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1. ENhancinG vAGinal dElivery in Greece through educational and behavioral interventions among maternity care providers regarding labor management: the ENGAGE stepped-wedge randomized prospective trial protocol

Author

Vrachnis, Nikolaos, Antonakopoulos, Nikolaos, von Dadelszen, Peter, Vidler, Marianne, Maroudias, Georgios, Bone, Jeffrey, Sandhu, Ash, Loukas, Nikolaos, Magee, Laura, Roussos, Nikolaos, Kassaris, Stefania, Fotiou, Alexandros, Zygouris, Dimitrios, Adonakis, Georgios, Akrivis, Christodoulos, Antsaklis, Aris, Athanasiadis, Apostolos, Bontis, Nikolaos, Daniilidis, Angelos, Daponte, Alexandros, Daskalakis, Georgios, Deligeoroglou, Efthimios, Dinas, Konstantinos, Drakakis, Peter, Gerede, Angeliki, Grimbizis, Grigorios, Iacovidou, Nicoletta, Kambas, Nikolaos, Katasos, Theodoros, Katsetos, Christos, Katsikis, Ilias, Makrigiannakis, Antonios, Matalliotakis, Michail, Messini, Christina, Mikos, Themis, Nikolettos, Nikolaos, Pados, Georgios, Paschopoulos, Minas, Patsouras, Konstantinos, Siahanidou, Soultana, Sioulas, Vasileios, Skentou, Chara, Stavros, Sofoklis, Temmerman, Marleen, Tsikouras, Panagiotis, Tsitsis, Vasilios, Vlahos, Nikolaos, Rodolakis, Alexandros, Papageorghiou, Aris, and Loutradis, Dimitrios

Published
2024
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4. Usability and Feasibility of PIERS on the Move: An mHealth App for Pre-Eclampsia Triage

Author

Lim, Joanne, Cloete, Garth, Dunsmuir, Dustin T, Payne, Beth A, Scheffer, Cornie, von Dadelszen, Peter, Dumont, Guy A, and Ansermino, J Mark

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundPre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter. ObjectiveThe aim of this study was to assess the usability of PotM (with mid-level health workers) for iteratively refining the system. MethodsDevelopment of the PotM user interface involved usability testing with target end-users in South Africa. Users were asked to complete clinical scenario tasks, speaking aloud to give feedback on the interface and then complete a questionnaire. The tool was then evaluated in a pilot clinical evaluation in Tygerberg Hospital, Cape Town. ResultsAfter ethical approval and informed consent, 37 nurses and midwives evaluated the tool. During Study 1, major issues in the functionality of the touch-screen keyboard and date scroll wheels were identified (total errors n=212); during Study 2 major improvements in navigation of the app were suggested (total errors n=144). Overall, users felt the app was usable using the Computer Systems Usability Questionnaire; median (range) values for Study 1 = 2 (1-6) and Study 2 = 1 (1-7). To demonstrate feasibility, PotM was used by one research nurse for the pilot clinical study. In total, more than 500 evaluations were performed on more than 200 patients. The median (interquartile range) time to complete an evaluation was 4 min 55 sec (3 min 25 sec to 6 min 56 sec). ConclusionsBy including target end-users in the design and evaluation of PotM, we have developed an app that can be easily integrated into health care settings in low- and middle-income countries. Usability problems were often related to mobile phone features (eg, scroll wheels, touch screen use). Larger scale evaluation of the clinical impact of this tool is underway.

Published
2015
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5. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

Author

Smith, Emily R, Oakley, Erin, Grandner, Gargi Wable, Ferguson, Kacey, Farooq, Fouzia, Afshar, Yalda, Ahlberg, Mia, Ahmadzia, Homa, Akelo, Victor, Aldrovandi, Grace, Barr, Beth A Tippett, Bevilacqua, Elisa, Brandt, Justin S, Broutet, Nathalie, Buhigas, Irene Fernández, Carrillo, Jorge, Clifton, Rebecca, Conry, Jeanne, Cosmi, Erich, Crispi, Fatima, Crovetto, Francesca, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J, Favre, Guillaume, Flaherman, Valerie J, Gale, Chris, Gil, Maria M, Gottlieb, Sami L, Gratacós, Eduard, Hernandez, Olivia, Jones, Stephanie, Kalafat, Erkan, Khagayi, Sammy, Knight, Marian, Kotloff, Karen, Lanzone, Antonio, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M, Longo, Valentina Laurita, Madhi, Shabir A, Magee, Laura A, Martinez-Portilla, Raigam Jafet, McClure, Elizabeth M, Metz, Tori D, Miller, Emily S, Money, Deborah, Moungmaithong, Sakita, Mullins, Edward, Nachega, Jean B, Nunes, Marta C, Onyango, Dickens, Panchaud, Alice, Poon, Liona C, Raiten, Daniel, Regan, Lesley, Rukundo, Gordon, Sahota, Daljit, Sakowicz, Allie, Sanin-Blair, Jose, Söderling, Jonas, Stephansson, Olof, Temmerman, Marleen, Thorson, Anna, Tolosa, Jorge E, Townson, Julia, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Waldorf, Kristina Adams, Whitehead, Clare, Yassa, Murat, Tielsch, Jim M, Langenegger, Eduard, Sam-Agudu, Nadia A, Gachuno, Onesmus W, Sekikubo, Musa, Mukwege, Denis M, Omore, Richard, Ouma, Gregory, Onyango, Clayton, Otieno, Kephas, Were, Zacchaeus Abaja, Were, Joyce, İlter, Pinar Birol, Mboizi, Robert, Hookham, Lauren, Meli, Federica, Bonanni, Giulia, Romanzi, Federica, Torcia, Eleonora, di Ilio, Chiara, Ananth, Cande V, Hill, Jennifer, Reddy, Ajay, Patrick, Haylea Sweat, Baba, Vuyelwa, and Adam, Mary

Subjects
Biodefense, Pneumonia, Lung, Infant Mortality, Vaccine Related, Emerging Infectious Diseases, Clinical Trials and Supportive Activities, Clinical Research, Pediatric, Perinatal Period - Conditions Originating in Perinatal Period, Preterm, Low Birth Weight and Health of the Newborn, Infectious Diseases, Prevention, Pneumonia & Influenza, Infection, Reproductive health and childbirth, Good Health and Well Being, Infant, Newborn, Pregnancy, Female, Humans, Pregnant Women, Prospective Studies, COVID-19, SARS-CoV-2, Maternal health, Epidemiology, Perinatal COVID PMA Study Collaborators
Abstract

IntroductionDespite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.MethodsWe screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.ResultsWe screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.ConclusionsThis analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

Published
2023

10. Machine learning-enabled maternal risk assessment for women with pre-eclampsia (the PIERS-ML model): a modelling study

Author

Brown, Mark A., Davis, Gregory K., Parker, Claire, Walters, Barry N., Sass, Nelson, Ansermino, J. Mark, Cao, Vivien, Cundiff, Geoffrey W., von Dadelszen, Emma C.M., Douglas, M. Joanne, Dumont, Guy A., Dunsmuir, Dustin T., Hutcheon, Jennifer A., Joseph, K.S., Lalji, Sayrin, Lee, Tang, Li, Jing, Lim, Kenneth I., Lisonkova, Sarka, Lott, Paula, Menzies, Jennifer M., Millman, Alexandra L., Palmer, Lynne, Payne, Beth A., Qu, Ziguang, Russell, James A., Sawchuck, Diane, Shaw, Dorothy, Still, D. Keith, Ukah, U. Vivian, Wagner, Brenda, Walley, Keith R., Hugo, Dany, Gruslin, The late Andrée, Tawagi, George, Smith, Graeme N., Côté, Anne-Marie, Moutquin, Jean-Marie, Ouellet, Annie B., Lee, Shoo K., Duan, Tao, Zhou, Jian, Haniff, The late Farizah, Mahajan, Swati, Noovao, Amanda, Karjalainend, Hanna, Kortelainen, Alja, Laivuori, Hannele, Ganzevoort, J. Wessel, Groen, Henk, Kyle, Phillipa M., Moore, M. Peter, Pullar, Barbra, Bhutta, Zulfiqar A., Qureshi, Rahat N., Sikandar, Rozina, Bhutta, The late Shereen Z., Cloete, Garth, Hall, David R., van Papendorp, The late Erika, Steyn, D. Wilhelm, Biryabarema, Christine, Mirembe, Florence, Nakimuli, Annettee, Allotey, John, Thangaratinam, Shakila, Nicolaides, Kypros H., Ionescu, Olivia, Syngelaki, Argyro, de Swiet, Michael, Magee, Laura A., von Dadelszen, Peter, Akolekar, Ranjit, Walker, James J., Robson, Stephen C., Broughton-Pipkin, Fiona, Loughna, Pamela, Vatish, Manu, Redman, Christopher W.G., Barry, Sarah J.E., Kavanagh, Kimberley, Montgomery-Csobán, Tunde, Murray, Paul, Robertson, Chris, Tsigas, Eleni Z., Woelkers, Douglas A., Lindheimer, Marshall D., Grobman, William A., Sibai, Baha M., Merialdi, Mario, Widmer, Mariana, Montgomery-Csobán, Tünde, Barry, Sarah J E, Vivian Ukah, U, Payne, Beth A, Nicolaides, Kypros H, Hutcheon, Jennifer A, and Magee, Laura A

Published
2024
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11. Protocol for a sequential, prospective meta-analysis to describe coronavirus disease 2019 (COVID-19) in the pregnancy and postpartum periods

Author

Smith, Emily R, Oakley, Erin, He, Siran, Zavala, Rebecca, Ferguson, Kacey, Miller, Lior, Grandner, Gargi Wable, Abejirinde, Ibukun-Oluwa Omolade, Afshar, Yalda, Ahmadzia, Homa, Aldrovandi, Grace, Akelo, Victor, Barr, Beth A Tippett, Bevilacqua, Elisa, Brandt, Justin S, Broutet, Natalie, Buhigas, Irene Fernández, Carrillo, Jorge, Clifton, Rebecca, Conry, Jeanne, Cosmi, Erich, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J, Favre, Guillaume, Flaherman, Valerie, Gale, Christopher, Gil, Maria M, Godwin, Christine, Gottlieb, Sami, Bellolio, Olivia Hernandez, Kara, Edna, Khagayi, Sammy, Kim, Caron Rahn, Knight, Marian, Kotloff, Karen, Lanzone, Antonio, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M, Longo, Valentina Laurita, Magee, Laura A, Martinez-Portilla, Raigam Jafet, McClure, Elizabeth, Metz, Torri D, Money, Deborah, Mullins, Edward, Nachega, Jean B, Panchaud, Alice, Playle, Rebecca, Poon, Liona C, Raiten, Daniel, Regan, Lesley, Rukundo, Gordon, Sanin-Blair, Jose, Temmerman, Marleen, Thorson, Anna, Thwin, Soe, Tolosa, Jorge E, Townson, Julia, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Waldorf, Kristina Adams, Whitehead, Clare, Yang, Huixia, Thorlund, Kristian, and Tielsch, James M

Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Health Sciences, Clinical Research, Emerging Infectious Diseases, Pediatric, Prevention, Reproductive health and childbirth, Good Health and Well Being, Adolescent, COVID-19, Child, Female, Humans, Infant, Newborn, Meta-Analysis as Topic, Postpartum Period, Pregnancy, Prospective Studies, Retrospective Studies, SARS-CoV-2, General Science & Technology
Abstract

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.

Published
2022

12. Concentrations and predictors of select nutrients in Canadian human milk samples from the Maternal-Infant Research on Environmental Chemicals pregnancy cohort

Author

Hopperton, Kathryn E, O’Neill, Erica, Chakrabarti, Subhadeep, Stanton, Melanie, Parnel, Sophie, Arbuckle, Tye E, Ashley-Martin, Jillian, Bertinato, Jesse, Bouchard, Maryse F, Borghese, Michael M, Brooks, Stephen, Cockell, Kevin, Dabeka, Robert, Joung, Meong Jin, Lanphear, Bruce P, Lapointe, Pascal, MacFarlane, Amanda J, MacPherson, Susan, Krzeczkowski, John, Rawn, Dorothea F K, von Dadelszen, Peter, Weiler, Hope A, Xiao, Chao Wu, and Fisher, Mandy

Published
2024
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14. Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Author

Calvert, Clara, Brockway, Meredith (Merilee), Zoega, Helga, Miller, Jessica E., Been, Jasper V., Amegah, Adeladza Kofi, Racine-Poon, Amy, Oskoui, Solmaz Eradat, Abok, Ishaya I., Aghaeepour, Nima, Akwaowo, Christie D., Alshaikh, Belal N., Ayede, Adejumoke I., Bacchini, Fabiana, Barekatain, Behzad, Barnes, Rodrigo, Bebak, Karolina, Berard, Anick, Bhutta, Zulfiqar A., Brook, Jeffrey R., Bryan, Lenroy R., Cajachagua-Torres, Kim N., Campbell-Yeo, Marsha, Chu, Dinh-Toi, Connor, Kristin L., Cornette, Luc, Cortés, Sandra, Daly, Mandy, Debauche, Christian, Dedeke, Iyabode Olabisi F., Einarsdóttir, Kristjana, Engjom, Hilde, Estrada-Gutierrez, Guadalupe, Fantasia, Ilaria, Fiorentino, Nicole M., Franklin, Meredith, Fraser, Abigail, Gachuno, Onesmus W., Gallo, Linda A., Gissler, Mika, Håberg, Siri E., Habibelahi, Abbas, Häggström, Jonas, Hookham, Lauren, Hui, Lisa, Huicho, Luis, Hunter, Karen J., Huq, Sayeeda, KC, Ashish, Kadambari, Seilesh, Kelishadi, Roya, Khalili, Narjes, Kippen, Joanna, Le Doare, Kirsty, Llorca, Javier, Magee, Laura A., Magnus, Maria C., Man, Kenneth K. C., Mburugu, Patrick M., Mediratta, Rishi P., Morris, Andrew D., Muhajarine, Nazeem, Mulholland, Rachel H., Bonnard, Livia Nagy, Nakibuuka, Victoria, Nassar, Natasha, Nyadanu, Sylvester D., Oakley, Laura, Oladokun, Adesina, Olayemi, Oladapo O., Olutekunbi, Olanike A., Oluwafemi, Rosena O., Ogunkunle, Taofik O., Orton, Chris, Örtqvist, Anne K., Ouma, Joseph, Oyapero, Oyejoke, Palmer, Kirsten R., Pedersen, Lars H., Pereira, Gavin, Pereyra, Isabel, Philip, Roy K., Pruski, Dominik, Przybylski, Marcin, Quezada-Pinedo, Hugo G., Regan, Annette K., Rhoda, Natasha R., Rihs, Tonia A., Riley, Taylor, Rocha, Thiago Augusto Hernandes, Rolnik, Daniel L., Saner, Christoph, Schneuer, Francisco J., Souter, Vivienne L., Stephansson, Olof, Sun, Shengzhi, Swift, Emma M., Szabó, Miklós, Temmerman, Marleen, Tooke, Lloyd, Urquia, Marcelo L., von Dadelszen, Peter, Wellenius, Gregory A., Whitehead, Clare, Wong, Ian C. K., Wood, Rachael, Wróblewska-Seniuk, Katarzyna, Yeboah-Antwi, Kojo, Yilgwan, Christopher S., Zawiejska, Agnieszka, Sheikh, Aziz, Rodriguez, Natalie, Burgner, David, Stock, Sarah J., and Azad, Meghan B.

Published
2023
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20. Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis

Author

Smith, Emily R., Oakley, Erin, Grandner, Gargi Wable, Rukundo, Gordon, Farooq, Fouzia, Ferguson, Kacey, Baumann, Sasha, Adams Waldorf, Kristina Maria, Afshar, Yalda, Ahlberg, Mia, Ahmadzia, Homa, Akelo, Victor, Aldrovandi, Grace, Bevilacqua, Elisa, Bracero, Nabal, Brandt, Justin S., Broutet, Natalie, Carrillo, Jorge, Conry, Jeanne, Cosmi, Erich, Crispi, Fatima, Crovetto, Francesca, del Mar Gil, Maria, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J., Favre, Guillaume, Fernandez Buhigas, Irene, Flaherman, Valerie, Gale, Christopher, Godwin, Christine L., Gottlieb, Sami, Gratacós, Eduard, He, Siran, Hernandez, Olivia, Jones, Stephanie, Joshi, Sheetal, Kalafat, Erkan, Khagayi, Sammy, Knight, Marian, Kotloff, Karen L., Lanzone, Antonio, Laurita Longo, Valentina, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M., Madhi, Shabir A., Magee, Laura A., Martinez-Portilla, Raigam Jafet, Metz, Torri D., Miller, Emily S., Money, Deborah, Moungmaithong, Sakita, Mullins, Edward, Nachega, Jean B., Nunes, Marta C., Onyango, Dickens, Panchaud, Alice, Poon, Liona C., Raiten, Daniel, Regan, Lesley, Sahota, Daljit, Sakowicz, Allie, Sanin-Blair, Jose, Stephansson, Olof, Temmerman, Marleen, Thorson, Anna, Thwin, Soe Soe, Tippett Barr, Beth A., Tolosa, Jorge E., Tug, Niyazi, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Whitehead, Clare, Wood, Mollie, Yang, Huixia, Zavala, Rebecca, and Tielsch, James M.

Published
2023
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21. Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

Author

Andruschak, John, Dale, Sheryll, Der, Kenny, Pacheco, Terri, Vida, Karen, Frick, Corrine, Bott, Nancy, Carr, Lee-Ann, Bedard, Daniel, Robert, Nicole, Sprague, Ann, Berthiaume, Maryse, Beaudoin, Richard, Attenborough, Rebecca, Fahey, John, Gagnon, Irene, Murphy, Phil, Allen, Victoria, Bocking, Alan, Bottomley, Jim, Bujold, Emmanuel, Campbell, Karen, Christilaw, Jan, Crane, Joan, Dodds, Linda, Donner, Allan, Dumont, Alexandre, Dzakpasu, Susie, Forson, Abigail, Fraser, Bill, Gagnon, Anita, Joseph, K.S., Klein, Michael, Kramer, Michael, LaFrance, Martine, Lemay, Karine, Liu, Shiliang, Moutquin, Jean-Marie, Nimrod, Carl, Platt, Robert, O’Brien, Beverley, Ohlsson, Arne, Wen, Shi Wu, Gulmezoghu, Metin, Shah, Archana, Villar, Jose, Yang, Jie, Armson, B. Anthony, Carson, George D., da Silva, Orlando, Heaman, Maureen, Janssen, Patricia, Murphy, Phil A., Pasquier, Jean Charles, Sauve, Reg, Von Dadelszen, Peter, Walker, Mark, and Lee, Shoo K.

Published
2022
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24. Halting the Canadian STRIDER randomised controlled trial of sildenafil for severe, early-onset fetal growth restriction: ethical, methodological, and pragmatic considerations

Author

von Dadelszen, Peter, Audibert, François, Bujold, Emmanuel, Bone, Jeffrey N., Sandhu, Ash, Li, Jing, Kariya, Chirag, Chung, Youkee, Lee, Tang, Au, Kelvin, Skoll, M. Amanda, Vidler, Marianne, Magee, Laura A., Piedboeuf, Bruno, Baker, Philip N., Lalji, Sayrin, and Lim, Kenneth I.

Published
2022
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31. Calcium supplementation for the prevention of pre‐eclampsia: Challenging the evidence from meta‐analyses.

Author

Wright, David, Wright, Alan, Magee, Laura A., Von Dadelszen, Peter, and Nicolaides, Kypros H.

Subjects
SENSITIVITY analysis, CALCIUM, CONFIDENCE intervals, DIETARY supplements, DATA analysis
Abstract

Objective: To investigate the validity of the conclusion from Cochrane reviews and meta‐analyses that treatment with calcium supplementation during pregnancy reduces the risk for pre‐eclampsia by 55%, which has been influential in international guidelines and future research. Design: Sensitivity analysis of data from Cochrane reviews of trials evaluating high‐dose calcium supplementation (of at least 1 g/day) for reduction of pre‐eclampsia risk. Setting: Systematic review and meta‐analysis. Population: The Cochrane reviews and meta‐analyses included 13 trials enrolling a total of 15 730 women. Random‐effects meta‐analysis of these studies resulted in a mean risk ratio (RR, calcium/placebo) of 0.45 (95% confidence interval [CI] 0.31–0.65; p < 0.0001). Methods: We carried out a sensitivity analysis of evidence from the relevant Cochrane review, to examine the impact of study size. Main outcome measures: pre‐eclampsia. Results: In the three largest studies, accounting for 13 815 (88%) of total recruitment, mean RR was 0.92 (95% CI 0.80–1.06) and there was no evidence of heterogeneity between studies (I2 = 0). With inclusion of the smaller studies, mean RR decreased to 0.45 and I2 increased to 70%. Conclusions: In assessment of the effect of calcium supplementation on pre‐eclampsia risk, the naive focus on the mean of the random‐effects meta‐analysis in the presence of substantial heterogeneity is highly misleading. Linked article: This article is commented on by Thornton pp. 1530–1531 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.17805. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Post-Pandemic Maternity Care Planning for Vaccination: A Qualitative Study of the Experiences of Women, Partners, Health Care Professionals, and Policy Makers in the United Kingdom.

Author

Dasgupta, Tisha, Boulding, Harriet, Easter, Abigail, Sutedja, Tania, Khalil, Asma, Mistry, Hiten D., Horgan, Gillian, Van Citters, Aricca D., Nelson, Eugene C., von Dadelszen, Peter, Duncan, Emma L., Silverio, Sergio A., and Magee, Laura A.

Subjects
MEDICAL personnel, COVID-19, COVID-19 vaccines, PREGNANT women, MATERNAL health services
Abstract

Maternal vaccination during pregnancy, in general and against COVID-19 infection, offers protection to both mother and baby, but uptake remains suboptimal. This study aimed to explore the perceptions regarding COVID-19 vaccination in pregnancy, particularly for marginalised populations and those living with social or medical complexity. A total of 96 semi-structured in-depth interviews were conducted with 40 women, 15 partners, 21 HCPs, and 20 policy makers, across all four nations of the United Kingdom (UK), discussing their lived experience of utilising, delivering, or developing policy for COVID-19 vaccination in pregnancy during the pandemic. Three themes were derived: (1) historical and social context, (2) communication of information and guidance, and (3) appraisal and action. Together these captured the participants' legacy of mistrust in drugs during pregnancy; prior positive experiences; concerns about missing information, conflicting information, or false information about COVID-19 vaccines; and confusing guidance for pregnant women. The final theme describes the participants' behaviour and actions undertaken consequent to their experiences and the available information. The findings suggest efforts to improve COVID-19 vaccination in pregnancy may be best focused on personalised communication of information. A trusting relationship and prior positive experiences with other vaccines, both in and outside of pregnancy, positively influenced perceptions of COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Author reply

Author

Wright, David, primary, Wright, Alan, additional, Magee, Laura A., additional, Von Dadelszen, Peter, additional, and Nicolaides, Kypros H., additional

Published
2024
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35. Machine learning-enabled maternal risk assessment for women with pre-eclampsia (the PIERS-ML model): a modelling study

Author

Montgomery-Csobán, Tünde, primary, Kavanagh, Kimberley, additional, Murray, Paul, additional, Robertson, Chris, additional, Barry, Sarah J E, additional, Vivian Ukah, U, additional, Payne, Beth A, additional, Nicolaides, Kypros H, additional, Syngelaki, Argyro, additional, Ionescu, Olivia, additional, Akolekar, Ranjit, additional, Hutcheon, Jennifer A, additional, Magee, Laura A, additional, von Dadelszen, Peter, additional, Brown, Mark A., additional, Davis, Gregory K., additional, Parker, Claire, additional, Walters, Barry N., additional, Sass, Nelson, additional, Ansermino, J. Mark, additional, Cao, Vivien, additional, Cundiff, Geoffrey W., additional, von Dadelszen, Emma C.M., additional, Douglas, M. Joanne, additional, Dumont, Guy A., additional, Dunsmuir, Dustin T., additional, Hutcheon, Jennifer A., additional, Joseph, K.S., additional, Lalji, Sayrin, additional, Lee, Tang, additional, Li, Jing, additional, Lim, Kenneth I., additional, Lisonkova, Sarka, additional, Lott, Paula, additional, Menzies, Jennifer M., additional, Millman, Alexandra L., additional, Palmer, Lynne, additional, Payne, Beth A., additional, Qu, Ziguang, additional, Russell, James A., additional, Sawchuck, Diane, additional, Shaw, Dorothy, additional, Still, D. Keith, additional, Ukah, U. Vivian, additional, Wagner, Brenda, additional, Walley, Keith R., additional, Hugo, Dany, additional, Gruslin, The late Andrée, additional, Tawagi, George, additional, Smith, Graeme N., additional, Côté, Anne-Marie, additional, Moutquin, Jean-Marie, additional, Ouellet, Annie B., additional, Lee, Shoo K., additional, Duan, Tao, additional, Zhou, Jian, additional, Haniff, The late Farizah, additional, Mahajan, Swati, additional, Noovao, Amanda, additional, Karjalainend, Hanna, additional, Kortelainen, Alja, additional, Laivuori, Hannele, additional, Ganzevoort, J. Wessel, additional, Groen, Henk, additional, Kyle, Phillipa M., additional, Moore, M. Peter, additional, Pullar, Barbra, additional, Bhutta, Zulfiqar A., additional, Qureshi, Rahat N., additional, Sikandar, Rozina, additional, Bhutta, The late Shereen Z., additional, Cloete, Garth, additional, Hall, David R., additional, van Papendorp, The late Erika, additional, Steyn, D. Wilhelm, additional, Biryabarema, Christine, additional, Mirembe, Florence, additional, Nakimuli, Annettee, additional, Allotey, John, additional, Thangaratinam, Shakila, additional, Nicolaides, Kypros H., additional, de Swiet, Michael, additional, Magee, Laura A., additional, Walker, James J., additional, Robson, Stephen C., additional, Broughton-Pipkin, Fiona, additional, Loughna, Pamela, additional, Vatish, Manu, additional, Redman, Christopher W.G., additional, Barry, Sarah J.E., additional, Montgomery-Csobán, Tunde, additional, Tsigas, Eleni Z., additional, Woelkers, Douglas A., additional, Lindheimer, Marshall D., additional, Grobman, William A., additional, Sibai, Baha M., additional, Merialdi, Mario, additional, and Widmer, Mariana, additional

Published
2024
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41. Causes and circumstances of maternal death: a secondary analysis of the Community-Level Interventions for Pre-eclampsia (CLIP) trials cohort

Author

Woo Kinshella, Mai-Lei, Wong, Hubert, von Dadelszen, Peter, Vilanculo, Faustino, Vidler, Marianne, Valá, Anifa, Ukah, Ugochi V, Tu, Domena K, Thabane, Lehana, Tchavana, Corsino, Thornton, Jim, Sotunsa, John O, Singer, Joel, Sheikh, Sana, Sharma, Sumedha, Sevene, Esperança, Schuurman, Nadine, Sawchuck, Diane, Sacoor, Charfudin, Revankar, Amit P, Raza, Farrukh, Ramdurg, Umesh Y, Qureshi, Rahat N, Pires, Rosa, Payne, Beth A, Nobela, Vivalde, Nkumbula, Cláudio, Nhancolo, Ariel, Nhamirre, Zefanias, Munguambe, Khátia, Mungarwadi, Geetanjali I, Mulungo, Dulce, Mocumbi, Sibone, Mitton, Craig, Merialdi, Mario, Memon, Javed, Matavele, Analisa, Mastiholi, Sphoorthi S, Mandlate, Ernesto, Mallapur, Ashalata A, Magee, Laura A, Maculuve, Sónia, Macuacua, Salésio, Macete, Eusébio, Macamo, Marta, Lui, Mansun, Li, Jing, Lewis, Gwyneth, Lewin, Simon, Lee, Tang, Langer, Ana, Kudachi, Uday S, Kodkany, Bhalachandra S, Knight, Marian, Kengapur, Gudadayya S, Kavi, Avinash J, Katageri, Geetanjali, Kariya, Chirag, Karadiguddi, Chandrappa C, Kamble, Namdev A, Joshi, Anjali M, Hutton, Eileen, Hussain, Amjad, Honnungar, Narayan V, Hoodbhoy, Zahra, Grobman, William, Goudar, Shivaprasad S, Gonçálves, Emília, Firoz, Tabassum, Fillipi, Veronique, Filimone, Paulo, Engelbrecht, Susheela M, Dunsmuir, Dustin T, Dumont, Guy, Drebit, Sharla K, Donnay, France, Dharamsi, Shafik, Dhamanekar, Vaibhav B, Derman, Richard, Darlow, Brian, Cutana, Silvestre, Chougala, Keval S, Chiaú, Rogério, Charantimath, Umesh, Byaruhanga, Romano Nkumbwa, Bone, Jeffrey N, Boene, Helena, Biz, Ana Ilda, Bique, Cassimo, Bhutta, Zulfiqar A, Betrán, Ana Pilar, Bellad, Mrutyunjaya B, Bannale, Shashidhar G, Aukes, Annet M, Augusto, Orvalho, Arion, Kristina, Ansermino, J Mark, Amose, Felizarda, Ahmed, Imran, and Adetoro, Olalekan O

Published
2021
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42. Blood pressure thresholds in pregnancy for identifying maternal and infant risk: a secondary analysis of Community-Level Interventions for Pre-eclampsia (CLIP) trial data

Author

Woo Kinshella, Mai-Lei, Wong, Hubert, Vilanculo, Faustino, Vala, Anifa, Ukah, Ugochi V, Tu, Domena K, Thabane, Lehana, Tchavana, Corsino, Thornton, Jim, Sotunsa, John O, Sheikh, Sana, Sharma, Sumedha, Schuurman, Nadine, Sawchuck, Diane, Revankar, Amit P, Raza, Farrukh, Ramdurg, Umesh Y, Pires, Rosa, Payne, Beth A, Nobela, Vivalde, Nkumbula, Cláudio, Nhancolo, Ariel, Nhamirre, Zefanias, Mungarwadi, Geetanjali I, Mulungo, Dulce, Mocumbi, Sibone, Mitton, Craig, Merialdi, Mario, Memon, Javed, Matavele, Analisa, Mastiholi, Sphoorthi S, Mandlate, Ernesto, Maculuve, Sónia, Macuacua, Salésio, Macete, Eusébio, Macamo, Marta, Lui, Mansun, Li, Jing, Lewis, Gwyneth, Lewin, Simon, Lee, Tang, Langer, Ana, Kudachi, Uday S, Kodkany, Bhalachandra S, Knight, Marian, Kengapur, Gudadayya S, Kavi, Avinash J, Katageri, Geetanjali M, Kariya, Chirag, Karadiguddi, Chandrappa C, Kamble, Namdev A, Joshi, Anjali M, Hutton, Eileen, Hussain, Amjad, Hoodbhoy, Zahra, Honnungar, Narayan V, Grobman, William, Gonçálves, Emília, Firoz, Tabassum, Fillipi, Veronique, Filimone, Paulo, Engelbrecht, Susheela M, Dunsmuir, Dustin T, Dumont, Guy, Drebit, Sharla K, Donnay, France, Dharamsi, Shafik, Dhamanekar, Vaibhav B, Derman, Richard, Darlow, Brian, Cutana, Silvestre, Chougala, Keval S, Chiaú, Rogério, Charantimath, Umesh S, Byaruhanga, Romano Nkumbwa, Boene, Helena, Biz, Ana Ilda, Bique, Cassimo, Betrán, Ana Pilar, Bannale, Shashidhar G, Augusto, Orvalho, Ansermino, J Mark, Amose, Felizarda, Ahmed, Imran, Adetoro, Olalekan O, Bone, Jeffrey N, Magee, Laura A, Singer, Joel, Nathan, Hannah, Qureshi, Rahat N, Sacoor, Charfudin, Sevene, Esperança, Shennan, Andrew, Bellad, Mrutyunjaya B, Goudar, Shivaprasad S, Mallapur, Ashalata A, Munguambe, Khátia, Vidler, Marianne, Bhutta, Zulfiqar A, and von Dadelszen, Peter

Published
2021
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43. The ability and safety of community-based health workers to safely initiate lifesaving therapies for pre-eclampsia in Ogun State, Nigeria: An analysis of 260 community treatments with MgSO4 and/or methyldopa

Author

Adepoju, Akinmade A., Vidler, Marianne, Akadri, Adebayo A., Jaiyesimi, Ebun, Nwankpa, Chimaobi C., Odubena, Oluwafayokemi O., Sharma, Sumedha, Li, Larry, Tu, Domena, Drebit, Sharla, Payne, Beth, Akeju, David O., Bhutta, Zulfiqar, Magee, Laura A., Nathan, Hannah L., Shennan, Andrew H., Sotunsa, John, Adetoro, Olalekan O., von Dadelszen, Peter, Dada, Olukayode A., and Soyinka, Olaokun

Published
2021
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47. Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa : an analysis of verbal autopsy data from six countries

Author

Gazeley, Ursula, Reniers, Georges, Romero-Prieto, Julio E., Calvert, Clara, Jasseh, Momodou, Herbst, Kobus, Khagayi, Sammy, Obor, David, Kwaro, Daniel, Dube, Albert, Dheresa, Merga, Kabudula, Chodziwadziwa W., Kahn, Kathleen, Urassa, Mark, Nyaguara, Amek, Temmerman, Marleen, Magee, Laura A., von Dadelszen, Peter, Filippi, Veronique, Gazeley, Ursula, Reniers, Georges, Romero-Prieto, Julio E., Calvert, Clara, Jasseh, Momodou, Herbst, Kobus, Khagayi, Sammy, Obor, David, Kwaro, Daniel, Dube, Albert, Dheresa, Merga, Kabudula, Chodziwadziwa W., Kahn, Kathleen, Urassa, Mark, Nyaguara, Amek, Temmerman, Marleen, Magee, Laura A., von Dadelszen, Peter, and Filippi, Veronique

Abstract

Objective: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum. Design: Open population cohort (Health and Demographic Surveillance Systems). Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43–365 days postpartum adjusting for HDSS and time period (2000–2009 and 2010–2019). Main outcome measures: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). Results: Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42 days postpartum did not change significantly between 2000–2009 and 2010–2019. Conclusions: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration

Published
2024
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48. Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg.

Author

Wilson, Milly G., Bone, Jeffrey N., Slade, Laura J., Mistry, Hiten D., Singer, Joel, Crozier, Sarah R., Godfrey, Keith M., Baird, Janis, von Dadelszen, Peter, and Magee, Laura A.

Subjects
PREGNANCY outcomes, BLOOD pressure, BLOOD pressure measurement, NEONATAL intensive care units, BLOOD testing
Abstract

Objective: To examine the association with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit‐to‐visit BP variability (BPV), adjusted for BP level. Design: An observational study. Setting: Analysis of data from the population‐based UK Southampton Women's Survey (SWS). Population or sample: 3003 SWS participants. Methods: Generalised estimating equations were used to estimate crude and adjusted relative risks (RRs) of adverse pregnancy outcomes by BP thresholds, and by BPV (as standard deviation [SD], average real variability [ARV] and variability independent of the mean [VIM]). Likelihood ratios (LRs) were calculated to evaluate diagnostic test properties, for BP at or above a threshold, compared with those below. Main outcome measures: Gestational hypertension, severe hypertension, pre‐eclampsia, preterm birth (PTB), small‐for‐gestational‐age (SGA) infants, neonatal intensive care unit (NICU) admission. Results: A median of 11 BP measurements were included per participant. For BP at ≥20 weeks' gestation, higher BP was associated with more adverse pregnancy outcomes; however, only BP <140/90 mmHg was a good rule‐out test (negative LR <0.20) for pre‐eclampsia and BP ≥140/90 mmHg a good rule‐in test (positive LR >8.00) for the condition. BP ≥160/110 mmHg could rule‐in PTB, SGA infants and NICU admission (positive LR >5.0). Higher BPV (by SD, ARV, or VIM) was associated with gestational hypertension, severe hypertension, pre‐eclampsia, PTB, SGA and NICU admission (adjusted RRs 1.05–1.39). Conclusions: While our findings do not support lowering the BP threshold for pregnancy hypertension, they suggest BPV could be useful to identify elevated risk of adverse outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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49. Impact of COVID‐19 on gestational diabetes pregnancy outcomes in the UK: A multicentre retrospective cohort study.

Author

Mclennan, Niamh‐Maire, Lindsay, Robert, Saravanan, Ponnusamy, Sukumar, Nithya, White, Sara L., von Dadelszen, Peter, Burden, Christy, Hunt, Kathryn, George, Priya, Hirst, Jane E., Lattey, Katherine, Lee, Tara T. M., Murphy, Helen R., Scott, Eleanor M., Magee, Laura A., and Reynolds, Rebecca M.

Subjects
GESTATIONAL diabetes, PREGNANCY outcomes, COVID-19 pandemic, COVID-19, COHORT analysis
Abstract

Objective: To determine the impact of implementing emergency care pathway(s) for screening, diagnosing and managing women with gestational diabetes (GDM) during COVID‐19. Design: Retrospective multicentre cohort. Setting: Nine National Health Service (NHS) Hospital Trusts/Health boards in England and Scotland. Population: 4915 women with GDM pre‐pandemic (1 April 2018 to 31 March 2020), and 3467 women with GDM during the pandemic (1 May 2020 to 31 March 2021). Methods: We examined clinical outcomes for women with GDM prior to and during the pandemic following changes in screening methods, diagnostic testing, glucose thresholds and introduction of virtual care for monitoring of antenatal glycaemia. Main Outcome Measures: Intervention at birth, perinatal mortality, large‐for‐gestational‐age infants and neonatal unit admission. Results: The new diagnostic criteria more often identified GDM women who were multiparous, had higher body mass index (BMI) and greater deprivation, and less frequently had previous GDM (all p < 0.05). During COVID, these women had no differences in the key outcome measures. Of the women, 3% were identified with pre‐existing diabetes at antenatal booking. Where OGTT continued during COVID, but virtual care was introduced, outcomes were also similar pre‐ and during the pandemic. Conclusions: Using HbA1c and fasting glucose identified a higher risk GDM population during the pandemic but this had minimal impact on pregnancy outcomes. The high prevalence of undiagnosed pre‐existing diabetes suggests that women with GDM risk factors should be offered HbA1c screening in early pregnancy. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Placental growth factor testing at 19–23 weeks of gestation as a guide to subsequent care in pregnancy: A prospective observational study.

Author

Magee, Laura A., Syngelaki, Argyro, Akolekar, Ranjit, von Dadelszen, Peter, and Nicolaides, Kypros H.

Subjects
PLACENTAL growth factor, PREGNANCY, NEONATAL intensive care units, FETAL growth retardation, LONGITUDINAL method
Abstract

Objective: To determine whether serum placental growth factor (PlGF) at 19–23 weeks of gestation can improve the identification of risk for adverse outcomes. Design: Prospective observational cohort study. Setting: Two English maternity units. Population: Unselected singleton pregnancies attending routine ultrasound at 19–23 weeks of gestation. Methods: Outcomes ascertained by health record review. Diagnostic test properties evaluated clinical risk factors for pre‐eclampsia (according to National Institute of Care Excellence) or fetal growth restriction (according to Royal College of Obstetricians and Gynaecologists), low PlGF at 19–23 weeks of gestation (<5th percentile) or both. Main outcome measures: Pre‐eclampsia, gestational hypertension, stillbirth, birthweight below third percentile or neonatal intensive care unit (NICU) admission for ≥48 h. Results: In 30 013 pregnancies, risk factors were present in 9941 (33.1%), low PlGF was present in 1501 (5.0%) and both ('two‐stage' screening) were present in 547 (1.8%) pregnancies. Risk factors detected 41.7%–54.7% of adverse outcomes, and could not meaningfully revise the risk (all positive likelihood ratios, +LR, <5.0; all negative likelihood ratios, −LR, ≥0.2). Low PlGF detected 8.5%–17.4% of adverse outcomes, but meaningfully increased risks (other than NICU admission) associated with delivery <37 weeks of gestation (+LR = 5.03–15.55); all −LRs were ≥0.2. 'Two‐stage' screening detected 4.2%–8.9% of adverse outcomes, with meaningful +LRs (6.28–18.61) at <37 weeks of gestation, except for NICU admission of ≥48 h, which had an +LR of 7.56 at <34 weeks of gestation; all −LRs were ≥0.2. No screening strategy meaningfully increased or decreased the detection of adverse outcome risk at term. Conclusions: Clinical risk factor screening has a high screen‐positive rate and a poor detection of adverse outcomes. False positives cannot be reduced by PlGF testing at 19–23 weeks of gestation; therefore, this cannot be recommended as a useful strategy on its own. [ABSTRACT FROM AUTHOR]

Published
2024
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