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Hutchens J, Frawley J, Sullivan EA. Is self-advocacy universally achievable for patients? The experiences of Australian women with cardiac disease in pregnancy and postpartum. Int J Qual Stud Health Well-being 2023; 18:2182953. [PMID: 36821349 PMCID: PMC9970247 DOI: 10.1080/17482631.2023.2182953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Patient self-advocacy is valued and promoted; however, it may not be readily accessible to all. This analysis examines the experiences of women in Australia who had cardiac disease in pregnancy or the first year postpartum through the lenses of self-advocacy and gender, specifically seeking to elaborate on the contexts, impacts, barriers, and women's responses to the barriers to self-advocacy. METHOD A qualitative study design was used. Twenty-five women participated in semi-structured in-depth interviews. Data were analysed using thematic analysis. RESULTS Analysis of findings generated the following themes: 1) Silent dream scream, 2) Easier said than done, 3) Crazy-making, and 4) Concentric circles of advocacy. Regardless of women's personal attributes, knowledge and experience, self-advocating for their health was complex and difficult and had negative cardiac and psychological outcomes. CONCLUSION While the women encountered significant barriers to self-advocating, they were resilient and ultimately developed strategies to be heard and to advocate on their own behalf and that of other women. Findings can be used to identify ways to support women to self-advocate and to provide adequately resourced and culturally safe environments to enable healthcare professionals to provide person-centred care.
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Affiliation(s)
- Jane Hutchens
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia,CONTACT Jane Hutchens School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, 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 2023. [PMID: 36915236 DOI: 10.1111/aogs.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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 Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Nadom Safi
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Zhouyang Li
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Antoinette Anazodo
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Marc Remond
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - David Roder
- Population Health, Beat Cancer Project, University of South Australia, Adelaide, South Australia, Australia
| | - Nada Hamad
- The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
| | - Michael Nicholl
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adrienne Gordon
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jane Frawley
- School of Public Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Elizabeth A Sullivan
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
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Hutchens J, Frawley J, Sullivan EA. Quality of life and mental health of women who had cardiac disease in pregnancy and postpartum. BMC Pregnancy Childbirth 2022; 22:797. [PMID: 36307772 PMCID: PMC9617394 DOI: 10.1186/s12884-022-05123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/25/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Cardiac disease is a leading cause of maternal morbidity and mortality yet there is limited research on women’s experiences and quality of life (QoL) outcomes. The aim of this study is to explore the general and health-related QoL (HRQoL) and mental health outcomes for women who have experienced cardiac disease in pregnancy and the first 12 months postpartum (CDPP). Methods This exploratory descriptive study recruited 43 women with acquired, genetic and congenital CDPP. Patient reported outcomes measures (PROMs) used were: WHOQoL-Bref, a Kansas City Cardiac Questionnaire (KCCQ), the Depression, Anxiety and Stress Scales-21 (DASS-21), the Cardiac Anxiety Questionnaire (CAQ) plus newly developed questions. Results Women reported low health satisfaction (51.7/100), physical health (55.2/100) and low HRQoL (63.1/100). Women had clinically significant scores for depression (24%), anxiety (22%) and stress (19.5%) (DASS-21) and 44.5% scored at least moderate anxiety on the CAQ. Most women (83.7%) were advised to avoid pregnancy which 88.9% found “upsetting” to “devastating”; 10.0% were offered counselling. Most women were concerned about reduced longevity (88.1%), offspring developing a cardiac condition (73.8%), and the limitations on enjoyment of life (57.1%). Women missed medical appointments due to cost (25.03%) and difficulty arranging childcare (45.5%). Conclusion The majority of women reported inadequate information and counselling support, with women with CDPP having sustained impaired QoL and mental health outcomes. The new and modified questions relating to mothering and children reflected the primacy of mothering to women’s identity and needs. Supplementary information The online version contains supplementary material available at 10.1186/s12884-022-05123-x.
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Hutchens J, Frawley J, Sullivan EA. The healthcare experiences of women with cardiac disease in pregnancy and postpartum: A qualitative study. Health Expect 2022; 25:1872-1881. [PMID: 35616361 PMCID: PMC9327873 DOI: 10.1111/hex.13532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiac disease affects an estimated 1%-4% of all pregnancies and is a leading cause of maternal morbidity and mortality. There is a lack of data on the healthcare experiences of affected women to inform health service delivery and person-centred care. This study sought to explore and understand the healthcare experiences of women with cardiac disease in pregnancy and postpartum. METHODS This qualitative study used semi-structured interviews with women who had cardiac disease in pregnancy or the first 12 months postpartum. Data were analysed using thematic analysis. RESULTS Participants were 25 women with pre-existing or newly diagnosed acquired, genetic and congenital cardiac disease. Analysis of the interviews highlighted the discrepancy between care aspirations and experiences. The participants had a wide range of cardiac diseases and timing of diagnoses, but had similar healthcare experiences of being dismissed, not receiving the information they required, lack of continuity of care and clinical guidelines and of feeling out of place within a healthcare system that did not accommodate their combined needs as a mother and a cardiac patient. CONCLUSION This study identified a lack of person-centred care and responsiveness of the healthcare system in providing fit-for-purpose healthcare for women with complex disease who are pregnant or new mothers. In particular, cardiac and maternity care providers have an opportunity to listen to women who are the experts on their emergent healthcare needs, contributing to development of the knowledge base on the healthcare experiences of having cardiac disease in pregnancy and postpartum. PATIENT OR PUBLIC CONTRIBUTION Public and patient input into the value and design of the study was gained through NSW Heart Foundation forums, including the Heart Foundation's women's patient group.
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Affiliation(s)
- Jane Hutchens
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Elizabeth A Sullivan
- College of Health, Mediicne and Wellbeing, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Justice Health and Forensic Mental Health Network, Newcastle, Australia
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Hutchens J, Frawley J, Sullivan EA. Cardiac disease in pregnancy and the first year postpartum: a story of mental health, identity and connection. BMC Pregnancy Childbirth 2022; 22:382. [PMID: 35501828 PMCID: PMC9063289 DOI: 10.1186/s12884-022-04614-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Women with cardiac disease in pregnancy and the first year postpartum often face uncertainty about their condition and the trajectory of their recovery. Cardiac disease is a leading cause of serious maternal morbidity and mortality, and the prevalence is increasing. Affected women are at risk of worsening cardiac disease, chronic illness, mental illness and trauma. This compounded risk may lead to significant and long-term negative outcomes. The aim of this study is to correct the lack of visibility and information on the experiences of women with cardiac disease in pregnancy and the first year postpartum. Methods A qualitative study using in-depth semi-structured interviews with twenty-five women who had acquired, congenital or genetic cardiac disease during pregnancy or the first year postpartum. Data were analysed and interpreted using a thematic analysis framework. Results Analysis of the interviews produced three major themes: 1) Ground zero: index events and their emotional and psychological impact, 2) Self-perception, identity and worthiness, and 3) On the road alone; isolation and connection. There was a narrative consistency across the interviews despite the women being diverse in age, cardiac diagnosis and cardiac health status, parity and timing of diagnosis. The thread prevailing over the temporal and clinical differences was one of distress, biographical disruption, identity, isolation, a necessitated re-imagining of their lives, and the process of multi-layered healing. Conclusion Acknowledging and understanding the breadth, complexity and depth of women’s experiences is fundamental to improving outcomes. Our findings provide unique insights into women’s experiences and challenges across a spectrum of diseases. Most women did not report an isolated trauma or distressing event, rather there was a layering and persistence of psychological distress necessitating enhanced assessment, management and continuity of care beyond the routine 6-week postpartum check. Further research is required to understand long-term outcomes and to refine the findings for specific disease cohorts to be able to respond effectively.
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Affiliation(s)
- Jane Hutchens
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Elizabeth A Sullivan
- Faculty of Health and Medicine, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia
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Hogan RG, Hammarberg K, Wang AY, Sullivan EA. ‘Battery hens’ or ‘nuggets of gold’: a qualitative study on the barriers and enablers for altruistic egg donation. HUM FERTIL 2021; 25:688-696. [DOI: 10.1080/14647273.2021.1873430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rosemarie G. Hogan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- School of Nursing, The University of Notre Dame Australia, Sydney, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Alex Y. Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
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Assifi AR, Kang M, Sullivan EA, Dawson AJ. Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence. PLoS One 2020; 15:e0242015. [PMID: 33166365 PMCID: PMC7652292 DOI: 10.1371/journal.pone.0242015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022] Open
Abstract
Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000–2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
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Affiliation(s)
- Anisa R. Assifi
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Melissa Kang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Angela J. Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Attawet J, Wang AY, Farquhar CM, Jordan V, Li Z, Sullivan EA. Pregnancy and birth outcomes of single versus multiple embryo transfer in gestational surrogacy arrangements: a systematic review and meta-analysis. HUM FERTIL 2020; 25:217-227. [PMID: 32609023 DOI: 10.1080/14647273.2020.1785643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy; (ii) live delivery; and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06-1.39, n = 5, I2 = 41%), live delivery (RR = 1.29, 95% CI: 1.10-1.51, n = 4, I2 = 35%) and multiple delivery rates (RR = 1.42, 95% CI: 6.58-69.73, n = 4, I2 = 54%) were statistically significantly different in MET compared to SET. Adverse events including miscarriage, preterm birth and low birthweight were found following MET. Our findings support the existing evidence that MET results in multiple pregnancy and subsequently more adverse outcomes compared to SET. From a public health perspective, SET should be advocated as the preferred treatment for gestational carriers.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Cindy M Farquhar
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Vanessa Jordan
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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Hogan RG, Wang AY, Li Z, Hammarberg K, Johnson L, Mol BW, Sullivan EA. Having a baby in your 40s with assisted reproductive technology: The reproductive dilemma of autologous versus donor oocytes. Aust N Z J Obstet Gynaecol 2020; 60:797-803. [PMID: 32424853 DOI: 10.1111/ajo.13179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increasing numbers of women ≥40 years old are accessing assisted reproductive technology (ART) due to age-related infertility. There is limited population-based evidence about the impact on the cumulative live birth rate (CLBR) of women aged ≥40 years using their own oocytes, compared to women of a similar age, using donor oocytes. AIMS To compare the CLBR for women ≥40 years undergoing ART using autologous oocytes and women of similar age using donor oocytes. MATERIALS AND METHODS This population-based retrospective cohort study used data from all women aged ≥40 years undergoing ART with donated (n = 987) or autologous oocytes (n = 19 170) in Victoria, Australia between 2009 and 2016. A discrete-time survival model was used to evaluate the CLBR following ART with donor or autologous oocytes. The odds ratio, adjusted for woman's age; male age; parity; cause of infertility; and the associated 95% confidence intervals (CI), were calculated. The numbers needed to be exposed (NNEs) were calculated from the adjusted odds ratio (aOR) and the CLBR in the autologous group. RESULTS The CLBR ranged from 28.6 to 42.5% in the donor group and from 12.5% to 1.4% in the autologous group. The discrete-time survival analysis with 95% CI demonstrated significant aOR on CLBR across all ages (range aOR: 2.56, 95% CI: 1.62-4.01 to aOR: 15.40, 95% CI: 9.10-26.04). CONCLUSIONS Women aged ≥40 years, using donor oocytes had a significantly higher CLBR than women using autologous oocytes. The findings can be used when counselling women ≥40 years about their ART treatment options and to inform public policy.
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Affiliation(s)
- Rosemarie G Hogan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alex Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
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Kendall S, Lighton S, Sherwood J, Baldry E, Sullivan EA. Incarcerated aboriginal women's experiences of accessing healthcare and the limitations of the 'equal treatment' principle. Int J Equity Health 2020; 19:48. [PMID: 32245479 PMCID: PMC7118909 DOI: 10.1186/s12939-020-1155-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Colonization continues in Australia, sustained through institutional and systemic racism. Targeted discrimination and intergenerational trauma have undermined the health and wellbeing of Australia’s Aboriginal and Torres Strait Islander population, leading to significantly poorer health status, social impoverishment and inequity resulting in the over-representation of Aboriginal people in Australian prisons. Despite adoption of the ‘equal treatment’ principle, on entering prison in Australia entitlements to the national universal healthcare system are revoked and Aboriginal people lose access to health services modelled on Aboriginal concepts of culturally safe healthcare available in the community. Incarcerated Aboriginal women experience poorer health outcomes than incarcerated non-Indigenous women and Aboriginal men, yet little is known about their experiences of accessing healthcare. We report the findings of the largest qualitative study with incarcerated Aboriginal women in New South Wales (NSW) Australia in over 15 years. Methods We employed a decolonizing research methodology, ‘community collaborative participatory action research’, involving consultation with Aboriginal communities prior to the study and establishment of a Project Advisory Group (PAG) of community expert Aboriginal women to guide the project. Forty-three semi-structured interviews were conducted in 2013 with Aboriginal women in urban and regional prisons in NSW. We applied a grounded theory approach for the data analysis with guidance from the PAG. Results Whilst Aboriginal women reported positive and negative experiences of prison healthcare, the custodial system created numerous barriers to accessing healthcare. Aboriginal women experienced institutional racism and discrimination in the form of not being listened to, stereotyping, and inequitable healthcare compared with non-Indigenous women in prison and the community. Conclusions ‘Equal treatment’ is an inappropriate strategy for providing equitable healthcare, which is required because incarcerated Aboriginal women experience significantly poorer health. Taking a decolonizing approach, we unpack and demonstrate the systems level changes needed to make health and justice agencies culturally relevant and safe. This requires further acknowledgment of the oppressive transgenerational effects of ongoing colonial policy, a true embracing of diversity of worldviews, and critically the integration of Aboriginal concepts of health at all organizational levels to uphold Aboriginal women’s rights to culturally safe healthcare in prison and the community.
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Affiliation(s)
- S Kendall
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia
| | - S Lighton
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia
| | - J Sherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, 2006, Australia
| | - E Baldry
- School of Social Sciences, UNSW Sydney, Sydney, 2052, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Broadway, 2007, Australia. .,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
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Pollock W, Peek MJ, Wang A, Li Z, Ellwood D, Homer CSE, Jackson Pulver L, McLintock C, Vaughan G, Knight M, Sullivan EA. Eclampsia in Australia and New Zealand: A prospective population-based study. Aust N Z J Obstet Gynaecol 2019; 60:533-540. [PMID: 31840809 DOI: 10.1111/ajo.13100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eclampsia is a serious consequence of pre-eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia. AIM To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ. MATERIALS AND METHODS A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre-eclampsia. RESULTS Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n = 9; 8.1%). Women with antepartum eclampsia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty-three (47.4%) women had pre-eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128; 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths. CONCLUSIONS Eclampsia is an uncommon consequence of pre-eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk.
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Affiliation(s)
- Wendy Pollock
- Maternal Critical Care, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J Peek
- Obstetrics and Gynaecology, ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alex Wang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Ellwood
- Department of Obstetrics and Gynaecology, Griffiths University, Southport, Queensland, Australia
| | - Caroline S E Homer
- Maternal and Child Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Lisa Jackson Pulver
- Indigenous Strategy and Services, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire McLintock
- National Women's Health, Auckland City Hospital, University of Auckland, Auckland, New Zealand
| | - Geraldine Vaughan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Marian Knight
- Maternal and Child Population Health, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth A Sullivan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Vaughan G, Dawson A, Peek MJ, Carapetis JR, Sullivan EA. Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis. Birth 2019; 46:560-573. [PMID: 31150150 DOI: 10.1111/birt.12435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a preventable cardiac condition that escalates risk in pregnancy. Models of care informed by evidence-based clinical guidelines are essential to optimal health outcomes. There are no published reviews that systematically explore approaches to care provision for pregnant women with RHD and examine reported measures. The review objective was to improve understanding of how attributes of care for these women are reported and how they align with guidelines. METHODS A search of 13 databases was supported by hand-searching. Papers that met inclusion criteria were appraised using CASP/JBI checklists. A content analysis of extracted data from the findings sections of included papers was undertaken, informed by attributes of quality care identified previously from existing guidelines. RESULTS The 43 included studies were predominantly conducted in tertiary care centers of low-income and middle-income countries. Cardiac guidelines were referred to in 25 of 43 studies. Poorer outcomes were associated with higher risk scores (detailed in 36 of 41 quantitative studies). Indicators associated with increased risk include anticoagulation during pregnancy (28 of 41 reported) and late booking (gestation documented in 15 of 41 studies). Limited access to cardiac interventions was discussed (19 of 43) in the context of poorer outcomes. Conversely, early assessment and access to regular multidisciplinary care were emphasized in promoting optimal outcomes for women and their babies. CONCLUSIONS Despite often complex care requirements in challenging environments, pregnancy provides an opportunity to strengthen health system responses and address whole-of-life health for women with RHD. A standard set of core indicators is proposed to more accurately benchmark care pathways, outcomes, and burden.
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Affiliation(s)
- Geraldine Vaughan
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Angela Dawson
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael J Peek
- The Australian National University and Centenary Hospital for Women and Children, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, Deneux-Tharaux C, Kristufkova A, Li Z, Schaap TP, Sullivan EA, Tuffnell D, Knight M. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS Med 2019; 16:e1002962. [PMID: 31714909 PMCID: PMC6850527 DOI: 10.1371/journal.pmed.1002962] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Amniotic fluid embolism (AFE) remains one of the principal reported causes of direct maternal mortality in high-income countries. However, obtaining robust information about the condition is challenging because of its rarity and its difficulty to diagnose. This study aimed to pool data from multiple countries in order to describe risk factors, management, and outcomes of AFE and to explore the impact on the findings of considering United Kingdom, international, and United States AFE case definitions. METHODS AND FINDINGS A population-based cohort and nested case-control study was conducted using the International Network of Obstetric Survey Systems (INOSS). Secondary data on women with AFE (n = 99-218, depending on case definition) collected prospectively in population-based studies conducted in Australia, France, the Netherlands, Slovakia, and the UK were pooled along with secondary data on a sample of control women (n = 4,938) collected in Australia and the UK. Risk factors for AFE were investigated by comparing the women with AFE in Australia and the UK with the control women identified in these countries using logistic regression. Factors associated with poor maternal outcomes (fatality and composite of fatality or permanent neurological injury) amongst women with AFE from each of the countries were investigated using logistic regression or Wilcoxon rank-sum test. The estimated incidence of AFE ranged from 0.8-1.8 per 100,000 maternities, and the proportion of women with AFE who died or had permanent neurological injury ranged from 30%-41%, depending on the case definition. However, applying different case definitions did not materially alter findings regarding risk factors for AFE and factors associated with poor maternal outcomes amongst women with AFE. Using the most liberal case definition (UK) and adjusting for the severity of presentation when appropriate, women who died were more likely than those who survived to present with cardiac arrest (89% versus 40%, adjusted odds ratio [aOR] 10.58, 95% confidence interval [CI] 3.93-28.48, p < 0.001) and less likely to have a source of concentrated fibrinogen (40% versus 56%, aOR 0.44, 95% CI 0.21-0.92, p = 0.029) or platelets given (24% versus 49%, aOR 0.23, 95% CI 0.10-0.52, p < 0.001). They also had a lower dose of tranexamic acid (median dose 0.7 g versus 2 g, p = 0.035) and were less likely to have had an obstetrician and/or anaesthetist present at the time of the AFE (61% versus 75%, aOR 0.38, 95% CI 0.16-0.90, p = 0.027). Limitations of the study include limited statistical power to examine factors associated with poor maternal outcome and the potential for residual confounding or confounding by indication. CONCLUSIONS The findings of our study suggest that when an AFE is suspected, initial supportive obstetric care is important, but having an obstetrician and/or anaesthetist present at the time of the AFE event and use of interventions to correct coagulopathy, including the administration of an adequate dose of tranexamic acid, may be important to improve maternal outcome. Future research should focus on early detection of the coagulation deficiencies seen in AFE alongside the role of tranexamic acid and other coagulopathy management strategies.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kitty W. M. Bloemenkamp
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
| | - Alexandra Kristufkova
- First Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zhuoyang Li
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Timme P. Schaap
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elizabeth A. Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Derek Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Assifi AR, Sullivan EA, Kang M, Dawson AJ. Adolescent abortion in 11 high‐income countries including Australia: towards the establishment of a minimum data set. Aust N Z J Public Health 2019; 43:577-581. [DOI: 10.1111/1753-6405.12947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/01/2019] [Accepted: 09/01/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Anisa R. Assifi
- The Australian Centre for Public and Population Health Research, Faculty of HealthUniversity of Technology Sydney New South Wales
| | - Elizabeth A. Sullivan
- The Australian Centre for Public and Population Health Research, Faculty of HealthUniversity of Technology Sydney New South Wales
- Office of the PVC Health and Medicine, Faculty of Health and MedicineUniversity of Newcastle New South Wales
| | - Melissa Kang
- The Australian Centre for Public and Population Health Research, Faculty of HealthUniversity of Technology Sydney New South Wales
| | - Angela J. Dawson
- The Australian Centre for Public and Population Health Research, Faculty of HealthUniversity of Technology Sydney New South Wales
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Sullivan EA, Vaughan G, Li Z, Peek MJ, Carapetis JR, Walsh W, Frawley J, Rémond MGW, Remenyi B, Jackson Pulver L, Kruske S, Belton S, McLintock C. The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high‐income setting: a prospective cohort study. BJOG 2019; 127:47-56. [DOI: 10.1111/1471-0528.15938] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 12/19/2022]
Affiliation(s)
- EA Sullivan
- Faculty of Health and Medicine The University of Newcastle Newcastle NSW Australia
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - G Vaughan
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - Z Li
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - MJ Peek
- ANU Medical School College of Health and Medicine The Australian National University Canberra ACT Australia
| | - JR Carapetis
- Telethon Kids InstituteThe University of Western Australia Perth WA Australia
- Perth Children's Hospital Perth WA Australia
| | - W Walsh
- The University of New South Wales Sydney NSW Australia
- Prince of Wales Hospital Sydney NSW Australia
| | - J Frawley
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - MGW Rémond
- Australian Centre for Public and Population Health Research Faculty of Health University of Technology Sydney Sydney NSW Australia
| | - B Remenyi
- Menzies School of Health Research Charles Darwin University Darwin NT Australia
| | | | - S Kruske
- The University of Queensland Brisbane Qld Australia
- Institute for Urban Indigenous Health Ltd Brisbane Qld Australia
| | - S Belton
- Menzies School of Health Research Charles Darwin University Darwin NT Australia
| | - C McLintock
- National Women's Health Auckland City Hospital Auckland New Zealand
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16
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Hogan RG, Wang AY, Li Z, Hammarberg K, Johnson L, Mol BW, Sullivan EA. Oocyte donor age has a significant impact on oocyte recipients' cumulative live-birth rate: a population-based cohort study. Fertil Steril 2019; 112:724-730. [PMID: 31248619 DOI: 10.1016/j.fertnstert.2019.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the impact of the donor's and recipient's age on the cumulative live-birth rate (CLBR) in oocyte donation cycles. DESIGN A population-based retrospective cohort study. SETTING Not applicable. PATIENT(S) All women using donated oocytes (n = 1,490) in Victoria, Australia, between 2009 and 2015. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The association between the donor's and recipient's age and CLBR modeled by multivariate Cox proportional hazard regression with the covariates of male partner's age, recipient parity, and cause of infertility adjusted for, and donor age grouped as <30, 30-34, 35-37, 38-40, and ≥41 years, and recipient age as <35, 35-37, 38-40, 41-42, 43-44, and ≥45 years. RESULT(S) The mean age of the oocyte donors was 33.7 years (range: 21 to 45 years) with 49% aged 35 years and over. The mean age of the oocyte recipients was 41.4 years (range: 19 to 53 years) with 25.4% aged ≥45 years. There was a statistically significant relationship between the donor's age and the CLBR. The CLBR for recipients with donors aged <30 years and 30-34 years was 44.7% and 43.3%, respectively. This decreased to 33.6% in donors aged 35-37 years, 22.6% in donors aged 38-40 years, and 5.1% in donors aged ≥41 years. Compared with recipients with donors aged <30 years, the recipients with donors aged 38-40 years had 40% less chance of achieving a live birth (adjusted hazard ratio 0.60; 95% CI, 0.43-0.86) and recipients with donors aged ≥41 years had 86% less chance of achieving a live birth (adjusted hazard ratio 0.14; 95% CI, 0.04-0.44). The multivariate analysis showed no statistically significant effect of the recipient's age on CLBR. CONCLUSION(S) We have demonstrated that the age of the oocyte donor is critical to the CLBR and is independent of the recipient woman's age. Recipients using oocytes from donors aged ≥35 years had a statistically significantly lower CLBR when compared with recipients using oocytes from donors aged <35 years.
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Affiliation(s)
- Rosemarie G Hogan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
| | - Alex Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, New South Wales, Australia
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17
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Sullivan EA, Kendall S, Chang S, Baldry E, Zeki R, Gilles M, Wilson M, Butler T, Levy M, Wayland S, Cullen P, Jones J, Sherwood J. Aboriginal mothers in prison in Australia: a study of social, emotional and physical wellbeing. Aust N Z J Public Health 2019; 43:241-247. [PMID: 30994971 DOI: 10.1111/1753-6405.12892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/01/2018] [Accepted: 02/01/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison. METHODS Cross-sectional survey, including a Short Form Health Survey (SF-12) and Kessler Psychological Distress Scale (5-item version) administered to Aboriginal women who self-identified as mothers. RESULTS Seventy-seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty-three per cent (n=59) of mothers in NSW were in prison for drug-related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty-eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF-12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1). CONCLUSIONS Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health: Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.
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Affiliation(s)
- Elizabeth A Sullivan
- Faculty of Health and Medicine, University of Newcastle, New South Wales.,The Australian Centre for Public and Population Health Research, University of Technology Sydney, New South Wales
| | - Sacha Kendall
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, New South Wales
| | - Sungwon Chang
- IMPACCT, Faculty of Health, University of Technology Sydney, New South Wales
| | - Eileen Baldry
- School of Social Sciences, UNSW Sydney, New South Wales
| | - Reem Zeki
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, New South Wales
| | - Marisa Gilles
- WA Country Health Service - Midwest, Western Australia
| | - Mandy Wilson
- National Drug Research Institute, Curtin University, Western Australia
| | - Tony Butler
- The Kirby Institute, UNSW Sydney, New South Wales
| | - Michael Levy
- Medical School, Australian National University, Canberra
| | - Sarah Wayland
- Faculty of Health Sciences, The University of Sydney, New South Wales
| | - Patricia Cullen
- School of Public Health and Community Medicine, UNSW Sydney, New South Wales
| | - Jocelyn Jones
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia
| | - Juanita Sherwood
- Faculty of Medicine and Health, The University of Sydney, New South Wales
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18
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Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N, Sullivan EA. Cumulative live birth rates following a 'freeze-all' strategy: a population-based study. Hum Reprod Open 2019; 2019:hoz004. [PMID: 30895269 PMCID: PMC6400239 DOI: 10.1093/hropen/hoz004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/07/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the cumulative live birth rate following a ‘freeze-all’ strategy compared with a ‘fresh-transfer’ strategy? SUMMARY ANSWER The ‘freeze-all’ strategy resulted in a similar cumulative live birth rate as the ‘fresh-transfer’ strategy among high responders (>15 oocytes retrieved) but did not benefit normal (10–15 oocytes) and suboptimal responders (<10 oocytes). WHAT IS KNOWN ALREADY Frozen-thawed embryo transfer is associated with a decreased risk of adverse obstetric and perinatal outcomes compared with fresh embryo transfer. It is unclear whether the ‘freeze-all’ strategy should be offered to all women undergoing ART treatment. STUDY DESIGN, SIZE, DURATION A population-based retrospective cohort study using data collected by the Victorian Assisted Reproductive Treatment Authority. This study included 14 331 women undergoing their first stimulated ART cycle with at least one oocyte fertilised between 1 July 2009 and 30 June 2014 in Victoria, Australia. Demographic characteristics, type of ART procedures and resulting pregnancy and birth outcomes were recorded for the stimulated cycle and associated thaw cycles until 30 June 2016, or until a live birth was achieved, or until all embryos from the stimulated cycle had been used. PARTICIPANTS/MATERIALS, SETTING, METHODS Women were grouped by whether they had undergone the ‘freeze-all’ strategy (n = 1028) where all embryos were cryopreserved for future transfer, or the ‘fresh-transfer’ strategy (n = 13 303) where selected embryo(s) were transferred in the stimulated cycle, and remaining embryo(s) were cryopreserved for future use. A discrete-time survival model was used to evaluate the cumulative live birth rate following ‘freeze-all’ and ‘fresh-transfer’ strategy. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1028 women undergoing ‘freeze-all’ strategy and 13 303 women undergoing ‘fresh-transfer’ strategy had 1788 and 22 334 embryo transfer cycles resulting in 452 and 5126 live births, respectively. Most women (61.3%) in the ‘freeze-all’ group had more than 15 oocytes retrieved in the stimulated cycle compared with 18.1% of women in the ‘fresh-transfer’ group (P < 0.001). For high responders (>15 oocytes), the cumulative live birth rate in the ‘freeze-all’ group was similar to the ‘fresh-transfer’ group (56.8% vs. 56.2%, adjusted hazard ratio (AHR) 0.90, 95% CI 0.77–1.04). However, the likelihood of a live birth was lower in the ‘freeze-all’ group compared with the ‘fresh-transfer’ group among normal responders (10–15 oocytes) (33.2% vs. 46.3%, AHR 0.62, 95% CI 0.46–0.83) and suboptimal responders (<10 oocytes) (14.6% vs. 28.0%, AHR 0.67, 95% CI 0.14–1.01). During the minimum follow-up time of 2 years, 34.1%, 24.4% and 8.4% of suboptimal, normal and high responders, respectively, in the ‘freeze-all’ group did not return for any embryo transfer after the stimulated cycle, whereas all women in the ‘fresh-transfer’ group had at least one embryo transferred in the stimulated cycle. LIMITATIONS REASONS FOR CAUTION A limitation of this population-based study is the lack of information available on clinic-specific protocols for the ‘freeze-all’ strategy and the potential impact of these on outcomes. Data were not available on whether the ‘freeze-all’ strategy was used to prevent ovarian hyperstimulation syndrome (OHSS). WIDER IMPLICATIONS OF THE FINDINGS This study presents population-based evidence on clinical efficacy associated with a ‘freeze-all’ and ‘fresh-transfer’ strategy. The ‘freeze-all’ strategy may benefit some subgroups of patients, including women who are high responders and those who are at risk of OHSS, but should not be offered universally. Clinicians should consider the potential impact of electively deferring embryo transfer on treatment discontinuation in choosing the optimal embryo transfer strategy for couples undergoing ART treatment. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd.
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Affiliation(s)
- Z Li
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia.,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - M Bowman
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia.,School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1010, New Zealand
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne VIC, Australia
| | - N Safi
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
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Zeki R, Li Z, Wang AY, Homer CS, Oats JJ, Marshall D, Sullivan EA. Obstetric anal sphincter injuries among women with gestational diabetes and women without gestational diabetes: A
NSW
population‐based cohort study. Aust N Z J Obstet Gynaecol 2019; 59:662-669. [DOI: 10.1111/ajo.12950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 12/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Reem Zeki
- The Australian Centre for Public and Population Health ResearchFaculty of HealthUniversity of Technology Sydney Sydney Australia
| | - Zhuoyang Li
- The Australian Centre for Public and Population Health ResearchFaculty of HealthUniversity of Technology Sydney Sydney Australia
| | - Alex Y. Wang
- The Australian Centre for Public and Population Health ResearchFaculty of HealthUniversity of Technology Sydney Sydney Australia
| | - Caroline S.E. Homer
- Centre for Midwifery, Child and Family HealthFaculty of HealthUniversity of Technology Sydney Sydney Australia
| | - Jeremy J.N. Oats
- Melbourne School of Population and Global HealthUniversity of Melbourne Melbourne Australia
| | | | - Elizabeth A. Sullivan
- The Australian Centre for Public and Population Health ResearchFaculty of HealthUniversity of Technology Sydney Sydney Australia
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20
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Javid N, Hyett JA, Walker SP, Sullivan EA, Homer CSE. A survey of opinion and practice regarding prenatal diagnosis of vasa previa among obstetricians from Australia and New Zealand. Int J Gynaecol Obstet 2019; 144:252-259. [PMID: 30575020 DOI: 10.1002/ijgo.12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/06/2018] [Accepted: 12/19/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To define current obstetric opinion and clinical practice regarding the prenatal diagnosis of vasa previa in Australia and New Zealand. METHODS A population-based cross-sectional survey of Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted from April to May, 2016. Descriptive analysis was used to define factors influencing opinion and practice regarding definition of vasa previa, attributable risk factors, and the value of screening. RESULTS Overall, 453 respondents were included in the study. Two-thirds (304/453; 67.1%) defined vasa previa as exposed fetal vessel(s) running over or within 2 cm of the internal os. A higher proportion of ultrasound specialists (30/65; 46.2%) preferred a broader definition as compared with generalists (115/388; 29.6%; P<0.001). Overall, Fellows were supportive (342/430; 79.5%) of both reporting ultrasound-based risk factors at the 20-week anomaly scan and targeted screening (298/430; 69.3%). Only 77/453 (17.0%) respondents recognized all five "known" risk factors for vasa previa. CONCLUSIONS There was a lack of consensus regarding the definition and diagnosis process for vasa previa. There was also a knowledge gap in risk factors for vasa previa that would inform a targeted screening policy. Nevertheless, support for targeted screening was strong from obstetricians who responded.
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Affiliation(s)
- Nasrin Javid
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jonathan A Hyett
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mercy Hospital for Women, University of Melbourne, Melbourne, Vic., Australia
| | | | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Abstract
OBJECTIVE Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services. METHOD We conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women's experiences extracted from each publication to inform new healthcare practices and communication. RESULTS Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences. CONCLUSIONS There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.
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Affiliation(s)
- Angela J Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yordanka Krastev
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - William A Parsonage
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Peek
- Department of Obstetrics and Gynaecology, Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Obstetrics, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Karin Lust
- Department of Obstetrics and Gynaecology, Women's and Newborn Services, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Wang AY, Safi N, Ali F, Lui K, Li Z, Umstad MP, Sullivan EA. Neonatal outcomes among twins following assisted reproductive technology: an Australian population-based retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:320. [PMID: 30089454 PMCID: PMC6083522 DOI: 10.1186/s12884-018-1949-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background While their incidence is on the rise, twin pregnancies are associated with risks to the mothers and their babies. This study aims to investigate the likelihood of adverse neonatal outcomes of twins following assisted reproductive technology (ART) compared to non-ART twins. Methods A retrospective population study using the Australian National Perinatal Data Collections (NPDC) which included 19,662 twins of ≥20 weeks gestational age or ≥ 400 g birthweight in Australia. Maternal outcomes and neonatal outcomes (preterm birth, low birth weight, resuscitation and neonatal death) were compared. Generalized Estimating Equations were used to assess the likelihood of any neonatal outcomes, with adjusted odds ratio (AOR) and 95% confidence intervals (CI) presented. Weinberg’s differential rule was used to estimate monozygotic twin rate. Results ART mothers were 3.3 years older than non-ART mothers. The rates of pregnancy-induced hypertension and gestational diabetes were significantly higher for ART mothers than non-ART mothers (12.2% vs. 8.4%, p < 0.01) and (9.7% vs. 7.5%, p < 0.01) respectively. The incidence of monozygotic twins was 2.0% for ART twins and 1.1% for non-ART twins. Compared with non-ART twins, ART twins had higher rates of preterm birth (AOR 1.13, 95% CI: 1.05–1.22), low birth weight (AOR 1.13, 95% CI: 1.05–1.22), and resuscitation (AOR 1.26, 95% CI: 1.17–1.36). Liveborn ART twins had 28% (AOR 1.28, 95% CI 1.09–1.50) increased odds of having any adverse neonatal outcome compared to liveborn non-ART twins, especially for opposite-sex ART twins (AOR 1.42, 95% CI 1.11–1.82). Conclusion As ART twins had higher rates of adverse outcome, special prenatal care is recommended. Couples accessing ART should be fully informed of the risk of adverse outcome of twin pregnancies.
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Affiliation(s)
- Alex Y Wang
- Faculty of Health, Australian Centre of Public and Population Health Research, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW, 2007, Australia.
| | - Nadom Safi
- Faculty of Health, Australian Centre of Public and Population Health Research, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW, 2007, Australia
| | - Fathalla Ali
- School of Women's and Children's Health, the University of New South Wales, Sydney, NSW, 2052, Australia
| | - Kei Lui
- School of Women's and Children's Health, the University of New South Wales, Sydney, NSW, 2052, Australia
| | - Zhuoyang Li
- Faculty of Health, Australian Centre of Public and Population Health Research, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW, 2007, Australia
| | - Mark P Umstad
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, Australian Centre of Public and Population Health Research, University of Technology Sydney, PO Box 123 Broadway, Ultimo, NSW, 2007, Australia
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Vaughan G, Tune K, Peek MJ, Jackson Pulver L, Remenyi B, Belton S, Sullivan EA. Rheumatic heart disease in pregnancy: strategies and lessons learnt implementing a population-based study in Australia. Int Health 2018; 10:480-489. [DOI: 10.1093/inthealth/ihy048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/02/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Geraldine Vaughan
- University of Technology Sydney, Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), Sydney, Australia
| | - Kylie Tune
- Menzies School of Health Research, Darwin, Australia
- The Royal Darwin Hospital, NT Cardiac, Darwin, Australia
| | - Michael J Peek
- The Australian National University and Centenary Hospital for Women and Children, Canberra, Australia
- The Canberra Hospital, Canberra, Australia
| | | | - Bo Remenyi
- Menzies School of Health Research, Darwin, Australia
- The Royal Darwin Hospital, NT Cardiac, Darwin, Australia
| | - Suzanne Belton
- Menzies School of Health Research, Darwin, Australia
- Primary Health Network, Darwin, Australia
| | - Elizabeth A Sullivan
- University of Technology Sydney, Faculty of Health, Australian Centre for Public and Population Health Research (ACPPHR), Sydney, Australia
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Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C, Johnson L, Safi N, Sullivan EA. ICSI does not increase the cumulative live birth rate in non-male factor infertility. Hum Reprod 2018; 33:1322-1330. [DOI: 10.1093/humrep/dey118] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/14/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Z Li
- Sydney Medical School, The University of Sydney, Sydney NSW, Australia
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - A Y Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - M Bowman
- Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne Vic, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne Vic, Australia
| | - N Safi
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
| | - E A Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney NSW, Australia
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Zeki R, Oats JJN, Wang AY, Li Z, Homer CSE, Sullivan EA. Cesarean section and diabetes during pregnancy: An NSW population study using the Robson classification. J Obstet Gynaecol Res 2018; 44:890-898. [PMID: 29442404 DOI: 10.1111/jog.13605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/29/2017] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to identify the main contributors to cesarean section (CS) among women with and without diabetes during pregnancy using the Robson classification and to compare CS rates within Robson groups. METHODS A population-based cohort study was conducted of all women who gave birth in New South Wales, Australia, between 2002 and 2012. Women with pregestational diabetes (types 1 and 2) and gestational diabetes mellitus (GDM) were grouped using the Robson classification. Adjusted odd ratios (AOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. RESULTS The total CS rate was 53.6% for women with pregestational diabetes, 36.8% for women with GDM and 28.5% for women without diabetes. Previous CS contributed the most to the total number of CS in all populations. For preterm birth, the contribution to the total was 20.5% for women with pregestational diabetes and 5.7% for women without diabetes. Compared to women without diabetes, for nulliparous with pregestational diabetes, the odds of CS was 1.4 (95% CI, 1.1-1.8) for spontaneous labor and 2.0 (95% CI, 1.7-2.3) for induction of labor. CONCLUSION A history of CS was the main contributor to the total CS. Reducing primary CS is the first step to lowering the high rate of CS among women with diabetes. Nulliparous women were more likely to have CS if they had pregestational diabetes. This increase was also evident in all multiparous women giving birth. The high rate of preterm births and CS reflects the clinical issues for women with diabetes during pregnancy.
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Affiliation(s)
- Reem Zeki
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alex Y Wang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elizabeth A Sullivan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Zeki R, Wang AY, Lui K, Li Z, Oats JJN, Homer CSE, Sullivan EA. Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study. BMJ Paediatr Open 2018; 2:e000224. [PMID: 29637191 PMCID: PMC5843011 DOI: 10.1136/bmjpo-2017-000224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/11/2017] [Accepted: 01/12/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomic (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)). DESIGN A population-based retrospective cohort study. SETTING New South Wales, Australia. PATIENTS All live-born TSV born to mothers with diabetes from 2002 to 2012. INTERVENTION Comparison of neonatal outcomes by mode of birth (prelabour caesarean section (CS) and planned vaginal birth resulted in intrapartum CS, non-instrumental or instrumental vaginal birth). MAIN OUTCOME MEASURES Five-minute Apgar score <7, admission to neonatal intensive care unit (NICU) or special care nursery (SCN) and the need for resuscitation. RESULTS Among the 48 882 TSV born to mothers with diabetes, prelabour CS was associated with a significant increase in the rate of admission to NICU/SCN compared with planned vaginal birth.For TSV born to mothers with pre-existing diabetes, compared with non-instrumental vaginal birth, instrumental vaginal birth was associated with increased odds of the need for resuscitation in macrosomic (adjusted ORs (AOR) 2.6; 95% CI (1.2 to 7.5)) and non-macrosomic TSV (AOR 3.3; 95% CI (2.2 to 5.0)).For TSV born to mothers with GDM, intrapartum CS was associated with increased odds of the need for resuscitation compared with non-instrumental vaginal birth in non-macrosomic TSV (AOR 2.3; 95% CI (2.1 to 2.7)). Instrumental vaginal birth was associated with increased likelihood of requiring resuscitation compared with non-instrumental vaginal birth for both macrosomic (AOR 2.3; 95% CI (1.7 to 3.1)) and non-macrosomic (AOR 2.5; 95% CI (2.2 to 2.9)) TSV. CONCLUSION Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth.
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Affiliation(s)
- Reem Zeki
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alex Y Wang
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kei Lui
- School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline S E Homer
- Faculty of Health, Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
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Chambers GM, Randall S, Mihalopoulos C, Reilly N, Sullivan EA, Highet N, Morgan VA, Croft ML, Chatterton ML, Austin MP. Mental health consultations in the perinatal period: a cost-analysis of Medicare services provided to women during a period of intense mental health reform in Australia. AUST HEALTH REV 2018; 42:514-521. [DOI: 10.1071/ah17118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients’ costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011–12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5 million for women giving birth in 2007, rising to A$29 million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the last decade, with the introduction of numerous policies aimed at prevention, screening and improving access to treatment. Several of these policies have been aimed at perinatal depression, which affects 15% of women giving birth. What does this paper add? This is the first population-based, cost analysis of mental health consultations during the perinatal period (pregnancy to end of the first postnatal year) in Australia. Almost 9% of women giving birth in 2007 had a mental health consultation funded though the MBS, compared with more than 14% in 2010. Over the same period there was a shift from psychiatric consultations to allied health and primary care consultations. In 2010, the total cost (provider fee) of these consultations was A$29 million, equating to an average cost per woman of A$689 and A$133 per service. Despite the changing policy environment, significant disparities exist in access to care according to geographic remoteness. What are the implications for practitioners? Recent policy initiatives have resulted in increasing access to mental health consultations for women around the time of childbirth. However, policies are needed that target women outside of major cities. Furthermore, evidence is needed on whether the increase in access has resulted in improved mental health outcomes for women at this vulnerable time. The cost data provided by this study are unique and will inform future mental health policy development and health economic evaluations.
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Chughtai AA, Wang AY, Hilder L, Li Z, Lui K, Farquhar C, Sullivan EA. Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births. Hum Reprod 2017; 33:320-327. [DOI: 10.1093/humrep/dex340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/21/2017] [Indexed: 11/13/2022] Open
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Donnolley NR, Chambers GM, Butler-Henderson KA, Chapman MG, Sullivan EA. More than a name: Heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study. Women Birth 2017; 30:332-341. [DOI: 10.1016/j.wombi.2017.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/16/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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Xu F, Sullivan EA, Forero R, Homer CSE. The association of Emergency Department presentations in pregnancy with hospital admissions for postnatal depression (PND): a cohort study based on linked population data. BMC Emerg Med 2017; 17:12. [PMID: 28335736 PMCID: PMC5364622 DOI: 10.1186/s12873-017-0123-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 03/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the impact of presenting to an Emergency Department (ED) during pregnancy on postnatal depression (PND) in women in New South Wales (NSW), Australia. METHOD An epidemiological population-based study using linked data from the NSW Emergency Department Data Collection (EDDC), the NSW Perinatal Data Collection (PDC) and the NSW Admitted Patients Data Collection (APDC) was conducted. Women who gave birth to their first child in NSW between 1 January 2006 and 31 December 2010 were followed up from pregnancy to the end of the first year after birth. RESULTS The study population includes 154,328 women who gave birth to their first child in NSW between 2006 and 2010. Of these, 31,764 women (20.58%) presented to ED during pregnancy (95%CI = 20.38-20.78). Women who presented to ED during pregnancy were more likely to be admitted to hospital for the diagnosis of unipolar depression (the adjusted relative risk (RR) =1.86, 95%CI = 1.49-2.31) and the diagnosis of mild mental and behavioural disorders associated with the puerperium (the adjusted RR = 1.55, 95%CI = 1.29-1.87) than those without ED presentation. CONCLUSION Women's hospital admissions for postnatal depression were associated with frequent ED presentations during pregnancy.
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Affiliation(s)
- Fenglian Xu
- Faculty of Health, University of Technology Sydney, Ultimo, 2007, Australia.
| | | | - Roberto Forero
- Simpson Centre for Health Service Research, SWS Clinical School and Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, 2017, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Ultimo, 2007, Australia
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Caress JB, Johnson JO, Abramzon YA, Hawkins GA, Gibbs JR, Sullivan EA, Chahal CS, Traynor BJ. Exome sequencing establishes a gelsolin mutation as the cause of inherited bulbar-onset neuropathy. Muscle Nerve 2017; 56:1001-1005. [PMID: 28039894 DOI: 10.1002/mus.25550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Progressive bulbar motor neuropathy is primarily caused by bulbar-onset ALS. Hereditary amyloidosis type IV also presents with a bulbar neuropathy that mimics motor neuron disease. The disease is prevalent in Finland only and is not commonly included in the differential diagnosis of ALS. METHODS We studied 18 members of a family in which some had bulbar motor neuropathy, and we performed exome sequencing. RESULTS Five affected family members were found to have a D187Y substitution in the GSN gene known to cause hereditary amyloidosis type IV. CONCLUSIONS This American family presented with progressive bulbar neuropathy due to a gelsolin mutation not found in Finland. Hereditary amyloidosis type IV presents with bulbar motor neuropathy and not with peripheral neuropathy as occurs with common forms of amyloidosis. This report demonstrates the power of exome sequencing to determine the cause of rare hereditary diseases with incomplete or atypical phenotypes. Muscle Nerve 56: 1001-1005, 2017.
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Affiliation(s)
- James B Caress
- Department of Neurology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, North Carolina, 27157, USA
| | - Janel O Johnson
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Yevgeniya A Abramzon
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuromuscular Diseases Research Section Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Gregory A Hawkins
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - J Raphael Gibbs
- Computational Biology Core, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA.,Department of Molecular Neuroscience, MRC Centre for Neuromuscular Diseases and the Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | | | | | - Bryan J Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
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Dawson AJ, Nicolls R, Bateson D, Doab A, Estoesta J, Brassil A, Sullivan EA. Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study. Reprod Health 2017; 14:39. [PMID: 28288649 PMCID: PMC5348908 DOI: 10.1186/s12978-017-0303-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs. METHODS We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically. RESULTS Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted. CONCLUSIONS Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women.
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Affiliation(s)
- Angela J Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia.
| | - Rachel Nicolls
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia
| | - Deborah Bateson
- The Sydney Medical School, Discipline, Gynaecology and Neonatology, University of Sydney and Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia
| | - Anna Doab
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia
| | - Jane Estoesta
- Evaluation and Research Operations, Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia
| | - Ann Brassil
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney and Family Planning New South Wales, 28-336 Liverpool Road, Ashfield, NSW, 2131, Australia
| | - Elizabeth A Sullivan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Ultimo, NSW, 2007, Australia
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Wang AY, Chughtai AA, Lui K, Sullivan EA. Morbidity and mortality among very preterm singletons following fertility treatment in Australia and New Zealand, a population cohort study. BMC Pregnancy Childbirth 2017; 17:50. [PMID: 28148237 PMCID: PMC5288897 DOI: 10.1186/s12884-017-1235-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to high rates of multiple birth and preterm birth following fertility treatment, the rates of mortality and morbidity among births following fertility treatment were higher than those conceived spontaneously. However, it is unclear whether the rates of adverse neonatal outcomes remain higher for very preterm (<32 weeks gestational age) singletons born after fertility treatment. This study aims to compare adverse neonatal outcomes among very preterm singletons born after fertility treatment including assisted reproductive technology (ART) hyper-ovulution (HO) and artificial insemination (AI) to those following spontaneous conception. METHODS The population cohort study included 24069 liveborn very preterm singletons who were admitted to Neonatal Intensive Care Unit (NICU) in Australia and New Zealand from 2000 to 2010. The in-hospital neonatal mortality and morbidity among 21753 liveborn very preterm singletons were compared by maternal mode of conceptions: spontaneous conception, HO, ART and AI. Univariate and multivariate binary logistic regression analysis was used to examine the association between mode of conception and various outcome factors. Odds ratio (OR) and adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. RESULTS The rate of small for gestational age was significantly higher in HO group (AOR 1.52, 95% CI 1.02-2.67) and AI group (AOR 2.98, 95% CI 1.53-5.81) than spontaneous group. The rate of birth defect was significantly higher in ART group (AOR 1.71, 95% CI 1.36-2.16) and AI group (AOR 3.01, 95% CI 1.47-6.19) compared to spontaneous group. Singletons following ART had 43% increased odds of necrotizing enterocolitis (AOR 1.43, 95% CI 1.04-1.97) and 71% increased odds of major surgery (AOR 1.71, 95% CI 1.37-2.13) compared to singletons conceived spontaneously. Other birth and NICU outcomes were not different among the comparison groups. CONCLUSIONS Compared to the spontaneous conception group, risk of congenital abnormality significantly increases after ART and AI; the risk of morbidities increases after ART, HO and AI. Preconception planning should include comprehensive information about the benefits and risks of fertility treatment on the neonatal outcomes.
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Affiliation(s)
- Alex Y Wang
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Abrar A Chughtai
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia
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Anazodo AC, Gerstl B, Stern CJ, McLachlan RI, Agresta F, Jayasinghe Y, Cohn RJ, Wakefield CE, Chapman M, Ledger W, Sullivan EA. Utilizing the Experience of Consumers in Consultation to Develop the Australasian Oncofertility Consortium Charter. J Adolesc Young Adult Oncol 2016; 5:232-9. [DOI: 10.1089/jayao.2015.0056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Antoinette C. Anazodo
- School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, Sydney, Australia
- Sydney Youth Cancer Service, Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Prince of Wales Hospital, Sydney, Australia
| | - Brigitte Gerstl
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Catharyn J. Stern
- Melbourne IVF, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Australia
| | - Robert I. McLachlan
- Monash IVF, Richmond, Australia
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Prahran, Australia
| | | | - Yasmin Jayasinghe
- The Royal Children's Hospital, Parkville, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women's Hospital, Parkville, Australia
| | - Richard J. Cohn
- School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Claire E. Wakefield
- School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Michael Chapman
- The Royal Hospital for Women, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Australia
| | - William Ledger
- The Royal Hospital for Women, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Australia
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Anazodo AC, Stern CJ, McLachlan RI, Gerstl B, Agresta F, Cohn RJ, Jayasinghe Y, Wakefield CE, Daly G, Chan D, Gilbert L, Kemertzis M, Orme LM, Wand H, Viney R, Gillam L, Deans R, Jetti M, Wu J, Chapman M, Ledger W, Sullivan EA. A Study Protocol for the Australasian Oncofertility Registry: Monitoring Referral Patterns and the Uptake, Quality, and Complications of Fertility Preservation Strategies in Australia and New Zealand. J Adolesc Young Adult Oncol 2016; 5:215-25. [DOI: 10.1089/jayao.2015.0062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Antoinette C. Anazodo
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Youth Cancer Service, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Sydney, Australia
| | - Catharyn J. Stern
- Melbourne IVF, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert I. McLachlan
- Monash IVF, Richmond, Victoria, Australia
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Brigitte Gerstl
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | | | - Richard J. Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Yasmin Jayasinghe
- The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Genevieve Daly
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Daisy Chan
- Prince of Wales Hospital, Sydney, Australia
| | - Lorrae Gilbert
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Matthew Kemertzis
- The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lisa M. Orme
- The Royal Children's Hospital, Parkville, Victoria, Australia
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Rosalie Viney
- University of Technology Sydney, Broadway, New South Wales, Australia
| | | | - Rebecca Deans
- The Royal Hospital for Women, Sydney, New South Wales, Australia
- Discipline of Obstetrics & Gynaecology, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Murali Jetti
- Salesforce Australia, Sydney, New South Wales, Australia
| | - John Wu
- Salesforce Australia, Sydney, New South Wales, Australia
| | - Michael Chapman
- The Royal Hospital for Women, Sydney, New South Wales, Australia
- Discipline of Obstetrics & Gynaecology, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - William Ledger
- The Royal Hospital for Women, Sydney, New South Wales, Australia
- Discipline of Obstetrics & Gynaecology, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Sullivan EA, Koro S, Tabrizi S, Kaldor J, Poumerol G, Chen S, O'Leary M, Garland SM. Prevalence of sexually transmitted diseases and human immunodeficiency virus among women attending prenatal services in Apia, Samoa. Int J STD AIDS 2016; 15:116-9. [PMID: 15006074 DOI: 10.1258/095646204322764316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is no routine prenatal screening for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) in pregnancy in Samoa. Testing for chlamydial infection is not available. To gather information on pregnant women, a prevalence survey was conducted in Apia, Samoa, utilizing two prenatal hospital clinics. Pregnant ( n = 427) women were tested for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using polymerase chain reaction (PCR), and for syphilis ( n = 441) by rapid plasmid reagin (RPR) and HIV ( n = 441) by enzyme-linked immunosorbent assay (ELISA). Results were: chlamydia 30.9% (132); trichomoniasis 20.8%; gonorrhoea 3.3%; syphilis 0.5%; and HIV 0%. Overall 42.7% had at least 1 STD. Young women aged <25 years were three times more likely to have a STD than older women (odds ratio = 3.0, 95% confidence intervals 2.0, 4.5). The lack of inexpensive, reliable field diagnostics remain a barrier to sustainable STD control programmes for pregnant women living in developing countries.
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Affiliation(s)
- E A Sullivan
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
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Hilder L, Walker JR, Levy MH, Sullivan EA. Preparing linked population data for research: cohort study of prisoner perinatal health outcomes. BMC Med Res Methodol 2016; 16:72. [PMID: 27312027 PMCID: PMC4910208 DOI: 10.1186/s12874-016-0174-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A study of pregnancy outcomes related to pregnancy in prison in New South Wales, Australia, designed a two stage linkage to add maternal history of incarceration and serious mental health morbidity, neonatal hospital admission and infant congenital anomaly diagnosis to birth data. Linkage was performed by a dedicated state-wide data linkage authority. This paper describes use of the linked data to determine pregnancy prison exposure pregnancy for a representative population of mothers. METHODS Researchers assessed the quality of linked records; resolved multiple-matched identities; transformed event-based incarceration records into person-based prisoner records and birth records into maternity records. Inconsistent or incomplete records were censored. Interrogation of the temporal relationships of all incarceration periods from the prisoner record with pregnancies from birth records identified prisoner maternities. Interrogation of maternities for each mother distinguished prisoner mothers who were incarcerated during pregnancy, from prisoner control mothers with pregnancies wholly in the community and a subset of prisoner mothers with maternities both types of maternity. Standard descriptive statistics are used to provide population prevalence of exposures and compare data quality across study populations stratified by mental health morbidity. RESULTS Women incarcerated between 1998 and 2006 accounted for less than 1 % of the 404,000 women who gave birth in NSW between 2000 and 2006, while women with serious mental health morbidity accounted for 7 % overall and 68 % of prisoners. Rates of false positive linkage were within the predicted limits set by the linkage authority for non-prisoners, but were tenfold higher among prisoners (RR 9.9; 95%CI 8.2, 11.9) and twice as high for women with serious mental health morbidity (RR 2.2; 95%CI 1.9, 2.6). This case series of 597 maternities for 558 prisoners pregnant while in prison (of whom 128 gave birth in prison); and 2,031 contemporaneous prisoner control mothers is one of the largest available. CONCLUSIONS Record linkage, properly applied, offers the opportunity to extend knowledge about vulnerable populations not amenable to standard ascertainment. Dedicated linkage authorities now provide linked data for research. The data are not research ready. Perinatal exposures are time-critical and require expert processing to prepare the data for research.
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Affiliation(s)
- Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, Australia.
| | - Jane R Walker
- Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Michael H Levy
- College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Elizabeth A Sullivan
- Faculty of Health University of Technology Sydney, Conjoint School of Women's and Children's Health, University of NSW, Sydney, Australia
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Chambers GM, Randall S, Hoang VP, Sullivan EA, Highet N, Croft M, Mihalopoulos C, Morgan VA, Reilly N, Austin MP. The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule. Aust N Z J Psychiatry 2016; 50:264-74. [PMID: 25943980 DOI: 10.1177/0004867415580154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. METHOD Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. RESULTS The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. CONCLUSION In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Sean Randall
- Centre for Population Health Research, Curtin University, Perth, WA, Australia
| | - Van Phuong Hoang
- Drug Policy Modelling Program (DPMP), National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | | | - Nicole Highet
- Centre of Perinatal Excellence (COPE), Melbourne, VIC, Australia
| | - Maxine Croft
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, Australia
| | - Nicole Reilly
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Marie-Paule Austin
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia St John of God Health Care, Sydney, NSW, Australia
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Wang AY, Dill SK, Bowman M, Sullivan EA. Gestational surrogacy in Australia 2004-2011: treatment, pregnancy and birth outcomes. Aust N Z J Obstet Gynaecol 2016; 56:255-9. [DOI: 10.1111/ajo.12451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Alex Y. Wang
- Faculty of Health; University of Technology Sydney; Broadway New South Wales Australia
| | | | | | - Elizabeth A. Sullivan
- Faculty of Health; University of Technology Sydney; Broadway New South Wales Australia
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Wang YA, Chughtai AA, Farquhar CM, Pollock W, Lui K, Sullivan EA. Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment. Fertil Steril 2016; 105:920-926.e2. [PMID: 26780118 DOI: 10.1016/j.fertnstert.2015.12.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the association between assisted reproductive technology (ART) treatment and the rate of combined gestational hypertension (GH), preeclampsia (PE). DESIGN Retrospective population study. SETTING Not applicable. PATIENT(S) A total of 596,520 mothers (3.6% ART mothers) who gave birth between 2007 and 2011. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Comparison of the rate of GH/PE for ART and non-ART mothers, with odds ratio (OR), adjusted odds ratio (AOR), and 95% confidence interval (CI) used to assess the association between ART and GH/PE. RESULT(S) The overall rate of GH/PE was 4.3%, with 6.4% for ART mothers and 4.3% for non-ART mothers. The rate of GH/PE was higher for mothers of twins than singletons (12.4% vs. 5.7% for ART mothers; 8.6% vs. 4.2% for non-ART mothers). The ART mothers had a 17% increased odds of GH/PE compared with the non-ART mothers (AOR 1.17; 95% CI, 1.10-1.24). After stratification by plurality, the difference in GH/PE rates between ART and non-ART mothers was not statistically significant, with AOR 1.05 (95% CI, 0.98-1.12) for mothers of singletons and AOR 1.10 (95% CI, 0.94-1.30) for mothers of twins. CONCLUSION(S) The changes in AOR after stratification indicated that multiple pregnancies after ART are the single most likely explanation for the increased rate of GH/PE among ART mothers. The lower rate of GH/PE among mothers of singletons compared with mothers of twins suggests that a policy to minimize multiple pregnancies after ART may reduce the excess risk of GH/PE due to ART treatment.
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Affiliation(s)
- Yueping A Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Abrar A Chughtai
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Wendy Pollock
- Mercy Hospital for Women, La Trobe University, Melbourne, Victoria, Australia
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Sullivan EA, Dickinson JE, Vaughan GA, Peek MJ, Ellwood D, Homer CSE, Knight M, McLintock C, Wang A, Pollock W, Jackson Pulver L, Li Z, Javid N, Denney-Wilson E, Callaway L. Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study. BMC Pregnancy Childbirth 2015; 15:322. [PMID: 26628074 PMCID: PMC4667490 DOI: 10.1186/s12884-015-0693-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. METHODS A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m(2) or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95% confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. RESULTS 370 super-obese women with a median BMI of 52.8 kg/m(2) (range 40.9-79.9 kg/m(2)) and prevalence of 2.1 per 1 000 women giving birth (95% CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2%), smoke (23.8%) and be socio-economically disadvantaged (36.2%). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95% CI: 1.77-3.29) and medical (AOR: 2.89, 95% CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6%) and admission to special care (HDU/ICU) (6.2%). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥ 4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95% CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5% versus 9.2%) or perinatal mortality (11.0 (95% CI: 4.3-28.0) versus 6.6 (95% CI: 2.6- 16.8) per 1 000 singleton births). CONCLUSIONS Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.
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Affiliation(s)
- Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
- School of Women's and Children's Health, The University of New South Wales, Sydney, Australia.
| | - Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia.
| | - Geraldine A Vaughan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Michael J Peek
- Department of Obstetrics and Gynaecology Medical School College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia.
- Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra, Australia.
| | - David Ellwood
- School of Medicine, Griffith University, Queensland, Australia.
- Gold Coast University Hospital, Queensland, Australia.
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
| | - Claire McLintock
- Obstetrics and Gynaecology, National Women's Health, Auckland City Hospital, Auckland, New Zealand.
| | - Alex Wang
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Wendy Pollock
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Lisa Jackson Pulver
- Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Nasrin Javid
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Elizabeth Denney-Wilson
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Leonie Callaway
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Medicine, The University of Queensland, Brisbane, Australia.
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Abstract
BACKGROUND Birthweight remains one of the strongest predictors of perinatal mortality and disability. Birthweight percentiles form a reference that allows the detection of neonates at higher risk of neonatal and postneonatal morbidity. The aim of the study is to present updated national birthweight percentiles by gestational age for male and female twins born in Australia. METHODS Population data were extracted from the Australian National Perinatal Data Collection for twins born in Australia between 2001 and 2010. A total of 43,833 women gave birth to 87,666 twins in Australia which were included in the study analysis. Implausible birthweights were excluded using Tukey's methodology based on the interquartile range. Univariate analysis was used to examine the birthweight percentiles for liveborn twins born between 20 and 42 weeks gestation. RESULTS Birthweight percentiles by gestational age were calculated for 85,925 live births (43,153 males and 42,706 females). Of these infants, 53.6% were born preterm (birth before 37 completed weeks of gestation) while 50.2% were low birthweight (<2500 g) and 8.7% were very low birthweight (<1500 g). The mean birthweight decreased from 2462 g in 2001 to 2440 g in 2010 for male twins, compared with 2485 g in 1991-94. For female twins, the mean birthweight decreased from 2375 g in 2001 to 2338 g in 2010, compared with 2382 g in 1991-94. CONCLUSIONS The birthweight percentiles provide clinicians and researchers with up-to-date population norms of birthweight percentiles for twins in Australia.
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Affiliation(s)
- Zhuoyang Li
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
- National Perinatal Epidemiology and Statistics Units, University of New South Wales, Sydney, Australia.
| | - Mark P Umstad
- The Royal Women's Hospital, Melbourne, Australia.
- The University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Australia.
| | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Units, University of New South Wales, Sydney, Australia.
| | - Fenglian Xu
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
- National Perinatal Epidemiology and Statistics Units, University of New South Wales, Sydney, Australia.
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Caress JB, Ciarlone SL, Sullivan EA, Griffin LP, Cartwright MS. Natural history of muscle cramps in amyotrophic lateral sclerosis. Muscle Nerve 2015; 53:513-7. [PMID: 26332705 DOI: 10.1002/mus.24892] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 06/19/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Muscle cramping is a common symptom in amyotrophic lateral sclerosis (ALS) that lacks efficacious treatment. The natural history of this symptom is unknown, which hampers efforts to design optimal clinical trials. METHODS We surveyed early stage ALS patients about their experience with cramps each month by phone for up to 21 months. RESULTS Cramps developed in 95% of patients over the course of their disease. The number of cramps experienced by an individual varied widely from month-to-month and trended lower after the first year of illness (P = 0.26). Those with limb-onset and age >60 years had more cramps than bulbar-onset (P < 0.0001) and younger patients (P < 0.0001). CONCLUSIONS The high variability of the number of cramps experienced suggests that clinical trials will need to use crossover designs or large numbers of participants, even when the treatment effect is substantial.
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Affiliation(s)
- James B Caress
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephanie L Ciarlone
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | | | - Leah P Griffin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Abstract
STUDY QUESTION What type of transferred embryo is associated with a lower rate of ectopic pregnancy? SUMMARY ANSWER The lowest risk of ectopic pregnancy was associated with the transfer of blastocyst, frozen and single embryo compared with cleavage stage, fresh and multiple embryos. WHAT IS KNOWN ALREADY Ectopic pregnancy is a recognized complication following assisted reproductive technology (ART) treatment. It has been estimated that the rate of ectopic pregnancy is doubled in pregnancies following ART treatment compared with spontaneous pregnancies. However, it was not clear whether the excess rate of ectopic pregnancy following ART treatment is related to the underlying demographic factors of women undergoing ART treatment, the number of embryos transferred or the developmental stage of the embryo. STUDY DESIGN, SIZE, DURATION A population-based cohort study of pregnancies following autologous treatment cycles between January 2009 and December 2011 were obtained from the Australian and New Zealand Assisted Reproduction Technology Database (ANZARD). The ANZARD collects ART treatment information and clinical outcomes annually from all fertility centres in Australia and New Zealand. PARTICIPANTS/MATERIALS, SETTING, METHODS Between 2009 and 2011, a total of 44 102 pregnancies were included in the analysis. The rate of ectopic pregnancy was compared by demographic and ART treatment factors. Generalized linear regression of Poisson distribution was used to estimate the likelihood of ectopic pregnancy. Odds ratios, adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. MAIN RESULTS AND THE ROLE OF CHANCE The overall rate of ectopic pregnancy was 1.4% for women following ART treatment in Australia and New Zealand. Pregnancies following single embryo transfers had 1.2% ectopic pregnancies, significantly lower than double embryo transfers (1.8%) (P < 0.01). The highest ectopic pregnancy rate was 1.9% for pregnancies from transfers of fresh cleavage embryo, followed by transfers of frozen cleavage embryo (1.7%), transfers of fresh blastocyst (1.3%), and transfers of frozen blastocyst (0.8%). Compared with fresh blastocyst transfer, the likelihood of ectopic pregnancy was 30% higher for fresh cleavage stage embryo transfers (AOR 1.30, 95% CI 1.07-1.59) and was consistent across subfertility groups. Transfer of frozen blastocyst was associated with a significantly decreased risk of ectopic pregnancy (AOR 0.70, 95% CI 0.54-0.91) compared with transfer of fresh blastocyst. LIMITATIONS, REASON FOR CAUTION A limitation of this population-based study is the lack of information available on clinical- specific protocols and processes for embryo transfer (i.e. embryo quality, cryopreservation protocol, transfer techniques, etc.) and the potential impact on outcomes. WIDER IMPLICATIONS OF THE FINDINGS The lowest risk of ectopic pregnancy was associated with the transfer of a single frozen blastocyst. This finding adds to the increasing evidence of better perinatal outcomes following frozen embryo transfers. The approach of freezing all embryos in the initiated fresh cycle and transfer of a single frozen blastocyst in the subsequent thaw cycle may improve the overall pregnancy and birth outcomes following ART treatment, in part by reducing the ectopic pregnancy rate. STUDY FUNDING/COMPETING INTERESTS There is no funding for this study. Authors declared no competing interest related to this study.
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Affiliation(s)
- Z Li
- Faculty of Health, University of Technology Sydney, Sydney 2007, Australia School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia Sydney Medical School, The University of Sydney, Sydney 2006, Australia
| | - E A Sullivan
- Faculty of Health, University of Technology Sydney, Sydney 2007, Australia School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia
| | - M Chapman
- School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia
| | - C Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1142, New Zealand
| | - Y A Wang
- Faculty of Health, University of Technology Sydney, Sydney 2007, Australia School of Women's and Children's Health, The University of New South Wales, Sydney 2031, Australia
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Reid S, Bajuk B, Lui K, Sullivan EA. Comparing CRIB-II and SNAPPE-II as mortality predictors for very preterm infants. J Paediatr Child Health 2015; 51:524-528. [PMID: 25266790 DOI: 10.1111/jpc.12742] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
Abstract
AIMS This article compares the severity of illness scoring systems clinical risk index for babies (CRIB)-II and score for neonatal acute physiology with perinatal extension (SNAPPE)-II for discriminatory ability and goodness of fit in the same cohort of babies of less than 32 weeks gestation and aims to provide validation in the Australian population. METHODS CRIB-II and SNAPPE-II scores were collected on the same cohort of preterm infants born within a 2-year period, 2003 and 2004. The discriminatory ability of each score was assessed by the area under the receiver operator characteristic curve, and goodness of fit was assessed by the Hosmer-Lemeshow (HL) test. The outcome measure was in-hospital mortality. A multivariate logistic regression model was tested for perinatal variables that might add to the risk of in-hospital mortality. RESULTS Data for both scores were available for 1607 infants. Both scores had good discriminatory ability (CRIB-II area under the curve 0.913, standard error (SE) 0.014; SNAPPE-II area under the curve 0.907, SE 0.012) and adequate goodness of fit (HL χ2 = 11.384, 8 degrees of freedom, P = 0.183 for CRIB-II; HL χ2 = 4.319, 7 degrees of freedom, P = 0.742 for SNAPPE-II). The multivariate model did not reveal other significant variables. CONCLUSIONS Both severity of illness scores are ascertained during the first 12 h of life and perform similarly. Both can facilitate risk-adjusted comparisons of mortality and quality of care after the first post-natal 12 h. CRIB-II scores have the advantage of being simpler to collect and calculate.
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Affiliation(s)
- Shelley Reid
- RPA Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- NSW Pregnancy and Newborn Services Network (PSN), Sydney, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
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- NSW Pregnancy and Newborn Services Network (PSN), Sydney, New South Wales, Australia
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Ishihara O, Adamson GD, Dyer S, de Mouzon J, Nygren KG, Sullivan EA, Zegers-Hochschild F, Mansour R. International committee for monitoring assisted reproductive technologies: world report on assisted reproductive technologies, 2007. Fertil Steril 2014; 103:402-13.e11. [PMID: 25516078 DOI: 10.1016/j.fertnstert.2014.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years. DESIGN Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during 2007. SETTING Not applicable. PATIENT(S) Infertile women and men undergoing ART globally. INTERVENTION(S) Collection and analysis of international ART data. MAIN OUTCOME MEASURE(S) Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. RESULT(S) Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh in vitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged ≥40 years increased to 19.8% from 15.5% in 2006. CONCLUSION(S) The international trend toward <3 transferred embryos continued, as did the wider uptake of FET. This was achieved without compromising delivery rates. The application of ART for women aged >40 years was a major component of ART services in some regions and countries.
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Affiliation(s)
- Osamu Ishihara
- Department of Obstetrics and Gynaecology, Saitama Medical University, Moroyama, Japan.
| | - G David Adamson
- Palo Alto Medical Foundation Fertility Physicians of North California, San Jose, California
| | - Silke Dyer
- Department of Obstetrics & Gynaecology, Groote Schuur Hopsital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jacques de Mouzon
- National Institute for Health and Medical Research, Gynecology, Obstetrics and Reproductive Medicine Unit, Cochin-Saint Vincent de Paul University Hospital, Paris, France
| | - Karl G Nygren
- Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology, Sydney, Sydney, New South Wales, Australia
| | - Fernando Zegers-Hochschild
- Clinica las Condes and Program of Ethics and Public Policies in Human Reproduction, University Diego Portales, Santiago, Chile
| | - Ragaa Mansour
- Egyptian In Vitro Fertilization-Embryo Transfer Center, Cairo, Egypt
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Xu XK, Wang YA, Li Z, Lui K, Sullivan EA. Risk factors associated with preterm birth among singletons following assisted reproductive technology in Australia 2007-2009--a population-based retrospective study. BMC Pregnancy Childbirth 2014; 14:406. [PMID: 25481117 PMCID: PMC4266897 DOI: 10.1186/s12884-014-0406-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background Preterm birth, a leading cause of neonatal death, is more common in multiple births and thus there has being an increasing call for reducing multiple births in ART. However, few studies have compared risk factors for preterm births amongst ART and non-ART singleton birth mothers. Methods A population-based study of 393,450 mothers, including 12,105 (3.1%) ART mothers, with singleton gestations born between 2007 and 2009 in 5 of the 8 jurisdictions in Australia. Univariable and multivariable logistic regression models were conducted to evaluate socio-demographic, medical and pregnancy factors associated with preterm births in contrasting ART and non-ART mothers. Results Ten percent of singleton births to ART mothers were preterm compared to 6.8% for non-ART mothers (P < 0.01). Compared with non-ART mothers, ART mothers were older (mean 34.0 vs 29.7 yr respectively), less socio-economically disadvantaged (12.4% in the lowest quintile vs 20.7%), less likely to be smokers (3.8% vs 19.4%), more likely to be first time mothers (primiparous 62.4% vs 40.5%), had more preexisting hypertension and complications during pregnancy. Irrespective of the mode of conception, preexisting medical and pregnancy complications of hypertension, diabetes and antepartum hemorrhages were consistently associated with preterm birth. In contrast, socio-demographic variables, namely young and old maternal age (<25 and >34), socioeconomic disadvantage (most disadvantaged quintile Odds Ratio (OR) 0.95, 95% Confidence Interval (CI): 0.77–1.17), smoking (OR 1.12, 95%CI: 0.79–1.61) and priminarity (OR 1.19, 95% CI: 1.05–1.35, AOR not significant) shown to be associated with elevated risk of preterm birth for non-ART mothers were not demonstrated for ART mothers, even after adjusting for potential confounders. Nonetheless, in multivariable analysis, the association between ART and the elevated risk for singleton preterm birth persisted after controlling for all included confounding medical, pregnancy and socio-economic factors (AOR 1.51, 95% CI: 1.42–1.61). Conclusions Preterm birth rate is approximately one-and-a-half-fold higher in ART mothers than non-ART mothers albeit for singleton births after controlling for confounding factors. However, ART mothers were less subject to the adverse influence from socio-demographic factors than non-ART mothers. This has implications for counselling prospective parents.
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Affiliation(s)
- Xu K Xu
- School of Medical Sciences, University of New South Wales, Kensington Campus, Sydney, NSW, 2052, Australia.
| | - Yueping A Wang
- School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. .,Faculty of Health, University of Technology Sydney, City Campus, Sydney, NSW, 2007, Australia.
| | - Zhuoyang Li
- School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. .,Faculty of Health, University of Technology Sydney, City Campus, Sydney, NSW, 2007, Australia.
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. .,Department of Newborn Care, Royal Hospital for Women, Sydney, NSW, 2031, Australia.
| | - Elizabeth A Sullivan
- School of Women's and Children's Health, University of New South Wales, Randwick Hospitals Campus, Sydney, NSW, 2031, Australia. .,Faculty of Health, University of Technology Sydney, City Campus, Sydney, NSW, 2007, Australia.
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Chambers GM, Hoang VP, Lee E, Hansen M, Sullivan EA, Bower C, Chapman M. Hospital costs of multiple-birth and singleton-birth children during the first 5 years of life and the role of assisted reproductive technology. JAMA Pediatr 2014; 168:1045-53. [PMID: 25222633 DOI: 10.1001/jamapediatrics.2014.1357] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood. OBJECTIVES To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births. DESIGN, SETTING, AND PARTICIPANTS A retrospective population cohort study using individually linked birth, hospital, and death records among 233,850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008. EXPOSURES Multiple-gestation delivery and ART conception. MAIN OUTCOMES AND MEASURES Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs. RESULTS Of 226,624 singleton, 6941 twin, and 285 HOM infants, 1.0% of singletons, 15.4% of twins, and 34.7% of HOM children were conceived following ART. Compared with singletons, twins and HOMs were 3.4 and 9.6 times, respectively, more likely to be stillborn and were 6.4 and 36.7 times, respectively, more likely to die during the neonatal period. Twins and HOMs were 18.7 and 525.1 times, respectively, more likely to be preterm, and 3.6 and 2.8 times, respectively, more likely to be small for gestational age. The mean hospital costs of a singleton, twin, and HOM child to age 5 years were $2730, $8993, and $24,411 (in 2009-2010 US dollars), respectively, with cost differences concentrated in the neonatal period and during the first year of life. Almost 15% of inpatient costs for multiple births could have been avoided if ART twins and HOMs had been born as singletons. CONCLUSIONS AND RELEVANCE Compared with singletons, multiple-birth infants consume significantly more hospital resources, particularly during the neonatal period and first year of life. A significant proportion of the clinical and economic burden associated with multiple births can be prevented through single-embryo transfer. Increasing ART use worldwide and persistently high ART multiple-birth rates in several countries highlight the need for strategies that encourage single-embryo transfer. The costs from this study can be generalized to other settings.
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Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
| | - Van Phuong Hoang
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
| | - Evelyn Lee
- National Perinatal Epidemiology and Statistics Unit, School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
| | - Michele Hansen
- Telethon Institute for Child Health Research, The University of Western Australia, West Perth, Western Australia
| | - Elizabeth A Sullivan
- School of Women's and Children's Health, The University of New South Wales, Sydney, Australia4University of Technology Sydney, Sydney, Australia
| | - Carol Bower
- Telethon Institute for Child Health Research, The University of Western Australia, West Perth, Western Australia
| | - Michael Chapman
- School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
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Xu F, Sullivan EA, Li Z, Burns L, Austin MP, Slade T. The increased trend in mothers' hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia. BMC Womens Health 2014; 14:119. [PMID: 25263987 PMCID: PMC4261248 DOI: 10.1186/1472-6874-14-119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/23/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The burden of mental and behavioural disorders in Australia has increased significantly over the last decade. The aim of the current study is to describe the hospital admission rates for mental illness over a 10-year period for primiparous mothers in the first year after birth. METHODS This is an Australian population-based descriptive study with linked data from the New South Wales Midwives Data Collection and Admitted Patients Data Collection. The study population included primiparous mothers who gave birth between 1 January 2001 and 31 December 2010. All hospital admissions with a mental health diagnosis in the first year after birth were recorded. RESULTS There were 6,140 mothers (1.67%) admitted to hospital with a principal diagnosis of mental health in the first year after birth between 2001 and 2010 in New South Wales (7,884 admissions, 2.15%). The hospital admission rates increased significantly over time, particularly from 2005. The increase in hospital admissions was mainly attributed to the diagnoses of unipolar depression, adjustment disorders and anxiety disorders. CONCLUSIONS This study shows that hospital admissions for mothers with a mental health diagnosis after birth in New South Wales has significantly increased in the last decade. Possible reasons for this change need to be studied further.
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Affiliation(s)
- Fenglian Xu
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031, Australia.
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Javid N, Sullivan EA, Halliday LE, Duncombe G, Homer CSE. "Wrapping myself in cotton wool": Australian women's experience of being diagnosed with vasa praevia. BMC Pregnancy Childbirth 2014; 14:318. [PMID: 25208480 PMCID: PMC4168202 DOI: 10.1186/1471-2393-14-318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vasa praevia (VP) is an obstetric condition that is associated with significant perinatal mortality and morbidity. Although the incidence of VP is low, it is one of the few causes of perinatal death that can be potentially prevented through detection and appropriate care. The experience of women diagnosed with or suspected to have VP is largely unknown. The aim of this study was to explore the experiences and impact that a diagnosis or suspected diagnosis of VP had on a group of Australian women. METHOD A qualitative study using a descriptive exploratory design was conducted and Australian women diagnosed with VP were recruited via online methods in 2012. An inductive approach was undertaken and interviews were analysed using the stages of thematic analysis. RESULTS Of the 14 women interviewed, 11 were diagnosed with VP during pregnancy with 5 subsequently found not to have VP (non-confirmed diagnosis). Three women were diagnosed during childbirth with one neonatal death. Five major themes were identified: feeling like a ticking time bomb; getting diagnosis right; being taken seriously; coping with inconsistent information; and, just a massive relief when it was all over. CONCLUSIONS This is the first study to describe women's experience of being diagnosed with or suspected to have VP. The findings from this research reveal the dilemmas these women face even if their baby is ultimately born healthy. Their need for clear and consistent information, sensitive care, support and continuity is evident. Clinicians can use these findings in developing information, counselling and models of care for these women.
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Affiliation(s)
| | | | | | | | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney (UTS), Broadway, New South Wales 2007, Australia.
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