ORCID Profile
0000-0001-8554-4696
Current Organisations
Flinders University
,
University of Adelaide
,
South Australian Health and Medical Research Institute
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Publisher: SAGE Publications
Date: 26-09-2013
Abstract: Domperidone is often used to promote lactation among women who have difficulty breastfeeding. To examine prescribing and dispensing practices of domperidone at the Women’s and Children’s Hospital (WCH), Adelaide. A retrospective audit of domperidone dispensing among women with singleton pregnancies who delivered at the WCH between January 2000 and July 2010 was undertaken. Women dispensed domperidone were identified using WCH pharmacy dispensing records. Maternal and infant clinical data were obtained from the WCH Perinatal Statistics Collection. An audit of paper-based medical records was undertaken for a random s le of 261 mother-child pairs to collect prescribing and additional clinical data. From 2000 to 2010, 1605 women were dispensed domperidone. There was a steady increase in the percentage of women dispensed domperidone, from 0.5% in 2000 to 5% of total WCH pregnancies in 2010. Among women dispensed domperidone, the percentage of women who received 1 dispensing remained consistent (20%) over time, as did the median number of days (12) from delivery to first dispensing. Multiparous women were more likely to receive domperidone within 3 days following delivery compared to primiparous women (8% vs 4% P .01). Most women (80%) received directions to take domperidone according to a standard tapering dosing regimen over 12 days. Notably, 60% of women had no documentation of being assessed by a lactation consultant. From 2000 to 2010, there was a considerable increase in domperidone dispensing. With a lack of clinical evidence to guide use, current practice appears to be based on anecdotal evidence.
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.REPROTOX.2012.03.003
Abstract: Prenatal exposure to SSRIs has the potential to alter fetal 5-HT signalling during critical periods of development: the long-term consequences of which have not been well studied. Of particular interest are the potential long-term effects of prenatal SSRI exposure on growth and body weight in later life, given the role of the serotonergic system in regulating food intake and body weight. Animal studies demonstrate that changes in 5-HT homeostasis during critical periods of fetal development can lead to sex-specific molecular and functional alterations in the serotonergic and HPA systems, leading to an increased risk of overweight in male, but not female, offspring in later life. This review highlights the evidence and the need for studies in humans to determine whether prenatal SSRI exposure is associated with alterations in child growth and body weight and the importance of delineating these effects from those of the underlying maternal illness.
Publisher: Wiley
Date: 12-2017
DOI: 10.1002/JPPR.1416
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 08-2017
DOI: 10.1002/JPPR.1371
Publisher: Wiley
Date: 23-10-2020
DOI: 10.1111/AJO.13257
Publisher: SAGE Publications
Date: 15-10-2014
Publisher: SAGE Publications
Date: 28-12-2018
Abstract: Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and reference-list checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology ( n = 38 e.g. electronic prescribing), organizational ( n = 16 e.g. guidelines, policies, and procedures), personnel ( n = 13 e.g. staff education), pharmacy ( n = 9 e.g. clinical pharmacy service), hazard and risk analysis ( n = 8 e.g. error detection tools), and multifactorial ( n = 18 e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies ( %) demonstrated a reduction in medication errors. A similar median reduction of 50–70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.WOMBI.2016.05.009
Abstract: Indirect and direct trauma following vaginal birth can negatively impact on the pelvic floor function increasing the risk of anal incontinence. It is often difficult for women to openly disclose that they have anal incontinence and there are limited data collection tools available for the identification of these women in a clinical setting. This study aims to describe the prevalence of undisclosed anal incontinence in antenatal and postnatal women with pelvic floor dysfunction. Retrospective cohort study of 230 antenatal and postnatal women referred to a Continence Nursing Service in a large tertiary hospital in South Australia, Australia, with pelvic floor dysfunction. A criteria list was utilised to access the primary reason for referral, anal incontinence assessments and attendance to an appointment. Anal incontinence was identified in 26% of women (n=59). Anal incontinence was the primary reason for referral amongst 8 women, with the remaining 51 women identified as having anal incontinence following clinical screening via phone consultation. Eighty six percent of women stated they had not previously disclosed anal incontinence to health professionals. Overall, 71% of symptomatic women (n=28 antenatal and n=14 postnatal women) attended appointments to a service specialising in pelvic floor dysfunction. Women presenting with urinary incontinence or other markers of pelvic floor dysfunction should be actively screened for anal incontinence as the prevalence of this condition is high amongst childbearing women.
Publisher: Informa UK Limited
Date: 26-02-2017
DOI: 10.1080/02770903.2016.1258080
Abstract: To determine the impact of self-reported maternal depression/anxiety on asthma control during pregnancy. Pregnant women with a doctor diagnosis of asthma (n = 189) were prospectively recruited at their antenatal booking visit, and the presence of maternal depression and anxiety was identified using self-report and routine questionnaire assessments. Data on exacerbations and asthma control were collected during gestation. Asthma control was assessed using the Juniper Asthma Control Questionnaire (ACQ) and women were classified as having recurrent uncontrolled asthma if their ACQ score was >1.5 during two or more consecutive study visits. Exacerbations were defined as events that led to increased treatment requirements, and doctor or hospital visits. There were 85 women with self-reported depression/anxiety and 104 women without self-reported depression/anxiety. The presence of depression/anxiety was associated with an increased likelihood (adjusted hazard ratio (HR) 1.67: 95% confidence interval (CI) 1.03-2.72) and incidence (adjusted incidence rate ratio (IRR) 1.71: 95% CI 1.13-2.58) of uncontrolled asthma during pregnancy, as well as an increased risk of recurrent uncontrolled asthma during 2 or more study visits (adjusted relative risk (RR) 1.98: 95% CI 1.00-3.91). No impact of depression/anxiety was observed with respect to the likelihood (adjusted HR 0.70: 95% CI 0.35-1.41) or incidence of exacerbations during pregnancy (adjusted IRR 0.66: 95% CI 0.35-1.26). This study provides evidence that the presence of maternal depression/anxiety is associated with an increased likelihood and incidence of uncontrolled asthma during pregnancy. Given the high prevalence of co-morbid depression/anxiety among asthmatics, further research investigating such associations is urgently required.
Publisher: Springer Science and Business Media LLC
Date: 20-01-2020
DOI: 10.1038/S41598-019-56961-3
Abstract: While peanut oral immunotherapy (POIT) represents a promising treatment for peanut allergies in children, safety concerns remain a common barrier to widespread adoption. We aimed to systematically assess available evidence to determine the risk and frequency of adverse events occurring during POIT, and examine study-level characteristics associated with their occurrence and severity. A systematic search of MEDLINE, EMBASE, and Web of Science was conducted through April 2019. Controlled and non-controlled studies evaluating POIT were eligible. Twenty-seven studies, involving 1488 subjects, were included. Adverse events to POIT were common and led to treatment discontinuation in 6.6% of children (95% CI 4.4–9.0 27 studies, I 2 = 48.7%). Adverse events requiring treatment with epinephrine occurred among 7.6% (4.5–11.4 26 studies, I 2 = 75.5%) of participants, at a rate of 2.0 per 10,000 doses (0.8–3.7 15 studies, I 2 = 64.4). Use of a rush treatment phase and targeting a higher maintenance dose were associated with a higher risk and frequency of epinephrine use, while using co-treatments in addition to POIT was associated with a lower risk of treatment discontinuation due to adverse events. While adverse events to POIT are common, this study provides promising explorative evidence that certain modifications to existing treatment protocols could significantly improve treatment outcomes.
Publisher: Wiley
Date: 16-02-2022
DOI: 10.1111/AOGS.14324
Abstract: Antidepressant use is common in the perinatal period, but there are concerns that it can negatively impact on breastfeeding outcomes. The aim of this study was to examine the effects of perinatal antidepressant use on breastfeeding initiation and duration. This was a retrospective analysis of 80 882 mother-infant dyads in the Norwegian Mother, Father and Child Cohort Study (MoBa). Women were first classified according to self-reported mental disorders and timing of antidepressant use before and/or after gestational week 28 (i.e., early-mid-gestation and/or late-gestation use). We subsequently classified women according to self-reported mental disorders and antidepressant use postpartum and whether antidepressants were continued from late gestation or were new/restarted. Breastfeeding outcomes included breastfeeding initiation as well as predominant or any breastfeeding and abrupt breastfeeding discontinuation until 6 months. Late-gestation antidepressant use was associated with a reduced likelihood of breastfeeding initiation (adjusted relative risk [aRR] 0.93 95% confidence interval [CI] 0.90-0.97) but not predominant (aRR 0.96 95% CI 0.67-1.39) or any (aRR 1.00 95% CI 0.93-1.07) breastfeeding at 6 months compared with unexposed women with mental disorders. When examined according to postnatal antidepressant use, no differences in predominant (aRR 0.94 95% CI 0.60-1.48) or any breastfeeding (aRR 0.99 95% CI 0.91-1.07) at 6 months were evident among women who continued antidepressant use from late gestation into the postpartum period compared with unexposed women with mental disorders. In contrast, new/restarted antidepressant use postpartum was associated with a reduced likelihood of predominant (aRR 0.37 95% CI 0.22-0.61) and any (aRR 0.49 95% CI 0.42-0.56) breastfeeding at 6 months, as well as increased risk of abrupt breastfeeding discontinuation (aRR 2.64 95% CI 2.07-3.37) compared with the unexposed women with mental disorders. A complex relation exists between depression, antidepressant use, and breastfeeding outcomes. Antidepressant use in late pregnancy was associated with a reduced likelihood of breastfeeding initiation but not breastfeeding duration or exclusivity. In contrast, initiating or restarting antidepressants postpartum was associated with poorer breastfeeding outcomes. Overall, women taking antidepressants and women with a mental disorder may benefit from additional education and support to improve breastfeeding rates and promote maternal and infant health and wellbeing.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.FERTNSTERT.2021.08.030
Abstract: To determine the proportion of pregnancies resulting in birth that were conceived with the use of clomiphene citrate (CC) and the frequency of multiple pregnancy. Whole-of-population cohort study, constructed through data linkage. Comprehensive Australian Government records of dispensed medications were linked to state Perinatal Registry records for all births of at least 20 weeks' gestation. The state of South Australia. Women who maintained pregnancy for at least 20 weeks and gave birth between July 2003 and December 2015, a total of 150,713 women with 241,561 pregnancies. Not applicable. Ongoing pregnancy occurring in proximity to CC, defined as dispensing from 90 days before to the end of a conception window derived from newborn date of birth and gestational age. Linkage to dispensed prescription records was achieved for 97.9% of women. Women who conceived with CC tended to be older and socioeconomically advantaged and more likely than other women to have a history of miscarriage. Ongoing pregnancies associated with CC comprised 1.6% of the total 5.7% were multiple births (mostly twins, 94.6%) compared with 1.5% in the remainder (98.5% twins). In South Australia, 1.6% of pregnancies (1 in 60) of at least 20 weeks' gestation were conceived proximal to CC dispensing. Of these, 5.7% were multiple pregnancies. This takes the proportion of women who achieved an ongoing pregnancy with medical assistance from 4.4%, based on reports from assisted reproductive technology clinics, to 6% in total.
Publisher: SAGE Publications
Date: 2008
Publisher: Wiley
Date: 28-10-2020
DOI: 10.1111/AJO.13084
Abstract: This is a brief summary of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) evidence-based guideline for the management of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG). The full guideline and executive summary including auditable outcomes are freely available on the SOMANZ website [uidelines.asp]. The guideline includes a proposed SOMANZ definition of NVP and HG and evidence-based practical advice regarding the investigation and management of NVP, HG and associated conditions including thyroid dysfunction. A practical algorithm for assessment and management as well as an in idual patient management plan and self-assessment tools are included.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.ANNEPIDEM.2013.08.005
Abstract: To investigate a possible association between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and childhood overweight at 7 years of age. Information on pregnancy exposures and prevalence of childhood overweight at 7 years of age was obtained from the Danish National Birth Cohort. Overweight was classified as body mass index >85th percentile, based on age and sex. Based on an a priori hypothesis, we conducted analyses stratified by child sex to examine sex-specific differences. Of eligible pregnant women, 127 reported using an SSRI, 490 reported having a psychiatric illness but no psychotropic medication use, and 35,568 reported no psychiatric illness and no psychotropic medication use. In comparison to children of mothers with a psychiatric illness but no SSRI use during pregnancy, prenatal SSRI exposure overall was not associated with an increased risk of childhood overweight (adjusted prevalence ratio [aPR] 1.12 95% confidence interval 0.71 to 1.77). However, when stratified according to child sex, an increased risk was observed among males (aPR 1.78 95% CI, 1.01 to 3.12) but not females (aPR 0.86 95% CI, 0.37 to 1.99). In contrast, female children of mothers with a psychiatric illness but no SSRI use during pregnancy were more likely to be overweight than female children of unexposed mothers (aPR 1.45 95% CI, 1.05 to 2.02). This association was not mirrored among males (aPR 1.06 95% CI, 0.76 to 1.50). We observed the potential for opposing sex-specific differences in the long-term effects of prenatal exposure to SSRI use and/or maternal psychiatric illness on childhood overweight. Limitations of the present study suggest that further research in this area may be warranted with larger s le sizes and longer follow-up.
Publisher: Wiley
Date: 21-10-2021
DOI: 10.1002/PTR.6914
Publisher: Elsevier BV
Date: 07-2014
Abstract: Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. Preconception dietary patterns have not been assessed in relation to perinatal outcomes. The objectives of this study were to identify associations between maternal dietary patterns in the 12 mo before conception on fetal growth and preterm delivery. Preconception food frequency data were collected retrospectively in 309 women. Dietary patterns were derived using factor analysis. Perinatal outcomes were collected at delivery with birth weight data calculated into percentiles to assess small and large for gestational age and preterm delivery at <37 wk. Three dietary patterns were identified: 1) high-protein/fruit (characterized by fish, meat, chicken, fruit, and some whole grains) 2) high-fat/sugar/takeaway (takeaway foods, potato chips, refined grains) and 3) vegetarian-type (vegetables, legumes, whole grains). A 1-SD increase in the scores on the high-protein/fruit pattern was associated with decreased likelihood of preterm birth (adjusted OR: 0.31 95% CI: 0.13, 0.72 P = 0.007), whereas the reverse direction was apparent for the high-fat/sugar/takeaway pattern (adjusted OR: 1.54 95% CI: 1.10, 2.15 P = 0.011). A 1-SD increase in the scores on the high fat/sugar/takeaway pattern was also associated with shorter gestation (adjusted regression coefficient: -2.7 95% CI: -4.3, -1.1 P = 0.001) and birth length (adjusted regression coefficient: -0.5 95% CI: -0.8, -0.1 P = 0.004). Nutrition before pregnancy is associated with perinatal outcomes. A dietary pattern containing several protein-rich food sources, fruit, and some whole grains is associated with reduced likelihood for preterm delivery, whereas a dietary pattern mainly consisting of discretionary items is associated with preterm delivery, shorter birth length, and earlier gestation. Poor dietary behaviors in the periconceptional period could be altered to promote behavior change in dietary intake to improve perinatal outcomes and the long-term health of the child.
Publisher: Wiley
Date: 18-07-2021
DOI: 10.1111/AJO.13407
Abstract: Women are susceptible to unintended, rapid repeat pregnancies in the first 12 months postpartum. Access to postpartum contraception, specifically long‐acting reversible contraception, enables better planning of pregnancy timing and spacing and allows optimisation of health before the next conception. Clinical Practice Guidelines (CPG), and implementation policies, supported by consumer input, can improve such access. We searched publicly available Australian and New Zealand guidelines and policy documents addressing postpartum contraception. One CPG detailed specific information about postpartum contraception and, although of high quality, requires modification to local contexts to support implementation and policy development.
Publisher: Wiley
Date: 11-01-2023
DOI: 10.1111/CEA.14254
Abstract: Peanut allergy affects 1%–3% of children in Western countries. Boiling peanuts has been demonstrated to result in a hypoallergenic product that may provide a safer way of inducing desensitization in peanut‐allergic patients by first inducing tolerance to boiled peanut. We aimed to assess the efficacy and safety of oral immunotherapy (OIT) using sequential doses of boiled peanuts followed by roasted peanuts for treating peanut allergy in children. In this open‐label, phase 2, single‐arm clinical trial, children aged 6–18 years with a positive history of peanut allergy and positive peanut skin prick test ≥ 8 mm and/or peanut‐specific IgE ≥ 15 kU/L at screening underwent OIT involving sequential up‐dosing with 12‐hour boiled peanut for 12 weeks, 2‐hour boiled peanut for 20 weeks and roasted peanut for 20 weeks, to a target maintenance dose of 12 roasted peanuts daily. Primary outcome: proportion of children passing open‐label oral food challenge involving cumulative administration of 12 roasted peanuts (12 g peanuts approximately 3000 mg peanut protein) 6–8 weeks after reaching the target maintenance dose. Secondary outcomes included treatment‐related adverse events and use of medications for treating allergy symptoms. Between 1 July 2017 and 22 June 2018, 70 participants were enrolled and commenced OIT. Desensitization was successfully induced in 56 of 70 (80%) participants. Withdrawal due to treatment‐related adverse events was infrequent ( n = 3). Treatment‐related adverse events were reported in 43 (61%) participants, corresponding to a rate of 6.58 per 1000 OIT doses. Medication use associated with treatment‐related adverse events was infrequent, with rescue epinephrine use reported by three (4%) participants (0.05 per 1000 doses). Oral immunotherapy using boiled followed by roasted peanuts represents a pragmatic approach that appears effective in inducing desensitization and is associated with a favourable safety profile.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
Publisher: Elsevier BV
Date: 08-2023
Publisher: European Respiratory Society (ERS)
Date: 30-07-2013
DOI: 10.1183/09031936.00054913
Abstract: Does cigarette smoking in pregnancy explain the increased risk of adverse perinatal outcomes that occur with maternal asthma or does it compound the effect? Using population based birth records, a retrospective analysis was conducted of all singleton pregnancies in South Australia over 10 years (1999-2008 n=172 305), examining maternal asthma, cigarette smoking and quantity of smoking to estimate odds ratios. Compared with nonasthmatic females who did not smoke during pregnancy, both asthmatic females who smoked and those who did not smoke during pregnancy had a significantly increased risk of gestational diabetes, antepartum haemorrhage, polyhydramnios, premature rupture of membranes, emergency Caesarean section, and the child being small for gestational age and having congenital abnormalities. These associations suggest that asthma, independently of maternal smoking, increases the risk of these adverse perinatal outcomes. Maternal smoking was itself associated with an increased risk of a number of poor neonatal outcomes, with a dose-response relationship observed. Notably, maternal asthma combined with cigarette smoking significantly increased the risk of preterm birth and urinary tract infections to a greater degree than with either exposure alone. Maternal asthma and cigarette smoking during pregnancy are both independently associated with adverse perinatal outcomes and, combined, compound the risk of preterm birth and urinary tract infections.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.EJOGRB.2015.11.038
Abstract: We sought to investigate the impact of introducing an antenatal asthma management service (AMS) on asthma control during pregnancy and subsequent perinatal outcomes. Prospective, observational cohort study of pregnant asthmatic women attending a tertiary hospital antenatal clinic. Asthmatic women were recruited from the antenatal clinic and were followed prospectively with visits at 12, 20, 28 and 36 weeks gestation. A new nurse-led AMS was introduced offering asthma self-management education and support. Outcomes were compared between women recruited before and after the AMS was introduced (n=89 and 80, respectively) and included prevalence of exacerbations during pregnancy, asthma control throughout pregnancy and perinatal outcomes, including preterm birth and small-for-gestational-age (SGA). The relative risk for exacerbations (0.69 CI: 0.33-1.42), loss of control (0.67 CI 0.46-0.99) and persistent uncontrolled asthma (0.48 CI 0.26-0.9) were all reduced with attendance to AMS during pregnancy. AMS was associated with non-statistically significant reductions in asthma exacerbations (19.1-15.0% p=0.480) and uncontrolled asthma at ≥ 2 study visits (21.3-11.3% p=0.078). These findings demonstrate the potential impact of an AMS in improving asthma control during pregnancy, supporting the need for an adequately powered RCT to determine its clinical- and cost-effectiveness.
Publisher: Jaypee Brothers Medical Publishing
Date: 2015
Publisher: SAGE Publications
Date: 29-11-2016
Publisher: Wiley
Date: 28-07-2021
DOI: 10.1111/MCN.13064
Publisher: Public Library of Science (PLoS)
Date: 04-12-2018
Publisher: Oxford University Press (OUP)
Date: 26-01-2014
DOI: 10.1111/IJPP.12092
Abstract: The objective of this study was to evaluate the use of an audience response system (i.e. clickers) as an engaging tool for learning and examine its potential for enhancing continuing education (CE) activities. Attendees at a symposium were invited to utilise and evaluate the use of clickers. Electronic data relating to participant demographics and feedback were collected using clickers during the symposium. The 60 attendees who used the clickers were mostly pharmacists (76%) who worked in hospital pharmacy practice (86%). Attendees strongly agreed or agreed that clickers were easy to use (94%), enhanced interaction (98%), allowed comparison of knowledge with that of their peers (78%), brought to attention their knowledge deficits (64%) and should be used again (94%). The innovative use of clickers at the symposium was very well received by all attendees and offered a number of benefits, including the ability to provide a more engaging and interactive CE activity.
Publisher: Wiley
Date: 26-09-2017
DOI: 10.1111/CEA.13024
Publisher: Wiley
Date: 13-05-2021
DOI: 10.1111/AJO.13359
Abstract: We conducted an online survey of 249 Australian women who currently or previously experienced severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG) and examined their experiences in being denied medications during pregnancy. One in four women reported being denied medications for NVP/HG, which most commonly involved doxylamine and encounters with community pharmacists. Women’s experiences reflected that lack of awareness of guidelines and unfavourable risk‐benefit assessments appeared to be key barriers to facilitating medication access. Approaches towards identifying and effectively addressing barriers to the provision of effective treatments for severe NVP and HG are urgently needed.
Publisher: Elsevier BV
Date: 06-2022
Publisher: SAGE Publications
Date: 12-2016
Abstract: Few studies have investigated breastfeeding outcomes among women exposed to antidepressants. This study aimed to evaluate the association between antidepressant use in late gestation and maternal psychiatric illness on breastfeeding rates at discharge from hospital. The authors conducted a retrospective cohort study of 32,662 women delivering live-born singletons between January 2001 and December 2008. Electronic hospital records were used to obtain data on antidepressant exposure during late gestation and whether mothers were breastfeeding at discharge from hospital following delivery. Five hundred seventy-five women received a dispensing for an antidepressant in late gestation (exposed), 1,552 did not receive a dispensing for an antidepressant but had a reported psychiatric illness (disease comparison), and 30,535 served as nonexposed controls. Exposed women were significantly less likely to be breastfeeding their infants at discharge from hospital compared with nonexposed women, adjusted odds ratio ( AOR) = 0.63, 95% confidence interval (CI) [0.50-0.80], but no statistically significant difference was observed when compared with women in the disease comparison group, AOR = 0.83, 95% CI [0.65-1.07]. In stratified analyses, compared with women in the disease comparison group, exposed women were significantly less likely to be breastfeeding their infants at discharge from hospital if their neonate was delivered at term, AOR = 0.73, 95% CI [0.55-0.98], but not preterm, AOR = 1.24, 95% CI [0.66-2.32]. While antidepressant use is associated with a reduction in breastfeeding rates, this association appears to be strongly influenced by factors such as underlying maternal psychiatric illness. Overall, these results highlight that these women may benefit from additional education and support to improve breastfeeding rates.
Publisher: AMPCo
Date: 25-05-2020
DOI: 10.5694/MJA2.50624
Publisher: Informa UK Limited
Date: 16-09-2015
Publisher: Oxford University Press (OUP)
Date: 25-05-2021
Abstract: Deprescribing may benefit older frail patients experiencing polypharmacy. We investigated the scope for deprescribing in acutely hospitalised patients and the long-term implications of continuation of medications that could potentially be deprescribed. Acutely hospitalised patients (n = 170) discharged to Residential Aged Care Facilities, ≥75 years and receiving ≥5 regular medications were assessed during admission to determine eligibility for deprescribing of key drug classes, along with the actual incidence of deprescribing. The impact of continuation of nominated drug classes (anticoagulants, antidiabetics, antiplatelets, antipsychotics, benzodiazepines, proton pump inhibitors (PPIs), statins) on a combined endpoint (death/readmission) was determined. Hyperpolypharmacy (& regular medications) was common (49.4%) at admission. Varying rates of deprescribing occurred during hospitalisation for the nominated drug classes (8–53%), with considerable potential for further deprescribing (34–90%). PPI use was prevalent (56%) and 89.5% of these had no clear indication. Of the drug classes studied, only continued PPI use at discharge was associated with increased mortality/readmission at 1 year (hazard ratio 1.54, 95% confidence interval (1.06–2.26), P = 0.025), driven largely by readmission. There is considerable scope for acute hospitalisation to act as a triage point for deprescribing in older patients. PPIs in particular appeared overprescribed in this susceptible patient group, and this was associated with earlier readmission. Polypharmacy in older hospitalised patients should be targeted for possible deprescribing during hospitalisation, especially PPIs.
Publisher: MDPI AG
Date: 03-02-2023
DOI: 10.3390/ANTIBIOTICS12020314
Abstract: Introduction: Early-life antibiotic exposure is common and impacts the development of the child’s microbiome and immune system. Information on the impacts of early-life antibiotics exposure on childhood asthma is lacking. Methods: This study examined associations between early-life (0–24 months) antibiotics exposure with childhood (6–15 years) asthma trajectories through the Australian Longitudinal Study of Australian Children (LSAC) and their linked data from the Pharmaceutical Benefits Scheme. Asthma phenotypes were derived by group-based trajectory modeling. Results: Of 5107 LSAC participants, 4318 were included in the final analyses (84.6% retention). Four asthma phenotypes were identified: Always-low-risk (79.0%), early-resolving asthma (7.1%), early-persistent asthma (7.9%), and late-onset asthma (6.0%). Any early-life antibiotic exposure increased risk 2.3-fold (95% CI: 1.47–3.67 p 0.001) for early-persistent asthma among all children. In subgroup analyses, early-persistent asthma risk increased by 2.7-fold with any second-generation cephalosporin exposure, and by 2-fold with any β-lactam other than cephalosporin or macrolide exposure. Conclusion: We concluded that early-life antibiotic exposure is associated with an increased risk of early-persistent childhood asthma. This reinforces scrutiny of early-life antibiotic use, particularly for common viral infections where no antibiotics are required.
Publisher: MDPI AG
Date: 28-04-2019
DOI: 10.3390/NU11050974
Abstract: Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological intervention with medications used to augment lactation, commonly referred to as galactagogues, is common. Galactagogues exert their pharmacological effects through altering the complex hormonal milieu regulating lactation, particularly prolactin and oxytocin. This narrative review provides an appraisal of the existing evidence regarding the efficacy and safety of pharmaceutical treatments for lactation insufficiency to guide their use in clinical practice. The greatest body of evidence surrounds the use of domperidone, with studies demonstrating moderate short-term improvements in breast milk supply. Evidence regarding the efficacy and safety of metoclopramide is less robust, but given that it shares the same mechanism of action as domperidone it may represent a potential treatment alternative where domperidone is unsuitable. Data on remaining interventions such as oxytocin, prolactin and metformin is too limited to support their use in clinical practice. The review provides an overview of key evidence gaps and areas of future research, including the impacts of pharmaceutical galactagogues on breast milk composition and understanding factors contributing to in idual treatment response to pharmaceutical galactagogues.
Publisher: Wiley
Date: 28-11-2022
DOI: 10.1111/PPE.12824
Abstract: Mastitis is a common and distressing maternal postpartum condition, but the relationship between mastitis timing and antibiotic treatment and breastfeeding outcomes and postnatal mental health is unclear. To describe the incidence of mastitis and treatment with antibiotics in first 6 months postpartum, and to investigate the impact of mastitis timing and antibiotic treatment on breastfeeding practices and postnatal mental health. This study is based on 79,985 mother‐infant dyads in the Norwegian Mother, Father and Child Cohort Study (MoBa). Women were classified according to self‐reported mastitis within first month (‘early’) or 1–6 months (‘later’) postpartum and antibiotic treatment. Breastfeeding outcomes included predominant or any breastfeeding and abrupt breastfeeding cessation until 6 months postpartum. Maternal mental health was assessed by self‐report at 6 months postpartum. The incidence of mastitis was 18.8%, with 36.8% reporting treatment with antibiotics. Women reporting early mastitis were less likely to report predominant breastfeeding (adjustedd relative risk [aRR] 0.92, 95% confidence interval [CI] 0.86, 0.99) and any breastfeeding for 6 months (aRR 0.97, 95% CI 0.96, 0.98) than women who did not report mastitis, and more likely to report abrupt breastfeeding cessation (aRR 1.37, 95% CI 1.23, 1.53). Late‐onset mastitis was not associated with poorer breastfeeding outcomes. Among women reporting mastitis, the risk of abrupt breastfeeding cessation was higher in those also reporting antibiotic use. Mastitis was associated with an increased risk of mental health problems postpartum which was highest among those reporting no antibiotic use (aRR 1.29, 95% CI 1.18, 1.41), in contrast to those also reporting antibiotic use (aRR 1.08, 95% CI 0.96, 1.22). Lactational mastitis and its associated treatment with antibiotics are common. Early ( month postpartum) mastitis appears to be a modest risk factor for suboptimal breastfeeding outcomes. In addition, mastitis is associated with poorer mental health.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Publisher: Wiley
Date: 11-04-2023
Abstract: To describe the pharmacoepidemiology and costs associated with medications dispensed during pregnancy. Pharmacoepidemiological study and cost analysis. Queensland, Australia. All women who gave birth in Queensland between January 2013 and June 2018. We used a whole‐of‐population linked administrative dataset, Maternity1000, to describe medications approved for public subsidy that were dispensed to 255 408 pregnant women. We describe the volume of medications dispensed and their associated costs from a Government and patient perspective. Prevalence of medication use proportion of total dispensings total medication costs in AUD 2020/21 ($1AUD = $0.67USD/£0.55GBP in December 2022). During pregnancy, 61% (95% CI 60.96–61.29%) of women were dispensed at least one medication approved for public subsidy. The mean number of items dispensed per pregnancy increased from 2.14 (95% CI 2.11–2.17) in 2013 to 2.47 (95% CI 2.44–2.51) in 2017 an increase of 15%. Furthermore, mean Government cost per dispensing increased by 41% from $21.60 (95% CI $20.99–$22.20) in 2013 to $30.44 (95% CI $29.38–$31.49) in 2017. These factors influenced the 53% increase in total Government expenditure observed for medication use during pregnancy between 2013 and 2017 ($2,834,227 versus $4,324,377) a disproportionate rise compared with the 17% rise in women's total out‐of‐pocket expenses observed over the same timeframe ($1,880,961 versus $2,204,415). Prevalence of medication use in pregnancy is rising and is associated with disproportionate and rapidly escalating cost implications for the Government.
Publisher: Wiley
Date: 30-06-2015
DOI: 10.1111/AJO.12371
Abstract: Pregnancy hand-held records (PHR) are a personally controlled health record utilised in the promotion of continuity of care across pregnancy by providing a single resource for the recording of pregnancy-related health information. To determine the accuracy of the PHR in relation to information on medications and adverse drug reactions (ADRs) and to examine the frequency and nature of any identified discrepancies. A 12-week prospective clinical audit of 300 women admitted to either the antenatal or postnatal ward at a tertiary-level maternity hospital. A detailed medication history was completed for each woman by a pharmacist, with women interviewed about medication use prior to and during their pregnancy as well as any ADRs. The medication history and PHR were compared to identify discrepancies. Medication discrepancies were extremely common, with 254 (84.7% 95% CI 80.6-88.8%) women having at least one or more medication-related discrepancy involving 686 (55% 95% CI 52.2-57.8%) prescription and nonprescription medications. Most common reasons for prescription medication discrepancies included the medication details being incomplete (44%), missing (29%) or incorrect (17%). ADRs and allergy discrepancies were also common, identified among 59 (20% 95% CI 15.5-24.5%) women. The PHR is of low accuracy in relation to the recording of medications and ADRs. This warrants further research to examine the impact of these discrepancies on patient care and outcomes. The identification of strategies for improving the recording of information on medications and ADRs in the PHR is also required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Publisher: Public Library of Science (PLoS)
Date: 03-05-2021
DOI: 10.1371/JOURNAL.PONE.0249599
Abstract: Galactagogues are foods, herbs or medications thought to support or increase breast milk supply. The use of galactagogues during lactation is becoming increasingly common despite limited evidence regarding effectiveness and safety, and no definitive recommendations for use in clinical practice. The aim of this study is to explore factors influencing women’s decisions to use galactagogues during lactation. Twenty-two semi-structured interviews were conducted in October and November 2019 (over the telephone or in person) with participants located in most Australian states and territories, including metro and regional areas. Interviews were audio-recorded, transcribed verbatim and thematically analysed using NVivo. Analysis revealed that following a concern about breast milk supply, the decision to use galactagogues was influenced by three core and interrelated domains: access to and quality of breastfeeding support, maternal agency and determination to provide breast milk. Women revealed many problematic experiences with health care professionals that left them feeling dismissed and confused due to provision of inconsistent and insufficient information that was sometimes at odds with their desire to provide breast milk. In this instance, some women turned to galactagogues to regain agency. A range of broader dimensions influencing decision-making also emerged. These were separated into categories that emphasise distinctions relating to breast milk supply, which included: maternal emotional wellbeing, social norms and pressures, concerns about infant development, maternal physical health and lactation history, as well as those relating specifically to galactagogue use, including: desire for a guaranteed/urgent response, risk-risk trade-off, acceptance and trust, and accessibility and cost. In understanding the complexity of decision-making concerning these substances, we identify opportunities to improve breastfeeding counselling and support. We recommend that support be in idually tailored to manage conflicting information, adopt communication styles that encourage trust and processes that enable shared decision-making to enhance or restore maternal agency. There is also considerable need to address evidence gaps regarding the effectiveness and safety of commonly used galactagogues, so that women can be appropriately counselled about potential benefits and harms.
Publisher: Wiley
Date: 15-08-2013
Publisher: Wiley
Date: 22-09-2021
DOI: 10.5694/MJA2.51275
Abstract: To examine primary care provision of early medical abortion services in Australia. Cross-sectional study analysis of Pharmaceutical Benefits Scheme (PBS) dispensing data. Women of child-bearing age (15-54 years), Australia, 2015-2019. Age-standardised rates of MS-2 Step prescriptions dispensed by year for 2015-2019, and age-standardised rates by state, remoteness area, and level 3 statistical areas (SA3s) for 2019. Numbers and proportions of SA3s in which MS-2 Step was not prescribed by a GP or dispensed by a community pharmacy during 2019 (unweighted and weighted by number of women of reproductive age), by state and remoteness area. During 2015-2019, 91 643 PBS prescriptions for MS-2 Step were dispensed the national age-standardised rate increased from 1.63 in 2015 to 3.79 prescriptions per 1000 women aged 15-54 years in 2019. In 2019, rates were higher in outer regional Australia (6.53 prescriptions per 1000 women aged 15-54 years) and remote Australia (6.02 per 1000) than in major cities (3.30 per 1000). However, about 30% of women in Australia lived in SA3s in which MS-2 Step had not been prescribed by a GP during 2019, including about 50% of those in remote Australia. The rate of early medical abortion is greater among women in remote, outer regional, and inner regional Australia than in major cities, but a considerable proportion of women live in areas in which MS-2 Step was not locally prescribed or dispensed during 2019. Supporting GPs in the delivery of early medical abortion services locally should be a focus of health policy.
Publisher: Wiley
Date: 10-07-2017
DOI: 10.1111/AJO.12657
Abstract: To investigate trends in receipt and timing of antenatal corticosteroid (ACS) administration over a ten-year interval. Retrospective cohort study of all live births from 2006 to 2015 occurring at a tertiary level teaching hospital in Adelaide, Australia. We analysed temporal trends in the receipt of single courses and repeat doses of ACSs, according to administration timing prior to birth. The main outcome measures were receipt of a single course of ACS and whether administration was 'Optimal' (≥24 h to <seven days) or 'Suboptimal' (<24 h OR ≥7 days) according to timing prior to birth, as well as administration of repeat doses. Among 47 105 live births, 4191 (8.9%) received any ACS, while 1009 (2.1%) received at least one repeat dose. From 2006/7 to 2014/15, receipt of a single course (relative risk (RR) 1.33 95%CI 1.21, 1.47) or repeat dose of ACS (RR 1.24 95%CI 1.01, 1.55) increased. Among women giving birth between 23-34 weeks gestation, receipt of any ACS increased from 75 to 84%, while an optimally timed single course of ACS increased from 20.4 to 31.0% (RR 1.40 95%CI 1.24, 1.87). From 2006/7 to 2014/15, the greatest increase in ACS administration was evident among infants born 35-36 and ≥37 weeks gestation by caesarean section (RR 1.94 95%CI 1.48, 2.55 and RR 2.55 95%CI 1.86, 3.50, respectively). While frequently used, less than half of ACS administration prior to preterm birth was optimally timed. The impact of suboptimal ACS timing on neonatal outcomes requires further investigation.
Publisher: Wiley
Date: 27-03-2018
Abstract: Mothers of preterm infants often struggle to produce enough breast milk to meet the nutritional needs of their infant. Galactagogues such as domperidone are often prescribed to increase breast milk supply but evidence supporting their role in clinical practice is uncertain. To evaluate the efficacy and safety of domperidone for increasing breast milk volume in mothers expressing breast milk for their preterm infants. MEDLINE, Embase and Web of Science were searched without language restrictions from first publication until January 2017. Bibliographies of articles and reviews were hand-searched for additional reports. Randomised controlled trials that compared domperidone with placebo in mothers of preterm infants (<37 weeks' gestation) experiencing insufficient milk supply. Two review authors independently assessed studies for inclusion, extracted data and evaluated study quality. Differences in breast milk volume and adverse events were combined using fixed effects meta-analysis. The pooled analysis of five trials consisting of 194 women demonstrated a moderate increase in daily breast milk volume of 88.3 ml/day (95% CI 56.8-119.8) with the use of domperidone compared with placebo. No difference was evident with respect to maternal adverse events (odds ratio 1.05, 95% CI 0.65-1.71), with no reported cases of prolonged QTc syndrome or sudden cardiac death. Sensitivity analyses showed no important differences in the estimates of effects. Domperidone is well tolerated and results in a moderate short-term increase in expressed breast milk volume among mothers of preterm infants previously identified as having insufficient breast milk supply. Domperidone leads to short-term improvements in breast milk volume in mothers of preterm infants.
Publisher: Wiley
Date: 14-04-2018
DOI: 10.1111/BCP.13575
Publisher: Wiley
Date: 14-05-2023
DOI: 10.5694/MJA2.51948
Abstract: To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013–2021. Retrospective cohort study analysis of 10% random s le of Pharmaceutical Benefits Scheme (PBS) dispensing data. People aged 18 years or younger dispensed PBS‐subsidised psychotropic medications in Australia, 2013–2021. Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0–6, 7–12, 13–18 years). The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000 girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000 girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013–2019 data for many classes, including antidepressants (boys: +6.1% 95% CI, 1.1–11.1% girls: +22.2% 95% CI, 17.4–26.9%), and psychostimulants (boys: +14.5% 95% CI, 8.0–21.1% girls: +27.7% 95% CI, 18.9–36.6%). The increases were greatest for girls aged 13–18 years (antidepressants: +20.3% 95% CI, 16.9–23.7% psychostimulants: +39.0% 95% CI, 27.9–50.0%). The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID‐19 pandemic, particularly to adolescent girls, should be investigated.
Publisher: European Respiratory Society (ERS)
Date: 02-2018
Publisher: Wiley
Date: 07-2017
DOI: 10.1002/PDS.4133
Publisher: AMPCo
Date: 26-05-2020
DOI: 10.5694/MJA2.50618
Publisher: Springer Science and Business Media LLC
Date: 07-02-2023
DOI: 10.1186/S13006-023-00541-9
Abstract: Domperidone is one of the most commonly utilised pharmacological galactagogues, with evidence of increasing use in clinical practice. However, the use of domperidone as a galactagogue remains controversial, with mixed evidence on safety and efficacy, leading to variable clinical practice recommendations. We sought to evaluate contemporary patterns of domperidone use and examine maternal experiences related to perceived safety and effectiveness. In 2019, we conducted an online, cross-sectional survey of Australian breastfeeding women to examine in idual experiences related to domperidone use, in addition to perceptions of safety and effectiveness. Among 1876 survey responses, 19% ( n = 355) reported using domperidone. Domperidone use was significantly higher in women who were primiparous, gave birth preterm, delivered by caesarean section, had self-perceived low milk supply, and saw a lactation consultant. Nearly 20% of women commenced domperidone use in the first week postpartum (19%, n = 67). The median duration of use was six weeks (interquartile range 3–16 weeks). Maximum reported doses of domperidone used ranged from 20 mg/day to 160 mg/day. Half ( n = 178, 50%) of women reported using a dose of 30 mg/day or less, 44% ( n = 155) reported using a dose between 31 and 60 mg/day, and 6% ( n = 22) reported using a dose greater than 61 mg/day. Nearly half of the respondents reported domperidone as ‘very’ or ‘extremely effective’ (45%, n = 161), with only 8% ( n = 27) reporting it was ‘not at all effective’. Almost half ( n = 172, 48%) of all women using domperidone reported side effects, including weight gain (25%), headaches (17%) and dry mouth (13%). Higher doses were associated with an increased likelihood of any side effects (≤ 30 mg/day, 38% -≤60 mg/day, 48%, 61 mg/day 73% P 0.004), with 31 (9%) stopping domperidone because of side effects. We identified widespread variation in domperidone utilisation patterns, with domperidone broadly perceived to be effective in increasing breast milk supply. Side effects associated with domperidone treatment were common, appeared to be dose-related, and were frequently associated with treatment cessation. These findings highlight the importance of improved clinical practice recommendations and generation of evidence from additional high-quality clinical trials evaluating the efficacy and safety of domperidone. More conclusive clinical trials are needed to determine the efficacy, as well as optimal dose and duration, of domperidone use.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
DOI: 10.1002/CHP.21269
Abstract: We investigated whether using an audience response system (ARS) as part of continuing education (CE) activities enhances immediate and long-term knowledge acquisition or learner reactions. A multicenter single-blinded controlled trial involving pharmacists at 2 metropolitan teaching hospitals was used for this investigation. Pharmacists were allocated to either (a) an interactive presentation incorporating multiple-choice questions (MCQs) answered using an ARS, or (b) the same, but noninteractive, presentation using summary points instead of MCQs. Baseline knowledge was evaluated using a 10-item questionnaire, which was also used to evaluate immediate and long-term (6 weeks later) knowledge acquisition. Learner reactions were evaluated through feedback questionnaires. The control and ARS intervention presentations were attended by 44 and 35 pharmacists, respectively. The 6-week follow-up questionnaire was completed by 35 control (80%) and 27 (77%) ARS group participants. Baseline knowledge was similar across groups (5.0 ± 1.6 SD vs 5.2 ± 1.6 p = .44) with no differences in immediate (8.3 ± 1.5 vs 7.9 ± 1.5 p = 0.30) or long-term (7.0 ± 1.6 vs 7.0 ± 1.5 p = 0.93) knowledge acquisition. Feedback regarding the use of an ARS was overwhelmingly positive, with participants feeling more strongly that the ARS enabled them to compare knowledge to that of their peers (p < .001). There was no observed benefit of an ARS in relation to immediate or long-term knowledge acquisition. The use of an ARS, however, appeared to facilitate enhanced interactivity and participant self-reflection of knowledge, with strong participant desire to continue their use in future CE activities.
Publisher: Springer Science and Business Media LLC
Date: 13-11-2011
DOI: 10.1007/S00228-011-1154-9
Abstract: The aim of this systematic review was to examine and compare differences in the way medication exposures are classified in studies using linked administrative data to investigate outcomes following medication use during pregnancy. This was undertaken with a focus on studies investigating specific neonatal outcomes following prenatal exposure to selective serotonin reuptake inhibitors (SSRIs). We searched Medline and Embase to identify studies that used linked administrative data to investigate specific neonatal outcomes (congenital malformations, birth weight, gestational age) following prenatal exposure to SSRIs. Key factors such as dose, duration and timing of exposure were inconsistently addressed in the studies identified. In addition, there was a great deal of variability in the way medication exposures were classified and how women who stop taking their medication before or during early pregnancy are handled in analyses. Furthermore, there are issues in assuming how and when women who receive a dispensing for a medication actually take it during pregnancy. This creates a great deal of uncertainty around medication exposure during pregnancy in studies using linked administrative data, potentially resulting in biased risk estimates. There is a need for greater focus on determining the most effective and accurate way of using linked administrative data to investigate outcomes following medication use during pregnancy in an effort to minimise potential biases.
Publisher: MDPI AG
Date: 16-07-2019
DOI: 10.3390/NU11071609
Abstract: Trace elements such as zinc, copper, and selenium are essential for reproductive health, but there is limited work examining how circulating trace elements may associate with fertility in humans. The aim of this study was to determine the association between maternal plasma concentrations of zinc, copper, and selenium, and time to pregnancy and subfertility. Australian women (n = 1060) who participated in the multi-centre prospective Screening for Pregnancy Endpoints study were included. Maternal plasma concentrations of copper, zinc and selenium were assessed at 15 ± 1 weeks’ gestation. Estimates of retrospectively reported time to pregnancy were documented as number of months to conceive subfertility was defined as taking more than 12 months to conceive. A range of maternal and paternal adjustments were included. Women who had lower zinc (time ratio, 1.20 (0.99–1.44)) or who had lower selenium concentrations (1.19 (1.01–1.40)) had a longer time to pregnancy, equivalent to a median difference in time to pregnancy of around 0.6 months. Women with low selenium concentrations were also at a 1.46 (1.06–2.03) greater relative risk for subfertility compared to women with higher selenium concentrations. There were no associations between copper and time to pregnancy or subfertility. Lower selenium and zinc trace element concentrations, which likely reflect lower dietary intakes, associate with a longer time to pregnancy. Further research supporting our work is required, which may inform recommendations to increase maternal trace element intake in women planning a pregnancy.
Publisher: Springer Science and Business Media LLC
Date: 04-11-2020
DOI: 10.1186/S12884-020-03363-3
Abstract: Iron deficiency anaemia in pregnancy (IDAP) affects 11–18% of Australian pregnancies and is associated with adverse perinatal outcomes. National prescribing data suggests the use of intravenous iron in pregnancy is increasingly common. This study aimed to: 1) Establish the current patterns of intravenous iron use by Fellows of the Royal Australian and New Zealand College of Obstetricians (FRANZCOG) when treating iron deficiency and IDAP including immediately postpartum and 2) Assess FRANZCOG opinions regarding potential trial of intravenous iron for first-line treatment of IDAP. An online survey of RANZCOG Fellows practicing obstetrics was distributed in September 2018. Results were analysed descriptively and responses compared by clinician demographics using Chi-squared testing. Of 484 respondents (21% of FRANZCOG), 457 were currently practicing obstetrics. Most prescribed intravenous iron in pregnancy (96%) and/or postpartum (85%). Most intravenous iron was prescribed for IDAP (98%) rather than iron deficiency without anaemia (53%), and for IDAP most commonly second-line to failed oral iron supplementation and first-line in special circumstances (59%). Intravenous iron prescribing was associated with shorter time since FRANZCOG completion ( p = 0.01), public hospital practice ( p = 0.008) and higher hospital birth numbers (p = 0.01). Most respondents (90%) would consider a randomised controlled trial of first-line intravenous iron for IDAP, although views on appropriate thresholds differed. Almost all respondents prescribed intravenous iron for IDAP, and while mostly used for second-line treatment over half sometimes used it first-line. With accelerating intravenous iron use, further research is required into its optimal use in pregnancy, recognizing important clinical outcomes and cost effectiveness.
Publisher: Wiley
Date: 12-2018
DOI: 10.1111/AJO.12884
Publisher: Wiley
Date: 03-2015
DOI: 10.1002/JPPR.1056
Publisher: Springer Science and Business Media LLC
Date: 10-2015
Publisher: Wiley
Date: 13-06-2017
DOI: 10.1111/AJO.12645
Abstract: Intravenous iron polymaltose (IPM) is commonly utilised in pregnancy when oral treatment is not tolerated or where rapid replenishment of iron stores is required, but data on use in pregnancy is scarce. To examine the use, safety and efficacy of intravenous IPM in pregnancy. Retrospective cohort study of pregnant women administered intravenous IPM between January 2014 and January 2016 at a Tertiary teaching hospital in Adelaide, Australia. Data on maternal characteristics, intravenous iron infusion details, and haematological parameters were collected from case notes and electronic records. Main outcome measures included indication for intravenous iron infusion, prevalence of infusion reactions, change in haemoglobin and correction of anaemia prior to delivery. Intravenous IPM was administered in 213 pregnancies, 62.0% of women with iron deficiency anaemia (IDA) and the remainder (38.0%) with non-anaemic iron deficiency. Adverse drug reactions (ADRs) occurred in 24% of women, of which 32% required infusion cessation. Anaemia was still present at delivery among 7%, and 17% of women with mild, and moderate/severe anaemia respectively. Approximately one in five anaemic women received an intravenous IPM dose below that recommended by the local guideline, particularly in women with a body mass index ≥ 25 kg/m Intravenous IPM is effective in treating IDA in pregnancy but is associated with a high prevalence of ADRs and treatment cessation.
Publisher: SAGE Publications
Date: 26-11-2020
Publisher: Wiley
Date: 20-06-2017
Publisher: SAGE Publications
Date: 10-12-2202
Publisher: Wiley
Date: 12-2010
DOI: 10.1002/J.2055-2335.2010.TB00557.X
Abstract: To determine the validity of electronic hospital pharmacy dispensing records as an indicator of late gestation exposure to antidepressants using medical records as the gold standard. Medical records (gold standard) were reviewed for a consecutive s le of 400 women who delivered at a large maternity hospital during 2005. Data on antidepressants used in pregnancy from the medical records were compared with the electronic pharmacy dispensing records to ascertain sensitivity and specificity. According to the medical records, 12 (3%) women were identified as taking antidepressants during late gestation. The electronic pharmacy dispensing records correctly identified 9 women as exposed to antidepressants (sensitivity score 75% 95%CI 43–95). No women were classified as exposed according to pharmacy dispensing records and classified as not exposed according to the medical records (specificity score 100% 95%CI 99–100). 7 (1.8%) women were identified in the medical records as taking antidepressants but had either stopped prior to pregnancy or on finding out that they were pregnant. These patients were not identified in the pharmacy dispensing records. Electronic hospital pharmacy dispensing records may provide an efficient alternative to paper records for identifying late gestation exposure to antidepressants, but will underestimate the exposure by 25%.
Publisher: AMPCo
Date: 09-2014
DOI: 10.5694/MJA13.11142
Abstract: To assess the impact of Aboriginal status, active cigarette smoking and smoking cessation during pregnancy on perinatal outcomes. Retrospective cohort study from 1 January 1999 to 31 December 2008. All singleton births in South Australia. Population-based birth records of pregnancies to Aboriginal women (n = 4245) and non-Aboriginal women (n = 167 746). Adjusted odds ratios (aORs) and 95% CIs for adverse maternal and neonatal outcomes according to Aboriginal status and maternal smoking in pregnancy. Active cigarette smoking during pregnancy was associated with an increased risk of adverse perinatal outcomes, including premature labour (Aboriginal, 1-10 cigarettes per day: aOR, 1.69 95% CI, 1.28-2.23 non-Aboriginal, 1-10 cigarettes per day: aOR, 1.46 95% CI, 1.34-1.58), preterm birth (Aboriginal, 1-10 cigarettes per day: aOR, 1.40 95% CI, 1.14-1.73 non-Aboriginal, 1-10 cigarettes per day: aOR, 1.48 95% CI, 1.39-1.57), intrauterine growth restriction (Aboriginal, 1-10 cigarettes per day: aOR, 2.33 95% CI, 1.77-3.08 non-Aboriginal, 1-10 cigarettes per day: aOR, 2.65 95% CI, 2.48-2.83) and small for gestational age (Aboriginal, 1-10 cigarettes per day: aOR, 2.49 95% CI, 2.06-3.00 non-Aboriginal, 1-10 cigarettes per day: aOR, 2.29 95% CI, 2.20-2.40). For both Aboriginal and non-Aboriginal women who smoked 11 or more cigarettes per day the aOR for these outcomes increased. Smoking cessation in the first trimester reduced these risks to levels comparable with non-smokers. The risk of each adverse outcome was greater in Aboriginal than non-Aboriginal women for all smoking categories however, interactions between Aboriginal status and smoking were not significant, indicating an equal contribution of smoking to poor outcomes in both populations. Smoking cessation or reduction during pregnancy would significantly improve outcomes in both Aboriginal and non-Aboriginal women. This should be made a clear priority to improve pregnancy outcomes for all women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
Publisher: Wiley
Date: 03-2014
Publisher: Springer Science and Business Media LLC
Date: 03-05-2018
DOI: 10.1007/S00228-018-2470-0
Abstract: To examine differences in longer-term breastfeeding outcomes among mothers of preterm infants according to domperidone exposure status, as well as examine the potential for effect modification according to maternal weight. Retrospective cohort study of 198 mothers of very preterm infants (born ≤ 30 weeks' gestation) who initiated breastfeeding and whose infants survived until hospital discharge. Data on domperidone use were obtained from hospital pharmacy records, with the primary outcome defined as continuation of breastfeeding at infant discharge from the Neonatal Unit. The relationship between domperidone exposure and breastfeeding status was investigated using multivariable regression analysis, adjusting for potential confounders. Additional pre-determined analyses were undertaken following stratification according to maternal weight to investigate the presence of effect modification. No overall difference was observed in the proportion of mothers continuing to breastfeed at the time of infant discharge from the Neonatal Unit according to whether or not they received domperidone (aRR 0.99 0.86-1.13). Notably, effect modification was observed according to maternal weight, with use of domperidone associated with a reduced likelihood of breastfeeding at discharge among women ≥ 70 kg (aRR 0.72 0.54-0.97), but not among those < 70 kg (aRR 1.16 0.92-1.46). Despite experiencing low milk supply, longer-term breastfeeding outcomes were similar between women who did and did not use domperidone. Differences in domperidone effectiveness according to maternal weight have important implications for clinical practice given the increasing prevalence of overweight/obesity in reproductive-age women and their higher risk of low milk supply, highlighting the importance of further research in this area.
Publisher: AMPCo
Date: 09-2014
DOI: 10.5694/MJA14.00626
Publisher: Elsevier BV
Date: 2016
Publisher: SAGE Publications
Date: 12-09-2018
Abstract: Medication errors are common in neonatal care and can lead to significant harm. We sought to explore utilization of various medication error prevention strategies across Australian and New Zealand neonatal units (NNUs) through a clinical practice survey. An electronic survey was distributed in October 2016 to relevant staff at each of the 29 level III NNUs identified as members of the Australian and New Zealand Neonatal Network (ANZNN). The survey contained questions relating to a range of medication error prevention strategies identified from a previous systematic review on the topic. The evaluated interventions targeted different aspects of the medication-use process including prescribing, evaluation/checking of orders by clinical pharmacists, transmission, preparation and dispensing of orders, storage of medications, and medication administration. From the 20 respondents, the evidence-based strategies most commonly utilized were use of smart pumps ( n = 18 90%), and ward-based clinical pharmacists ( n = 17 85%). Interventions least commonly utilized included barcode scanning with medication administration ( n = 0 0%), electronic prescribing and clinical decision support ( n = 1 5%), and dedicated medication administration nurse ( n = 2 10%). The total number of evidence-based medication error prevention strategies utilized in each NNU ranged from 2 to 10 (median = 7), 10 of 16 strategies were utilized by less than 50% of NNUs. While evidence supports utilization of a number of medication error prevention strategies, these appear inconsistently utilized across current practice settings.
Publisher: Wiley
Date: 24-02-2017
DOI: 10.1002/JPPR.1289
Publisher: SAGE Publications
Date: 20-12-2012
Abstract: To date, the investigation of teratogenic effects of medications has largely focused on physical alterations present at birth (i.e. malformations) as opposed to functional alterations (i.e. neurodevelopment, metabolic function) that may not be apparent at birth but could influence an in idual’s health and risk of disease in later life. The use of routinely collected health data represents one approach to better identifying, quantifying, and understanding the long-term risks or benefits of medication use during pregnancy. As such, the objective of this review was to identify and explore opportunities and challenges associated with using routinely collected health data to examine long-term effects of medication use during pregnancy. Drawing on published research several key methodological issues associated with their use in investigating long-term outcomes are reviewed. While significant opportunities exist to make greater use of routinely collected health data, there are a number of key challenges. Identified challenges relate to aspects of study design and analysis, and include obtaining access to data, the ability to match records across datasets and over long periods of time, how medication exposures are ascertained and classified, issues around loss to follow-up how outcomes are ascertained and classified, and the careful interpretation of results in light of study and data limitations. Understanding key challenges associated with using routinely collected health data to investigate long-term effects of medication use during pregnancy is essential in supporting their appropriate use and interpretation, which will contribute to improving the quality of research undertaken and ensure the reliability of results obtained.
Publisher: Cambridge University Press (CUP)
Date: 09-01-2012
DOI: 10.1017/S2040174411000808
Abstract: The objective was to investigate the association between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and overweight in offspring at 4–5 years of age. We conducted a retrospective cohort study using linked records from the Women's and Children's Health Network in South Australia, Australia. Women were eligible to participate if they gave birth to singleton, live-born infants between September 2000 and December 2005. Women were excluded if they received a dispensing for an antidepressant other than SSRIs or an antipsychotic or an anti-epileptic or had a chronic medical condition. Of the 6560 eligible women, 71 received a dispensing for an SSRI (exposed), 204 had a reported psychiatric illness but did not receive a dispensing for any antidepressant (untreated psychiatric illness) and 6285 did not have a reported psychiatric illness and did not receive a dispensing for any antidepressant (unexposed). Childhood overweight was classified as a body mass index th percentile, based on age and sex. At 4–5 years of age, female offspring of exposed mothers were less likely to be overweight compared with female offspring of mothers with an untreated psychiatric illness [adjusted Prevalence Ratio (aPR) 0.23 95% confidence interval (CI) 0.05–0.98] and female offspring of unexposed mothers (aPR 0.27 0.07–0.99). No association with overweight was observed among male offspring of exposed mothers compared with male offspring of mothers with an untreated psychiatric illness (aPR 1.17 0.54–2.51) and male offspring of unexposed mothers (aPR 0.93 0.52–1.67). Further research is required to confirm these findings and examine the potential mechanisms behind the sex-specific differences.
Publisher: Public Library of Science (PLoS)
Date: 24-07-2017
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 12-2021
DOI: 10.1111/AJO.13442
Publisher: Springer Science and Business Media LLC
Date: 08-01-2014
Abstract: Pregnancy presents a unique situation for the management of asthma as it can alter the course of asthma severity and its treatment, which in turn can affect pregnancy outcomes. Despite awareness of the substantial adverse effects associated with asthma during pregnancy, little has been done to improve its management and reduce associated perinatal morbidity and mortality. The aim of this randomized controlled trial is to evaluate the clinical and cost effectiveness of an Antenatal Asthma Management Service. Design: Multicentre, randomized controlled trial. Inclusion criteria: Women with physician diagnosed asthma, which is not currently in remission, who are less than 20 weeks gestation with a singleton pregnancy and do not have a chronic medical condition. Trial entry and randomization: Eligible women with asthma, stratified by treatment site, disease severity and parity, will be randomized into either the ‘Standard Care Group’ or the ‘Intervention Group’. Study groups: Both groups will be followed prospectively throughout pregnancy. Women in the ‘Standard Care Group’ will receive routine obstetric care reflecting current clinical practice in Australian hospitals. Women in the ‘Intervention Group’ will receive additional care through the nurse-led Antenatal Asthma Management Service, based in the antenatal outpatient clinic. Women will receive asthma education with a full assessment of their asthma at 18, 24, 30 and 36 weeks gestation. Each antenatal visit will include a 60 min session where asthma management skills are assessed including: medication adherence and knowledge, inhaler device technique, recognition of asthma deterioration and possession of a written asthma action plan. Furthermore, subjects will receive education about asthma control and management skills including trigger avoidance and smoking cessation counseling when appropriate. Primary study outcome: Asthma exacerbations during pregnancy. S le size: A s le size of 378 women will be sufficient to show an absolute reduction in asthma exacerbations during pregnancy of 20% (alpha 0.05 two-tailed, 90% power, 5% loss to follow-up). The integration of an asthma education program within the antenatal clinic setting has the significant potential to improve the participation of pregnant women in the self-management of their asthma, reduce asthma exacerbations and improve perinatal health outcomes. ACTRN12613000244707
Publisher: Wiley
Date: 23-07-2018
DOI: 10.1111/OBR.12698
Publisher: Wiley
Date: 03-2012
Publisher: Wiley
Date: 18-01-2016
Publisher: BMJ
Date: 23-06-2023
DOI: 10.1136/BMJSRH-2023-201830
Abstract: Short birth intervals and unintended pregnancy are associated with poorer maternal and infant outcomes. There is a risk of pregnancy during the immediate postpartum period unless contraception is initiated. This retrospective cohort study aimed to capture the current patterns of hormonal contraceptive provision within 12 months postpartum in a high-income country. We used a linked administrative dataset comprising all women who gave birth in Queensland, Australia between 1 July 2012 and 30 June 2018 (n=339 265 pregnancies). We described our cohort by whether they were provided with government-subsidised hormonal contraception within 12 months postpartum. The associations between hormonal postpartum contraceptive provision and demographic and clinical characteristics were examined using univariate and multivariate logistic regression and presented in terms of crude and adjusted odds ratios with 95% confidence intervals. A majority of women (60.2%) were not provided with government-subsidised hormonal postpartum contraception within 12 months postpartum. Women who were younger ( years), were overweight or obese, smoked, were born in Australia, were non-Indigenous, gave birth in a public hospital, or were in the lowest socioeconomic status group were more likely to be provided with postpartum contraception after adjusting for other covariates, compared with their counterparts. Strategies to increase the provision and uptake of contraception in the immediate postpartum period are needed to prevent short birth intervals and unintended pregnancy and ensure women’s fertility intentions are enacted. Ongoing research is needed to examine the factors influencing women’s access to contraceptive services and, further, the types of contraception provided.
Publisher: SAGE Publications
Date: 29-10-2014
Abstract: Insufficient milk supply is 1 of the most commonly reported reasons for discontinuation of infant breastfeeding. Although domperidone is often used to improve milk supply, knowledge of factors associated with the use of domperidone in clinical practice is scarce. This study aimed to examine factors associated with the use of domperidone as a galactogogue at the Women’s and Children’s Hospital (WCH), Adelaide. A retrospective cohort study was conducted, involving women who delivered live-born singletons (N = 21 914) at the WCH between January 2004 and December 2008. Women dispensed domperidone were identified using WCH pharmacy dispensing records. Maternal and infant clinical data were obtained from the WCH Perinatal Statistics Collection. Relationships between maternal/infant demographic and clinical variables and the use of domperidone were examined through univariate and multivariate logistic regression analyses. Key factors associated with an increased likelihood of women receiving domperidone were increasing maternal age (adjusted odds ratio [aOR] = 1.04 95% confidence interval [CI], 1.03-1.06), maternal obesity (aOR = 1.41 95% CI, 1.16-1.77), primiparity (aOR = 1.94 95% CI, 1.63-2.30), delivery by cesarean section (aOR = 1.31 95% CI, 1.10-1.55), preterm birth (aOR = 3.54 95% CI, 2.79-4.50), and neonatal hospitalization (aOR = 2.51 95% CI, 2.01-3.14). In addition, statistically significant trends were observed between increasing socioeconomic status and year of delivery and an increased likelihood of women receiving domperidone (all Ps .004). These findings are of clinical importance as they not only reinforce previous findings regarding risk factors for women experiencing lactation difficulties but also highlight the need for improved research regarding the rational and efficacious use of domperidone to improve breastfeeding outcomes.
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1186/S13006-021-00438-5
Abstract: Domperidone is the most frequently prescribed medicine used to increase breast milk supply. There is considerable controversy surrounding the use of domperidone in lactation, due to limited evidence about efficacy and concerns about rare but life-threatening side-effects. Despite this, in many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. The aim of this paper was to explore women’s experiences of using domperidone during breastfeeding. Semi-structured interviews were conducted in 2019 with 15 women in Australia who reported using domperidone as a galactagogue during breastfeeding. Interviews were recorded, transcribed and analysed thematically. Women reported a wide variety of practices concerning the timing of initiation of domperidone use, including prophylactic use, as well as the dose and duration of use. Prolonged periods of use and unsupervised dosing were commonly reported, these practices were sometimes associated with a fear of the consequences of stopping, insufficient provision of information about the drug or feeling dismissed by health professionals. Some women indicated that when doctors refused to prescribe domperidone they responded by doctor shopping and seeking anecdotal information about benefits and risks online, leading to unsupervised practices. Women often reported high expectations surrounding the effectiveness of domperidone, and most used the medication in conjunction with food/herbal galactagogues and non-galactagogue support. Positive outcomes following domperidone use included having greater confidence in breastfeeding and pride at achieving breastfeeding goals. This study identified a variety of practices concerning domperidone use, including potentially unsafe practices, linked in some cases to inconsistent advice from health professionals and a reliance on online, anecdotal information sources. These findings emphasise the urgent need for development of clinical practice guidelines and a greater focus on translating existing evidence concerning domperidone into clinical practice, including clinical support that is tailored to women’s needs.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2018
Publisher: Springer Science and Business Media LLC
Date: 04-08-2023
DOI: 10.1186/S12905-023-02559-X
Abstract: To investigate the management of subfertility and infertility among Aboriginal and Torres Strait Islander females attending Australian general practice. Cross-sectional study of 1,258,581 women (18–49 years) attending general practice between January 2011 and June 2019, utilising data from NPS MedicineWise MedicineInsight, a national general practice database in Australia. The prevalence of subfertility/infertility encounters was lower for Aboriginal and Torres Strait Islander females (12.37 per 1,000) than for non-Indigenous females (16.62 per 1,000). Aboriginal and Torres Strait Islander females with a subfertility/infertility encounter were younger and more likely to live outside Major cities and in areas of socioeconomic disadvantage than non-Indigenous females. Rates of prescribed infertility medications were not different between groups, however Aboriginal and Torres Strait Islander females were more likely to receive a pelvic ultrasound (24.30% vs. 19.90%) tests for luteinizing hormone (31.89% vs. 25.65%) testosterone (14.93% vs. 9.96%) and glycated haemoglobin (HbA1c) (6.32% vs. 3.41%),but less likely to receive an anti-müllerian hormone test (2.78% vs. 7.04%). Lower encounter rates for infertility/subfertility among Aboriginal and Torres Strait Islander peoples may indicate access issues, preferred use of Aboriginal community-controlled health centres or younger average age at first birth and thus less age-related infertility. Future efforts should focus on maximising the inclusiveness of infertility surveillance. There is also a need for further research into the experiences of and preferences for infertility care and associated barriers among Aboriginal and Torres Strait Islander people.
Publisher: Cambridge University Press (CUP)
Date: 05-10-2015
DOI: 10.1017/S2040174415007151
Abstract: The objective was to investigate the association between early and late maternal smoking during pregnancy on offspring body mass index (BMI). We undertook a retrospective cohort study using linked records from the Women’s and Children’s Health Network in South Australia. Among a cohort of women delivering a singleton, live-born infants between January 2000 and December 2005 ( n =7658), 5961 reported not smoking during pregnancy, 297 reported quitting smoking during the first trimester of pregnancy, and 1400 reported continued smoking throughout pregnancy. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance programme. The main outcome measure was age- and sex-specific BMI z-score. At 4 to 5 years, mean ( s.d. ) BMI z-score was 0.40 (1.05), 0.60 (1.07) and 0.65 (1.18) in children of mothers who reported never smoking, quitting smoking and continued smoking during pregnancy, respectively. Compared with the group of non-smokers, both quitting smoking and continued smoking were associated with an increase in child BMI z-score of 0.15 (95% confidence interval: 0.01–0.29) and 0.21 (0.13–0.29), respectively. A significant dose–response relationship was also observed between the number of cigarettes smoked per day on average during the second half of pregnancy and the increase in offspring BMI z-score ( P .001). In conclusion, any maternal smoking in pregnancy, even if mothers quit, is associated with an increase in offspring BMI at 4 to 5 years of age.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.PHRS.2017.12.019
Abstract: Maternal asthma represents a significant burden to in iduals and the healthcare system, affecting 1 in 10 pregnancies worldwide. Approximately 50% of asthmatic women experience a deterioration of asthma control at some stage during pregnancy, with a number requiring use of oral corticosteroids for the management of acute exacerbations. The presence of maternal asthma and exacerbations during pregnancy is a noted risk factor for a range of adverse perinatal outcomes including preterm birth, small-for-gestational age, pre-ecl sia, and gestational diabetes. These negative impacts highlight the need for evidence-based approaches for improving asthma management during pregnancy and subsequent perinatal outcomes. Despite this, relatively small progress has been made in enhancing the management of maternal asthma in the clinical setting. A major challenge in improving outcomes of asthmatic pregnancies is that there is no single simplified approach for improving outcomes, but rather the requirement to consider the dynamic relationship between a myriad of interrelated factors that ultimately determine an in idual's ability to maintain adequate asthma control. Understanding how these factors are impacted by pregnancy and how they can be addressed through various interventions is therefore important in optimising health outcomes. This review summarises key factors involved in influencing outcomes associated with maternal asthma. This includes an overview of the use of asthma medications in pregnancy, while also considering the impacts of interrelated aspects such as medication adherence, health-seeking behaviours, biological and lifestyle factors, co-morbidities, and asthma self-management strategies on asthma control. Addressing such factors through multidisciplinary approaches towards treatment have potential to improve the health of mothers and their offspring. Optimising asthma control should be a high priority within the antenatal setting, with women advised about the importance of good asthma control, managing asthma actively throughout pregnancy by utilising their asthma medications, and managing exacerbations in a timely and effective manner.
Publisher: BMJ
Date: 08-2023
DOI: 10.1136/BMJOPEN-2023-073154
Abstract: Improving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pills (ECPs) or to have medical abortion (MA) medicines dispensed. The ALLIANCE trial aims to compare the subsequent uptake of effective contraception (hormonal or intrauterine) in women seeking ECP or MA medicines, who receive the ALLIANCE community pharmacy-based intervention with those who do not receive the intervention. ALLIANCE is a stepped-wedge pragmatic cluster randomised trial in Australian community pharmacies. The ALLIANCE intervention involves community pharmacists delivering structured, patient-centred, effectiveness-based contraceptive counselling (and a referral to a contraceptive prescriber where appropriate) to women seeking either ECPs or to have MA medicines dispensed. Women participants will be recruited by participating pharmacists. A total of 37 pharmacies and 1554 participants will be recruited. Pharmacies commence in the control phase and are randomised to transition to the intervention phase at different time points (steps). The primary outcome is the self-reported use of effective contraception at 4 months secondary outcomes include use of effective contraception and the rate of pregnancies or induced abortions at 12 months. A process and economic evaluation of the trial will also be undertaken. Ethical approval has been obtained from the Monash University Human Research Ethics Committee (#34563). An explanatory statement will be provided and written consent will be obtained from all participants (pharmacy owner, pharmacist and women) before their commencement in the trial. Dissemination will occur through a knowledge exchange workshop, peer-reviewed journal publications, presentations, social media and conferences. ACTRN12622001024730.
Publisher: Oxford University Press (OUP)
Date: 04-05-2018
Abstract: Is preconception dietary intake associated with reduced fecundity as measured by a longer time to pregnancy (TTP)? Lower intake of fruit and higher intake of fast food in the preconception period were both associated with a longer TTP. Several lifestyle factors, such as smoking and obesity, have consistently been associated with a longer TTP or infertility, but the role of preconception diet in women remains poorly studied. Healthier foods or dietary patterns have been associated with improved fertility, however, these studies focused on women already diagnosed with or receiving treatments for infertility, rather than in the general population. This was a multi-center pregnancy-based cohort study of 5628 nulliparous women with low-risk singleton pregnancies who participated in the Screening for Pregnancy Endpoints (SCOPE) study. A total of 5598 women were included. Data on retrospectively reported TTP and preconception dietary intake were collected during the first antenatal study visit (14-16 weeks' gestation). Dietary information for the 1 month prior to conception was obtained from food frequency questions for fruit, green leafy vegetables, fish and fast foods, by a research midwife. Use of any fertility treatments associated with the current pregnancy was documented (yes, n = 340, no, n = 5258). Accelerated failure time models with log normal distribution were conducted to estimate time ratios (TR) and 95% CIs. The impact of differences in dietary intake on infertility (TTP >12 months) was compared using a generalized linear model (Poisson distribution) with robust variance estimates, with resulting relative risks (RR) and 95% CIs. All analyses were controlled for a range of maternal and paternal confounders. Sensitivity analyses were conducted to explore potential biases common to TTP studies. Lower intakes of fruit and higher intakes of fast food were both associated with modest increases in TTP and infertility. Absolute differences between the lowest and highest categories of intake for fruit and fast food were in the order of 0.6-0.9 months for TTP and 4-8% for infertility. Compared with women who consumed fruit ≥3 times/day, the adjusted effects of consuming fruit ≥1-<3 times/day (TR = 1.06, 95% CI: 0.97-1.15), 1-6 times/week (TR = 1.11, 95% CI: 1.01-1.22) or <1-3 times/month (TR = 1.19, 95% CI: 1.03-1.36), corresponded to 6, 11 and 19% increases in the median TTP (Ptrend = 0.007). Similarly, compared with women who consumed fast food ≥4 times/week, the adjusted effects of consuming fast food ≥2- 0-<2 times/week (TR 0.79, 95% CI 0.69-0.89) or no fast food (TR = 0.76, 95% CI: 0.61-0.95), corresponded to an 11, 21 and 24% reduction in the median TTP (Ptrend <0.001). For infertility, compared with women who consumed fruit ≥3 times/day, the adjusted effects of consuming fruit ≥1-<3 times/day, 1-6 times/week or <1-3 times/month corresponded to a 7, 18 and 29% increase in risk of infertility (Ptrend = 0.043). Similarly, compared with women who consumed fast food ≥4 times/week, the adjusted effects of consuming fast food ≥2- 0-<2 times/week, or no fast food, corresponded to an 18, 34 and 41% reduced risk of infertility (Ptrend <0.001). Pre-pregnancy intake of green leafy vegetables or fish were not associated with TTP or infertility. Estimates remained stable across a range of sensitivity analyses. Collection of dietary data relied on retrospective recall and evaluated a limited range of foods. Paternal dietary data was not collected and the potential for residual confounding cannot be eliminated. Compared to prospective TTP studies, retrospective TTP studies are prone to a number of potential sources of bias. These findings underscore the importance of considering preconception diet for fecundity outcomes and preconception guidance. Further research is needed assessing a broader range of foods and food groups in the preconception period. The SCOPE database is provided and maintained by MedSciNet AB (medscinet.com). The Australian SCOPE study was funded by the Premier's Science and Research Fund, South Australian Government (www.dfeest.sa.gov.au/science-research remiers-research-and-industry-fund). The New Zealand SCOPE study was funded by the New Enterprise Research Fund, Foundation for Research Science and Technology Health Research Council (04/198) Evelyn Bond Fund, Auckland District Health Board Charitable Trust. The Irish SCOPE study was funded by the Health Research Board of Ireland (CSA/2007/2 www.hrb.ie). The UK SCOPE study was funded by National Health Service NEAT Grant (Neat Grant FSD025), Biotechnology and Biological Sciences Research council (www.bbsrc.ac.uk/funding GT084) and University of Manchester Proof of Concept Funding (University of Manchester) Guy's and St. Thomas' Charity (King's College London) and Tommy's charity (www.tommys.org/ King's College London and University of Manchester) and Cerebra UK (www.cerebra.org.uk University of Leeds). L.E.G. is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship (ID 1070421). L.J.M. is supported by a SACVRDP Fellowship a program collaboratively funded by the National Heart Foundation, the South Australian Department of Health and the South Australian Health and Medical Research Institute. L.C.K. is supported by a Science Foundation Ireland Program Grant for INFANT (12/RC/2272). C.T.R. was supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship (GNT1020749). There are no conflicts of interest to declare. Not applicable.
Publisher: Wiley
Date: 07-2017
DOI: 10.1111/IMJ.13467
Abstract: Intravenous iron is commonly utilised in pregnancy when treatment with oral is not tolerated or where rapid replenishment of iron stores is required. To examine the relationship between doses of intravenous iron administered during pregnancy according to different maternal bodyweight measures and subsequent treatment response. Retrospective cohort study of pregnant women with confirmed iron deficiency anaemia who received intravenous iron polymaltose at a tertiary teaching hospital in Australia from 1 January 2014 to 31 January 2016. Diagnosis of anaemia and/or iron deficiency, infusion dosage characteristics and haematological parameters were collected from paper-based case notes and electronic records. The dose of intravenous iron administered was examined relative to maternal total bodyweight (TBW), ideal bodyweight (IBW) (equation = 45.5 kg + 0.9 kg/cm for each cm over 152 cm) and adjusted bodyweight (equation = IBW + [0.4 × (TBW - IBW)]). A total of 122 pregnancies was identified where women had confirmed iron deficiency anaemia and received a single infusion of intravenous iron polymaltose. Dose-response relationships were evident between change in haemoglobin from treatment until delivery and intravenous iron dose according to adjusted bodyweight (adjusted beta coefficient 0.70 (95% CI 0.24-1.15)) and pre-pregnancy total bodyweight (adjusted beta coefficient 0.83 (95% CI 0.36-1.29)), but not ideal bodyweight (adjusted beta coefficient 0.37 (95% CI -0.04-0.78)). Calculating iron deficit using adjusted bodyweight most closely matched that based on a physiological estimate of iron deficit according to weight-based total blood volume. Optimal treatment outcomes in pregnant women requiring intravenous iron may be reached by dosing according to adjusted pre-pregnancy bodyweight rather than ideal bodyweight.
Publisher: Wiley
Date: 17-11-2017
DOI: 10.1002/JPPR.1312
Publisher: Wiley
Date: 04-2018
DOI: 10.1002/JPPR.1437
Publisher: Wiley
Date: 03-2012
DOI: 10.1002/J.2055-2335.2012.TB00125.X
Abstract: Pharmaceutical reforms were introduced to South Australia in 2007 and resulted in significant changes to the provision of medications on discharge for postnatal women. Women are required to pay for each medication provided on discharge, where previously these were free of charge. To determine whether postnatal women discharged from the Women's and Children's Hospital purchased recommended non‐prescription medications. Postnatal women who delivered over a 3‐week period (May to June 2010) completed a short questionnaire during a home visit by a midwife in the days following discharge. The questionnaire collected data on demographics, as well as on medications supplied on discharge, whether non‐prescription medications were recommended to be purchased post‐discharge and whether these medications were purchased. 70 questionnaires were returned and analysed (response rate 30%). 110 non‐prescription medications were recommended for purchase post‐discharge 42 were not purchased because they were present at home. Of the remainder, 42 (62%) were purchased and 26 (38%) were not purchased. The most common reason for medications not being purchased was that it was no longer required (59%). Medications purchased most often included iron (83%) and vitamin D (100%), while those purchased least often included urinary alkalinisers (33%) and fibre supplements (44%). Pharmaceutical reforms do not appear to have had an adverse impact on non‐prescription medication management in postnatal women. The majority of non‐prescription medications were purchased as recommended post‐discharge.
Publisher: Wiley
Date: 20-10-2020
Publisher: Springer Science and Business Media LLC
Date: 16-10-2022
DOI: 10.1007/S00404-021-06279-1
Abstract: To assess the independent and joint contribution of the in idual components of metabolic syndrome, and known risk factors for gestational diabetes (GDM), on risk of GDM. Two thousand nine hundred and fifteen women from Australia and New Zealand, who participated in The Screening for Pregnancy Endpoints Study (SCOPE), were included. Using the SCOPE clinical data set and biomarkers obtained at 14-16 weeks' gestation, a logistic regression model was fitted to the binary outcome GDM, with in idual metabolic syndrome components (waist circumference, blood pressure, glucose, HDL-C, triglycerides), recruitment site, and other established factors associated with GDM. Hierarchical partitioning was used to assess the relative contribution of each variable. Of the 2915 women, 103 women (3.5%) developed GDM. The deviance explained by the logistic regression model containing all variables was 18.65% and the AUC was 0.809. Seventy percent of the independent effect was accounted for by metabolic syndrome components. The highest independent relative contribution to GDM was circulating triglycerides (17 ± 3%), followed by waist circumference (13 ± 3%). Glucose and maternal BMI contributed 12 ± 2% and 12 ± 3%, respectively. The remaining factors had an independent relative contribution of < 10%. Triglyceride concentrations had the highest independent relative importance for risk of GDM. Increased focus for lowering triglycerides as an important risk factor for GDM is warranted.
Publisher: Springer Science and Business Media LLC
Date: 11-2011
DOI: 10.2165/11593130-000000000-00000
Abstract: The aim of this review was to critically appraise the existing literature with a particular focus on identifying methodological issues associated with studying outcomes following the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Existing studies evaluating outcomes following prenatal SSRI exposure suffer from a number of important methodological limitations that should be taken into account when interpreting their results. The contradictory results obtained from prospective and retrospective cohort studies and case-control studies could be accounted for by dissimilarity between study populations, selection bias, detection bias, confounding, or differences in underlying maternal illness, data sources used, exposure classification, follow-up and statistical power/analysis. Only a small number of studies actually account for underlying maternal illness and how this may lead to adverse pregnancy outcomes. Even when such information is available, studies that include data on maternal illness have small s le sizes, limiting the statistical power to identify statistically and clinically relevant associations. Pregnancy outcomes may be confounded by the higher incidence of smoking, alcohol consumption and substance abuse frequently encountered amongst those suffering from depression, factors that are often insufficiently controlled for. While evidence of associations between prenatal SSRI exposure and adverse pregnancy outcomes are conflicting, there is an urgent need to evaluate how the particular SSRI used, the dose, timing and duration of use, genetics (maternal, paternal and/or fetal), concomitant medication use, maternal characteristics and underlying maternal illness all interact to alter pregnancy outcomes.
Publisher: SAGE Publications
Date: 23-04-2015
Abstract: Background: Despite the large burden medication-related morbidity and mortality places on the Australian health care system, there is little known about the extent of this problem in a women’s health (obstetric and gynecology) setting. Objective: Determine the frequency and nature of medication-related problems (MRPs) occurring in a women’s health unit (WHU) of an Australian teaching hospital. Methods: A prospective audit of consecutive cases of patients treated in the WHU at a tertiary-level teaching hospital was undertaken by a clinical pharmacist over a 5-week period. Data collected included the following: patient characteristics, type of MRP (using a modified version of the Hepler-Strand classification system), medication involved (according to the World Health Organisation Anatomical Therapeutic Chemical classification system), and clinical significance (using a 2-level severity index). Results: A total of 454 potential MRPs were identified over the 5-week period among 241 patients. A total of 39 MRPs (8.6%) identified were deemed to be of moderate/high clinical significance. The highest number of MRPs (221 49%) was identified among women admitted following a cesarean delivery, with 83 of 85 women in this group experiencing at least 1 MRP. Additional factors associated with an increased likelihood of patients experiencing a MRP included increased age, length of hospital stay, and number of regular medications taken prior to and during admission ( P 0.05). Conclusion: The widespread nature of identified MRPs in this setting suggests that various approaches to minimizing these problems and mitigating the associated burden on the health care system are warranted.
Publisher: SAGE Publications
Date: 03-03-2022
DOI: 10.1177/08903344221077131
Abstract: Galactagogues have been used for centuries to induce, maintain, or increase a mother’s milk supply. Recently, there has been an apparent increase in utilization and promotion of galactagogues, largely in the absence of data regarding their efficacy and safety. However, there is limited contemporary evidence about knowledge of these substances in the community or how and where in iduals seek information. To evaluate knowledge about galactagogue use during breastfeeding among birth parents, including recognition of specific substances, perceptions of safety, and common information sources. An online, prospective, cross-sectional survey of Australian birthing parents ( N = 2055) who were currently breastfeeding or had previously breastfed their infants was conducted from September to December 2019. The survey included questions about recognition of galactagogues, perceptions of safety, and information-seeking behaviors. Among participants, 47% ( n = 882) were primiparous and 65% ( n = 1,219) were currently breastfeeding. The most recognized galactagogues included lactation cookies (89% n = 1,828), brewer's yeast (79% n = 1,629), fenugreek (74% n = 1,519), and domperidone (69% n = 1,420). Respondents cited the internet (52% n = 1,066), lactation support providers (46% n = 951), midwives (42% n = 873), general practitioners (39% n = 802), and social media (35% n = 714) as common information sources. Lactation support providers and breastfeeding helplines were commonly rated as helpful whereas, general practitioners and community pharmacists were often rated as unhelpful. While most participants perceived galactagogues to be safe, herbal or dietary galactagogues were perceived to be safer than pharmaceutical galactagogues. Our Australian community survey of in iduals with current or previous breastfeeding experience identified widespread recognition of galactagogue use, with participants reporting a broad range of information-seeking behaviors and generally perceiving galactagogues as being safe to use.
Publisher: Cambridge University Press (CUP)
Date: 24-04-2015
DOI: 10.1017/S1368980015001226
Abstract: To examine pre-conception dietary patterns in pregnant asthmatic women and to identify associations between maternal diet and asthma control during pregnancy. Cross-sectional study. Pre-conception food frequency data were collected retrospectively. Asthma control was assessed using the Global Initiative for Asthma guidelines. Dietary patterns were derived using factor analysis. Binary logistic regression analyses were used to test the association between uncontrolled asthma and each dietary pattern ( Z -score), with values presented as odds ratio and 95 % confidence interval. Antenatal clinic in a tertiary hospital, Adelaide, Australia, May 2009–July 2013. One hundred and fifty-eight asthmatic pregnant women. Three dietary patterns were identified: (i) ‘high protein/fruit’ (strong food group loadings for fish, meat, chicken, fruit) (ii) ‘high fat/sugar/takeaway’ (takeaway foods, crisps, refined grains) and (iii) ‘vegetarian-type’ (vegetables, fruit, soya milk, whole grains). A 1 sd increase in score on the high fat/sugar/takeaway pattern was associated with increased likelihood of uncontrolled asthma (adjusted OR=1·54 95 % CI 1·07, 2·23 P= 0·022). Women with uncontrolled asthma ( n 115) had higher energy-adjusted intakes of saturated fat, monounsaturated fat, carbohydrate, sugar and fibre compared with women with controlled asthma ( n 43, all P ≤0·05). Pre-pregnancy dietary patterns may influence maternal asthma control. Our work highlights the importance of achieving a healthy diet before pregnancy that is low in saturated fat, sugar and takeaway foods, and therefore higher in lean meats, poultry and fish, as well as fruits, vegetables and whole grains. A healthy dietary pattern should be encouraged in all asthmatic women who are of childbearing age, and should additionally be promoted before pregnancy and beyond.
Publisher: Wiley
Date: 15-09-2015
Abstract: To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH). Retrospective cohort study. Tertiary teaching hospital in Adelaide, Australia. A total of 30 198 women delivering between 2002 and 2008. Relative risks adjusted for maternal sociodemographics and comorbidities (aRRs) were calculated for PPH, comparing women with late-gestation exposure to antidepressants (n = 558), women with a psychiatric illness but no antidepressant use (n = 1292), and women with neither antenatal exposures (n = 28 348). Additional sensitivity analyses were undertaken, examining associations with severe PPH and postpartum anaemia. The primary outcome was PPH, defined as a recorded blood loss of ≥500 mL for vaginal deliveries and ≥1000 mL for caesarean sections. Secondary outcomes included severe PPH (≥1000 mL blood loss, irrespective of method of delivery), and the presence of postpartum anaemia (identified from hospital medical records). Compared with unexposed controls, women exposed to antidepressants had an increased risk of PPH (aRR 1.53 95% confidence interval, 95% CI 1.25-1.86), whereas no increased risk was observed for women with a psychiatric illness but no antidepressant use (aRR 1.04 95% CI 0.89-1.23). In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk of severe PPH (aRR 1.84 95% CI 1.39-2.44), as well as postpartum anaemia (aRR 1.80 95% CI 1.46-2.22). Exposure to antidepressants in late gestation was associated with a significantly increased risk of PPH. Although potential confounding by unmeasured factors cannot be ruled out, these findings suggest a direct effect of antidepressant exposure on PPH. Late gestation antidepressant exposure is associated with a significantly increased risk of postpartum haemorrhage.
Publisher: Public Library of Science (PLoS)
Date: 07-2021
DOI: 10.1371/JOURNAL.PONE.0254049
Abstract: Galactagogues are substances thought to increase breast milk production, however evidence to support their efficacy and safety remain limited. We undertook a survey among Australian women to examine patterns of use of galactagogues and perceptions regarding their safety and effectiveness. An online, cross-sectional survey was distributed between September and December 2019 via national breastfeeding and preterm birth support organisations, and networks of several research institutions in Australia. Women were eligible to participate if they lived in Australia and were currently reviously breastfeeding. The survey included questions about galactagogue use (including duration and timing), side effects and perceived effectiveness (on a scale of 1 [Not at all effective] to 5 [Extremely effective]). Among 1876 respondents, 1120 (60%) reported using one or more galactagogues. Women were 31.5 ± 4.8 years (mean ± standard deviation) at their most recent birth. Sixty-five percent of women were currently breastfeeding at the time of the survey. The most commonly reported galactagogues included lactation cookies (47%), brewer’s yeast (32%), fenugreek (22%) and domperidone (19%). The mean duration of use for each galactagogue ranged from 2 to 20 weeks. Approximately 1 in 6 women reported commencing galactagogues within the first week postpartum. Most women reported receiving recommendations to use herbal/dietary galactagogues from the internet (38%) or friends (25%), whereas pharmaceutical galactagogues were most commonly prescribed by General Practitioners (72%). The perceived effectiveness varied greatly across galactagogues. Perceived effectiveness was highest for domperidone (mean rating of 3.3 compared with 2.0 to 3.0 among other galactagogues). Over 23% of domperidone users reported experiencing multiple side effects, compared to an average of 3% of women taking herbal galactagogues. This survey demonstrates that galactagogues use is common in Australia. Further research is needed to generate robust evidence about galactagogues’ efficacy and safety to support evidence-based strategies and improve breastfeeding outcomes.
Publisher: Wiley
Date: 15-09-2015
Abstract: To investigate the impact of prenatal antidepressant exposure on behavioural problems in children at 7 years of age. Nationwide population-based study. Danish National Birth Cohort. A cohort of 49 178 pregnant women recruited between 1996 and 2002. Data obtained from computer-assisted telephone interviews twice during pregnancy were used to identify children born to: (i) depressed women who took antidepressants during pregnancy (n = 210) (ii) depressed women who did not take any antidepressants during pregnancy (n = 231) and (iii) healthy women who were not depressed (n = 48 737). Childhood behavioural problems at 7 years of age were examined using the validated Danish parent-report version of the Strengths and Difficulties Questionnaire (SDQ). SDQ scores. No associations were observed between prenatal antidepressant exposure and abnormal SDQ scores for overall problem behaviour (adjusted relative risk, aRR 1.00 95% confidence interval, 95% CI 0.49-2.05), hyperactivity/inattention (aRR 0.99 95% CI 0.56-1.75), or peer problems (aRR 1.04 95% CI 0.57-1.91). Although prenatal antidepressant exposure appeared to be associated with abnormal SDQ scores on the subscales of emotional symptoms (aRR 1.68 95% CI 1.18-2.38) and conduct problems (aRR 1.58 95% CI 1.03-2.42), these associations were significantly attenuated following adjustment for antenatal mood status (aRR 1.20 95% CI 0.85-1.70 and aRR 1.19 95% CI 0.77 1.83, respectively). Untreated prenatal depression was associated with an increased risk of all behavioural outcomes evaluated, compared with unexposed children, with significant attenuation following adjustment for antenatal mood status. The results of this study suggest that independent of maternal illness, prenatal antidepressant exposure is not associated with an increased risk of behavioural problems in children at 7 years of age. Prenatal antidepressant exposure is not associated with an increased risk of child behavioural problems.
Publisher: Wiley
Date: 05-11-2017
Publisher: Wiley
Date: 11-07-2023
DOI: 10.1111/AJO.13719
Abstract: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy liver disease, characterised by pruritus and increased total serum bile acids (TSBA), Australian incidence 0.6–0.7%. ICP is diagnosed by non‐fasting TSBA ≥ 19 μmol/L in a pregnant woman with pruritus without rash without a known pre‐existing liver disorder. Peak TSBA ≥ 40 and ≥ 100 μmol/L identify severe and very severe disease respectively, associated with spontaneous preterm birth when severe, and with stillbirth, when very severe. Benefit‐vs‐risk for iatrogenic preterm birth in ICP remains uncertain. Ursodeoxycholic acid remains the best pharmacotherapy preterm, improving perinatal outcome and reducing pruritus, although it has not been shown to reduce stillbirth.
Publisher: Wiley
Date: 03-2010
DOI: 10.1002/J.2055-2335.2010.TB00725.X
Abstract: One of the biggest challenges health professionals face when counselling patients about medication use in pregnancy is accessibility to evidence‐based information on the risks or benefits associated with treatment. There is inadequate information available regarding the immediate and long‐term effects of medications used by pregnant women on the mother and the fetus. Novel surveillance techniques using population‐based record linkage could enable better identification, quantification and understanding of long‐term risks or benefits of medications used during pregnancy. The technology, data and expertise are available to make it happen.
Publisher: AMPCo
Date: 22-08-2019
DOI: 10.5694/MJA2.50308
Abstract: To compare the effects on perinatal maternal and neonatal outcomes of intravenous and oral iron therapy as first-line treatment of iron deficiency anaemia (IDA) in pregnant women. A meta-analysis, applying fixed and random effects models, of randomised controlled trials (RCTs) that compared the effects of intravenous and oral iron therapy for pregnant women with IDA. MEDLINE, EMBASE, Scopus, Cochrane Register of Controlled Trials, Web of Science bibliographies of identified articles. Fifteen eligible studies with a total of 1938 participants were identified. Each was at high risk of bias in at least one domain ten were undertaken in low or middle income countries. Evidence (from nine RCTs) that intravenous iron was superior to oral iron in reducing the need for blood transfusion at delivery was low quality (Peto odds ratio, 0.19 [95% CI, 0.05-0.78] number needed to treat, 95 [95% CI, 81-348]). Evidence that intravenous iron was superior to oral iron in increasing neonatal birthweight (eight RCTs: mean difference, 58 g 95% CI, 4-112 g) or reducing the rate of breastfeeding cessation within 24 months of delivery (one RCT: hazard ratio, 0.70 95% CI, 0.50-0.99) was of low or very low quality. While intravenous iron treatment was superior to oral iron for improving maternal haematological parameters at delivery, their effects on neonatal haematological parameters were similar. There is no strong evidence that first-line therapy with intravenous iron is superior to oral administration for treating IDA in pregnant women. The few identified differences in outcomes were small in magnitude and from studies at high risk of bias. International Prospective Register of Systematic Reviews (PROSPERO), CRD42019120652.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.EJOGRB.2016.07.487
Abstract: To examine the patterns and predictors of inter-pregnancy body mass index (BMI) change and its impact on perinatal outcomes in the second pregnancy. Retrospective cohort study. Tertiary teaching hospital in Adelaide, Australia. Women with their first and second consecutive, singleton deliveries occurring between 2000 and 2012 (N=5371). Inter-pregnancy weight change calculated based on difference between BMI at respective antenatal booking visits. Association between inter-pregnancy weight change and perinatal outcomes investigated using multivariate generalised linear models, with stratification according to initial maternal BMI category in first pregnancy. Gestational diabetes (GDM) pregnancy induced hypertensive disorders small-for-gestational age (SGA) preterm birth large-for-gestational age (LGA) and macrosomia (>4500g). On average, women with a normal BMI gained 1kg/m(2) between first and second pregnancies, while women who were overweight or obese gained 1.37kg/m(2). Among women with a normal BMI in their first pregnancy, a BMI increase of ≥4kg/m(2) was associated with increased risk of developing GDM (aRR 1.97 95% CI 1.22-3.19), a macrosomic (aRR 4.06 95% CI 2.25-7.34) or LGA infant (aRR 1.31 0.96-1.78) in the second pregnancy, while a reduction in BMI (≤-2kg/m(2)) was associated with an increased risk of SGA (aRR 1.94 1.19-3.16). Among women who were overweight or obese in their first pregnancy, a BMI increase of ≥2-4 and ≥4kg/m(2) was associated with increased risks of developing GDM in the second pregnancy (aRR 1.39 95% CI 1.01-1.91 and aRR 1.64 95% CI 1.16-2.31 ptrend<0.001), while no associations were observed for a BMI increase and risk of a macrosomic, SGA, or LGA infant. In contrast, reduction in BMI (≤-2kg/m(2)) was associated with a reduced risk of GDM (aRR 0.58 95% CI 0.37-0.90) and SGA (aRR 0.47 95% CI 0.25-0.87). Increases in BMI between pregnancies is associated with an increased risk for perinatal complications, even in normal-weight women, while a reduction in BMI is associated with improved perinatal outcomes among women who are overweight/obese. Inter-pregnancy weight control is an important target to reduce the risk of an adverse perinatal outcome in a subsequent pregnancy.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.REPROTOX.2012.01.006
Abstract: In the absence of randomised controlled trials, knowledge of outcomes associated with medication use during pregnancy is dependent on observational studies. Numerous observational study designs exist, with the decision on which is most appropriate depending on a number of factors, including the exposure and outcome under investigation and knowledge of key methodological issues. This review provides an overview of the key methodological issues involved in undertaking observational studies to investigate medication use during pregnancy, including selection bias, exposure and outcome classification, information bias, confounding and statistical analysis. This review also discusses observational study types used to investigate outcomes associated with medication use during pregnancy and summarises their relative strengths and weaknesses. Knowledge of the strengths, weaknesses and methodological issues associated with observational studies can assist clinicians in making assessments about the validity and applicability of results presented in order to provide the best recommendations to patients.
Publisher: Wiley
Date: 03-2008
DOI: 10.1002/J.2055-2335.2008.TB00787.X
Abstract: The adverse effects and long‐term health risks associated with antipsychotic use means that monitoring children and adolescents prescribed these medications is important. To implement an evidence‐based chart and guideline to monitor physical health and adverse effects in children and adolescents prescribed antipsychotics in a range of practice settings and to identify the barriers and benefits of implementation. Using an action research approach a pilot trial was undertaken to implement a chart and guideline in a range of practice settings. Patient and health professional resource kits and an information compact disc were produced to facilitate implementation. Barriers identified during implementation were doctor/health professional, patient‐related and environmental. Carer and doctor satisfaction questionnaires were administered to assess the implementation process and evaluate the quality and usefulness of the monitoring chart and guideline. 10 doctors were recruited to participate in the implementation trial and 21 patients prescribed antipsychotics were enrolled. Monitoring data collected retrospectively from patients' case notes, such as weight/height measurements and haematological monitoring were congruent with the guideline in 41% and 29% of patients respectively. Carer and doctor satisfaction questionnaires indicated that the monitoring package was well received and raised awareness of potential adverse effects and the importance of monitoring. The monitoring package can bridge the evidence to practice gap regarding monitoring physical health and adverse effects in children and adolescents prescribed antipsychotics.
Publisher: Wiley
Date: 24-03-2022
DOI: 10.5694/MJA2.51472
Publisher: Frontiers Media SA
Date: 29-07-2021
Abstract: Necrotising enterocolitis (NEC) is a devastating disease affecting preterm infants, with little improvement in mortality rates and treatment strategies in the last 30 years. Human milk oligosaccharides (HMOs) are emerging as a potential preventive therapy, with multiple protective functions postulated. Our aim is to summarise the evidence concerning the role of HMOs in NEC development and emerging strategies to tailor the delivery of HMOs to preterm infants. Most research efforts to date have focused on supplementing preterm infants with simple oligosaccharides, which are structurally different to HMOs and derived mainly from plants. Clinical trials demonstrate limited benefits for NEC prevention arising from the use of these supplements. Alternative strategies under investigation include optimising HMOs for infants receiving donor human milk, concentrating oligosaccharides from donor human milk and from animal milks, as well as more sophisticated synthetic oligosaccharide production strategies. Critically, high quality evidence to support implementation of any of these approaches in the neonatal unit is lacking. Whether it is a specific HMO alone or a combination of HMOs that exert protective effects remains to be elucidated. Further challenges include how best to manufacture and administer oligosaccharides whilst retaining bioactivity and safety, including evaluation of the long-term effects of altering the balance of HMOs and gut microbiota in preterm infants. While several human clinical trials are underway, further research is needed to understand whether a tailored approach to oligosaccharide supplementation is beneficial for preterm infants.
Publisher: Wiley
Date: 18-09-2018
DOI: 10.1111/AJO.12695
Abstract: Intravenous (IV) iron in pregnancy is useful where oral iron is not tolerated or a rapid replenishment of iron is required. To review the literature on the efficacy and safety of different IV iron preparations in the management of antenatal iron-deficiency anaemia (IDA). We searched MEDLINE, Embase and Scopus from inception to June 2016. Eligible studies were randomised controlled trials (RCTs) and observational studies, involving administration of IV iron (ferric carboxymaltose (FCM), iron polymaltose (IPM) or iron sucrose (IS)), regardless of comparator, to manage antenatal IDA. Two independent reviewers selected studies, extracted data and assessed quality. A total of 47 studies were eligible (21 RCTs and 26 observational studies), investigating IS (n = 2635 41 studies), FCM (n = 276 four studies) and IPM (n = 164 three studies). All IV preparations resulted in significant improvements in haematological parameters, with a median increase of 21.8 g/L at 3-4 weeks and 30.1 g/L by delivery, but there was no evidence of any associated improvements in clinical outcomes. A greater median increase in Hb was observed with a high (25 g/L range: 20-39.6 g/L) compared with low dose (20 g/L range: 6.2-50.3 g/L). The median prevalence of adverse drug reactions for IPM (2.2% range: 0-4.5%) was lower than FCM (5.0% range: 0-20%) and IS (6.7% range: 0-19.5%). While IV iron in pregnancy improves haematological parameters, there is an absence of evidence for improvements in important maternal or perinatal outcomes. No single preparation of IV iron appeared to be superior, with the current IV iron preparation of choice largely determined by cost and convenience around administration.
Publisher: Wiley
Date: 23-10-2017
DOI: 10.1111/AJO.12731
Abstract: Galactagogues represent substances used to enhance breast milk production. Between 2001 and 2014 we identified 2034 phone calls regarding the use of galactagogues made to MotherSafe. The majority involved discussion of domperidone (n = 1884 92.6%), with the remainder relating to metoclopramide (n = 153 7.5%) or other herbal galactagogues (eg fenugreek, milk thistle n = 262 12.9%). A 50% decrease in total calls occurred from 2011 to 2014, while the percentage of calls regarding herbal galactagogues increased from 0% in 2001 to 23% in 2014. These findings support the need for more robust research surrounding the use of galactagogues in clinical practice.
Publisher: CSIRO Publishing
Date: 04-04-2023
DOI: 10.1071/SH22138
Abstract: Online platforms have emerged as a convenient way for in iduals to access contraception. However, the extent to which such services exist in Australia and how they operate is currently unknown. We aimed to identify Australian online contraception platforms and evaluate the services they provide to determine the degree to which they may facilitate equitable access to contraception. We conducted an internet search to identify online contraception platforms operating in Australia. Data were extracted from each of the platforms relating to operating policies, services provided and associated payment processes, as well as prescribing and screening processes for assessing user suitability. As of July 2022, eight online contraception platforms operating within Australia were identified. All platforms offered oral contraception, with two also offering the vaginal ring, and one emergency oral contraception. None of the platforms provided access to long-acting reversible contraception. Significant variability existed in product and membership costs across platforms, with only one platform providing access to subsidised medicines. Five platforms restricted services to those already using oral contraception. Overall, online questionnaires were deemed to be adequately screening for important contraindications to using oral contraception. While online contraception platforms may be a valuable option for some in iduals who face access barriers and are willing to pay out-of-pocket for to have their contraception sent straight to their home, they do not necessarily ensure that in iduals can access their contraceptive method of choice or address recognised financial and structural barriers to contraceptive care.
Publisher: Springer Science and Business Media LLC
Date: 04-06-2023
DOI: 10.1007/S00127-022-02307-W
Abstract: Prevalence of depression and anxiety in people with cystic fibrosis (PwCF) and their caregivers is high, however, results have been inconsistent. This systematic review and meta-analysis aimed to estimate the prevalence of depression and anxiety in PwCF and their caregivers and explore sources of heterogeneity. MEDLINE, EMBASE, CINAHL plus and PsychINFO databases were searched from inception to January 2021. Studies were included if a specific psychometric tool (PT) to assess depression or anxiety (rather than quality of life) was used and did not involve a transitory patient state. Random-effects models were applied due to high anticipated heterogeneity and I 2 estimates were calculated. Sources of heterogeneity were explored through subgroup comparisons. The presence of small-study effects was investigated visually using funnel plots and statistically using the Egger test. A total of 94 articles (48 full-text publications, 46 abstracts) were included. Depression prevalence in adolescents aged 12–18 years ( n = 2386), adults ( n = 9206) and caregivers ( n = 6617) were 18.7% (95% CI 12.8–25.3%, I 2 = 89.2%), 27.2% (95% CI 23.6–31%, I 2 = 90.4%), and 32.8% (95% CI 27.9–37.9%, I 2 = 90.3%), respectively. Anxiety prevalence in adolescents aged 12–18 years ( n = 2142) was 26% (95% CI 19.6–33%, I 2 = 86.4%), 28.4% (95% CI 25–31.9%, I 2 = 85%) for adults ( n = 8175), and 38.4% (95% CI 30.8–46.2%, I 2 = 94.6%) for caregivers ( n = 5931). Prevalence differed by the PT used and study location. This comprehensive analysis found the prevalence of depression and anxiety in PwCF and their caregivers to be high, supporting recommendations for regular screening. Choice of PT significantly influenced prevalence, indicating a need for future studies to identify the optimal PT for each CF population to identify those most at risk.
Publisher: American Psychiatric Association Publishing
Date: 11-2013
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.REPROTOX.2015.10.003
Abstract: Hypericum perforatum (HP also known as St. John's Wort) is one of the most commonly used herbal therapies in the management of depressive illness. The aim of this study was to evaluate the potential side effects of HP during pregnancy on pregnancy outcome. Using data from the Danish National Birth Cohort (DNBC), we investigated outcomes among 38 HP exposed pregnancies compared to a group of 90,128 women. Associations between HP use and gestational age, preterm birth, birth weight, malformations and Apgar scores were investigated. Preterm birth did not differ across the groups. While the prevalence of malformations in the HP exposed group was slightly higher (8.1%) than observed in the control groups (3.3% p=0.13), this was based on only three cases and was not of any specific pattern.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.JTEMB.2017.11.016
Abstract: Maternal micronutrient deficiencies in pregnancy can have profound effects on fetal development and pregnancy outcome. Plasma trace minerals including copper, zinc, selenium and iron have been shown to be extremely important in supporting reproduction. We sought to determine whether there is an association between maternal trace mineral status in early pregnancy and pregnancy complications using a prospective cohort study of 1065 pregnant Australian women who were recruited as part of the Screening for Pregnancy Endpoints (SCOPE) study in Adelaide. Copper, zinc, selenium and iron present in the plasma were measured using mass spectrometry in s les collected at 15±1 weeks' gestation. After adjusting for covariates, women with lower plasma copper ( 32.5μmol/L) (aRR=0.87 95% CI=0.76, 0.99 and aRR=0.88 95% CI=0.78, 1.00, respectively). This was also observed when adjusting for plasma zinc and selenium status (<27.9μmol/L: aRR=0.81 95% CI=0.69, 0.96 and 27.9-32.5μmol/L: aRR=0.84 95% CI=0.72, 0.98). Combined low copper and zinc status was also associated with a reduced risk of any pregnancy complication as compared with high copper and zinc status (aRR=0.80 95% CI=0.70, 0.93). These results provide justification for further work into elucidating the mechanistic role of trace elements in early pregnancy, as well as their interactions in supporting successful pregnancy outcomes.
Publisher: European Respiratory Society (ERS)
Date: 2016
DOI: 10.1183/23120541.00054-2015
Abstract: There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex. 50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53–5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25–4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01–1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% versus 9.5% p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% versus 11.8% p=0.201) These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone.
Publisher: Elsevier BV
Date: 04-2015
Publisher: Wiley
Date: 10-03-2019
Abstract: To determine: (1) the association between metabolic syndrome (MetS), time to pregnancy (TTP), and infertility (2) associations between in idual and an increasing number of MetS components, TTP, and infertility and (3) whether these relationships differ by body mass index (BMI 12 months) were compared using a generalised linear model (Poisson distribution) with robust variance estimates (relative risks, RRs 95% CIs). All analyses (entire cohort and split by BMI) were controlled for a range of maternal and paternal confounding factors. Time to pregnancy and infertility. Of the 5519 women included, 12.4% (n = 684) had MetS. Compared with women without MetS, women with MetS had a longer TTP (adjusted TR 1.30 95% CI 1.15-1.46), which was similar in women who were obese and in women who were not obese. Marginal estimates for median TTP in women with MetS versus without MetS was 3.1 months (3.0-3.3 months) versus 4.1 months (3.6-4.5 months), respectively. Women with MetS were at a 62% greater risk for infertility and were at a greater risk for infertility whether they were obese (adjusted RR 1.62 95% CI 1.15-2.29) or not (adjusted RR 1.73 95% CI 1.33-2.23). Reduced high-density lipoprotein cholesterol (HDL-C) and raised triglycerides (TGs) were the main in idual components associated with risk for infertility. Metabolic syndrome is associated with longer TTP and infertility, independent of obesity. Additional studies, before pregnancy, are required to support our findings and to determine the applicability of which combinations of metabolic abnormalities pose the greatest risk to delayed fertility, or whether in idual components are amenable to modification. Metabolic syndrome is associated with longer time to pregnancy and infertility, independent of obesity.
Publisher: AMPCo
Date: 04-2015
DOI: 10.5694/MJA14.01585
Publisher: Springer Science and Business Media LLC
Date: 20-06-2018
Publisher: Wiley
Date: 08-04-2013
Location: Australia
No related grants have been discovered for Luke Grzeskowiak.