ORCID Profile
0000-0001-7141-2086
Current Organisations
Royal Women's Hospital
,
UNSW Sydney
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Publisher: Informa UK Limited
Date: 08-06-2019
DOI: 10.1080/02770903.2018.1471709
Abstract: Asthma exacerbations and medication non-adherence are significant clinical problems during pregnancy. While asthma self-management education is effective, the number of education sessions required to maximise asthma management knowledge and inhaler technique and whether improvements persist postpartum, are unknown. This paper describes how asthma knowledge, skills, and inhaled corticosteroid (ICS) use have changed over time. Data were obtained from 3 cohorts of pregnant women with asthma recruited in Newcastle, Australia between 2004 and 2017 (N = 895). Medication use, adherence, knowledge, and inhaler technique were compared between cohorts. Changes in self-management knowledge/skills and women's perception of medication risk to the fetus were assessed in 685 women with 5 assessments during pregnancy, and 95 women who had a postpartum assessment. At study entry, 41%, 29%, and 38% of participants used ICS in the 2004, 2007, and 2013 cohorts, respectively (p = 0.017), with 40% non-adherence in each cohort. Self-management skills of pregnant women with asthma did not improve between 2004 and 2017 and possession of a written action plan remained low. Maximum improvements were reached by 3 sessions for medications knowledge and one session for inhaler technique, and were maintained postpartum. ICS adherence was maximally improved after one session, but not maintained postpartum. Perceived risk of asthma medications on the fetus was highest for corticosteroid-containing medication and was significantly reduced following education. There was a high prevalence of non-adherence and poor self-management skills in all cohorts. More awareness of the importance of optimal asthma management during pregnancy is warranted, since no improvements were observed over the past decade.
Publisher: MDPI AG
Date: 27-11-2019
DOI: 10.3390/NU11122888
Abstract: In animal studies, vitamin D supplementation has been shown to improve gut microbiota and intestinal inflammation. However, limited evidence exists on the effect of vitamin D supplementation on the human gut microbiota. We examined the effect of vitamin D supplementation on faecal microbiota in 26 vitamin D-deficient (25-hydroxyvitamin D (25(OH)D) ≤50 nmol/L), overweight or obese (BMI ≥25 kg/m2) otherwise healthy adults. Our study was ancillary to a community based double-blind randomised clinical trial, conducted between 2014 and 2016. The participants provided stool s les at baseline and after 100,000 international units (IU) loading dose of cholecalciferol followed by 4000 IU daily or matching placebo for 16 weeks. Faecal microbiota was analysed using 16S rRNA sequencing V6–8 region. There was no significant difference in microbiome α- ersity between vitamin D and placebo groups at baseline and follow-up (all p 0.05). In addition, no clustering was found based on vitamin D supplementation at follow-up (p = 0.3). However, there was a significant association between community composition and vitamin D supplementation at the genus level (p = 0.04). The vitamin D group had a higher abundance of genus Lachnospira, and lower abundance of genus Blautia (linear discriminate analysis .0). Moreover, in iduals with 25(OH)D nmol/L had a higher abundance of genus Coprococcus and lower abundance of genus Ruminococcus compared to those with 25(OH)D nmol/L. Our findings suggest that vitamin D supplementation has some distinct effects on faecal microbiota. Future studies need to explore whether these effects would translate into improved clinical outcomes.
Publisher: Elsevier BV
Date: 09-2014
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.DIABRES.2012.10.013
Abstract: Pregnancy in women with type 1 diabetes mellitus (T1DM) is generally associated with increased insulin requirements. To determine the frequency and significance of declining insulin requirements in late gestation in women with T1DM. We conducted a retrospective review of 54 women seen at our institution from 2006 to 2010 with a diagnosis of T1DM pre-pregnancy and presentation for antenatal care prior to 28 weeks. Information was collected regarding patient demographics, insulin dose and pregnancy outcome. A 15% difference in weight-adjusted basal insulin from 30 weeks gestation to delivery was considered significant. Five women (9.3%) had a fall of 15% or more and 23 (42.5%) had a rise of 15% or more rise in insulin requirements. There were fewer neonatal intensive care admissions but more infants with an APGAR <8 at 5 min in women with a fall in insulin requirements. These differences were not evident when the data were re-analysed by quartiles of change. In most women with T1DM, insulin requirements show little change from 30 weeks gestation until delivery. Almost 10% of women had a significant fall in insulin requirements which did not correlate with adverse neonatal outcome. These results require validation in a larger, prospective trial.
Publisher: American Diabetes Association
Date: 10-04-2014
DOI: 10.2337/DC13-1934
Abstract: Outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus have improved, but there is still excess morbidity compared with normal pregnancy. Management strategies appropriately focus on maternal glycemia, which demonstrably improves pregnancy outcomes for mother and infant. However, we may be reaching the boundaries of obtainable glycemic control for many women. It has been acknowledged that maternal lipids are important in pregnancies complicated by diabetes. Elevated maternal lipids are associated with preecl sia, preterm delivery, and large-for-gestational-age infants. Despite this understanding, assessment of management strategies targeting maternal lipids has been neglected to date. Consideration needs to be given to whether normalizing maternal lipids would further improve pregnancy outcomes. This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether it is time to start actively managing this aspect of maternal metabolism.
Publisher: American Diabetes Association
Date: 13-02-2013
DOI: 10.2337/DC12-1097
Abstract: This study was designed to compare glucose, lipids, and C-reactive protein (CRP) in women with gestational diabetes mellitus treated with metformin or insulin and in cord plasma of their offspring and to examine how these markers relate to infant size at birth. Women with gestational diabetes mellitus were randomly assigned to metformin or insulin in the Metformin in Gestational Diabetes trial. Fasting maternal plasma glucose, lipids, and CRP were measured at randomization, 36 weeks’ gestation, and 6–8 weeks postpartum as well as in cord plasma. Women with available cord blood s les (metformin n = 236, insulin n = 242) were included. Maternal plasma triglycerides increased more from randomization to 36 weeks’ gestation in women treated with metformin (21.93%) versus insulin (9.69%, P & 0.001). Maternal and cord plasma lipids, CRP, and neonatal anthropometry did not differ between treatments. In logistic regression analyses adjusted for confounders, the strongest associations with birth weight & th centile were maternal triglycerides and measures of glucose control at 36 weeks. There were few differences in circulating maternal and neonatal markers of metabolic status and no differences in measures of anthropometry between the offspring of women treated with metformin and the offspring of women treated with insulin. There may be subtle effects of metformin on maternal lipid function, but the findings suggest that treating gestational diabetes mellitus with metformin does not adversely affect lipids or CRP in cord plasma or neonatal anthropometric measures.
Publisher: Frontiers Media SA
Date: 22-08-2018
Publisher: MDPI AG
Date: 05-10-2021
DOI: 10.3390/NU13103511
Abstract: Studies of obstetric outcomes in women consuming low-carbohydrate diets have reported conflicting results. Most studies have defined low-carbohydrate diets by the percentage that carbohydrates contribute to overall energy intake, rather than by an absolute amount in grams per day (g/d). We hypothesised that a low absolute carbohydrate diet affects obstetric outcomes differently than a low percentage carbohydrate diet. Dietary data were collected from overweight or obese women in the Study of Probiotic IN Gestational diabetes at 16- and 28-weeks’ gestation. Obstetric outcomes were compared between women whose carbohydrate intake was in the lowest quintile vs quintiles 2–5. Mean gestation was increased in women whose absolute carbohydrate intake was in the lowest quintile at 16 and at both 16- and 28-weeks’ gestation compared with all other women (16: 39.7 vs. 39.1 weeks, p = 0.008 16 and 28: 39.8 vs. 39.1, p = 0.005). In linear regression analysis, a low absolute carbohydrate intake at 16 and at 28 weeks’ gestation was associated with increased gestation at delivery (16: p = 0.04, adjusted R2 = 0.15, 28: p = 0.04, adjusted R2 = 0.17). The coefficient of beta at 16 weeks’ gestation was 0.50 (95% CI 0.03–0.98) and at 28 weeks’ gestation was 0.51 (95%CI 0.03–0.99) meaning that consumption of a low absolute carbohydrate diet accounted for an extra 3.5 days in gestational age. This finding was not seen in women whose percentage carbohydrate intake was in the lowest quintile. Low-carbohydrate consumption in pregnancy is associated with increased gestational age at delivery.
Publisher: Wiley
Date: 26-08-2021
DOI: 10.1111/AJO.13418
Abstract: In this clinical review we highlight aspects of the diagnosis and management of pulmonary embolism (PE) in pregnancy and post‐partum and how this may impact on antenatal and postnatal management. Investigation for PE in pregnancy is challenging and includes appropriate patient selection and knowledge of the risks and benefits of pulmonary imaging modalities. The complete Society of Obstetric Medicine of Australia and New Zealand Position Statement on Pulmonary Embolism in Pregnancy and Post‐Partum comprehensively reviews all aspects of diagnosis, investigation and management and is accessible at uidelines.asp . It includes a summary of all recommendations and a guide to developing a management plan for birth in women on anticoagulation.
Publisher: Springer Science and Business Media LLC
Date: 11-11-2015
DOI: 10.1007/S11892-014-0567-0
Abstract: Complications of pregnancy are associated with adverse outcomes for mother and baby in the short and long term. The gut microbiome has been identified as a key factor for maintaining health outside of pregnancy and could contribute to pregnancy complications. In addition, the vaginal and the recently revealed placental microbiome are altered in pregnancy and may play a role in pregnancy complications. Probiotic supplementation could help to regulate the unbalanced microflora composition observed in obesity and diabetes. Here, the impact of probiotic supplementation during pregnancy and infancy is reviewed. There are indications for a protective role in preecl sia, gestational diabetes mellitus, vaginal infections, maternal and infant weight gain and allergic diseases. Large, well-designed randomised controlled clinical trials along with metagenomic analysis are needed to establish the role of probiotics in adverse pregnancy and infancy outcomes.
Publisher: Springer International Publishing
Date: 11-10-2017
Publisher: Wiley
Date: 04-2009
Publisher: The Endocrine Society
Date: 04-2014
DOI: 10.1210/JC.2013-2581
Abstract: Fibroblast growth factor 21 (FGF21) can regulate glucose and lipid metabolism. The placenta actively synthesizes and secretes many hormones, but it is unknown whether this includes FGF21. This study aimed to analyze the placental expression of FGF21 in women with or without gestational diabetes mellitus (GDM). FGF21 and peroxisome proliferator-activated receptor (PPAR)-α mRNA and protein expression were measured in the placentae of 20 women with and 18 without GDM. mRNA expression of PPARα, FGF receptors 1-4, the coreceptor β-klotho, and glucose transporter (GLUT)-1, -3, and -4 was investigated. Maternal and fetal circulating FGF21 levels were assessed in 10 mother-baby dyads per condition. FGF21 was expressed in the placenta and its mRNA expression increased in women with GDM [10.75 (interquartile range 3.28-125.6 AU)] vs control [0.83 (0.22-4.78), P < .001], as is its protein expression [GDM 2.89 (1.44-5.10)] vs control [0.42 (0.05-1.98), P < .05]. PPARα mRNA but not protein expression was increased in GDM [2.94 (0.70-7.26)] vs control [0.99 (0.43-2.17), P < .05] and was positively correlated to FGF21 mRNA expression (ρ = 0.43, P < .01). Placental mRNA expression of FGF receptors and GLUT1 was unchanged, and β-klotho, GLUT3, and GLUT4 showed increased expression in GDM. Maternal circulating FGF21 levels were similar [GDM 323 (75-921) vs control 269 (49-731) pg/mL, P = .81]. FGF21 was undetected in fetal cord blood. FGF21 is expressed in the placenta and its expression is increased in GDM. The absence of FGF21 in fetal cord blood suggests that neither placental FGF21 nor maternal circulating FGF21 is secreted into the fetal circulation. Placental FGF21 may be a regulator of placental metabolism.
Publisher: CRC Press
Date: 17-04-2016
Publisher: The Endocrine Society
Date: 21-09-2018
Abstract: Primary hyperparathyroidism (PHPT) in pregnancy has historically been associated with substantial maternofetal morbidity and mortality rates. The optimal treatment and timing of surgical intervention in pregnancy remain contested. To compare maternofetal outcomes of medically and surgically treated patients with PHPT in pregnancy. Retrospective chart review. Quaternary referral hospital. Women with PHPT in pregnancy treated between 1 January 2000 and 31 December 2015. Medical therapy or parathyroid surgery. Timing of diagnosis maternal corrected serum calcium concentrations gestation, indication and mode of delivery complications attributable to PHPT birth weight and admission to the neonatal intensive care unit (NICU). Twenty-two pregnancies were managed medically, and six patients underwent parathyroidectomy in pregnancy (five in trimester 2, and one at 32 weeks gestation). Most patients treated medically either had a corrected serum calcium concentration <2.85 mmol/L in early pregnancy or had PHPT diagnosed in trimester 3. Of viable medically managed pregnancies, 30% were complicated by preecl sia, and preterm delivery occurred in 66% of this group. All preterm neonates required admission to the NICU for complications related to prematurity. All surgically treated patients delivered their babies at term, and there were no complications of parathyroid surgery. Maternofetal outcomes have improved relative to that reported in early medical literature in patients treated medically and surgically, but the rates of preecl sia and preterm delivery were higher in medically treated patients. The study was limited by its retrospective design and small s le sizes.
Publisher: Informa UK Limited
Date: 14-08-2014
DOI: 10.3109/10641955.2014.946614
Abstract: Pre-ecl sia continues to be a challenge--to understand the underlying pathogenesis and to prevent or treat in the clinical setting. One area of potential therapies opening up is treatment of maternal lipids and clinical trials are underway using statins in early pre-ecl sia. At present, most potential therapies to treat lipids cannot be recommended for general use in pregnancy and if we were to target maternal lipids to reduce rates of pre-ecl sia, very large numbers of women may need to be treated. Prior to reaching that point, we first need to understand whether maternal lipids are pathogenic in the processes underlying pre-ecl sia. The aim of this review is to examine the role of lipids in the pathogenesis and outcomes of pre-ecl sia, how abnormal lipid genes may be implicated and consider whether treatment of hyperlipidemia has a more general place in the prevention or treatment of pre-ecl sia.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 25-02-2013
Publisher: Wiley
Date: 24-08-2016
DOI: 10.1111/AJO.12391
Abstract: Perinatal mortality and morbidity related to growth restriction and macrosomia are predicted by birthweight. Estimated fetal weight is a surrogate measure for neonatal weight, and accurate measurement of this is central to providing counselling and managing preterm birth. To assess the accuracy of estimated fetal weight (EFW) measured by two sonographers within 1 week of delivery using Hadlock formula. Two sonographers independently scanned 150 women with singleton pregnancies, who were booked for elective delivery. The sonographers measured four biometric measurements in estimating fetal weight. The accuracy of EFW compared to the birthweight was examined. We also assessed the sensitivity and specificity for diagnosis of small-for-gestational age (SGA) and large-for-gestational age (LGA) according to the EFW. Estimated fetal weight was similar to actual birthweight, with a mean percentage difference (SD) of 1.4(7.0) (P = 0.44). The reliability coefficient of EFW compared to actual birthweight was 0.97 (95% CI (0.96, 0.98)). There was no significant difference between the sonographers for EFWs and among the sonographers from the ultrasound scan to delivery interval. The sensitivity and specificity for detection of SGA and LGA were 93.3% and 99.3%, 60% and 95.6%, respectively. There is high reproducibility with minimum discrepancy from actual birthweight among sonographers 1 week prior to delivery using Hadlock formula with better prediction of SGA neonates.
Publisher: BMJ
Date: 03-2019
Publisher: American Diabetes Association
Date: 07-2018
DOI: 10.2337/DB18-1422-P
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
DOI: 10.1161/HYPERTENSIONAHA.116.07910
Abstract: The risk of developing pregnancy-induced hypertension and preecl sia is higher in obese pregnant women. In obesity, the composition of the gut microbiota is altered. Obesity is also associated with low-grade inflammation. Metabolites from the gut microbiota may contribute to both hypertension and inflammation. The aim of this study is to investigate whether the composition of the gut microbiota in overweight and obese pregnant women is associated with blood pressure and levels of plasminogen activator inhibitor-1. The composition of the gut microbiota was determined with 16S ribosomal RNA sequencing in 205 women at 16 weeks gestation from the SPRING study (the Study of Probiotics in Gestational Diabetes). Expression of butyrate-producing genes in the gut microbiota was assessed by real-time polymerase chain reaction. Plasminogen activator inhibitor-1 levels were measured in fasting serum of a subset of 70 women. Blood pressure was slightly but significantly higher in obese compared with overweight women. The abundance of the butyrate-producing genus Odoribacter was inversely correlated with systolic blood pressure. Butyrate production capacity was decreased, but plasminogen activator inhibitor-1 concentrations increased in obese pregnant women. Plasminogen activator inhibitor-1 levels were inversely correlated with expression of butyrate kinase and Odoribacter abundance. This study shows that in overweight and obese pregnant women at 16 weeks gestation, the abundance of butyrate-producing bacteria and butyrate production in the gut microbiota is significantly negatively associated with blood pressure and with plasminogen activator inhibitor-1 levels. Increasing butyrate-producing capacity may contribute to maintenance of normal blood pressure in obese pregnant women.
Publisher: Elsevier BV
Date: 06-2003
DOI: 10.1016/S0003-9993(02)04944-4
Abstract: To determine characteristics of pain, the relation between pain and mood, the effect of pain on activities, and the perceived difficulty in coping with pain in patients hospitalized for treatment of complications associated with spinal cord injury (SCI). Cohort survey. Hospital inpatient unit in Australia. Consecutive s le of patients (N=88) admitted to a hospital spinal injuries unit with complications after SCI. Two eligible patients declined to participate. Face-to-face interview with questionnaire. Pain severity, global self-rated health, mood (Kessler Mood Inventory), and interference with activities (Von Korff disability scale). Sixty-six (75%) of the 88 subjects experienced pain, with an average time of onset +/- standard deviation of 8.02+/-12.4 years 27% of those with pain described it as severe or excruciating. Subjects with pain were less likely to rate their global health as excellent or very good when compared with those who did not have pain (22% vs 44%, respectively). Patients with pain had significantly greater levels of psychologic distress than did people with SCI and no pain. Pain is a common problem in people admitted to hospital with SCI for treatment of other complications. It has a significant impact on activities and is associated with a reduction in global self-rated health and higher levels of psychologic distress.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Springer Science and Business Media LLC
Date: 06-06-2017
DOI: 10.1038/S41598-017-03066-4
Abstract: A distinct bacterial signature of the placenta was reported, providing evidence that the fetus does not develop in a sterile environment. The oral microbiome was suggested as a possible source of the bacterial DNA present in the placenta based on similarities to the oral non-pregnant microbiome. Here, the possible origin of the placental microbiome was assessed, examining the gut, oral and placental microbiomes from the same pregnant women. Microbiome profiles from 37 overweight and obese pregnant women were examined by 16SrRNA sequencing. Fecal and oral contributions to the establishment of the placental microbiome were evaluated. Core phylotypes between body sites and metagenome predictive functionality were determined. The placental microbiome showed a higher resemblance and phylogenetic proximity with the pregnant oral microbiome. However, similarity decreased at lower taxonomic levels and microbiomes clustered based on tissue origin. Core genera: Prevotella, Streptococcus and Veillonella were shared between all body compartments. Pathways encoding tryptophan, fatty-acid metabolism and benzoate degradation were highly enriched specifically in the placenta. Findings demonstrate that the placental microbiome exhibits a higher resemblance with the pregnant oral microbiome. Both oral and gut microbiomes contribute to the microbial seeding of the placenta, suggesting that placental colonization may have multiple niche sources.
Publisher: MDPI AG
Date: 08-08-2019
DOI: 10.3390/NU11081836
Abstract: The gut microbiome in pregnancy has been associated with various maternal metabolic and hormonal markers involved in glucose metabolism. Maternal ketones are of particular interest due to the rise in popularity of low-carbohydrate diets. We assessed for differences in the composition of the gut microbiota in pregnant women with and without ketonuria at 16 weeks gestation. Fecal s les were obtained from 11 women with fasting ketonuria and 11 matched controls. The s les were analyzed to assess for differences in gut microbiota composition by 16S rRNA sequencing. Supervised hierarchical clustering analysis showed significantly different beta- ersity between women with and without ketonuria, but no difference in the alpha- ersity. Group comparisons and network analysis showed that ketonuria was associated with an increased abundance of the butyrate-producing genus Roseburia. The bacteria that contributed the most to the differences in the composition of the gut microbiota included Roseburia, Methanobrevibacter, Uncl. RF39, and Dialister in women with ketonuria and Eggerthella, Phascolarctobacterium, Butyricimonas, and Uncl. Coriobacteriaceae in women without ketonuria. This study found that the genus Roseburia is more abundant in the gut microbiota of pregnant women with ketonuria. Roseburia is a butyrate producing bacterium and may increase serum ketone levels.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.PREGHY.2018.09.002
Abstract: To obtain arm and finger measurements of women ≥32 weeks gestation to determine: the requirement for different arm cuff sizes the suitability of available finger cuffs in this population the best predictor of arm conicity the frequency of cuff placement on the forearm or leg. Prospective observational pilot study. Right and left mid-arm circumference (MAC) and to compare these to the recommended cuff sizes right and left finger circumference right and left arm conicity the responses of women to a three-point Likert scale regarding cuff placement. Measurements were obtained for 450 women at an Australian tertiary hospital with a median (IQR) gestation of 35.7 (34.0-37.0) 299 (66.4%) were Caucasian and 35 (7.8%) had gestational hypertension. The median (IQR) body mass index (BMI) was 29.6 kg/m A small percentage of women are likely to be unsuited to traditional arm cuffs. Available finger-cuffs would suit this population. BMI could potentially be used to select women with cone-shaped arms for future studies of alternative devices.
Publisher: Wiley
Date: 19-04-2021
Publisher: Wiley
Date: 27-02-2014
Publisher: Springer Science and Business Media LLC
Date: 08-03-2015
Publisher: SAGE Publications
Date: 08-12-2012
Abstract: Moyamoya disease is a rare cerebrovascular occlusive disorder characterized by stenosis in the circle of Willis with the development of a compensatory circulation. It has been associated with significant morbidity in pregnancy including intracranial haemorrhage, ischaemic stroke and epilepsy. We present the case of a 26-year-old woman with a previous diagnosis of moyamoya vasculopathy with bilateral superficial temporal to middle cerebral artery bypass grafting. During the second trimester, she developed significant neurological symptoms related to postural hypotension in the presence of a stenosis of the right-sided graft. The hypotension was treated with fludrocortisone therapy with improvement in blood pressure and symptoms. Moyamoya vasculopathy poses unique challenges to obstetric care. This is the first report of use of fludrocortisone for maintenance of blood pressure during pregnancy in this condition.
Publisher: Wiley
Date: 2020
DOI: 10.1111/IMJ.14355
Abstract: Psychosocial assessment should be part of clinic visits for people with diabetes mellitus (DM). To assess the usage and acceptance of a diabetes psychosocial assessment tool (DPAT) and to profile the clinical and psychosocial characteristics of young people with diabetes. Over a 12-month period, young adults (18-25 years) attending diabetes clinic were offered DPAT. The tool embeds validated screening tools including the Problem Areas in Diabetes 20 (PAID-20) questionnaire, the Patient Health Questionnaire-4 (PHQ-4) and the World Health Organization Well-Being Index-5 (WHO-5). Baseline clinical data were collected and questions regarding social support, body image, eating concerns, hypoglycaemia and finances were included. Over the 12 month, the form was offered to 155 participants (64.6% of eligible attendees). The majority (96.1%) had type 1 DM with a mean duration of 10.5 (±5.3 SD) years. Average glycated haemoglobin (HbA1c) was 8.7% (±1.5 SD) (or 71.2 mmol/mol ±16.5 SD). Severe diabetes-related distress (PAID-20 ≥ 40) was found in 19.4%. Low WHO-5 scores (28-50 points) were seen in 14.8%. PHQ-4 identified 25.8% with anxiety and 16.1% with depression. Significant weight, shape and eating concerns were identified in 27.1, 26.6 and 28.4%, respectively. Serious hypoglycaemia concerns were raised by 4.5%. DPAT revealed a high prevalence of psychosocial stress among young adults with DM. The tool was easy to use and accepted by patients and may aid streamlining referrals to relevant members of a multidisciplinary team.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.PLACENTA.2016.12.003
Abstract: Over the past decade, the role of the microbiome in regulating metabolism, immune function and behavior in humans has become apparent. It has become clear that the placenta is not a sterile organ, but rather has its own endogenous microbiome. The composition of the placental microbiome is distinct from that of the vagina and has been reported to resemble the oral microbiome. Compared to the gut microbiome, the placental microbiome exhibits limited microbial ersity. This review will focus on the current understanding of the placental microbiota in normal healthy pregnancy and also in disease states including preterm birth, chorioamnionitis and maternal conditions such as obesity, gestational diabetes mellitus and preecl sia. Factors known to alter the composition of the placental microbiota will be discussed in the final part of this review.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.CLNESP.2019.02.013
Abstract: Enteral nutrition is a source of carbohydrate that may exacerbate hyperglycaemia. Its treatment, insulin, potentially exacerbates glycaemic variability. This was a prospective, parallel group, blinded, randomised feasibility trial. Patients were eligible if 18 years or over when admitted to the intensive care unit and receiving enteral nutrition (EN) exclusively with two consecutive blood glucose > 10 mmol/L. A standardized glucose management protocol determined administration of insulin. Key outcome measures were insulin administered and glycaemic variability (coefficient of variation) over the first 48 h. 41 patients were randomized to either standard EN (14.1 g/100 mL carbohydrate n = 20) or intervention EN (7.4 g/100 mL carbohydrate n = 21). Overall 59% were male, mean (±SD) age of 62.3 years ± 10.4, APACHE II score of 16.5 ± 7.8 and a median (IQR) Body Mass Index 29.0 kg/m A low carbohydrate formula was associated with reduced insulin use and glycaemic variability in enterally-fed critically ill patients with hyperglycaemia. Further large trials are required to determine the impact of this formula on clinical outcomes. Registered under Australian and New Zealand Clinical Trials Registry, ANZCTR number: 12614000166673.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.PLACENTA.2016.12.006
Abstract: Maternal obesity is growing in prevalence and is associated with increased morbidity and mortality for both mother and child. Women who are obese during pregnancy have a greater risk of metabolic complications such as gestational diabetes mellitus (GDM) as well as type 2 diabetes after pregnancy. Children of obese and/or GDM mothers have an increased susceptibility to congenital abnormalities and a range of cardio-metabolic disorders. The placenta is at the interface of the maternal and fetal environments and, its function per se, plays a major role in dictating the impact of maternal health on fetal development. Here, we review the literature on how placental function is affected in pregnancies complicated by obesity, and pre-gestational and gestational diabetes. The focus is on the availability of three key substrates in these conditions: glucose, lipids, and amino acids, and their impact on placental metabolic activity. Maternal obesity and diabetes are not always associated with fetal compromise and the adaptation of the placenta may partially determine the outcome. Understanding the differences in metabolic adaptation may open avenues for therapeutic development.
Publisher: Wiley
Date: 02-2015
DOI: 10.1111/AJO.12300
Abstract: Increasing physical activity in pregnancy may improve pregnancy outcomes for obese women. Exercise could reduce gestational weight gain, improve the maternal circulating lipid profile as well as alter leptin, Interleukin-8 (IL-8) and Monocyte Chemoattractant Protein-1 (MCP-1) levels. The aim of this study was to investigate the effects of exercise on gestational weight gain, maternal circulating lipids, IL-8, MCP-1 and leptin levels in obese pregnant women. The analysis was performed in the 35 obese women enrolled in the pilot BAMBINO randomised controlled trial who provided blood s les at 12- and 28-weeks gestation. Women in the exercise intervention arm received an in idualised exercise plan. Blood s les, exercise diary and pedometer data were obtained at 12-, 20-, 28- and 36-weeks' gestation. Cord blood was obtained at delivery. Women in the exercise arm exercised more than those in the control arm (P = 0.038). There was no difference in gestational weight gain, excess gestational weight gain, MCP-1 and leptin levels between women in the exercise intervention (n = 19) or the control arm (n = 16). IL-8 was not detectable. Exercise did not alter the maternal lipid profile. The low level of physical activity achieved in obese women in the exercise intervention arm was insufficient to alter gestational weight gain, MCP-1, leptin or circulating lipid levels.
Publisher: Oxford University Press (OUP)
Date: 10-2018
Publisher: S. Karger AG
Date: 11-12-2015
DOI: 10.1159/000360354
Publisher: Oxford University Press (OUP)
Date: 07-12-2018
Publisher: Wiley
Date: 20-09-2017
Publisher: Hindawi Limited
Date: 21-12-2021
DOI: 10.1111/PEDI.13169
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.BEEM.2010.05.010
Abstract: Vitamin D has historically been considered to play a role solely in bone and calcium metabolism. Human disease associations and basic physiological studies suggest that vitamin D deficiency is plausibly implicated in adverse health outcomes including mortality, malignancy, cardiovascular disease, immune functioning and glucose metabolism. There is considerable evidence that low maternal levels of 25 hydroxyvitamin D are associated with adverse outcomes for both mother and fetus in pregnancy as well as the neonate and child. Vitamin D deficiency during pregnancy has been linked with a number of maternal problems including infertility, preecl sia, gestational diabetes and an increased rate of caesarean section. Likewise, for the child, there is an association with small size, impaired growth and skeletal problems in infancy, neonatal hypocalcaemia and seizures, and an increased risk of HIV transmission. Other childhood disease associations include type 1 diabetes and effects on immune tolerance. The optimal concentration of 25 hydroxyvitamin D is unknown and compounded by difficulties in defining the normal range. Whilst there is suggestive physiological evidence to support a causal role for many of the associations, whether vitamin D deficiency is a marker of poor health or the underlying aetiological problem is unclear. Randomised controlled trials of vitamin D supplementation with an appropriate assessment of a variety of health outcomes are required.
Publisher: Springer Science and Business Media LLC
Date: 04-09-2015
Publisher: American Diabetes Association
Date: 14-12-2021
DOI: 10.2337/DC20-2008
Abstract: Current dietary advice for women with gestational diabetes mellitus is to avoid diets that result in elevated ketone levels. This guidance stems from a concern that maternal ketones are associated with poor fetal and childhood outcomes, including reduced childhood intelligence quota. The evidence behind these guidelines is conflicting and inconsistent. Given that dietary counseling is the initial treatment strategy for women with diabetes in pregnancy, it is important that clinicians understand the concern regarding maternal ketones. This review examines the physiology of ketogenesis in pregnancy, the prevalence of elevated maternal ketone levels, and the relationship between maternal ketones and fetal and childhood outcomes.
Publisher: Brill | Wageningen Academic
Date: 15-01-2014
Publisher: Springer Science and Business Media LLC
Date: 27-02-2017
DOI: 10.1038/SREP43481
Abstract: Oral microorganisms are important determinants of health and disease. The source of the initial neonatal microbiome and the factors dictating initial human oral microbiota development are unknown. This study aimed to investigate this in placental, oral and gut microbiome profiles from 36 overweight or obese mother-baby dyads as determined by 16S rRNA sequencing. Expression of five antibiotic resistance genes of the β-lactamase class was analysed in the infant oral microbiota s les by QPCR. The neonatal oral microbiota was 65.35% of maternal oral, 3.09% of placental, 31.56% of unknown and 0% of maternal gut origin. Two distinct neonatal oral microbiota profiles were observed: one strongly resembling the maternal oral microbiota and one with less similarity. Maternal exposure to intrapartum antibiotics explained the segregation of the profiles. Families belonging to Proteobacteria were abundant after antibiotics exposure while the families Streptococcaceae, Gemellaceae and Lactobacillales dominated in unexposed neonates. 26% of exposed neonates expressed the Vim-1 antibiotic resistance gene. These findings indicate that maternal intrapartum antibiotic treatment is a key regulator of the initial neonatal oral microbiome.
Publisher: Springer Science and Business Media LLC
Date: 29-09-2014
Publisher: Wiley
Date: 21-11-2020
Abstract: The female reproductive tract represents a continuum between the vagina and the upper genital tract. New evidence from cultivation-independent studies suggests that the female upper genital tract is not sterile however, the significance of this for reproductive health and disease remains to be elucidated fully. Further, diagnosis and treatment of infectious reproductive tract pathologies using cultivation-independent technologies represents a largely unchartered area of modern medical science. The challenge now is to design well-controlled experiments to account for the ease of contamination known to confound molecular-based studies of low-biomass niches, including the uterus and placenta. This will support robust assessment of the potential function of microorganisms, microbial metabolites, and cell-free bacterial DNA on reproductive function in health and disease. TWEETABLE ABSTRACT: Molecular microbial studies of low-biomass niches require stringent experimental controls to reveal causal relations in reproductive health and disease.
Publisher: Wiley
Date: 06-11-2013
DOI: 10.1111/AJO.12139
Abstract: Australian Fitness to Drive guidelines suggest that anyone who has had a seizure of any kind in the context of a 'metabolic' disorder should avoid driving for a period of 6 months. The special case of ecl sia is not mentioned. In this study, we aimed to assess what advice healthcare professionals involved in the peripartum care of women provide to women who have an ecl tic seizure, what investigations they would conduct to exclude other causes of seizures and their level of awareness of whether ecl sia was addressed in the Australian Fitness to Drive guidelines. A survey of 165 healthcare professionals attending the 2012 Society of Obstetric Medicine of Australia and New Zealand annual scientific meeting. Participants included registered nurses, midwives, consultant obstetricians, consultant physicians, doctors in training and others, interested in medical disorders of pregnancy. One hundred and nine conference attendees completed the survey (response rate 66.1%). 58 respondents (53.2%) had cared for 5 or more women with peripartum seizures, and 23 respondents (21.1%) had cared for 10 or more women with peripartum seizures. 46 respondents (42.2%) had never considered the issue of driving after an ecl tic seizure. For those who had considered the issue, advice ranged from no restriction (n = 5, 4.6%), no driving for 1-2 weeks (n = 14, 12.8%), no driving for 3 months (n = 20, 18.4%) or no driving for 6 months (n = 6, 5.5%). Many healthcare professionals caring for women with peripartum seizures have not considered issues relating to fitness to drive after an ecl tic seizure. There is a wide range of advice provided. Better prospective data are required regarding the risk of subsequent seizure after ecl sia, to inform clear fitness to drive guidelines.
Publisher: Public Library of Science (PLoS)
Date: 12-08-2014
Publisher: S. Karger AG
Date: 19-04-2023
DOI: 10.1159/000480163
Publisher: Wiley
Date: 06-11-2021
DOI: 10.1111/JHN.12959
Abstract: Hyperglycaemia occurs frequently in the critically ill. Dietary intake of advanced glycation end‐products (AGEs), specifically N ε‐(carboxymethyl)lysine (CML), may exacerbate hyperglycaemia through perturbation of insulin sensitivity. The present study aimed to determine whether the use of nutritional formulae, with varying AGE loads, affects the amount of insulin administered and inflammation. Exclusively tube fed patients ( n = 35) were randomised to receive Nutrison Protein Plus Multifibre®, Diason® or Glucerna Select®. Insulin administration was standardised according to protocol based on blood glucose ( mmol L –1 ). S les were obtained at randomisation and 48 h later. AGEs in nutritional formula, plasma and urine were measured using mass spectrometry. Plasma inflammatory markers were measured using an enzyme‐linked immunosorbent assay and multiplex bead‐based assays. AGE concentrations of CML in nutritional formulae were greatest with delivery of Nutrison Protein Plus® (mean [SD] 6335 pmol mol –1 [2436]) compared to Diason® (4836 pmol mol –1 [1849]) and Glucerna Select® (4493 pmol mol –1 [1829 pmol mol –1 ]) despite patients receiving similar amounts of energy (median [interquartile range] 12 MJ [8.2–13.7 MJ], 11.5 MJ [8.3–14.5 MJ], 11.5 MJ [8.3–14.5 MJ]). More insulin was administered with Nutrison Protein Plus® (2.47 units h –1 [95% confidence interval (CI) = 1.57–3.37 units h –1 ]) compared to Diason® (1.06 units h –1 [95% CI = 0.24–1.89 units h –1 ]) or Glucerna Select® (1.11 units h –1 [95% CI = 0.25–1.97 units h –1 ] p = 0.04). Blood glucose concentrations were similar. There were associations between greater insulin administration and reductions in circulating interleukin‐6 ( r = –0.46, p 0.01), tumour necrosis factor‐α ( r = −0.44, p 0.05), high sensitivity C‐reactive protein ( r = −0.42, p 0.05) and soluble receptor for advanced glycation end‐products ( r = −0.45, p 0.01) concentrations. The administration of greater AGE load in nutritional formula potentially increases the amount of insulin required to maintain blood glucose within a normal range during critical illness. There was an inverse relationship between exogenous insulin and plasma inflammatory markers.
Publisher: Elsevier BV
Date: 06-2021
Publisher: SAGE Publications
Date: 08-04-2015
Abstract: There is a paucity of Australian data regarding renal disease in pregnancy. We undertook a retrospective cohort study at a tertiary institution to examine the impact of renal disease on pregnancy outcomes and the effect of pregnancy on disease progression. A total of 55 pregnancies of patients with renal disease admitted from 2003 to 2010 to the Royal Brisbane and Women’s Hospital were analysed. Pre-conception variables, fetal/delivery and maternal outcomes were analysed in this group and in a control group of women with normal kidney function pre-pregnancy. Of the 55 pregnancies, 71% experienced pre-term delivery, 38% had intra-uterine growth restriction and 62% required caesarean section. Of all, 60% of neonates required neonatal intensive care unit (NICU) admission and six perinatal deaths occurred. Of all, 67% of women suffered preecl sia, 47% anaemia and 3 patients required dialysis in pregnancy. Postpartum deterioration of renal function occurred in patients with pre-conception chronic kidney disease stage 3–5. Chronic kidney disease of all stages is a risk factor for adverse pregnancy outcomes. In a tertiary institution however, there is a high rate of successful pregnancy (84%).
Publisher: MDPI AG
Date: 04-04-2019
DOI: 10.3390/JCM8040452
Abstract: Emerging evidence suggests a role for the gut microbiota in glucose metabolism and diabetes. Few studies have examined the associations between the faecal microbiome and insulin sensitivity and secretion using gold-standard methods in high-risk populations prior to diabetes onset. We investigated the relationships between faecal microbiota composition (16S rRNA sequencing) and gold-standard measures of insulin sensitivity (hyperinsulinaemic-euglycaemic cl ) and insulin secretion (intravenous glucose tolerance test) in 38 overweight or obese otherwise healthy in iduals. Genus Clostridium was positively associated with insulin sensitivity, and genera Dialister and Phascolarctobacterium were related to both insulin sensitivity and secretion. Insulin sensitivity was associated with a higher abundance of Phascolarctobacterium and lower abundance of Dialister. Those with higher insulin secretion had a higher abundance of Dialister and lower abundance of Bifidobacterium, compared to those with lower insulin secretion. Body mass index (BMI) was positively correlated with Streptococcus abundance whereas Coprococcus abundance was negatively correlated to BMI and percent body fat. These results suggest that faecal microbiota is related to insulin sensitivity and secretion in overweight or obese adults. These correlations are distinct although partially overlapping, suggesting different pathophysiological pathways. Our findings can inform future trials aiming to manipulate gut microbiome to improve insulin sensitivity and secretion and prevent type 2 diabetes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-03-2018
Publisher: The Endocrine Society
Date: 18-03-2019
Publisher: Elsevier BV
Date: 03-2021
Publisher: MDPI AG
Date: 17-12-2020
DOI: 10.3390/NU12123862
Abstract: Pregnancy alters the inflammatory state, metabolic hormones, and gut microbiota composition. It is unclear if the lower abundance of dietary fiber-fermenting, short-chain fatty acid-producing bacteria observed in hypertension also occurs in hypertensive disorders of pregnancy (HDP). This study investigated the relationship between dietary fiber intake and the gut microbiota profile at 28 weeks gestation in women who developed HDP in late pregnancy (n = 22) or remained normotensive (n = 152) from the Study of PRobiotics IN Gestational diabetes (SPRING). Dietary fiber intake was classified as above or below the median of 18.2 g/day. Gut microbiota composition was examined using 16S rRNA gene licon sequencing. The gut permeability marker zonulin was measured in a subset of 46 s les. In women with future HPD, higher dietary fiber intake was specifically associated with increased abundance of Veillonella, lower abundance of Adlercreutzia, Anaerotruncus and Uncl. Mogibacteriaceae and higher zonulin levels than normotensive women. Fiber intake and zonulin levels were negatively correlated in women with normotensive pregnancies but not in pregnancies with future HDP. In women with normotensive pregnancies, dietary fiber intake may improve gut barrier function. In contrast, in women who develop HDP, gut wall barrier function is impaired and not related to dietary fiber intake.
Publisher: Wiley
Date: 09-11-2022
DOI: 10.1111/DOM.14584
Publisher: Wiley
Date: 03-07-2017
DOI: 10.1111/AJO.12646
Abstract: SOMANZ (Society of Obstetric Medicine Australia and New Zealand) has written a guideline to provide evidence-based guidance for the investigation and care of women with sepsis in pregnancy or the postpartum period. The guideline is evidence-based and incorporates recent changes in the definition of sepsis. The etiology, investigation and treatment of bacterial, viral and non-infective causes of sepsis are discussed. Obstetric considerations relevant to anaesthetic and intensive care treatment in sepsis are also addressed. A multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women have contributed to the development of the guidelines. This is an executive summary of the guidelines.
Publisher: MDPI AG
Date: 13-04-2021
DOI: 10.3390/NU13041266
Abstract: Background: Maternal triglycerides are increasingly recognised as important predictors of infant growth and fat mass. The variability of triglyceride patterns during the day and their relationship to dietary intake in women in late pregnancy have not been explored. This prospective cohort study aimed to examine the utility of monitoring capillary triglycerides in women in late pregnancy. Methods: Twenty-nine women (22 with gestational diabetes (GDM) and 7 without) measured capillary glucose and triglycerides using standard meters at home for four days. On two of those days, they consumed one of two standard isocaloric breakfast meals: a high-fat/low-carbohydrate meal (66% fat) or low fat/high carbohydrate meal (10% fat). Following the standard meals, glucose and triglyceride levels were monitored. Results: Median capillary triglycerides were highly variable between women but did not differ between GDM and normoglycaemic women. There was variability in capillary triglycerides over four days of home monitoring and a difference in incremental area under the curve for capillary triglycerides and glucose between the two standard meals. The high-fat standard meal lowered the incremental area under the curve for capillary glucose (p 0.0001). Fasting (rho 0.66, p = 0.0002) and postpradial capillary triglycerides measured at home correlated with venous triglyceride levels. Conclusions: The lack of differences in response to dietary fat intake and the correlation between capillary and venous triglycerides suggest that monitoring of capillary triglycerides before and after meals in pregnancy is unlikely to be useful in the routine clinical practice management of women with gestational diabetes mellitus.
Publisher: SAGE Publications
Date: 05-11-2012
Abstract: Maternal mortality is a rare occurrence in developed nations. Given the low maternal mortality rate, other markers must be used to assess maternal risk and quality of obstetric care. One such is admission to critical care. To determine the rate of admission, diagnosis and management of women from conception and up to 6 weeks postpartum to critical care units including coronary care (CCU), high dependency unit (HDU) and intensive care units (ICU). We performed a retrospective review of obstetric patients requiring critical care admission from January 1995 to August 2010. Demographic details, obstetric history, place of admission (CCU, HDU or ICU) and fetal/neonatal outcomes were examined as were initial indication for critical care admission, final diagnosis and treatment administered. Data were available from 308 admission incidents. There were 259 (84%) admissions to ICU and 49 (15.9%) to CCU. More than a third of women were transferred from another institution. Those women transferred were more unwell and had a higher mortality rate than local women. Primary diagnoses: obstetric haemorrhage (ICU 30.9%), hypertensive disorders of pregnancy (ICU 16.2%, CCU 12.2%), infection (ICU 14.2%, CCU 6.1%), pre-existing cardiac disease (ICU 9.3%, CCU 55.1%). The obstetric population represents only a small percentage of critical care utilisation and overall morbidity and mortality. However, this population is an important and growing group. Increased surveillance peripartum in a critical care facility allows earlier detection of maternal compromise and detailed management. Analysis of these ‘near misses’ in obstetrics aims to improve pregnancy outcomes.
Publisher: Wiley
Date: 13-05-2020
DOI: 10.1002/JPPR.1617
Publisher: Springer Science and Business Media LLC
Date: 03-05-2021
DOI: 10.1038/S41598-021-88786-4
Abstract: To examine if skin autofluorescence (sAF) differed in early adulthood between in iduals with type 1 diabetes and age-matched controls and to ascertain if sAF aligned with risk for kidney disease. Young adults with type 1 diabetes ( N = 100 20.0 ± 2.8 years M:F 54:46 FBG-11.6 ± 4.9 mmol/mol diabetes duration 10.7 ± 5.2 years BMI 24.5(5.3) kg/m 2 ) and healthy controls ( N = 299 20.3 ± 1.8 years M:F-83:116 FBG 5.2 ± 0.8 mmol/L BMI 22.5(3.3) kg/m 2 ) were recruited. Skin autofluorescence (sAF) and circulating AGEs were measured. In a subset of both groups, kidney function was estimated by GFR CKD-EPI CysC and uACR, and DKD risk defined by uACR tertiles. Youth with type 1 diabetes had higher sAF and BMI, and were taller than controls. For sAF, 13.6% of variance was explained by diabetes duration, height and BMI ( P model = 1.5 × 10 –12 ). In the sub-set examining kidney function, eGFR and sAF were higher in type 1 diabetes versus controls. eGFR and sAF predicted 24.5% of variance in DKD risk ( P model = 2.2 × 10 –9 ), which increased with diabetes duration (51% P model 2.2 × 10 –16 ) and random blood glucose concentrations (56% P model 2.2 × 10 –16 ). HbA 1C and circulating fructosamine albumin were higher in in iduals with type 1 diabetes at high versus low DKD risk. eGFR was independently associated with DKD risk in all models. Higher eGFR and longer diabetes duration are associated with DKD risk in youth with type 1 diabetes. sAF, circulating AGEs, and urinary AGEs were not independent predictors of DKD risk. Changes in eGFR should be monitored early, in addition to uACR, for determining DKD risk in type 1 diabetes.
Publisher: The Endocrine Society
Date: 30-10-2020
Abstract: Cardiovascular disease occurs prematurely in type 1 diabetes. The additional risk of overweight is not well characterized. The primary aim was to measure the impact of body mass index (BMI) in youth with type 1 diabetes on cardiovascular risk factors. The secondary aim was to identify other determinants of cardiovascular risk. Observational longitudinal study of 7061 youth with type 1 diabetes followed for median 7.3 (interquartile range [IQR] 4-11) years over 41 (IQR 29-56) visits until March 2019. 15 tertiary care diabetes centers in the Australasian Diabetes Data Network. Participants were aged 2 to 25 years at baseline, with at least 2 measurements of BMI and blood pressure. Standardized systolic and diastolic blood pressure scores and non–high-density lipoprotein (HDL) cholesterol were co-primary outcomes. Urinary albumin/creatinine ratio was the secondary outcome. BMI z-score related independently to standardized blood pressure z- scores and non-HDL cholesterol. An increase in 1 BMI z-score related to an average increase in systolic/diastolic blood pressure of 3.8/1.4 mmHg and an increase in non-HDL cholesterol (coefficient + 0.16 mmol/L, 95% confidence interval [CI], 0.13-0.18 P & 0.001) and in low-density lipoprotein (LDL) cholesterol. Females had higher blood pressure z-scores, higher non-HDL and LDL cholesterol, and higher urinary albumin/creatinine than males. Indigenous youth had markedly higher urinary albumin/creatinine (coefficient + 2.15 mg/mmol, 95% CI, 1.27-3.03 P & 0.001) and higher non-HDL cholesterol than non-Indigenous youth. Continuous subcutaneous insulin infusion was associated independently with lower non-HDL cholesterol and lower urinary albumin/creatinine. BMI had a modest independent effect on cardiovascular risk. Females and Indigenous Australians in particular had a more adverse risk profile.
Publisher: Informa UK Limited
Date: 13-03-2018
Publisher: Elsevier BV
Date: 04-2021
Publisher: MDPI AG
Date: 12-07-2018
DOI: 10.3390/NU10070890
Abstract: The composition of the gut microbiota can be influenced by dietary composition. In pregnancy, the maternal gut microbiome has associations with maternal and infant metabolic status. There is little known regarding the impact of a vegetarian diet in pregnancy on maternal gut microbiota. This study explored the gut microbiota profile in women who were vegetarian or omnivorous in early gestation. Women were selected from participants in the Study of PRobiotics IN Gestational diabetes (SPRING) randomised controlled trial. Nine women identified as vegetarians were matched to omnivorous women in a 1:2 ratio. Microbiota analyses were performed using 16S rRNA gene licon sequencing and analysed using the Quantitative Insights Into Microbial Ecology (QIIME) and Calypso software tools. There was no difference in alpha ersity, but beta ersity was slightly reduced in vegetarians. There were differences seen in the relative abundance of several genera in those on a vegetarian diet, specifically a reduction in Collinsella, Holdemania, and increases in the relative abundances of Roseburia and Lachnospiraceae. In this sub-analysis of gut microbiota from women in early pregnancy, a vegetarian as compared to omnivorous diet, was associated with a different gut microbiome, with features suggesting alterations in fermentation end products from a mixed acid fermentation towards more acetate/butyrate.
Publisher: Wiley
Date: 30-03-2023
Abstract: Modifiable behaviours during the first 1000 days of life influence developmental trajectories of adult chronic diseases. Despite this, sub‐optimal dietary intakes during pregnancy and excessive gestational weight gain are common. Very little is known about partners' dietary patterns and the influence on women's pregnancy dietary patterns. We aimed to examine dietary intake during pregnancy among women and their partners, and gestational weight gain patterns in the Queensland Family Cohort pilot study. The Queensland Family Cohort is a prospective, observational study piloted at a Brisbane (Australia) tertiary maternity hospital from 2018 to 2021. Participant characteristics, weight gain, dietary and nutrient intake were assessed. Data were available for 194 pregnant women and their partners. Poor alignment with Australian Guide to Healthy Eating recommendations was observed. Highest alignment was for fruit (40% women) and meat/alternatives (38% partners) and lowest for breads/cereals ( % women) and milk/alternatives (13% partners). Fewer women (4.4%–60.3%) than their partners (5.4%–92.3%) met guidelines for all micronutrient intakes from food alone, particularly folic acid, iodine, and iron. Women were more likely to meet daily recommendations for fruit, vegetables, dairy, bread/cereals, and meat/alternatives when their partners also met recommendations. Women with a higher pre‐pregnancy body mass index were more likely to gain above recommended weight gain ranges. In this contemporary cohort of pregnant women and their partners, sub‐optimal dietary patterns and deficits in some nutrients were common. There is an urgent need for evidence‐informed public health policy and programs to improve diet quality during pregnancy due to intergenerational effects.
Publisher: Elsevier BV
Date: 03-2021
Publisher: American Diabetes Association
Date: 18-03-2021
DOI: 10.2337/DB20-1081
Abstract: Half of the mortality in diabetes is seen in in iduals & years of age and commonly predicted by the early onset of diabetic kidney disease (DKD). In type 1 diabetes, increased urinary albumin-to-creatinine ratio (uACR) during adolescence defines this risk, but the pathological factors responsible remain unknown. We postulated that early in diabetes, glucose variations contribute to kidney injury molecule-1 (KIM-1) release from circulating T cells, elevating uACR and DKD risk. DKD risk was assigned in youth with type 1 diabetes (n = 100 20.0 ± 2.8 years males/females, 54:46 HbA1c 66.1 [12.3] mmol/mol diabetes duration 10.7 ± 5.2 years and BMI 24.5 [5.3] kg/m2) and 10-year historical uACR, HbA1c, and random blood glucose concentrations collected retrospectively. Glucose fluctuations in the absence of diabetes were also compared with streptozotocin diabetes in apolipoprotein E−/− mice. Kidney biopsies were used to examine infiltration of KIM-1–expressing T cells in DKD and compared with other chronic kidney disease. In iduals at high risk for DKD had persistent elevations in uACR defined by area under the curve (AUC uACRAUC0–10yrs, 29.7 ± 8.8 vs. 4.5 ± 0.5 P & 0.01 vs. low risk) and early kidney dysfunction, including ∼8.3 mL/min/1.73 m2 higher estimated glomerular filtration rates (modified Schwartz equation Padj & 0.031 vs. low risk) and plasma KIM-1 concentrations (∼15% higher vs. low risk P & 0.034). High-risk in iduals had greater glycemic variability and increased peripheral blood T-cell KIM-1 expression, particularly on CD8+ T cells. These findings were confirmed in a murine model of glycemic variability both in the presence and absence of diabetes. KIM-1+ T cells were also infiltrating kidney biopsies from in iduals with DKD. Healthy primary human proximal tubule epithelial cells exposed to plasma from high-risk youth with diabetes showed elevated collagen IV and sodium–glucose cotransporter 2 expression, alleviated with KIM-1 blockade. Taken together, these studies suggest that glycemic variations confer risk for DKD in diabetes via increased CD8+ T-cell production of KIM-1.
Publisher: European Respiratory Society
Date: 07-09-2020
Publisher: Wiley
Date: 20-10-2011
Publisher: Informa UK Limited
Date: 03-2017
Publisher: Elsevier BV
Date: 07-2017
Publisher: MDPI AG
Date: 08-03-2022
DOI: 10.3390/NU14061139
Abstract: The oral microbiota can contribute to the regulation of blood pressure by increasing the availability of nitric oxide through the reduction of nitrate to nitrite, which can be converted into nitric oxide in the stomach and then enter the circulation. It is unclear if the composition of the oral microbiota is different between women who do and do not develop preecl sia. This study aimed to compare the composition of the buccal microbiota just prior to the development of symptoms at 36 weeks gestation in 12 women who developed late-onset preecl sia and 24 matched women who remained normotensive throughout pregnancy by 16S rRNA gene licon sequencing. The abundance of the nitrate-reducing Veillonella spp V. parvula and V. dispar and a subunit of nitrate reductase narH was compared using real-time PCR. The abundance of bacteria was correlated with maternal blood pressure and dietary intake of nitrate-containing vegetables. The results showed that the abundance of nitrate-reducing bacteria including Veillonella, specifically V. parvula, and Prevotella was reduced in women who developed preecl sia. Veillonella but not Prevotella abundance was negatively correlated with maternal blood pressure. The dietary intake of nitrate-containing vegetables did not differ between the groups and was not correlated with the abundance of Veillonella. There was no difference in the abundance of the nitrate reductase subunit narH between the groups. These results suggest that the abundance of nitrate-reducing bacteria is reduced in the oral microbiota of women who later develop preecl sia, indicating a potential pathway for prevention.
Publisher: SAGE Publications
Date: 05-12-2018
Abstract: Ketonuria may be associated with adverse fetal outcomes. This study aimed to determine the prevalence of ketonuria at three time points in pregnancy and to assess whether ketonuria correlates with a clinical indication for performing a urine test. Women had fasting urinary ketone levels measured at 16 and 28 weeks gestation and random ketone levels measured close to 36 weeks gestation. All ketone levels in the third trimester were recorded along with the clinical indication for the test. One hundred and eighty-seven women were included in the study. Twenty-two per cent of women had ketonuria at either 16 or 28 weeks gestation and 8% at 36 weeks gestation. Ketonuria was significantly more likely if a test was performed for a clinical indication ( p = 0.0002). Ketonuria in pregnancy is common affecting at least one in five women. Ketonuria is more common in women who have a clinical indication for performing a urine test.
Publisher: BMJ
Date: 13-07-2017
DOI: 10.1136/BMJ.J3245
Publisher: Wiley
Date: 21-06-2018
DOI: 10.1002/JPPR.1399
Publisher: American Diabetes Association
Date: 29-04-2021
DOI: 10.2337/DC21-ER06B
Publisher: Elsevier BV
Date: 04-2022
Publisher: Oxford University Press (OUP)
Date: 11-02-2019
DOI: 10.1093/MNRAS/STZ401
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/204295
Abstract: Obesity in the childbearing population is increasingly common. Obesity is associated with increased risk for a number of maternal and neonatal pregnancy complications. Some of these complications, such as gestational diabetes, are risk factors for long-term disease in both mother and baby. While clinical practice guidelines advocate for healthy weight prior to pregnancy, there is not a clear directive for achieving healthy weight before conception. There are known benefits to even moderate weight loss prior to pregnancy, but there are potential adverse effects of restricted nutrition during the periconceptional period. Epidemiological and animal studies point to differences in offspring conceived during a time of maternal nutritional restriction. These include changes in hypothalamic-pituitary-adrenal axis function, body composition, glucose metabolism, and cardiovascular function. The periconceptional period is therefore believed to play an important role in programming offspring physiological function and is sensitive to nutritional insult. This review summarizes the evidence to date for offspring programming as a result of maternal periconception weight loss. Further research is needed in humans to clearly identify benefits and potential risks of losing weight in the months before conceiving. This may then inform us of clinical practice guidelines for optimal approaches to achieving a healthy weight before pregnancy.
Publisher: Springer Science and Business Media LLC
Date: 21-11-2012
DOI: 10.1007/S00592-012-0444-8
Abstract: The gut microbiome has a complex relationship with host metabolism and immune function. Host health and diet influence the composition of the gut microbiome, and conversely, different microbiome compositions influence host metabolism. Gestational diabetes mellitus is increasingly common and has serious implications for maternal and foetal health both during pregnancy and later in life. To date, clinical trials of exercise and dietary interventions to prevent the onset of gestational diabetes have had heterogeneous results and have proven disappointingly difficult. Alternative prevention strategies of gestational diabetes mellitus need to be considered and trialled in a placebo-controlled manner in combination with dietary and behavioural measures. One such potential preventative therapy is probiotic supplementation, that is, ingestion of specific bacterial strains with beneficial effects on the host. Probiotic supplements have been shown to improve metabolism by increasing host insulin sensitivity, cholesterol metabolism and also have a beneficial effect on the immune system. This discussion paper examines the evidence for the influence of the gut microbiome on host metabolism and the potential metabolic impact of probiotic supplementation, with particular regard for the evidence surrounding a possible use of probiotic supplements for the prevention of gestational diabetes. Probiotics offer the tantalising possibility of a feasible intervention for the prevention of gestational diabetes and improvement of metabolic syndromes, but there is a pressing need for further studies of the mechanisms underlying the apparent metabolic benefits and for the use of randomised controlled trials to allow examination of the effectiveness of probiotic supplementation in this setting.
Publisher: SAGE Publications
Date: 25-12-2022
DOI: 10.1177/1753495X221146342
Abstract: Pregnancy in women with cystic fibrosis (CF) is becoming more common. Long-term metabolic issues such as diabetes are also becoming more common and have potentially important impacts on pregnancy outcomes. This study aimed to assess the impact of diabetes on pregnancy outcomes for women with CF. We undertook a retrospective chart audit of pregnancies to women with CF at the two tertiary obstetric hospitals in Southeast Queensland associated with CF and transplant management clinics between 2006 and 2016. A total of 38 pregnancies among 26 women were identified. Four women (five pregnancies) had cystic fibrosis-related diabetes (CFRD) diagnosed prior to pregnancy, and 12 women (15 pregnancies) developed gestational diabetes (GDM) complicating pregnancy. CFRD and GDM were associated with higher rates of delivery complications, prematurity, and the need for neonatal intensive care unit admission. Diabetes is common during pregnancy in women with CF and impacts pregnancy outcomes.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2019
Publisher: American Diabetes Association
Date: 18-01-2019
DOI: 10.2337/DC18-2248
Abstract: Given the role of gut microbiota in regulating metabolism, probiotics administered during pregnancy might prevent gestational diabetes mellitus (GDM). This question has not previously been studied in high-risk overweight and obese pregnant women. We aimed to determine whether probiotics (Lactobacillus rhamnosus and Bifidobacterium animalis subspecies lactis) administered from the second trimester in overweight and obese women prevent GDM as assessed by an oral glucose tolerance test (OGTT) at 28 weeks’ gestation. Secondary outcomes included maternal and neonatal complications, maternal blood pressure and BMI, and infant body composition. This was a double-blind randomized controlled trial of probiotic versus placebo in overweight and obese pregnant women in Brisbane, Australia. The study was completed in 411 women. GDM occurred in 12.3% (25 of 204) in the placebo arm and 18.4% (38 of 207) in the probiotics arm (P = 0.10). At OGTT, mean fasting glucose was higher in women randomized to probiotics (79.3 mg/dL) compared with placebo (77.5 mg/dL) (P = 0.049). One- and two-hour glucose measures were similar. Preecl sia occurred in 9.2% of women randomized to probiotics compared with 4.9% in the placebo arm (P = 0.09). Excessive weight gain occurred in 32.5% of women in the probiotics arm (55 of 169) compared with 46% in the placebo arm (81 of 176) (P = 0.01). Rates of small for gestational age (& th percentile) were 2.4% in the probiotics arm (5 of 205) and 6.5% in the placebo arm (13 of 199) (P = 0.042). There were no differences in other secondary outcomes. The probiotics used in this study did not prevent GDM in overweight and obese pregnant women.
Publisher: Baishideng Publishing Group Inc.
Date: 2014
Publisher: American Diabetes Association
Date: 16-11-2020
DOI: 10.2337/DBI20-0037
Publisher: Springer Science and Business Media LLC
Date: 17-05-2016
Publisher: American Diabetes Association
Date: 08-11-2017
DOI: 10.2337/DC16-2181
Publisher: OMICS Publishing Group
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 10-04-2017
DOI: 10.1038/SREP45615
Abstract: Scientific Reports 7: Article number: 43481 published online: 27 February 2017 updated: 10 April 2017. In the Supplementary Information file originally published with this Article, Supplementary Figures 3, 4, 5, 6, and 7 were incorrectly labelled as Supplementary Figures 1, 2, 3, 4, and 5 respectively.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Hindawi Limited
Date: 10-06-2022
DOI: 10.1111/PEDI.13364
Abstract: Competing challenges in adolescence and young adulthood can distract from optimal type 1 diabetes (T1D) self-management, and increase risks of premature morbidity and mortality. There are limited data mapping the glycemic control of people with T1D in this age group, across Australasia. Clinical data were extracted from the Australasian Diabetes Data Network, a prospective clinical diabetes registry. Inclusion criteria were in iduals with T1D aged 16-25 years at their last recorded T1D healthcare visit (from 1st January 2011 to 31st December 2020), with T1D duration of at least 1 year. Data were stratified by two last recorded T1D healthcare visit ranges, while generalized estimated equation (GEE) modeling was used to examine factors associated with HbA1c across visits during the 10 year period. Data from 6329 young people (52.6% male) attending 24 diabetes centers across Australasia were included. At the last visit within the most recent 5 years, mean ± SD age was 18.5 ± 2.3 years, T1D duration was 8.8 ± 4.7 years and HbA1c was 8.8 ± 1.8% (72.2 ± 19.9 mmol/mol) only 12.3% had an HbA1c below the international target of <7.0% (53 mmol/mol). Across all T1D healthcare visits, in GEE modeling, higher HbA1c was associated with female sex (B = 0.20 95% CI 0.12 to 0.29, p < 0.001), longer T1D duration (B = 0.04, 0.03 to 0.05, p < 0.001). Lower HbA1c was associated with attendance at a pediatric T1D healthcare setting (B = -0.33, -0.45 to -0.21, p < 0.001) and use of CSII versus BD/MDI therapy (B = -0.49, -0.59 to 0.40, p < 0.001). This Australasian study demonstrates widespread and persistent sub-optimal glycemic control in young people with T1D, highlighting the urgent need to better understand how healthcare services can support improved glycemic control in this population.
Publisher: Wiley
Date: 16-11-2020
DOI: 10.1111/AJO.13265
Publisher: American Diabetes Association
Date: 23-05-2016
DOI: 10.2337/DB16-0278
Abstract: Overweight and obese women are at a higher risk for gestational diabetes mellitus. The gut microbiome could modulate metabolic health and may affect insulin resistance and lipid metabolism. The aim of this study was to reveal relationships between gut microbiome composition and circulating metabolic hormones in overweight and obese pregnant women at 16 weeks' gestation. Fecal microbiota profiles from overweight (n = 29) and obese (n = 41) pregnant women were assessed by 16S rRNA sequencing. Fasting metabolic hormone (insulin, C-peptide, glucagon, incretin, and adipokine) concentrations were measured using multiplex ELISA. Metabolic hormone levels as well as microbiome profiles differed between overweight and obese women. Furthermore, changes in some metabolic hormone levels were correlated with alterations in the relative abundance of specific microbes. Adipokine levels were strongly correlated with Ruminococcaceae and Lachnospiraceae, which are dominant families in energy metabolism. Insulin was positively correlated with the genus Collinsella. Gastrointestinal polypeptide was positively correlated with the genus Coprococcus but negatively with family Ruminococcaceae. This study shows novel relationships between gut microbiome composition and the metabolic hormonal environment in overweight and obese pregnant women at 16 weeks' gestation. These results suggest that manipulation of the gut microbiome composition may influence pregnancy metabolism.
Publisher: Springer International Publishing
Date: 11-10-2017
Publisher: Cambridge University Press (CUP)
Date: 23-05-2018
DOI: 10.1017/S0007114518001149
Abstract: Fe is an essential nutrient for many bacteria, and Fe supplementation has been reported to affect the composition of the gut microbiota in both Fe-deficient and Fe-replete in iduals outside pregnancy. This study examined whether the dose of Fe in pregnancy multivitamin supplements affects the overall composition of the gut microbiota in overweight and obese pregnant women in early pregnancy. Women participating in the SPRING study with a faecal s le obtained at 16 weeks’ gestation were included in this substudy. For each subject, the brand of multivitamin used was recorded. Faecal microbiome composition was assessed by 16S rRNA sequencing and analysed with the QIIME software suite. Dietary intake of Fe was assessed using a FFQ at 16 weeks’ gestation. Women were grouped as receiving low ( mg/d, n 94) or high (≥60 mg/d n 65) Fe supplementation. The median supplementary Fe intake in the low group was 10 (interquartile range (IQR) 5–10) v . 60 (IQR 60–60) mg/d in the high group ( P ·001). Dietary Fe intake did not differ between the groups (10·0 (IQR 7·4–13·3) v . 9·8 (IQR 8·2–13·2) mg/d). Fe supplementation did not significantly affect the composition of the faecal microbiome at any taxonomic level. Network analysis showed that the gut microbiota in the low Fe supplementation group had a higher predominance of SCFA producers. Pregnancy multivitamin Fe content has a minor effect on the overall composition of the gut microbiota of overweight and obese pregnant women at 16 weeks’ gestation.
Publisher: American Diabetes Association
Date: 12-06-2013
DOI: 10.2337/DC12-2132
Abstract: Factors associated with increasing maternal triglyceride concentrations in late pregnancy include gestational age, obesity, preecl sia, and altered glucose metabolism. In a subgroup of women in the Metformin in Gestational Diabetes (MiG) trial, maternal plasma triglycerides increased more between enrollment (30 weeks) and 36 weeks in those treated with metformin compared with insulin. The aim of this study was to explain this finding by examining factors potentially related to triglycerides in these women. Of the 733 women randomized to metformin or insulin in the MiG trial, 432 (219 metformin and 213 insulin) had fasting plasma triglycerides measured at enrollment and at 36 weeks. Factors associated with maternal triglycerides were assessed using general linear modeling. Mean plasma triglyceride concentrations were 2.43 (95% CI 2.35–2.51) mmol/L at enrollment. Triglycerides were higher at 36 weeks in women randomized to metformin (2.94 [2.80–3.08] mmol/L +23.13% [18.72–27.53%]) than insulin (2.65 [2.54–2.77] mmol/L, P = 0.002 +14.36% [10.91–17.82%], P = 0.002). At 36 weeks, triglycerides were associated with HbA1c (P = 0.03), ethnicity (P = 0.001), and treatment allocation (P = 0.005). In insulin-treated women, 36-week triglycerides were associated with 36-week HbA1c (P = 0.02), and in metformin-treated women, they were related to ethnicity. At 36 weeks, maternal triglycerides were related to glucose control in women treated with insulin and ethnicity in women treated with metformin. Whether there are ethnicity-related dietary changes or differences in metformin response that alter the relationship between glucose control and triglycerides requires further study.
Publisher: Frontiers Media SA
Date: 02-09-2020
Publisher: SAGE Publications
Date: 18-06-2021
Abstract: Asthma and gestational diabetes mellitus are prevalent during pregnancy and associated with adverse perinatal outcomes. The risk of gestational diabetes mellitus is increased with asthma, and more severe asthma yet, the underlying mechanisms are unknown. This review examines existing literature to explore possible links. Asthma and gestational diabetes mellitus are associated with obesity, excess gestational weight gain, altered adipokine levels and low vitamin D levels yet, it’s unclear if these underpin the gestational diabetes mellitus–asthma association. Active antenatal asthma management reportedly mitigates asthma-associated gestational diabetes mellitus risk. However, mechanistic studies are lacking. Existing research suggests asthma management during pregnancy influences gestational diabetes mellitus risk this may have important implications for future antenatal strategies to improve maternal-fetal outcomes by addressing both conditions. Addressing shared risk factors, as part of antenatal care, may also improve outcomes. Finally, mechanistic studies, to establish the underlying pathophysiology linking asthma and gestational diabetes mellitus, could uncover new treatment approaches to optimise maternal and child health outcomes.
Publisher: Wiley
Date: 09-09-2022
DOI: 10.1111/IMJ.15919
Abstract: The Diabetes Psychosocial Assessment Tool (DPAT) was developed to assess the psychosocial well‐being of young adults with type 1 diabetes in clinical practice. The DPAT includes three validated questionnaires (assessing diabetes distress, anxiety/depressive symptoms and emotional well‐being) and an agenda‐setting tool. It is currently used by the Queensland Statewide Diabetes Clinical Network (available at Clinical Excellence Queensland). To describe agenda items set by young adults with type 1 diabetes and investigate their association with emotional well‐being/social support. The DPAT was completed by young adults attending routine diabetes outpatient appointments at the Mater Hospital (Brisbane) between November 2016 and January 2020. For the current analysis, data included responses on agenda‐setting and outcomes from three validated questionnaires. Responses of 277 young adults (15–26 years) were analysed. Ninety‐four (34%) reported one to three agenda item(s). Common agenda items were diabetes technology and medications, but other topics raised included pregnancy, body image and eating concerns. Participants with moderate diabetes distress or anxiety symptoms were more likely to list at least one agenda item ( P = 0.006 P = 0.002), as were females and older participants. Several agenda items for young adults with type 1 diabetes were identified and were more likely to be raised by those with elevated diabetes distress and anxiety symptoms. The DPAT is a valuable and convenient tool that can be easily applied in routine clinical practice to enable clinicians to understand the concerns of the young adult population and deliver personalised medicine to optimise long‐term outcomes.
No related grants have been discovered for Helen L Barrett.