ORCID Profile
0000-0002-3128-4523
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/10641950701521742
Abstract: To determine the association between adverse maternal erinatal outcomes and Canadian and U.S. preecl sia severity criteria. Using PIERS data (Preecl sia Integrated Estimate of RiSk), an international continuous quality improvement project for women hospitalized with preecl sia, we examined the association between preecl sia severity criteria and adverse maternal and perinatal outcomes (univariable analysis, Fisher's exact test). Not evaluated were variables performed in 110 microM) or perinatal outcomes (dBP >110 mm Hg and suspected abruption) (at p < 0.01). In the PIERS cohort, most factors used in the Canadian or American classifications of severe preecl sia do not predict adverse maternal and/or perinatal outcomes. Future classification systems should take this into account.
Publisher: Wiley
Date: 2023
DOI: 10.1002/IJGO.14537
Abstract: Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8–10‐fold higher risk of developing type 2 diabetes and a 2‐fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.
Publisher: Public Library of Science (PLoS)
Date: 21-01-2014
Publisher: Elsevier BV
Date: 11-2014
Publisher: Elsevier BV
Date: 10-2011
Publisher: Wiley
Date: 17-06-2013
DOI: 10.1111/PPE.12061
Abstract: The Maternal-Infant Research on Environmental Chemicals (MIREC) Study was established to obtain Canadian biomonitoring data for pregnant women and their infants, and to examine potential adverse health effects of prenatal exposure to priority environmental chemicals on pregnancy and infant health. Women were recruited during the first trimester from 10 sites across Canada and were followed through delivery. Questionnaires were administered during pregnancy and post-delivery to collect information on demographics, occupation, life style, medical history, environmental exposures and diet. Information on the pregnancy and the infant was abstracted from medical charts. Maternal blood, urine, hair and breast milk, as well as cord blood and infant meconium, were collected and analysed for an extensive list of environmental biomarkers and nutrients. Additional biospecimens were stored in the study's Biobank. The MIREC Research Platform encompasses the main cohort study, the Biobank and follow-up studies. Of the 8716 women approached at early prenatal clinics, 5108 were eligible and 2001 agreed to participate (39%). MIREC participants tended to smoke less (5.9% vs. 10.5%), be older (mean 32.2 vs. 29.4 years) and have a higher education (62.3% vs. 35.1% with a university degree) than women giving birth in Canada. The MIREC Study, while smaller in number of participants than several of the international cohort studies, has one of the most comprehensive datasets on prenatal exposure to multiple environmental chemicals. The biomonitoring data and biological specimen bank will make this research platform a significant resource for examining potential adverse health effects of prenatal exposure to environmental chemicals.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2011
Publisher: Canadian Science Publishing
Date: 06-1987
DOI: 10.1139/Y87-176
Abstract: The objective of this study was to determine whether fetal urinary excretion is a major route of ethanol transfer into the amniotic fluid surrounding the fetus following maternal administration of ethanol. Conscious instrumented pregnant ewes between 130 and 137 days' gestation (term, 147 days) with (n = 3) or without (n = 3) a catheter in the fetal bladder were administered 1 g ethanol/kg maternal body weight as a 1-h maternal intravenous infusion. Maternal blood, fetal blood, and amniotic fluid s les were collected at selected times, and fetal urine was collected continuously from the bladder-cannulated fetus during the 14-h study for the determination of ethanol concentrations. Fetal urinary excretion of ethanol occurred, and the total amount of ethanol excreted represented 0.30 ± 0.07 (SD)% of the maternal ethanol dose. The renal clearance of ethanol by the fetus was 0.43 ± 0.06 mL/min. The pharmacokinetics of ethanol in the maternal–fetal unit and the amniotic fluid for the bladder-cannulated fetal preparation were similar to the data for the nonbladder-cannulated preparation. The data indicate that fetal urinary excretion of ethanol is a secondary route of ethanol transfer into the amniotic fluid. It would appear that diffusion of ethanol across membranes from the maternal and fetal circulations is a major route of ethanol transfer into this intrauterine compartment.
Publisher: Elsevier BV
Date: 02-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/S1701-2163(16)30047-0
Abstract: Magnesium sulphate (MgSO4) has been recommended for fetal neuroprotection to prevent cerebral palsy, with national societies adopting new guidelines for its use. A knowledge translation project to implement Canadian guidelines is ongoing. Discussion about MgSO4 for fetal neuroprotection could not occur distinct from MgSO4 for ecl sia prophylaxis and treatment. Thus, in order to explore standardization of MgSO4 use in Canada, we sought to compare local protocols for ecl sia and fetal neuroprotection across tertiary perinatal centres. Twenty-five Canadian tertiary perinatal centres were asked to submit their protocols for use of MgSO4 for ecl sia prophylaxis/treatment and fetal neuroprotection. Information abstracted included date of protocol, definitions of indications for treatment, details of MgSO4 administration, maternal and fetal monitoring, antidote for toxicity, and abnormal signs requiring physician attention. Descriptive analyses were used to compare site protocols with known definitions of preecl sia. Data from the Canadian Perinatal Network (CPN) were used to verify what was done in clinical practice. Twenty-two of the 25 centres submitted protocols for ecl sia prevention/treatment. Eleven of these provided a definition of preecl sia that warranted treatment five of the 22 advised treatment of severe preecl sia only. Criteria for treatment and monitoring procedures varied across centres. Sixteen of the 22 sites with protocols had data from the CPN. Of 635 women with pre-ecl sia, 422 (66.5%) received MgSO4. Twenty of 25 centres provided protocols for fetal neuroprotection. Definitions of indications were consistent across sites, except for gestational age cut-off. This study suggests that local protocols are often inconsistent with published evidence. While this may be related to local institutional practices, relevant processes must be put in place to maximize uniformity of practice and improve patient care.
Publisher: Wiley
Date: 2023
DOI: 10.1002/IJGO.14549
Abstract: Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long‐term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma‐informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre‐, ante‐, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre‐existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.
Publisher: Elsevier BV
Date: 06-2011
Publisher: Elsevier BV
Date: 2011
Publisher: Elsevier BV
Date: 05-2011
Publisher: Elsevier BV
Date: 05-2011
Publisher: Public Library of Science (PLoS)
Date: 11-2018
Publisher: Elsevier BV
Date: 07-2011
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/S1701-2163(16)35015-0
Abstract: Platelet count has been proposed as a screening test for generalized coagulopathy in women with preecl sia. We performed this study to determine the relationship between platelet counts and the risk of abnormal coagulation and adverse maternal outcomes in women with preecl sia. We used data from women in the PIERS (Pre-ecl sia Integrated Estimate of RiSk) database. Abnormal coagulation was defined as either an international normalized ratio result greater than and/or a serum fibrinogen level less than the BC Women's Hospital laboratory's pregnancy-specific normal range. The relationship between platelet counts and adverse maternal outcomes was explored using a logistic regression analysis. The sensitivity, specificity, positive predictive value, and negative predictive value of platelet counts in identifying abnormal coagulation or adverse maternal outcomes were calculated. Abnormal coagulation occurred in 105 of 1405 eligible women (7.5%). The odds of having abnormal coagulation were increased for women with platelet counts < 50 × 10(9)/L (OR 7.78 95% CI 3.36 to 18.03) and between 50 and 99 × 10(9)/L (OR 2.69 95% CI 1.44 to 5.01) compared with women who had platelet counts above 150 × 10(9)/L. Platelet counts < 100 × 10(9)/L were associated with significantly increased odds of adverse maternal outcomes, most specifically blood transfusion. A platelet count of < 100 × 10(9)/L had good specificity in identifying abnormal coagulation and adverse maternal outcomes (92% [95% CI 91% to 94%] and 92% [95% CI 91% to 94%], respectively), but poor sensitivity (22% [95% CI 15% to 31%] and 16% [95% CI 11% to 23%], respectively). A platelet count < 100 × 10(9)/L is associated with an increased risk of abnormal coagulation and maternal adverse outcomes in women with preecl sia. However, the platelet count should not be used in isolation to guide care because of its poor sensitivity. Whether or not a platelet count is normal should not be used to determine whether further coagulation tests are needed.
Publisher: BMJ
Date: 12-09-2018
DOI: 10.1136/BMJ.K3478
Abstract: To determine the efficacy of high dose folic acid supplementation for prevention of pre-ecl sia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-ecl sia in a previous pregnancy, or body mass index ≥35. Randomised, phase III, double blinded international, multicentre clinical trial. 70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK). 2464 pregnant women with at least one high risk factor for pre-ecl sia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group) 2301 were included in the intention to treat analyses. Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral tablets) or placebo from eight weeks of gestation to the end of week 16 of gestation until delivery. Clinicians, participants, adjudicators, and study staff were masked to study treatment allocation. The primary outcome was pre-ecl sia, defined as hypertension presenting after 20 weeks’ gestation with major proteinuria or HELLP syndrome (haemolysis, elevated liver enzymes, low platelets). Pre-ecl sia occurred in 169/1144 (14.8%) women in the folic acid group and 156/1157 (13.5%) in the placebo group (relative risk 1.10, 95% confidence interval 0.90 to 1.34 P=0.37). There was no evidence of differences between the groups for any other adverse maternal or neonatal outcomes. Supplementation with 4.0 mg/day folic acid beyond the first trimester does not prevent pre-ecl sia in women at high risk for this condition. Current Controlled Trials ISRCTN23781770 and ClinicalTrials.gov NCT01355159 .
Publisher: Elsevier BV
Date: 03-2008
Publisher: Elsevier BV
Date: 03-2015
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.AJOG.2010.01.050
Abstract: We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women. In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions. Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99 95% confidence interval, 0.78-1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes. Vitamin C and E supplementation did not reduce the rate of preecl sia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.
Publisher: Wiley
Date: 2023
DOI: 10.1002/IJGO.14540
Abstract: Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high‐income countries and approximately 25% in low‐ and middle‐income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long‐term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.
No related grants have been discovered for Graeme Smith.