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BACKGROUND Studies in southern New Zealand indicate that up to a quarter of women experienced infertility, likely due to delay in childbearing. However, these findings may not be generalisable to the whole population. AIMS To assess the lifetime prevalence of infertility and evidence for disparities for New Zealand men and women in a nationally representative sample. MATERIALS AND METHODS In 2014/15 a general health survey with a module on sexual and reproductive health was conducted among New Zealand residents aged 16-74 years; 3792 men and 5222 women provided information on infertility. RESULT(S) There were 8.2% (95% CI 7.1-9.4%) of men and 12.5% (11.3-13.8%) of women who had experienced infertility; among fertility-tested women this was 15.4% (14.0-16.9%). Prevalence peaked in the 35-44 year age group (14.3% for men, 19.1% for women and 20.8% for fertility-tested women). Estimates for European, Māori and Asian ethnicities were similar. Pacific men and women had higher relative risks: 2.37 (95% CI 1.51-3.71) and 1.76 (1.27-2.44), respectively, compared with Europeans. Medical help was sought by 69.3% (95% CI 62.4-75.5%) of infertile men and 68.2% (63.1-72.9%) of women; this was significantly lower for Māori and Pacific. CONCLUSIONS Infertility levels for those of European ethnicity were similar to studies in southern New Zealand, and in other high-income countries. However, infertility levels were just as high for Māori, and higher for Pacific people, despite experiencing fertility at younger ages. Focusing on reducing causes of infertility other than delayed childbearing would likely contribute to addressing this health disparity. more...

This report adds to the limited existing literature concerning dermatoses in Samoa. Conditions encountered during a 4-day private clinic are reported. Amongst the 75 patients reviewed, eczema was the most frequent condition diagnosed. This was followed by infective dermatoses particularly pityriasis versicolor and tinea infections. Reassuringly, in 97% of cases, suitable medications were available locally. more...

Aim To determine whether vitamin D supplementation reduces primary care visits for acute respiratory infection (ARI). Methods A randomised, double-blind, placebo-controlled trial was conducted in New Zealand and powered to determine the vitamin D dose needed to achieve normal vitamin D status during infancy. Healthy pregnant women, from 27 weeks’ gestation to birth, and their infants, from birth to age 6 months, were assigned to placebo or one of the two dosages of daily oral vitamin D3. Woman/infant pairs were randomised to placebo/placebo, 1000 IU/400 IU or 2000 IU/800 IU. For this ad hoc analysis, the primary care records of enrolled children were audited to age 18 months. Results Two hundred and sixty pregnant women were randomised to placebo (n = 87), lower-dose (n = 87) or higher-dose (n = 86) vitamin D3. In comparison with the placebo group (99%), the proportion of children making any ARI visits was smaller in the higher-dose (87%, p = 0.004), but not the lower-dose vitamin D3 group (95%, p = 0.17). The median number of ARI visits/child was less in the higher-dose vitamin D3 group from age 6–18 months (placebo 4, lower dose 3, higher dose 2.5; p = 0.048 for higher-dose vitamin D3 vs. placebo). Conclusion Vitamin D3 supplementation during pregnancy and infancy reduces primary care visits for ARI during early childhood. more...

Introduction Adopting the modified International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosing gestational diabetes mellitus (GDM) will increase the prevalence of GDM resulting in increased resource utilisation and an unknown effect on clinical outcomes. Aims To determine the prevalence of GDM by the modified IADPSG criteria and compare characteristics and pregnancy outcomes between women with GDM by IADPSG-additional, those with GDM by the New Zealand Society for the Study of Diabetes (NZSSD) criteria and those with a normal oral glucose tolerance test (OGTT). Methods All women who delivered at Counties Manukau District Health Board (CMDHB) for a 12-month period from July 2012 to June 2013 had demographic, pregnancy and laboratory data obtained from hospital databases and clinical records. Results Of the 6376 (85%) of eligible women screened for GDM, 381 (6%) had GDM by NZSSD criteria and an additional 238 (4%) by the modified IADPSG-additional criteria, a relative increase of 62%. Women with GDM by NZSSD criteria had similar characteristics compared to women with GDM by IADPSG-additional. The outcomes between the two groups were also similar with the exception of a higher induction of labour (IOL) rate in women with GDM by NZSSD and a higher mean birthweight in the GDM by IADPSG-additional. Conclusion Adopting the modified IADPSG criteria will result in a 62% increase in the number of GDM cases with a significant impact on workload and resources. Currently, there is insufficient evidence to support the introduction of the IADPSG criteria for our service. more...

Background: There is a keen interest to develop research systems and increase research output in the 14 Pacific Island Forum Countries (PIFC) to support development of policies and practice based on locally relevant research evidence. Aims: To assess the quantity and characteristics of reproductive health research output by each country (14 PIFC) from 2000 to 2011 using New Zealand’s reproductive research outputs as the reference. Methods: A systematic search of the literature using a broad definition of reproductive health. Results: There were 174 papers published in the PIFC from 2000 to 2011 compared with 628 papers published in New Zealand (NZ). Most (57%) of the PIFC papers were from Papua New Guinea (PNG), although Samoa had the most papers by population (10/100 000). Five of the countries did not have a single publication. The majority of papers from both the PIFC and NZ were observational studies (72 vs 36%). Authors from Australia were responsible for 34% of PIFC publications followed by 25% from PNG. Sixty-three per cent of papers by PIFC sole and first authors were published in local journals, whereas 86% of non-PIFC authors published in international journals. Conclusion: There is a need for reproductive research in PIFC. PNG had the most publications on the back of a wellfunded dedicated research institute and a significant collaboration with Australian researchers. The large number of papers in PIFC countries without PIFC authors raises the question about the need to require non-PIFC researchers to enter into genuine research partnerships in order to build research capacity in the PIFC. more...

Background: In high-income countries, stillbirth rates have been static in recent decades. Unexplained stillbirths account for up to 50% of these deaths. Methods: A case–control study was conducted in Auckland, New Zealand, from July 2006 to June 2009 to explore modifiable risk factors for late stillbirth (≥28 weeks of gestation). Eligible participants were women who had a singleton late stillbirth without a congenital abnormality. Two controls with ongoing pregnancies were randomly selected at the same gestation as each case. Data were collected through face-to-face interviews and from clinical records. Results: A total of 155/215 (72%) cases and 310/429 (72%) controls consented to take part in the study. Women who had a late stillbirth were more likely to be of Pacific ethnicity and of parity ≥4 (OR = 1.7, 95% CI: 1.1–2.6 and 2.7, 95% CI: 1.4–5.3, respectively). The median gestational age at diagnosis of fetal death was 261 days (IQR 239–279), and the median gestation at which the controls were interviewed was 264.5 days (IQR 240–274) P = 0.48. ‘Unexplained antepartum death’ (n = 61, 39.4%) and ‘fetal growth restriction’ (n = 29, 18.7%) accounted for almost 60% of stillbirths. The post-mortem rate for all cases was 47% (73/155) and 43% (26/61) for those classified as ‘unexplained antepartum death’. Conclusion: This study of risk factors for stillbirth is novel in that it used gestation-matched controls with ongoing pregnancies. Its detailed investigation into maternal health and behaviour during pregnancy has the potential to lead to a better understanding of modifiable risk factors for late stillbirth. more...

Background: New Zealand Government policy during the past decade has placed a high priority on closing socioeconomic and ethnic gaps in health outcome. Aim: To analyse New Zealand's trends in preterm and small for gestational age (SGA) births and late fetal deaths during 1980–2001 and to undertake ethnic specific analyses, resulting in risk factor profiles, for each ethnic group. Methods: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for the period 1980–2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and New Zealand Deprivation Index decile. Trend analysis was undertaken for 1980–1994 while multivariate logistic regression was used to explore risk factors for 1996–2001. Results: During 1980–1994, preterm birth rates were highest amongst Maori women. Preterm rates increased by 30% for European/other women, in contrast to non-significant declines of 7% for Maori women and 4% for Pacific women during this period. During the same period, rates of SGA were highest amongst Maori women. Rates of SGA declined by 30% for Pacific women, 25% for Maori women and 19% for European/other women during this period. Rates of late fetal death were highest amongst Pacific women during 1980–1994, but declined by 49% during this period, the rate of decline being similar for all ethnic groups. Conclusions: The marked differences in both trend data and risk factor profiles for women in New Zealand's largest ethnic groups would suggest that unless ethnicity is specifically taken into account in future policy and planning initiatives, the disparities seen in this analysis might well persist into future generations. more...

Pacific women in New Zealand reside in areas of higher socioeconomic deprivation compared to women from other ethnic groups. Pacific women and their health are further disadvantaged because of genetic predisposition and sociocultural factors that cause ill-health. The correlations between pregnancy outcomes, risk factors and other health indices in Pacific women need evaluation.To examine trends in preterm birth, small for gestational age (SGA) and late fetal death for Pacific women during 1980-2001 and to explore risk factors which make this group vulnerable to adverse birth outcome.De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001.Pacific women had the lowest rates of preterm birth and SGA when compared to Maori and European women. In addition, preterm birth rates underwent a non-significant 4% decline and SGA rates a 30% decline during 1980-1994. Although there has been a 49% decline in late fetal deaths during 1980-1994, the rate remained higher for Pacific women than for Maori and European/other women.Despite residing in areas of high socioeconomic deprivation, which is associated with poor pregnancy outcomes for Maori and European/other women, Pacific women had better pregnancy outcomes, with lower preterm and SGA rates. The significant decline in rates of late fetal death during the past two decades is a cause for celebration; however, the rate remains higher for Pacific women than for other ethnic groups. Biological, cultural and social factors might explain the better pregnancy outcomes for Pacific women and these factors should be considered when developing future prevention programmes. more...

Background: Pacific women in New Zealand reside in areas of higher socioeconomic deprivation compared to women from other ethnic groups. Pacific women and their health are further disadvantaged because of genetic predisposition and sociocultural factors that cause ill-health. The correlations between pregnancy outcomes, risk factors and other health indices in Pacific women need evaluation. Aims: To examine trends in preterm birth, small for gestational age (SGA) and late fetal death for Pacific women during 1980‐2001 and to explore risk factors which make this group vulnerable to adverse birth outcome. Methods: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980‐2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980‐1994 and multivariate logistic regression was used to explore risk factors for 1996‐2001. Results: Pacific women had the lowest rates of preterm birth and SGA when compared to Maori and European women. In addition, preterm birth rates underwent a non-significant 4% decline and SGA rates a 30% decline during 1980‐1994. Although there has been a 49% decline in late fetal deaths during 1980‐1994, the rate remained higher for Pacific women than for Maori and European/other women. Conclusions: Despite residing in areas of high socioeconomic deprivation, which is associated with poor pregnancy outcomes for Maori and European/other women, Pacific women had better pregnancy outcomes, with lower preterm and SGA rates. The significant decline in rates of late fetal death during the past two decades is a cause for celebration; however, the rate remains higher for Pacific women than for other ethnic groups. Biological, cultural and social factors might explain the better pregnancy outcomes for Pacific women and these factors should be considered when developing future prevention programmes. more...

Background. To determine the accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Desig... more...