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Butler SE, Wallace EM, Bisits A, Selvaratnam RJ, Davey MA. Induction of labor and cesarean birth in lower-risk nulliparous women at term: A retrospective cohort study. Birth 2024. [PMID: 38173333 DOI: 10.1111/birt.12806] [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] [Received: 04/12/2023] [Revised: 10/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. METHODS Population-based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi-square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. RESULTS Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower-risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13-1.32)), 39 (aOR 1.31(1.23-1.40)), 40 (aOR 1.42(1.35-1.50)), and 41 weeks of gestation (aOR 1.43(1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations. DISCUSSION For lower-risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only.
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Affiliation(s)
- Sarah E Butler
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Health, Melbourne, Victoria, Australia
| | - Andrew Bisits
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Roshan J Selvaratnam
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Davies-Tuck ML, Davey MA, Hodges RL, Wallace EM. Fetal surveillance from 39 weeks' gestation to reduce stillbirth in South Asian-born women. Am J Obstet Gynecol 2023; 229:286.e1-286.e9. [PMID: 36907532 DOI: 10.1016/j.ajog.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND In July 2017, the State of Victoria's largest maternity service implemented a new clinical guideline to reduce the rates of stillbirth at term for South Asian women. OBJECTIVE This study aimed to evaluate the impact of offering fetal surveillance from 39 weeks to South Asian-born women on rates of stillbirth and neonatal and obstetrical interventions. STUDY DESIGN This was a cohort study of all women receiving antenatal care at 3 large metropolitan university-affiliated teaching hospitals in Victoria, who gave birth in the term period between January 2016 and December 2020. Differences in rates of stillbirth, neonatal deaths, perinatal morbidities, and interventions after July 2017 were determined. Multigroup interrupted time-series analysis was used to assess changes in rates of stillbirth and induction of labor. RESULTS A total of 3506 South Asian-born women gave birth before, and 8532 after the change in practice. There was a 64% reduction in term stillbirth (95% confidence interval, 87% to 2%; P=.047) after the change in practice from 2.3 per 1000 births to 0.8 per 1000 births. The rates of early neonatal death (3.1/1000 vs 1.3/1000; P=.03) and special care nursery admission (16.5% vs 11.1%; P<.001) also decreased. There were no significant differences in admission to the neonatal intensive care unit, 5-minute Apgar score <7, or birthweight, or differences in the trends of induction of labor per month. CONCLUSION Fetal monitoring from 39 weeks may offer an alternative to routine earlier induction of labor to reduce the rates of stillbirth without causing an increase in neonatal morbidity and attenuating trends in obstetrical interventions.
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Affiliation(s)
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Ryan L Hodges
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Health, Clayton, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Department of Health and Human Services, Melbourne, Australia
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Selvaratnam RJ, Wallace EM, Rolnik DL, Mol BW, Butler SE, Bisits A, Lawson J, Davey MA. Elective induction of labour at full-term gestations and childhood school outcomes. J Paediatr Child Health 2023; 59:1028-1034. [PMID: 37294278 DOI: 10.1111/jpc.16449] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
AIM To explore the association between induction of labour at full-term gestations in low-risk nulliparous women and childhood school outcomes. METHODS A retrospective whole-of-population cohort study linking perinatal data to educational test scores at grades 3, 5 and 7 in Victoria, Australia. Low-risk nulliparous women with singleton pregnancies induced at 39 and 40 weeks without a medical indication were compared to those expectantly managed from that week of gestation. Multivariable logistic regressions were used as well as generalised estimating equations on longitudinal data. RESULTS At 39 weeks, there were 3687 and 103 164 infants in the induction and expectant arms, respectively. At 40 weeks' gestation, there were 7914 and 70 280 infants, respectively. Infants born to nulliparous women induced at 39 weeks' gestation had significantly poorer educational outcomes at grade 3 (adjusted odds ratio (aOR) = 1.39, 95% confidence interval (CI): 1.13-1.70) but not grades 5 (aOR = 1.05, 95% CI: 0.84-1.33) and 7 (aOR = 1.07, 95% CI: 0.81-1.40) compared to those expectantly managed. Infants born to nulliparous women induced at 40 weeks had comparable educational outcomes at grade 3 (aOR = 1.06, 95% CI: 0.90-1.25) but poorer educational outcomes at grades 5 (aOR = 1.23, 95% CI: 1.05-1.43) and 7 (aOR = 1.23, 95% CI: 1.03-1.47) compared to those expectantly managed. CONCLUSIONS There were inconsistent associations between elective induction of labour at full-term gestations in low-risk nulliparous women and impaired childhood school outcomes.
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Affiliation(s)
- Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Victorian Government, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Department of Health, Victorian Government, Melbourne, Victoria, Australia
| | - Daniel L Rolnik
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Ben W Mol
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Sarah E Butler
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Andrew Bisits
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Janna Lawson
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Victorian Government, Melbourne, Victoria, Australia
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Phan TG, Lim R, Krause M, Chan ST, McDonald H, Gan PY, Zhang SR, Barreto Arce LJ, Vuong J, Thirugnanachandran T, Clissold B, Ly J, Singhal S, Hervet MV, Kim HA, Drummond GR, Wallace EM, Ma H, Sobey CG. Corrigendum: Phase I trial outcome of amnion cell therapy in patients with ischemic stroke (I-ACT). Front Neurosci 2023; 17:1237920. [PMID: 37600008 PMCID: PMC10433147 DOI: 10.3389/fnins.2023.1237920] [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: 06/10/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fnins.2023.1153231.].
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Affiliation(s)
- Thanh G. Phan
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Mirja Krause
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Siow T. Chan
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Hannah McDonald
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Poh-Yi Gan
- Department of Medicine, Centre for Inflammatory Diseases, Monash Medical Centre, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Immunology, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
| | - Shenpeng R. Zhang
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Liz J. Barreto Arce
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Jason Vuong
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Tharani Thirugnanachandran
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Benjamin Clissold
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - John Ly
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Shaloo Singhal
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Marie Veronic Hervet
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Hyun Ah Kim
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Grant R. Drummond
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Euan M. Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Henry Ma
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Christopher G. Sobey
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
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Scott N, Abeysuriya RG, Delport D, Sacks-Davis R, Nolan J, West D, Sutton B, Wallace EM, Hellard M. COVID-19 epidemic modelling for policy decision support in Victoria, Australia 2020-2021. BMC Public Health 2023; 23:988. [PMID: 37237343 DOI: 10.1186/s12889-023-15936-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Policy responses to COVID-19 in Victoria, Australia over 2020-2021 have been supported by evidence generated through mathematical modelling. This study describes the design, key findings, and process for policy translation of a series of modelling studies conducted for the Victorian Department of Health COVID-19 response team during this period. METHODS An agent-based model, Covasim, was used to simulate the impact of policy interventions on COVID-19 outbreaks and epidemic waves. The model was continually adapted to enable scenario analysis of settings or policies being considered at the time (e.g. elimination of community transmission versus disease control). Model scenarios were co-designed with government, to fill evidence gaps prior to key decisions. RESULTS Understanding outbreak risk following incursions was critical to eliminating community COVID-19 transmission. Analyses showed risk depended on whether the first detected case was the index case, a primary contact of the index case, or a 'mystery case'. There were benefits of early lockdown on first case detection and gradual easing of restrictions to minimise resurgence risk from undetected cases. As vaccination coverage increased and the focus shifted to controlling rather than eliminating community transmission, understanding health system demand was critical. Analyses showed that vaccines alone could not protect health systems and need to be complemented with other public health measures. CONCLUSIONS Model evidence offered the greatest value when decisions needed to be made pre-emptively, or for questions that could not be answered with empiric data and data analysis alone. Co-designing scenarios with policy-makers ensured relevance and increased policy translation.
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Affiliation(s)
- Nick Scott
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Romesh G Abeysuriya
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dominic Delport
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Nolan
- Victorian Government Department of Health, Victoria, Australia
| | - Daniel West
- Victorian Government Department of Health, Victoria, Australia
| | - Brett Sutton
- Victorian Government Department of Health, Victoria, Australia
| | - Euan M Wallace
- Victorian Government Department of Health, Victoria, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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Phan TG, Lim R, Chan ST, McDonald H, Gan PY, Zhang SR, Barreto Arce LJ, Vuong J, Thirugnanachandran T, Clissold B, Ly J, Singhal S, Hervet MV, Kim HA, Drummond GR, Wallace EM, Ma H, Sobey CG. Phase I trial outcome of amnion cell therapy in patients with ischemic stroke (I-ACT). Front Neurosci 2023; 17:1153231. [PMID: 37229431 PMCID: PMC10204798 DOI: 10.3389/fnins.2023.1153231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background We proposed a Phase I dose escalation trial to assess the safety of allogeneic human amniotic epithelial cells (hAECs) in stroke patients with a view to informing the design for a Phase II trial. Methods The design is based on 3 + 3 dose escalation design with additional components for measuring MR signal of efficacy as well as the effect of hAECs (2-8 × 106/kg, i.v.) on preventing immunosuppression after stroke. Results Eight patients (six males) were recruited within 24 h of ischemic stroke onset and were infused with hAECs. We were able to increase the dose of hAECs to 8 × 106 cells/kg (2 × 106/kg, n = 3; 4 × 106/kg, n = 3; 8 × 106/kg, n = 2). The mean age is 68.0 ± 10.9 (mean ± SD). The frequencies of hypertension and hyperlipidemia were 87.5%, diabetes was 37.5%, atrial fibrillation was 50%, ischemic heart disease was 37.5% and ever-smoker was 25%. Overall, baseline NIHSS was 7.5 ± 3.1, 7.8 ± 7.2 at 24 h, and 4.9 ± 5.4 at 1 week (n = 8). The modified Rankin scale at 90 days was 2.1 ± 1.2. Supplemental oxygen was given in five patients during hAEC infusion. Using pre-defined criteria, two serious adverse events occurred. One patient developed recurrent stroke and another developed pulmonary embolism whilst in rehabilitation. For the last four patients, infusion of hAECs was split across separate infusions on subsequent days to reduce the risk for fluid overload. Conclusion Our Phase I trial demonstrates that a maximal dose of 2 × 106/kg hAECs given intravenously each day over 2 days (a total of 4 × 106/kg) is safe and optimal for use in a Phase II trial. Clinical trial registration ClinicalTrials.gov, identifier ACTRN12618000076279P.
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Affiliation(s)
- Thanh G. Phan
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Siow T. Chan
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Hannah McDonald
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Poh-Yi Gan
- Department of Medicine, Centre for Inflammatory Diseases, Monash Medical Centre, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- Department of Immunology, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
| | - Shenpeng R. Zhang
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Liz J. Barreto Arce
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Jason Vuong
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Tharani Thirugnanachandran
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Benjamin Clissold
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - John Ly
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Shaloo Singhal
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Marie Veronic Hervet
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Hyun Ah Kim
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Grant R. Drummond
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
| | - Euan M. Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Henry Ma
- Clinical Trials, Imaging and Informatics Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Christopher G. Sobey
- Department of Microbiology, Anatomy, Physiology and Pharmacology, Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC, Australia
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Barber CV, Yo JH, Rahman RA, Wallace EM, Palmer KR, Marshall SA. Activin A and pathologies of pregnancy: a review. Placenta 2023; 136:35-41. [PMID: 37028223 DOI: 10.1016/j.placenta.2023.03.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
Activin A is a two-subunit protein belonging to the transforming growth factor β superfamily. First discovered almost three decades ago, it has since been implicated in diverse physiological roles, ranging from wound repair to reproduction. After 30 years of research, altered activin A levels are now understood to be associated with the development of various diseases, making activin A a potential therapeutic target. In pregnancy, the placenta and fetal membranes are major producers of activin A, with significantly enhanced serum concentrations now recognised as a contributor to numerous gestational disorders. Evidence now suggests that circulating levels of activin A may be clinically relevant in the early detection of pregnancy complications, including miscarriage and preeclampsia. This review aims to summarise our current understanding of activin A as a potential diagnostic marker in common pregnancy pathologies.
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Selvaratnam RJ, Wallace EM, Rolnik DL, Davey MA. Childhood school outcomes for infants born to women with hypertensive disorders during pregnancy. Pregnancy Hypertens 2022; 30:51-58. [DOI: 10.1016/j.preghy.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
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Tanner MS, De Guingand D, Reddy M, Rowson S, Rolnik DL, Davey MA, Mol BW, Wallace EM, Da Silva Costa F, Palmer KR. The effect of comorbidities on the sFLT-1: PlGF ratio in preeclampsia. Pregnancy Hypertens 2022; 29:98-100. [DOI: 10.1016/j.preghy.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 12/01/2022]
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Selvaratnam RJ, Wallace EM, Davis PG, Rolnik DL, Fahey M, Davey M. The 5-minute Apgar score and childhood school outcomes. Acta Paediatr 2022; 111:1878-1884. [PMID: 35665536 DOI: 10.1111/apa.16443] [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] [Received: 02/26/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
AIM To examine the association between Apgar score at 5 min and childhood developmental and educational outcome. METHODS A population-based data linkage study of births ≥37 weeks' gestation linked to developmental outcomes at preparatory school and educational outcomes at school grades 3, 5 and 7 in Victoria, Australia. Multivariable logistic regressions and generalised estimating equations were used. RESULTS There were 167,126 singleton infants with developmental results and 392,933 singleton infants with at least one educational result. There was an inverse relationship between Apgar score at 5 min and poor developmental and educational outcomes, with the worst outcomes among Apgar scores of 0-3. Apgar scores of 7, 8 and 9 were all associated with poorer developmental outcomes (aOR = 1.31, 95% CI: 1.12-1.54; aOR = 1.17, 95% CI: 1.05-1.29; aOR = 1.08, 95% CI: 1.02-1.13 respectively), while Apgar scores of 7 and 8 were associated with poorer educational outcomes at grades 3, 5, and 7. With progression through grades 3, 5, and 7, the extent of the difference in educational outcomes diminished (e.g. for Apgar scores of 0-3: aOR = 3.33, 95% CI: 1.85-6.00 in grade 3 and aOR = 1.49, 95% CI: 0.75-2.96 in grade 7). CONCLUSION Apgar scores below 10 at 5 min are associated with poorer developmental and educational outcomes in school.
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Affiliation(s)
- Roshan J. Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology Monash University Clayton Vic. Australia
- Safer Care Victoria, Department of Health, Victorian Government Melbourne Vic. Australia
| | - Euan M. Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology Monash University Clayton Vic. Australia
- Department of Health, Victorian Government Melbourne Vic. Australia
| | - Peter G. Davis
- Newborn Research The Royal Women's Hospital Parkville Vic. Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Parkville Vic. Australia
| | - Daniel L. Rolnik
- The Ritchie Centre, Department of Obstetrics and Gynaecology Monash University Clayton Vic. Australia
| | - Michael Fahey
- Department of Paediatrics Monash University Clayton Vic. Australia
| | - Mary‐Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology Monash University Clayton Vic. Australia
- Safer Care Victoria, Department of Health, Victorian Government Melbourne Vic. Australia
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11
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Zhu D, Krause M, Yawno T, Kusuma GD, Schwab R, Barabadi M, Maleken AS, Chan ST, Hunt R, Greening D, Wallace EM, Lim R. Assessing the impact of gestational age of donors on the efficacy of amniotic epithelial cell-derived extracellular vesicles in experimental bronchopulmonary dysplasia. Stem Cell Res Ther 2022; 13:196. [PMID: 35550006 PMCID: PMC9102678 DOI: 10.1186/s13287-022-02874-4] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background and rationale Extracellular vesicles (EVs) are a potential cell-free regenerative medicine. Human amniotic epithelial cells (hAECs) are a viable source of cell therapy for diseases like bronchopulmonary dysplasia (BPD). However, little is known about the impact of gestational age of the donor on the quality of hAEC-derived EVs.
Aims To determine the impact of gestational age on hAEC-derived EVs in experimental BPD.
Results Term hAEC-derived EVs displayed a significantly higher density of surface epitopes (CD142 and CD133) and induced greater macrophage phagocytosis compared to preterm hAEC-EVs. However, T cell proliferation was more significantly suppressed by preterm hAEC-EVs. Using a model of experimental BPD, we observed that term but not preterm hAEC-EVs improved tissue-to-airspace ratio and septal crest density. While both term and preterm hAEC-EVs reduced the levels of inflammatory cytokines on postnatal day 7, the improvement in lung injury was associated with increased type II alveolar cells which was only observed in term hAEC-EV treatment group. Furthermore, only neonatal term hAEC-EVs reduced airway hyper-responsiveness, mitigated pulmonary hypertension and protected against right ventricular hypertrophy at 6 weeks of age. Conclusion Term hAEC-EVs, but not preterm hAEC-EVs, have therapeutic efficacy in a mouse model of BPD-like lung injury. Therefore, the impact of donor criteria should be considered when applying perinatal cells-derived EV therapy for clinical use.
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Affiliation(s)
- Dandan Zhu
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Mirja Krause
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Tamara Yawno
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia. .,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia. .,Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.
| | - Gina D Kusuma
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Renate Schwab
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Mehri Barabadi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia
| | - Amina S Maleken
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Siow T Chan
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Rod Hunt
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia
| | - David Greening
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, VIC, Australia.,Central Clinical School, Monash University, Clayton, VIC, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia
| | - Euan M Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
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12
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Reddy M, Palmer K, Rolnik DL, Wallace EM, Mol BW, Da Silva Costa F. Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre-eclampsia. Ultrasound Obstet Gynecol 2022; 59:596-605. [PMID: 34985800 DOI: 10.1002/uog.24851] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/14/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess the performance of placental, fetal and maternal cardiovascular markers in the prediction of adverse perinatal and maternal outcomes in women with suspected or confirmed pre-eclampsia. METHODS This was a prospective prognostic accuracy study of women with suspected or confirmed pre-eclampsia who underwent a series of investigations to measure maternal hemodynamic indices, mean arterial pressure, augmentation index, ophthalmic artery peak systolic velocity (PSV) ratio, uterine artery pulsatility index (UtA-PI), fetal biometric and Doppler parameters, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). The performance of these markers, individually or in combination, in predicting adverse perinatal and maternal outcomes was then assessed using receiver-operating-characteristics (ROC)-curve analysis. Adverse maternal outcome was defined as one or more of severe hypertension, admission to the intensive care unit, eclampsia, placental abruption, HELLP syndrome, disseminated intravascular coagulation, platelets < 100 × 109 /L, creatinine > 90 μmol/L and alanine aminotransferase > 100 U/L. Adverse perinatal outcome was defined as one or more of preterm birth at or before 34 + 0 weeks, neonatal intensive care unit admission for > 48 h, respiratory distress syndrome, intraventricular hemorrhage, hypoxic ischemic encephalopathy, necrotizing enterocolitis, retinopathy of prematurity and confirmed fetal infection. RESULTS We recruited 126 women with suspected (n = 31) or confirmed (n = 95) pre-eclampsia at a median gestational age of 33.9 weeks (interquartile range, 30.9-36.3 weeks). Pregnancies with adverse perinatal outcome compared to those without had a higher median UtA-PI (1.3 vs 0.8; P < 0.001), ophthalmic artery PSV ratio (0.8 vs 0.7; P = 0.01) and umbilical artery PI percentile (82.0 vs 68.5; P < 0.01) and lower median estimated fetal weight percentile (4.0 vs 43.0; P < 0.001), abdominal circumference percentile (4.0 vs 63.0; P < 0.001), middle cerebral artery PI percentile (28.0 vs 58.5; P < 0.001) and cerebroplacental ratio percentile (18.0 vs 46.5; P < 0.001). Pregnancies with adverse perinatal outcome also had a higher median sFlt-1 (8208.0 pg/mL vs 4508.0 pg/mL; P < 0.001), lower PlGF (27.2 pg/mL vs 76.3 pg/mL; P < 0.001) and a higher sFlt-1/PlGF ratio (445.4 vs 74.4; P < 0.001). The best performing individual marker for predicting adverse perinatal outcome was the sFlt-1/PlGF ratio (area under the ROC curve (AUC), 0.87 (95% CI, 0.81-0.93)), followed by estimated fetal weight (AUC, 0.81 (95% CI, 0.73-0.89)). Women who experienced adverse maternal outcome had a higher median sFlt-1 level (7471.0 pg/mL vs 5131.0 pg/mL; P < 0.001) and sFlt-1/PlGF ratio (204.3 vs 93.3; P < 0.001) and a lower PlGF level (37.0 pg/mL vs 66.1 pg/mL; P = 0.01) and estimated fetal weight percentile (16.5 vs 37.0; P = 0.04). All markers performed poorly in predicting adverse maternal outcome, with sFlt-1 (AUC, 0.69 (95% CI, 0.60-0.79)) and sFlt-1/PlGF ratio (AUC, 0.69 (95% CI, 0.59-0.78)) demonstrating the best individual performance. The addition of cardiovascular, fetal or other placental indices to the sFlt-1/PlGF ratio did not improve the prediction of adverse maternal or perinatal outcomes. CONCLUSIONS The sFlt-1/PlGF ratio performs well in predicting adverse perinatal outcomes but is a poor predictor of adverse maternal outcomes in women with suspected or diagnosed pre-eclampsia. The addition of cardiovascular or fetal indices to the model is unlikely to improve the prognostic performance of the sFlt-1/PlGF ratio. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Reddy
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | - K Palmer
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | - D L Rolnik
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Monash Women's, Monash Health, Clayton, Victoria, Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - F Da Silva Costa
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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13
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Barber C, Yap Y, Hannan NJ, Wallace EM, Marshall SA. Activin A causes endothelial dysfunction of mouse aorta and human aortic cells. Reproduction 2022; 163:145-155. [PMID: 35038317 DOI: 10.1530/rep-21-0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/16/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
Preeclampsia is a multisystem hypertensive disorder of pregnancy that remains one of the leading causes of maternal and perinatal morbidity and mortality worldwide. The widespread maternal endothelial dysfunction that underlies preeclampsia is thought to arise from excessive placental production of various factors combined with enhanced oxidative stress. While previous studies have reported elevated activin A in women diagnosed with preeclampsia, whether activin A can cause vascular dysfunction has not yet been thoroughly investigated. Here, we demonstrated that different subtypes of activin A receptors were localised to the endothelial and smooth muscle cells of mouse and human aortae. Then, the aorta of healthy female C57Bl6J mice (n = 8) were incubated for 24 h in various concentrations of recombinant activin A to mimic early pregnancy (5 ng/mL), late pregnancy (20 ng/mL) and preeclampsia (50 ng/mL). Vascular reactivity as assessed by wire myography revealed that only the preeclamptic level of activin A impaired agonist-mediated endothelium-dependent relaxation by reducing the vasodilator prostanoid contribution to relaxation. However, agonist-mediated endothelium-independent mechanisms were unaffected. Further investigations carried out on human aortic endothelial cells suggested that the impairment of aorta relaxation could also be driven by increased endothelial cell permeability, and decreased cell viability, adherence and proliferation. This is the first direct evidence to show that activin A can induce endothelial dysfunction in whole blood vessels, suggesting that at high circulating levels it may contribute to the widespread endothelial dysfunction in women with preeclampsia.
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Affiliation(s)
- Courtney Barber
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Yann Yap
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- The Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Natalie J Hannan
- Translational Obstetrics Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne & Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Sarah A Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- The Hudson Institute of Medical Research, Clayton, Victoria, Australia
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14
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Yap YW, Hannan NJ, Wallace EM, Marshall SA. Silencing of Nrf genes in the human placenta as measured by SDS-PAGE and Western Blotting techniques. Placenta 2022; 118:70-74. [PMID: 35045361 DOI: 10.1016/j.placenta.2022.01.007] [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] [Received: 10/20/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
Nuclear factor erythroid 2-related factor-2 (Nrf2), and the less well characterised proteins Nrf1 and Nrf3, are member of the cap 'n' collar family of transcription factors. Nrf proteins regulate the expression of endogenous antioxidant enzymes and have recently become the targets for various therapeutic treatments. Recently, Nrf proteins have been of particular interest as a target in placental-derived oxidative stress induced pregnancy disorders. Here, we report the presence of Nrf1, Nrf2 and Nrf3 proteins in both human primary trophoblast and human trophoblast choriocarcinoma cell line (BeWo). We also detail the steps taken to successfully silence all Nrf proteins in both human primary trophoblast cells and BeWo via detection of mRNA and protein using quantitative PCR, and SDS-PAGE and Western Blotting respectively.
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Affiliation(s)
- Yann W Yap
- The Hudson Institute of Medical Research, Clayton, 3168, Victoria, Australia; The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, 3168, Victoria, Australia
| | - Natalie J Hannan
- Therapeutics Discovery and Vascular Function in Pregnancy Group, The Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne & Mercy Perinatal, Mercy Hospital for Women, Heidelberg, 3084, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, 3168, Victoria, Australia
| | - Sarah A Marshall
- The Hudson Institute of Medical Research, Clayton, 3168, Victoria, Australia; The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, 3168, Victoria, Australia.
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15
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Palmer KR, Tanner M, Davies-Tuck M, Rindt A, Papacostas K, Giles ML, Brown K, Diamandis H, Fradkin R, Stewart AE, Rolnik DL, Stripp A, Wallace EM, Mol BW, Hodges RJ. Widespread Implementation of a Low-Cost Telehealth Service in the Delivery of Antenatal Care During the COVID-19 Pandemic: An Interrupted Time-Series Analysis. Obstet Gynecol Surv 2022. [DOI: 10.1097/01.ogx.0000805176.26681.ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Tanner MS, Malhotra A, Davey MA, Wallace EM, Mol BW, Palmer KR. Maternal and neonatal complications in women with medical comorbidities and preeclampsia. Pregnancy Hypertens 2021; 27:62-68. [PMID: 34942478 DOI: 10.1016/j.preghy.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/23/2021] [Accepted: 12/10/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate how medical comorbidities - chronic hypertension, pre-gestational or gestational diabetes and obesity - influence maternal and neonatal complications from preeclampsia. STUDY DESIGN We undertook a retrospective cohort study of women delivering in Victoria, Australia, between 2009 and 2017. We compared the likelihood of having a maternal complication before delivery or neonatal complication after birth between women with and without comorbidities. We used causal mediation analysis for neonatal outcomes to separate the effects of comorbidities and of prematurity on morbidity. MAIN OUTCOME MEASURES Pregnancy complications (eclampsia; haemolysis, elevated liver enzymes, low platelets syndrome; placental abruption; stillbirth) and neonatal complications (respiratory distress syndrome; neonatal sepsis; a 5-minute APGAR < 5; neonatal intensive care unit admission). RESULTS Women with comorbidities delivered at a median (interquartile range) of 37.0 (36.0-39.0) weeks gestation, earlier than women without comorbidities (38.0 (36.0-39.0) weeks, p < 0.001). Women with comorbidities were less likely than those without to suffer any pregnancy complication prior to delivery (adjusted relative risk 0.78, 95% confidence interval 0.72-0.86); however, their neonates suffered more respiratory distress syndrome (aRR 1.43, 95% CI 1.31-1.57), neonatal sepsis (aRR 1.42, 95% CI 1.17-1.72) and NICU admission (aRR 1.37, 95% CI 1.23-1.53). Earlier delivery was a major contributor to worse neonatal outcomes. CONCLUSIONS Medical comorbidities are associated with earlier delivery among women with preeclampsia. This is associated with fewer maternal complications, but worse neonatal outcomes.
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Affiliation(s)
- Michael S Tanner
- Department of Obstetrics and Gynaecology, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia.
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Level 5, Monash Children's Hospital, 246 Clayton Road, Clayton 3168, Victoria, Australia; Monash Womens' and Newborn, Monash Health, 246 Clayton Road, Clayton 3168, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia; Monash Womens' and Newborn, Monash Health, 246 Clayton Road, Clayton 3168, Victoria, Australia
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17
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Tanner MS, De Guingand D, Reddy M, Rowson S, Rolnik DL, Da Silva Costa F, Davey MA, Mol BW, Wallace EM, Palmer KR. The effect of preexisting medical comorbidities on the preeclamptic phenotype: a retrospective cohort study. Hypertens Pregnancy 2021; 40:336-345. [PMID: 34697981 DOI: 10.1080/10641955.2021.1991371] [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: 10/20/2022]
Abstract
Objective:To compare the effect of comorbidities on the phenotype and outcomes of preeclampsia.Methods: A matched retrospective cohort study of women delivering at a tertiary maternity center following a diagnosis of preeclampsia. We collected data on signs and symptoms, biochemical markers, and maternal and perinatal outcomes.Results:We studied 474 women; 158 women with and 316 without comorbidities. Compared to women without comorbidities, women with comorbidities delivered earlier. They suffered fewer maternal but more neonatal complications.Conclusion: Women with comorbidities receive earlier intervention than women without comorbidities, which may lead to fewer maternal complications but worse neonatal outcomes.
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Affiliation(s)
- Michael S Tanner
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia
| | - Deborah De Guingand
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia
| | - Maya Reddy
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia.,Monash Women's Services, Monash Health, Clayton, Australia
| | - Saskia Rowson
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia
| | - Daniel L Rolnik
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia.,Monash Women's Services, Monash Health, Clayton, Australia
| | - Fabricio Da Silva Costa
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia.,Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mary-Ann Davey
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia
| | - Ben W Mol
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia
| | - Euan M Wallace
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia
| | - Kirsten R Palmer
- Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia.,Monash Women's Services, Monash Health, Clayton, Australia
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18
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Giles ML, Davey MA, Wallace EM. Associations Between Maternal Immunisation and Reduced Rates of Preterm Birth and Stillbirth: A Population Based Retrospective Cohort Study. Front Immunol 2021; 12:704254. [PMID: 34557193 PMCID: PMC8454544 DOI: 10.3389/fimmu.2021.704254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Stillbirth and preterm birth (PTB) remain two of the most important, unresolved challenges in modern pregnancy care. Approximately 10% of all births are preterm with nearly one million children dying each year due to PTB. It remains the most common cause of death among children under five years of age. The numbers for stillbirth are no less shocking with 2.6 million babies stillborn each year. With minimal impact on the rate of these adverse birth outcomes over the past decade there is an urgent need to identify more effective interventions to tackle these problems. In this retrospective cohort study, we used whole-of-population data, to determine if maternal immunization during pregnancy against influenza and/or pertussis, is associated with a lower risk of PTB, delivering a small-for-gestational age (SGA) infant, developing preeclampsia or stillbirth. Women with a singleton pregnancy at 28 or more weeks' gestation delivering in Victoria, Australia from July 2015 to December 2018 were included in the analysis. Log-binomial regression was used to measure the relationship between vaccination during pregnancy against influenza and against pertussis, with preterm birth, SGA, preeclampsia and stillbirth. Variables included in the adjusted model were maternal age, body mass index, first or subsequent birth, maternal Indigenous status, socio-economic quintile, smoking, public or private maternity care and metropolitan or rural location of the hospital. Women who received influenza vaccine were 75% less likely to have a stillbirth (aRR 025; 95% CI 0.20, 0.31), and 31% less likely to birth <37 weeks (aRR 0.69; 95% CI 0.66, 0.72). Women who received pertussis vaccine were 77% less likely to have a stillbirth (aOR 0.23; 95% CI 0.18, 0.28) and 32% less likely to birth <37 weeks gestation (aRR 0.68; 95% CI 0.66, 0.71). Vaccination also reduced the odds of small for gestational age by 13% and reduced the odds of pre-eclampsia when restricted to primiparous women. This association was seen over four different influenza seasons and independent of the time of year suggesting that any protective effect on obstetric outcomes afforded by maternal vaccination may not be due to a pathogen-specific response but rather due to pathogen-agnostic immune-modulatory effects.
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Affiliation(s)
- Michelle L. Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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19
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Giles ML, Wallace EM, Alpren C, Brady N, Crouch S, Romanes F, Sutton B, Cheng A. Suppression of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After a Second Wave in Victoria, Australia. Clin Infect Dis 2021; 73:e808-e810. [PMID: 33354719 PMCID: PMC7799206 DOI: 10.1093/cid/ciaa1882] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/18/2020] [Accepted: 12/21/2020] [Indexed: 11/14/2022] Open
Abstract
Countries around the world are experiencing a second wave of COVID-19 which is proving to be difficult to control. This report describes the combination of physical distancing, mandatory mask wearing, movement restrictions and enhanced test, trace and isolation efforts that can be used to successfully suppress community transmission to zero.
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Affiliation(s)
- Michelle L Giles
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,Department of Obstetrics and Gynecology, Monash University, Melbourne,Australia
| | - Euan M Wallace
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,Department of Obstetrics and Gynecology, Monash University, Melbourne,Australia
| | - Charles Alpren
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Nicole Brady
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Simon Crouch
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Finn Romanes
- Department of Health and Human Services, Victorian Government , Melbourne, Australia
| | - Brett Sutton
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Allen Cheng
- Department of Health and Human Services, Victorian Government , Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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20
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Aridas JD, Yawno T, Sutherland AE, Nitsos I, Wong FY, Hunt RW, Ditchfield M, Fahey MC, Malhotra A, Wallace EM, Gunn AJ, Jenkin G, Miller SL. Melatonin augments the neuroprotective effects of hypothermia in lambs following perinatal asphyxia. J Pineal Res 2021; 71:e12744. [PMID: 34032315 DOI: 10.1111/jpi.12744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
Therapeutic hypothermia (TH) is standard care in high-resource birth settings for infants with neonatal encephalopathy. TH is partially effective and adjuvant therapies are needed. Here, we examined whether the antioxidant melatonin (MLT) provides additive benefit with TH, compared to TH alone or MLT alone, to improve recovery from acute encephalopathy in newborn lambs. Immediately before cesarean section delivery, we induced asphyxia in fetal sheep via umbilical cord occlusion until mean arterial blood pressure fell from 55 ± 3 mm Hg in sham controls to 18-20 mm Hg (10.1 ± 1.5 minutes). Lambs were delivered and randomized to control, control + MLT (60 mg iv, from 30 minutes to 24 hours), asphyxia, asphyxia + TH (whole-body cooling to 35.1 ± 0.8°C vs. 38.3 ± 0.17°C in sham controls, from 4-28 hours), asphyxia + MLT, and asphyxia + TH + MLT. At 72 hours, magnetic resonance spectroscopy (MRS) was undertaken, and then brains were collected for neuropathology assessment. Asphyxia induced abnormal brain metabolism on MRS with increased Lactate:NAA (P = .003) and reduced NAA:Choline (P = .005), induced apoptotic and necrotic cell death across gray and white matter brain regions (P < .05), and increased neuroinflammation and oxidative stress (P < .05). TH and MLT were independently associated with region-specific reductions in oxidative stress, inflammation, and cell death, compared to asphyxia alone. There was an interaction between TH and MLT such that the NAA:Choline ratio was not significantly different after asphyxia + TH + MLT compared to sham controls but had a greater overall reduction in neuropathology than either treatment alone. This study demonstrates that, in newborn lambs, combined TH + MLT for neonatal encephalopathy provides significantly greater neuroprotection than either alone. These results will guide the development of further trials for neonatal encephalopathy.
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Affiliation(s)
- James Ds Aridas
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
| | - Tamara Yawno
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Amy E Sutherland
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
| | - Ilias Nitsos
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Flora Y Wong
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
| | - Rod W Hunt
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
- Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | | | - Michael C Fahey
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
| | - Atul Malhotra
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Paediatrics, Monash University, Clayton, Vic., Australia
- Monash Children's Hospital, Monash Health, Clayton, Vic., Australia
| | - Euan M Wallace
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Alistair J Gunn
- Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Graham Jenkin
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - Suzanne L Miller
- Hudson Institute of Medical Research, The Ritchie Centre, Clayton, Vic., Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
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21
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Newnham JP, Schilling C, Petrou S, Morris JM, Wallace EM, Brown K, Edwards L, Skubisz MM, White SW, Rynne B, Arrese CA, Doherty DA. The health and educational costs of preterm birth to 18 years of age in Australia. Aust N Z J Obstet Gynaecol 2021; 62:55-61. [PMID: 34268727 DOI: 10.1111/ajo.13405] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm birth is the greatest cause of death up to five years of age and an important contributor to lifelong disability. There is increasing evidence that a meaningful proportion of early births may be prevented, but widespread introduction of effective preventive strategies will require financial support. AIMS This study estimated the economic cost to the Australian government of preterm birth, up to 18 years of age. MATERIALS AND METHODS A decision-analytic model was developed to estimate the costs of preterm birth in Australia for a hypothetical cohort of 314 814 children, the number of live births in 2016. Costs to Australia's eight jurisdictions included medical expenditures and additional costs to educational services. RESULTS The total cost of preterm birth to the Australian government associated with the annual cohort was estimated at $1.413 billion (95% CI 1047-1781). Two-thirds of the costs were borne by healthcare services during the newborn period and one-quarter of the costs by educational services providing special assistance. For each child, the costs were highest for those born at the earliest survivable gestational age, but the larger numbers of children born at later gestational ages contributed heavily to the overall economic burden. CONCLUSION Preterm birth leaves many people with lifelong disabilities and generates a significant economic burden to society. The costs extend beyond those to the healthcare system and include additional educational needs. Assessments of economic costs should inform economic evaluations of interventions aimed at the prevention or treatment of preterm birth.
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Affiliation(s)
- John P Newnham
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Chris Schilling
- Economics and Modelling, KPMG, Melbourne, Victoria, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan M Morris
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Melbourne, Victoria, Australia
| | - Kiarna Brown
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lindsay Edwards
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Monika M Skubisz
- Department of Obstetrics, Women's and Children's Hospital, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Brendan Rynne
- Economics and Modelling, KPMG, Melbourne, Victoria, Australia
| | - Catherine A Arrese
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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22
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Palmer KR, Tanner M, Davies-Tuck M, Rindt A, Papacostas K, Giles ML, Brown K, Diamandis H, Fradkin R, Stewart AE, Rolnik DL, Stripp A, Wallace EM, Mol BW, Hodges RJ. Widespread implementation of a low-cost telehealth service in the delivery of antenatal care during the COVID-19 pandemic: an interrupted time-series analysis. Lancet 2021; 398:41-52. [PMID: 34217399 PMCID: PMC8248925 DOI: 10.1016/s0140-6736(21)00668-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little evidence is available on the use of telehealth for antenatal care. In response to the COVID-19 pandemic, we developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. To inform this clinical initiative, we aimed to assess the effectiveness and safety of telehealth in antenatal care. METHODS We analysed routinely collected health data on all women giving birth at Monash Health, a large health service in Victoria (Australia), using an interrupted time-series design. We assessed the impact of telehealth integration into antenatal care from March 23, 2020, across low-risk and high-risk care models. Allowing a 1-month implementation period from March 23, 2020, we compared the first 3 months of telehealth integrated care delivered between April 20 and July 26, 2020, with conventional care delivered between Jan 1, 2018, and March 22, 2020. The primary outcomes were detection and outcomes of fetal growth restriction, pre-eclampsia, and gestational diabetes. Secondary outcomes were stillbirth, neonatal intensive care unit admission, and preterm birth (birth before 37 weeks' gestation). FINDINGS Between Jan 1, 2018, and March 22, 2020, 20 031 women gave birth at Monash Health during the conventional care period and 2292 women gave birth during the telehealth integrated care period. Of 20 154 antenatal consultations provided in the integrated care period, 10 731 (53%) were delivered via telehealth. Overall, compared with the conventional care period, no significant differences were identified in the integrated care period with regard to the number of babies with fetal growth restriction (birthweight below the 3rd percentile; 2% in the integrated care period vs 2% in the conventional care period, p=0·72, for low-risk care models; 5% in the integrated care period vs 5% in the conventional care period, p=0·50 for high-risk care models), number of stillbirths (1% vs 1%, p=0·79; 2% vs 2%, p=0·70), or pregnancies complicated by pre-eclampsia (3% vs 3%, p=0·70; 9% vs 7%, p=0·15), or gestational diabetes (22% vs 22%, p=0·89; 30% vs 26%, p=0·06). Interrupted time-series analysis showed a significant reduction in preterm birth among women in high-risk models (-0·68% change in incidence per week [95% CI -1·37 to -0·002]; p=0·049), but no significant differences were identified in other outcome measures for low-risk or high-risk care models after telehealth integration compared with conventional care. INTERPRETATION Telehealth integrated antenatal care enabled the reduction of in-person consultations by 50% without compromising pregnancy outcomes. This care model can help to minimise in-person interactions during the COVID-19 pandemic, but should also be considered in post-pandemic health-care models. FUNDING None.
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Affiliation(s)
- Kirsten R Palmer
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - Michael Tanner
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | | | - Andrea Rindt
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Kerrie Papacostas
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Michelle L Giles
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Kate Brown
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Helen Diamandis
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Rebecca Fradkin
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Alice E Stewart
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia
| | - Daniel L Rolnik
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Andrew Stripp
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia; Monash Health, Clayton, VIC, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Safer Care Victoria, Melbourne, VIC, Australia
| | - Ben W Mol
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Ryan J Hodges
- Monash Women's and Newborn, Monash Health, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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23
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Zhu D, Fang H, Kusuma GD, Schwab R, Barabadi M, Chan ST, McDonald H, Leong CM, Wallace EM, Greening DW, Lim R. Impact of chemically defined culture media formulations on extracellular vesicle production by amniotic epithelial cells. Proteomics 2021; 21:e2000080. [PMID: 34081834 DOI: 10.1002/pmic.202000080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023]
Abstract
The therapeutic properties of cell derived extracellular vesicles (EVs) make them promising cell-free alternative to regenerative medicine. However, clinical translation of this technology relies on the ability to manufacture EVs in a scalable, reproducible, and cGMP-compliant manner. To generate EVs in sufficient quantity, a critical step is the selection and development of culture media, where differences in formulation may influence the EV manufacturing process. In this study, we used human amniotic epithelial cells (hAECs) as a model system to explore the effect of different formulations of chemically defined, commercially sourced media on EV production. Here, we determined that cell viability and proliferation rate are not reliable quality indicators for EV manufacturing. The levels of tetraspanins and epitope makers of EVs were significantly impacted by culture media formulations. Mass spectrometry-based proteomic profiling revealed proteome composition of hAEC-EVs and the influence of media formulations on composition of EV proteome. This study has revealed critical aspects including cell viability and proliferation rate, EV yield, and tetraspanins, surface epitopes and proteome composition of EVs influenced by media formulations, and further insight into standardised EV production culture media that should be considered in clinical-grade scalable EV manufacture for generation of therapeutic EVs.
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Affiliation(s)
- Dandan Zhu
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Haoyun Fang
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Gina D Kusuma
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Renate Schwab
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Mehri Barabadi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Siow Teng Chan
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Hannah McDonald
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Cheng Mee Leong
- Thermo Fisher Scientific Australia Pty Ltd, Scoresby, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - David W Greening
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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24
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Stenning FJ, Polglase GR, te Pas AB, Crossley KJ, Kluckow M, Gill AW, Wallace EM, McGillick EV, Binder C, Blank DA, Roberts C, Hooper SB. Effect of maternal oxytocin on umbilical venous and arterial blood flows during physiological-based cord clamping in preterm lambs. PLoS One 2021; 16:e0253306. [PMID: 34138957 PMCID: PMC8211207 DOI: 10.1371/journal.pone.0253306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 06/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Delayed umbilical cord clamping (UCC) after birth is thought to cause placental to infant blood transfusion, but the mechanisms are unknown. It has been suggested that uterine contractions force blood out of the placenta and into the infant during delayed cord clamping. We have investigated the effect of uterine contractions, induced by maternal oxytocin administration, on umbilical artery (UA) and venous (UV) blood flows before and after ventilation onset to determine whether uterine contractions cause placental transfusion in preterm lambs. METHODS AND FINDINGS At ~128 days of gestation, UA and UV blood flows, pulmonary arterial blood flow (PBF) and carotid arterial (CA) pressures and blood flows were measured in three groups of fetal sheep during delayed UCC; maternal oxytocin following mifepristone, mifepristone alone, and saline controls. Each successive uterine contraction significantly (p<0.05) decreased UV (26.2±6.0 to 14.1±4.5 mL.min-1.kg-1) and UA (41.2±6.3 to 20.7 ± 4.0 mL.min-1.kg-1) flows and increased CA pressure and flow (47.1±3.4 to 52.8±3.5 mmHg and 29.4±2.6 to 37.3±3.4 mL.min-1.kg-1). These flows and pressures were partially restored between contractions, but did not return to pre-oxytocin administration levels. Ventilation onset during DCC increased the effects of uterine contractions on UA and UV flows, with retrograde UA flow (away from the placenta) commonly occurring during diastole. CONCLUSIONS We found no evidence that amplification of uterine contractions with oxytocin increase placental transfusion during DCC. Instead they decreased both UA and UV flow and caused a net loss of blood from the lamb. Uterine contractions did, however, have significant cardiovascular effects and reduced systemic and cerebral oxygenation.
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Affiliation(s)
- Fiona J. Stenning
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Graeme R. Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Arjan B. te Pas
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kelly J. Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Martin Kluckow
- Department of Neonatalogy, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Andrew W. Gill
- Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Erin V. McGillick
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Corinna Binder
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Douglas A. Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Newborn Research, The Royal Women’s Hospital, Melbourne, Australia
| | - Calum Roberts
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Stuart B. Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- * E-mail:
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25
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Selvaratnam RJ, Wallace EM, Treleaven S, Hooper SB, Davis PG, Davey MA. Does detection of fetal growth restriction improve neonatal outcomes? J Paediatr Child Health 2021; 57:677-683. [PMID: 33314475 DOI: 10.1111/jpc.15310] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
AIM Timely delivery of fetal growth restriction (FGR) is a balance between avoiding stillbirth and minimising prematurity. We sought to assess the neonatal outcomes for babies suspected of FGR, both true and false positives. METHODS This population cohort study examined all singleton births in Victoria, Australia from 2000 to 2017 (n = 1 231 415). Neonatal morbidities associated with neonatal intensive care unit (NICU) admission were assessed for babies born ≥32 weeks' with severe FGR (<3rd centile) and babies with birthweight ≥10th centile who were iatrogenically delivered for suspected FGR. RESULTS Babies with severe FGR iatrogenically delivered for suspected FGR were more likely to require NICU admission than babies with severe FGR who were not detected (3.0% vs. 1.1%, P < 0.001). After adjusting for potential confounders, the odds of NICU admission were increased (adjusted odds ratio (aOR) = 3.00, 95% confidence interval = 2.45-3.67; P < 0.001). Rates of NICU admission were also higher in ≥10th centile babies iatrogenically delivered for suspected FGR than for ≥10th centile babies who entered labour spontaneously (1.8% vs. 0.5%, P < 0.001). After adjustments, the odds of NICU admission were increased (aOR = 3.91, 95% confidence interval = 3.40-4.49; P < 0.001). NICU admissions were associated with morbidities related to iatrogenic prematurity. CONCLUSIONS Detection and planned delivery of FGR reduces stillbirth but may be associated with increased neonatal morbidity related to iatrogenic prematurity.
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Affiliation(s)
- Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - Sophie Treleaven
- Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
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26
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Selvaratnam RJ, Wallace EM, Hunt RW, Davey MA. Preventing harm: A balance measure for improving the detection of fetal growth restriction. Aust N Z J Obstet Gynaecol 2021; 61:715-721. [PMID: 33772758 DOI: 10.1111/ajo.13340] [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] [Received: 10/29/2020] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increasing the detection of fetal growth restriction (FGR), while reducing stillbirth, also leads to unnecessary early intervention, and associated morbidity, for normally grown babies who are incorrectly suspected of FGR. AIMS We sought to design a balance measure that addresses the specificity of FGR detection. METHODS A retrospective cohort study on all singleton births ≥32 weeks gestation in 2016 and 2017 in Victoria. We compared two balance measures for the detection of FGR, defined as the proportion of all babies iatrogenically delivered before 39 weeks gestation for suspected FGR that had a birthweight ≥10th centile (balance measure 1) or ≥25th centile (balance measure 2). Hospital level performance on each balance measure was derived and compared to an existing performance measure for severe FGR detection in Victoria. RESULTS Of the 38 hospitals analysed, 12 (32%) had a favourable performance on an existing indicator of FGR detection, seven (18%) hospitals had a favourable performance on balance measure 1, and 15 (39%) had a favourable performance on balance measure 2. There was a moderate correlation between hospital performance on the existing indicator and on balance measure 1 (r = 0.447, P = 0.005) but not balance measure 2 (r = -0.063, P = 0.71). There was no difference in perinatal mortality between high performing hospitals and low performing hospitals. CONCLUSION Introducing a balance measure into routine reporting may bring greater awareness to the unintended harm associated with increased detection of FGR.
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Affiliation(s)
- Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - Rodney W Hunt
- Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Neonatal Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Newborn, Monash Health, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
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27
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Schwab RHM, Goonetilleke M, Zhu D, Kusuma GD, Wallace EM, Sievert W, Lim R. Amnion Epithelial Cells — a Therapeutic Source. Curr Stem Cell Rep 2021. [DOI: 10.1007/s40778-021-00187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Langston-Cox A, Marshall SA, Lu D, Palmer KR, Wallace EM. Melatonin for the Management of Preeclampsia: A Review. Antioxidants (Basel) 2021; 10:antiox10030376. [PMID: 33802558 PMCID: PMC8002171 DOI: 10.3390/antiox10030376] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/11/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Preeclampsia is a disease specific to pregnancy characterised by new-onset hypertension with maternal organ dysfunction and/or fetal growth restriction. It remains a major cause of maternal and perinatal morbidity and mortality. For sixty years, antihypertensives have been the mainstay of treating preeclampsia and only recently have insights into the pathogenesis of the disease opened new avenues for novel therapies. Melatonin is one such option, an endogenous and safe antioxidant, that may improve the maternal condition in preeclampsia while protecting the fetus from a hostile intrauterine environment. Here we review the evidence for melatonin as a possible adjuvant therapy for preeclampsia, including in vitro evidence supporting a role for melatonin in protecting the human placenta, preclinical models, vascular studies, and clinical studies in hypertension and pregnancy.
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Affiliation(s)
- Annie Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
| | - Sarah A. Marshall
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
| | - Daisy Lu
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
| | - Kirsten R. Palmer
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
- Monash Health, Clayton, VIC 3168, Australia
| | - Euan M. Wallace
- The Ritchie Centre, Department of Obstetrics and Gynecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia; (A.L.-C.); (S.A.M.); (D.L.); (K.R.P.)
- Correspondence: ; Tel.: +61-3-9594-5145; Fax: +61-3-9594-5003
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Selvaratnam RJ, Rolnik DL, Davey MA, Wallace EM. Stillbirth: are we making more progress than we think? A retrospective cohort study. BJOG 2021; 128:1304-1312. [PMID: 33539656 DOI: 10.1111/1471-0528.16665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify how the changing stillbirth risk profile of women is affecting the interpretation of the stillbirth rate. DESIGN A retrospective, population-based cohort study from 1983 to 2018. SETTING Victoria, Australia. POPULATION A total of 2 419 923 births at ≥28 weeks of gestation. METHODS Changes in maternal characteristics over time were assessed. A multivariable logistic regression model was developed for stillbirth, based on maternal characteristics in 1983-1987, and used to calculate individual predictive probabilities of stillbirth from the regression equation. The number of expected stillbirths per year as a result of the change in maternal demographics was then calculated, assuming no changes in care and in the associations between maternal characteristics and stillbirth over time. MAIN OUTCOME MEASURE Stillbirth. RESULTS Compared with 1983-1987, there were more women in older age groups giving birth, more nulliparous women, more indigenous women and women born in Oceania, Asia and Africa, more multiple pregnancies and more women with pre-existing diabetes in 2014-2018. Despite this, the rate of stillbirth fell from 5.42 per 1000 births in 1983 to 1.72 per 1000 births in 2018 (P < 0.001). Applying the multivariable logistic regression equation, derived from the 1983-87 data, to each year, had there been no changes in care or in the associations between maternal characteristics and stillbirth, the rate of stillbirth would have increased by 12%, from 4.94 per 1000 in 1983 to 5.54 per 1000 in 2018, as a result of the change in maternal characteristics. CONCLUSIONS Population rates of stillbirth are falling faster than is generally appreciated. TWEETABLE ABSTRACT Population reductions in stillbirth have been underestimated as a result of changing maternal characteristics.
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Affiliation(s)
- R J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - D L Rolnik
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - M-A Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Health and Human Services, Victorian Government, Victoria, Australia
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Matheson A, McGannon CJ, Malhotra A, Palmer KR, Stewart AE, Wallace EM, Mol BW, Hodges RJ, Rolnik DL. Prematurity Rates During the Coronavirus Disease 2019 (COVID-19) Pandemic Lockdown in Melbourne, Australia. Obstet Gynecol 2021; 137:405-407. [PMID: 33543904 PMCID: PMC7884082 DOI: 10.1097/aog.0000000000004236] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 10/19/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/02/2022]
Abstract
Low rates of preterm birth were observed during the coronavirus disease 2019 (COVID-19) lockdown in Melbourne, Australia.
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Affiliation(s)
- Alexia Matheson
- Department of Obstetrics and Gynaecology, Women's and Newborn, Monash Health, Monash Newborn, Monash Children's Hospital, the Departments of Paediatrics and Obstetrics and Gynaecology, Monash University, and Safer Care Victoria, Melbourne, Australia
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Burger RJ, Temmink JD, Wertaschnigg D, Ganzevoort W, Reddy M, Davey MA, Wallace EM, Mol BW. Trends in singleton preterm birth in Victoria, 2007 to 2017: A consecutive cross-sectional study. Acta Obstet Gynecol Scand 2021; 100:1230-1238. [PMID: 33382080 PMCID: PMC8359202 DOI: 10.1111/aogs.14074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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: 11/01/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 01/01/2023]
Abstract
Introduction Preterm birth is a major cause of perinatal morbidity and mortality worldwide. In many countries preterm birth rates are increasing, largely as a result of increases in iatrogenic preterm birth, whereas in other countries rates are stable or even declining. The objective of the study is to describe trends in singleton preterm births in Victoria from 2007 to 2017 in relation to trends in perinatal mortality to identify opportunities for improvements in clinical care. Material and methods We conducted a consecutive cross‐sectional study in all women with a singleton pregnancy giving birth at ≥20 weeks of pregnancy in Victoria, Australia, between 2007 and 2017, inclusive. Rates of preterm birth and perinatal mortality were calculated and trends were analyzed in all pregnancies, in pregnancies complicated by fetal growth problems, hypertension, (pre)eclampsia or prelabor rupture of membranes (PROM), and in (low‐risk) pregnancies not complicated by any of these conditions. Results There were 811 534 singleton births between 2007 and 2017. Preterm birth increased from 5.9% (4074 births) to 6.4% (4893 births; P < .001), due to an increase in iatrogenic preterm birth from 2.5% (1730 births) to 3.6% (2730 births; P < .001). Comparable trends were seen in pregnancies complicated by fetal growth problems and hypertension and in pregnancies not complicated by small for gestational age (SGA), hypertension, (pre)eclampsia or PROM (all P < .001). In pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM the perinatal mortality rate from 20 weeks of gestation fell (13 to 12 per 1000 births; P < .001). In pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM there was no significant change in the perinatal mortality from 28 weeks and no decrease in the preterm weekly prospective stillbirth risk. Conclusions The singleton preterm birth rate in Victoria is increasing, driven by an increase in iatrogenic preterm birth, both in pregnancies complicated by SGA and hypertension, and in pregnancies not complicated by SGA, hypertension, (pre)eclampsia or PROM. While perinatal mortality decreased in the pregnancies complicated by SGA, hypertension, (pre)eclampsia or PROM, no significant reduction in perinatal mortality from 28 weeks or in preterm weekly prospective stillbirth risk was noted in the pregnancies not complicated by any of these conditions.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Josephina D Temmink
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Dagmar Wertaschnigg
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Wessel Ganzevoort
- Reproduction and Development Research Institute, Department of Obstetrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maya Reddy
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia.,Safer Care Victoria, Melbourne, VIC, Australia
| | - Ben-Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
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Reddy M, Fenn S, Rolnik DL, Mol BW, da Silva Costa F, Wallace EM, Palmer KR. The impact of the definition of preeclampsia on disease diagnosis and outcomes: a retrospective cohort study. Am J Obstet Gynecol 2021; 224:217.e1-217.e11. [PMID: 32795430 DOI: 10.1016/j.ajog.2020.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The diagnostic criteria for preeclampsia have evolved from the traditional definition of de novo hypertension and proteinuria to a broader definition of hypertension with evidence of end-organ dysfunction. Although this change is endorsed by various societies such as the International Society for the Study of Hypertension in Pregnancy and the American College of Obstetricians and Gynecologists, there remains controversy with regard to the implementation of broader definitions and the most appropriate definition of end-organ dysfunction. OBJECTIVE This study aimed to assess the impact of different diagnostic criteria for preeclampsia on rates of disease diagnosis, disease severity, and adverse outcomes and to identify associations between each component of the different diagnostic criteria and adverse pregnancy outcomes. STUDY DESIGN We performed a retrospective cohort study of singleton pregnancies at Monash Health between January 1, 2016 and July 31, 2018. Within this population, all cases of gestational hypertension and preeclampsia were reclassified according to the International Society for the Study of Hypertension in Pregnancy 2001, American College of Obstetricians and Gynecologists 2018, and International Society for the Study of Hypertension in Pregnancy 2018 criteria. Differences in incidence of preeclampsia and maternal and perinatal outcomes were compared between the International Society for the Study of Hypertension in Pregnancy 2001 group and the extra cases identified by American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018. Outcomes assessed included biochemical markers of preeclampsia, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes. Multiple logistic regression analysis was also performed to assess each component of the American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018 criteria and their associations with adverse maternal and perinatal outcomes. RESULTS Of 22,094 pregnancies, 751 (3.4%) women had preeclampsia as defined by any of the 3 criteria. Compared with International Society for the Study of Hypertension in Pregnancy 2001, the American College of Obstetricians and Gynecologists 2018 criteria identified an extra 42 women (n=654 vs n=696, 6.4% relative increase) with preeclampsia, and International Society for the Study of Hypertension in Pregnancy 2018 identified an extra 97 women (n=654 vs n=751, 14.8% relative increase). The additional women identified by International Society for the Study of Hypertension in Pregnancy 2018 exhibited a milder form of disease with lower rates of severe hypertension (62.4% vs 44.3%; P<.01) and magnesium sulfate use (11.9% vs 4.1%; P<.05) and a trend toward lower rates of adverse maternal outcomes (9.8% vs 4.1%). These women also delivered at a later gestation, and their babies had a lower number of neonatal intensive care unit admissions and adverse perinatal outcomes. Objective features such as fetal growth restriction, thrombocytopenia, renal and liver impairment, and proteinuria were associated with an increased risk of adverse maternal and perinatal outcomes, whereas subjective neurologic features demonstrated poorer associations. CONCLUSION Implementation of broader definitions of preeclampsia will result in an increased incidence of disease diagnosis. However, because women who exclusively fulfill the new criteria have a milder phenotype of the disease, it remains uncertain whether this will translate to improved outcomes.
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Selvaratnam RJ, Davey MA, Hudson RM, Farrell T, Wallace EM. Improving maternity care in Victoria: An accidental learning healthcare system. Aust N Z J Obstet Gynaecol 2021; 61:165-168. [PMID: 33523472 DOI: 10.1111/ajo.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Health and Human Services, Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Health and Human Services, Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
| | - Robyn M Hudson
- Department of Health and Human Services, Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
| | - Tanya Farrell
- Department of Health and Human Services, Safer Care Victoria, Victorian Government, Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Department of Health and Human Services, Victorian Government, Melbourne, Victoria, Australia
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Sharlov R, Taniar D, Phan T, Beare R, Srikanth V, Ma H, Farrell T, White C, Wallace EM, Davies-Tuck M. Where do low risk women live relative to maternity services across Victoria? Expanding access to public homebirth models across Victoria. Women Birth 2021; 35:e91-e97. [PMID: 33451928 DOI: 10.1016/j.wombi.2021.01.004] [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] [Received: 10/02/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
PROBLEM Currently <1% of Australian women give birth at home. BACKGROUND In Australia there are very few options for women to access public funded homebirth. AIM We aimed to use geo-mapping to identify the number of women eligible for homebirth in Victoria, based on the criteria of uncomplicated pregnancies and residing within 15-25kms of suitable maternity services, to plan future maternity care options. METHODS Retrospective study of births between 2015 and 2017 in Victoria, Australia. All women who were identified as having a low risk pregnancy at the beginning of pregnancy were included. The number of women within 15 and 25km of a suitable Victorian public maternity hospital and catchment boundaries around each hospital were determined. FINDINGS Between 2015 and 2017, 126,830 low risk women gave birth in Victoria, of whom half live within 25km of seven Victorian hospitals. Currently, 2% of suitable women who live close to the current public homebirth models accessed them. DISCUSSION We present a method to inform the expansion of maternity service options using Victoria as an example. On the basis of the maximum number of low risk women living close by, we have also identified the Victorian maternity services that would be most suitable for creation of public homebirth or low risk continuity of midwifery models. CONCLUSION This approach could can be used to plan other maternity care services.
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Affiliation(s)
- Rodion Sharlov
- Faculty of Information Technology, Monash University, Australia
| | - David Taniar
- Faculty of Information Technology, Monash University, Australia
| | - Thanh Phan
- Department of Neurology, Monash Health, Australia; Faculty of Medicine, Monash University, Australia
| | - Richard Beare
- Faculty of Medicine, Monash University, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Velandai Srikanth
- Academic Unit, Peninsula Health, Frankston, Melbourne, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Henry Ma
- Department of Neurology, Monash Health, Australia
| | | | | | - Euan M Wallace
- Safer Care Victoria, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Miranda Davies-Tuck
- Safer Care Victoria, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
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Langston-Cox AG, Anderson D, Creek DJ, Palmer KR, Marshall SA, Wallace EM. Sulforaphane Bioavailability and Effects on Blood Pressure in Women with Pregnancy Hypertension. Reprod Sci 2021; 28:1489-1497. [PMID: 33409874 DOI: 10.1007/s43032-020-00439-5] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/13/2020] [Indexed: 12/18/2022]
Abstract
Sulforaphane, an isothiocyanate found in cruciferous vegetables such as broccoli, shows promise as an adjuvant therapy for preeclampsia. To inform future clinical trials, we set out to determine the bioavailability of sulforaphane in non-pregnant and preeclamptic women. In six healthy female volunteers, we performed a crossover trial to compare the bioavailability of sulforaphane and metabolites afforded by an activated and non-activated broccoli extract preparation. We then undertook a dose escalation study of the activated broccoli extract in 12 women with pregnancy hypertension. In non-pregnant women, an equivalent dose of activated broccoli extract gave higher levels of sulforaphane and metabolites than a non-activated extract (p < 0.0001) and greater area under the curve (AUC) (3559 nM vs. 2172 nM, p = 0.03). Compared to non-pregnant women, in women with preeclampsia, the same dose of activated extract gave lower levels of total metabolites (p < 0.000) and AUC (3559 nM vs. 1653 nM, p = 0.007). Doubling the dose of the activated extract in women with preeclampsia doubled levels of sulforaphane and metabolites (p = 0.02) and AUC (1653 nM vs. 3333 nM, p = 0.02). In women with preeclampsia, activated broccoli extract was associated with modest decreases in diastolic blood pressure (p = 0.05) and circulating levels of sFlt-1 (p = 0.0002). A myrosinase-activated sulforaphane formulation affords better sulforaphane bioavailability than a non-activated formulation. Higher doses of sulforaphane are required to achieve likely effective doses in pregnant women than in non-pregnant women. Sulforaphane may improve endothelial function and blood pressure in women with pregnancy hypertension.
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Affiliation(s)
- A G Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - D Anderson
- Monash Proteomics and Metabolomics Facility, Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - D J Creek
- Monash Proteomics and Metabolomics Facility, Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - K R Palmer
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - S A Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
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Baker EK, Wallace EM, Davis PG, Malhotra A, Jacobs SE, Hooper SB, Lim R. A protocol for cell therapy infusion in neonates. Stem Cells Transl Med 2021; 10:773-780. [PMID: 33405397 PMCID: PMC8046110 DOI: 10.1002/sctm.20-0281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/27/2020] [Revised: 11/05/2020] [Accepted: 11/29/2020] [Indexed: 01/22/2023] Open
Abstract
Cell therapies for neonatal morbidities are progressing to early phase clinical trials. However, protocols for intravenous (IV) delivery of cell therapies to infants have not been evaluated. It has been assumed the cell dose prescribed is the dose delivered. Early in our clinical trial of human amnion epithelial cells (hAECs), we observed cells settling in the syringe and IV tubing used to deliver the suspension. The effect on dose delivery was unknown. We aimed to quantify this observation and determine an optimal protocol for IV delivery of hAECs to extremely preterm infants. A standard pediatric infusion protocol was modeled in the laboratory. A syringe pump delivered the hAEC suspension over 60 minutes via a pediatric blood transfusion set (200‐μm filter and 2.2 mL IV line). The infusion protocol was varied by agitation methods, IV‐line volumes (0.2‐2.2 mL), albumin concentrations (2% vs 4%), and syringe orientations (horizontal vs vertical) to assess whether these variables influenced the dose delivered. The influence of flow rate (3‐15 mL/h) was assessed after other variables were optimized. The standard infusion protocol delivered 17.6% ± 9% of the intended hAEC dose. Increasing albumin concentration to 4%, positioning the syringe and IV line vertically, and decreasing IV‐line volume to 0.6 mL delivered 99.7% ± 13% of the intended hAEC dose. Flow rate did not affect dose delivery. Cell therapy infusion protocols must be considered. We describe the refinement of a cell infusion protocol that delivers intended cell doses and could form the basis of future neonatal cell delivery protocols.
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Affiliation(s)
- Elizabeth K Baker
- Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Atul Malhotra
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, Australia.,Department of Paediatrics, Monash University, Victoria, Australia
| | - Susan E Jacobs
- Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
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Andrews CJ, Ellwood DA, Gordon A, Middleton P, Homer CSE, Wallace EM, Nicholl MC, Marr C, Sketcher-Baker K, Weller M, Seeho SKM, Flenady VJ. Stillbirth in Australia 2: Working together to reduce stillbirth in Australia: The Safer Baby Bundle initiative. Women Birth 2020; 33:514-519. [PMID: 33092700 DOI: 10.1016/j.wombi.2020.09.006] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
The rate of late gestation stillbirth in Australia is unacceptably high. Up to one third of stillbirths are preventable, particularly beyond 28 weeks' gestation. The aim of this second paper in the Stillbirth in Australia series is to highlight one key national initiative, the Safer Baby Bundle (SBB), which has been led by the Centre of Research Excellence in Stillbirth in partnership with state health departments. Addressing commonly identified evidence practice gaps, the SBB contains five elements that, when implemented together, should result in better outcomes than if performed individually. This paper describes the development of the SBB, what the initiative aims to achieve, and progress to date. By collaborating with Departments of Health and other partners to amplify uptake of the SBB, we anticipate a reduction of at least 20% in Australia's stillbirth rate after 28 weeks' gestation is achievable.
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Affiliation(s)
- Christine J Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - David A Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Griffith University, School of Medicine and Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Adrienne Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Philippa Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Euan M Wallace
- Safer Care Victoria, Department of Health and Human Services, Melbourne, Victoria, Australia; The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Michael C Nicholl
- Women and Babies Research, University of Sydney, Sydney, NSW, Australia
| | - Carrie Marr
- Clinical Excellence Commission, Department of Health, Sydney, NSW, Australia
| | | | - Megan Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Sean K M Seeho
- Women and Babies Research, University of Sydney, Sydney, NSW, Australia
| | - Vicki J Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia.
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Ham S, Harrison C, de Kretser D, Wallace EM, Southwick G, Temple-Smith P. Potential treatment of keloid pathogenesis with follistatin 288 by blocking the activin molecular pathway. Exp Dermatol 2020; 30:402-408. [PMID: 33119185 DOI: 10.1111/exd.14223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
Keloids are benign tumours caused by abnormal wound healing driven by increased expression of cytokines, including activin A. This study compared effects of activins on normal and keloid-derived human dermal fibroblasts and investigated a novel treatment for keloids using follistatin. Normal skin and keloid tissue samples from 11 patients were used to develop primary fibroblast cultures, which were compared in terms of their histology and relevant gene (qRT-PCR and RNAseq) and protein (ELISA) expression. Activin A (INHBA) and connective tissue growth factor (CTGF) gene expression were significantly upregulated in keloid fibroblasts, as was activin A protein expression in cell lysates and culture medium. Activator protein 1 inhibitor (SR11302) significantly decreased INHBA and CTGF expression in keloid fibroblasts and a single treatment of follistatin over 5 days significantly inhibited activin and various matrix-related genes in keloid fibroblasts when compared to controls. Follistatin, by binding activin A, suppressed CTGF expression suggesting a novel therapeutic role in managing keloids and perhaps other fibrotic diseases.
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Affiliation(s)
- Seungmin Ham
- Departments of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Craig Harrison
- Departments of Physiology, Monash University, Melbourne, Victoria, Australia
| | - David de Kretser
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Departments of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
| | - Euan M Wallace
- Departments of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Graeme Southwick
- Departments of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Melbourne Institute of Plastic Surgery, Malvern, Victoria, Australia
| | - Peter Temple-Smith
- Departments of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Davidson JO, van den Heuij LG, Fraser M, Wassink G, Miller SL, Lim R, Wallace EM, Jenkin G, Gunn AJ, Bennet L. Window of opportunity for human amnion epithelial stem cells to attenuate astrogliosis after umbilical cord occlusion in preterm fetal sheep. Stem Cells Transl Med 2020; 10:427-440. [PMID: 33103374 PMCID: PMC7900589 DOI: 10.1002/sctm.20-0314] [Citation(s) in RCA: 13] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022] Open
Abstract
There is increasing evidence that administration of many types of stem cells, including human amnion epithelial cells (hAECs), can reduce hypoxic-ischemic injury, including in the perinatal brain. However, the therapeutic window for single dose treatment is not known. We compared the effects of early and delayed intracerebroventricular administration of hAECs in fetal sheep at 0.7 gestation on brain injury induced by 25 minutes of complete umbilical cord occlusion (UCO) or sham occlusion. Fetuses received either 1 × 106 hAECs or vehicle alone, as an infusion over 1 hour, either 2 or 24 hours after UCO. Fetuses were killed for brain histology at 7 days post-UCO. hAEC infusion at both 2 and 24 hours had dramatic anti-inflammatory and anti-gliotic effects, including significantly attenuating the increase in microglia after UCO in the white and gray matter and the number of astrocytes in the white matter. Both protocols partially improved myelination, but had no effect on total or immature/mature numbers of oligodendrocytes. Neuronal survival in the hippocampus was increased by hAEC infusion at either 2 or 24 hours, whereas only hAECs at 24 hours were associated with improved neuronal survival in the striatum and thalamus. Neither protocol improved recovery of electroencephalographic (EEG) power. These data suggest that a single infusion of hAECs is anti-inflammatory, anti-gliotic, and neuroprotective in preterm fetal sheep when given up to 24 hours after hypoxia-ischemia, but was associated with limited white matter protection after 7 days recovery and no improvement in the recovery of EEG power.
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Affiliation(s)
- Joanne O Davidson
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Lotte G van den Heuij
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Mhoyra Fraser
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Guido Wassink
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Alistair J Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
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Langston-Cox A, Leo CH, Tare M, Wallace EM, Marshall SA. Sulforaphane improves vascular reactivity in mouse and human arteries after "preeclamptic-like" injury. Placenta 2020; 101:242-250. [PMID: 33032098 DOI: 10.1016/j.placenta.2020.09.001] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The widespread maternal endothelial dysfunction that underlies the manifestations of preeclampsia is thought to arise from excessive placental production of antiangiogenic factors and enhanced oxidative stress. Therefore, we assessed whether the natural antioxidant sulforaphane could improve vascular function. METHODS Cell viability of human umbilical vein endothelial cells (HUVECs) was assessed after 24 or 48 h in normoxia (20% O2) or hypoxia (1% O2) with or without sulforaphane. To model vascular dysfunction associated with preeclampsia, mouse mesenteric arteries were incubated in trophoblast conditioned media (TCM), and human omental arteries incubated in preeclamptic explant media (PEM) with or without sulforaphane. Both media are rich in antiangiogenic compounds associated with preeclampsia. TCM was generated from primary cytotrophoblast cells from term placentae of normotensive, while PEM was generated from explants from preeclamptic women. Reactivity was assessed by wire myography. sulforaphane's actions as a vasodilator were also investigated. RESULTS Under conditions of hypoxia, sulforaphane improved HUVEC viability. In mouse mesenteric arteries, sulforaphane reduced contraction evoked by potassium (p < 0.001), phenylephrine and endothelin 1 (all p < 0.001). Sulforaphane also inhibited Ca2+-induced contraction (p = 0.014). Sulforaphane prevented TCM-induced augmentation of phenylephrine and angiotensin II-mediated contraction of mouse mesenteric arteries. In human omental arteries, sulforaphane induced vasodilation (p < 0.001), and prevented PEM-induced endothelial dysfunction by restoring arterial sensitivity to the endothelium-dependent vasodilator bradykinin (p = 0.008). DISCUSSION Sulforaphane causes relaxation in arteries and protects against arterial dysfunction induced by placental-derived antiangiogenic factors, which are known to contribute to the preeclampsia.
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Affiliation(s)
- A Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - C H Leo
- Science, Mathematics and Technology, Singapore University of Technology & Design, Singapore
| | - M Tare
- Monash Rural Health, Monash University, Churchill, VIC, 3842, Australia; Department of Physiology, Monash University, Clayton, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - S A Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
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Baker EK, Jacobs SE, Lim R, Wallace EM, Davis PG. Cell therapy for the preterm infant: promise and practicalities. Arch Dis Child Fetal Neonatal Ed 2020; 105:563-568. [PMID: 32253200 DOI: 10.1136/archdischild-2019-317896] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023]
Abstract
Recent decades have seen the rapid progress of neonatal intensive care, and the survival rates of the most preterm infants are improving. This improvement is associated with changing patterns of morbidity and new phenotypes of bronchopulmonary dysplasia and preterm brain injury are recognised. Inflammation and immaturity are known contributors to their pathogenesis. However, a new phenomenon, the exhaustion of progenitor cells is emerging as an important factor. Current therapeutic approaches do not adequately address these new mechanisms of injury. Cell therapy, that is the use of stem and stem-like cells, with its potential to both repair and prevent injury, offers a new approach to these challenging conditions. This review will examine the rationale for cell therapy in the extremely preterm infant, the preclinical and early clinical evidence to support its use in bronchopulmonary dysplasia and preterm brain injury. Finally, it will address the challenges in translating cell therapy from the laboratory to early clinical trials.
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Affiliation(s)
- Elizabeth K Baker
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia .,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan E Jacobs
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Lim
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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Langston-Cox A, Muccini AM, Marshall SA, Yap Y, Palmer KR, Wallace EM, Ellery SJ. Corrigendum to "Sulforaphane improves syncytiotrophoblast mitochondrial function after in vitro hypoxic and superoxide injury" [Placenta 96 (2020) 44-54]. Placenta 2020; 101:261. [PMID: 32843242 DOI: 10.1016/j.placenta.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - A M Muccini
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - S A Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Y Yap
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - K R Palmer
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Monash Women's, Monash Health, Clayton, VIC, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - S J Ellery
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
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Davies-Tuck M, Ruzic M, Davey MA, Hodges R, Nowotny B, Flenady V, Andrews C, Wallace EM. Understanding staff views and experiences of a clinical practice change to reduce stillbirth in South Asian women: A cross-sectional survey. Women Birth 2020; 34:e390-e395. [PMID: 32828713 DOI: 10.1016/j.wombi.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In July 2017, Victoria's largest maternity service implemented a new clinical practice guideline to reduce the rates of term stillbirth in women of South Asian background. AIM To capture the views and experiences of clinical staff following the implementation of the new clinical guideline. METHODS Cross sectional survey of clinical staff providing maternity care in August 2018, 12 months post implementation. Staff were asked to provide their agreement with ten statements assessing: perceived need for the guideline, implementation processes, guideline clarity, and clinical application. Open-ended questions provided opportunities to express concerns and offer suggestions for improvement. The frequency of responses to each question were tabulated. Open ended responses were grouped together to identify themes. FINDINGS A total of 120 staff completed the survey, most (n=89, 74%) of whom were midwives. Most staff thought the rationale (n=95, 79%), the criteria for whom they applied (83%, n=99), and the procedures and instructions within the guideline were clear (74%, n=89). Staff reported an increase in workload (72%, n=86) and expressed concerns related to rationale and evaluation of the guidelines, lack of education for both staff and pregnant South Asian women, increased workload and insufficient resources, patient safety and access to care. Challenges relating to shared decision making and communicating with women whose first language is not English were also identified. DISCUSSION This study has identified key barriers to and opportunities for improving implementation and highlighted additional challenges relating to new clinical guidelines which focus on culturally and linguistically diverse women.
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Affiliation(s)
- Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
| | - Mikayla Ruzic
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Ryan Hodges
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Benjamin Nowotny
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; Safer Care Victoria, Melbourne, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; Safer Care Victoria, Melbourne, Australia
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Ellery SJ, Murthi P, Davies-Tuck ML, Della Gatta PA, May AK, Kowalski GM, Callahan DL, Bruce CR, Alers NO, Miller SL, Erwich JJHM, Wallace EM, Walker DW, Dickinson H, Snow RJ. Placental creatine metabolism in cases of placental insufficiency and reduced fetal growth. Mol Hum Reprod 2020; 25:495-505. [PMID: 31323678 DOI: 10.1093/molehr/gaz039] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/16/2019] [Accepted: 06/27/2019] [Indexed: 11/14/2022] Open
Abstract
Creatine is a metabolite involved in cellular energy homeostasis. In this study, we examined placental creatine content, and expression of the enzymes required for creatine synthesis, transport and the creatine kinase reaction, in pregnancies complicated by low birthweight. We studied first trimester chorionic villus biopsies (CVBs) of small for gestational age (SGA) and appropriately grown infants (AGA), along with third trimester placental samples from fetal growth restricted (FGR) and healthy gestation-matched controls. Placental creatine and creatine precursor (guanidinoacetate-GAA) levels were measured. Maternal and cord serum from control and FGR pregnancies were also analyzed for creatine concentration. mRNA expression of the creatine transporter (SLC6A8); synthesizing enzymes arginine:glycine aminotransferase (GATM) and guanidinoacetate methyltransferase (GAMT); mitochondrial (mtCK) and cytosolic (BBCK) creatine kinases; and amino acid transporters (SLC7A1 & SLC7A2) was assessed in both CVBs and placental samples. Protein levels of AGAT (arginine:glycine aminotransferase), GAMT, mtCK and BBCK were also measured in placental samples. Key findings; total creatine content of the third trimester FGR placentae was 43% higher than controls. The increased creatine content of placental tissue was not reflected in maternal or fetal serum from FGR pregnancies. Tissue concentrations of GAA were lower in the third trimester FGR placentae compared to controls, with lower GATM and GAMT mRNA expression also observed. No differences in the mRNA expression of GATM, GAMT or SLC6A8 were observed between CVBs from SGA and AGA pregnancies. These results suggest placental creatine metabolism in FGR pregnancies is altered in late gestation. The relevance of these changes on placental bioenergetics should be the focus of future investigations.
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Affiliation(s)
- Stacey J Ellery
- The Ritchie Centre, Hudson Institute of Medical Research, and Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Padma Murthi
- Department of Physiology, Monash University, Clayton, Victoria; Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Miranda L Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, and Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Paul A Della Gatta
- Institute for Physical Activity and Nutrition, School of Exercise Sciences, Deakin, Geelong, Australia
| | - Anthony K May
- Institute for Physical Activity and Nutrition, School of Exercise Sciences, Deakin, Geelong, Australia
| | - Greg M Kowalski
- Institute for Physical Activity and Nutrition, School of Exercise Sciences, Deakin, Geelong, Australia
| | - Damien L Callahan
- Centre for Cellular and Molecular Biology, School of Life and Environmental Science, Deakin University, Burwood, Melbourne, Australia
| | - Clinton R Bruce
- Institute for Physical Activity and Nutrition, School of Exercise Sciences, Deakin, Geelong, Australia
| | - Nicole O Alers
- The Ritchie Centre, Hudson Institute of Medical Research, and Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, and Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Jan Jaap H M Erwich
- Dept of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Euan M Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, and Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - David W Walker
- School of Health & Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Hayley Dickinson
- The Ritchie Centre, Hudson Institute of Medical Research, and Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Rod J Snow
- Institute for Physical Activity and Nutrition, School of Exercise Sciences, Deakin, Geelong, Australia
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Affiliation(s)
| | | | - Euan M Wallace
- Monash University, Melbourne, VIC.,Safer Care Victoria, Melbourne, VIC
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Reddy M, Rolnik DL, Harris K, Li W, Mol BW, Da Silva Costa F, Wallace EM, Palmer K. Challenging the definition of hypertension in pregnancy: a retrospective cohort study. Am J Obstet Gynecol 2020; 222:606.e1-606.e21. [PMID: 31954700 DOI: 10.1016/j.ajog.2019.12.272] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 10/14/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In routine antenatal care, blood pressure is used as a screening tool for preeclampsia and its associated adverse outcomes. As such women with a blood pressure greater than 140/90 mm Hg undergo further investigation and closer follow-up, whereas those with lower blood pressures receive no additional care. In the nonpregnant setting, the American College of Cardiology now endorses lower hypertensive thresholds and it remains unclear whether these lower thresholds should also be considered in pregnancy. OBJECTIVE (1) To examine the association between lower blood pressure thresholds (as per the American College of Cardiology guidelines) and pregnancy outcomes and (2) to determine whether there is a continuous relationship between blood pressure and pregnancy outcomes and identify the point of a change at which blood pressure is associated with an increased risk of such outcomes. STUDY DESIGN This was a retrospective study of singleton pregnancies at Monash Health, Australia. Data were obtained with regards to maternal characteristics and blood pressure measurements at varying gestational ages. Blood pressures were then categorized as (1) mean arterial pressure and (2) normal, elevated, stage 1 and stage 2 hypertension, as per the American College of Cardiology guidelines. Multivariable regression analysis was performed to identify associations between blood pressure categories and pregnancy outcomes. RESULTS This study included 18,243 singleton pregnancies. We demonstrated a positive dose-response relationship between mean arterial pressure and the development of preeclampsia in later pregnancy. Across all gestational ages, the risk of preeclampsia was greater in those with "elevated blood pressure" and "stage 1 hypertension" in comparison with the normotensive group (adjusted risk ratio; 2.45, 95% confidence interval, 1.74-3.44 and adjusted risk ratio, 6.60; 95% confidence interval, 4.98-8.73 respectively, at 34-36 weeks' gestation). There was also an association between stage 1 hypertension, preterm birth, and adverse perinatal outcomes. CONCLUSION This study demonstrated that preeclampsia and the associated adverse outcomes are not exclusive to those with blood pressures greater than 140/90 mm Hg. As such, those with prehypertensive blood pressures may also benefit from closer monitoring. Further research is essential to determine whether lowering the blood pressure threshold in pregnancy would improve detection and outcomes.
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Affiliation(s)
- Maya Reddy
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia; Monash Women's, Monash Health, Melbourne, Victoria, Australia.
| | - Daniel Lorber Rolnik
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia; Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Katrina Harris
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Wentao Li
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Ben Willem Mol
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Fabricio Da Silva Costa
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia; Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Euan M Wallace
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Kirsten Palmer
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia; Monash Women's, Monash Health, Melbourne, Victoria, Australia
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Langston-Cox A, Muccini AM, Marshall SA, Yap, Palmer KR, Wallace EM, Ellery SJ. Sulforaphane improves syncytiotrophoblast mitochondrial function after in vitro hypoxic and superoxide injury. Placenta 2020; 96:44-54. [PMID: 32560857 DOI: 10.1016/j.placenta.2020.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/18/2019] [Revised: 04/22/2020] [Accepted: 05/10/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Placental mitochondrial dysfunction contributes to the oxidative stress that underlies preeclampsia. Here, we assessed whether sulforaphane (SFN) could improve syncytiotrophoblast mitochondrial function after in vitro hypoxic and superoxide injury. METHODS Placental cytotrophoblasts were isolated from healthy term placentae (n = 12) and incubated for 48 h in 8% O2 ± 1 μM SFN before acute (4hrs) or chronic (24hrs) hypoxic (1% O2), or superoxide (xanthine/xanthine oxidase) injury. Cytotrophoblasts were also isolated from preeclamptic placentae (n = 5) and cultured in 8% O2 ± 1 μM SFN. Mitochondrial respiration was measured using the Seahorse MitoStress XF assay. Cells were stained with mitotracker red to assess mitochondrial membrane health and mitochondrial gene expression assessed using RT-qPCR. RESULTS SFN prevented significant reductions in syncytiotrophoblast mitochondrial maximal respiration, spare respiratory capacity, basal respiration and ATP production following acute hypoxia. Chronic hypoxia only reduced maximal and spare respiratory capacity. SFN prevented these negative changes and increased respiration overall. Alternatively, acute superoxide injury significantly increased mitochondrial maximal respiration and spare respiratory capacity. SFN treatment further increased basal respiration following superoxide injury and prevented significant decreases in ATP production and coupling efficiency. In preeclamptic placentae, SFN significantly increased mitochondrial maximal respiration, spare respiratory capacity, basal respiration and ATP production, and decreased proton leak. SFN up-regulated mRNA expression of mitochondrial complexes and corrected an up-regulation in fission gene expression observed after hypoxic-superoxide injury. Finally, preliminary results suggest SFN prevented hypoxia-induced impairment of mitochondrial membrane structure. DISCUSSION SFN mitigated hypoxia and superoxide induced changes to syncytiotrophoblast mitochondrial function in vitro, and improved mitochondrial respiration in trophoblast cells from preeclamptic placentae.
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Affiliation(s)
- A Langston-Cox
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - A M Muccini
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - S A Marshall
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Yap
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - K R Palmer
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Monash Women's, Monash Health, Clayton, VIC, Australia
| | - E M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - S J Ellery
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia; Hudson Institute of Medical Research, Clayton, VIC, Australia
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Giles ML, Davey MA, Wallace EM. Chronic hepatitis B infection and the risk of gestational diabetes: a cross-sectional study. BJOG 2020; 127:1147-1152. [PMID: 32176400 DOI: 10.1111/1471-0528.16217] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE An estimated two billion people worldwide live with hepatitis B virus (HBV) infection. Many of these are women of reproductive age. Studies that have examined pregnancy outcomes in women living with HBV have reported conflicting results in relation to the incidence of gestational diabetes (GDM). The aim of this study is to examine if gestational diabetes is more common in women with chronic HBV residing in a non-Asian country. DESIGN Cross-sectional study. SETTING Victoria, Australia. POPULATION All singleton births between 2009 and 2017. METHODS Poisson regression was performed to determine whether gestational diabetes is more common in women with HBV than in women without HBV taking into account other risk factors such as maternal age, body mass index (BMI), parity and country of birth. MAIN OUTCOME MEASURE Gestational diabetes diagnosis in women with chronic HBV infection. RESULTS For women with HBV, the unadjusted incidence risk ratio for GDM was 1.75 (95% CI 1.6-1.9). After adjusting for region of birth, BMI, parity, age and smoking, the adjusted incidence risk ratio was 1.2 (95% CI 1.1-1.3). The highest incidence (37.1%) of GDM was in women with HBV and a BMI of >40. CONCLUSIONS The findings from this study confirm an association between HBV and GDM. TWEETABLE ABSTRACT HBV is associated with GDM with an incidence risk ratio for GDM of 1.75 (95% CI 1.6-1.9).
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Affiliation(s)
- M L Giles
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia.,Women's and Children's Health, Monash Health, Melbourne, Vic., Australia
| | - M-A Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Melbourne, Vic., Australia
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Selvaratnam RJ, Davey MA, Mol BW, Wallace EM. Increasing obstetric intervention for fetal growth restriction is shifting birthweight centiles: a retrospective cohort study. BJOG 2020; 127:1074-1080. [PMID: 32180311 DOI: 10.1111/1471-0528.16215] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of increasing obstetric intervention on birthweight centiles. DESIGN Retrospective cohort study of births in five 2-year epochs: 1983-84, 1993-94, 2003-2004, 2013-2014 and 2016-2017. POPULATION 665 205 singleton births at ≥32 weeks' gestation. SETTING All maternity services in Victoria, Australia. METHODS For each epoch, we calculated the birthweight cutoffs defining each birthweight centile at 34, 37 and 40 weeks' gestation. We calculated rates of iatrogenic delivery over time. We then calculated the number of babies whose birthweight would have classified them as ≥3rd centile based on 1983-84 centile definitions but as <3rd centile based on 2016-2017 centile definitions. MAIN OUTCOME MEASURES Birthweight centile, and gestation at delivery. RESULTS From 1983-84 to 2016-2017, the rate of iatrogenic delivery for singleton pregnancies increased at all term gestations: 1.6-6.4% at 37 weeks', 4.5-18.3% at 38 weeks', 7.6-23.9% at 39 weeks' and 18.4-25.1% at 40 weeks' (all P < 0.001). Over the same period, the birthweight cutoffs defining the 3rd, 5th and 10th centiles increased significantly at term, but not preterm, gestations. This led to increasing numbers of term births being classified as small for gestational age (SGA). Of the 2748 babies born in 2016-2017 at 37-39 weeks' gestation with a birthweight <3rd centile in that period, 1478 (53.8%) would have been classified as ≥3rd centile based on 1983-84 centile definitions. CONCLUSION Increasing intervention is shifting the birthweight cutoffs that define birthweight centiles and thereby redefining what constitutes SGA. This undermines the use of population-derived birthweight centiles to audit clinical care. TWEETABLE ABSTRACT Increasing obstetric intervention is shifting birthweight centiles and therefore definitions of normality.
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Affiliation(s)
- R J Selvaratnam
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
| | - M-A Davey
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Department of Health and Human Services, Victorian Government, Melbourne, Vic., Australia
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Rahman RA, Murthi P, Singh H, Gurungsinghe S, Leaw B, Mockler JC, Lim R, Wallace EM. Hydroxychloroquine Mitigates the Production of 8-Isoprostane and Improves Vascular Dysfunction: Implications for Treating Preeclampsia. Int J Mol Sci 2020; 21:ijms21072504. [PMID: 32260307 PMCID: PMC7177667 DOI: 10.3390/ijms21072504] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
In preeclampsia, widespread maternal endothelial dysfunction is often secondary to excessive generation of placental-derived anti-angiogenic factors, including soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), along with proinflammatory cytokines such as tumour necrosis factor-α (TNF-α) and activin A, understanding of which offers potential opportunities for the development of novel therapies. The antimalarial hydroxychloroquine is an anti-inflammatory drug improving endothelial homeostasis in lupus. It has not been explored as to whether it can improve placental and endothelial function in preeclampsia. In this in vitro study, term placental explants were used to assess the effects of hydroxychloroquine on placental production of sFlt-1, sEng, TNF-α, activin A, and 8-isoprostane after exposure to hypoxic injury or oxidative stress. Similarly, human umbilical vein endothelial cells (HUVECs) were used to assess the effects of hydroxychloroquine on in vitro markers of endothelial dysfunction. Hydroxychloroquine had no effect on the release of sFlt-1, sEng, TNF-α, activin A, or 8-isoprostane from placental explants exposed to hypoxic injury or oxidative stress. However, hydroxychloroquine mitigated TNF-α-induced HUVEC production of 8-isoprostane and Nicotinanamide adenine dinucleotide phosphate (NADPH) oxidase expression. Hydroxychloroquine also mitigated TNF-α and preeclamptic serum-induced HUVEC monolayer permeability and rescued the loss of zona occludens protein zona occludens 1 (ZO-1). Although hydroxychloroquine had no apparent effects on trophoblast function, it may be a useful endothelial protectant in women presenting with preeclampsia.
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Affiliation(s)
- Rahana Abd Rahman
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
- Department of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur 56000, Malaysia
- Correspondence: (R.A.R.); (P.M.); (E.M.W.)
| | - Padma Murthi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3052, Australia
- Correspondence: (R.A.R.); (P.M.); (E.M.W.)
| | - Harmeet Singh
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
| | - Seshini Gurungsinghe
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
| | - Bryan Leaw
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
| | - Joanne C. Mockler
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
| | - Rebecca Lim
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
| | - Euan M. Wallace
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
- Correspondence: (R.A.R.); (P.M.); (E.M.W.)
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