJ. The impact of diabetes during pregnancy on neonatal outcomes among the Aboriginal population in Western Australia: a whole-population study. Int J Epidemiol 2023; 52:1400-1413. [PMID: 37263617 DOI: 10.1093/ije/dyad072] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/13/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have a high prevalence of diabetes in pregnancy (DIP), which includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). We aimed to characterize the impact of DIP in babies born to Aboriginal mothers. METHODS A retrospective cohort study, using routinely collected linked health data that included all singleton births (N = 510 761) in Western Australia between 1998 and 2015. Stratified by Aboriginal status, generalized linear mixed models quantified the impact of DIP on neonatal outcomes, estimating relative risks (RRs) with 95% CIs. Ratio of RRs (RRRs) examined whether RRs differed between Aboriginal and non-Aboriginal populations. RESULTS Exposure to DIP increased the risk of adverse outcomes to a greater extent in Aboriginal babies. PGDM heightened the risk of large for gestational age (LGA) (RR: 4.10, 95% CI: 3.56-4.72; RRR: 1.25, 95% CI: 1.09-1.43), macrosomia (RR: 2.03, 95% CI: 1.67-2.48; RRR: 1.39, 95% CI: 1.14-1.69), shoulder dystocia (RR: 4.51, 95% CI: 3.14-6.49; RRR: 2.19, 95% CI: 1.44-3.33) and major congenital anomalies (RR: 2.14, 95% CI: 1.68-2.74; RRR: 1.62, 95% CI: 1.24-2.10). GDM increased the risk of LGA (RR: 2.63, 95% CI: 2.36-2.94; RRR: 2.00, 95% CI: 1.80-2.22), macrosomia (RR: 1.95, 95% CI: 1.72-2.21; RRR: 2.27, 95% CI: 2.01-2.56) and shoulder dystocia (RR: 2.78, 95% CI: 2.12-3.63; RRR: 2.11, 95% CI: 1.61-2.77). Birthweight mediated about half of the DIP effect on shoulder dystocia only in the Aboriginal babies. CONCLUSIONS DIP differentially increased the risks of fetal overgrowth, shoulder dystocia and congenital anomalies in Aboriginal babies. Improving care for Aboriginal women with diabetes and further research on preventing shoulder dystocia among these women can reduce the disparities.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Helen D Bailey
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Paul Rheeder
- Department of Internal Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Rhonda Marriott
- Ngangk Yira Research Centre, Murdoch University, Perth, Western Australia, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Ngangk Yira Research Centre, Murdoch University, Perth, Western Australia, Australia
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21
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Law HD, Randall DA, Armstrong BK, D’este C, Lazarevic N, Hosking R, Smurthwaite KS, Trevenar SM, Lucas RM, Clements ACA, Kirk MD, Korda RJ. Relative Risks of Adverse Perinatal Outcomes in Three Australian Communities Exposed to Per- and Polyfluoroalkyl Substances: Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6886. [PMID: 37835156 PMCID: PMC10572760 DOI: 10.3390/ijerph20196886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Firefighting foams containing per- and polyfluoroalkyl substances (PFAS) have caused environmental contamination in several Australian residential areas, including Katherine in the Northern Territory (NT), Oakey in Queensland (Qld), and Williamtown in New South Wales (NSW). We examined whether the risks of adverse perinatal outcomes were higher in mothers living in these exposure areas than in selected comparison areas without known contamination. METHODS We linked residential addresses in exposure areas to addresses collected in the jurisdictional Perinatal Data Collections of the NT (1986-2017), Qld (2007-2018), and NSW (1994-2018) to select all pregnancies from mothers who gave birth while living in these areas. We also identified one comparison group for each exposure area by selecting pregnancies where the maternal address was in selected comparison areas. We examined 12 binary perinatal outcomes and three growth measurements. For each exposure area, we estimated relative risks (RRs) of adverse outcomes and differences in means of growth measures, adjusting for sociodemographic characteristics and other potential confounders. RESULTS We included 16,970 pregnancies from the NT, 4654 from Qld, and 7475 from NSW. We observed elevated risks of stillbirth in Oakey (RR = 2.59, 95% confidence interval (CI) 1.25 to 5.39) and of postpartum haemorrhage (RR = 1.94, 95% CI 1.13 to 3.33) and pregnancy-induced hypertension (RR = 1.88, 95% CI 1.30 to 2.73) in Williamtown. The risks of other perinatal outcomes were not materially different from those in the relevant comparison areas or were uncertain due to small numbers of events. CONCLUSIONS There was limited evidence for increased risks of adverse perinatal outcomes in mothers living in areas with PFAS contamination from firefighting foams. We found higher risks of some outcomes in individual areas, but these were not consistent across all areas under study and could have been due to chance, bias, or confounding.
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Affiliation(s)
- Hsei Di Law
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Deborah A. Randall
- Women and Babies Research, Northern Clinical School, The University of Sydney, St Leonards, NSW 2050, Australia
| | - Bruce K. Armstrong
- School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
| | - Catherine D’este
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Nina Lazarevic
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Rose Hosking
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Kayla S. Smurthwaite
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Susan M. Trevenar
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Robyn M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | | | - Martyn D. Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Rosemary J. Korda
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
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22
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Rogers AM, Youssef GJ, Teague S, Sunderland M, Le Bas G, Macdonald JA, Mattick RP, Allsop S, Elliott EJ, Olsson CA, Hutchinson D. Association of maternal and paternal perinatal depression and anxiety with infant development: A longitudinal study. J Affect Disord 2023; 338:278-288. [PMID: 37302506 DOI: 10.1016/j.jad.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Maternal and paternal perinatal depression and anxiety are theorised to adversely impact infant development. Yet, few studies have assessed both mental health symptoms and clinical diagnoses within the one study. Moreover, research on fathers is limited. This study therefore aimed to examine the association between symptoms and diagnoses of maternal and paternal perinatal depression and anxiety with infant development. METHOD Data were from the Triple B Pregnancy Cohort Study. Participants included 1539 mothers and 793 partners. Depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale and Depression Anxiety Stress Scales. Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia were assessed using the Composite International Diagnostic Interview in trimester three. Infant development was assessed at 12-months using the Bayley Scales of Infant and Toddler Development. RESULTS Antepartum, maternal depressive and anxiety symptoms were associated with poorer infant social-emotional (d = -0.11, p = .025) and language development (d = -0.16, p = .001). At 8-weeks postpartum, maternal anxiety symptoms were associated with poorer overall development (d = -0.11, p = .030). No association was observed for clinical diagnoses in mothers, nor paternal depressive and anxiety symptoms or clinical diagnoses; albeit risk estimates were largely in the expected direction of adverse effects on infant development. CONCLUSIONS Evidence suggests that maternal perinatal depression and anxiety symptoms may adversely impact infant development. Effects were small but findings underscore the importance of prevention, early screening and intervention, alongside consideration of other risk factors during early critical periods.
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Affiliation(s)
- Alana M Rogers
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - George J Youssef
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - Samantha Teague
- Department of Psychology, College of Healthcare Sciences, James Cook University, Queensland, Australia.
| | - Matthew Sunderland
- University of Sydney, Matilda Centre for Research in Mental Health and Substance Use, New South Wales, Australia.
| | - Genevieve Le Bas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
| | - Richard P Mattick
- The University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia.
| | - Steve Allsop
- Curtin University, National Drug Research Institute, Western Australia, Australia.
| | - Elizabeth J Elliott
- University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescence, New South Wales, Australia; Sydney Children's Hospitals Network, Westmead, Sydney, Australia.
| | - Craig A Olsson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
| | - Delyse Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia; The University of New South Wales, National Drug and Alcohol Research Centre, New South Wales, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Australia.
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23
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Adane AA, Shepherd CCJ, Walker R, Bailey HD, Galbally M, Marriott R. Perinatal outcomes of Aboriginal women with mental health disorders. Aust N Z J Psychiatry 2023; 57:1331-1342. [PMID: 36927100 PMCID: PMC10517592 DOI: 10.1177/00048674231160986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births. METHODS We used whole population-based linked data to conduct a retrospective cohort study (N = 38,592) using all Western Australia singleton Aboriginal births (1990-2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals. RESULTS After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder. CONCLUSIONS This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.
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Affiliation(s)
- Akilew A Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Carrington CJ Shepherd
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Indigenous Studies, The University of Western Australia, Crawley, WA, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Megan Galbally
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Clinical Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
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Deitch J, Yates CJ, Hamblin PS, Kevat D, Shahid I, Teale G, Lee I. Prevalence of gestational diabetes mellitus, maternal obesity and associated perinatal outcomes over 10 years in an Australian tertiary maternity provider. Diabetes Res Clin Pract 2023; 203:110793. [PMID: 37343727 DOI: 10.1016/j.diabres.2023.110793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The International Association of Diabetes in Pregnancy Study Groups (IADPSG) gestational diabetes mellitus (GDM) criteria have been heavily scrutinised with concerns that the consequent GDM prevalence increase has not been associated with improved perinatal outcomes. AIMS At a tertiary hospital in Melbourne, Australia we aimed to evaluate prevalence trends for GDM, type 2 diabetes (T2DM), maternal obesity and large-for-gestational age (LGA) and assess changes in perinatal outcomes following IADPSG criteria uptake in 2015. METHODS A retrospective cohort study of singleton births from 20 weeks' gestation was conducted between 1st January 2011 and 31st December 2020. Maternal characteristics and perinatal outcomes were extracted from medical records. RESULTS 52,795 pregnancies were included. GDM prevalence increased 2.7 times from 8.9% in 2011 to 23.7% in 2020 and increased annually by 8.59% (95%CI 7.77, 9.42). The rate of T2DM increased annually by 11.69% (95%CI 7.72, 16.67). Obesity prevalence increased annually by 3.18% (95%CI 2.58, 3.78). Induction of labour (IOL) prevalence increased annually by 8.35% (95%CI 5.69, 11.06). LGA prevalence remained unchanged. Increasing maternal obesity was the major contributing factor for LGA prevalence. CONCLUSIONS From 2011 to 2020 GDM, obesity and T2DM prevalence increased significantly, with associated increased IOL, without change in LGA rates. Prospective studies are required to explore interactions between GDM, obesity, LGA and obstetric interventions.
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Affiliation(s)
- J Deitch
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - C J Yates
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - P S Hamblin
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - D Kevat
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Obstetric Medicine, Western Health, St Albans, Victoria, Australia
| | - I Shahid
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia
| | - G Teale
- Department of Obstetrics & Gynaecology, Western Health, St Albans, Victoria, Australia
| | - I Lee
- Department of Diabetes & Endocrinology, Western Health, St Albans, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Davis JW, Seeber CE, Nathan EA, Strunk T, Gill A, Sharp M. Outcomes to 5 years of outborn versus inborn infants <32 weeks in Western Australia: a cohort study of infants born between 2005 and 2018. Arch Dis Child Fetal Neonatal Ed 2023; 108:499-504. [PMID: 36804194 DOI: 10.1136/archdischild-2022-324749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE We compared mortality and morbidity of inborn versus outborn very preterm infants <32 weeks' gestation in Western Australia (WA) between 2005 and 2018. DESIGN Retrospective cohort study. PATIENTS Infants <32 weeks' gestation who were born in WA. MAIN OUTCOME MEASURES Mortality was assessed as death before discharge home from the tertiary neonatal intensive care unit. Short-term morbidities included combined brain injury (intracranial haemorrhage grade ≥3 and cystic periventricular leukomalacia) and other major neonatal outcomes. Developmental assessments at age 2, 3 and 5 years were evaluated. We performed multivariable logistic regression analysis of outborn status on outcomes, controlling for gestational age, birth weight z-score, sex and multiple birth. RESULTS A total of 4974 infants were born in WA between 22 and 32 weeks' gestation between 2005 and 2018 of which 4237 (89.6%) were inborn and 443 (10.4%) were outborn. Overall mortality to discharge was higher in outborn infants (20.5% (91/443) vs 7.4% (314/4237); adjusted OR (aOR) 2.44, 95% CI 1.60 to 3.70, p<0.001). Outborn infants had higher rates of combined brain injury than those inborn (10.7% (41/384) vs 6.0% (246/4115); aOR 1.98, 95% CI 1.37 to 2.86), p<0.001). No difference in up to 5-year developmental measures was detected. Follow-up data were available for 65% of outborn and 79% of inborn infants. CONCLUSIONS Outborn preterm infants <32 weeks in WA had increased odds of mortality and combined brain injury than those inborn. Developmental outcomes up to 5 years were similar between groups. Loss to follow-up may have impacted the long-term comparison.
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Affiliation(s)
- Jonathan W Davis
- Newborn Emergency Transport Service of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - C E Seeber
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andy Gill
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Mary Sharp
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, Child and Adolescent Health Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Katleba KD, Ghosh PM, Mudryj M. Beyond Prostate Cancer: An Androgen Receptor Splice Variant Expression in Multiple Malignancies, Non-Cancer Pathologies, and Development. Biomedicines 2023; 11:2215. [PMID: 37626712 PMCID: PMC10452427 DOI: 10.3390/biomedicines11082215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Multiple studies have demonstrated the importance of androgen receptor (AR) splice variants (SVs) in the progression of prostate cancer to the castration-resistant phenotype and their utility as a diagnostic. However, studies on AR expression in non-prostatic malignancies uncovered that AR-SVs are expressed in glioblastoma, breast, salivary, bladder, kidney, and liver cancers, where they have diverse roles in tumorigenesis. AR-SVs also have roles in non-cancer pathologies. In granulosa cells from women with polycystic ovarian syndrome, unique AR-SVs lead to an increase in androgen production. In patients with nonobstructive azoospermia, testicular Sertoli cells exhibit differential expression of AR-SVs, which is associated with impaired spermatogenesis. Moreover, AR-SVs have been identified in normal cells, including blood mononuclear cells, neuronal lipid rafts, and the placenta. The detection and characterization of AR-SVs in mammalian and non-mammalian species argue that AR-SV expression is evolutionarily conserved and that AR-SV-dependent signaling is a fundamental regulatory feature in multiple cellular contexts. These discoveries argue that alternative splicing of the AR transcript is a commonly used mechanism that leads to an expansion in the repertoire of signaling molecules needed in certain tissues. Various malignancies appropriate this mechanism of alternative AR splicing to acquire a proliferative and survival advantage.
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Affiliation(s)
- Kimberley D. Katleba
- Veterans Affairs-Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA; (K.D.K.); (P.M.G.)
- Department of Medical Microbiology and Immunology, 1 Shields Avenue, UC Davis, Davis, CA 95616, USA
| | - Paramita M. Ghosh
- Veterans Affairs-Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA; (K.D.K.); (P.M.G.)
- Department of Urologic Surgery, 4860 Y Street, UC Davis, Sacramento, CA 95718, USA
- Department of Biochemistry and Molecular Medicine, 1 Shields Avenue, UC Davis, Davis, CA 95616, USA
| | - Maria Mudryj
- Veterans Affairs-Northern California Health Care System, 10535 Hospital Way, Mather, CA 95655, USA; (K.D.K.); (P.M.G.)
- Department of Medical Microbiology and Immunology, 1 Shields Avenue, UC Davis, Davis, CA 95616, USA
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Association between maternal influenza vaccination and neurodevelopmental disorders in childhood: a longitudinal, population-based linked cohort study. Arch Dis Child 2023; 108:647-653. [PMID: 37001967 PMCID: PMC10423464 DOI: 10.1136/archdischild-2022-324269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/02/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To assess the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and the risk of a diagnosis of a neurodevelopmental disorder in early childhood. DESIGN Retrospective cohort study. SETTING Population-based birth registry linked with health administrative databases in Western Australia (WA). PARTICIPANTS Singleton, liveborn children born between 1 April 2012 and 1 July 2016 in WA. EXPOSURE Receipt of seasonal IIV during pregnancy obtained from a state-wide antenatal vaccination database. MAIN OUTCOME MEASURES Clinical diagnosis of a neurodevelopmental disorder was recorded from hospital inpatient and emergency department records. We used Cox proportional hazard regression, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio (HR) of neurodevelopmental disorders associated with in utero exposure to seasonal IIV. RESULTS The study included 140 514 children of whom, 15 663 (11.2%) were exposed to seasonal IIV in utero. The prevalence of neurodevelopmental disorders was 5.4%, including mental or behavioural (0.4%), neurological (5.1%), seizure (2.2%) and sleep disorders (2.7%). Maternal IIV was not associated with increased risk of neurodevelopmental disorders (HR 1.00; 95% CI 0.91 to 1.08). Children exposed in the first trimester had a lower risk of seizure disorders (adjusted HR [aHR] 0.73; 95% CI 0.54 to 0.998), and preterm children exposed any time during pregnancy had a lower risk of sleep disorders (aHR 0.63; 95% CI 0.41 to 0.98). CONCLUSIONS We did not observe increased risk of neurodevelopmental disorders following in utero exposure to seasonal IIV. Although we observed some evidence for lower risk of seizure and sleep disorders, additional studies are required to confirm.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- eNable Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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Tindal K, Filby CE, Gargett CE, Cousins F, Palmer KR, Vollenhoven B, Davies-Tuck M. Endometrial Origins of Stillbirth (EOS), a case-control study of menstrual fluid to understand and prevent preterm stillbirth and associated adverse pregnancy outcomes: study protocol. BMJ Open 2023; 13:e068919. [PMID: 37433731 DOI: 10.1136/bmjopen-2022-068919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Current research aimed at understanding and preventing stillbirth focuses almost exclusively on the role of the placenta. The underlying origins of poor placental function leading to stillbirth, however, remain poorly understood. There is evidence demonstrating that the endometrial environment in which the embryo implants impacts not only the establishment of pregnancy but also the development of some pregnancy outcomes. Menstrual fluid has recently been applied to the study of menstrual disorders such as heavy menstrual bleeding or endometriosis, however, it has great potential in the study of adverse pregnancy outcomes. This study aims to identify differences in menstrual fluid and menstrual cycle characteristics of women who have experienced preterm stillbirth and other associated adverse pregnancy outcomes, compared with those who have not. The association between menstrual fluid composition and menstrual cycle characteristics will also be determined. METHODS AND ANALYSIS This is a case-control study of women who have experienced a late miscarriage, spontaneous preterm birth or preterm stillbirth or a pregnancy complicated by placental insufficiency (fetal growth restriction or pre-eclampsia), compared with those who have had a healthy term birth. Cases will be matched for maternal age, body mass index and gravidity. Participants will not currently be on hormonal therapy. Women will be provided with a menstrual cup and will collect their sample on day 2 of menstruation. Primary exposure measures include morphological and functional differences in decidualisation of the endometrium (cell types, immune cell subpopulations and protein composition secreted from the decidualised endometrium). Women will complete a menstrual history survey to capture menstrual cycle length, regularity, level of pain and heaviness of flow. ETHICS AND DISSEMINATION Ethics approval was obtained from Monash University Human Research Ethics Committee (27900) on 14/07/2021 and will be conducted in accordance with these conditions. Findings from this study will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Kirstin Tindal
- The Ritchie Centre at Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Caitlin E Filby
- Faculty of Medicine Nursing and Health Sciences, Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Caroline E Gargett
- The Ritchie Centre at Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Fiona Cousins
- The Ritchie Centre at Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Kirsten Rebecca Palmer
- Department of Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
- Monash University Women's Health Research Program, Melbourne, Victoria, Australia
| | - Beverley Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
- Monash University Women's Health Research Program, Melbourne, Victoria, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre at Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
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29
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O'Hare K, Watkeys O, Whitten T, Dean K, Laurens KR, Harris F, Carr VJ, Green MJ. Cumulative environmental risk in early life is associated with mental disorders in childhood. Psychol Med 2023; 53:4762-4771. [PMID: 35866367 DOI: 10.1017/s0033291722001702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND No single environmental factor is a necessary or sufficient cause of mental disorder; multifactorial and transdiagnostic approaches are needed to understand the impact of the environment on the development of mental disorders across the life course. METHOD Using linked multi-agency administrative data for 71 932 children from the New South Wales Child Developmental Study, using logistic regression, we examined associations between 16 environmental risk factors in early life (prenatal period to <6 years of age) and later diagnoses of mental disorder recorded in health service data (from age 6 to 13 years), both individually and summed as an environmental risk score (ERS). RESULTS The ERS was associated with all types of mental disorder diagnoses in a dose-response fashion, such that 2.8% of children with no exposure to any of the environmental factors (ERS = 0), compared to 18.3% of children with an ERS of 8 or more indicating exposure to 8 or more environmental factors (ERS ⩾ 8), had been diagnosed with any type of mental disorder up to age 13-14 years. Thirteen of the 16 environmental factors measured (including prenatal factors, neighbourhood characteristics and more proximal experiences of trauma or neglect) were positively associated with at least one category of mental disorder. CONCLUSION Exposure to cumulative environmental risk factors in early life is associated with an increased likelihood of presenting to health services in childhood for any kind of mental disorder. In many instances, these factors are preventable or capable of mitigation by appropriate public policy settings.
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Affiliation(s)
- Kirstie O'Hare
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Oliver Watkeys
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Tyson Whitten
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- School of Social Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia
| | - Kristin R Laurens
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
| | - Felicity Harris
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Vaughan J Carr
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - Melissa J Green
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
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Gartland D, Nikolof A, Glover K, Leane C, Cahir P, Hameed M, Brown SJ. Patterns of Health and Health Service Use in a Prospective Cohort of Aboriginal and Torres Strait Islander Children Aged 5-9 Years Living in Urban, Regional and Remote Areas of South Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6172. [PMID: 37372759 DOI: 10.3390/ijerph20126172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Despite longstanding recognition of disparities in Aboriginal and Torres Strait Islander child health, progress to reduce disparities is slow. To improve the capacity of policy makers to target resources, there is an urgent need for epidemiological studies providing prospective data on child health outcomes. We undertook a prospective population-based study of 344 Aboriginal and Torres Strait Islander children born in South Australia. Mothers and caregivers reported on child health conditions, use of health services and the social and familial context of the children. A total of 238 children with a mean age of 6.5 years participated in wave 2 follow-up. Overall, 62.7% of the children experienced one or more physical health conditions in the 12 months prior to wave 2 follow-up, 27.3% experienced a mental health condition and 24.8% experienced a developmental condition. The 12-month period prevalence of physical, developmental and mental health conditions was similar for children living in urban, regional and remote areas. While most children had had at least one visit with a general practitioner, some children experiencing physical, developmental and mental health conditions appear to be missing out on specialist and allied health care. Greater efforts by governments and policy makers are needed to strengthen outreach, recognition, referral and follow-up.
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Affiliation(s)
- Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Arwen Nikolof
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Karen Glover
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Cathy Leane
- Women's and Children's Health Network, SA Health, North Adelaide, SA 5006, Australia
| | - Petrea Cahir
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Mohajer Hameed
- 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 Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
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Harris F, Dean K, Watkeys OJ, Laurens KR, Tzoumakis S, Carr VJ, Green MJ. Conditions of Birth and Early Childhood Developmental Risk for Mental Disorders. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01549-2. [PMID: 37270433 DOI: 10.1007/s10578-023-01549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
Distinct classes of children in the general population are at increased odds of later mental illness and other adverse outcomes according to patterns of early childhood developmental vulnerability. If certain risk factors known at the time of birth are reliably associated with membership in early childhood risk classes, then preventative interventions could be initiated in the earliest years of life. Associations between 14 factors known at the time of birth and membership in early childhood risk classes were examined in 66,464 children. Risk class membership was associated with maternal mental illness, parental criminal charges and being male; distinct patterns of association were shown for some conditions, for example, prenatal child protection notification was uniquely associated with misconduct risk'. These findings suggest that risk factors known at the time of birth could assist in very early detection of children who may benefit from early intervention in the first 2000 days.
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Affiliation(s)
- Felicity Harris
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Justice Health & Forensic Mental Network, Matraville, NSW, Australia
| | - Oliver J Watkeys
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Kristin R Laurens
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Stacy Tzoumakis
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Griffith Criminology Institute, Griffith University, Southport, QLD, Australia
- School of Criminology and Criminal Justice, Griffith University, Southport, QLD, Australia
| | - Vaughan J Carr
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Melissa J Green
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
- Neuroscience Research Australia, Sydney, NSW, Australia.
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Kadife E, Harper A, Chien K, Lino TK, Brownfoot FC. Novel genes associated with a placental phenotype in knockout mice also respond to cellular stressors in primary human trophoblasts. Placenta 2023; 139:68-74. [PMID: 37331027 DOI: 10.1016/j.placenta.2023.05.012] [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: 08/18/2022] [Revised: 04/17/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Placental insufficiency is a leading cause of intrauterine growth restriction, contributing to perinatal morbidity and mortality. The molecular regulation of placental development and what causes placental insufficiency is poorly understood. Recently, a panel of genes were found to cause significant placental dysmorphologies in mice with severely growth restricted off-spring. We aimed to assess whether these genes were also implicated in human intrauterine growth restriction. METHODS We explored the expression of nine genes in primary cytotrophoblast cells in hypoxic (n = 6) and glucose starvation (n = 5) conditions in vitro. We also explored whether the genes were dysregulated in intrauterine growth restricted human placental samples (n = 11), with (n = 20) or without preeclampsia compared to gestationally matched controls (<34 weeks gestation) (n = 17). RESULTS Hypoxic stress significantly upregulated the expressions of BRD2 (p = 0.0313), SMG9 (p = 0.0313) genes. In contrast, glucose starvation significantly suppressed Kif1bp (p = 0.0089) in primary cytotrophoblasts. The FRYL, NEK9, CHTOP, PSPH, ATP11A, HM13 genes did not change under hypoxia or glucose starvation conditions. The expression of these genes was not altered in placenta from patients with intrauterine growth restriction, compared to gestationally matched controls. DISCUSSION We demonstrate that some of the genes that cause a placental phenotype in mice, respond to hypoxic and glucose mediated stress in human cytotrophoblast isolations. Despite this, they are unchanged in placenta from patients with intrauterine growth restriction. Therefore, dysregulation of these genes is less likely to contribute to preterm intrauterine growth restriction in humans.
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Affiliation(s)
- Elif Kadife
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Alesia Harper
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Keegan Chien
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Tu'uhevaha Kaitu'u Lino
- Diagnostics Discovery and Reverse Translation in Pregnancy, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - Fiona C Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women Heidelberg, 163 Studley Road, Heidelberg, 3084, Victoria, Australia.
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Hegerty C, Ostini R. Benefits and harms associated with an increase in gestational diabetes diagnosis in Queensland, Australia: a retrospective cohort comparison of diagnosis rates, outcomes, interventions and medication use for two periods, 2011-2013 and 2016-2018, using a large perinatal database. BMJ Open 2023; 13:e069849. [PMID: 37192791 DOI: 10.1136/bmjopen-2022-069849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To assess benefits and harms arising from increasing gestational diabetes (GDM) diagnosis, including for women with normal-sized babies. DESIGN, SETTING AND PARTICIPANTS Diagnosis rates, outcomes, interventions and medication use are compared in a retrospective cohort study of 229 757 women birthing in public hospitals of the Australian State of Queensland during two periods, 2011-2013 and 2016-2018, using data from the Queensland Perinatal Data Collection. OUTCOME MEASURES Comparisons include hypertensive disorders, caesarean section, shoulder dystocia and associated harm, induction of labour (IOL), planned birth (PB), early planned birth <39 weeks (EPB), spontaneous labour onset with vaginal birth (SLVB) and medication use. RESULTS GDM diagnosis increased from 7.8% to 14.3%. There was no improvement in shoulder dystocia associated injuries, hypertensive disorders or caesarean sections. There was an increase in IOL (21.8%-30.0%; p<0.001), PB (36.3% to 46.0%; p<0.001) and EPB (13.5%-20.6%; p<0.001), and a decrease in SLVB (56.0%-47.3%; p<0.001). Women with GDM experienced an increase in IOL (40.9%-49.8%; p<0.001), PB (62.9% to 71.8%; p<0.001) and EPB (35.3%-45.7%; p<0.001), and a decrease in SLVB (30.01%-23.6%; p<0.001), with similar changes for mothers with normal-sized babies. Of women prescribed insulin in 2016-2018, 60.4% experienced IOL, 88.5% PB, 76.4% EPB and 8.0% SLVB. Medication use increased from 41.2% to 49.4% in women with GDM, from 3.2% to 7.1% in the antenatal population overall, from 3.3% to 7.5% in women with normal-sized babies and from 2.21% to 4.38% with babies less than the 10th percentile. CONCLUSION Outcomes were not apparently improved with increased GDM diagnosis. The merits of increased IOL or decreased SLVB depend on the views of individual women, but categorising more pregnancies as abnormal, and exposing more babies to the potential effects of early birth, medication effects and growth limitation may be harmful.
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Affiliation(s)
- Christopher Hegerty
- Warwick Hospital, Queensland Health, Warwick, Queensland, Australia
- General Rural Medicine, Queensland Government Department of Health and Ageing, Warwick, Queensland, Australia
| | - Remo Ostini
- Rural Clinical School Research Centre, University of Queensland School of Medicine, Toowoomba, Queensland, Australia
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O’Hare K, Watkeys O, Whitten T, Dean K, Laurens KR, Tzoumakis S, Harris F, Carr VJ, Green MJ. Cumulative Environmental Risk in Early Life: Associations With Schizotypy in Childhood. Schizophr Bull 2023; 49:244-254. [PMID: 36302227 PMCID: PMC10016419 DOI: 10.1093/schbul/sbac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Psychotic disorders are associated with a growing number of recognized environmental exposures. Cumulative exposure to multiple environmental risk factors in childhood may contribute to the development of different patterns of schizotypy evident in early life. Hypotheses were that distinct profiles of schizotypy would have differential associations with a cumulative score of environmental risk factors. STUDY DESIGN We prospectively examined the relationship between 19 environmental exposures (which had demonstrated replicated associations with psychosis) measured from the prenatal period through to age 11 years, and 3 profiles of schizotypy in children (mean age = 11.9 years, n = 20 599) that have been established in population data from the New South Wales-Child Development Study. Multinomial logistic regression was used to examine associations between membership in each of 3 schizotypy profiles (true schizotypy, introverted schizotypy, and affective schizotypy) and exposure to a range of 19 environmental risk factors for psychosis (both individually and summed as a cumulative environmental risk score [ERS]), relative to children showing no risk. RESULTS Almost all environmental factors were associated with at least 1 schizotypy profile. The cumulative ERS was most strongly associated with the true schizotypy profile (OR = 1.61, 95% CI = 1.52-1.70), followed by the affective (OR = 1.33, 95% CI = 1.28-1.38), and introverted (OR = 1.32, 95% CI = 1.28-1.37) schizotypy profiles. CONCLUSIONS Consistent with the cumulative risk hypothesis, results indicate that an increased number of risk exposures is associated with an increased likelihood of membership in the 3 schizotypy profiles identified in middle childhood, relative to children with no schizotypy profile.
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Affiliation(s)
- Kirstie O’Hare
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Oliver Watkeys
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Tyson Whitten
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- School of Social Sciences, University of Adelaide, South Australia, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia
| | - Kristin R Laurens
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Queensland University of Technology (QUT), School of Psychology and Counselling, Brisbane, Australia
| | - Stacy Tzoumakis
- School of Criminology and Criminal Justice, Griffith University, Southport, Australia
- Griffith Criminology Institute, Griffith University, Southport, Australia
| | - Felicity Harris
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Vaughan J Carr
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - Melissa J Green
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
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Di Ciaccio PR, Mills G, Shipton MJ, Campbell B, Gregory G, Langfield J, Greenwood M, McKeague S, Shanavas M, Eslick R, Kidson-Gerber G, Smallbone P, Tang C, Morris K, Bilmon I, Yannakou C, Badoux X, Berkahn L, Farina S, Mason KD, Motum P, Goss K, Hamad N. The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance. Br J Haematol 2023; 201:887-896. [PMID: 36880558 DOI: 10.1111/bjh.18727] [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: 12/12/2022] [Revised: 02/18/2023] [Accepted: 02/18/2023] [Indexed: 03/08/2023]
Abstract
Lymphoma in pregnancy (LIP) presents unique clinical, social and ethical challenges; however, the evidence regarding this clinical scenario is limited. We conducted a multicentre retrospective observational study reporting on the features, management, and outcomes of LIP in patients diagnosed between January 2009 and December 2020 at 16 sites in Australia and New Zealand for the first time. We included diagnoses occurring either during pregnancy or within the first 12 months following delivery. A total of 73 patients were included, 41 diagnosed antenatally (AN cohort) and 32 postnatally (PN cohort). The most common diagnoses were Hodgkin lymphoma (HL; 40 patients), diffuse large B-cell lymphoma (DLBCL; 11) and primary mediastinal B-cell lymphoma (PMBCL; six). At a median follow up of 2.37 years, the 2- and 5-year overall survival (OS) for patients with HL were 91% and 82%. For the combined DLBCL and PMBCL group, the 2-year OS was 92%. Standard curative chemotherapy regimens were successfully delivered to 64% of women in the AN cohort; however, counselling regarding future fertility and termination of pregnancy were suboptimal, and a standardised approach to staging lacking. Neonatal outcomes were generally favourable. We present a large multicentre cohort of LIP reflecting contemporary practice and identify areas in need of ongoing research.
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Affiliation(s)
- Pietro R Di Ciaccio
- Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.,College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.,School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Georgia Mills
- Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia.,Faculty of Medicine, Macquarie University, Ryde, New South Wales, Australia
| | - Michael J Shipton
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Belinda Campbell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | | | - Jenna Langfield
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Matthew Greenwood
- Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sean McKeague
- Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Mohammad Shanavas
- Mater Hospital Brisbane, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Renee Eslick
- The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Giselle Kidson-Gerber
- Prince of Wales Hospital and The Royal Hospital for Women, Randwick, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | | | - Catherine Tang
- Gosford Hospital, Gosford, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirk Morris
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Ian Bilmon
- Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Westmead Hospital, Westmead, New South Wales, Australia
| | - Costas Yannakou
- Epworth Freemasons, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Xavier Badoux
- St George Hospital, Kogarah, New South Wales, Australia
| | | | | | - Kylie D Mason
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Motum
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Nada Hamad
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Medicine, Sydney, University of Notre, Sydney, New South Wales, Australia
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36
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Fasting Glucose Level on the Oral Glucose Tolerance Test Is Associated with the Need for Pharmacotherapy in Gestational Diabetes Mellitus. Nutrients 2023; 15:nu15051226. [PMID: 36904224 PMCID: PMC10005728 DOI: 10.3390/nu15051226] [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: 01/30/2023] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Gestational diabetes mellitus (GDM) has a rapidly increasing prevalence, which poses challenges to obstetric care and service provision, with known serious long-term impacts on the metabolic health of the mother and the affected offspring. The aim of this study was to evaluate the association between glucose levels on the 75 g oral glucose tolerance test and GDM treatment and outcomes. We performed a retrospective cohort study of women with GDM attending a tertiary Australian hospital obstetric clinic between 2013 and 2017, investigating the relationship between the 75 g oral glucose tolerance test (OGTT) glucose values, and obstetric (timing of delivery, caesarean section, preterm birth, preeclampsia), and neonatal (hypoglycaemia, jaundice, respiratory distress and NICU admission) outcomes. This time frame encompassed a change in diagnostic criteria for gestational diabetes, due to changes in international consensus guidelines. Our results showed that, based on the diagnostic 75 g OGTT, fasting hyperglycaemia, either alone or in combination with elevated 1 or 2 h glucose levels, was associated with the need for pharmacotherapy with either metformin and/or insulin (p < 0.0001; HR 4.02, 95% CI 2.88-5.61), as compared to women with isolated hyperglycaemia at the 1 or 2 h post-glucose load timepoints. Fasting hyperglycaemia on the OGTT was more likely in women with higher BMI (p < 0.0001). There was an increased risk of early term birth in women with mixed fasting and post-glucose hyperglycaemia (adjusted HR 1.72, 95% CI 1.09-2.71). There were no significant differences in rates of neonatal complications such as macrosomia or NICU admission. Fasting hyperglycaemia, either alone or in combination with post-glucose elevations on the OGTT, is a strong indicator of the need for pharmacotherapy in pregnant women with GDM, with significant ramifications for obstetric interventions and their timing.
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37
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Safi N, Li Z, Anazodo A, Remond M, Hayen A, Currow D, Roder D, Hamad N, Nicholl M, Gordon A, Frawley J, Fotheringham P, Sullivan E. Pregnancy associated cancer, timing of birth and clinical decision making-a NSW data linkage study. BMC Pregnancy Childbirth 2023; 23:105. [PMID: 36759774 PMCID: PMC9909861 DOI: 10.1186/s12884-023-05359-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The incidence of pregnancy-associated cancer (PAC), comprising cancer diagnosed during pregnancy or within one year postpartum, is increasing. We investigated the obstetric management and outcomes of women with PAC and their babies. METHODS A population-based observational study of all women who gave birth between 1994 and 2013 in New South Wales, Australia. Women were stratified into three groups: those diagnosed during pregnancy (gestational cancer group), those diagnosed within one year of giving birth (postpartum cancer group), and a no-PAC group. Generalized estimating equations were used to examine the association between PAC and adverse maternal and neonatal outcomes. RESULTS One million seven hundred eighty-eight thousand four hundred fifty-onepregnancies were included-601 women (614 babies) were in the gestational cancer group, 1772 women (1816 babies) in the postpartum cancer group, and 1,786,078 women (1,813,292 babies) in the no-PAC group. The overall crude incidence of PAC was 132.7/100,000 women giving birth. The incidence of PAC increased significantly over the twenty-year study period from 93.5/100,000 in 1994 to 162.5/100,000 in 2013 (2.7% increase per year, 95% CI 1.9 - 3.4%, p-value < 0.001). This increase was independent of maternal age. The odds of serious maternal complications (such as acute abdomen, acute renal failure, and hysterectomy) were significantly higher in the gestational cancer group (adjusted odds ratio (AOR) 5.07, 95% CI 3.72 - 6.90) and the postpartum cancer group (AOR 1.55, 95% CI 1.16 - 2.09). There was no increased risk of perinatal mortality in babies born to women with PAC. However, babies of women with gestational cancer (AOR 8.96, 95% CI 6.96 - 11.53) or postpartum cancer (AOR 1.36, 95% CI 1.05 - 1.81) were more likely to be planned preterm birth. Furthermore, babies of women with gestational cancer had increased odds of a severe neonatal adverse outcome (AOR 3.13, 95% CI 2.52 - 4.35). CONCLUSION Women with PAC are more likely to have serious maternal complications. While their babies are not at increased risk of perinatal mortality, they are more likely to experience poorer perinatal outcomes associated with preterm birth. The higher rate of birth intervention among women with gestational cancers reflects the complexity of clinical decision-making in this context.
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Affiliation(s)
- Nadom Safi
- grid.266842.c0000 0000 8831 109XCollege of Health, Medicine and Wellbeing, University of Newcastle, 130 University Drive, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Zhuoyang Li
- grid.266842.c0000 0000 8831 109XCollege of Health, Medicine and Wellbeing, University of Newcastle, 130 University Drive, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Antoinette Anazodo
- grid.415193.bPrince of Wales Hospital, Nelune Comprehensive Cancer Centre, Randwick, NSW 2031 Australia
| | - Marc Remond
- grid.266842.c0000 0000 8831 109XCollege of Health, Medicine and Wellbeing, University of Newcastle, 130 University Drive, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Andrew Hayen
- grid.117476.20000 0004 1936 7611School of Public Health, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - David Currow
- grid.1007.60000 0004 0486 528XUniversity of Wollongong, the Vice-Chancellor’s Unit, NSW, Wollongong, 2522 Australia
| | - David Roder
- grid.1026.50000 0000 8994 5086University of South Australia, Population Health, Beat Cancer Project, Adelaide, SA Australia
| | - Nada Hamad
- grid.410697.dThe Kinghorn Cancer Centre, Darlinghurst, NSW 2010 Australia
| | - Michael Nicholl
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Adrienne Gordon
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Jane Frawley
- grid.117476.20000 0004 1936 7611School of Public Health, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Penelope Fotheringham
- grid.266842.c0000 0000 8831 109XCollege of Health, Medicine and Wellbeing, University of Newcastle, 130 University Drive, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Elizabeth Sullivan
- College of Health, Medicine and Wellbeing, University of Newcastle, 130 University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
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Brew BK, Gibberd A, Marks GB, Murphy VE, Jorm L, Chambers GM, Hartz D, Eades S, McNamara B. Maternal asthma in Australian indigenous women and perinatal outcomes: A whole population-linked study. Int J Gynaecol Obstet 2023; 160:653-660. [PMID: 35869950 PMCID: PMC10952457 DOI: 10.1002/ijgo.14363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the association between maternal asthma and adverse perinatal outcomes in an Australian Indigenous population. METHODS This prospective cohort study included all Indigenous mother and baby dyads for births from 2001 to 2013 in Western Australia (n = 25 484). Data were linked from Western Australia Births, Deaths, Midwives, Hospital, and Emergency Department collections. Maternal asthma was defined as a self-reported diagnosis at an antenatal visit or hospitalization or emergency visit for asthma during pregnancy or less than 3 years before pregnancy. Associations with birth, labor, and pregnancy outcomes were assessed using generalized estimating equations. Asthma exacerbation during pregnancy and stratification by remoteness was also assessed. RESULTS Maternal asthma was associated with placental abruption (adjusted odds ratio [aOR], 1.59 [95% confidence interval (CI), 1.07-2.35]), threatened preterm labor (aOR, 1.58 [95% CI, 1.39-1.79]), and emergency cesarean sections (aOR, 1.27 [95% CI, 1.13-1.44]). These risks increased further with an asthma exacerbation during pregnancy or if the mother was from a remote area. No associations were found for low birth weight, preterm birth, small for gestational age, or perinatal mortality. CONCLUSION Maternal asthma in Indigenous women is associated with an increased risk of emergency cesarean sections, placental abruption, and threatened preterm labor. These risks may be mitigated by improved management of asthma exacerbations during pregnancy.
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Affiliation(s)
- Bronwyn K. Brew
- Centre for Big Data Research in HealthUNSWSydneyNew South WalesAustralia
- National Perinatal and Statistics UnitSchool of Clinical Medicine & Centre for Big Data Research in Health, UNSWSydneyNew South WalesAustralia
| | - Alison Gibberd
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Guy B. Marks
- Woolcock Institute of Medical ResearchSydneyNew South WalesAustralia
- South West Sydney Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
| | - Vanessa E. Murphy
- Priority Research Centre for Health Lungs, School of Medicine and Public HealthUniversity of Newcastle, and Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Louisa Jorm
- Centre for Big Data Research in HealthUNSWSydneyNew South WalesAustralia
| | - Georgina M. Chambers
- Centre for Big Data Research in HealthUNSWSydneyNew South WalesAustralia
- National Perinatal and Statistics UnitSchool of Clinical Medicine & Centre for Big Data Research in Health, UNSWSydneyNew South WalesAustralia
| | - Donna Hartz
- College of Health Medicine and Wellbeing, School of Nursing and MidwiferyUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Sandra Eades
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Bridgette McNamara
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
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Han-Menz C, Whiteley G, Evans R, Razak A, Malhotra A. Systemic postnatal corticosteroids and magnetic resonance imaging measurements of corpus callosum and cerebellum of extremely preterm infants. J Paediatr Child Health 2023; 59:282-287. [PMID: 36404722 PMCID: PMC10098787 DOI: 10.1111/jpc.16286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022]
Abstract
AIM To compare the size of the corpus callosum (CC) and cerebellum on magnetic resonance imaging (MRI) brain scans conducted at term equivalent age (TEA) in extremely preterm infants who received systemic postnatal corticosteroids (PCS) to extremely preterm infants who did not receive systemic PCS and determine the dose-dependent effects on these outcomes. METHODS Single-centre retrospective cohort study including extremely preterm infants (born < 26 weeks' gestation) who had MRI brain scans at TEA. CC and cerebellar measurements were evaluated by two radiologists who were blinded to steroid use and their independent measurements were averaged. Comparative analyses were conducted between exposed (to systemic PCS) and non-exposed groups. RESULTS Eighty-three extremely preterm infants with mean (SD) 24.9 (0.91) weeks' gestational age, 721.8 (156) g birthweight were included; 38 with systemic PCS exposure and 45 without exposure. After adjustment for birthweight and other significant neonatal morbidities, there was no significant difference noted in corpus callosum length (CCL) between unexposed and exposed groups (adjusted mean (SE) 39.5 (0.57) mm vs. 38.5 (0.62) mm; P = 0.29). Similarly, the ratios of CCL/fronto-occipital diameter (FOD) and CCL/biparietal diameter (BPD) were not significantly different between the groups (CCL/FOD (0.40 (0.01) vs. 0.41 (0.01); P = 0.70) and CCL/BPD (0.51 (0.01) vs. 0.52 (0.01); P = 0.62)). Finally, no significant differences in cerebellar measurements, such as vermian height (adjusted mean (SE) 24.0 (0.46) mm vs. 23.5 (0.51 mm); P = 0.47) and transcerebellar diameter (adjusted mean (SE) 49.3 (0.74) mm vs. 4.78 (0.82) mm; P = 0.22) were found. No dose-dependent effects of systemic PCS on CC and cerebellar measurements were identified. CONCLUSIONS Systemic PCS use in extremely preterm infants was not associated with a change in the CC and cerebellar measurements on MRI brain scan at TEA.
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Affiliation(s)
- Charmaine Han-Menz
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Gillian Whiteley
- Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Rachel Evans
- Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Abdul Razak
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
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40
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Bailey HD, Gray C, Adane AA, Strobel NA, White SW, Marriott R, Tessema GA, Shepherd CCJ, Sharp M. Early mortality among aboriginal and non-aboriginal women who had a preterm birth in Western Australia: A population-based cohort study. Paediatr Perinat Epidemiol 2023; 37:31-44. [PMID: 36331146 PMCID: PMC10946802 DOI: 10.1111/ppe.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Having a preterm (<37 weeks' gestation) birth may increase a woman's risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women. OBJECTIVES We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status. METHODS This retrospective cohort study used population-based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all-cause and cause-specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality. RESULTS There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 non-Aboriginal mothers (7646 deaths) with 8.6 million person-years of follow-up. The all-cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95% CI 135.5, 238.5) per 100,000 person-years respectively. Among non-Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95% CI 29.4, 44.9) per 100,000 person-years. The HR for all-cause mortality for Aboriginal and non-Aboriginal mothers associated with preterm birth were 1.48 (95% CI 1.32, 1.66) and 1.35 (95% CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes. CONCLUSIONS Both Aboriginal and non-Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening.
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Affiliation(s)
- Helen D. Bailey
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Caitlin Gray
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Akilew A. Adane
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Natalie A. Strobel
- Kurongkurl KatitjinEdith Cowan UniversityMount LawleyWestern AustraliaAustralia
| | - Scott W. White
- Division of Obstetrics and GynaecologyThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Maternal Fetal Medicine ServiceKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
| | - Rhonda Marriott
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Gizachew A. Tessema
- Curtin School of Population Health, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - Carrington C. J. Shepherd
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Ngangk Yira Research Institute for ChangeMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Mary Sharp
- Telethon Kids InstituteThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of NeonatologyKing Edward Memorial HospitalSubiacoWestern AustraliaAustralia
- Centre for Neonatal Research and EducationThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of NeonatologyPerth Children's HospitalNedlandsWestern AustraliaAustralia
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SLC38A4 Amino Acid Transporter Expression Is Significantly Lower in Early Preterm Intrauterine Growth Restriction Complicated Placentas. Int J Mol Sci 2022; 24:ijms24010403. [PMID: 36613847 PMCID: PMC9820794 DOI: 10.3390/ijms24010403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022] Open
Abstract
Intrauterine growth restriction (IUGR), predominantly caused by placental insufficiency, affects partitioning of nutrients to the fetus. The system A sodium-coupled transporters (SNAT or SLC38), of types A1, A2, and A4, control non-essential amino acid uptake and supply. Here, we aimed to investigate the expression of these transporters across different placental disease cohorts and cells. To determine disease impact, transporter expressions at the gene (qPCR) and protein (western blots) level were assessed in gestationally matched placental tissues. Early (<34 weeks), and late (34−36 weeks) onset IUGR cases with/out preeclampsia were compared to preterm controls. We also investigated level of transporter expression in primary trophoblasts under glucose deprivation (n = 6) and hypoxia conditions (n = 7). SLC38A4 protein was significantly downregulated in early preterm pregnancies complicated with IUGR with/out preeclampsia. There were no differences in late preterm IUGR cohorts. Furthermore, we demonstrate for the first time in primary trophoblast cells, that gene expression of the transporters was sensitive to and induced by glucose starvation. SLC38A4 mRNA expression was also significantly upregulated in response to hypoxia. Thus, SLC38A4 expression was persistently low in early preterm IUGR pregnancies, regardless of disease aetiology. This suggests that gestational age at delivery, and consequently IUGR severity, may influence loss of its expression.
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O'Connor A, Shand AW, Schneuer FJ, Nassar N, Austin MP. Assessing the relationship between psychosocial risk and pregnancy outcomes using the perinatal integrated psychosocial assessment (PIPA) tool. Birth 2022; 49:648-660. [PMID: 35233836 DOI: 10.1111/birt.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Perinatal Integrated Psychosocial Assessment (PIPA) tool screens for anxiety, depression, and psychosocial factors in pregnancy. We aimed to assess the association between PIPA-determined psychosocial risk and obstetric and neonatal outcomes. METHODS Cohort study of all pregnant women who gave birth at ≥20 weeks of gestation in 2017-2019 at a tertiary maternity hospital in, Sydney, Australia. Women completed PIPA at their first antenatal visit and were assigned a PIPA risk category. At-risk women were reviewed and referred for support. The association between PIPA risk category and obstetric and neonatal outcomes was evaluated using multivariable logistic regression adjusting for sociodemographic and pregnancy factors. RESULTS In all, 5969 women completed PIPA; 71.4% were assessed no/low risk, 17.5% medium risk, and 11.1% medium-high/high risk. Compared with no/low-risk women, medium-high/high-risk women were more likely to remain in hospital for >72 hours (aOR 1.47 [95% CI 1.33-1.64]); to not be breastfeeding at discharge (aOR 1.77 [95% CI 1.20-2.61]); to have their infants experience birth complications (aOR 1.24 [95% CI 1.03-1.50]); and to be admitted to the NICU (aOR 1.63 [95% CI 1.26-2.11]). There was a modest increase in odds of cesarean birth (aOR 1.12 [95% CI 1.00-1.27]), and no association with preterm birth or low birthweight. The risk of adverse outcomes disappeared for medium-high/high-risk women referred for support. CONCLUSIONS The PIPA tool identified one in 10 women at high psychosocial risk with increased risk of adverse obstetric and neonatal outcomes. Adverse outcomes were attenuated for high-risk women who were referred for extra support, suggesting that psychosocial review and referral for high-risk women may reduce the risk of adverse obstetric and neonatal outcomes.
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Affiliation(s)
- Anne O'Connor
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Antonia W Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Francisco J Schneuer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Financial Markets Foundation for Children, Sydney, New South Wales, Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Perinatal & Women's Mental Health Unit, St John of God Burwood Hospital, Sydney, New South Wales, Australia
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Hui L, Marzan MB, Rolnik DL, Potenza S, Pritchard N, Said JM, Palmer KR, Whitehead CL, Sheehan PM, Ford J, Mol BW, Walker SP. Reductions in stillbirths and preterm birth in COVID-19-vaccinated women: a multicenter cohort study of vaccination uptake and perinatal outcomes. Am J Obstet Gynecol 2022; 228:585.e1-585.e16. [PMID: 36336084 PMCID: PMC9632261 DOI: 10.1016/j.ajog.2022.10.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND COVID-19 infection in pregnancy is associated with a higher risk of progression to severe disease, but vaccine uptake by pregnant women is hindered by persistent safety concerns. COVID-19 vaccination in pregnancy has been shown to reduce stillbirth, but its relationship with preterm birth is uncertain. OBJECTIVE This study aimed to measure the rate of COVID-19 vaccine uptake among women giving birth in Melbourne, Australia, and to compare perinatal outcomes by vaccination status. STUDY DESIGN This was a retrospective multicenter cohort study conducted after the June 2021 government recommendations for messenger RNA COVID-19 vaccination during pregnancy. Routinely collected data from all 12 public maternity hospitals in Melbourne were extracted on births at ≥20 weeks' gestation from July 1, 2021 to March 31, 2022. Maternal sociodemographic characteristics were analyzed from the total birth cohort. Perinatal outcomes were compared between vaccinated and unvaccinated women for whom weeks 20 to 43 of gestation fell entirely within the 9-month data collection period. The primary outcomes were the rates of stillbirth and preterm birth (spontaneous and iatrogenic) in singleton pregnancies of at least 24 weeks' gestation, after exclusion of congenital anomalies. Secondary perinatal outcomes included the rate of congenital anomalies among infants born at ≥20 weeks' gestation and birthweight ≤third centile and newborn intensive care unit admissions among infants born without congenital anomalies at ≥24 weeks' gestation. We calculated the adjusted odds ratio of perinatal outcomes among vaccinated vs unvaccinated women using inverse propensity score-weighting regression adjustment with multiple covariates; P<.05 was considered statistically significant. RESULTS Births from 32,536 women were analyzed: 17,365 (53.4%) were vaccinated and 15,171 (47.6%) were unvaccinated. Vaccinated women were more likely to be older, nulliparous, nonsmoking, not requiring an interpreter, of higher socioeconomic status, and vaccinated against pertussis and influenza. Vaccination status also varied by region of birth. Vaccinated women had a significantly lower rate of stillbirth compared with unvaccinated women (0.2% vs 0.8%; adjusted odds ratio, 0.18; 95% confidence interval, 0.09-0.37; P<.001). Vaccination was associated with a significant reduction in total preterm births at <37 weeks (5.1% vs 9.2%; adjusted odds ratio, 0.60; 95% confidence interval, 0.51-0.71; P<.001), spontaneous preterm birth (2.4% vs 4.0%; adjusted odds ratio, 0.73; 95% confidence interval, 0.56-0.96; P=.02), and iatrogenic preterm birth (2.7% vs 5.2%; adjusted odds ratio, 0.52; 95% confidence interval, 0.41-0.65; P<.001). Infants born to vaccinated mothers also had lower rates of admission to the neonatal intensive care unit. There was no significant increase in the rate of congenital anomalies or birthweight ≤3rd centile in vaccinated women. Vaccinated women were significantly less likely to have an infant with a major congenital anomaly compared with the unvaccinated group (2.4% vs 3.0%; adjusted odds ratio, 0.72; 95% confidence interval, 0.56-0.94; P=.02). This finding remained significant even when the analysis was restricted to women vaccinated before 20 weeks' gestation. CONCLUSION COVID-19 vaccination during pregnancy was associated with a reduction in stillbirth and preterm birth, and not associated with any adverse impact on fetal growth or development. Vaccine coverage was substantially influenced by known social determinants of health.
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Affiliation(s)
- Lisa Hui
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia,Reproductive Epidemiology Group, Murdoch Children’s Research Institute, Melbourne, Australia,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Melbourne, Australia,Department of Obstetrics and Gynaecology, The Northern Hospital, Northern Health, Melbourne, Australia,Corresponding author: Lisa Hui, MBBS, PhD
| | - Melvin B. Marzan
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia,Reproductive Epidemiology Group, Murdoch Children’s Research Institute, Melbourne, Australia,Center for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Daniel L. Rolnik
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia,Department of Obstetrics and Gynaecology, Frankston Hospital, Peninsula Health, Melbourne, Australia,Harvard T.H. School of Public Health, Harvard University, Cambridge, MA
| | - Stephanie Potenza
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Melbourne, Australia
| | - Natasha Pritchard
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Melbourne, Australia
| | - Joanne M. Said
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia,Department of Maternal-Fetal Medicine, Joan Kirner Women’s and Children’s Hospital, Western Health, Melbourne, Australia
| | - Kirsten R. Palmer
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Clare L. Whitehead
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia,Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Melbourne, Australia
| | - Penelope M. Sheehan
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia,Department of Obstetrics and Gynaecology, Box Hill Hospital, Eastern Health, Melbourne, Australia
| | - Jolyon Ford
- Department of Obstetrics and Gynaecology, Frankston Hospital, Peninsula Health, Melbourne, Australia
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Australia,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Susan P. Walker
- Department of Obstetrics and Gynaecology, Melbourne Medical School, The University of Melbourne, Melbourne, Australia,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Mercy Health, Melbourne, Australia
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Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study. PLoS One 2022; 17:e0274521. [PMID: 36215239 PMCID: PMC9551630 DOI: 10.1371/journal.pone.0274521] [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: 05/26/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Sex impacts birthweight, with male babies heavier on average. Birthweight charts are thus sex specific, but ultrasound fetal weights are often reported by sex neutral standards. We aimed to identify what proportion of infants would be re-classified as SGA if sex-specific charts were used, and if this had a measurable impact on perinatal outcomes. METHODS Retrospective cohort study including all infants born in Victoria, Australia, from 2005-2015 (529,261 cases). We applied GROW centiles, either adjusted or not adjusted for fetal sex. We compared overall SGA populations, and the populations of males considered small by sex-specific charts only (SGAsex-only), and females considered small by sex-neutral charts only (SGAunadjust-only). RESULTS Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of SGA females were reclassified as average for gestational age (AGA) using sex-specific charts. These female newborns were not at increased risk of stillbirth, combined perinatal mortality, NICU admissions, low Apgars or emergency CS compared with an AGA infant, but were at greater risk of being iatrogenically delivered on suspicion of growth restriction. 25.0% male infants were reclassified as SGA by sex-specific charts. These male newborns, compared to the AGAall infant, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90), combined perinatal mortality (RR 1.80, 95%CI 1.26-2.57), NICU admissions (RR 1.38, 95%CI 1.12-1.71), Apgars <7 at 5 minutes (RR 1.40, 95%CI 1.25-1.56) and emergency CS (RR 1.12, 95%CI 1.06-1.18). CONCLUSIONS Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as SGA, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Sex-specific charts may help inform decisions and improve outcomes.
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Wan A, Zampogna C, Reddy M, Robinson A, Hodges R, Rolnik DL. Performance of a risk factor-based approach in the detection of small for gestational age neonates: A cohort study. Aust N Z J Obstet Gynaecol 2022. [PMID: 36184072 DOI: 10.1111/ajo.13620] [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: 06/01/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antenatal detection of fetal growth restriction allows the opportunity to increase surveillance and initiate intervention to prevent adverse outcomes. Detection of small for gestational age (SGA) fetuses with risk factor screening and selective ultrasonography is the standard of care in Australia, but evidence regarding performance is lacking. AIMS To evaluate the diagnostic performance of a risk factor-based screening approach in detection of SGA neonates. MATERIALS AND METHODS Retrospective cohort study conducted in a metropolitan maternity service, including all consecutive singleton deliveries over 20 weeks gestation from July 2016 to December 2017, and excluding terminations of pregnancy. An SGA neonate was defined by birthweight below the tenth percentile according to Australian reference ranges. Antenatally detected SGA cases were defined by estimated fetal weight or abdominal circumference below the tenth percentile for gestational age, or abnormal symphysio-fundal height. The diagnostic accuracy of the screening protocol was calculated using detection rates and false-positive rates. RESULTS There were 13 384 singleton pregnancies included. There were 1330 infants (10.0%) who were SGA at birth. Antenatal detection rate of SGA neonates was 39.6% (95% confidence interval (CI) 37.0-42.3%), with a false-positive rate of 10.2% (95% CI 9.6-10.7%). There were 10 266 pregnancies (77.0%) which had at least one risk factor for an SGA infant. Of these, 6650 (64.8%) underwent at least one fetal growth ultrasound after 24 weeks gestation. CONCLUSIONS Antenatal recognition of poor fetal growth is suboptimal using our current screening protocol. Three-quarters of pregnancies demonstrated risk factors for delivering an SGA infant, but growth ultrasonography may be underutilised.
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Affiliation(s)
- Anna Wan
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Christopher Zampogna
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Alice Robinson
- Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
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de Alwis N, Beard S, Binder NK, Pritchard N, Kaitu’u-Lino TJ, Walker SP, Stock O, Groom K, Petersen S, Henry A, Said JM, Seeho S, Kane SC, Tong S, Hui L, Hannan NJ. Placental OLAH Levels Are Altered in Fetal Growth Restriction, Preeclampsia and Models of Placental Dysfunction. Antioxidants (Basel) 2022; 11:1677. [PMID: 36139751 PMCID: PMC9495588 DOI: 10.3390/antiox11091677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Previously, we identified elevated transcripts for the gene Oleoyl-ACP Hydrolase (OLAH) in the maternal circulation of pregnancies complicated by preterm fetal growth restriction. As placental dysfunction is central to the pathogenesis of both fetal growth restriction and preeclampsia, we aimed to investigate OLAH levels and function in the human placenta. We assessed OLAH mRNA expression (qPCR) throughout pregnancy, finding placental expression increased as gestation progressed. OLAH mRNA and protein levels (Western blot) were elevated in placental tissue from cases of preterm preeclampsia, while OLAH protein levels in placenta from growth-restricted pregnancies were comparatively reduced in the preeclamptic cohort. OLAH expression was also elevated in placental explant tissue, but not isolated primary cytotrophoblast cultured under hypoxic conditions (as models of placental dysfunction). Further, we discovered that silencing cytotrophoblast OLAH reduced the expression of pro- and anti-apoptosis genes, BAX and BCL2, placental growth gene, IGF2, and oxidative stress gene, NOX4. Collectively, these findings suggest OLAH could play a role in placental dysfunction and may be a therapeutic target for mitigating diseases associated with this vital organ. Further research is required to establish the role of OLAH in the placenta, and whether these changes may be a maternal adaptation or consequence of disease.
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Affiliation(s)
- Natasha de Alwis
- Therapeutics Discovery and Vascular Function in Pregnancy Group, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Northern Health, Epping, VIC 3076, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Sally Beard
- Therapeutics Discovery and Vascular Function in Pregnancy Group, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Northern Health, Epping, VIC 3076, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Natalie K. Binder
- Therapeutics Discovery and Vascular Function in Pregnancy Group, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Natasha Pritchard
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
- Translational Obstetrics Group, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Tu’uhevaha J. Kaitu’u-Lino
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
- Translational Obstetrics Group, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Susan P. Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Owen Stock
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Katie Groom
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
| | - Scott Petersen
- Centre for Maternal Fetal Medicine, Mater Mothers’ Hospital, South Brisbane, QLD 4101, Australia
| | - Amanda Henry
- Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Joanne M. Said
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
- Maternal Fetal Medicine, Joan Kirner Women’s & Children’s Sunshine Hospital, St Albans, VIC 3021, Australia
| | - Sean Seeho
- Women and Babies Research, Sydney Medical School-Northern, Faculty of Medicine and Health, University of Sydney, St Leonards, NSW 2065, Australia
| | - Stefan C. Kane
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
- Department of Maternal Fetal Medicine, Royal Women’s Hospital, Parkville, VIC 3052, Australia
| | - Stephen Tong
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
- Translational Obstetrics Group, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
| | - Lisa Hui
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Northern Health, Epping, VIC 3076, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Natalie J. Hannan
- Therapeutics Discovery and Vascular Function in Pregnancy Group, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC 3084, Australia
- Northern Health, Epping, VIC 3076, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC 3010, Australia
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Ibiebele I, Nippita T, Baber R, Torvaldsen S. Pregnancy outcomes in women with endometriosis and/or ART use: a population-based cohort study. Hum Reprod 2022; 37:2350-2358. [PMID: 36018266 PMCID: PMC9527458 DOI: 10.1093/humrep/deac186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the association between endometriosis and adverse pregnancy outcomes with ART use and non-use? SUMMARY ANSWER Endometriosis and ART use are both associated with increased risk of preterm birth, antepartum haemorrhage, placenta praevia and planned birth (caesarean delivery or induction of labour). WHAT IS KNOWN ALREADY There are contradictory findings on the association between endometriosis and adverse pregnancy outcomes, and many large studies have not considered the effect of ART use. STUDY DESIGN, SIZE, DURATION Population-based cohort study of 578 221 eligible pregnancies during 2006-2015, comparing pregnancy outcomes across four groups (No endo/no ART, No endo/ART, Endo/no ART and Endo/ART). PARTICIPANTS/MATERIALS, SETTING, METHODS All female residents of New South Wales, Australia aged 15-45 years and their index singleton pregnancy of at least 20 weeks gestation or 400 g birthweight. Linked hospital, pregnancy/birth and mortality data were used. Modified Poisson regression with robust error variances was used to estimate adjusted risk ratios (aRRs) and 99% CIs, adjusting for sociodemographic and pregnancy factors. MAIN RESULTS AND THE ROLE OF CHANCE Compared to women without endometriosis who had pregnancies without ART use, there was increased risk of preterm birth (<37 weeks) in all groups [No endo/ART (aRR 1.85, 99% CI 1.46-2.34), Endo/no ART (aRR 1.24, 99% CI 1.06-1.44), Endo/ART (aRR 1.93, 99% CI 1.11-3.35)] and antepartum haemorrhage [No endo/ART (aRR 1.99, 99% CI 1.39-2.85), Endo/no ART (aRR 1.31, 99% CI 1.03-1.67), Endo/ART (aRR 2.69, 99% CI 1.30-5.56)] among pregnancies affected by endometriosis or ART use, separately and together. There was increased risk of placenta praevia [No endo/ART (aRR 2.26, 99% CI 1.42-3.60), Endo/no ART (aRR 1.66, 99% CI 1.18-2.33)] and planned birth [No endo/ART (aRR 1.08, 99% CI 1.03-1.14), Endo/no ART (aRR 1.11, 99% CI 1.07-1.14)] among pregnancies with endometriosis or ART use, separately. There was increased risk of placental abruption [No endo/ART (aRR 2.36, 99% CI 1.12-4.98)], maternal morbidity [No endo/ART (aRR 1.67, 99% CI 1.07-2.62)] and low birthweight (<2500 g) [No endo/ART (aRR 1.45, 99% CI 1.09-1.93)] among pregnancies with ART use without endometriosis. There was decreased risk of having a large-for-gestational age infant [Endo/no ART (aRR 0.83, 99% CI 0.73-0.94)] among pregnancies with endometriosis without ART use. LIMITATIONS, REASONS FOR CAUTION Endometriosis is often under-diagnosed and women with a history of hospital diagnosis of endometriosis may represent those with more symptomatic or severe disease. If the effects of endometriosis on pregnancy are greater for those with more severe disease, our results may over-estimate the effect of endometriosis on adverse pregnancy outcomes at a population level. We were unable to assess the effect of endometriosis stage or typology on the study outcomes. WIDER IMPLICATIONS OF THE FINDINGS These results suggest that women with endometriosis including those who used ART to achieve pregnancy are a higher-risk obstetric group requiring appropriate surveillance and management during their pregnancy. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Prevention Research Support Program, funded by the New South Wales Ministry of Health. The funder had no role in the design, data collection and analysis, interpretation of results, manuscript preparation or the decision to submit the manuscript for publication. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ibinabo Ibiebele
- The University of Sydney Northern Clinical School, Women and Babies Research, Sydney, New South Wales, Australia.,Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
| | - Tanya Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, Sydney, New South Wales, Australia.,Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rodney Baber
- The University of Sydney Northern Clinical School, Women and Babies Research, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, Sydney, New South Wales, Australia.,Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia.,School of Population Health, UNSW, Sydney, New South Wales, Australia
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de Alwis N, Fato BR, Beard S, Binder NK, Kaitu’u-Lino TJ, Onda K, Hannan NJ. Assessment of the Proton Pump Inhibitor, Esomeprazole Magnesium Hydrate and Trihydrate, on Pathophysiological Markers of Preeclampsia in Preclinical Human Models of Disease. Int J Mol Sci 2022; 23:ijms23179533. [PMID: 36076929 PMCID: PMC9455231 DOI: 10.3390/ijms23179533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 12/02/2022] Open
Abstract
Previously, we demonstrated that the proton pump inhibitor, esomeprazole magnesium hydrate (MH), could have potential as a repurposed treatment against preeclampsia, a serious obstetric condition. In this study we investigate the difference in the preclinical effectiveness between 100 µM of esomeprazole MH and its hydration isomer, esomeprazole magnesium trihydrate (MTH). Here, we found that both treatments reduced secretion of sFLT-1 (anti-angiogenic factor) from primary cytotrophoblast, but only esomeprazole MH reduced sFLT-1 secretion from primary human umbilical vein endothelial cells (assessed via ELISA). Both drugs could mitigate expression of the endothelial dysfunction markers, vascular cell adhesion molecule-1 and endothelin-1 (via qPCR). Neither esomeprazole MH nor MTH quenched cytotrophoblast reactive oxygen species production in response to sodium azide (ROS assay). Finally, using wire myography, we demonstrated that both compounds were able to induce vasodilation of human omental arteries at 100 µM. Esomeprazole is safe to use in pregnancy and a candidate treatment for preeclampsia. Using primary human tissues and cells, we validated that esomeprazole is effective in enhancing vascular relaxation, and can reduce key factors associated with preeclampsia, including sFLT-1 and endothelial dysfunction. However, esomeprazole MH was more efficacious than esomeprazole MTH in our in vitro studies.
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Affiliation(s)
- Natasha de Alwis
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Bianca R. Fato
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Sally Beard
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Natalie K. Binder
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Tu’uhevaha J. Kaitu’u-Lino
- Diagnostics Discovery and Reverse Translation in Pregnancy Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
| | - Kenji Onda
- Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo 192-0392, Japan
| | - Natalie J. Hannan
- Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, VIC 3084, Australia
- Correspondence: ; Tel.: +61-3-8458-4371
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49
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Pritchard NL, Tong S, Walker SP, Lindquist AC. Fetal size classified using gestational days rather than gestational weeks improves correlation with stillbirth risk: A statewide population study. PLoS One 2022; 17:e0271538. [PMID: 35947552 PMCID: PMC9365147 DOI: 10.1371/journal.pone.0271538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/02/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
Many growth charts provide single centile cutoffs for each week of gestation, yet fetuses gain weight throughout the week. We aimed to assess whether using a single centile per week distorts the proportion of infants classified as small and their risk of stillbirth across the week.
Design
Retrospective cohort study.
Setting
Victoria, Australia.
Population
Singleton, non-anomalous infants born from 2005–2015 (529,261).
Methods
We applied growth charts to identify small-for-gestational-age (SGA) fetuses on week-based charts (single centile per gestational week) and day-based charts (centile per gestational day).
Main outcome measures
Proportions <10th centile by each chart, and stillbirth risk amongst SGA infants.
Results
Using week-based charts, 12.1% of infants born on the first day of a gestational week were SGA, but only 7.8% on the final day; ie. an infant born at the end of the week was 44% less likely to be classed as SGA (p<0.0001). The relative risk of stillbirth amongst SGA infants born on the final day of the week compared with the first was 1.47 (95%CI 1.09–2.00, p = 0.01). Using day charts, SGA proportions were similar and stillbirth risk equal between the beginning and end of the week (9.5% vs 9.9%).
Conclusions
Growth standards using a single cutoff for a gestational week overestimate the proportion of infants that are small at the beginning of the week and underestimate the proportion at the end. This distorts the risk of stillbirth amongst SGA infants based on when in the week an infant is born. Day-based charts should be used.
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Affiliation(s)
- Natasha L. Pritchard
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- * E-mail:
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P. Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea C. Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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50
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Kochhar P, Vukku M, Rajashekhar R, Mukhopadhyay A. microRNA signatures associated with fetal growth restriction: a systematic review. Eur J Clin Nutr 2022; 76:1088-1102. [PMID: 34741137 DOI: 10.1038/s41430-021-01041-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022]
Abstract
Placental-origin microRNA (miRNA) profiles can be useful toward early diagnosis and management of fetal growth restriction (FGR) and associated complications. We conducted a systematic review to identify case-control studies that have examined miRNA signatures associated with human FGR. We systematically searched PubMed and ScienceDirect databases for relevant articles and manually searched reference lists of the relevant articles till May 18th, 2021. Of the 2133 studies identified, 21 were included. FGR-associated upregulation of miR-210 and miR-424 and downregulation of a placenta-specific miRNA cluster miRNA located on C19MC (miR-518b, miR-519d) and miR-221-3p was reported by >1 included studies. Analysis of the target genes of these miRNA as well as pathway analysis pointed to the involvement of angiogenesis and growth signaling pathways, such as the phosphatidylinositol 3-kinase- protein kinase B (PI3K-Akt) pathway. Only 3 out of the 21 included studies reported FGR-associated miRNAs in matched placental and maternal blood samples. We conclude that FGR-associated placental miRNAs could be utilized to inform clinical practice towards early diagnosis of FGR, provided enough evidence from studies on matched placental and maternal blood samples become available.Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42019136762.
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Affiliation(s)
- P Kochhar
- Division of Nutrition, St. John's Research Institute, A Recognized Research Centre of University of Mysore, Bangalore, India
| | - M Vukku
- Division of Nutrition, St. John's Research Institute, A Recognized Research Centre of University of Mysore, Bangalore, India
| | - R Rajashekhar
- Division of Nutrition, St. John's Research Institute, A Recognized Research Centre of University of Mysore, Bangalore, India.,Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - A Mukhopadhyay
- Division of Nutrition, St. John's Research Institute, A Recognized Research Centre of University of Mysore, Bangalore, India.
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