11 results on '"Mills, Tracey A."'
Search Results
2. Women's experiences of a pregnancy whilst attending a specialist antenatal service for pregnancies after stillbirth or neonatal death: a qualitative interview study.
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Smith, Debbie M., Thomas, Suzanne, Stephens, Louise, Mills, Tracey A., Hughes, Christine, Beaumont, Joanna, and Heazell, Alexander E. P.
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PRENATAL care ,NEONATAL death ,STILLBIRTH ,MATERNITY nursing ,PREGNANCY complications ,PREGNANCY - Abstract
Aim: Pregnancy after the death of a baby is associated with numerous, varied psychological challenges for pregnant women. This study aimed to explore women's experiences of pregnancy whilst attending a specialist antenatal service for pregnancies after a perinatal death.Methods: Semi-structured interviews with twenty women in a subsequent pregnancy after a perinatal death were conducted and analyzed taking an inductive thematic analysis approach.Results: All women expressed a heightened "awareness of risk". Two subthemes demonstrated how increased awareness of risk affected their experience and their desire regarding antenatal and postnatal support. Women talked about stillbirth being a "quiet, unspoken subject" causing them internal conflict as they had an awareness of pregnancy complications that other people did not. Navigating subsequent pregnancies relied on them "expecting the worst and hoping for the best" in terms of pregnancy outcomes. Women viewed specialist antenatal care in pregnancy after perinatal loss favorably, as it enabled them to receive tailored care that met their needs stemming from their increased awareness of and personal expectations of risk.Conclusion: Women's experiences can be used to develop models of care but further studies are required to determine to identify which components are most valued. [ABSTRACT FROM AUTHOR]
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- 2022
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3. The RESPECT Study for consensus on global bereavement care after stillbirth
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Shakespeare, Clare, Merriel, Abi, Bakhbakhi, Danya, Blencowe, Hannah, Boyle, Frances M, Flenady, Vicki, Gold, Katherine, Horey, Dell, Lynch, Mary, Mills, Tracey A, Murphy, Margaret M, Storey, Claire, Toolan, Miriam, Siassakos, Dimitrios, and RESPECT (Research of Evidence based Stillbirth care Principles t
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Adult ,Postnatal Care ,Consensus ,Delphi Technique ,Health Personnel ,media_common.quotation_subject ,Acknowledgement ,Global health ,Respect ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Bereavement care ,Surveys and Questionnaires ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Quality of Health Care ,Reproductive health ,media_common ,030219 obstetrics & reproductive medicine ,business.industry ,Stakeholder ,Obstetrics and Gynecology ,Professional-Patient Relations ,General Medicine ,Stillbirth ,Systematic review ,Female ,Grief ,The Internet ,Empathy ,business ,Bereavement - Abstract
OBJECTIVE: To develop global consensus on a set of evidence-based core principles for bereavement care after stillbirth.METHODS: A modified policy-Delphi methodology was used to consult international stakeholders and healthcare workers with experience in stillbirth between September 2017 and October 2018 Five sequential rounds involved two expert stakeholder meetings and three internet-based surveys, including a global internet-based survey targeted at healthcare workers in a wide range of settings.RESULTS: Initially, 23 expert stakeholders considered 43 evidence-based themes derived from systematic reviews, identifying 10 core principles. The global survey received 236 responses from participants in 26 countries, after which nine principles met a priori criteria for inclusion. The final stakeholder meeting and internet-based survey of all participants confirmed consensus on eight core principles. Highest quality bereavement care should be enabled through training of healthcare staff to reduce stigma and establish respectful care, including acknowledgement and support for grief responses, and provision for physical and psychologic needs. Women and families should be supported to make informed choices, including those concerning their future reproductive health.CONCLUSION: Consensus was established for eight principles for stillbirth bereavement care. Further work should explore implementation and involve the voices of women and families globally.
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- 2020
4. “Nature makes you blind to the risks”: An exploration of womens' views surrounding decisions on the timing of childbearing in contemporary society.
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Lavender, Tina, Logan, Janette, Cooke, Alison, Lavender, Rebecca, and Mills, Tracey A.
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Objective To gain an understanding of womens' views surrounding decisions on the timing of childbearing. Study Design This study was based on interviews with 18 childless women, from North-West England, in three age groups: Six women aged between 18 and 24; Six women aged between 25 and 34; and six women aged 35 or more. Data were analysed using a hermeneutic phenomenological approach with thematic analysis. Results Three main themes were identified. Women perceived themselves as living within boundaries , defined internally and externally; they aspired to being a great mother or no mother ; and had a desire to contribute to family and society, at multiple levels. Risks associated with delaying childbearing had little or no influence on decision-making. The overarching phenomenon was social comparability; decisions were made in the context of women's knowledge and perceptions of others and a high degree of critical self-evaluation. Conclusion We conclude that social reality dominates womens' reproductive decisions. Whilst the biological reality is that fertility reduces and medical complications increase with maternal age, social discourses deter women from acknowledging this. Medical risks associated with advanced maternal age are undermined by the notion that women can choose when to start a family. [ABSTRACT FROM AUTHOR]
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- 2015
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5. Maternal obesity and its effect on placental cell turnover.
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Higgins, Lucy, Mills, Tracey A., Greenwood, Susan L., Cowley, Elizabeth J., Sibley, Colin P., and Jones, Rebecca L.
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OBESITY in women , *PLACENTA physiology , *PREGNANCY complications , *BODY mass index , *CHORIONIC gonadotropins , *IMMUNOHISTOCHEMISTRY , *IMAGE analysis - Abstract
Background: Maternal obesity is a frequent obstetric risk factor, linked with short- and long-term consequences for mother and child, including foetal overgrowth, growth restriction and stillbirth. The mechanisms underlying these pathologies remain unknown but likely involve the placenta. Aims: To study placental cell turnover in relation to maternal body mass index (BMI). Methods: Term placental villous tissue was randomly sampled from 24 pregnancies, with a range of maternal BMI of 19.5-49.6. Immunohistochemistry was performed for human chorionic gonadotropin, Ki67 and M30 and image analysis used to calculate syncytiotrophoblast area and proliferative and apoptotic indices. Results were compared categorically between women of BMI 18.5-24.9 (normal), BMI 30.0-39.9 (obese classes 1and 2) and BMI 40+ (obese class 3) and continuously against BMI; p < 0.05 by the Kruskal-Wallis test or linear regression was considered statistically significant. Results: Increased maternal BMI was associated with categorical (normal versus obese class 3 and obese classes 1 and 2 versus obese class 3, both p < 0.05) and continuous ( r2 = 0.24, p = 0.016) reductions in the proliferative index and a continuous reduction ( r2 = 0.17, p = 0.047) in the apoptotic index. Discussion: Maternal obesity is associated with a dose-dependent reduction in placental villous proliferation and apoptosis which may increase susceptibility to adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]
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- 2013
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6. Advanced Maternal Age and Adverse Pregnancy Outcome: Evidence from a Large Contemporary Cohort.
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Kenny, Louise C., Lavender, Tina, McNamee, Roseanne, O’Neill, Sinéad M., Mills, Tracey, and Khashan, Ali S.
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PREGNANCY complications ,MATERNAL age ,HEALTH outcome assessment ,COHORT analysis ,CHILDBIRTH ,EPIDEMIOLOGY ,AGING ,MISCARRIAGE - Abstract
Background: Recent decades have witnessed an increase in mean maternal age at childbirth in most high-resourced countries. Advanced maternal age has been associated with several adverse maternal and perinatal outcomes. Although there are many studies on this topic, data from large contemporary population-based cohorts that controls for demographic variables known to influence perinatal outcomes is limited. Methods: We performed a population-based cohort study using data on all singleton births in 2004–2008 from the North Western Perinatal Survey based at The University of Manchester, UK. We compared pregnancy outcomes in women aged 30–34, 35–39 and ≥40 years with women aged 20–29 years using log-linear binomial regression. Models were adjusted for parity, ethnicity, social deprivation score and body mass index. Results: The final study cohort consisted of 215,344 births; 122,307 mothers (54.19%) were aged 20–29 years, 62,371(27.63%) were aged 30–34 years, 33,966(15.05%) were aged 35–39 years and 7,066(3.13%) were aged ≥40 years. Women aged 40+ at delivery were at increased risk of stillbirth (RR = 1.83, [95% CI 1.37–2.43]), pre-term (RR = 1.25, [95% CI: 1.14–1.36]) and very pre-term birth (RR = 1.29, [95% CI:1.08–1.55]), Macrosomia (RR = 1.31, [95% CI: 1.12–1.54]), extremely large for gestational age (RR = 1.40, [95% CI: 1.25–1.58]) and Caesarean delivery (RR = 1.83, [95% CI: 1.77–1.90]). Conclusions: Advanced maternal age is associated with a range of adverse pregnancy outcomes. These risks are independent of parity and remain after adjusting for the ameliorating effects of higher socioeconomic status. The data from this large contemporary cohort will be of interest to healthcare providers and women and will facilitate evidence based counselling of older expectant mothers. [ABSTRACT FROM AUTHOR]
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- 2013
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7. ‘Informed and uninformed decision making’—Women's reasoning, experiences and perceptions with regard to advanced maternal age and delayed childbearing: A meta-synthesis
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Cooke, Alison, Mills, Tracey A., and Lavender, Tina
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INFORMED consent (Medical law) , *DECISION making , *PRENATAL care , *OBSTETRICS , *MATERNAL age , *HOSPITAL maternity services , *PREGNANCY , *QUALITATIVE research , *CINAHL database , *MEDICAL information storage & retrieval systems , *NURSING databases , *PSYCHOLOGY information storage & retrieval systems , *MEDLINE , *PATIENTS , *SYSTEMATIC reviews , *EMPIRICAL research , *THEMATIC analysis , *EVALUATION - Abstract
Objectives: To identify what factors affect women's' decisions to delay childbearing, and to explore women's' experiences and their perceptions of associated risks. Design: Systematic procedures were used for search strategy, study selection, data extraction and analysis. Findings were synthesised using an approach developed from meta-ethnography. Data sources: We included qualitative papers, not confined to geographical area (1980–2009). Databases included CINAHL, MEDLINE, EMBASE, PsycInfo, ASSIA, MIDIRS, British Nursing Index and the National Research Register. We selected qualitative empirical studies exploring the views and experiences of women of advanced maternal age who were childless or primigravidae with a singleton pregnancy or primiparous. Review methods: Twelve papers fulfilled the selection criteria and were included for synthesis. Results: Women appear to face an issue of ‘informed and uninformed decision making’; those who believe they are informed but may not be, those who are not informed and find out they are at risk once pregnant, and those who are well informed but choose to delay pregnancy anyway. Maternity services could provide information to enable informed choice regarding timing of childbearing. Conclusions: Health professionals need to be mindful of the fact that women delay childbearing for various reasons. A strategy of pre-conception education may be beneficial in informing childbearing decisions. Obstetricians and midwives should be sensitive to the fact that women may not be aware of all the risks associated with delayed childbearing. [Copyright &y& Elsevier]
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- 2010
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8. Acute and chronic modulation of placental chorionic plate artery reactivity by reactive oxygen species
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Mills, Tracey A., Wareing, Mark, Shennan, Andrew H., Poston, Lucilla, Baker, Philip N., and Greenwood, Susan L.
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OXYGEN in the body , *BLOOD flow , *VASCULAR resistance , *FETAL physiology , *REACTIVITY (Chemistry) , *PREECLAMPSIA , *PATHOLOGICAL physiology , *FETAL growth retardation - Abstract
Abstract: Control of vascular resistance and blood flow in the fetoplacental circulation is incompletely understood. Reactive oxygen species (ROS), physiological and pathophysiological regulators of vascular tone, are elevated in preeclampsia (PE), a disease of pregnancy characterized by increased fetoplacental vascular resistance. We tested the hypothesis that ROS modulate vascular reactivity in placental chorionic plate arteries. Wire myography was used to examine (1) the effects of acute exposure to ROS on arterial function in normal pregnancy and (2) the effects of maternal antioxidant supplementation on arterial reactivity in women at high risk for PE participating in the Vitamins in Pre-eclampsia (VIP) trial. ROS generated by xanthine plus xanthine oxidase enhanced basal tension, vasoconstriction in response to the thromboxane mimetic U46619, and relaxation in response to sodium nitroprusside. Hydrogen peroxide and peroxynitrite increased basal tone and relaxed preconstricted arteries (U44619), respectively. In women at risk for PE, chorionic plate artery constriction in response to U46619 was greater in the women receiving placebo compared to the women supplemented with the antioxidant vitamins C and E. ROS may regulate fetoplacental vascular resistance and blood flow in the short term, and chronic exposure to raised ROS could contribute to elevated fetoplacental vascular resistance in PE and fetal growth restriction (FGR). [Copyright &y& Elsevier]
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- 2009
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9. The Effect of Mode of Delivery on Placental Chorionic Plate Vascular Reactivity.
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Mills, Tracey A., Baker, Philip N., and Wareing, Mark
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OBSTETRICS , *PLACENTA , *CESAREAN section , *OXYGEN , *SODIUM nitroferricyanide , *VEINS - Abstract
Objective: To determine whether delivery mode influences placental chorionic plate arterial and venous vascular reactivity. Methods: Normal term placentas were obtained after vaginal delivery or cesarean section. Chorionic plate arterial and venous function was assessed by wire myography. Results: Sodium nitroprusside-induced arterial relaxation increased post cesarean section at 20% oxygen. Decreased U46619-induced venous contraction was observed in vaginal deliveries at 7% oxygen. Sodium nitroprusside-induced relaxation increased in vaginal delivery at 20% oxygen. Conclusion: Delivery mode does not alter chorionic plate arterial vascular reactivity under physiological conditions, however venous reactivity was modified, a factor for consideration when interpreting functional experimental data. [ABSTRACT FROM AUTHOR]
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- 2007
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10. Maternal Obesity Impairs Specific Regulatory Pathways in Human Myometrial Arteries1
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Hayward, Christina E., Cowley, Elizabeth J., Mills, Tracey A., Sibley, Colin P., and Wareing, Mark
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- 2014
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11. Advanced Maternal Age: Identifying Mechanisms Underlying Vulnerability to Stillbirth
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Lean, Samantha, MILLS, TRACEY TA, HEAZELL, ALEXANDER AEP, Jones, Rebecca, Mills, Tracey, and Heazell, Alexander
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Pregnancy ,Placenta ,parasitic diseases ,Advanced Maternal Age ,Stillbirth ,Fetal Growth Restriction - Abstract
Advanced maternal age (AMA) is defined as childbearing in mothers ≥35 years of age and is becoming increasingly prevalent in high income countries. AMA has been associated with increased risk of adverse pregnancy outcomes, particularly stillbirth. Although AMA mothers have higher rates of chromosomal abnormalities and maternal co-morbidities, AMA remains an independent risk factor for stillbirth. Despite these findings, the etiology behind this increased risk is unknown. We hypothesise that an altered maternal environment, including increased oxidative stress and inflammation, due to ageing causes placental dysfunction which increases AMA mothers’ vulnerability to stillbirth.A holistic approach was applied to investigate placental dysfunction in AMA. Firstly, a systematic review and meta-analysis comprehensively reviewed existing data on AMA and associated adverse pregnancy outcomes. Secondly, Manchester Advanced Maternal Age Study (MAMAS), a multi-centre prospective observational cohort study, was conducted to investigate risk factors for composite adverse pregnancy outcome (CAPO) in AMA. MAMAS utilised both uni- and multivariate analysis on demographic and clinical data, and measuring biomarkers of ageing and placental dysfunction by ELISA in maternal circulation during the third trimester of pregnancy. Utero-placental dysfunction was directly investigated in uncomplicated AMA pregnancies by quantifying placental morphology, placental nutrient transport capabilities and both placental and maternal uterine vascular responses. Finally, a C57BL/6J murine model of AMA was developed and characterised to further investigate maternal age on pregnancy outcome and the role of the placenta. In the meta-analysis, maternal age was linearly associated with increased risk of stillbirth and other adverse outcomes strongly associated with placental dysfunction (fetal growth restriction, preeclampsia and placental abruption). In MAMAS, smoking status and primiparity were predictive of CAPO. After adjustment, AMA mothers had an odd ratio of 2.05-3.43 of CAPO compared to 20-30 year old mothers. AMA mothers showed evidence of increased oxidative stress and pro-inflammatory bias. AMA mothers who suffered CAPO showed reduced placental endocrine capacity seen in placental dysfunction. Placentas from uneventful AMA pregnancies showed evidence of accelerated ageing and placental adaptation with increased nutrient transport, increased placental weight but reduced efficiency, and altered vascular function. AMA mice showed many similar aspects to human AMA with increased fetal loss, fetal growth restriction and increased placental size. These studies provide robust evidence for increased incidence of adverse pregnancy outcome due to placental dysfunction in pregnancies of women of AMA. This finding requires the appropriate recognition in a clinical context, with a greater focus on personalised obstetric care in an attempt to reduce stillbirth rates in this high risk population. By optimising antenatal and obstetric care for AMA mothers, we could reduce stillbirth rates by 4.7% - the population attributable risk due to AMA. These studies highlight key areas of future research that will further understanding into stillbirth risk in AMA pregnancy, test predictive models and test therapies and clinical care interventions an ultimately improve pregnancy outcome in mothers of AMA. Pregnant mothers over the age of 35 years old are classified as advanced maternal age (AMA). AMA is known to be associated with increased risks in pregnancy, including the baby being born too small or dying before birth (stillbirth). This risk of stillbirth in AMA is even true independently of the genetic defects in the eggs and maternal diseases that are more often seen in these women due to their age. However, it is not know why this increased risk of stillbirth occurs in AMA mothers. The placenta is a vital organ in pregnancy that regulates blood and nutrient supply to the baby and is known to not work properly (known a placental dysfunction) in pregnancies where the baby doesn’t grow properly or is stillborn. We propose that changes in the mother due to her age will affect the way that her placenta works and this is the reason why more babies are born small or are stillborn in AMA mothers compared to younger mothers. Firstly, we reviewed existing studies to see how many have found evidence of pregnancy diseases known to be caused by placental dysfunction in AMA pregnancies. We set up a clinical study called Manchester Advanced Maternal Age Study (MAMAS) and recruited pregnant mothers to investigate lifestyle risk factors for having poor outcomes (with placental links) in AMA. We collected mothers’ blood to see if higher levels of markers of ageing were detectable in AMA and if they were related to increased risk of poor outcome. The placentas from these mothers were used to measure their size, whether the cells were dividing or dying and how well they could transport nutrients from mother to baby. Placental and uterine vessels were tested to see how well they can control blood flow to the baby during pregnancy. Finally, a mouse model of AMA was developed and characterised to further investigate maternal age on pregnancy outcome and the role of the placenta.Previous studies showed that AMA was more strongly linked to increased risk of pregnancy outcomes that are associated with placental dysfunction than those that are not. In MAMAS, smoking and carrying a first pregnancy made mothers and being AMA increased risk of suffering a poor outcome. AMA mothers who had normal outcomes showed evidence of increased ageing markers but also increased mechanisms to counteract ageing related damage in their blood. AMA mothers who had poor outcome had higher levels of age related damage and inflammatory responses to that damage. They had lower levels of placental hormones indicating placental dysfunction. Placentas from AMA pregnancies had to work harder to keep the baby healthy by increasing their size, nutrient transport and altering placental and maternal vascular function. However, they still functioned less efficiently than placentas from younger mothers. Our mouse model of AMA showed many similar aspects to human AMA with small pups, high rates of stillbirth and larger placentas. These studies provide robust evidence for placental dysfunction can explain why mothers over the age of 35 years are more at risk of having small babies or stillborn babies. This finding should be recognised by doctors and midwives when deciding how to manage their pregnancies. If so, we could reduce national stillbirth rates by 4.7%. The mouse model offers a way for us to test interventions in AMA pregnancies to improve their outcome.
- Published
- 2016
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