Journal articles on the topic 'Pregnancy Complications Australia'
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Taylor, Lee, Delyse Hutchinson, Ron Rapee, Lucy Burns, Christine Stephens, and Paul S. Haber. "Clinical Features and Correlates of Outcomes for High-Risk, Marginalized Mothers and Newborn Infants Engaged with a Specialist Perinatal and Family Drug Health Service." Obstetrics and Gynecology International 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/867265.
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Background. There is a paucity of research in Australia on the characteristics of women in treatment for illicit substance use in pregnancy and the health outcomes of their neonates.Aims. To determine the clinical features and outcomes of high-risk, marginalized women seeking treatment for illicit substance use in pregnancy and their neonates.Methods. 139 women with a history of substance abuse/dependence engaged with a perinatal drug health service in Sydney, Australia. Maternal (demographic, drug use, psychological, physical, obstetric, and antenatal care) and neonatal characteristics (delivery, early health outcomes) were examined.Results. Compared to national figures, pregnant women attending a specialist perinatal and family drug health service were more likely to report being Australian born, Aboriginal or Torres Strait Islander, younger, unemployed, and multiparous. Opiates were the primary drug of concern (81.3%). Pregnancy complications were common (61.9%). Neonates were more likely to be preterm, have low birth weight, and be admitted to special care nursery. NAS was the most prevalent birth complication (69.8%) and almost half required pharmacotherapy.Conclusion. Mother-infant dyads affected by substance use in pregnancy are at significant risk. There is a need to review clinical models of care and examine the longer-term impacts on infant development.
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Melody, Shannon M., Karen Wills, Luke D. Knibbs, Jane Ford, Alison Venn, and Fay Johnston. "Maternal Exposure to Ambient Air Pollution and Pregnancy Complications in Victoria, Australia." International Journal of Environmental Research and Public Health 17, no. 7 (April 9, 2020): 2572. http://dx.doi.org/10.3390/ijerph17072572.
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The relationship between maternal exposure to ambient air pollution and pregnancy complications is not well characterized. We aimed to explore the relationship between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM) and placental abruption. Using administrative data, we defined a state-wide cohort of singleton pregnancies born between 1 March 2012 and 31 December 2015 in Victoria, Australia. Annual average NO2 and PM2.5 was assigned to maternal residence at the time of birth. 285,594 singleton pregnancies were included. An IQR increase in NO2 (3.9 ppb) was associated with reduced likelihood of hypertensive disorders of pregnancy (RR 0.89; 95%CI 0.86, 0.91), GDM (RR 0.92; 95%CI 0.90, 0.94) and placental abruption (RR 0.81; 95%CI 0.69, 0.95). Mixed observations and smaller effect sizes were observed for IQR increases in PM2.5 (1.3 µg/m3) and pregnancy complications; reduced likelihood of hypertensive disorders of pregnancy (RR 0.95; 95%CI 0.93, 0.97), increased likelihood of GDM (RR 1.02; 95%CI 1.00, 1.03) and no relationship for placental abruption. In this exploratory study using an annual metric of exposure, findings were largely inconsistent with a priori expectations and further research involving temporally resolved exposure estimates are required.
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CHEN, CHIEN-YI, and MEI-HWEI CHANG. "HEPATITIS B AND PREGNANCY, THE SCIENTIFIC BASIS FOR PERINATAL PREVENTION." Fetal and Maternal Medicine Review 21, no. 2 (March 15, 2010): 89–113. http://dx.doi.org/10.1017/s0965539510000021.
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Hepatitis B and its complications are one of the major global health problems. Around 2 billion individuals are infected by hepatitis B virus (HBV) worldwide, more than 350 million are chronically infected, and approximately 15 to 40 percents of them will develop serious complications such as liver cirrhosis, hepatic failure, or hepatocellular carcinoma (HCC). The worldwide prevalence of chronic HBV infection ranges from 0.1 to 20 percent and varies widely in different geographic areas. According to the prevalence rate, WHO has classified countries into 3 levels: high areas (>8%) such as Africa, Asia, Western Pacific and Middle East; intermediate areas (2–8%) such as South America and Eastern Europe, and low areas (<2%) such as Western Europe, North America, and Australia.
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Nossent, Johannes, Warren Raymond, Helen Keen, Charles Inderjeeth, and David Preen. "Pregnancy outcomes in women with a history of immunoglobulin A vasculitis." Rheumatology 58, no. 5 (December 24, 2018): 884–88. http://dx.doi.org/10.1093/rheumatology/key408.
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Abstract Objectives Case series suggest an increased risk of pregnancy complications in women with a history of IgA vasculitis (IgAV); however, no large quantitative studies have examined this possible association to date. We compared pregnancy rates and outcomes between female IgAV patients and controls and assessed flare risk of IgAV during pregnancy. Methods Using state-wide hospital morbidity data we compared rates for live birth, preterm birth, abortive outcome and gestational complications between female IgAV patients (International Classification of Diseases-9-Clinical Modification 287.0; International Classification of Diseases-10-Australian Modification D69.0) (n = 121) and non-exposed age-matched controls (n = 284) in Western Australia. Results presented are means compared by Kruskal–Wallis test and proportions with odds ratios (ORs) (95% CI) compared by χ2 testing. Results There were 247 pregnancies in IgAV patients during which no disease flares were recorded and 556 pregnancies in controls. IgAV patients were younger at first pregnancy (24.7 vs 27.0 years, P < 0.01) and had 43 unsuccessful pregnancies (17.4%) and 204 live births with 17 preterm deliveries (8.3%). Women with IgAV had increased odds of spontaneous abortion (OR 1.9, 95% CI 1.1, 3.1, P = 0.04), preterm delivery (OR 2.0, 95% CI 1.1, 3.9, P = 0.02) and gestational hypertension (OR 4.7, 95% CI 2.3, 9.8). While gravidity did not differ (mean pregnancy number 2.4 vs 2.3, P = 0.36), IgAV patients had over a two-fold greater number of obstetric visits than controls (5.1 vs 2.5, P < 0.01). Conclusions Hospitalization for IgAV has little impact on fertility and IgAV rarely flares during pregnancy. However, a history of IgAV associates with increased odds of spontaneous abortions, gestational hypertension and preterm delivery.
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Gebremedhin, Amanuel Tesfay, Gizachew Assefa Tessema, Annette K. Regan, and Gavin F. Pereira. "Association between interpregnancy interval and pregnancy complications by history of complications: a population-based cohort study." BMJ Open 11, no. 12 (December 2021): e046962. http://dx.doi.org/10.1136/bmjopen-2020-046962.
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ObjectiveTo examine if the association between interpregnancy interval (IPI) and pregnancy complications varies by the presence or absence of previous complications.Design and settingPopulation-based longitudinally linked cohort study in Western Australia (WA).ParticipantsMothers who had their first two (n=252 368) and three (n=96 315) consecutive singleton births in WA between 1980 and 2015.Outcome measuresWe estimated absolute risks (AR) of preeclampsia (PE) and gestational diabetes (GDM) for 3–60 months of IPI according to history of each outcome. We modelled IPI using restricted cubic splines and reported adjusted relative risk (RRs) with 95% CI at 3, 6, 12, 24, 36, 48 and 60 months, with 18 months as reference.ResultsRisks of PE and GDM were 9.5%, 2.6% in first pregnancies, with recurrence rates of 19.3% and 41.5% in second pregnancy for PE and GDM, respectively. The AR of GDM ranged from 30% to 43% across the IPI range for mothers with previous GDM compared with 2%–8% for mothers without previous GDM. For mothers with no previous PE, greater risks were observed for IPIs at 3 months (RR 1.24, 95% CI 1.07 to 1.43) and 60 months (RR 1.40, 95% CI 1.29 to 1.53) compared with 18 months. There was insufficient evidence for increased risk of PE at shorter IPIs of <18 months for mothers with previous PE. Shorter IPIs of <18 months were associated with lower risk than at IPIs of 18 months for mothers with no previous GDM.ConclusionsThe associations between IPIs and risk of PE or GDM on subsequent pregnancies are modified by previous experience with these conditions. Mothers with previous complications had higher absolute, but lower RRs than mothers with no previous complications. However, IPI remains a potentially modifiable risk factor for mothers with previous complicated pregnancies.
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Luccisano, Sharon P., Heinrich C. Weber, Giuliana O. Murfet, Iain K. Robertson, Sarah J. Prior, and Andrew P. Hills. "An Audit of Pre-Pregnancy Maternal Obesity and Diabetes Screening in Rural Regional Tasmania and Its Impact on Pregnancy and Neonatal Outcomes." International Journal of Environmental Research and Public Health 18, no. 22 (November 16, 2021): 12006. http://dx.doi.org/10.3390/ijerph182212006.
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Maternal obesity in pregnancy, a growing health problem in Australia, adversely affects both mothers and their offspring. Gestational diabetes mellitus (GDM) is similarly associated with adverse pregnancy and neonatal complications. A low-risk digital medical record audit of antenatal and postnatal data of 2132 pregnant mothers who gave birth between 2016–2018 residing in rural-regional Tasmania was undertaken. An expert advisory group guided the research and informed data collection. Fifty five percent of pregnant mothers were overweight or obese, 43.6% gained above the recommended standards for gestational weight gain and 35.8% did not have an oral glucose tolerance test. The audit identified a high prevalence of obesity among pregnant women and low screening rates for gestational diabetes mellitus associated with adverse maternal and neonatal pregnancy outcomes. We conclude that there is a high prevalence of overweight and obesity among pregnant women in rural regional Tasmania. Further GDM screening rates are low, which require addressing.
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Croft, Maxine L., Vera Morgan, Anne W. Read, and Assen S. Jablensky. "Recorded Pregnancy Histories of the Mothers of Singletons and the Mothers of Twins: A Longitudinal Comparison." Twin Research and Human Genetics 13, no. 6 (December 1, 2010): 595–603. http://dx.doi.org/10.1375/twin.13.6.595.
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A population-based record linkage case cohort of 239,995 births, to 119,214 women, born in Western Australia from 1980 to 2001 inclusive, was used to measure the recording of selected indicators of maternal health (current and prior) during pregnancy. We compared records of women with singleton pregnancies with that in twin pregnancies Mothers of first- and second-born singletons (n= 117,647) were compared with women with a first-born singleton followed by twins (n= 1,567). Binary indicators were used to calculate population prevalence of medical conditions, pregnancy complications and birth outcomes. Infant outcomes included stillbirth, low birthweight, preterm birth and birth defects. Women with twins were significantly older and taller, with similar rates of medical conditions and pregnancy complications during first singleton pregnancies compared with women with two consecutive singletons. However, during their second pregnancy, women with twins had significantly higher rates of essential hypertension, pre-eclampsia, threatened abortion, premature rupture of the membranes and ante partum hemorrhage with abruption than women with singletons. For both groups, maternal conditions in the first pregnancy were underreported in the second pregnancy, including diabetes, epilepsy, asthma, chronic renal dysfunction and essential hypertension. At the second birth, twins were 3 times more likely to be stillborn, 17 times more likely to be low birthweight and 4 times more likely to be delivered preterm compared with singletons. This research demonstrates the importance for epidemiologists and others, of having access to a complete maternal medical history for analyses of risks associated with maternal, infant and childhood morbidity.
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Thompson, S. D., R. C. Nowak, J. Zhang, G. A. Dekker, and C. T. Roberts. "278. IGF2 polymorphisms predict pregnancy outcome." Reproduction, Fertility and Development 20, no. 9 (2008): 78. http://dx.doi.org/10.1071/srb08abs278.
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IGF-II is an important determinant of placental trophoblast invasion and subsequent placental function. IGF-II can act in autocrine/paracrine and endocrine fashions to promote placental invasion and differentiation and within both the fetus and placenta to promote fetal growth. We aimed to determine whether polymorphisms in Igf2 are associated with common pregnancy complications associated with uteroplacental insufficiency. Pregnant women were recruited in early pregnancy for a prospective case control study at the Women's and Children's Hospital and Lyell McEwin Health Service, Adelaide, Australia. Buffy coats were retrieved from maternal blood sampled at 15 weeks gestation, paternal blood and cord blood collected following delivery. Pregnancy outcomes were classified into normal (n = 126), preeclampsia (PE, n = 31), gestational hypertension (GH, n = 18), small-for-gestational-age (SGA, n = 50), PE+SGA (n = 16) or preterm birth (PTB, n = 19) by an experienced obstetrician. Three polymorphisms in Igf2, Igf2 ApaI and Igf2 MspI single nucleotide polymorphisms, and INS+2336 deletion/insertion polymorphism were selected for investigation. DNA was extracted from buffy coats and genotyping was performed by PCR followed by High Resolution Melt analyses. Data were analysed by Chi Square and Fisher's Exact Test and Likelihood Ratios (LR) were calculated. In normal pregnancies, all polymorphisms were in Hardy–Weinberg Equilibrium. Igf2 ApaI in the neonate, and hence placenta, was associated with PE (P = 0.016, LR = 7.46) and PTB (P = 0.024, LR = 8.61). Neonatal Igf2 MspI was associated with SGA (P = 0.007, LR = 9.81). Gestational age was associated with maternal Igf2 ApaI (P = 0.0004) and INS+2336 (P = 0.0021), as well as neonatal INS+2336 (P = 0.0046). Birthweight was associated with paternal Igf2 MspI (P = 0.044) when corrected for gestational age. Although this work is ongoing, data thus far suggest polymorphisms in the gene encoding IGF-II, primarily in the placenta, are associated with a range of pregnancy complications which have been associated with impaired placental function. Ongoing research will determine whether these polymorphisms are associated with aberrant placental Igf2 expression.
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Rao, Nitesh N., Chris Wilkinson, Mark Morton, Greg D. Bennett, Graeme R. Russ, Patrick T. Coates, and Shilpa Jesudason. "Successful pregnancy in a recipient of an ABO-incompatible renal allograft." Obstetric Medicine 12, no. 1 (March 7, 2018): 42–44. http://dx.doi.org/10.1177/1753495x17745390.
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Kidney transplantation restores fertility in patients with end-stage renal disease, with many successful pregnancies after kidney transplantation being reported. However, there are little data regarding pregnancy in women transplanted under modern-era desensitisation protocols that utilise rituximab, plasma exchange and intravenous immunoglobulin, including ABO-incompatible transplants. Pregnancies in ABO-incompatible recipients can pose new challenges from an immunological perspective. Here, we report a case of successful pregnancy using in vitro fertilisation, in a renal transplant recipient who underwent desensitisation two years prior, that included use of rituximab and plasma exchange to receive an ABO-incompatible transplant from her husband and subsequent father of the baby. We believe this was the first case of successful pregnancy after ABO-incompatible kidney transplantation in Australia and New Zealand. This case also highlights the difficulties faced in conception following transplantation and demonstrates that in vitro fertilisation utilising ovulation induction can be successfully utilised for conception in this cohort. This recipient also had gestational diabetes, worsening renal function and preterm delivery which are important complications often seen in pregnancies of solid organ transplant recipients.
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d’Emden, Michael, Donald McLeod, Jacobus Ungerer, Charles Appleton, and David Kanowski. "Development of a fasting blood glucose-based strategy to diagnose women with gestational diabetes mellitus at increased risk of adverse outcomes in a COVID-19 environment." PLOS ONE 15, no. 12 (December 3, 2020): e0243192. http://dx.doi.org/10.1371/journal.pone.0243192.
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Objective To evaluate the role of fasting blood glucose (FBG) to minimise the use of the oral glucose tolerance test in pregnancy (POGTT) for the diagnosis of gestational diabetes mellitus (GDM). Research design and methods We analysed the POGTTs of 26,242 pregnant women in Queensland, Australia, performed between 1 January 2015 and 30 June 2015. A receiver operator characteristics (ROC) assessment was undertaken to indicate the FBG level that most effectively identified women at low risk of an abnormal result. Results There were 3,946 (15.0%) patients having GDM with 2,262 (8.6%) having FBG ≥ 5.1mmol/l. The ROC identified FBG levels >4.6mmol/l having the best specificity (77%) and sensitivity (54%) for elevated 1 and/or 2hr BGLs. There were 19,321 (73.7%) women having FBG < 4.7mmol/l with a prevalence of GDM of 4.0%, less than 1/3rd the overall rate. Only 4,638 (17.7%) women having FBGs from 4.7–5.0mmol/l would require further evaluation to confirm or exclude the diagnosis. Conclusion This contemporary study of women across the state of Queensland, Australia suggests the FBG can be used effectively to define glucose tolerance in pregnancy, minimising their contact with pathology laboratories and potential exposure to the corona virus. This analysis, used in conjunction with outcome data from the HAPO study, provides reassurance to women and their health professionals that FBG < 4.7mmol/l has both a low rate of abnormal glucose tolerance and minimal adverse pregnancy-associated complications.
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Aranha, Algenes, Usman H. Malabu, Venkat Vangaveti, Elham Saleh Reda, Yong Mong Tan, and Kunwarjit Singh Sangla. "Macrosomia in non–gestational diabetes pregnancy: glucose tolerance test characteristics and feto–maternal complications in tropical Asia Pacific Australia." Asian Pacific Journal of Tropical Biomedicine 4, no. 6 (June 2014): 436–40. http://dx.doi.org/10.12980/apjtb.4.2014apjtb-2013-0027.
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Miller, Margaret, Lydia Hearn, Paige van der Pligt, Jane Wilcox, and Karen J. Campbell. "Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care." Australian Journal of Primary Health 20, no. 2 (2014): 123. http://dx.doi.org/10.1071/py13080.
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Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30–50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women’s weight and related lifestyle behaviours in child-bearing years is an outstanding ‘missed opportunity’ for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.
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Homer, Caroline S. E., Seong L. Cheah, Chris Rossiter, Hannah G. Dahlen, David Ellwood, Maralyn J. Foureur, Della A. Forster, et al. "Maternal and perinatal outcomes by planned place of birth in Australia 2000 – 2012: a linked population data study." BMJ Open 9, no. 10 (October 2019): e029192. http://dx.doi.org/10.1136/bmjopen-2019-029192.
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ObjectiveTo compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home.DesignA population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ2tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance.SettingAll eight Australian states and territories.ParticipantsWomen with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks’ gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home.Main outcome measuresMode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death).ResultsCompared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth.ConclusionsThis is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.
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Chong, Krystle Y., Yee K. Mak, Beverley Vollenhoven, and Ben W. Mol. "An Audit of Management of Ectopic Pregnancy in a Major Tertiary Healthcare Service." Fertility & Reproduction 03, no. 01 (March 2021): 14–18. http://dx.doi.org/10.1142/s266131822150002x.
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Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.
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Tsakiridis, Ioannis, Sonia Giouleka, Alexandra Arvanitaki, Apostolos Mamopoulos, George Giannakoulas, Georgios Papazisis, Apostolos Athanasiadis, and Themistoklis Dagklis. "Chronic hypertension in pregnancy: synthesis of influential guidelines." Journal of Perinatal Medicine 49, no. 7 (April 20, 2021): 859–72. http://dx.doi.org/10.1515/jpm-2021-0015.
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Abstract Chronic hypertension in pregnancy accounts for a substantial proportion of maternal morbidity and mortality and is associated with adverse perinatal outcomes, most of which can be mitigated by appropriate surveillance and management protocols. The aim of this study was to review and compare recommendations of published guidelines on this condition. Thus, a descriptive review of influential guidelines from the National Institute for Health and Care Excellence, the Society of Obstetric Medicine of Australia and New Zealand, the International Society of Hypertension, the International Society for the Study of Hypertension in Pregnancy, the European Society of Cardiology, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists on chronic hypertension in pregnancy was conducted. All guidelines agree on the definition and medical management, the need for more frequent antenatal care and fetal surveillance and the re-evaluation at 6–8 weeks postpartum. There is also a consensus that the administration of low-dose aspirin is required to prevent preeclampsia, although the optimal dosage remains controversial. No universal agreement has been spotted regarding optimal treatment blood pressure (BP) targets, need for treating mild-to-moderate hypertension and postnatal BP measurements. Additionally, while the necessity of antenatal corticosteroids and magnesium sulfate for preterm delivery is universally recommended, the appropriate timing of delivery is not clearly outlined. Hence, there is a need to adopt consistent practice protocols to optimally manage these pregnancies; i.e. timely detect and treat any potential complications and subsequently reduce the associated morbidity and mortality.
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Wood, Anna, Diana MacKay, Dana Fitzsimmons, Ruth Derkenne, Renae Kirkham, Jacqueline A. Boyle, Christine Connors, et al. "Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia." International Journal of Environmental Research and Public Health 17, no. 3 (January 22, 2020): 720. http://dx.doi.org/10.3390/ijerph17030720.
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Background: Hyperglycaemia in pregnancy contributes to adverse outcomes for women and their children. The postpartum period is an opportune time to support women to reduce cardiometabolic and diabetes risk in subsequent pregnancies. Aims: To identify strengths and gaps in current care for Aboriginal women after a pregnancy complicated by hyperglycaemia. Methods: A retrospective review of the 12 month postpartum care provided by primary health centres in remote Australia in 2013–2014 identified 195 women who experienced hyperglycaemia in pregnancy (gestational diabetes (GDM) (n = 147), type 2 diabetes (T2D) (n = 39), and unclear diabetes status (n = 9)). Results: Only 80 women (54%) with GDM had postpartum glycaemic checks. Of these, 32 women were diagnosed with prediabetes (n = 24) or diabetes (n = 8). Compared to women with GDM, women with T2D were more likely to have their weight measured (75% vs. 52%, p <0.01), and smoking status documented as “discussed” (65% vs. 34%, p < 0.01). Most women (97%) accessed the health centre at least once in the 12 month postpartum period but, during these visits, only 52% of women had service provision, either structured or opportunistic, related to diabetes. Conclusion: High rates of dysglycaemia among women screened for T2D after GDM in the 12 month postpartum period highlight the need for increased screening and early intervention to prevent the development of T2D and its complications. Whilst a clear strength was high postpartum attendance, many women did not attend health services for diabetes screening or management.
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Goller, Jane L., Alysha M. De Livera, Rebecca, J. Guy, Nicola Low, Basil Donovan, Matthew Law, John M. Kaldor, Christopher K. Fairley, and Jane S. Hocking. "Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009–2014: ecological analysis of hospital data." Sexually Transmitted Infections 94, no. 7 (May 2, 2018): 534–41. http://dx.doi.org/10.1136/sextrans-2017-053423.
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ObjectiveTo analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014.MethodsWe calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15–44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. We stratified PID diagnoses as chlamydial-related or gonorrhoeal-related (Chlamydia trachomatis (CT)-related or Neisseria gonorrhoeae (NG)-related), acute, unspecified and chronic, and analysed variations by year, age and residential area using Poisson regression models.ResultsFor PID, the rate of all admissions in 2014 was 63.3 per 100 000 women (95% CI 60.8 to 65.9) and of all presentations in EDs was 97.0 per 100 000 women (95% CI 93.9 to 100.2). Comparing 2014 with 2009, the rate of all PID admissions did not change, but the rate of all presentations in EDs increased (adjusted incidence rate ratio (aIRR) 1.34, 95% CI 1.24 to 1.45), and for admissions by PID category was higher for CT-related or NG-related PID (aIRR 1.73, 95% CI 1.31 to 2.28) and unspecified PID (aIRR 1.09, 95% CI 1.00 to 1.19), and lower for chronic PID (aIRR 0.84, 95% CI 0.74 to 0.95). For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher.ConclusionsPID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women. Updated primary care data are needed to better understand PID epidemiology and healthcare usage.
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Kavi, Avinash, Mai-Lei Woo Kinshella, Umesh Y. Ramadurg, Umesh Charantimath, Geetanjali M. Katageri, Chandrashekhar C. Karadiguddi, Narayan V. Honnungar, et al. "Community engagement for birth preparedness and complication readiness in the Community Level Interventions for Pre-eclampsia (CLIP) Trial in India: a mixed-method evaluation." BMJ Open 12, no. 12 (December 2022): e060593. http://dx.doi.org/10.1136/bmjopen-2021-060593.
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ObjectiveTo describe the process of community engagement (CE) in northern Karnataka, India and its impact on pre-eclampsia knowledge, birth preparedness and complication readiness, pregnancy-related care seeking and maternal morbidity.DesignThis study was a secondary analysis of a cluster randomised trial of Community Level Interventions for Pre-eclampsia (CLIP). A total of 12 clusters based on primary health centre catchment areas were randomised to intervention or control. CE was conducted in intervention clusters. CE attendance was summarised according to participant group using both quantitative and qualitative assessment. Pre-eclampsia knowledge, birth preparedness, health services engagement and perinatal outcomes was evaluated within trial surveillance. Outcomes were compared between trial arms using a mixed effects logistic regression model on RStudio (RStudio, Boston, USA). Community feedback notes were thematically analysed on NVivo V.12 (QSR International, Melbourne, Australia).SettingBelagavi and Bagalkote districts in rural Karnataka, India.ParticipantsPregnant women and women of reproductive age, mothers and mothers-in-law, community stakeholders and male household decision-makers and health workers.ResultsA total of 1379 CE meetings were conducted with 39 362 participants between November 2014 and October 2016. CE activities may have had an effect on modifying community attitudes towards hypertension in pregnancy and its complications. However, rates of pre-eclampsia knowledge, birth preparedness, health services engagement and maternal morbidities among individual pregnant women were not significantly impacted by CE activities in their area.ConclusionEvaluation of our CE programme in India demonstrates the feasibility of reaching pregnant women alongside household decision-makers, community stakeholders and health workers. More research is needed to explore the pathways of impact between broad community mobilisation to strengthen support for maternal care seeking and clinical outcomes of individual pregnant women.Trial registration numberNCT01911494.
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Marinovich, M. Luke, Annette K. Regan, Mika Gissler, Maria C. Magnus, Siri Eldevik Håberg, Amy M. Padula, Jonathan A. Mayo, et al. "Developing evidence-based recommendations for optimal interpregnancy intervals in high-income countries: protocol for an international cohort study." BMJ Open 9, no. 1 (January 2019): e027941. http://dx.doi.org/10.1136/bmjopen-2018-027941.
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IntroductionShort interpregnancy interval (IPI) has been linked to adverse pregnancy outcomes. WHO recommends waiting at least 2 years after a live birth and 6 months after miscarriage or induced termination before conception of another pregnancy. The evidence underpinning these recommendations largely relies on data from low/middle-income countries. Furthermore, recent epidemiological investigations have suggested that these studies may overestimate the effects of IPI due to residual confounding. Future investigations of IPI effects in high-income countries drawing from large, population-based data sources are needed to inform IPI recommendations. We aim to assess the impact of IPIs on maternal and child health outcomes in high-income countries.Methods and analysisThis international longitudinal retrospective cohort study will include more than 18 million pregnancies, making it the largest study to investigate IPI in high-income countries. Population-based data from Australia, Finland, Norway and USA will be used. Birth records in each country will be used to identify consecutive pregnancies. Exact dates of birth and clinical best estimates of gestational length will be used to estimate IPI. Administrative birth and health data sources with >99% coverage in each country will be used to identify maternal sociodemographics, pregnancy complications, details of labour and delivery, birth and child health information. We will use matched and unmatched regression models to investigate the impact of IPI on maternal and infant outcomes, and conduct meta-analysis to pool results across countries.Ethics and disseminationEthics boards at participating sites approved this research (approval was not required in Finland). Findings will be published in peer-reviewed journals and presented at international conferences, and will inform recommendations for optimal IPI in high-income countries. Findings will provide important information for women and families planning future pregnancies and for clinicians providing prenatal care and giving guidance on family planning.
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Mulligan, Ea C. "Striving for excellence in abortion services." Australian Health Review 30, no. 4 (2006): 468. http://dx.doi.org/10.1071/ah060468.
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The legalisation of abortion allowed the publication of surgical outcome data demonstrating low complication rates. South Australian data from the outcomes of surgery conducted at the Pregnancy Advisory Centre illustrate the monitoring of complication rates such as uterine perforation, continuing pregnancy and incomplete abortion to improve surgical outcomes. While quality improvement systems produce positive results, there are many barriers to their uptake in Australia. Hostility towards abortion has the potential effect of retarding the adoption of improved techniques.
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Ng, Ashley P., Natasha Frawley, Chris Hogan, Andrew Grigg, Solomon Cohney, Kathy Nicholls, and Gavin Becker. "Thrombotic Thrombocytopenic Purpura: Is Plasma Exchange Enough? A Fifteen Year Australian Experience at the Royal Melbourne Hospital." Blood 108, no. 11 (November 16, 2006): 3991. http://dx.doi.org/10.1182/blood.v108.11.3991.3991.
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Abstract Introduction Thrombotic Thrombocytopenic Purpura (TTP) is a cause of microangiopathic-haemolytic anaemia and thrombocytopenia, associated with renal and neurological dysfunction with thrombotic complications causing significant morbidity and mortality. Methods A restrospective single-institution analysis of patients with TTP treated between 1990–2005. Renal or bone marrow transplantation patients were excluded. Results Forty patients were identified. Aetiology was idiopathic 75% (n=30), connective tissue disease-related 12.5% (n=5), malignancy-related 5% (n=2) and pregnancy-related 7.5% (n=3). Presenting features: neurological 62.5% (n=25), renal impairment (creatinine>0.11 mmol/L) 76% (n=28), microangiopathic-haemolytic anaemia 97.5% (n=39) and thrombocytopenia 100% (mean platelet-count 42x10^9/L). Mean Hb 93 g/L and mean Lactose dehydrogenase (LD) 2517 U/L (<420). 38 patients received up-front single plasma-volume plasma-exchange using fresh-frozen plasma (median 11 exchanges). All received steroids. Complete-response (CR) (normalisation of platelet count, LD, neurological examination and rising Hb), was achieved in 79% (n=30) following plasma-exchange of whom 43% (n=13) relapsed (median 14.5 days from therapy-cessation): eleven achieved CR2 with further therapy and two died from TTP-related complications. Partial-response (PR) was obtained in 7.9% (n=3) with up-front plasma-exchange: one remained in PR with prostate-cancer treatment and two relapsed: one achieved CR and one sustained-PR with further therapy. 13% (n=5) were refractory to plasma-exchange: four died from TTP-related complications and one achieved CR with treatment intensification. Therapeutic intensification included steroids (n=34), vincristine (n=7), intravenous immunoglobulin (n=6), Rituximab (n=3) and splenectomy (n=6). Conclusion TTP is associated with a significant relapse-rate (43%) and TTP-related mortality (16%) despite plasma-exchange. Delineation of patients at high risk of relapse following CR will potentially allow targetted treatment intensification. Treatment intensification is also clearly required for patients with refractory TTP and consideration may be given to other immunosuppressive agents, such the chimeric monoclonal anti-CD20 antibody, Rituximab, as a steroid-sparing agent and to potentially avoid splenectomy. We propose a central TTP registry is developed within Australia such that therapeutic strategies can be systematically evaluated in a multicentre setting.
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Bai, Michelle, Daniella Susic, Anthony J. O’Sullivan, and Amanda Henry. "Reproducibility of Bioelectrical Impedance Analysis in Pregnancy and the Association of Body Composition with the Risk of Gestational Diabetes: A Substudy of MUMS Cohort." Journal of Obesity 2020 (September 22, 2020): 1–12. http://dx.doi.org/10.1155/2020/3128767.
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Introduction. Bioelectrical impedance analysis (BIA) is a rapid and noninvasive method of body composition analysis; however, reproducibility between BIA instruments in pregnancy is uncertain. Adverse maternal body composition has been linked to pregnancy complications including gestational diabetes mellitus (GDM). This study aimed to evaluate the reproducibility of three BIA instruments in pregnancy and analyse the relationship between the body composition and the GDM risk. Methods. A prospective cohort (n = 117) of women with singleton pregnancies participating in the Microbiome Understanding in Maternity Study (MUMS) at St. George Hospital, Sydney, Australia. Anthropometric measurements and BIA body composition were measured at ≤13 weeks (T1), 20–24 weeks (T2), and 32–36 weeks (T3) of gestation. Body fat percentage (BFP), total body water (TBW), and impedance were estimated by three BIA instruments: Bodystat 1500, RJL Quantum III, and Tanita BC-587. GDM status was recorded after 75 g oral glucose tolerance test was performed at 28 weeks or earlier. Agreement between BIA instruments was assessed using Bland–Altman analysis. Logistic regression modelling explored associations of BFP with GDM. Results. Method comparison reproducibility between Bodystat and RJL was stronger than between Bodystat and Tanita for both BFP and TBW% at all three time points. RJL overestimated BFP on average by 3.3% (p<0.001), with limits of agreement within ±5% for all trimesters. Average BFP was not significantly different between Tanita and Bodystat although limits of agreement exceeded ±5%. GDM diagnosis was independently associated with increased BFP in T1 (adjusted OR 1.117 per 1% increase; 95% CI 1.020–1.224; p=0.017) and in T2 (adjusted OR 1.113 per 1% increase; 95% CI 1.010–1.226; p=0.031) and with Asian ethnicity in all models (OR 7.4–8.1). Conclusion. Reproducibility amongst instruments was moderate; therefore, interchangeability between instruments, particularly for research purposes, cannot be assumed. In this cohort, GDM risk was modestly associated with increasing BFP and strongly associated with Asian ethnicity.
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Secomandi, Laura, Michela Borghesan, Michael Velarde, and Marco Demaria. "The role of cellular senescence in female reproductive aging and the potential for senotherapeutic interventions." Human Reproduction Update 28, no. 2 (December 16, 2021): 172–89. http://dx.doi.org/10.1093/humupd/dmab038.
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Abstract BACKGROUND Advanced maternal age is associated with decreased oocyte quantity and quality as well as uterine and placental dysfunctions. These changes lead to infertility, pregnancy complications and birth defects in the offspring. As the mean age of giving birth is increasing worldwide, prevention of age-associated infertility and pregnancy complications, along with the more frequent use of ART, become extremely important. Currently, significant research is being conducted to unravel the mechanisms underlying female reproductive aging. Among the potential mechanisms involved, recent evidence has suggested a contributing role for cellular senescence, a cellular state of irreversible growth arrest characterized by a hypersecretory and pro-inflammatory phenotype. Elucidating the role of senescence in female reproductive aging holds the potential for developing novel and less invasive therapeutic measures to prevent or even reverse female reproductive aging and increase offspring wellbeing. OBJECTIVE AND RATIONALE The review will summarize the positive and negative implications of cellular senescence in the pathophysiology of the female reproductive organs during aging and critically explore the use of novel senotherapeutics aiming to reverse and/or eliminate their detrimental effects. The focus will be on major senescence mechanisms of the ovaries, the uterus, and the placenta, as well as the potential and risks of using senotherapies that have been discovered in recent years. SEARCH METHODS Data for this review were identified by searches of MEDLINE, PubMed and Google Scholar. References from relevant articles using the search terms ‘Cellular Senescence’, ‘Aging’, ‘Gestational age’, ‘Maternal Age’, ‘Anti-aging’, ‘Uterus’, ‘Pregnancy’, ‘Fertility’, ‘Infertility’, ‘Reproduction’, ‘Implant’, ‘Senolytic’, ‘Senostatic’, ‘Senotherapy’ and ‘Senotherapeutic’ where selected. A total of 182 articles published in English between 2005 and 2020 were included, 27 of which focus on potential senotherapies for reproductive aging. Exclusion criteria were inclusion of the terms ‘male’ and ‘plants’. OUTCOMES Aging is a major determinant of reproductive wellbeing. Cellular senescence is a basic aging mechanism, which can be exploited for therapeutic interventions. Within the last decade, several new strategies for the development and repurposing of drugs targeting senescent cells have emerged, such as modulators of the anti-inflammatory response, oxidative stress, DNA damage, and mitochondria and protein dysfunctions. Several studies of female reproductive aging and senotherapies have been discussed that show promising results for future interventions. WIDER IMPLICATIONS In most countries of the Organization for Economic Co-operation and Development, the average age at which women give birth is above 30 years. Currently, in countries such as the Netherlands, Australia, Spain, Finland, Germany and the UK, birth rates among 30- to 34-year-olds are now higher than in any other age groups. This review will provide new knowledge and scientific advancement on the senescence mechanisms during female reproductive aging, and benefit fundamental and clinical scientists and professionals in the areas of reproduction, cancer, immunobiology and fibrosis.
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Mari, Etwell. "Decreased Fetal Movements are an Important Red Flag in Second Half of Pregnancy: A Case Report of Baby Saved by Mother’s Attention to Fetal Movements." Current Opinion in Gynecology and Obstetrics 1, no. 1 (April 17, 2018): 21–27. http://dx.doi.org/10.18314/cogo.v1i1.862.
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Stillbirth affects over 2,500 families in Australia, New Zealand and over 2.64 million families worldwide annually. Stillbirths are often preceded by maternal perception of decreased fetal movement (DFM). DFM is also strongly linked to adverse perinatal outcomes such as neurodevelopmental disability, infection, fetal to maternal haemorrhage (FMH), emergency delivery, umbilical cord complications, small for gestational age (SGA) and fetal growth restriction (FGR /IUGR). Decreased fetal movements for some women may be associated with placental dysfunction, which could lead to fetal growth restriction and/or stillbirth. While evidence is still emerging in this area, some studies indicate that a reduction in stillbirth rates may be achieved by increasing maternal, clinician and community awareness about the importance of DFM. Fetal movements are an important simple maker of fetal wellbeing, while reduced fetal movements can be the early symptom of fetal compromise and failure to respond by a mother or maternity provider might lead to intrauterine fetal death (IUFD). Fetal movement counting (Fetal Kicks monitoring) is very controversial, maternal anxiety has been highlighted as a big issue in those who follow fetal kick counting advice. The value of maternal fetal movements (FM) monitoring has been assessed in a number of studies of pregnant women. There are conflicting results with most showing no overall reduction in perinatal losses even when fetal movement monitoring has been recommended. Fetuses that are experiencing sub acute and slow progressing fetal compromise can be saved if mothers detect reduced fetal activity and present to their midwife or Obstetrician.
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Foo, Damien, Mohinder Sarna, Gavin Pereira, Hannah C. Moore, and Annette K. Regan. "Prenatal influenza vaccination and allergic and autoimmune diseases in childhood: A longitudinal, population-based linked cohort study." PLOS Medicine 19, no. 4 (April 5, 2022): e1003963. http://dx.doi.org/10.1371/journal.pmed.1003963.
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Background Few studies have evaluated the effect of maternal influenza vaccination on the development of allergic and autoimmune diseases in children beyond 6 months of age. We aimed to investigate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and subsequent diagnosis of allergic and autoimmune diseases. Methods and findings This longitudinal, population-based linked cohort study included 124,760 singleton, live-born children from 106,206 mothers in Western Australia (WA) born between April 2012 and July 2016, with up to 5 years of follow-up from birth. In our study cohort, 64,169 (51.4%) were male, 6,566 (5.3%) were Aboriginal and/or Torres Strait Islander children, and the mean age at the end of follow-up was 3.0 (standard deviation, 1.3) years. The exposure was receipt of seasonal IIV during pregnancy. The outcomes were diagnosis of an allergic or autoimmune disease, including asthma and anaphylaxis, identified from hospital and/or emergency department (ED) records. Inverse probability of treatment weights (IPTWs) accounted for baseline probability of vaccination by maternal age, Aboriginal and/or Torres Strait Islander status, socioeconomic status, body mass index, parity, medical conditions, pregnancy complications, prenatal smoking, and prenatal care. The models additionally adjusted for the Aboriginal and/or Torres Strait Islander status of the child. There were 14,396 (11.5%) maternally vaccinated children; 913 (6.3%) maternally vaccinated and 7,655 (6.9%) maternally unvaccinated children had a diagnosis of allergic or autoimmune disease, respectively. Overall, maternal influenza vaccination was not associated with diagnosis of an allergic or autoimmune disease (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.95 to 1.09). In trimester-specific analyses, we identified a negative association between third trimester influenza vaccination and the diagnosis of asthma (n = 40; aHR, 0.70; 95% CI, 0.50 to 0.97) and anaphylaxis (n = 36; aHR, 0.67; 95% CI, 0.47 to 0.95).We did not capture outcomes diagnosed in a primary care setting; therefore, our findings are only generalizable to more severe events requiring hospitalization or presentation to the ED. Due to small cell sizes (i.e., <5), estimates could not be determined for all outcomes after stratification. Conclusions In this study, we observed no association between in utero exposure to influenza vaccine and diagnosis of allergic or autoimmune diseases. Although we identified a negative association of asthma and anaphylaxis diagnosis when seasonal IIV was administered later in pregnancy, additional studies are needed to confirm this. Overall, our findings support the safety of seasonal inactivated influenza vaccine during pregnancy in relation to allergic and autoimmune diseases in early childhood and support the continuation of current global maternal vaccine programs and policies.
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Vuong, Lan N., Vu N. A. Ho, Tuong M. Ho, Vinh Q. Dang, Tuan H. Phung, Nhu H. Giang, Anh H. Le, et al. "In-vitro maturation of oocytes versus conventional IVF in women with infertility and a high antral follicle count: a randomized non-inferiority controlled trial." Human Reproduction 35, no. 11 (September 24, 2020): 2537–47. http://dx.doi.org/10.1093/humrep/deaa240.
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Abstract STUDY QUESTION Is one cycle of IVM non-inferior to one cycle of conventional in IVF with respect to live birth rates in women with high antral follicle counts (AFCs)? SUMMARY ANSWER We could not demonstrate non-inferiority of IVM compared with IVF. WHAT IS KNOWN ALREADY IVF with ovarian hyperstimulation has limitations in some subgroups of women at high risk of ovarian stimulation, such as those with polycystic ovary syndrome. IVM is an alternative ART for these women. IVM may be a feasible alternative to IVF in women with a high AFC, but there is a lack of data from randomized clinical trials comparing IVM with IVF in women at high risk of ovarian hyperstimulation syndrome. STUDY DESIGN, SIZE, DURATION This single-center, randomized, controlled non-inferiority trial was conducted at an academic infertility center in Vietnam from January 2018 to April 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 546 women with an indication for ART and a high AFC (≥24 follicles in both ovaries) were randomized to the IVM (n = 273) group or the IVF (n = 273) group; each underwent one cycle of IVM with a prematuration step versus one cycle of IVF using a standard gonadotropin-releasing hormone antagonist protocol with gonadotropin-releasing hormone agonist triggering. The primary endpoint was live birth rate after the first embryo transfer. The non-inferiority margin for IVM versus IVF was −10%. MAIN RESULTS AND THE ROLE OF CHANCE Live birth after the first embryo transfer occurred in 96 women (35.2%) in the IVM group and 118 women (43.2%) in the IVF group (absolute risk difference –8.1%; 95% confidence interval (CI) –16.6%, 0.5%). Cumulative ongoing pregnancy rates at 12 months after randomization were 44.0% in the IVM group and 62.6% in the IVF group (absolute risk difference –18.7%; 95% CI –27.3%, –10.1%). Ovarian hyperstimulation syndrome did not occur in the IVM group, versus two cases in the IVF group. There were no statistically significant differences between the IVM and IVF groups with respect to the occurrence of pregnancy complications, obstetric and perinatal complications, preterm delivery, birth weight and neonatal complications. LIMITATIONS, REASONS FOR CAUTION The main limitation of the study was its open-label design. In addition, the findings are only applicable to IVM conducted using the prematuration step protocol used in this study. Finally, the single ethnicity population limits the external generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS Our randomized clinical trial compares live birth rates after IVM and IVF. Although IVM is a viable and safe alternative to IVF that may be suitable for some women seeking a mild ART approach, the current study findings approach inferiority for IVM compared with IVF when cumulative outcomes are considered. Future research should incorporate multiple cycles of IVM in the study design to estimate cumulative fertility outcomes and better inform clinical decision-making. STUDY FUNDING/COMPETING INTEREST(S) This work was partly supported by Ferring grant number 000323 and funded by the Vietnam National Foundation for Science and Technology Development (NAFOSTED) and by the Fund for Research Flanders (FWO). LNV has received speaker and conference fees from Merck, grant, speaker and conference fees from Merck Sharpe and Dohme, and speaker, conference and scientific board fees from Ferring; TMH has received speaker fees from Merck, Merck Sharp and Dohme, and Ferring; RJN has received conference and scientific board fees from Ferring, is a minor shareholder in an IVF company, and receives grant funding from the National Health and Medical Research Council (NHMRC) of Australia; BWM has acted as a paid consultant to Merck, ObsEva and Guerbet, and is the recipient of grant money from an NHMRC Investigator Grant; RBG reports grants and fellowships from the NHMRC of Australia; JS reports lecture fees from Ferring Pharmaceuticals, Biomérieux, Besins Female Healthcare and Merck, grants from Fund for Research Flanders (FWO), and is co-inventor on granted patents on CAPA-IVM methodology in the US (US10392601B2) and Europe (EP3234112B1); TDP, VQD, VNAH, NHG, AHL, THP and RW have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER NCT03405701 (www.clinicaltrials.gov). TRIAL REGISTRATION DATE 16 January 2018. DATE OF FIRST PATENT’S ENROLMENT 25 January 2018.
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Kovacek-Stanic, Gordana. "Biomedically assisted reproduction and child birth: Surrogate motherhood in comparative European law and Serbia." Stanovnistvo 51, no. 1 (2013): 1–21. http://dx.doi.org/10.2298/stnv1301001k.
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Surrogate motherhood is an arrangement in which a woman agrees to carry and deliver a child for another couple who ordered the pregnancy. This procedure is applied today in Great Britain, Holland (although without legal regulations), Israel, Greece, Ukraine, Armenia, Georgia, the USA and Australia, and it is forbidden in France, Austria, Spain, Germany, Switzerland and Slovenia. There are two types of surrogacy, one when the woman gives birth to a child who is genetically her own ("partial", genetic surrogacy), and the other where the surrogate mother only carries and gives birth to a child, whereby the child is genetically from the couple that wanted the child, or the fertilized egg is from a third woman (donor), or the embryo was donated ("full", "total", gestational surrogacy). In these cases two women take part in conception and birth of the child while in the last case there is a third woman who will raise the child. Biologically observed, the woman whose egg has been fertilized may be called the genetic mother, while the woman who carried the pregnancy and gave birth to the child - the gestational carrier. Taking into consideration that the Preliminary Draft of the Serbian Civil Law anticipates the introduction of surrogate motherhood into domestic law, we believe restrictive solutions should first be taken into consideration. This would mean that only full surrogating should be allowed, namely the egg should be from the woman who wants the child and not the surrogate mother. In domestic conditions, genetic surrogation should not be allowed as it leads to confusion in family relations, and kinships still have an important social and legal significance in our country. The surrogate mother should be a woman who has already given birth, because in that way any possible shocks which might arise after birth when the woman who has to handover the child to the intended couple would be avoided. The next condition would be that persons involved in this procedure should have usual residency in Serbia so as to prevent any international complications or problems. As far as compensation is concerned, only compensation of so-called reasonable expenses which the surrogate mother would incur should be allowed. The surrogate contract should be approved by a court judge, who would have the obligation to determine if all legal conditions have been fulfilled for surrogate motherhood, and to explain the contract effects to the contracting parties. Apart from that, psycho-social counselling of all persons involved in the procedure should be anticipated.
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Parmar, Meghavini R., and Pradhyuman Vaja. "Effect of pregnancy induced hypertension on maternal and perinatal outcome at tertiary care center in Ahmedabad, Gujarat, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 10 (September 23, 2017): 4661. http://dx.doi.org/10.18203/2320-1770.ijrcog20174460.
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Background: Pregnancy is a physiological event for utmost women. Almost 20% - 30% of the adult population and more than 5% - 8% of all pregnancies in the world suffered from hypertension (HTN) and 5% - 22% of all pregnancies have develop some kind of medical problem due to hypertensive. To study the prevalence of PIH and to find out the association of PIH with perinatal and maternal outcome.Methods: Prospective study was done among 110 cases of PIH admitted at department of obstetrics and Gynecology in B.J. Medical college, Ahmedabad during July 2005 to July 2007. Hypertension was identified based on the definition by the Australian Society of the Study of Hypertension in Pregnancy and that of the Working Group Report on High Blood Pressure in Pregnancy, which establish blood pressure levels > 140/90 mmHg or hypertension diagnosis marked on the record.Results: Almost 44% participants had mild PIH and 56% had severe PIH. Almost 32% participants had grade I changes and 29% had grade II changes. Low birth weight was found in 53% baby. Maternal complication observed in 16% participants. Out of 16 patients, highest incidence of eclampsia was observed followed by APH, DIC respectively. One incidence of maternal death also occurred. Perinatal complications were observed in 46% cases which include IUGR (60.9%), birth asphyxia (8.7%), RDS (4.3%) and perinatal death (15.2%) respectively.Conclusions: Pregnancy-induced hypertension is associated with multiple complications in the mother and baby, and particularly preterm delivery. Timely intervention of regular ANC check-up, nutrition, health education etc. can reduce the severity of PIH which lead to decrease in maternal and perinatal complications.
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Beaujouan, Éva, Anna Reimondos, Edith Gray, Ann Evans, and Tomáš Sobotka. "Declining realisation of reproductive intentions with age." Human Reproduction 34, no. 10 (September 27, 2019): 1906–14. http://dx.doi.org/10.1093/humrep/dez150.
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Abstract STUDY QUESTION What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age? SUMMARY ANSWER For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men. WHAT IS KNOWN ALREADY Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications. STUDY DESIGN, SIZE, DURATION This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18–45 and 528 women aged 18–41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised. PARTICIPANTS/MATERIALS, SETTINGS, METHODS Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions. MAIN RESULTS AND THE ROLE OF CHANCE Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38–41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child. LIMITATIONS, REASONS FOR CAUTION Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age. WIDER IMPLICATIONS OF THE FINDINGS Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages. STUDY FUNDING/COMPETING INTEREST(S) This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan’s work was partly funded by the Austrian Science Fund (FWF) project ‘Later Fertility in Europe’ (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest.
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Adane, A. A., G. D. Mishra, and L. R. Tooth. "Maternal preconception weight trajectories, pregnancy complications and offspring’s childhood physical and cognitive development." Journal of Developmental Origins of Health and Disease 9, no. 6 (August 14, 2018): 653–60. http://dx.doi.org/10.1017/s2040174418000570.
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AbstractThere is limited evidence on the association between maternal preconception body mass index (BMI) trajectories and pregnancy complications and child development. This study examined the relationships of maternal BMI trajectories, diabetes and hypertensive disorders during pregnancy and offspring’s childhood physical and cognitive development. Data were from the Australian Longitudinal Study on Women’s Health and the Mothers and their Children’s Health study (n=771). Women’s preconception BMI trajectories were identified using group-based trajectory modelling. Children’s physical and cognitive development (up to the average age of 5 years) were obtained from the Ages and Stages Questionnaire (suspected gross motor delay) and the Australian Early Development Census (AEDC). Generalized estimating equation models, adjusted for maternal sociodemographic and lifestyle factors, were used for analyses. Three distinct BMI trajectories were identified (normative, chronically overweight and chronically obese). Children born to chronically obese women were more likely to be classified as developmentally vulnerable/at-risk on AEDC domains; gross and fine motor skills [risk ratio (RR)=1.64, 95% confidence interval (CI): 1.04, 2.61] and communication skills and general knowledge (RR=1.71, 95% CI: 1.09, 2.68). They also had an elevated risk of suspected gross motor delay (RR=2.62, 95% CI: 1.26, 5.44) compared with children born to women with a normative BMI trajectory. Maternal diabetes or hypertensive disorders during pregnancy were not associated with child outcomes. Maternal preconception BMI trajectories were associated with poorer childhood development. This study finding underscores the importance of excessive weight gain prevention throughout the reproductive stage of life.
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Perram, Jacinta, Stephanie Anderson, Stephen Matthews, Melly Gou, and P. Joy Ho. "Assisted Reproductive Technology Required to Achieve High Conception Rates, Despite a Low Incidence of Hypogonadotrophic Hypogonadism in Thalassemia and Sickle Cell Disease Patients." Blood 138, Supplement 1 (November 5, 2021): 4989. http://dx.doi.org/10.1182/blood-2021-147102.
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Abstract Background Early and effective iron chelation has improved life expectancy and decreased disease complications for people with transfusion dependent thalassemia (TDT) and Sickle Cell Disease (SCD). Fertility challenges and pregnancy complications have historically limited reproductive options in this group, however improved disease management has made subfertility a chronic disease complication requiring attention. Despite this, there are very few reports on rates of conception and pregnancy outcomes in this population. Methods A 20 year retrospective analysis (1997 - 2017) was performed to evaluate fertility outcomes in women with TDT and SCD at an Australian referral centre. Patients with TDT and SCD who tried to conceive during the study period were included. Use of assisted reproductive technologies (ART), as well as pregnancy outcomes and neonatal and maternal complications were assessed. Results Eleven women with TDT and 3 with SCD tried to conceive during the study period. Median age at conception was 28 years (range 21-35). A total of 28 pregnancies and 25 live births were reported, including 2 spontaneous early pregnancy losses, a termination for anencephaly and a reduction of triplets. There was 1 multiple gestation in the cohort. At least 1 live birth occurred in 13 of the 14 women (93%). Spontaneous conception was reported in 9 women, of whom 8 had at least one resulting live birth, with a total of 15 live births from spontaneous conception. Of 5 women who were unable to conceive spontaneously, four had a diagnosis of hypogonadotrophic hypogonadism (HH) - two conceived following ovarian stimulation (OS), one required in vitro fertilization (IVF), and one did not pursue IVF following unsuccessful OS. The cause of subfertility was unknown in one patient, who conceived with IVF following failed OS. Three women who had an initial spontaneous conception required assisted reproductive technology (ART) for subsequent pregnancies, with no cause for subfertility identified. Mean ferritin at conception was 2911 mmol/L (range 164 to 8697mmol/L), and there was no association between ferritin at conception and need for ART. A trend was observed between increasing age and use of ART. Nine of the thirteen (69%) women who achieved pregnancy underwent Cesarean section for their first delivery. Prematurity (birth prior to 37 weeks' gestation) occurred in 5 (20%) of live births. Intrauterine growth restriction (IUGR) evidenced by birth weight <10 th centile for gestational age at birth was observed in 7 of 25 births (28%). This included one very low birth weight neonate delivered following induction for suspected IUGR. Respiratory distress syndrome occurred in two neonates in the setting of prematurity (delivered at 31 and 33 weeks gestation), both from women with TDT. Post partum hemorrhage (PPH) occurred after four deliveries in three women with TDT. There were no neonatal or maternal deaths. Conclusions Our data is the first analysis of fertility and pregnancy outcomes in Australian patients with TDT or SCD. Publications in this area are limited, and primarily report on pregnancy outcomes without capturing failure to conceive. Our findings are encouraging, with high conception rates achieved, with the use of ART where needed. Ferritin level did not predict difficulty with spontaneous conception and few of the women (29%) had HH, despite many having significant hyperferritinemia. Overall, 48% of live births resulted from ART, despite 58% of these patients not having a diagnosis of HH. This indicates that pituitary iron deposition with resultant HH alone does not adequately explain subfertility in this population. Our data also highlight the importance of affordable ART access for this patient population despite the clinical gains achieved with effective chelation therapy. Pregnancies were largely uncomplicated with excellent maternal and foetal outcomes. A high rate of IUGR was observed, supporting classification of pregnancy in this population as high risk. Rates of Cesarean section for first delivery were more than double the Australian average, likely in part due to high IUGR rates. Neonatal complications and PPH occurred at general population rates. Guidelines around pregnancy management in this population abound, however large prospective studies are needed to identify those at risk of sub- and infertility, even in the era of effective chelation. Disclosures No relevant conflicts of interest to declare.
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Gupta, Akhil, Shantha Rose Joseph, and Bill Jeffries. "Managing a rare complication of HELLP syndrome in Australia: Spontaneous liver haematoma in pregnancy." Australian and New Zealand Journal of Obstetrics and Gynaecology 61, no. 2 (February 12, 2021): 188–94. http://dx.doi.org/10.1111/ajo.13318.
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Sykes, S. D., E. R. Lumbers, K. G. Pringle, T. Zakar, G. A. Dekker, and C. T. Roberts. "306. PREDICTING GESTATIONAL DIABETES FROM MATERNAL ANGIOTENSIN II AND ANGIOTENSIN 1–7 LEVELS AT 15 WEEKS GESTATION." Reproduction, Fertility and Development 22, no. 9 (2010): 106. http://dx.doi.org/10.1071/srb10abs306.
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Gestational diabetes (GD), a pregnancy complication defined by glucose intolerance with onset during pregnancy, is a condition affecting 5.5%–8.8% of Australian pregnancies1. Untreated GD increases perinatal mortality and babies from GD pregnancies have an increased risk of diabetes and obesity, whilst mothers have an increased risk of type II diabetes later in life1. Circulating levels of angiotensin 1–7 (Ang1–7), a peptide of the renin angiotensin system, have been reported to be reduced in third trimester pregnancies with GD2. The effects of Ang1–7 generally oppose those of angiotensin II (AngII) and it is possible that in early gestation pro-angiogenic functions of AngII are counterbalanced by Ang1–7, causing placental insufficiency and pregnancy complications. We wanted to determine the predictive capability of AngII and Ang1–7, in early gestation, for GD. Healthy nulliparous pregnant women from the Adelaide SCOPE cohort with GD (n = 36) or serving as controls (n = 131) had both peptides measured at 15 weeks using an RIA (D. Casley, Prosearch Pty. Ltd.) on EDTA treated plasma. A predictive model was constructed using logistic regression and area under the curve after ROC analysis (AROC, Table 1). AngII did not change the model and was omitted. This model shows that for every one unit increase of Log (Ang1–7 pg/mL) peptide levels the odds of acquiring GD increase five times, suggesting that Ang1–7 levels in early gestation may be a better disease marker than those seen at late pregnancy. (1) Hoffman L, Nolan C, Wilson JD, et al., 1998. Gestational diabetes mellitus – management guidelines. The Australasian Diabetes in Pregnancy Society. Med. J. Aust. 169, 93–97.(2) Nogueira AI, Santos RAS, Simoes e Silva AC, et al., 2007. The pregnancy-induced increase of plasma angiotensin-(1–7) is blunted in gestational diabetes. Regul. Pep., 141, 55–60.
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Khalafallah, Alhossain A., Abdul-Rauf O. Ibraheem, Qiong Yue Teo, Abdul-Majeed AlBarzan, Ramanathan Parameswaran, Emily Hooper, Toly Pavlov, Amanda E. Dennis, and Terry Hannan. "Review of Management and Outcomes in Women with Thrombophilia Risk during Pregnancy at a Single Institution." ISRN Obstetrics and Gynecology 2014 (February 17, 2014): 1–6. http://dx.doi.org/10.1155/2014/381826.
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Pregnancy is a hypercoagulable state associated with an increased risk of venous thromboembolic disease (VTE). We retrospectively studied 38 Caucasian pregnant women with thrombophilia risk and compared their obstetric outcomes with a matched cohort without known thrombophilia risk during the period between January 2007 and December 2010. There were (2) cases with factor V Leiden, (6) prothrombin gene mutation, (1) antithrombin III deficiency, (2) protein C deficiency, (3) protein S deficiency, (10) MTHFR mutation, (7) anti-cardiolipin antibodies, and (1) lupus anticoagulant. Patients without thrombophilia who presented with recurrent unprovoked VTE were considered as high risk (6 cases). Most patients received anticoagulation (34/38) with aspirin only (6), enoxaparin (27), and warfarin (1). Twenty-six out of thirty-eight pregnant women (68.4%) with an increased risk of thrombophilia experienced one or more obstetric complications defined as hypertension, preeclampsia, placenta abruptio, VTE, and oligohydramnios, compared with 15 out of 40 (37.5%) pregnant women in the control group (OR 3.6; 95% CI 1.42, 9.21, P<0.001). The incidence of obstetric complications was significantly higher in the thrombophilia group compared to the controls. However, these complications were the lowest among patients who received full-dose anticoagulation. Our study suggests that strict application of anticoagulation therapy for thrombophilia of pregnancy is associated with an improved pregnancy outcome. The study was registered in the Australian and New Zealand Clinical Trials Registry under ACTRN12612001094864.
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Rahmawati, Sitti, Mark A. Graber, Mohammad Hakimi, Ali Ghufron Multi, Indra Bastian, and Nurulhuda Rahman. "Cost Comparison of Emergency Cesarean Section in Indonesia: The impact of Australian Model of Diagnosis-related Groups as a Payment System for Patient Care in Hospitals." Open Access Macedonian Journal of Medical Sciences 9, E (March 8, 2021): 216–23. http://dx.doi.org/10.3889/oamjms.2021.5831.
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BACKGROUND: The cesarean section in Indonesia was higher, still worrying for women and babies’ health with pregnancy complications. It will have psychological effects such as trauma and stress during labor and its consequences on labor cost. AIM: This study’s purpose was to determine the cost of cesarean delivery as a diagnosis of transition-related groups and the Australian-diagnosis-related groups (AR-DRGs) model’s impact. METHODS: The research method is descriptive qualitative study. The 42 samples are pregnant women and that selected by purposive sampling. The data are collected from a secondary data source of medical record installations, observations, interview interviews, and focus group discussion with health professionals, nurses, doctors, and midwives. Data analysis is based on the activity-based costing system method. It includes cost treatment per disease diagnosis, cesarean section AR-DRG 370 method as a payment method for hospital treatment. RESULTS: Determinants of cost differences in cesarean section surgery are based on AR-DRG 370 related to diabetes and eclampsia (complications and comorbidities) with relatively high-cost rates of O01A DRGs of US$ 2639 due to high-risk pregnancy complications. Complications of mild pregnancy (DRGO01D) with different categories of uterine rupture and sepsis have a low-cost average at the total cost of US$ 1251. Payment ability of an average of 42 respondents shows the costs category of DRGs O01A-DRGs O01D US$ 7088 or US$ 169, per patient and length of stay 4–6 days. CONCLUSIONS: The impact of Australia’s AR-DRGs model of transition DRG prospective payment shows that the health system can improve the quality of professional services in hospitals and control costs, and labor costs are cheaply profitable for hospitals. The results are accurate and experienced to be applied in Indonesian hospitals.
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Morgan, Vera A., Patsy Di Prinzio, Giulietta Valuri, Maxine Croft, Thomas McNeil, and Assen Jablensky. "Are familial liability for schizophrenia and obstetric complications independently associated with risk of psychotic illness, after adjusting for other environmental stressors in childhood?" Australian & New Zealand Journal of Psychiatry 53, no. 11 (July 24, 2019): 1105–15. http://dx.doi.org/10.1177/0004867419864427.
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Objective: The interplay between genetic and environmental factors on risk for psychotic illness remains poorly understood. The aim of this study was to estimate independent and combined effects of familial liability for schizophrenia and exposure to obstetric complications on risk for developing psychotic illness, covarying with exposure to other environmental stressors. Methods: This whole-population birth cohort study used record linkage across Western Australian statewide data collections (midwives, psychiatric, hospital admissions, child protection, mortality) to identify liveborn offspring ( n = 1046) born 1980–1995 to mothers with schizophrenia, comparing them to offspring of mothers with no recorded psychiatric history ( n = 298,370). Results: Both maternal schizophrenia and pregnancy complications were each significantly associated with psychotic illness in offspring, with no interaction. Non-obstetric environmental stressors significantly associated with psychotic illness in offspring included the following: being Indigenous; having a mother who was not in a partnered relationship; episodes of disrupted parenting due to hospitalisation of mother, father or child; abuse in childhood; and living in areas of greatest socioeconomic disadvantage and with elevated rates of violent crime. Adjustment for these other environmental stressors reduced the hazard ratio for maternal schizophrenia substantially (from hazard ratio: 5.7, confidence interval: 4.5–7.2 to hazard ratio: 3.5, confidence interval: 2.8–4.4), but not the estimate for pregnancy complications (hazard ratio: 1.1, confidence interval: 1.0–1.2). The population attributable fraction for maternal schizophrenia was 1.4 and for pregnancy complications was 2.1. Conclusion: Our finding of a substantial decrease in risk of psychotic illness associated with familial liability for psychosis following adjustment for other environmental stressors highlights potentially modifiable risk factors on the trajectory to psychotic illness and suggests that interventions that reduce or manage exposure to these risks may be protective, despite a genetic liability.
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Chadwick, Verity L., Georgia Mills, Pietro R. Di Ciaccio, Catherine Tang, Rachel Dear, John Moore, Sam Milliken, et al. "A Minority of Women of Child Bearing Potential Are Tested for Pregnancy before Chemoimmunotherapy: An Australian Cancer Centre Experience." Blood 138, Supplement 1 (November 5, 2021): 4940. http://dx.doi.org/10.1182/blood-2021-154028.
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Abstract Background: Chemotherapy is potentially harmful to the developing foetus and there is limited data on the foetal impact of immunotherapy except for rituximab. Therefore determining pregnancy status prior to initiation of chemo- and or immuno-therapy (CIT) should be standard of care. Repeat screening or testing during and after chemotherapy should be considered as women often cannot tell that they are pregnant due to overlapping symptoms of pregnancy, malignancy and treatment. This is of particular importance in women who are not on effective forms of contraception for personal choice or clinical reasons. Clinicians cannot presume that a patient's pregnancy status has been checked, or rely on any assumptions of abstinence, contraception or infertility based on secondary amenorrhoea. While CIT teratogenicity should be part of the informed consent discussion and it is recommended that pregnancy screening occur prior to CIT, there are no specific guidelines on this or on testing during CIT. It is our institutional standard to document consent using a standard tick box form to confirm a discussion of common and uncommon side effects of treatment, long term and life threating complications and impacts on fertility. Teratogenicity, pregnancy implications or contraception are not specified. We performed a retrospective review to evaluate the uptake of pregnancy screening prior to and during first-line CIT as well as an audit of documentation of contraception counselling in haematological and solid-organ malignancies at a large Australian tertiary cancer centre. Methods: We searched our electronic outpatient medical record database for Women of Child Bearing Potential (WoCBP) who were diagnosed with a malignancy and received outpatient based CIT between May 1 2015 and June 12 2020. WoCBP was defined as women 18-55 years of age with no record of menopause or definitive infertility. We captured patient demographics, disease details and CIT regimen. We collected result of any serum or urine b-HCG pregnancy tests done within 90 days prior to or during CIT administration and if positive, the pregnancy outcome. We captured any documentation regarding contraception prior to or during treatment. Results: A total of 415 WoCBP with a median age of 42 years (range 19-51) were included. The majority of women (79.3%) were treated for solid organ malignancies compared to haematological malignancies (20.7%) (Table 1). Only 17.1% were screened for pregnancy prior to its initiation. The average time between screening and CIT initiation was 19.5 days (range 0-90 days). Given the broad range of regimens and taking into consideration teratogenicity potential, CIT was categorised as immunotherapy alone (32.5%), chemotherapy containing an alkylating agent (25.8%) or an antimetabolite (3.9%), combination chemoimmunotherapy (15.2%) and other (22.7%). Rates of pregnancy screening within these categories is represented in Figure 1. One patient with early breast cancer had a positive pregnancy test during her 4 th cycle of adjuvant chemotherapy with paclitaxel, in the emergency department for a presentation of nausea, anorexia, abdominal pain and diarrhoea. The outcome in this case was an early spontaneous miscarriage estimated at 3-4 weeks gestation. This is the only patient who had a pregnancy test beyond the first cycle of CIT. Only 14.8% of patients had documentation of past or present contraception methods. None of the patients had documentation regarding counselling on recommended forms of contraception. Conclusion: A minority of WoCBP received a pregnancy test prior to commencing CIT for haematological or solid organ malignancy, and none intentionally received a test prior to subsequent chemotherapy cycles through the oncology/haematology service. Also none of the women had documented counselling on contraception. These results are concerning because missing a positive pregnancy test puts women at risk of foetal complications, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. Our results are consistent with the 2 other reports on this topic and are likely generalizable to other cancer centres. This highlights the urgent need for guidelines to increase the rate of pregnancy testing in WoCBP receiving CIT and contraception counselling prior to CIT. Figure 1 Figure 1. Disclosures Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
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Roberts, Claire, Steven Thompson, Denise Furness, Shalem Lee, Paul Anderson, Howard Morris, and Gus Dekker. "M13.4 Vitamin D related genes and maternal circulating 250H vitamin D3 associate with pregnancy complications in an Australian population." Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health 1 (October 2010): S10—S11. http://dx.doi.org/10.1016/s2210-7789(10)60053-0.
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Roberts, C. T., S. Thompson, D. Furness, S. Lee, P. Anderson, H. Morris, and G. Dekker. "Season, vitamin D-related genes and maternal circulating 25OH vitamin D3 associate with pregnancy complications in an Australian population." Journal of Reproductive Immunology 86, no. 1 (August 2010): 66. http://dx.doi.org/10.1016/j.jri.2010.06.141.
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Gete, Dereje G., Michael Waller, and Gita D. Mishra. "Prepregnancy dietary patterns and risk of preterm birth and low birth weight: findings from the Australian Longitudinal Study on Women's Health." American Journal of Clinical Nutrition 111, no. 5 (April 13, 2020): 1048–58. http://dx.doi.org/10.1093/ajcn/nqaa057.
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ABSTRACT Background Findings from previous studies on associations between prepregnancy dietary patterns and preterm birth and low birth weight (LBW) are limited and inconsistent. Objectives To examine the association between prepregnancy dietary patterns and the risk of preterm birth and LBW. Methods This study included 3422 and 3508 singleton live births from the Australian Longitudinal Study on Women's Health (ALSWH) for the analyses of preterm birth and LBW, respectively. We included women who were nulliparous and nonpregnant at baseline surveys. We used factor analyses and the Healthy Eating Index-2015 (HEI-2015) score to derive maternal dietary patterns. Four dietary patterns were identified with factor analyses: meats and high-fats; prudent diets; sugar, refined grains, and processed foods; and traditional vegetables. Preterm birth and LBW were assessed using maternal reports from ALSWH data between 2003 and 2015. Multivariable logistic regression analyses were used. Results Greater adherence to the traditional vegetables pattern before pregnancy was associated with a lower risk of preterm birth and spontaneous preterm birth after adjustments for lifestyle factors and pregnancy complications, highest compared with lowest tertile (adjusted OR = 0.72, 95% CI: 0.53, 0.99) and (RR ratio = 0.62, 95% CI: 0.39, 1.00), respectively. However, these associations were attenuated by the prepregnancy BMI. No significant associations were observed between prepregnancy dietary patterns and LBW. Conclusion This study suggests that better adherence to the traditional vegetables pattern before pregnancy is associated with a lower risk of preterm birth, particularly spontaneous preterm birth among nulliparous women. This finding warrants further examination.
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Wills, Hannah, Jim Tsaltas, Michael J. W. Cooper, Geoffrey D. Reid, Matthew Morgan, Rod Woods, and Oshri Barel. "Laparoscopic Surgery for Colorectal Endometriosis and its Impact upon Fertility: An Updated Australian Series of 307 Cases." Journal of Endometriosis and Pelvic Pain Disorders 9, no. 3 (May 27, 2017): 193–99. http://dx.doi.org/10.5301/jeppd.5000289.
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Introduction Colorectal involvement occurs in up to 12% of cases of endometriosis. Various surgical options for its management have been described, including segmental resection and disc excision, with debate surrounding indications for surgery and the impact of such procedures. The current study aimed to describe the experiences of three Australian gynaecologists regarding laparoscopic bowel surgery for colorectal endometriosis. Methods The records of three gynaecological surgeons were analysed for patients who underwent surgical removal of colorectal endometriosis by way of appendicectomy, bowel disc excision and/or segmental resection, between 1999 and 2012. Results A total of 307 patients were identified. Sixteen (5.2%) underwent appendicectomy, 146 (47.6%) underwent disc excision, 126 (41.0%) underwent segmental resection and 19 (6.2%) underwent simultaneous procedures. The majority of procedures were performed laparoscopically (265 of 307; 86.3%). Nineteen procedures (6.2%) were planned laparotomies due to the known extent of disease. Twenty-three procedures were converted from laparoscopy to laparotomy (conversion rate of 7.5%). Complications occurred in 35 of the 307 cases (11.4%). Sixty-seven women amongst the 122 wishing to conceive post-operatively achieved at least one pregnancy (pregnancy rate of 54.9%). Of the 84 pregnancies achieved amongst the 67 women who conceived, 49 (58.3%) were achieved through assisted reproductive technologies, and 31 pregnancies (36.9%) were conceived spontaneously. This information was unavailable for 4 pregnancies (4.8%). Conclusions The current series demonstrates that laparoscopic surgery for severe disease is feasible in specialised centres. Furthermore, such surgery may have a positive impact upon post-operative fertility.
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Tatarczuch, Maciek, John F. Seymour, Louise Creati, Elchanan H. Januszewicz, and Kate Burbury. "Pulmonary Hypertension (PHT) and Pleural Effusion During Dasatinib Therapy For CML Frequently Lead To Drug Withdrawal." Blood 122, no. 21 (November 15, 2013): 1504. http://dx.doi.org/10.1182/blood.v122.21.1504.1504.
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Abstract Aim/Background Imatinib, a tyrosine-kinase inhibitor (TKI), first line therapy for chronic myeloid leukemia in chronic phase (CML-CP) for over a decade, has an established side-effect profile. Clinical trials with 2nd generation (2G) TKIs have significantly deeper and faster cytogenetic and major molecular responses (MMR), though impact on long-term toxicity and survival remains to be determined. Dasatinib (DAS), an oral 2G TKI 350x more potent than imatinib in vitro, is generally well tolerated, with <15% patients in clinical trials requiring change in therapy due to adverse events (AE). However, potentially life-threatening PHT or pleural effusions can occur in up to 10% and 25% respectively. Little is known about this important toxicity, in terms of risk factors and natural history (including reversibility post drug cessation or dose modifications). We present our local experience with DAS, with a focus on pulmonary toxicity. Methods Retrospective review of all patients treated with DAS at PMCC (Melbourne, Australia) April 2003-July 2013. Patient data including demographics, disease characteristics, co-morbidities, pathology, radiology, TKI regimens, clinical course and AE were extracted from institution electronic records. Results Cohort included 37 patients: 33 CML-CP, 1 CML in accelerated phase, 1 post allograft relapsed Ph+ Acute Lymphoblastic Leukemia, 2 Ph+ Acute Myeloid Leukemia. 13/37 (35%) developed clinically significant pulmonary toxicity, including 9 (24%) patients with transthoracic echocardiography (TTE) evidence of elevated resting right ventricular pulmonary venous pressures (RVSP) whilst on DAS: 5 (14%) confirmed PHT (RVSP>36 mmHg), 3 (8%) RVSP in upper limit of normal (RVSP 30-36mmHg) and 1 with RVSP>30 post DAS cessation (RVSP not available during therapy). 7 (19%) were symptomatic of PHT, 4 (11%) required medical management. 12/37 (32%) had radiological evidence of pleural effusion: 10 (27%) symptomatic, 5 (14%) bilateral, 5 (14%) right sided, 2 (5%) left sided. 7 (19%) patients with PHT had associated pleural effusion (5/5 with RVSP >36, 2 RVSP>30), however 5 (14%) developed symptomatic pleural effusions without evidence of PHT. 6 (16%) patients required surgical intervention (5 drainage, 1 pleurodesis). 2 (5%) had persistent symptoms despite DAS cessation. RVSP normalised in 3 patients post DAS cessation (median time 24 months, range 1-26) but did not in 1 patient (follow up: 38 months). Serial TTEs were not performed in 5 patients. Risk factors (e.g. cardiovascular, pulmonary, other medications, vasculitides, disease status) were not more prominent in the PHT group, though a statistically significant difference in age between the two groups was noted. Of the entire cohort, 23/37 (62%) have ceased DAS for the following reasons: 8 (22%) disease progression, 5 (14%) PHT, 1 (3%) pleural effusion (without associated PHT), 4 (11%) other DAS-related toxicity, 2 (5%) sustained MMR, 1 (3%) sepsis, 1 (3%) pregnancy, 1 (3%) acute coronary syndrome. Conclusion The current model of TKIs use in CML requires life-long therapy, which demands durable tolerability and safety. We found clinically relevant pulmonary complications of DAS therapy to be more frequent than previously reported, perhaps due to non-specific symptoms and low levels of awareness. We now recommend obtaining baseline chest X-ray and TTE prior to DAS therapy. Any new pulmonary signs or symptoms warrant early investigation, including repeat TTE for assessment of pulmonary arterial pressures. Moreover, the patient’s capacity to tolerate PHT or pleural effusions, although difficult to predict, should be considered in choice of TKI agent. Disclosures: No relevant conflicts of interest to declare.
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Grace, Rachael F., Paola Bianchi, Bertil Glader, Andreas Glenthøj, Bryan Jones, Hitoshi Kanno, Kevin H. M. Kuo, et al. "An Ongoing Global, Longitudinal, Observational Study of Patients with Pyruvate Kinase Deficiency: The PEAK Registry." Blood 134, Supplement_1 (November 13, 2019): 2223. http://dx.doi.org/10.1182/blood-2019-123059.
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Pyruvate kinase (PK) deficiency is an autosomal recessive disease caused by mutations in the PKLR gene that lead to reduced red blood cell PK (PK-R) enzyme activity. This rare hereditary glycolytic enzymopathy, with over 300 causative PKLR mutations identified to date, results in defective red blood cell glycolysis and hemolytic anemia. While the clinical presentation is variable, patients with PK deficiency may experience symptoms of hemolytic anemia, most commonly fatigue (sometimes extreme), jaundice, and dyspnea. No disease-specific therapy currently exists and treatment is limited to supportive care, including red blood cell transfusions, splenectomy/cholecystectomy, and iron chelation. Affected neonates may need phototherapy or exchange transfusions for severe hyperbilirubinemia. Allogeneic stem cell transplantation may cure the disease but experience is limited and the outcome is variable. Due the rarity of PK deficiency, its prevalence, clinical burden, and long-term clinical course are not well defined. To address this gap, Boston Children's Hospital is nearing completion of the observational PK deficiency Natural History Study (ClinicalTrials.gov NCT02053480; N=254) to better understand the natural history and clinical burden of the disease. This longitudinal analysis (2-year follow-up) will report on PK deficiency-related signs, symptoms, and treatment outcomes. In order to continue and expand upon the collection of longitudinal data for PK deficiency, the Pyruvate Kinase Deficiency Global Longitudinal Registry (the PEAK Registry; NCT03481738) was developed. This registry study is a global, longitudinal, observational study for adult and pediatric patients with PK deficiency. Its primary objective is to record the natural history, treatment, outcomes, variability in clinical manifestations, and disease burden of patients with PK deficiency. Secondary objectives include data collection to assess the prevalence, incidence, and complications associated with PK deficiency; evaluate pregnancy outcomes; and investigate possible phenotype-genotype correlations. The study also aims to provide longitudinal data to assist physicians with the clinical management of individual patients. In order to maximize the amount of longitudinal data available, a novel data management system is being employed to harmonize Natural History Study and PEAK Registry data. Approximately 500 patients will be enrolled over 7 years at an estimated 60 study centers in up to 20 countries in the 9-year study. All enrolled patients will be followed prospectively for at least 2 years and up to 9 years. Site and patient recruitment began in 2018. As of July 2019, 43 sites in 11 countries are active (Figure) and site recruitment has begun in Thailand, South Korea, and Australia. An update on patient enrollment will be provided. Disclosures Grace: Agios Pharmaceuticals, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding. Bianchi:Agios Pharmaceuticals, Inc.: Consultancy. Glader:Agios Pharmaceuticals, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Glenthøj:Celgene: Consultancy; Novo Nordisk: Honoraria; Alexion: Research Funding; Novartis: Consultancy; Agios Pharmaceuticals, Inc.: Consultancy. Jones:Agios Pharmaceuticals, Inc.: Employment, Equity Ownership. Kanno:Agios Pharmaceuticals, Inc.: Honoraria. Kuo:Pfizer: Consultancy; Novartis: Consultancy, Honoraria; Celgene: Consultancy; Bluebird Bio: Consultancy; Bioverativ: Other: Data Safety Monitoring Board; Agios: Consultancy; Alexion: Consultancy, Honoraria; Apellis: Consultancy. Layton:Novartis: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; Cerus Corporation: Membership on an entity's Board of Directors or advisory committees. van Beers:Pfizer: Research Funding; RR Mechatronics: Research Funding; Agios Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Research Funding. Xu:Agios: Employment, Equity Ownership.
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Andraweera, P. H., S. D. Thompson, R. C. Nowak, V. J. Zhang, G. A. Dekker, and C. T. Roberts. "161. PATERNAL AND FETAL SINGLE NUCLEOTIDE POLYMORPHISMS IN KDR GENE ASSOCIATE WITH PREECLAMPSIA AND INTRAUTERINE GROWTH RESTRICTION." Reproduction, Fertility and Development 21, no. 9 (2009): 79. http://dx.doi.org/10.1071/srb09abs161.
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Introduction: Preeclampsia (PE) and intrauterine growth restriction (IUGR) together contribute to maternal and neonatal morbidity and mortality. Abnormal placental angiogenesis is implicated in these pregnancy complications. KDR is the main receptor for vascular endothelial growth factor, a potent angiogenic factor which regulates placental angiogenesis. Derangements in KDR expression are known to result in abnormal angiogenesis. We aimed to determine whether polymorphisms in KDR gene (KDR T604C and KDR C1192C) are associated with PE and IUGR. Methods: 1169 nulliparous pregnant women and their partners were recruited prospectively at the Lyell McEwin Hospital and women monitored throughout pregnancy. PE and IUGR were classified using strict guidelines. Uncomplicated pregnancies were deemed controls. Peripheral blood was collected from couples and cord blood collected at delivery. DNA extraction from buffy coats and genotyping were performed at the Australian Genome Research Facility using the Sequenom MassARRAY system. Genotypes for PE (n=63) and IUGR (n=94) were compared with controls (n=373) and analysed using ANOVA and Chi Square. Odds Ratios (OR) were calculated. Results: Paternal and neonatal KDR T604C were associated with PE (p=0.028, OR=1.9, 95%CI=1.08–3.34 and p=0.008, OR=2.5, 95%CI=1.3–4.78). Paternal and neonatal KDR T604C were associated with IUGR (p=0.005, OR=2.01, 95%CI=1.24–3.25 and p=0.01, OR=1.15, 95% CI=1.22–3.79). Neonates with KDR T604C CC genotype were 144.5g lighter than those with the TT genotype (p=0.05). Mean customised birth weight centile was 8.7 lower for fathers with KDR T604C CC genotype compared to CT (p=0.041). KDR C1192T SNP was not associated with outcome. Conclusion: Our results suggest that KDR T604C polymorphism is associated with both PE and IUGR. We are the first to demonstrate an association between paternal KDR polymorphisms and pregnancy complications. Paternal genes acting via the placenta appear to contribute to the risk of PE and IUGR. Ongoing research will determine the role of these polymorphisms in placental angiogenesis.
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Roberts, Claire, Steven Thompson, Denise Furness, Paul Anderson, Howard Morris, and Gustaaf Dekker. "729: Season and vitamin D related genes but not maternal circulating 25OH vitamin D associate with pregnancy complications in an Australian population." American Journal of Obstetrics and Gynecology 201, no. 6 (December 2009): S263. http://dx.doi.org/10.1016/j.ajog.2009.10.746.
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Rosian, Katharina. "VP14 Screening Recommendations For Socioeconomic Disadvantages In Pregnancy." International Journal of Technology Assessment in Health Care 33, S1 (2017): 152. http://dx.doi.org/10.1017/s0266462317003087.
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INTRODUCTION:In 2015, 18.3 percent of the Austrian population were at risk of poverty and social exclusion - about 211,000 (20 percent) women aged 20–39 years were affected. International studies report that poverty may lead to an increased risk of complications and pathologies during pregnancy. Further, children who grow up in poverty often have poorer long-term health outcomes.METHODS:In order to identify recent guidelines (2011-2016) a comprehensive handsearch was conducted in the guideline databases National Guideline Clearinghouse (NGC) and Guidelines International Network (GIN). Moreover, a handsearch for systematic reviews and primary studies was conducted in PubMed.RESULTS:Two guidelines, the British National Institute for Health and Clinical Excellence (NICE) Guideline “Pregnancy and Complex Social Factors”, as well as the Australian Health Ministers' Advisory Council (AHMAC) Guideline “Antenatal Care”, address socioeconomic disadvantages of women during antenatal care. The recommendation of the AHMAC is that pregnancy care should be offered to all pregnant women. In addition, an individual approach will help to pay particular attention to socioeconomic factors and to incorporate them in routine examinations. NICE recommends in its guideline, affected women should be supported in order to ensure adequate prenatal care. NICE also defines criteria which are used to identify pregnant women who are in greater need of support. The only identified study developed and tested a tool for the identification of patients affected by poverty. The authors of this Canadian pilot study concluded that the defined questions helped to identify socioeconomically disadvantaged persons during anamnesis without stigmatizing.CONCLUSIONS:Due to the proven link between poverty and health risks, special attention must be paid to socioeconomically disadvantaged pregnant women. Research on non-stigmatizing instruments, which can identify vulnerable women, is of great importance. In addition to social policy measures, it is necessary to ensure that low-threshold services are available for socioeconomic disadvantaged women and their children.
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Hayman, Melanie J., Kristie-Lee Alfrey, Kim Waters, Summer Cannon, Gregore I. Mielke, Shelley E. Keating, Gabriela P. Mena, et al. "Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis." JMIR mHealth and uHealth 10, no. 1 (January 19, 2022): e31607. http://dx.doi.org/10.2196/31607.
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Background Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps.
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Green, Melissa J., Stacy Tzoumakis, Kristin R. Laurens, Kimberlie Dean, Maina Kariuki, Felicity Harris, Nicole O’Reilly, Marilyn Chilvers, Sally A. Brinkman, and Vaughan J. Carr. "Latent profiles of early developmental vulnerabilities in a New South Wales child population at age 5 years." Australian & New Zealand Journal of Psychiatry 52, no. 6 (November 6, 2017): 530–41. http://dx.doi.org/10.1177/0004867417740208.
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Objective: Detecting the early emergence of childhood risk for adult mental disorders may lead to interventions for reducing subsequent burden of these disorders. We set out to determine classes of children who may be at risk for later mental disorder on the basis of early patterns of development in a population cohort, and associated exposures gleaned from linked administrative records obtained within the New South Wales Child Development Study. Methods: Intergenerational records from government departments of health, education, justice and child protection were linked with the Australian Early Development Census for a state population cohort of 67,353 children approximately 5 years of age. We used binary data from 16 subdomains of the Australian Early Development Census to determine classes of children with shared patterns of Australian Early Development Census–defined vulnerability using latent class analysis. Covariates, which included demographic features (sex, socioeconomic status) and exposure to child maltreatment, parental mental illness, parental criminal offending and perinatal adversities (i.e. birth complications, smoking during pregnancy, low birth weight), were examined hierarchically within latent class analysis models. Results: Four classes were identified, reflecting putative risk states for mental disorders: (1) disrespectful and aggressive/hyperactive behaviour, labelled ‘misconduct risk’ ( N = 4368; 6.5%); (2) ‘pervasive risk’ ( N = 2668; 4.0%); (3) ‘mild generalised risk’ ( N = 7822; 11.6%); and (4) ‘no risk’ ( N = 52,495; 77.9%). The odds of membership in putative risk groups (relative to the no risk group) were greater among children from backgrounds of child maltreatment, parental history of mental illness, parental history of criminal offending, socioeconomic disadvantage and perinatal adversities, with distinguishable patterns of association for some covariates. Conclusion: Patterns of early childhood developmental vulnerabilities may provide useful indicators for particular mental disorder outcomes in later life, although their predictive utility in this respect remains to be established in longitudinal follow-up of the cohort.
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Jamieson, Emma L., Erica P. Spry, Andrew B. Kirke, David N. Atkinson, and Julia V. Marley. "Real-World Gestational Diabetes Screening: Problems with the Oral Glucose Tolerance Test in Rural and Remote Australia." International Journal of Environmental Research and Public Health 16, no. 22 (November 14, 2019): 4488. http://dx.doi.org/10.3390/ijerph16224488.
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Gestational diabetes mellitus (GDM) is the most common antenatal complication in Australia. All pregnant women are recommended for screening by 75 g oral glucose tolerance test (OGTT). As part of a study to improve screening, 694 women from 27 regional, rural and remote clinics were recruited from 2015–2018 into the Optimisation of Rural Clinical and Haematological Indicators for Diabetes in pregnancy (ORCHID) study. Most routine OGTT samples were analysed more than four hours post fasting collection (median 5.0 h, range 2.3 to 124 h), potentially reducing glucose levels due to glycolysis. In 2019, to assess pre-analytical plasma glucose (PG) instability over time, we evaluated alternative sample handling protocols in a sample of participants. Four extra samples were collected alongside routine room temperature (RT) fluoride-oxalate samples (FLOXRT): study FLOXRT; ice slurry (FLOXICE); RT fluoride-citrate-EDTA (FC Mix), and RT lithium-heparin plasma separation tubes (PST). Time course glucose measurements were then used to estimate glycolysis from ORCHID participants who completed routine OGTT after 24 weeks gestation (n = 501). Adjusting for glycolysis using FLOXICE measurements estimated 62% under-diagnosis of GDM (FLOXRT 10.8% v FLOXICE 28.5% (95% CI, 20.8–29.5%), p < 0.001). FC Mix tubes provided excellent glucose stability but gave slightly higher results (Fasting PG: +0.20 ± 0.05 mmol/L). While providing a realistic alternative to the impractical FLOXICE protocol, direct substitution of FC Mix tubes in clinical practice may require revision of GDM diagnostic thresholds.
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Pereira, Lenore, Takako Tabata, and Matthew Petitt. "Cytomegalovirus infection and pathogenesis in the human placenta." Microbiology Australia 36, no. 4 (2015): 171. http://dx.doi.org/10.1071/ma15061.
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Human cytomegalovirus (HCMV) is the most common cause of congenital viral infection. Affected children can have permanent neurological complications, including hearing loss, visual impairment and mental retardation1–3. In Australia, 57% of women are seronegative and at risk for primary infection and transmission of virus to the fetus during pregnancy4. Despite its public health significance, the specific molecular and cellular basis of HCMV replication in the human placenta and pathogenesis associated with poor clinical outcome are unknown. Direct fetal infection is involved in severe cases of neuropathology and infection of the placenta can impair its development and functions resulting in a hypoxic environment5–8 and stillbirth6,9,10. Gestational age at the time of infection is an important determinant of outcome. The rates of virus transmission increase from 30% in first trimester to over 70% in third trimester suggesting different mechanisms for overcoming the placental barrier2. Remarkable insights into viral pathogenesis factors that function in the tissue environment have been gained by studying congenitally infected placentas and explants infected by clinical strains ex vivo. Together these studies revealed that direct infection of specialised placental cells and paracrine factors contribute to impaired development and functional defects.