Northern Clinical School

Effect of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis (COMBO) dataset

2023-05-11T04:57:25Z

Effect of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis (COMBO) dataset Robbins, Sarah We will share the data of 196 participants including demographics, clinical characteristics, and outcome measures at baseline, weeks 2, 6 and 12.

Stepped care approach for medial tibiofemoral osteoarthritis (STREAMLINE) dataset

2023-05-11T04:58:13Z

Stepped care approach for medial tibiofemoral osteoarthritis (STREAMLINE) dataset Robbins, Sarah The full dataset includes the data of 170 participants including demographics, clinical characteristics and outcomes at baseline, 20 and 32 weeks.

Supplementary Materials for Natural History and Predictive Factors of Outcome in Medullary Thyroid Microcarcinoma

2023-03-29T03:44:58Z

Supplementary Materials for Natural History and Predictive Factors of Outcome in Medullary Thyroid Microcarcinoma Glover, Anthony Supplementary Materials for publication Natural History and Predictive Factors of Outcome in Medullary Thyroid Microcarcinoma published in The Journal of Clinical Endocrinology & Metabolism

Achieving safe surgery after COVID-19 vaccination

2026-04-22T03:37:05Z

Achieving safe surgery after COVID-19 vaccination Kovoor, J.G.; Jacobsen, J.H.W.; Duncan, J.; Addo, A.A.; Tivey, D.R.; Babidge, W.J.; Penn, D.; Churchill, J.; Collinson, T.G.; Kok, J.; Kelly, S.; Lu, V.H.; Beavis, V.S.; MacCormick, A.D.; Kearney, B.J.; Gowans, E.J.; Hewett, P.J.; Hugh, T.J.; Woo, H.H.; Padbury, R.T.; Scott, D.A.; Frydenberg, M.; Maddern, G.J.

Sustaining the Australian respiratory workforce through the COVID-19 pandemic: a scoping literature review

2026-04-29T00:36:51Z

Sustaining the Australian respiratory workforce through the COVID-19 pandemic: a scoping literature review Stone, Emily; Irving, Louis B.; Tonga, Katrina O.; Thompson, Bruce The outbreak of the COVID-19 pandemic in late 2019 and in 2020 presented challenges to healthcare workers (HCW) around the world that were unexpected and dramatic. The relentless progress of infection, starting in China and rapidly spreading to Europe, North America and elsewhere gave more remote countries, like Australia, time to prepare but also time for unease. HCW everywhere had to readjust and change their work practices to cope. Further waves of infection and transmission with newer variants pose challenges to HCW and health systems, even after mass vaccination. Respiratory medicine HCW found themselves at the frontline, developing critical care services to support intensive care units and grappling with unanticipated concerns about safety, risk and the need to retrain. Several studies have addressed the need for rapid changes in the healthcare workforce for COVID-19 and the impact of this preparation on HCW themselves. In this paper, we present a scoping review of the literature on preparing HCW for the pandemic, explore the Australian experience of building the respiratory workforce and propose evidence-based recommendations to sustain this workforce in an unprecedented high-risk environment.

Growth in emergency department self-harm or suicidal ideation presentations in young people: Comparing trends before and since the COVID-19 first wave in New South Wales, Australia.

2026-04-22T03:37:06Z

Growth in emergency department self-harm or suicidal ideation presentations in young people: Comparing trends before and since the COVID-19 first wave in New South Wales, Australia. Sara, Grant; Wu, Jianyun; Uesi, John; Jong, Nancy; Perkes, Iain; Knight, Katherine; O'Leary, Fenton; Trudgett, Carla; Bowden, Michael INTRODUCTION: Self-harm presentations in children and young people have increased internationally over the last decade. The COVID-19 pandemic has the potential to worsen these trends. OBJECTIVE: To describe trends in emergency department self-harm or suicidal ideation presentations for children and young people in New South Wales before and since the COVID-19 pandemic. METHODS: We studied presentations for self-harm or suicidal ideation by 10- to 24-year-olds to New South Wales emergency departments, using interrupted time series analysis to compare annualised growth before COVID (2015 to February 2020) and since COVID (March 2020 to June 2021). Subgroup analyses compared age group, gender, triage category, rurality and disadvantage. Time series decomposition via generalised additive models identified long-term, seasonal and short-term trends. RESULTS: Self-harm or suicidal ideation presentations by young people in New South Wales increased by 8.4% per annum pre-COVID. Growth accelerated since COVID, to 19.2% per annum, primarily due to increased presentations by females aged 13-17_years (47.1% per annum since COVID, from 290 per 10,000 in 2019 to 466 per 10,000 in 2021). Presentations in males aged 10-24_years did not increase since COVID (105.4 per 10,000 in 2019, 109.8 per 10,000 in 2021) despite growing 9.9% per annum before COVID. Presentation rates accelerated significantly in socio-economically advantaged areas. Presentations in children and adolescents were strongly linked to school semesters. CONCLUSION: Emergency department self-harm or suicidal ideation presentations by New South Wales young people grew steadily before COVID. Understanding the sustained increase remains a priority. Growth has increased since COVID particularly for adolescent females, but not among adolescent males. Surprisingly, the largest post-COVID increases in annual growth occurred in socio-economically advantaged and urban regions. The COVID-19 pandemic appears to have added new challenges, particularly in females in the developmentally critical early adolescent and teenage years.

Study protocol for a randomised controlled trial of enhanced informed consent compared to standard informed consent to improve patient understanding of early phase oncology clinical trials (CONSENT)

2026-04-22T03:37:06Z

Study protocol for a randomised controlled trial of enhanced informed consent compared to standard informed consent to improve patient understanding of early phase oncology clinical trials (CONSENT) Pal, Abhijit; Stapleton, Sarah; Yap, Christina; Lai-Kwon, Julia; Daly, Robert; Magkos, Dimitrios; Baikady, Bindumalini Rao; Minchom, Anna; Banerji, Udai; De Bono, Johann; Karikios, Deme; Boyle, Frances; Lopez, Juanita INTRODUCTION: Early phase cancer clinical trials have become increasingly complicated in terms of patient selection and trial procedures-this is reflected in the increasing length of participant information sheets (PIS). Informed consent for early phase clinical trials has been contentious due to the potential ethical issues associated with performing experimental research on a terminally ill population which has exhausted standard treatment options. Empirical studies have demonstrated significant gaps in patient understanding regarding the nature and intent of these trials. This study aims to test whether enhanced informed consent for patient education can improve patient scores on a validated questionnaire testing clinical trial comprehension. METHODS AND ANALYSIS: This is a randomised controlled trial that will allocate patients who are eligible to participate in one of four investigator-initiated clinical trials at the Royal Marsden Drug Development Unit to either a standard arm or an experimental arm, stratified by age and educational level. The standard arm will involve the full length trial PIS, followed by electronic or paper administration of the Quality of Informed Consent Questionnaire Parts A and B (QuIC-A and QuIC-B). The experimental arm will involve the full length trial PIS, exposure to a two-page study aid and 10 online educational videos, followed by administration of the QuIC-A and QuIC-B. The primary endpoint will be the difference (using a one-sided two-sample t-test) in the QuIC-A score, which measures objective understanding, between the standard and experimental arm. Accrual target is at least 17 patients per arm to detect an 8 point difference (80% power, alpha 0.05). ETHICS AND DISSEMINATION: Ethics approval was granted by the National Health Service Health Research Authority on 15 June 2020-IRAS Project ID 277065, Protocol Number CCR5165, REC Reference 20/EE/0155. Results will be disseminated via publication in a relevant journal. TRIAL REGISTRATION NUMBER: NCT04407676; Pre-results.

A Versatile, Secure and Sustainable All-In-One Biobank-Registry Data Solution: The A3BC REDCap Model

2022-01-17T04:12:08Z

A Versatile, Secure and Sustainable All-In-One Biobank-Registry Data Solution: The A3BC REDCap Model Willers, Craig; Lynch, Tom; Chand, Vibhasha; Islam, Mohammad; Lassere, Marissa; March, Lyn Introduction: A key element in the big data revolution is large-scale biobanking and the associated development of high-quality data collections and supporting informatics solutions. As such, in establishing the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), we sought to establish a low-cost, nation-scale data management system capable of managing a multi-site biobank-registry with complex longitudinal sample and data requirements. Materials and Methods: We assessed several international commercial and non-profit software platforms using standardised system requirement criteria and follow-up interviews. Vendor compliance scoring was prioritised to meet our project-critical requirements. Consumer / end-user co-design was integral to refining our system requirements for optimised adoption. Customisation of the selected software solution was performed to optimise field auto-population between participant timepoints and forms, using modules that are transferable and do not impact core code. Institutional and independent testing was used to ensure data security. Results: We selected the widely used research web application Research Electronic Data Capture (REDCap) which is “free” (under non-profit license agreement terms), highly configurable and customisable to a variety of biobank and registry needs, and can be developed/ maintained by biobank users with modest IT skill, time and cost. We created a secure, comprehensive participant-centric biobank-registry database that includes: (a) best practice data security measures (incl. multi-site access login using institutional user credentials), (b) permission-to-contact and dynamic itemised e-consent, (c) a complete chain of custody from consent to longitudinal biospecimen-data collection to publication, (d) complex longitudinal patient-reported surveys, (e) integration of record-level extracted/ linked participant data, (f) significant form auto-population for streamlined data capture, and (g) native dashboards for operational visualisations. Conclusion: We recommend the versatile, reusable and sustainable informatics model we have developed in REDCap for prospective chronic disease biobanks or registry-biobanks (of local to national complexity) supporting holistic research into disease prediction, precision medicine and prevention strategies.

The incidence of cardiac complications in patients hospitalised with COVID_19 in Australia: the AUS_COVID study

2026-04-29T00:36:52Z

The incidence of cardiac complications in patients hospitalised with COVID_19 in Australia: the AUS_COVID study Bhatia, Kunwardeep S; Gaal, William; Kritharides, Leonard; Chow, Clara K; Bhindi, Ravinay; Allahwala, Usaid; Chia, Justin; Choong, Christopher YP; Chui, Karina; Ciofani, Jonathan; Delaney, Anthony; Harris, Benjamin; Hudson, Bernard; Kanagaratnam, Logan; Kotsiou, George; Nour, Daniel; Sritharan, Hari Prakash; Bhagwandeen, Rohan; Brieger, David B; Yong, Andy; Dwivedi, Girish; Hillis, Graham; Kandadai, Dhanvee; Javorsky, George; Jepson, Nigel; Lee, Astin; Lo, Sidney TH; MacIsaac, Andrew I; McQuillan, Brendan M; Ranasinghe, Isuru; Vasanthakumar, Sheran; Walton, Antony; Weaver, James; Jayadeva, Pavithra; Wilson, William; Zhu, John

A Versatile, Secure and Sustainable All-In-One Biobank-Registry Data Solution: The A3BC REDCap Model

2021-11-28T22:45:37Z

Pharmacokinetic and pharmacodynamic alterations in older people with dementia

2020-07-13T02:58:45Z

Pharmacokinetic and pharmacodynamic alterations in older people with dementia Reeve, Emily; Trenaman, SC; Rockwood, K; Hilmer, Sarah N Introduction: The number of people with dementia internationally is increasing. Older adults with dementia are prescribed multiple medications, both to treat dementia symptoms and to manage their other medical conditions. Dementia is correlated with increasing age and frailty; this provides insight into how the efficacy and toxicity of medications may be altered in people with dementia. Areas covered: This review discusses the current evidence of the alterations in pharmacokinetics that can occur with aging, frailty and in people with dementia. The evidence is presented via the four primary pharmacokinetic processes (absorption, distribution, metabolism and elimination). Additionally, distribution into the brain, sex considerations and potential pharmacodynamic alterations in older people with dementia are discussed. Expert opinion: While the evidence is limited, people with dementia appear to be at a higher risk of toxicity of some medications due to altered pharmacokinetic processes and pharmacodynamics. There are a number of limitations to the research and there are still significant gaps in knowledge in this field. Proactive, ongoing review of the appropriateness of choice of medication, dose and whether or not a medication is required at all is necessary for achieving quality use of medications in people living with dementia.

Women's views about the timing of birth

2026-04-29T00:36:51Z

Women's views about the timing of birth Todd, Angela L.; Zhang, Lillian Y.; Khambalia, Amina Z.; Roberts, Christine L. Background: Estimated date of birth (EDB) is used to guide clinical management of women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined. Aims: To explore women’s expectations of giving birth on or near their EDB, and their attitudes to alternative estimates for timing of birth. Methods: A survey of pregnant women attending four public hospitals in Sydney, Australia, between July and December 2012. Results: Among 769 surveyed women, 42% expected to birth before their due date, 16% after the due date, 15% within a day or so of the due date, and 27% had no expectations. Nulliparous women were more likely to expect to give birth before their due date. Women in the earlier stages of pregnancy were more likely to have no expectations or to expect to birth before the EDB while women in later pregnancy were more likely to expect birth after their due date. For timing of birth information, only 30% of women preferred an EDB; the remainder favoured other options. Conclusions: Most women understood the EDB is imprecise. The majority of women expressed a preference for timing of birth information in a format other than an EDB. In support of woman-centred care, it may be helpful to ask each woman how she would like to receive estimated timing of birth information.

Outcomes of gallstone disease during pregnancy: a population based data linkage study

2026-04-29T00:36:54Z

Outcomes of gallstone disease during pregnancy: a population based data linkage study Ibiebele, Ibinabo; Schnitzler, Margaret; Nippita, Tanya; Ford, Jane B Background Gallstone disease is a leading indication for non-obstetric abdominal surgery during pregnancy. There are limited whole population data on maternal and neonatal outcomes. This population-based study aims to describe the outcomes of gallstone disease during pregnancy in an Australian setting. Methods Linked hospital, birth and mortality data for all women with singleton pregnancies in New South Wales, Australia, 2001-2012 were analysed. Exposure of interest was gallstone disease (acute biliary pancreatitis, gallstones with/without cholecystitis). Outcomes including preterm birth (spontaneous and planned), readmission, morbidity and mortality (maternal and neonatal) were compared between pregnancies with and without gallstone disease and within disease subtypes. Adjusted risk ratios (aRRs) and 99% confidence intervals were estimated using modified Poisson regression and adjusted for maternal and pregnancy factors. Results Among 1,064,089 pregnancies, 1882 (0.18%) had gallstone disease. Of these, 239 (12.7%) had an antepartum cholecystectomy and 1643 (87.3%) were managed conservatively. Of those managed conservatively, 319 (19.0%) had a postpartum cholecystectomy. Gallstone disease was associated with increased risk of preterm birth (aRR 1.3, 99% CI 1.1, 1.6) particularly planned preterm birth (aRR 1.6, 99% CI 1.2, 2.1), maternal morbidity (aRR 1.6, 99% CI 1.1, 2.3), maternal readmission (aRR 4.7, 99% CI 4.2, 5.3), and neonatal morbidity (aRR 1.4, 99% CI 1.1, 1.7). Surgery was associated with decreased risk of maternal readmission (aRR 0.4, 99% CI 0.2, 0.7). Conclusions Gallstone disease during pregnancy was associated with adverse maternal and neonatal outcomes. Most women with gallstone disease during pregnancy are managed conservatively. Surgical management was associated with decreased risk of readmission.

Pediatric admissions that include intensive care: a population-based study

2026-04-29T00:36:50Z

Pediatric admissions that include intensive care: a population-based study Ibiebele, Ibinabo; Algert, Charles S.; Bowen, Jennifer R.; Roberts, Christine L. Background Pediatric admissions to intensive care outside children’s hospitals are generally excluded from registry-based studies. This study compares pediatric admission to specialist pediatric intensive care units (PICU) with pediatric admissions to intensive care units (ICU) in general hospitals in an Australian population. Methods We undertook a population-based record linkage cohort study utilizing longitudinally-linked hospital and death data for pediatric hospitalization from New South Wales, Australia, 2010-2013. The study population included all new pediatric, post-neonatal hospital admissions that included time in ICU (excluding neonatal ICU). Results Of 498,466 pediatric hospitalizations, 7,525 (1.5%) included time in an intensive care unit – 93.7% to PICU and 6.3% to ICU in a general (non-PICU) hospital. Non-PICU admissions were of older children, in rural areas, with shorter stays in ICU, more likely admitted for acute conditions such as asthma, injury or diabetes, and less likely to have chronic conditions, receive continuous ventilatory support, blood transfusion, parenteral nutrition or die. Conclusions A substantial proportion of children are admitted to ICUs in general hospitals. A comprehensive overview of pediatric ICU admissions includes these admissions and the context of the total hospitalization.

Population-Based Study of Sleep Apnea in Pregnancy and Maternal and Infant Outcomes

2026-04-29T00:36:51Z

Population-Based Study of Sleep Apnea in Pregnancy and Maternal and Infant Outcomes Bin, Yu Sun; Cistulli, Peter A.; Ford, Jane B. Study Objectives: To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort. Methods: Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth in hospital from 2002 to 2012 (N=636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension. Results: Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.68; 95% CI 1.40 – 2.07), planned delivery (1.15; 1.07 – 1.23), preterm birth (1.50; 1.21 – 1.84), 5-minute Apgar <7 (1.60; 1.07 – 2.38), admission to neonatal intensive care/special care nursery (1.26; 1.11 – 1.44), large-for-gestational-age infants (1.27; 1.04 – 1.55) but not with gestational diabetes (1.09; 0.82 – 1.46), caesarean section (1.06; 0.96 – 1.17), perinatal death (1.73; 0.92 – 3.25), or small-for-gestational-age infants (0.81; 0.61 – 1.08). Conclusions: Sleep apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history.

High maternal iron status, dietary iron intake and iron supplement use in pregnancy and risk of gestational diabetes mellitus: In-house study and systematic review

2026-04-29T00:04:59Z

High maternal iron status, dietary iron intake and iron supplement use in pregnancy and risk of gestational diabetes mellitus: In-house study and systematic review Khambalia, Amina Z.; Aimone, Ashley; Nagubandi, Preethi; Roberts, Christine L.; McElduff, Aidan; Morris, Jonathan M.; Powell, Katie; Tasevski, Vitomir; Nassar, Natasha Background: High iron measured using dietary and serum biomarkers have been associated with type 2 diabetes; however it is uncertain whether a similar association exists for gestational diabetes mellitus (GDM). Objectives: To conduct a cohort study examining first trimester body iron stores and subsequent risk of GDM and to include these findings in a systematic review of all studies examining the association between maternal iron status, iron intake (dietary and supplemental) and the risk of GDM. Methods: Serum samples for women with first trimester screening were linked to birth and hospital records for data on maternal characteristics and GDM diagnosis. Blood was analysed for ferritin, soluble transferrin receptor (sTfR) and C-reactive protein (CRP). Associations between iron biomarkers and GDM were assessed using multivariate logistic regression. A systematic review and meta-analysis, registered with PROSPERO (CRD42014013663) included all studies published in English from Jan 1995 to March 2014 that examined the association between iron and GDM and included an appropriate comparison group. Results: Of 3, 776 women, 3.4% subsequently developed GDM. Adjusted analyses found increased odds of GDM for ferritin (OR 1.41; 95% CI: 1.11, 1.78) but not for sTfR (OR 1.00, 95% CI: 0.97, 1.03) levels. Two trials of iron supplementation in early pregnancy found no association with GDM. Increased risk of GDM was associated with higher levels of maternal ferritin and serum iron and dietary heme iron intakes. Conclusions: Increased risk of GDM among women with high serum ferritin and iron levels and dietary heme iron intakes warrants further investigation.

Vulvoplasty in NSW 2001-2013: A population-based record-linkage study

2026-04-29T00:36:59Z

Vulvoplasty in NSW 2001-2013: A population-based record-linkage study Ampt, Amanda J.; Roach, Vijay; Roberts, Christine L. Objectives: To compare characteristics of women who have vulvoplasty procedures with other women; quantify short-term adverse events and complications; and determine any association of vulvoplasty on future births. Design, setting and participants: A population-based record-linkage study was undertaken using the New South Wales (NSW) Admitted Patient Data Collection and NSW Perinatal Data Collection. All women who had vulvoplasties in hospital during 2001 - 2013 were identified, and their characteristics compared with all women of reproductive age (reference population). Main outcome measures: Admissions for vulvoplasty and repeat vulvoplasties; serious complications or adverse events following vulvoplasty procedures; birth mode and perineal outcomes for primiparous women with and without prior vulvoplasty. Results: There were 4,592 vulvoplasty procedures performed on 4,381 women, increasing by 64.5% over the study period. Compared to the reference population, women who had vulvoplasty were more likely to be Australian born (74.6% vs 67.6%); have other cosmetic surgery (10.1% vs 1.7%); and never been married (43.1% vs 33.1%). The serious adverse event/complication rate was 7.2%. Of those with a subsequent first birth, 40.0% had a caesarean section, compared with 30.3% of other women (p<0.001); while among vaginal births, perineal outcomes including tears and episiotomies were not significantly different (p=0.87; p=0.20). Conclusions: Since 2001, the number of vulvoplasties performed in NSW has increased dramatically, with no obvious biological reason for the rise. The procedure was not without serious complications necessitating hospital readmission in some instances. This study provides objective outcome information for counselling women who are contemplating vulvoplasty

Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes.

2026-04-29T00:36:55Z

Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes. Khambalia, Amina Z.; Collins, Clare E.; Roberts, Christine L.; Morris, Jonathan M.; Powell, Katie; Tasevski, Vitomir; Nassar, Natasha Background: There are several biomarkers for measuring iron deficiency (ID) in pregnancy, but evidence of their prevalence in association with inflammation and adverse pregnancy outcomes is inconclusive. Objectives: To describe the prevalence and determinants of ID in women in the first trimester of pregnancy and associations with pregnancy and birth outcomes. Design: A record-linkage cohort study of archived serum samples of women attending first trimester screening and birth and hospital data to ascertain maternal characteristics and pregnancy outcomes. Sera were analysed for iron stores (ferritin; μg/L), tissue iron (soluble transferrin receptor, sTfR; nmol/L) and inflammatory (C-reactive protein, CRP; mg/L) biomarkers. Total body iron (TBI) was calculated from serum ferritin and sTfR concentrations. Multivariate logistic regression analyzed risk factors and pregnancy outcomes associated with ID using the definitions: serum ferritin <12 μg/L, TfR ≥21.0 nmol/L and TBI<0 mg/kg. Results: Of 4,420 women, the prevalence of ID based on ferritin, sTfR and TBI was 19.6%, 15.3% and 15.7%, respectively. Risk factors of ID varied depending on which iron parameter was used and included maternal age <25 years, multiparity, socioeconomic disadvantage, high maternal body weight and inflammation. ID was associated with reduced risk of gestational diabetes (GDM) defined using serum ferritin and TBI, but not sTfR and increased risk of large for gestation age (LGA) infants defined using TBI only. Conclusions: Nearly 1 in 5 Australian women begin pregnancy with ID. Evidence suggests excess maternal weight and inflammation play a role in the relationships between ID and GDM and LGA infants.

Population-Based Study of Sleep Apnea in Pregnancy and Maternal and Infant Outcomes

2026-04-29T00:36:52Z

Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study

2026-04-29T00:36:54Z

Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study Bin, Yu Sun; Ford, Jane B.; Nicholl, Michael C.; Roberts, Christine L. Introduction: There is a lack of information on childhood outcomes by mode of delivery for term breech presentation. We aimed to compare childhood mortality, cerebral palsy, hospitalizations, development, and educational outcomes associated with intended vaginal breech birth (VBB) compared to planned cesarean section (CS). Materials and Methods: Population birth and hospital records from New South Wales, Australia were used to identify women with non-anomalous pregnancies eligible for VBB from 2001 to 2012. Intended mode of delivery was inferred from labor onset and management. Death, hospital, and education records were used for follow-up until 2014. Cox proportional hazards regression and modified Poisson regression were used for analysis. Results: Of 15,340 women considered eligible for VBB, 7.8% intended VBB, 74.2% planned CS, and intention was uncertain for 18.1%. Intended VBB did not differ from planned CS on infant mortality (Fisher’s exact p=0.55), childhood mortality (Fisher’s exact p=0.50), cerebral palsy (Fisher’s exact p=1.00), hospitalization in the first year of life (adjusted HR 1.04; 95% CI 0.90 – 1.20), hospitalization between the first and sixth birthdays (0.92; 0.82 – 1.04), being developmentally vulnerable (adjusted RR 1.22; 95% CI 0.48 – 1.88) or having special needs status (0.95; 0.48 – 1.88) when aged 4 – 6, scoring more than 1 standard deviation below the mean on tests of reading (1.10; 0.87 – 1.40) and numeracy (1.04; 0.81 – 1.34) when aged 7 – 9. Conclusions: Planned vaginal breech birth confers no additional risks for child health, development, or educational achievement compared to planned cesarean section.

Outcomes of breech birth by mode of delivery: a population linkage study

2026-04-29T00:36:56Z

Outcomes of breech birth by mode of delivery: a population linkage study Bin, Yu Sun; Roberts, Christine L.; Ford, Jane B.; Nicholl, Michael C. Background: Trial evidence supports a policy of caesarean section for singleton breech presentations at term but vaginal breech birth is considered a safe option for selected women. Aims: To provide recent Australian data on outcomes associated with intended mode of delivery for term breech singletons in women who meet conservative eligibility criteria for vaginal breech birth. Materials and Methods: Birth and hospital records from 2009 to 2012 in New South Wales were used to identify women with non-anomalous pregnancies who would be considered eligible for vaginal breech birth. Intended mode of delivery was inferred from labour onset and management. Results: Of 10,133 women with term breech singleton pregnancies, 5,197 (51.3%) were classified as eligible for vaginal breech delivery. Of these, 6.8% intended vaginal breech birth, 76.4% planned caesarean section, and intention could not be determined for 16.8%. Women intending vaginal delivery had higher rates of neonatal morbidity (6.0% vs. 2.1%), neonatal birth trauma (7.4% vs. 0.9%), Apgar <4 at 1 minute (10.5% vs. 1.1%), Apgar<7 at 5 minutes (4.3% vs. 0.5%), and NICU/SCN admissions (16.2% vs. 6.6%) than those planning caesarean section. Increased perinatal risks remained after adjustment for maternal characteristics. Severe maternal morbidity (1.4% vs. 0.7%) and postpartum readmission (4.6% vs. 4.0%) were higher in the intended vaginal compared to planned caesarean births but these differences were not statistically significant. Conclusions: In a population of women classified as being eligible for vaginal breech birth, intended vaginal delivery was associated with higher rates of neonatal morbidity than planned caesarean section.

Preconception Care - Issues Paper

2026-04-29T00:36:50Z

Preconception Care - Issues Paper Lum, Margaret N.; Todd, Angela L. The evidence for the link between maternal risk factors (including smoking, obesity, alcohol use and maternal mental health) and perinatal morbidity and mortality rates among Australian women is clear. There is also a growing body of evidence that Indigenous women are significantly more likely than their non-Indigenous counterparts to be impacted by these risk factors. Risk factors originate from genetic, environmental and behavioural factors. In alignment with the Health and Social Policy Branch’s Strategic Plan, Healthy, Safe and Well, the purpose of this paper is to focus on those risk factors that have a behavioural element and can, therefore, be modified, or impacted by strategies to minimise associated harms. Smoking in pregnancy has been highlighted as the most significant preventable cause of morbidity and death among women and infants. The risk of smoking increases among Indigenous and other disadvantaged women. A combination of policy and social marketing interventions involving comprehensive bans on advertising and sponsorship, tobacco price increases, bans on smoking in work and public places, health warnings on packs, mass media, QUIT telephone coaching and monitoring by a physician have been found to be most effective. Trends in nutrition, physical activity and obesity suggest a need for greater awareness and education of women in their reproductive years, prior to conception. Given women who are overweight or obese at conception are at increased risk of excessive gestational weight gain, parenting education and the setting of weight management goals have had some traction in antenatal care, however, the success of such programs relies on regular attendance and health practitioner skill. Although targeted health promotion interventions have increased acceptance of the importance of a healthy diet and exercise, many health practitioners lack skills to manage the problem, and evidence of the efficacy of such interventions in achieving reductions in obesity at the population level is lacking. Aboriginal women are at increased risk of obesity and government support for culturally appropriate programs targeting lifestyle behaviours and supporting health eating and physical activity in local communities have the potential to impact positively. Alcohol consumption among young women and pregnant women in NSW represents a significant risk factor potentially impacting the unborn fetus. Whilst the proportion of women engaged in heavy drinking in pregnancy is low, the adverse outcomes (including FASD) of heavy gestational alcohol consumption and the lack of evidence around safe levels of consumption highlight the issue as a high public health priority. Mandatory labelling of alcohol products and training of health professionals have been proposed as best practice interventions, in combination with addressing issues of pricing and taxation and advocating abstinence from drinking during pregnancy. The estimated prevalence of harmful drinking in Indigenous populations is twice that of non-Indigenous populations and the normalisation of harmful consumption highlights the need to target Indigenous populations, Aboriginal Medical Services (AMS) and Aboriginal clinicians to give health practitioners the skills and resources needed to advocate for reduced alcohol consumption in pre-pregnancy. Key components of effective interventions targeting Aboriginal women and health practitioners in contact with women in preconception and pregnancy are interactive community-based education, culturally appropriate printed resources and ongoing community engagement. Maternal mental health issues are estimated to affect 10-15% of women in high income countries during the perinatal period. Policy frameworks in NSW reflect recognition of the need for greater awareness of maternal mental health and the requirement to integrate programs that provide support for women’s well-being in the antenatal and postnatal phase into policy, planning and delivery of health services. An evidence-based health home visiting program called Sustaining NSW Families, developed for the identification and treatment of women at risk of antenatal and postnatal depression, has been found to be effective as an early intervention tool. Factors impacting the health and well-being of Aboriginal people include spirituality, the relationship with family, land and culture and these factors are all intertwined. Programs targeting these women need to be culturally appropriate, driven by the community and run by a workforce who understands the psycho-social risks resulting from intergenerational trauma.

Association of maternal tocolysis or antenatal corticosteroids with cerebral palsy: a study protocol

2026-04-29T00:36:51Z

Association of maternal tocolysis or antenatal corticosteroids with cerebral palsy: a study protocol Algert, Charles S.; Roberts, Christine L.; Morris, Jonathan M.; Kenyon, Sara; Brocklehurst, Peter Cerebral palsy (CP) is the most common developmental disorder associated with lifelong motor impairment and disability. Although severe intrapartum hypoxia/ischaemia during birth may be instrumental in the causal pathway leading to cerebral palsy this accounts for only 10% of cases. Antenatal exposures that lead to cerebral palsy are, therefore, important to understand, particularly those that are modifiable. This application seeks to determine whether antenatal exposure to medications to prevent uterine contractions (tocolysis) and assist lung maturation (corticosteroids) have any association with cerebral palsy, particularly in pregnancies presenting moderately preterm. We plan to perform a secondary analysis on two large existing datasets (the ORACLE trials) of pregnancies presenting before term. If an association is found the results could have significant implications for clinical management and the direction of future research.

Contribution of Changing Risk Factors to the Trend in Breech Presentation at Term

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Contribution of Changing Risk Factors to the Trend in Breech Presentation at Term Bin, Yu Sun; Roberts, Christine L.; Nicholl, Michael C.; Nassar, Natasha; Ford, Jane B. Background: Recent population-wide changes in perinatal risk factors may affect rates of breech presentation at birth, and have implications for the provision of breech services and clinical training in breech management. Aims: To determine the trend in breech presentation at term and investigate whether changes in maternal and pregnancy characteristics explain the observed trend. Materials and Methods: All singleton term (≥37 week) births in New South Wales during 2002 – 2012 were identified through birth and associated hospital records. Annual rates of breech presentation were determined. Logistic regression modelling was used to predict expected rates of breech presentation over time and these were compared with observed rates. A priori predictors included maternal age, country of birth, parity, smoking during pregnancy, diabetes, pregnancy hypertension, placenta praevia, previous singleton term breech, previous caesarean section, infant sex, gestational age, birthweight, and congenital anomalies. Hospital and Medicare data were used to assess trends in external cephalic version. Results: Among 914,147 singleton term births, 3.1% were breech at delivery. Rates declined from 3.6% in 2002 to 2.7% in 2012 (test for trend p<0.001). Breech presentation was predicted to increase from 3.6% in 2002 to 4.3% in 2012 because of increased maternal age, nulliparity, maternal diabetes, history of breech presentation and previous caesarean section. Use of external cephalic version appears to have increased over time. Conclusions: Breech presentation at delivery has decreased in New South Wales. Increased use of external cephalic version likely accounts for this decline, as changes in risk factors do not.

Postnatal care utilization by Vietnamese women

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Postnatal care utilization by Vietnamese women Trinh, Anh T.; Nippita, Tanya A.; Dien, Trang N.; Roberts, Christine L. Only 70% of Vietnamese attend any postnatal health care and this is primarily for infant immunization.

Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia

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Intravenous iron: barriers and facilitators to its use at nine maternity hospitals in New South Wales, Australia Mayson, Eleni; Ampt, Amanda J.; Shand, Antonia W.; Ford, Jane B. Background: Anaemia in pregnancy is mostly due to iron deficiency, and the use of intravenous (IV) iron is gaining acceptance as a treatment option. Recently released obstetric transfusion guidelines recommend IV iron in maternity patients requiring iron when oral formulations are poorly tolerated, unlikely to be well absorbed, or when rapid restoration of iron stores is required. Aim: To identify barriers and facilitators to the use of IV iron in pregnancy among 9 maternity hospitals in New South Wales. Materials & Methods: A qualitative research study was undertaken using semi-structured interviews. Nine maternity units were chosen to cover a range of clinical settings and obstetric blood transfusion rates. Interviews were conducted with haematologists, obstetricians and midwives, and included questions about the use of IV iron in each institution. Interviews were transcribed, coded, and NVivo software was used to develop themes. Results: 125 interviews were conducted: 61 with doctors. The use of IV iron differed between hospitals and individual doctors. There were hospital/pharmaceutical, clinician and patient factors which acted as either barriers or facilitators to the use of IV iron. Where perceived barriers outweighed facilitators in a particular hospital, doctors were less likely to use IV iron. Conclusion: The use of IV iron, as perceived by doctors, differed across hospitals. There are some potentially modifiable barriers to the use of IV iron that may need to be addressed for IV iron to be available to obstetric patients not tolerating oral formulations or requiring rapid restoration of iron stores

Prevalence of noncaesarean uterine surgical scars in a maternity population

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Prevalence of noncaesarean uterine surgical scars in a maternity population Nippita, Tanya A.; Schemann, Kathrin; Roberts, Christine L.

Increased planned delivery contributes to declining rates of pregnancy hypertension in Australia: a population-based record linkage study

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Increased planned delivery contributes to declining rates of pregnancy hypertension in Australia: a population-based record linkage study Roberts, Christine L.; Algert, Charles S.; Morris, Jonathan M.; Ford, Jane B. Objective: Since the 1990s, pregnancy hypertension rates have declined in some countries but not all. Increasing rates of early planned delivery (before the due date) have been hypothesised as the reason for the decline. The aim of this study was to explore whether early planned delivery can partly explain the declining pregnancy hypertension rates in Australia. Design: Population-based record linkage study utilising linked birth and hospital records Setting and Participants: A cohort of 1,076,122 deliveries in New South Wales, Australia, 2001-2012. Outcome measures: Pregnancy hypertension (including gestational hypertension, preeclampsia and eclampsia) was the main outcome, preeclampsia was a secondary outcome Results: From 2001 to 2012, pregnancy hypertension rates declined by 22% from 9.9% to 7.7% and preeclampsia by 27% from 3.3% to 2.4% (trend P <0.0001). At the same time, planned deliveries increased: prelabour caesarean section by 43% (12.9% to 18.4%) and labour inductions by 10% (24.8% to 27.2%). Many maternal risk factors for pregnancy hypertension significantly increased (P<0.01) over the study period including nulliparity, age ≥35 years, diabetes, overweight and obesity, and use of assisted reproductive technologies; some risk factors decreased including multi-fetal pregnancies, age <20 years, autoimmune diseases and previous pregnancy hypertension. Given these changes in risk factors the pregnancy hypertension rate was predicted to increase to 10.5%. Examination of annual gestational age distributions showed that pregnancy hypertension rates actually declined from 38 weeks gestation and were steepest from 41 weeks; at least 36% of the decrease could be attributed to planned deliveries. The risk factors for pregnancy hypertension were also risk factors for planned delivery. Conclusions: It appears that an unanticipated consequence of increasing early planned deliveries is a decline in the incidence of pregnancy hypertension. Women with risk factors for hypertension were relatively more likely to be selected for early delivery.

International caesarean section rates – the rising tide

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International caesarean section rates – the rising tide Roberts, Christine L.; Nippita, Tanya A.

Prevalence, repairs and complications of hypospadias: an Australian population-based study

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Prevalence, repairs and complications of hypospadias: an Australian population-based study Schneuer, Francisco J.; Holland, Andrew J.A.; Pereira, Gavin; Bower, Carol; Nassar, Natasha Objective: To investigate hypospadias prevalence and trends, rate of surgical repairs and post-repair complications in an Australian population. Methods: Hypospadias cases were identified from all live born infants in New South Wales, Australia, 2001-2010 using routinely collected birth and hospital data. Prevalence, trends, surgical procedures or repairs, hospital admissions and complications following surgery were evaluated. Risk factors for re-operation and complications were assessed using multivariate logistic regression. Results: There were 3,186 boys with hypospadias in 2001-2010. Overall prevalence was 35.1 per 10,000 livebirths and remained constant during the study period. Proportions of anterior, middle, proximal and unspecified hypospadias were 41.3%, 26.2%, 5.8% and 26.6%, respectively. Surgical procedures were performed in 1,945 (61%) boys, with 1,718 primary repairs. The overall post-surgery complication rate involving fistulas or strictures was 13%, but higher (33%) for proximal cases. Complications occurred after one year post-repair in 52.3% of cases and up to five years. Boys with proximal or middle hypospadias were at increased risk of re-operation or complications, but age at primary repair did not affect the outcome. Conclusions: One in 285 infants were affected with hypospadias, 60% required surgical repair or correction and one in eight experienced complications. The frequency of late complications would suggest that clinical review should be maintained for more than one year post-repair.

Variation in and factors associated with timing of low risk, pre-labour repeat caesarean sections in NSW, 2008-2011

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Variation in and factors associated with timing of low risk, pre-labour repeat caesarean sections in NSW, 2008-2011 Schemann, Kathrin; Patterson, Jillian A.; Nippita, Tanya A.; Ford, Jane B.; Matha, Deborah; Roberts, Christine L. In April 2007, the New South Wales (NSW) Ministry of Health released an evidence-based policy directive requiring that ‘where there are no compelling medical indications, elective or pre-labour caesarean section does not occur prior to 39 completed week’s gestation’. This study describes variation in and factors associated with hospital rates of early (37-38 weeks gestation), low risk pre-labour repeat caesarean section at term. Linked birth and hospital data for low-risk, pre-labour repeat caesarean sections in NSW in 2008-2011 were analysed using multi-level regression modelling. Rates were adjusted for casemix and hospital factors. In 2008-2011, there were 15,163 pre-labour repeat caesarean sections among low risk women in NSW. Overall, 34.7% of low risk pre-labour repeat caesarean sections occurred before 39 weeks gestation. Casemix and hospital factor adjusted NSW public hospital rates of early (37-38 weeks gestation), low risk, pre-labour repeat caesarean section at term varied widely (16.3%-67.5%). Smoking, private health care, assisted reproductive technology, higher parity, a non-caesarean uterine scar and delivering in a hospital with CPAP facilities were associated with higher odds of early delivery. Hospitals with higher rates of low risk deliveries and higher propensity for vaginal birth after caesarean rates had lower odds of early delivery. The findings suggest poor uptake of the policy for pre-labour caesarean from 39 weeks. Large between-hospital variation persisted following adjustment, suggesting that non-medical factors are related to timing of low risk, pre-labour caesarean section. Further strategies are needed to enhance adherence to evidence-based policy.

Dietary vitamin, mineral and herbal supplement use: a cross-sectional survey of before and during pregnancy use in Sydney, Australia.

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Dietary vitamin, mineral and herbal supplement use: a cross-sectional survey of before and during pregnancy use in Sydney, Australia. Shand, Antonia W.; Walls, Mariyam; Chatterjee, Rahul; Nassar, Natasha; Khambalia, Amina Z. AIM: To describe use of dietary vitamin, mineral and herbal supplements before and during pregnancy. METHODS: Pregnant women attending antenatal care at two tertiary Sydney hospitals between January and March 2014 completed an anonymous survey. Information on general maternal and pregnancy characteristics and the use of dietary and herbal supplements, including type, duration, and sources of information was collected. Frequency and contingency tabulations were performed. RESULTS: 612 women agreed to participate (91% response rate). 23 were excluded due to incomplete data. Of 589 women included in the analysis, the mean gestational age at the time of survey was 28.5 weeks (SD 8.3), 55% had no children, and 67% were tertiary educated. Overall 62.9% of women reported taking a multivitamin (MV) and/or folic acid (FA) supplement in the 3 months pre-pregnancy. At the time of the survey 93.8% of women were taking at least one supplement (median 2, range 1-13). During pregnancy 79.1% of women were taking MVs, including 59.2% taking MV only and 19.9% taking MV and FA. The 5 most common supplements outside of a MV were FA (31%), iron (30%), vitamin D (23%), calcium (13%) and fish oil (12%). CONCLUSION: Use of folic acid and MVs and other supplements during and pre-pregnancy is relatively high, although pre-pregnancy FA supplementation rates could still be improved. Further research on the actual dosages and dietary intakes consumed are needed to examine whether pregnant women have adequate intake of nutrients, regardless of supplement use.

Evaluation of first trimester serum soluble endothelial cell-specific tyrosine kinase receptor in normal and affected pregnancies

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Evaluation of first trimester serum soluble endothelial cell-specific tyrosine kinase receptor in normal and affected pregnancies Schneuer, Francisco J.; Nassar, Natasha; Guilbert, Cyrille; Tasevski, Vitomir; Ashton, Anthony W.; Morris, Jonathan M.; Roberts, Christine L. Aims: To assess soluble endothelial cell-specific tyrosine kinase receptor (sTie-2) levels in the first trimester of pregnancy and its association with adverse pregnancy outcomes; and examine the predictive accuracy. Study Design: In this nested case-control study, serum sTie-2 levels were measured in 2,616 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum sTie-2 with subsequent adverse pregnancy outcomes. Results: Median (interquartile range) sTie-2 for the total population was 19.6 ng/ml (13.6-26.4). Maternal age, weight, and smoking status significantly affected sTie-2 levels. There was no difference in serum sTie-2 between unaffected and women with adverse pregnancy outcomes. After adjusting maternal and clinical risk factors, low sTie-2 (<25th centile) was associated with preeclampsia (Adjusted odds ratio: 1.61; 95%CI: 1.01-2.57), however, the accuracy of sTie-2 in predicting preeclampsia was not different from chance (AUC=0.54; P=0.08) and does not add valuable predictive information to maternal and clinical risk factors. Conclusions: Our findings suggest that low sTie-2 levels are associated with preeclampsia, however, it does not add valuable information to clinical and maternal risk factor information in predicting preeclampsia or any other adverse pregnancy outcomes.

Hospitalisations from one to six years of age: Effects of Gestational Age and Severe Neonatal Morbidity

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Hospitalisations from one to six years of age: Effects of Gestational Age and Severe Neonatal Morbidity Stephens, Alexandre S.; Lain, Samantha J.; Roberts, Christine L.; Bowen, Jennifer R.; Simpson, Judy M.; Nassar, Natasha Background: To investigate whether the adverse infant health outcomes associated with early birth and severe neonatal morbidity (SNM) persist beyond the first year of life and impact on paediatric hospitalisations for children up to six years of age. Methods: The study population included all singleton live births, >32 weeks gestation in New South Wales, Australia in 2001-2005, with follow-up to six years of age. Birth data were probabilistically linked to hospitalisation data (n=392,964). The odds of hospitalisation, mean hospital length of stay (LOS) and costs, and cumulative LOS were evaluated by gestational age and SNM using multivariable analyses. Results: A total of 74,341 (18.9%) and 41,404 (10.5%) infants were hospitalized once and more than once, respectively. SNM was associated with increased odds of hospitalisation once (adjusted odds ratio (aOR) 1.16 [95% CI 1.10, 1.22]), and more than once (aOR 1.51 [1.42, 1.60]). Decreasing gestational age was associated with increasing odds of hospitalisation more than once from aOR 1.19 at 37-38 weeks to 1.49 at 33-34 weeks. Average LOS and costs per hospital admission were increased with SNM but not with decreasing gestational age. Cumulative LOS was significantly increased with SNM and decreasing gestational age. Conclusions: Adverse effects of SNM and early birth persist between one and six years of age. Strategies to prevent early birth and reduce SNM, and to increase health monitoring of vulnerable infants throughout childhood may help reduce paediatric hospitalisations.

Delivery of a Small-For-Gestational-Age Infant and Risk of Maternal Cardiovascular Disease – A Population-Based Record Linkage Study

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Delivery of a Small-For-Gestational-Age Infant and Risk of Maternal Cardiovascular Disease – A Population-Based Record Linkage Study Ngo, Anh D.; Roberts, Christine L.; Chen, Jian Sheng; Figtree, Gemma Background. Delivery of small for gestational age (SGA) infants has been associated with increased risk of future maternal cardiovascular disease (CVD). However, whether the risk increases progressively with the greater severity of SGA and number of SGA infants has not been explored. Methods. A population-based record linkage study was conducted among 812,732 women delivering live born, singleton infants at term between 1994 and 2011 in New South Wales, Australia. Birth records were linked to the mothers’ subsequent hospitalization or death records to identify CVD events (coronary heart disease, cerebrovascular events, and chronic heart failure) after a median of 7.4 years. Cox proportional hazard regression was used to estimate adjusted hazard ratios (AHR) [95% confidence interval (CI)] for the associations between the severity (moderate or extreme) of SGA and number of SGA infants and subsequent risk of maternal CVD, accounting for maternal age at last birth, socioeconomic status, parity, smoking, (pre-gestational and gestational) diabetes, and (chronic and pregnancy) hypertension. Results. Compared to mothers of non-SGA infants, AHRs [95%CI] of CVD among mothers of moderately and extremely SGA infants were 1.36 [1.23-1.49], and 1.66 [1.47-1.87], respectively, while AHRs among mothers with 1, 2, and ≥3 SGA infants were 1.42 [1.30-1.54], 1.65 [1.34-2.03], and 2.42 [1.52-3.85], respectively, indicating a dose-response relationship. AHRs of specific CVD categories showed a similar pattern. Conclusions. Delivery of an SGA infant was associated with a dose-dependent increase in the risk of maternal CVD according to both the severity of SGA and number of previous SGA infants.

Pregnancy outcomes for women with rare autoimmune diseases

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Pregnancy outcomes for women with rare autoimmune diseases Chen, Jian Sheng; Roberts, Christine L.; Simpson, Judy M.; March, Lyn M. Objective: To examine pregnancy outcomes and pregnancy-related health service utilisation among women with rare autoimmune diseases. Methods: This population-based cohort study of an Australian obstetric population (New South Wales 2001-2011) used birth records linked to hospital records for identification of rare autoimmune diseases including systemic vasculitis, vasculitis limited to skin, systemic sclerosis, dermatopolymyositis and other systemic involvement of connective tissue. We excluded births to women with systemic lupus erythematosus or rheumatoid arthritis and births >6 months before the first documented diagnosis of the rare autoimmune disease. Modified Poisson regression was used to compare study outcomes between women with autoimmune diseases and the general obstetric population. Results: There were 991,701 births including 409 (0.04%) births to 293 women with rare autoimmune diseases. Of the 409 pregnancies, 202 (49%) delivered by cesarean delivery and 72 (18%) were preterm; these rates were significantly higher than those in the general obstetric population (28% and 7% respectively). Compared to the general population, women with autoimmune diseases had higher rates of hypertensive disorders, antepartum hemorrhage and severe maternal morbidity, and required longer hospitalization at delivery and more hospital admissions and tertiary obstetric care. Compared to other infants, those whose mothers had a rare autoimmune disease were at increased risk of admission to neonatal intensive care unit, severe neonatal morbidity and perinatal death. Conclusions: Women with rare autoimmune diseases were at increased risk of having both maternal complications and adverse neonatal outcomes; their pregnancies should be closely monitored.

Esophageal atresia and tracheo-esophageal fistula in Western Australia: prevelence and trends

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Esophageal atresia and tracheo-esophageal fistula in Western Australia: prevelence and trends Leoncini, Emanuele; Bower, Carol; Nassar, Natasha Objectives A recent international study reported a higher prevalence of esophageal atresia with or without tracheo-esophageal fistula (EA±TEF) in Western Australia (WA). The aim of this study was to examine the prevalence and trends of EA and/or TEF in WA; determine the proportion of cases with associated anomalies; and explore the impact of time of diagnosis. Methods The study population comprised all infants born in WA, 1980-2009 and registered with EA and/or TEF on the WA Register of Developmental Anomalies (WARDA). Results EA±TEF and TEF alone affect, on average, 1 in every 2,927 births in WA, with a total prevalence of 3.00 and 0.42 per 10,000 births, respectively. The prevalence of EA±TEF increased by 2.0% per annum, with only cases with associated anomalies (64% of cases) demonstrating an increase. TEF rates were stable. Among EA±TEF infants, the proportion of live births, stillbirths and elective terminations of pregnancy for fetal anomaly (TOPFA) was 79%, 6% and 15%, respectively; while the majority (94%) of TEF only cases were live births. In 2000-2009 there was 30% fall in EA±TEF live births with 61 (58%) cases diagnosed in first week of life, 10 (9%) prenatally and 34 (32%) at postmortem only. Conclusions A higher prevalence of EA±TEF in WA was observed with increase over time attributable to increase with associated anomalies. Consistent reporting, availability of prenatal diagnosis and ascertainment of cases following TOPFA or postmortem examinations can significantly affect prevalence of EA and/or TEF.

Iron supplement use in pregnancy – are the right women taking the right amount?

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Iron supplement use in pregnancy – are the right women taking the right amount? Chatterjee, Rahul; Shand, Antonia W.; Nassar, Natasha; Walls, Mariyam; Khambalia, Amina Z. Objectives: To examine the prevalence and determinants of iron supplement use and the amount of iron consumed from iron-containing supplements. Methods: A cross-sectional survey was performed in antenatal clinics in two tertiary hospitals in Sydney, Australia between January and March 2014. Results: Of 612 (91% response rate) pregnant women, 589 with complete data were analysed. The overall prevalence of iron-containing supplement use was 88.0%, of which 70.1% was MV only, 7.2% was iron-only and 22.2% was both. Use of iron-containing supplements was associated with increased gestational age, a diagnosis of anaemia or iron deficiency (ID) in the current pregnancy and pre-pregnancy use of an iron-containing supplement. Several risk factors for ID or anaemia such as on-red meat eating and previous miscarriage were not associated with current iron supplement use. About 65% of women diagnosed with ID, and 62.3% of women diagnosed with anaemia were taking an iron-only supplement, with or without a MV. The proportion of women consuming low (<30), preventative (30-99) and treatment (≥100) mg/day doses were 36.8%, 45.4%, and 17.8%, respectively. Only 46.7% of women diagnosed with ID were taking ≥100 mg/day iron from supplements, while 23.3% were taking <30 mg/day. Conclusion: Women are consuming varying doses of iron and some high-risk women are taking inadequate doses of iron to prevent or treat ID or iron deficiency anaemia. Healthcare professionals are best positioned to advise women on iron supplement use in pregnancy and should educate women individually about the type and dose of supplement best suited to their needs.

Age of blood and adverse outcomes in a maternity population

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Age of blood and adverse outcomes in a maternity population Patterson, Jillian A.; Irving, David O.; Isbister, James P.; Morris, Jonathan M.; Mayson, Eleni; Roberts, Christine L.; Ford, Jane B. BACKGROUND In recent times there has been debate around whether longer storage time of blood is associated with increased rates of adverse outcomes following transfusion. It is unclear whether results focused on cardiac or critically ill patients apply to a maternity population. This study investigates whether older blood is associated with increased morbidity and readmission in women undergoing obstetric transfusion. STUDY DESIGN AND METHODS Women giving birth in hospitals in New South Wales, Australia between July 2006‐December 2010 were included in the study population if they had received between 1‐4 red cell units during the birth admission. Information on women’s characteristics, transfusions and outcomes were obtained from 5 routinely collected datasets including blood collection, birth and hospitalisation data. Generalised propensity score methods were used to determine the effect of age of blood on rates of severe morbidity and readmission, independent of confounding factors. RESULTS Transfusion data were available for 2990 women, with a median age of blood transfused of 20 days (interquartile range 14,27 days). There were no differences in the age of blood transfused between women with and without severe morbidity (21 (14,28) vs 22 (15,30) days), and in women readmitted or not (22 (14,28) vs 22 (16,30) days). After considering potential confounding factors, no relationship was found between the age of blood transfused and rates of severe morbidity and readmission. CONCLUSION Among women receiving low volume transfusions during a birth admission, there was no evidence of increased rates of adverse outcomes following transfusion with older blood.

Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study

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Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study Schemann, Kathrin; Patterson, Jillian A.; Nippita, Tanya A.; Ford, Jane B.; Roberts, Christine L. Background: Internationally, repeat caesarean sections (Robson Classification Group 5) make the single largest contribution to overall caesarean section rates and hospital-to-hospital variation has been reported. It is unknown if case-mix and hospital factors explain variation in hospital rates of repeat caesarean sections and whether these rates are associated with maternal and neonatal morbidity. Methods: This population-based record linkage study utilised data from New South Wales, Australia between 2007 and 2011. The study population included all maternities with prior caesarean section that were singleton, cephalic and at term. Multilevel regression models were used with primary outcomes of ‘planned repeat caesarean section’ and ‘intra-partum caesarean section’. The associations between quintiles of risk-adjusted hospital rates of planned and intra-partum repeat caesarean sections and case-mix adjusted maternal and neonatal morbidity rates, postpartum haemorrhage rates and Apgar score below 7 at five minutes rates were also assessed. Results: Of 61894 maternities with a prior caesarean section in 81 hospitals, 82.1% resulted in a repeat caesarean section and 17.9% in vaginal birth. Of the caesarean sections, 72.7% were planned and 9.4% were unplanned intra-partum. Crude hospital rates of planned caesarean sections ranged from 50.7% to 98.4%. Overall 49.0% of between-hospital variation in planned repeat caesarean section rates was explained by patient characteristics (17.3%) and hospital factors (31.7%). Increased odds of planned caesarean section were associated with private hospital status and lower hospital propensity for vaginal birth after caesarean. There were no associations between quintiles of planned repeat caesarean section and adjusted morbidity rates. Crude rates of intra-partum caesarean section ranged from 12.9% to 71.9%. In total, 27.5% of between hospital variation in rates of intra-partum caesarean section was explained by patient (19.5%) and hospital factors (8.0%). The adjusted morbidity rates differed among quintiles of hospital intra-partum caesarean section rates, but were influenced by a few hospitals with outlying rates. 3 Conclusions: About half of the variation in hospital planned repeat caesarean section rates was explained and strategies aimed at modifying these rates should not affect morbidity rates. Intra-partum caesarean sections were associated with morbidity but not in a systematic manner

Breastfeeding issues - Initiating and sustaining breastfeeding: a literature summary

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Breastfeeding issues - Initiating and sustaining breastfeeding: a literature summary Lum, Margaret N.; Todd, Angela L.; Porter, Maree The evidence for the benefits of breastfeeding over other feeding options for newborn infants’ health and development is clear. The WHO and UNICEF have recommended a global target that all infants should be exclusively breastfed up to 6 months. In Australia, policies and strategies have been developed and implemented to promote and support breastfeeding. Evidence indicates that almost all Australian women (~96%) initiate breastfeeding. This suggests an awareness and acceptance of the benefits of breastfeeding. However, the proportion of women who sustain exclusive breastfeeding to 6 months is low, in Australia and internationally. Research has shown that specific maternal and birth characteristics can help identify women who are more or less likely to initiate and sustain breastfeeding. Such evidence could help inform future strategies aimed at specific target groups. The evaluation of existing strategies can also help determine best options for further implementation. For example, research tells us the majority of women make infant feeding decisions prior to and irrespective of, contact with health professionals, suggesting the importance of familial, social and community factors. Information and support provided in the first days after birth by Lactation Consultants and midwives appears to contribute to women initiating breastfeeding, but not sustaining it. Breastfeeding problems are most likely to present once the mother has left hospital; such problems are well known predictors for early formula supplementation and breastfeeding cessation. Policies and programs should therefore give increased focus to this period. Research shows that professional, partner and family support positively influence the continuation of breastfeeding beyond a woman’s stay in hospital, so further efforts may be needed to engage with women and those closest to them. Further research is needed to understand the information and support needs of women, including potentially hidden and hard-to-reach groups, if we are to progress the global goal of exclusive breastfeeding to 6 months. Finally, women who make an informed choice not to breastfeed or who experience early feeding problems report feelings of guilt, failure and being judged. The extent to which current policies and programs meet these women’s needs, or indeed contribute to these negative feelings, also needs further investigation.

Linkage rate between NSW Perinatal Data Collection birth records and government school NAPLAN educational records, by gestational age at birth

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Linkage rate between NSW Perinatal Data Collection birth records and government school NAPLAN educational records, by gestational age at birth Hennessy, Daneeta; Torvaldsen, Siranda; Roberts, Christine L.

Pre-notification letter type and response rate to a postal survey among women who have recently given birth

2026-04-29T00:36:53Z

Pre-notification letter type and response rate to a postal survey among women who have recently given birth Todd, Angela L.; Porter, Maree; Williamson, Jennifer; Patterson, Jillian A.; Roberts, Christine L. Background: Surveys are commonly used in health research to assess patient satisfaction with hospital care. Achieving an adequate response rate, in the face of declining trends over time, threatens the quality and reliability of survey results. This paper reports on a postal satisfaction survey conducted with women who had recently given birth, and explores the effect of two strategies on response rates. Methods: A sample of 2048 Australian women who had recently given birth were invited to participate in a postal survey about their recent experiences with maternity care. The study design included two different strategies intended to increase response rates: a randomised controlled trial testing two types of pre-notification letter (with or without the option of opting out of the survey), and a request for consent to link survey data with existing routinely collected health data (omitting the latter data items from the survey reduced survey length and participant burden). Results: The survey had an overall response rate of 46%. Women receiving the pre-notification letter with the option of opting out of the survey were more likely to actively decline to participate than women receiving the letter without this option, although the overall numbers of women were small (27 versus 12). Letter type was not significantly associated with the return of a completed survey. Among women who completed the survey, 97% gave consent to link their survey data with existing health data. Conclusions: Seeking consent for record linkage was highly acceptable to women who completed the survey, and represents an important strategy to add to the arsenal for designing and implementing effective surveys. In addition to aspects of survey design, future research should explore how to more effectively influence personal constructs that contribute to the decision to participate in surveys.

Ethnicity or cultural group identity of pregnant women in Sydney, Australia: is country of birth a reliable proxy measure?

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Ethnicity or cultural group identity of pregnant women in Sydney, Australia: is country of birth a reliable proxy measure? Porter, Maree; Todd, Angela L.; Zhang, Lillian Y. Background: Australia has one of the most ethnically and culturally diverse maternal populations in the world. Routinely few variables are recorded in clinical data or health research to capture this diversity. This paper explores and how pregnant women, Australian-born and overseas-born, respond to survey questions on ethnicity or a cultural group identity, and whether country of birth is a reliable proxy measure. Methods: Frequency tabulations and inductive qualitative analysis of data from two questions on country of birth, and identification with an ethnicity or cultural group from a larger survey of pregnant women attending public antenatal clinics across four hospitals in Sydney, Australia. Results: Responses varied widely among the 762 with 75 individual cultural groups or ethnicities and 68 countries of birth reported. For Australian-born women (n=293), 23% identified with a cultural group or ethnicity, and 77% did not. For overseas-born women (n=469), 44% identified with a cultural group or ethnicity and 56% did not. Responses were coded under five emerging themes. Conclusions: Ethnicity and cultural group identity are complex concepts; women across and within countries of birth identified differently. Over three quarters of Australian-born, and over half of over-seas born women, reported no ethnicity or cultural group identity, indicating country of birth is not a reliable measure for identifying diversity. Researchers should scrutinise research questions and data usage, policy makers consider the complexity of ethnicity or cultural group identity, and the limitations of a single variable measure to identify ethnically and culturally diverse pregnant women and deliver woman-centred care.

The Candida in Pregnancy Study - Statistical Analysis Plan

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The Candida in Pregnancy Study - Statistical Analysis Plan Patterson, Jillian A.; Algert, Charles S.; Roberts, Christine L.

Testing a health research instrument to develop a statewide survey on maternity care

2026-04-29T00:36:56Z

Testing a health research instrument to develop a statewide survey on maternity care Todd, Angela L.; Aitken, Clare A.; Boyd, Jason; Porter, Maree Partnerships between researchers and end users are an important strategy for research uptake in policy and practice. This paper describes how collaboration between an academic research organisation (the Kolling Institute) and a government performance reporting agency (the NSW Bureau of Health Information (BHI)), contributed to the development of a new statewide maternity care survey for NSW.

Maternity Care in NSW - Having Your Say 2013-14. A survey about women’s views of their maternity care

2026-04-29T00:36:57Z

Maternity Care in NSW - Having Your Say 2013-14. A survey about women’s views of their maternity care Todd, Angela L.; Porter, Maree; Ampt, Amanda J.; Morris, Jonathan M.; Nicholl, Michael C.; Roberts, Christine L. This report details the findings of a survey with women about their expectations and experiences of maternity care in public hospitals in New South Wales (NSW), Australia. The report provides background information about the survey project, and a summary of the responses from the women participating in the survey. The survey and this report have been structured around the three main maternity care periods: antenatal (pregnancy); birth; and postnatal (the first days and weeks after birth). All women who gave birth between 1 May and 31 July 2013 at seven public maternity units in NSW were eligible to participate in the survey. These seven maternity units account for approximately 11% of births in public hospitals in NSW, and represent a mixture of urban and regional, and tertiary and smaller health services. A total of 2048 women were mailed a survey. Survey packs were returned as undeliverable for 59 women, and 913 women returned a completed survey, representing a response rate of 46% (913/1989).

Variation in hospital rates of induction of labour: a population-based record linkage study

2026-04-29T00:36:54Z

Variation in hospital rates of induction of labour: a population-based record linkage study Nippita, Tanya A; Trevena, Judy A; Patterson, Jillian A; Ford, Jane B; Morris, Jonathan M; Roberts, Christine L. BACKGROUND: Understanding the extent of hospital heterogeneity in induction of labour (IOL) practices to identify areas of practice improvement may result in improved maternity outcomes. We examined inter-hospital variation in rates of IOL to identify potential targets to reduce high rates of practice variation. METHODS: Population-based record linkage study of all births of ≥24 weeks gestation in 72 hospitals in New South Wales, Australia, 2010-2011. Births were categorized into 10 mutually exclusive groups, derived from the Robson caesarean section (CS) classification. These groups were categorised by parity, plurality, fetal presentation, prior CS and gestational age. Multilevel logistic regression was used to examine variation in hospital IOL rates by the groups, adjusted for differences in casemix. RESULTS: The overall IOL rate was 26.7% (46,922 of 175,444 maternities were induced), ranging from 9.7%- 41.2% (interquartile range 21.8%- 29.8%) between hospitals. Nulliparous and multiparous women at 39-40 weeks gestation with a singleton cephalic birth were the greatest contributors to the overall IOL rate (23.5% and 20.2% of all IOL respectively), and had persisting high unexplained variation after adjustment for casemix (adjusted hospital IOL rates ranging from 11.8%- 44.9% and 7.1%- 40.5% respectively). In contrast, there was little variation in inter-hospital IOL rates among multiparous women with a singleton cephalic birth at ≥41 weeks gestation, women with singleton non-cephalic pregnancies, and women with multifetal pregnancies. CONCLUSION: Seven of the 10 groups showed high or moderate unexplained variation in inter-hospital IOL rates, most pronounced for women at 39-40 weeks gestation with a singleton cephalic birth. Outcomes associated with divergent practice require determination, which may guide strategies to reduce practice variation.

Change in smoking status during two consecutive pregnancies: A population-based cohort study

2026-04-29T00:36:53Z

Change in smoking status during two consecutive pregnancies: A population-based cohort study Tran, Duong T; Roberts, Christine L.; Seeho, Sean; Jorm, Louisa R; Havard, Alys Objective: To investigate changes in tobacco smoking in two consecutive pregnancies and factors associated with the change. Design: Population-based cohort study. Setting: New South Wales, Australia, 2000-2010 Population: 183,385 women having first and second singleton pregnancies. Methods: Descriptive and multivariable logistic regression analyses of perinatal data linked to hospital admission data. Main outcome measures: Proportion of women smoking during their first pregnancy who quit by their second, and of women not smoking in their first pregnancy who did smoke during their second. Results: Among 22,761 smokers in the first pregnancy, 33.5% had quit by their second. Among 160,624 non-smokers in their first pregnancy, 3.6% smoked during their second. Women who aged ≥25 years, were married, born in a non-English speaking country, used private obstetric care, and lived in a socio-economically advantaged area were more likely to quit or less likely to start smoking in the second pregnancy. Smokers who had gestational hypertension (adjusted odds ratio and 95% confidence interval: 1.36, 1.23-1.51), a large-for-gestational-age infant (1.66, 1.46-1.89), and a stillbirth (1.44, 1.06-1.94) were more likely to quit, whereas smokers whose infant was small-for-gestational-age (0.65, 0.60-0.70) or admitted to special care nursery (0.87, 0.81-0.94) were less likely to quit. Among non-smokers in the first pregnancy, the risk of smoking in second pregnancy increased with late antenatal attendance (e.g. ≥26 weeks, 1.30, 1.14-1.48), gestational diabetes (1.25, 95%CI 1.07-1.45), preterm birth (e.g. spontaneous 1.25, 1.10-1.43), caesarean section (e.g. 2 prelabour 1.13, 1.01-1.26), and infant small-for-gestational-age (1.37, 1.26-1.48) or required special care nursery (1.14, 1.06-1.23). Inter-pregnancy interval of ≥3 years was associated with either change in smoking status. Conclusions: Most smokers continue to smoke in their next pregnancy, even among those who experienced poor outcomes. Intensive interventions should be explored and offered to women at the highest risk.

The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis

2026-04-29T00:36:59Z

The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis Schiff, Michal; Algert, Charles S; Ampt, Amanda J; Sywak, Mark S; Roberts, Christine L. Background: Cosmetic breast augmentation (breast implants) is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades. Women need information about all associated outcomes in order to make an informed decision regarding whether to undergo cosmetic breast surgery. We conducted a systematic review to assess breastfeeding outcomes among women with breast implants compared to women without. Methods: A systematic literature search of Medline, Pubmed, CINAHL and Embase databases was conducted using the earliest inclusive dates through December 2013. Eligible studies included comparative studies that reported breastfeeding outcomes (any breastfeeding, and among women who breastfed, exclusive breastfeeding) for women with and without breast implants. Pairs of reviewers extracted descriptive data, study quality, and outcomes. Rate ratios (RR) and 95% confidence intervals (CI) were pooled across studies using the random-effects model. The Newcastle-Ottawa scale (NOS) was used to critically appraise study quality, and the National Health and Medical Research Council Level of Evidence Scale to rank the level of the evidence. Results: Three small, observational studies met the inclusion criteria. The quality of the studies was fair (NOS 4-6) and the level of evidence was low (III-2 - III-3). There was no significant difference in attempted breastfeeding (one study, RR 0.94, 95%CI 0.76, 1.17). However, among women who breastfed, all three studies reported a reduced likelihood of exclusive breastfeeding amongst women with breast implants with a pooled rate ratio of 0.60 (95%CI 0.40, 0.90). Conclusions: This systematic review and meta-analysis suggests that women with breast implants who breastfeed were less likely to exclusively feed their infants with breast milk compared to women without breast implants.