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Background: In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes. Methods: The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM‐care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes. Results: Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22–0.75; P = 0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR = 3.13, 95% CI = 2.23–4.41; P < 0.001) and had a greater number of dietetic consultations (β‐coefficient = 0.28, 95% CI = 0.17–0.39; P < 0.001) compared to women managed through diet. Conclusions: Dietetic intervention plays a key role in optimising maternal and neonatal health outcomes for women with GDM. Exploring further the impact of dietetic intervention in women diagnosed with GDM is key with respect to understanding the optimal delivery of care for these women. The type and number of consultations included in a dietetic intervention should be investigated further. [ABSTRACT FROM AUTHOR]

Background: Aripiprazole is a second generation antipsychotic medication that has been a useful addition to the treatment of severe mental illness due to its low metabolic and sedation risk profile. Pregnancy is a time of high risk of metabolic complications such as gestational diabetes and the postpartum period is often a time when sedation can compromise infant care. To date there is limited data in pregnancy on the safety of aripiprazole use. While available data do not suggest an elevated malformation risk in pregnancy, there is less information available on pregnancy and neonatal complications.Methods: This study presents preliminary data on pregnancy and neonatal complications on 26 women who took aripiprazole in pregnancy. These women attended at antenatal clinics for women with severe mental illness at two hospitals in Australia.Results: Overall aripiprazole was not associated with an increased risk of gestational diabetes. However, use of aripiprazole in pregnancy was associated with an increased risk of pregnancy hypertension, lower birth weight, shorter gestation at birth and higher rates of admission of the neonate than the expected population rates.Limitations: These findings need to be replicated in a larger, well-designed study to ensure they do not reflect confounding factors.Conclusions: Findings demonstrate that aripiprazole is unlikely to pose a metabolic risk in pregnancy but other pregnancy complications including hypertension, need to be examined in further studies. [ABSTRACT FROM AUTHOR]

Maternal psychological distress during pregnancy is a potential risk factor for various birth complications. This study aimed to explore psychological factors associated with adverse birth outcomes. Symptoms of psychological distress, individual characteristics, and medical complications were assessed at two time points antenatally in 285 women from Australia and New Zealand; birth outcomes were assessed postpartum, between January 2014 and September 2015. Hierarchical multiple regression analyses were conducted to examine the relation of psychological distress to adverse birth outcomes. Medical complications during pregnancy, such as serious infections, placental problems and preeclampsia, and antenatal cannabis use, were the factors most strongly associated with adverse birth outcomes, accounting for 22 percent of the total variance (p < .001). Symptoms of depression and/or anxiety, low social support, and low sense of coherence were not associated with birth complications. In unadjusted analyses, self-reported diagnosis of anxiety disorder during pregnancy and an orientation toward aRegulatormothering style were associated with adverse birth outcomes; however, after controlling for medical complications, these were no longer associated. Our study results indicate that antenatal depressive and/or anxiety symptoms were not independently associated with adverse birth outcomes, a reassuring finding for women who are already psychologically vulnerable during pregnancy. [ABSTRACT FROM PUBLISHER]

Objective: To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.Methods: A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.Results: Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8-10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.Conclusion: The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes. [ABSTRACT FROM AUTHOR]

Background There are no contemporary cohorts examining pregnancy outcomes in women with type 2 diabetes (T2D) in Australia. Aim To compare pregnancy outcomes in women with and without T2D, and assess effects of body mass index ( BMI) and glycaemic control on outcomes. Materials and methods An historical cohort study was conducted of all singleton births > 20 weeks gestation at a specialist maternity network in Australia from 2010 to 2013. Data were extracted from the Birthing Outcomes System database. Multivariable logistic regression analysis was used to examine associations between presence of T2D and pregnancy outcomes. Results Outcomes for 138 pregnancies with T2D and 27 075 pregnancies in women without diabetes were compared (type 1 diabetes and gestational diabetes excluded). Women with T2D were older and more overweight compared to women without diabetes ( P < 0.01). Their babies were born earlier ( P < 0.01) with increased risk of large for gestational age (adjusted odds ratio 2.13 (95% CI 1.37-3.32)), hypoglycaemia (4.90 (2.79-8.61)), jaundice (2.58 (1.61-4.13)) and shoulder dystocia (2.72 (1.09-6.78)), but not congenital malformations or perinatal death. Women with T2D had a higher risk of induction (4.03 (2.71-5.99)), caesarean section (2.10 (1.44-3.04)), preterm birth (2.74 (1.78-4.24)) and pre-eclampsia (2.75 (1.49-5.10)). An HbA1c ≥ 6.0% (42 mmol/mol) was associated with increased preterm birth, special care nursery admission, hypoglycaemia and jaundice. Conclusions Despite availability of preconception care, good glycaemic control and specialist management, T2D remains associated with increased adverse obstetric and neonatal outcomes. Further research to examine predictors of adverse outcomes may assist in targeted antenatal surveillance and management. [ABSTRACT FROM AUTHOR]

Background Conception using assisted reproduction treatments ( ART) has been associated with an increased risk of pregnancy complications. It is uncertain if this is caused by ART directly, or is an association of the underlying factors causing infertility. Aims We assessed the relationship between assisted conception (AC) and maternal or fetal complications in a large retrospective cohort study. In a nested cohort of women receiving infertility treatment, we determined if such risk rests predominantly with certain causes of infertility. Materials and Methods Retrospective database analysis of 50 381 women delivering a singleton pregnancy in four public hospital obstetric units in western Sydney, and a nested cohort of 508 women receiving ART at a single fertility centre, in whom the cause of infertility was known. Results A total of 1727 pregnancies followed AC; 48 654 were spontaneous conceptions. Adjusted for age, body mass index and smoking, AC was associated with increased risk of preterm delivery ( OR 1.73, 95% CI 1.50-2.02), hypertension ( OR 1.55, 95% CI 1.34-1.82) and diabetes ( OR 1.51, 95% CI 1.30-1.75). In the nested cohort, ovulatory dysfunction was present in 145 women and 336 had infertility despite normal ovulatory function. Ovulatory dysfunction was associated with increased risk of diabetes ( OR 2.94, 95% CI 1.72-5.02) and hypertension ( OR 2.40, 95% CI 1.15-5.00) compared to women with normal ovulatory function. Conclusions Assisted conception is associated with increased risk of pregnancy complications. This risk appears greatest for women whose underlying infertility involves ovulatory dysfunction. Such disorders probably predispose towards diabetes and hypertension, which is then exacerbated by pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To assess maternal abdominal subcutaneous fat thickness (SFT) measured by ultrasound as an independent predictor of adverse pregnancy outcomes.Design: A prospective longitudinal cohort study performed on pregnancies delivered between 2012 and 2014.Setting: Sydney, Australia.Population: About 1510 pregnant women attending routine obstetric ultrasounds.Methods: Maternal SFT was measured on routine ultrasounds at 11-14 weeks' gestation (SFT1) and 18-22 weeks' gestation (SFT2). SFT measurements were assessed for estimating risks for obesity-related pregnancy outcomes using logistic regression modelling adjusted for maternal age, parity, smoking status and body mass index (BMI).Main Outcome Measures: Hypertensive disease, gestational diabetes, caesarean section, low birthweight, preterm delivery, neonatal respiratory distress, Apgar scores, and admission to a neonatal intensive care unit.Results: SFT1 and SFT2 were measured on 1461 and 1363 women, respectively. Mean thickness (range) were 21.2 mm (6.9-73.9) for SFT1 and 20.3 mm (7.5-68.0) for SFT2. Complete outcome data were available for 1385 pregnancies. In all, 54% of the women were overweight/obese. The SFT measures decreased from early to mid-pregnancy in overweight/obese women. There was moderate correlation between BMI and SFT1 (R(2) = 0.56) and BMI and SFT2 (R(2) = 0.55). In a multivariate model, SFT1 and SFT2 were better predictors for adverse pregnancy outcomes than BMI.Conclusion: Maternal SFT is a significant independent predictor of adverse pregnancy outcomes. Incorporation of SFT into future models for adverse pregnancy outcome may prove valuable. [ABSTRACT FROM AUTHOR]

Background American evidence suggests women are not well informed about the optimal duration of pregnancy or the earliest time for safe birth. Similar evidence does not exist in Australia. Aims To explore pregnant women's beliefs about the duration of pregnancy and the earliest time for safe birth, and to compare the results with US data. Methods A cross-sectional survey of pregnant women attending antenatal clinics at four public hospitals in Sydney, Australia, included information on maternal and pregnancy characteristics, and two questions exploring women's beliefs about the duration of pregnancy, and the earliest time for safe birth. Responses were grouped as: late preterm (34-36 weeks), early term (37-38 weeks) and full term (39-40 weeks). Results Of the 784 surveyed women, 52% chose 39-40 weeks as the duration of a full-term pregnancy, while for the earliest time for safe birth, 10% chose 39-40 weeks and 57% chose 37-38 weeks. Some maternal characteristics were associated with women's beliefs, including having a medical and/or pregnancy complication, country of birth, level of education, employment status and attending a tertiary hospital. The associations were different for each question. In comparison with US studies, Australian women were more likely to choose later gestations for both the duration of pregnancy and the earliest time for safe birth. Conclusions A significant proportion of women believe that full-term pregnancy and earliest time for safe birth occur before 39 weeks, suggesting opportunities for better communication about the benefits and risks of birthing at different gestations. [ABSTRACT FROM AUTHOR]

Background The widespread use of assisted reproductive technologies has led to an increase in the prevalence of monozygotic twins. Twinning after blastocyst transfer results in monochorionic placentation; a form of placentation that is associated with higher risks of mortality and morbidity. Aims This study describes complication rates of monochorionic diamniotic ( MCDA) twin pregnancies and examines whether they differ between spontaneous and assisted conceptions. Methods A five-year retrospective review of 294 MCDA twin pregnancies that had no evidence of structural abnormality on ultrasound at 12 weeks' gestation. Outcomes of spontaneous and assisted conceptions Day 3 ( D3) cleavage stage embryo or Day 5 ( D5) blastocyst transfer) pregnancies were compared. Results Two hundred and eighteen (74.1%) MCDA twin pregnancies were conceived spontaneously, whilst 14 (4.8%) resulted from D3 cleavage stage embryo and 62 (21.1%) resulted from D5 blastocyst transfer. Fetal and whole pregnancy loss rates were high, affecting 11.4% and 8.8% of cases, respectively. 16.2% of pregnancies were delivered <32 weeks' and 66% <37 weeks' gestation. 36.2% of infants were small for gestational age and selective intrauterine growth restriction ( IUGR) affected 7.5% of pregnancies. There was no significant difference in the prevalence of complications between spontaneous and assisted conceptions. Conclusions Assisted conception with either D3 cleavage stage embryo or D5 blastocyst transfer does not increase the risk of complication in a MCDA twin pregnancy. Mortality in monochorionic twins remains high despite early recognition and heightened surveillance throughout pregnancy. Information describing the risks of monochorionic twinning and of subsequent complications may be of value to women undergoing assisted conception. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Brown S, Gartland D, Donath S, MacArthur C. Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study. BJOG 2011;118:991-1000. To investigate the contribution of prolonged labour, method of birth, timing of caesarean section and other obstetric risk factors to postpartum urinary incontinence. Prospective pregnancy cohort. Six metropolitan public hospitals in Victoria, Australia. A total of 1507 nulliparous women recruited to the maternal health study in early pregnancy (≤24 weeks). Data from hospital medical records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and 3 months postpartum analysed using univariable and multivariable logistic regression. Urinary incontinence 3 months postpartum in women continent before the index pregnancy. Of the women continent before pregnancy, 26% reported new incontinence at 3 months postpartum. Compared with women who had a spontaneous vaginal birth, women who had a caesarean section before labour (adjusted odds ratio [OR] 0.2, 95% CI 0.1-0.5) or in the first stage of labour (adjusted OR 0.2, 95% CI 0.1-0.4) were less likely to be incontinent 3 months postpartum. Adjusted OR for incontinence after caesarean section in the second stage of labour compared with spontaneous vaginal birth was 0.5 (95% CI 0.2-1.0). Prolonged second stage labour was associated with increased likelihood of postpartum incontinence in women who had a spontaneous vaginal birth (adjusted OR 1.9, 95% CI 1.1-3.4) or operative vaginal birth (adjusted OR 1.7, 95% CI 1.0-2.8). In addition to pregnancy itself, physiological changes associated with the second stage of labour appear to play a role in postpartum urinary incontinence. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Dekker G, Chan A, Luke C, Priest K, Riley M, Halliday J, King J, Gee V, O’Neill M, Snell M, Cull V, Cornes S. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study. BJOG 2010;117:1358–1365. Objective Higher risks of uterine rupture have been reported among women attempting vaginal birth after caesarean (VBAC) particularly following induction with prostaglandins, compared with women who do not labour. This study aimed to estimate these risks as well as that associated with oxytocin use. Design Population-based retrospective cohort study involving all women who had their first births by caesarean. In their second birth, risks of uterine rupture among women without labour and women who had labour augmented or induced were compared with women who gave birth after spontaneous labour. Setting Four Australian states in 1998–2000. Population Women on pregnancy outcome databases with a second birth after a prior caesarean for their first birth. Methods From 29 008 women identified from the databases, those with uterine rupture were identified and validated using hospital case records. Main outcome measure Uterine rupture. Results The risk of complete uterine rupture among women without labour was 0.01%. The risk in spontaneous labour without augmentation was 0.15%, considerably higher when there was augmentation with oxytocin (1.91%). The risk with induction of labour was 0.54% for oxytocin alone, 0.68% for prostaglandin alone, 0.63% without either and 0.88% when they were combined. Compared with spontaneous labour, risks were increased three- to five-fold for any induction, six-fold for prostaglandin combined with oxytocin and 14-fold for augmentation with oxytocin. Conclusions Careful consideration should be given to the use of oxytocin for augmentation of labour or induction by any method for women with a previous caesarean in view of increased risks of uterine rupture. [ABSTRACT FROM AUTHOR]

Smoking and the deaths and suffering it causes are more common among Aboriginal and Torres Strait Islander peoples and Māori than other Australians and New Zealanders. While, many tobacco control activities that are not specifically targeted at children will have a positive impact on child health, this review concentrates on recent tobacco control research on pregnant women and children. The important tasks are to reduce smoking by pregnant Māori and Aboriginal and Torres Strait Islander women to reduce infant and child exposure to second-hand smoke and to reduce smoking initiation of children and adolescents. Health professionals who want to reduce the suffering caused by smoking among Māori and Aboriginal and Torres Strait Islander children can be guided by much new relevant research evidence and clear frameworks about how to approach tobacco control in these communities. [ABSTRACT FROM AUTHOR]

Abstract: Reduced farrowing rates due to late pregnancy loss (LPL) is a manifestation of seasonal infertility in pigs. This study was undertaken to determine sow- and gilt-specific risk factors leading to LPL during the seasonal infertility period (January to April) in Australia. Age at first service was considered to be a major gilt-specific risk factor, whereas sow-specific factors considered included parity, prior wean-to-service interval, prior lactation length, and number of piglets weaned in the lactation period immediately preceding the mating/pregnancy event under scrutiny. Logistic regression analysis of these factors was undertaken on 13,213 animals from three farms (Farms A, B, and C). Age at first service for gilts had an effect on LPL (P<0.05) on Farm C when compared with that for Farms A and B, with those mated at approximately 220 d having the lowest rate of LPL. For older sows, parity was a factor on Farms A and C (P<0.001), with the proportion of sows with LPL increasing with increasing parity. When the data from each farm were combined and analyzed, there was a significant farm by WSI interaction, with animals from Farm C being most at-risk for LPL. Sows with shorter lactation periods (P<0.05) and smaller litters (P<0.05) at the previous lactation had a greater chance of LPL on all farms. Under the conditions of this study, we were able to identify risk factors for LPL that producers can manipulate during the seasonal infertility period to improve breeding herd productivity. [Copyright &y& Elsevier]

Despite low fertility rates in Western countries, maternity remains one of the major goals of women from various socioeconomic backgrounds. While most women will have low-risk pregnancies, common serious disorders of pregnancy, such as preeclampsia, premature rupture of the membranes, placenta previa, or fetal growth restriction, may compromise maternal and infant outcomes. The experiences of urban and rural women in Australia who have had difficulties in maintaining their pregnancies are analyzed in this article. We study the impact of individual and social factors that facilitate or impede women's adjustment to the risks associated with these disorders. The analysis of in-depth interviews with 27 women hospitalized antenatally indicates that most women were unfamiliar with the diagnoses and acted as passive “decision takers,” complying with medical advice to remain in the hospital. Admission to a tertiary hospital ward that provided care to women with pregnancy disorders promoted the formation of a new identity, that of a woman whose pregnancy did not follow the expected path. Further, hospitalization offered women the opportunity to interact with others in similar difficult situations and, hence, feel less isolated. [ABSTRACT FROM AUTHOR]

The article discusses the significance of patients, doctors, media and pharmaceutical companies in the prevention of multiple gestation in Australia and New Zealand. It highlights the importance of patient education on the accurate information of the risks and complications involved in multiple pregnancies. It mentions that media stories are unhelpful in offering information of grand multiple pregnancies by not showing the negative impact of premature children.