Search

Background: Gestational diabetes mellitus (GDM) is associated with life-long increased risk of type 2 diabetes: affected women are advised to undergo oral glucose tolerance testing (OGTT) at 6-12 weeks postpartum, then glucose screening every 1-3 years., Aims: We investigated whether in women with GDM, antenatal clinical factors predicted postpartum abnormal glucose tolerance and compliance with screening., Materials and Methods: In women with GDM delivering 2007 to mid-2009 in a single hospital, antenatal/obstetric data and glucose tests at 6-12 weeks postpartum and during 5.5 years post-pregnancy were retrospectively collected. Predictors of return for testing and abnormal glucose tolerance were identified using multivariate analysis., Results: Of 165 women, 117 (70.9%) returned for 6-12 week postpartum OGTT: 23 (19.6%) were abnormal. Smoking and parity, independent of socioeconomic status, were associated with non-return for testing. Fasting glucose ≥5.4 mmol/L on pregnancy OGTT predicted both non-return for testing and abnormal OGTT. During 5.5 years post-pregnancy, 148 (89.7%) women accessed glucose screening: nine (6.1%) developed diabetes, 33 (22.3%) had impaired fasting glucose / impaired glucose tolerance. Predictors of abnormal glucose tolerance were fasting glucose ≥5.4 mmol/L and 2-h glucose ≥9.3 mmol/L on pregnancy OGTT (~2.5-fold increased risk), and polycystic ovary syndrome (~3.4 fold increased risk). Risk score calculation, based on combined antenatal factors, did not improve predictions., Conclusions: Antenatal clinical factors were modestly predictive of return for testing and abnormal glucose tolerance post-pregnancy in women with GDM. Risk score calculations were ineffective in predicting outcomes: risk scores developed in other populations require validation. Ongoing glucose screening is indicated for all women with GDM., (© 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objective: There is a need for emerging Australian data on emergency peripartum hysterectomy (EPH) especially in rural areas due to the associated high maternal morbidity and mortality. The aim of this study is to review the incidence and complications of EPH in the northern region of Tasmania., Design: A retrospective cohort study at a single health care institution during a 10 year period., Setting: Launceston General Hospital, the main maternity referral centre for the northern region of Tasmania., Participants: Case notes of women coded with hysterectomy during childbirth were included and analysed., Main Outcome Measures: Primary outcomes were maternal and neonatal morbidity and mortality., Results: Eighteen women were identified, giving an incidence of 1.01 per 1000 births. Indications for surgery were abnormal placentation, uterine atony and uterine rupture. Maternal morbidity was high, and included intensive care admissions (55%), disseminated intravascular coagulopathy (50%), hypovolemic shock (38%), febrile illness (27%) and urinary tract injuries (22%). The mean estimated total blood loss was 4091.6 mL, and 88% of women received blood transfusions. All women received prophylactic antibiotics. Women with morbidly adherent placenta were likely to experience more complications and transfusions. There were no maternal or neonatal deaths identified., Conclusion: The rate of peripartum hysterectomy in rural Tasmania is higher compared with other Australian tertiary-level hospitals, suggesting that Australian women birthing in rural and regional areas might be at greater risk. Maternal morbidity associated with abnormal placentation is high; hence, better diagnostic modalities and multidisciplinary antenatal management are required to improve maternal outcomes., (© 2014 National Rural Health Alliance Inc.)

Pregnancy is a hypercoagulable state associated with an increased risk of venous thromboembolic disease (VTE). We retrospectively studied 38 Caucasian pregnant women with thrombophilia risk and compared their obstetric outcomes with a matched cohort without known thrombophilia risk during the period between January 2007 and December 2010. There were (2) cases with factor V Leiden, (6) prothrombin gene mutation, (1) antithrombin III deficiency, (2) protein C deficiency, (3) protein S deficiency, (10) MTHFR mutation, (7) anti-cardiolipin antibodies, and (1) lupus anticoagulant. Patients without thrombophilia who presented with recurrent unprovoked VTE were considered as high risk (6 cases). Most patients received anticoagulation (34/38) with aspirin only (6), enoxaparin (27), and warfarin (1). Twenty-six out of thirty-eight pregnant women (68.4%) with an increased risk of thrombophilia experienced one or more obstetric complications defined as hypertension, preeclampsia, placenta abruptio, VTE, and oligohydramnios, compared with 15 out of 40 (37.5%) pregnant women in the control group (OR 3.6; 95% CI 1.42, 9.21, P < 0.001). The incidence of obstetric complications was significantly higher in the thrombophilia group compared to the controls. However, these complications were the lowest among patients who received full-dose anticoagulation. Our study suggests that strict application of anticoagulation therapy for thrombophilia of pregnancy is associated with an improved pregnancy outcome. The study was registered in the Australian and New Zealand Clinical Trials Registry under ACTRN12612001094864.

Background: To date, there are no data available concerning the impact of iron therapy on the long-term well-being and health-related quality of life (HRQoL) in pregnancy., Objective: To assess the long-term effect of iron therapy on HRQoL in pregnancy., Design: This is a follow-up study conducted between January 2010 and January 2011 of an earlier randomised open-label clinical trial of intravenous and oral iron versus oral iron for pregnancy-related iron deficiency anaemia. We used a modified version of the SF-36 questionnaire together with the original prospective HRQoL data collected during and after pregnancy., Participants and Interventions: Of the original evaluable 183 pregnant Caucasian women randomised to receive oral iron or a single intravenous iron polymaltose infusion followed by oral iron maintenance, 126 women completed the follow-up HRQoL study., Methods: The participants were followed up 4 weeks after treatment, predelivery and postdelivery for a median period of 32 months (range, 26-42) with a well-being and HRQoL questionnaire using a modified SF-36 QoL-survey and child growth charts as set by the Australasian Paediatric Endocrine Group (APEG)., Results: Patients who received intravenous iron demonstrated significantly higher haemoglobin and serum ferritin levels (p<0.001). There were strong associations between iron status and a number of the HRQoL parameters, with improved general health (p<0.001), improved vitality (physical energy) (p<0.001), less psychological downheartedness (p=0.005), less clinical depression (p=0.003) and overall improved mental health (p<0.001). The duration of breastfeeding was longer (p=0.046) in the intravenous iron group. The babies born in both groups recorded similarly on APEG growth chart assessments., Conclusions: Our data suggest that HRQoL is improved until after pregnancy in anaemic pregnant women by repletion of their iron stores during pregnancy. About 80% of the intravenous iron group showed a maintained normal ferritin until delivery with long-term benefits. Further studies to confirm these findings are warranted.

Nutritional iron-deficiency anaemia (IDA) is the most common disorder in the world, affecting more than two billion people. The World Health Organization's global database on anaemia has estimated a prevalence of 14% based on a regression-based analysis. Recent data show that the prevalence of IDA in pregnant women in industrialized countries is 17.4% while the incidence of IDA in developing countries increases significantly up to 56%. Although oral iron supplementation is widely used for the treatment of IDA, not all patients respond adequately to oral iron therapy. This is due to several factors including the side effects of oral iron which lead to poor compliance and lack of efficacy. The side effects, predominantly gastrointestinal discomfort, occur in a large cohort of patients taking oral iron preparations. Previously, the use of intravenous iron had been associated with undesirable and sometimes serious side effects and therefore was underutilised. However, in recent years, new type II and III iron complexes have been developed, which offer better compliance and toleration as well as high efficacy with a good safety profile. In summary, intravenous iron can be used safely for a rapid repletion of iron stores and correction of anaemia during and after pregnancy.

Two poly(p-phenylenevinylene) derivative alternating copolymers (P1-I and P2-I) have been prepared featuring iodo substituents and m-phenylene units to periodically disrupt conjugation. P1-I was derivatized with various chromophores to yield P1a-f. In P1a-f, the chromophores were positioned within a sterically protected pocket shielding them from interchain interactions so that intrachain interactions between polymer segments could be observed. Solution and film properties of polymers have been examined. Post-polymerization chromophore modification leads to new photophysical properties such as intramolecular charge transfer and fluorescent resonance energy transfer processes in some cases., (Copyright © 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The solution processability of a conducting metallopolymer (CMP1) based on a 2,2'-bipyridyl (bipy) derivatized poly(p-phenylene vinylene) (PPV) backbone has been accomplished by the strategic placement of sterically demanding mesityl side chains. The enhanced solubility of CMP1 can be traced to the prevention of coordinative crosslinking between polymer chains. The sterically enforced 1:1 bipy/metal ratio was confirmed by job analysis of absorption spectroscopic titration data. In addition to enhanced processability, this strategy also leads to twice as many metal ions, and consequently twice the charge, on CMP1 versus traditional bipyridyl-PPV metallopolymers that are typified by a 2:1 bipy/metal ratio with certain metals., (Copyright © 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

A sterically-encumbered 5,5'-distyryl-2,2'-bipyridyl derivative that enforces a 1:1 metal-to-ligand ratio acts as a selective turn-on sensor for Zn(2+) in THF.

Taxation of tobacco is a widely-used strategy that prompts smoking cessation among adults and reduces cigarette consumption among continuing smokers. Registered Indian tobacco use prevalence is at least double that of the rest of Canadians and is in part due to the lower cost of tobacco products purchased on reserve by Registered Indians (RIs) as they are tax exempt. Although registered Indian communities have the ability to collect tax on tobacco products and direct the use of these revenues, this strategy is rarely utilized. Tobacco taxation could have substantial health and economic benefits to RI communities, but perhaps is not culturally-appropriate. In order to better support RI communities, governments and other organizations need to examine this policy instrument in the context of RI populations.

The rate of tobacco use is higher among First Nations (FN) peoples than among other Canadians. Cessation pharmacotherapy agents reduce tobacco use, but the appropriateness and effectiveness of these agents among FN smokers are not entirely clear. Rates of tobacco cessation pharmacotherapy use among FN smokers are unknown; such information would be useful for program planners and would indicate appropriateness of use. To examine cessation pharmacotherapy use, we extracted claims for nicotine gum, nicotine patch, and bupropion SR (Zyban) from the Non-Insured Health Benefits pharmacy database for FN persons living within British Columbia during 2001. A total of 3.8% (95% CI=3.6-4.0) of FN claimants filled a prescription for at least one tobacco cessation pharmacotherapy agent; 61.7% were female, and their mean age was 38.1 years. Most claims (60.5%) were for bupropion, followed by nicotine patch (40.7%) and nicotine gum (4.7%). A total of 4.6% of claimants used both nicotine patch and bupropion,.8% used nicotine gum and nicotine patch, and.5% used nicotine gum and bupropion. Pharmacotherapy agents appear to be used less often by FN smokers than by other Canadian smokers for several possible reasons. Additional research is needed related to FN populations and cessation pharmacotherapy use in terms of cultural appropriateness, barriers to use, and effectiveness.

Thunderstorm-associated asthma epidemics have been documented in the literature, but no Canadian experience has been reported. On July 31, 2000, a thunderstorm-associated epidemic of asthma or shortness of breath occurred in Calgary, Alberta. The Calgary Health Region investigated the event using diagnostic data from emergency departments, an urgent care medical clinic and patient interviews, in addition to bioaerosol counts, pollutant data and weather data reflecting atmospheric conditions at that time. On July 31, 2000 and August 1, 2000, 157 people sought care for asthma symptoms. The expected number of people to seek care for such symptoms in a 48 h period in Calgary is 17. Individuals with a personal or family history of asthma, allergies or hay fever who were not taking regular medication for these conditions and who were outdoors before the storm appeared to have been preferentially affected. A stagnant air mass the day before the thunderstorm may have resulted in declining bioaerosol concentrations, and the possible accumulation of spore and pollen reservoirs within mould and plant structures. The elevated bioaerosol concentrations observed on the day of the thunderstorm may be attributed to the sudden onset of high winds during the thunderstorm, which triggered a sudden release of spores and pollens into the atmosphere, which was probably responsible for the epidemic. Several pollutant levels slightly increased on the day of the storm and possibly also played a role in symptom development. It is unclear whether an atmospheric pressure drop contributed to the release of spores and pollens.