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Johns EC, Halligan DL, Tammsalu T, Hill EA, Riha RL, Denison FC, Reynolds RM. Gene expression profiling of placentae from obese women with obstructive sleep apnoea. Placenta 2022; 121:53-60. [DOI: 10.1016/j.placenta.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 11/15/2022]
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Johns EC, Hill EA, Williams S, Sabil A, Riha RL, Denison FC, Reynolds RM. High prevalence of obstructive sleep apnea in pregnant women with class III obesity: a prospective cohort study. J Clin Sleep Med 2022; 18:423-432. [PMID: 34351847 PMCID: PMC8805001 DOI: 10.5664/jcsm.9578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To determine the prevalence of obstructive sleep apnea (OSA) in a cohort of women with class III obesity, and a comparator lean group, in the second and third trimesters of pregnancy. Secondary objectives were to compare characteristics of women with obesity with and without OSA and to assess factors that were predictive of OSA. METHODS We performed a prospective cohort study involving 33 women with class III obesity (mean body mass index 43.5 ± 3.9 kg/m2) and 39 lean women (body mass index 22.0 ± 1.7 kg/m2) with singleton pregnancies. Participants completed 2 level 3 sleep studies between 12-22 weeks and 32-38 weeks gestation. OSA was defined as a respiratory event index ≥ 5 events/h (≥ 3% desaturation criteria). Levels of interleukin-6, glucose, and C-peptide were quantified in maternal blood. Logistic regression analysis was performed to determine predictors of OSA. RESULTS OSA was identified in 12 (37.5%) and 14 (50.0%) women with obesity and in 1 (2.6%) and 3 (9.1%) lean women in the second and third trimesters, respectively. Women with obesity with OSA were older than those with no OSA but otherwise had similar characteristics. In unadjusted analysis of women with obesity, increased age, body mass index, homeostatic model assessment of insulin resistance, and history of nonsmoking were associated with increased odds of OSA. In multivariable analysis, only increased age remained significantly associated with OSA. CONCLUSIONS OSA is highly prevalent in pregnant women with class III obesity. Further research is required to establish effective management strategies for the growing number of women in this high-risk group. CITATION Johns EC, Hill EA, Williams S, et al. High prevalence of obstructive sleep apnea in pregnant women with class III obesity: a prospective cohort study. J Clin Sleep Med. 2022;18(2):423-432.
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Affiliation(s)
- Emma C. Johns
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Elizabeth A. Hill
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stevie Williams
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Renata L. Riha
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona C. Denison
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Rebecca M. Reynolds
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom
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Fazzi C, Denison FC, Saunders DH, Norman JE, Reynolds RM. Options in Pregnancy to Increase ActiveLy Sitting (OPALS) Feasibility Study. Int J Environ Res Public Health 2021; 18:5673. [PMID: 34073151 PMCID: PMC8197813 DOI: 10.3390/ijerph18115673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A negative association between obesity and pregnancy outcomes has been described, as well as between time sedentary and pregnancy outcomes. Most interventions based on physical activity involving obese pregnant women have failed in improving pregnancy outcomes. Exchanging time spent in sedentary activities with time spent in light-intensity activities, performed in a home-based setting, might help morbidly obese pregnant women. We aimed to assess the feasibility of an exercise intervention. METHODS An exercise intervention for morbidly obese pregnant women was designed involving morbidly obese pregnant women. Pregnant women with BMI ≥ 40 kg/m² with 20 or less weeks of gestation were invited to take part in the OPALS Feasibility Study. A home-based approach was employed. Participants were asked to perform the intervention for at least 12 weeks, and to register their performance in an activity diary. After the intervention, participants were asked to return the activity diary and answer a feasibility questionnaire. RESULTS In the intervention, 28 participants took part. Six women completed the intervention for 12 weeks or more. All declared they intended to keep on doing the intervention. All women reported that the exercises made them feel better. CONCLUSION Empowering, and involving morbidly obese pregnant women in taking care of themselves and giving them realistic tasks to do on their own and around their environment helps to increase commitment, as does avoiding the effect of their own weight whilst exercising. A 20% of compliance was observed in this study, which might be explained by the difficulties that pregnancy and excess weight mean. Thus, for future studies, we suggest adding a supervision plan to increase that number.
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Affiliation(s)
- Caterina Fazzi
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (C.F.); (F.C.D.)
- Department of Physical Education, Sports and Recreation, Metropolitan University of Educational Sciences, Santiago 7760197, Chile
| | - Fiona C. Denison
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (C.F.); (F.C.D.)
| | - David H. Saunders
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh EH8 8AQ, UK;
| | - Jane E. Norman
- Health Sciences Faculty Office, University of Bristol, Bristol BS8 1UD, UK;
| | - Rebecca M. Reynolds
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (C.F.); (F.C.D.)
- The British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH8 8AQ, UK
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Wastnedge EAN, Fretwell J, Johns EC, Denison FC, Reynolds RM. First and second pregnancy outcomes in women with class III obesity: An observational cohort study. Obes Res Clin Pract 2021; 15:357-361. [PMID: 34034974 DOI: 10.1016/j.orcp.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Class III obesity (BMI ≥ 40 kg/m2) during pregnancy predisposes mother and offspring to a range of adverse pregnancy complications and outcomes. Risk profiles vary between pregnancies and are affected by interpregnancy weight gain. We evaluated the risk of adverse outcomes in women with BMI ≥ 40 kg/m2 in first and second pregnancies, and the impact of interpregnancy weight change on this risk. MATERIALS AND METHODS Data were extracted for all women with BMI ≥ 40 kg/m2 at first antenatal visit, who completed antenatal and delivery care for first and second pregnancies in NHS Lothian between 1/1/2009-31/12/2018. Multiple pregnancies and recipients of bariatric surgery were excluded. RESULTS 442 pregnancies among 221 women were included. In first pregnancy, median (interquartile range) weight was 117 kg (108.5-126.7), age 28 years (24-31) and BMI 42 kg/m2 (41.0-44.5), 14.4% had gestational diabetes (GDM), 11.3% had pregnancy-induced hypertension and 44.6% had a post-partum haemorrhage (PPH). 20.8% of babies were large for gestational age (LGA, ≥97% centile at birth). In second pregnancy, women were heavier with a median weight of 119.9 kg (109.0-130.0, p = 0.00) with 19.9% gaining over 10 kg. Women were more likely to develop GDM (21.6%, p = 0.02). Babies were heavier with 40% of babies LGA (p < 0.0001). Interpregnancy weight change had no significant impact on GDM, pregnancy induced hypertension, PPH, perinatal mortality or LGA. CONCLUSIONS In a population of women with BMI ≥ 40 kg/m2, pregnancy complications are common and risk is higher in second pregnancy. The interpregnancy period is a critical time to engage women in health improvement and weight loss strategies to maximise outcomes for mother and offspring.
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Affiliation(s)
- Elizabeth A N Wastnedge
- Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Little France Drive, Edinburgh, United Kingdom.
| | - Janey Fretwell
- Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Little France Drive, Edinburgh, United Kingdom.
| | - Emma C Johns
- Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Little France Drive, Edinburgh, United Kingdom.
| | - Fiona C Denison
- Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Little France Drive, Edinburgh, United Kingdom.
| | - Rebecca M Reynolds
- Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Little France Drive, Edinburgh, United Kingdom.
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Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, Critchley HOD. Pregnancy and COVID-19. Physiol Rev 2021; 101:303-318. [PMID: 32969772 PMCID: PMC7686875 DOI: 10.1152/physrev.00024.2020] [Citation(s) in RCA: 295] [Impact Index Per Article: 98.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023] Open
Abstract
There are many unknowns for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe SARS-CoV-2 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation. These may have positive or negative effects on COVID-19 disease progression. The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management. Besides the direct impacts of the disease, a plethora of indirect consequences of the pandemic adversely affect maternal health, including reduced access to reproductive health services, increased mental health strain, and increased socioeconomic deprivation. In this review, we explore the current knowledge of COVID-19 in pregnancy and highlight areas for further research to minimize its impact for women and their children.
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Affiliation(s)
- Elizabeth A N Wastnedge
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sara R van Boeckel
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah J Stock
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona C Denison
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacqueline A Maybin
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Hilary O D Critchley
- Tommy's Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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Viola IM, Peterson B, Pisetta G, Pavar G, Akhtar H, Menoloascina F, Mangano E, Dunn KE, Gabl R, Nila A, Molinari E, Cummins C, Thompson G, Lo TYM, Denison FC, Digard P, Malik O, Dunn MJG, McDougall CM, Mehendale FV. Face Coverings, Aerosol Dispersion and Mitigation of Virus Transmission Risk. IEEE Open J Eng Med Biol 2021; 2:26-35. [PMID: 34812420 PMCID: PMC8545035 DOI: 10.1109/ojemb.2021.3053215] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/02/2020] [Accepted: 01/12/2021] [Indexed: 11/15/2022] Open
Abstract
The SARS-CoV-2 virus is primarily transmitted through virus-laden fluid particles ejected from the mouth of infected people. Face covers can mitigate the risk of virus transmission but their outward effectiveness is not fully ascertained. Objective: by using a background oriented schlieren technique, we aim to investigate the air flow ejected by a person while quietly and heavily breathing, while coughing, and with different face covers. Results: we found that all face covers without an outlet valve reduce the front flow through by at least 63% and perhaps as high as 86% if the unfiltered cough jet distance was resolved to the anticipated maximum distance of 2-3 m. However, surgical and handmade masks, and face shields, generate significant leakage jets that may present major hazards. Conclusions: the effectiveness of the masks should mostly be considered based on the generation of secondary jets rather than on the ability to mitigate the front throughflow.
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Affiliation(s)
| | - Brian Peterson
- 1 School of EngineeringUniversity of Edinburgh Edinburgh EH9 3BF U.K
| | - Gabriele Pisetta
- 1 School of EngineeringUniversity of Edinburgh Edinburgh EH9 3BF U.K
| | - Geethanjali Pavar
- 1 School of EngineeringUniversity of Edinburgh Edinburgh EH9 3BF U.K
| | - Hibbah Akhtar
- 1 School of EngineeringUniversity of Edinburgh Edinburgh EH9 3BF U.K
- 2 Department of Mechanical EngineeringUniversity of Engineering and Technology Lahore Lahore 54890 Pakistan
| | | | - Enzo Mangano
- 1 School of EngineeringUniversity of Edinburgh Edinburgh EH9 3BF U.K
| | - Katherine E Dunn
- 1 School of EngineeringUniversity of Edinburgh Edinburgh EH9 3BF U.K
| | - Roman Gabl
- 1 School of EngineeringUniversity of Edinburgh Edinburgh EH9 3BF U.K
| | - Alex Nila
- 3 Lavision U.K. Ltd. Bicester EH8 9AB U.K
| | - Emanuela Molinari
- 4 School of InformaticsUniversity of Edinburgh Edinburgh EH14 4AS U.K
| | - Cathal Cummins
- 5 Maxwell Institute for Mathematical Sciences, Department of Mathematics and Institute for Infrastructure and EnvironmentHeriot-Watt University Edinburgh EH16 4SB U.K
| | - Gerard Thompson
- 6 Centre for Clinical Brain Sciences, University of Edinburgh Edinburgh EH16 4SB U.K
| | - Tsz-Yan Milly Lo
- 7 Paediatric Critical Care Unit, Royal Hospital for Sick Children Edinburgh EH16 4UX U.K
- 8 Usher InstituteUniversity of Edinburgh Edinburgh EH16 4UX U.K
| | - Fiona C Denison
- 9 The Queen's Medical Research InstituteUnivesity of Edinburgh Edinburgh EH16 4TJ U.K
| | - Paul Digard
- 10 The Roslin InstituteUniversity of Edinburgh Midlothian EH25 9RG U.K
| | - Omair Malik
- 11 Department of AnaesthesiaRoyal Hospital for Sick Children Edinburgh EH9 1LF U.K
| | - Mark J G Dunn
- 12 Department of Critical CareNHS Lothian Edinburgh EH1 3EG U.K
| | - Catherine M McDougall
- 7 Paediatric Critical Care Unit, Royal Hospital for Sick Children Edinburgh EH16 4UX U.K
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Johns EC, Denison FC, Reynolds RM. Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes. Acta Physiol (Oxf) 2020; 229:e13458. [PMID: 32087033 DOI: 10.1111/apha.13458] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022]
Abstract
Sleep disordered breathing (SDB) is a common obesity-related co-morbidity with strong associations to cardiometabolic disease. The risk of SDB is increased during pregnancy, particularly among obese pregnant women. Accumulating evidence suggests that an association exists between maternal SDB and the development of adverse pregnancy outcomes, particularly gestational diabetes and hypertensive disorders of pregnancy. Intermittent hypoxia, a central characteristic of SDB, has been shown in animal and clinical studies to dysregulate several biological pathways. This includes the promotion of oxidative stress, increased inflammation, activation of the hypothalamic-pituitary-adrenal axis, increased sympathetic activity and impaired glucose and insulin metabolism. This review considers how, during pregnancy, these pathophysiological processes are plausible mechanisms through which SDB may contribute to an increased risk of adverse outcomes, for the mother and perhaps also the offspring. However, a lack of robust evidence specific to the pregnant population, including limited evaluation of the placental function in affected pregnancies, limits our ability to draw definite conclusions on mechanisms contributing to adverse pregnancy outcomes and, indeed, the strength of association between SDB and certain pregnancy complications.
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Affiliation(s)
- Emma C. Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
| | - Fiona C. Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
| | - Rebecca M. Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
- BHF/University Centre for Cardiovascular Science University of Edinburgh, Queen's Medical Research Institute Edinburgh United Kingdom
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Abokhrais IM, Denison FC, Whitaker LHR, Saunders PTK, Doust A, Williams LJ, Horne AW. Correction: A two-arm parallel double-blind randomised controlled pilot trial of the efficacy of Omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis-associated pain (PurFECT1). PLoS One 2020; 15:e0230055. [PMID: 32106274 PMCID: PMC7046280 DOI: 10.1371/journal.pone.0230055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Johns EC, Denison FC, Reynolds RM. The impact of maternal obesity in pregnancy on placental glucocorticoid and macronutrient transport and metabolism. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165374. [PMID: 30684643 DOI: 10.1016/j.bbadis.2018.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/12/2018] [Accepted: 12/26/2018] [Indexed: 12/15/2022]
Abstract
Maternal obesity is the most common metabolic disturbance in pregnancy affecting >1 in 5 women in some countries. Babies born to obese women are heavier with more adiposity at birth, and are vulnerable to obesity and metabolic disease across the lifespan suggesting offspring health is 'programmed' by fetal exposure to an obese intra-uterine environment. The placenta plays a major role in dictating the impact of maternal health on prenatal development. Maternal obesity impacts the function of integral placental receptors and transporters for glucocorticoids and nutrients, key drivers of fetal growth, though mechanisms remain poorly understood. This review aims to summarise current knowledge in this area, and considers the impact of obesity on the epigenetic machinery of the placenta at this vital juncture in offspring development. Further research is required to advance understanding of these areas in the hope that the trans-generational cycle of obesity can be alleviated.
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Affiliation(s)
- Emma C Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom; BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, United Kingdom.
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Abokhrais IM, Denison FC, Whitaker LHR, Saunders PTK, Doust A, Williams LJ, Horne AW. A two-arm parallel double-blind randomised controlled pilot trial of the efficacy of Omega-3 polyunsaturated fatty acids for the treatment of women with endometriosis-associated pain (PurFECT1). PLoS One 2020; 15:e0227695. [PMID: 31951599 PMCID: PMC6968860 DOI: 10.1371/journal.pone.0227695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background Endometriosis is defined by the presence of endometrial-like tissue (lesions) outside the uterus, commonly on the pelvic peritoneum. It affects 6–10% of women and is associated with debilitating pelvic pain. Current management options are often unsatisfactory. Omega-3 polyunsaturated fatty acids (O-PUFA) have the potential to reduce the painful symptoms associated with endometriosis, reduce lesion size, preserve the patient’s ability to conceive, and have minimal side effects. We performed a two-arm, parallel double-blinded randomised controlled trial to inform the planning of a future multicentre randomised controlled trial to evaluate the efficacy of O-PUFA for endometriosis-associated pain. Objectives The primary objectives of the trial were to assess recruitment and retention rates. The secondary objectives were to determine the acceptability to women of the proposed methods of recruitment, randomisation, treatments and questionnaires, to estimate the variability in the proposed primary endpoints to inform the sample size calculation and to refine the research methodology for the future definitive trial. Methods We recruited women with endometriosis from June 2016 to June 2017 and randomised them to eight weeks of treatment with O-PUFA or olive oil. Pain scores and quality of life questionnaires were collected at baseline and eight weeks. We calculated the proportion of eligible women randomised, and of randomised participants who were followed up to eight weeks. Acceptability questionnaires were used to evaluate women’s experiences of the trial. Results The proportion of eligible participants who were randomised was 45.2% (33/73) and 81.8% (27/33) completed the study. The majority of participants described their overall trial experience favourably and there were no adverse events in either group. Conclusion Our pilot trial supports the feasibility of a future larger trial to definitively evaluate the efficacy of O-PUFA for endometriosis-associated pain. Trial registration The trial was registered on the ISRCTN registry (registration number ISRCTN44202346).
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Affiliation(s)
- Ibtisam M. Abokhrais
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona C. Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucy H. R. Whitaker
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Ann Doust
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew W. Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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Denison FC, Carruthers KF, Hudson J, McPherson G, Scotland G, Brook-Smith S, Clarkson C, Peace M, Brewin J, Chua GN, Hallowell N, Norman JE, Lawton J, Norrie J. Glyceryl trinitrate to reduce the need for manual removal of retained placenta following vaginal delivery: the GOT-IT RCT. Health Technol Assess 2019; 23:1-72. [PMID: 31912780 PMCID: PMC6970217 DOI: 10.3310/hta23700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Retained placenta is associated with postpartum haemorrhage and can lead to significant maternal morbidity if untreated. The only effective treatment is the surgical procedure of manual removal of placenta, which is costly, requires skilled staff, requires an operative environment and is unpleasant for women. Small studies suggest that glyceryl trinitrate may be an effective medical alternative. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of sublingual glyceryl trinitrate spray compared with placebo in reducing the need for manual removal of placenta in women with retained placenta after vaginal delivery following the failure of current management. DESIGN A group-sequential randomised double-blind placebo-controlled trial with a cost-effectiveness analysis. SETTING There were 29 obstetric units in the UK involved in the study. PARTICIPANTS There were 1107 women (glyceryl trinitrate group, n = 543; placebo group, n = 564) randomised between October 2014 and July 2017. INTERVENTIONS Glyceryl trinitrate spray was administered to 541 women in the intervention group, and a placebo was administered to 563 women in the control group. MAIN OUTCOME MEASURES Four primary outcomes were defined: (1) clinical - the need for manual removal of placenta, (2) safety - measured blood loss, (3) patient sided - satisfaction with treatment and side effects and (4) economic - cost-effectiveness of both treatments using the UK NHS perspective. Secondary clinical outcomes included a > 15% decrease in haemoglobin level, time from randomisation to delivery of placenta in theatre, the need for earlier manual removal of placenta than planned, increase in heart rate or decrease in blood pressure, requirement for blood transfusion, requirement for general anaesthesia, maternal pyrexia, and sustained uterine relaxation requiring additional uterotonics. RESULTS No difference was observed between the glyceryl trinitrate group and the control group for the placenta remaining undelivered within 15 minutes of study treatment (93.3% vs. 92%; odds ratio 1.01, 95% confidence interval 0.98 to 1.04; p = 0.393). There was no difference in blood loss of > 1000 ml between the glyceryl trinitrate group and the control group (22.2% vs. 15.5%; odds ratio 1.14, 95% confidence interval 0.88 to 1.48; p = 0.314). Palpitations were more common in the glyceryl trinitrate group than in the control group after taking the study drug (9.8% vs. 4.0%; odds ratio 2.60, 95% confidence interval 1.40 to 4.84; p = 0.003). There was no difference in any other measures of patient satisfaction between the groups. There was no difference in costs to the health service between groups (mean difference £55.30, 95% confidence interval -£199.20 to £309.79). Secondary outcomes revealed that a fall in systolic or diastolic blood pressure, or an increase in heart rate, was more common in the glyceryl trinitrate group than in the control group (odds ratio 4.9, 95% confidence interval 3.7 to 6.4; p < 0.001). The need for a blood transfusion was also more common in the glyceryl trinitrate group than in the control group (odds ratio 1.53, 95% confidence interval 1.04 to 2.25; p = 0.033). CONCLUSIONS Glyceryl trinitrate spray did not increase the delivery of retained placenta within 15 minutes of administration when compared with the placebo, and was not cost-effective for medical management of retained placenta. More participants reported palpitations and required a blood transfusion in the glyceryl trinitrate group. Further research into alternative methods of medical management of retained placenta is required. TRIAL REGISTRATION Current Controlled Trials ISRCTN88609453. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 70. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kathryn F Carruthers
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gladys McPherson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sheonagh Brook-Smith
- Simpson's Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Cynthia Clarkson
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Mathilde Peace
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Gin Nie Chua
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Julia Lawton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit/Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Denison FC, Carruthers KF, Hudson J, McPherson G, Chua GN, Peace M, Brewin J, Hallowell N, Scotland G, Lawton J, Norrie J, Norman JE. Nitroglycerin for treatment of retained placenta: A randomised, placebo-controlled, multicentre, double-blind trial in the UK. PLoS Med 2019; 16:e1003001. [PMID: 31887169 PMCID: PMC6936786 DOI: 10.1371/journal.pmed.1003001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Retained placenta following vaginal delivery is a major cause of postpartum haemorrhage. Currently, the only effective treatments for a retained placenta are the surgical procedures of manual removal of placenta (MROP) and uterine curettage, which are not universally available, particularly in low- and middle-income countries. The objective of the trial was to determine whether sublingual nitroglycerin spray was clinically effective and cost-effective for medical treatment of retained placenta following vaginal delivery. METHODS AND FINDINGS A randomised, placebo-controlled, double-blind trial was undertaken between October 2014 and July 2017 at 29 delivery units in the UK (Edinburgh, Glasgow, Manchester, Newcastle, Preston, Warrington, Chesterfield, Crewe, Durham, West Middlesex, Aylesbury, Furness, Southampton, Bolton, Sunderland, Oxford, Nottingham [2 units], Burnley, Chertsey, Stockton-on-Tees, Middlesborough, Chester, Darlington, York, Reading, Milton Keynes, Telford, Frimley). In total, 1,107 women with retained placenta following vaginal delivery were recruited. The intervention was self-administered 2 puffs of sublingual nitroglycerin (800 μg; intervention, N = 543) or placebo spray (control, N = 564). The primary clinical outcome was the need for MROP, assessed at 15 minutes following administration of the intervention. Analysis was based on the intention-to-treat principle. The primary safety outcome was measured blood loss between study drug administration and transfer to the postnatal ward or other clinical area. The primary patient-sided outcomes were satisfaction with treatment and side-effect profile, assessed by questionnaires pre-discharge and 6 weeks post-delivery. Secondary clinical outcomes were measured at 5 and 15 minutes after study drug administration and prior to hospital discharge. There was no statistically significant or clinically meaningful difference in need for MROP by 15 minutes (primary clinical outcome, 505 [93.3%] for nitroglycerin versus 518 [92.0%] for placebo, odds ratio [OR] 1.01 [95% CI 0.98-1.04], p = 0.393) or blood loss (<500 ml: nitroglycerin, 238 [44.3%], versus placebo, 249 [44.5%]; 500 ml-1,000 ml: nitroglycerin, 180 [33.5%], versus placebo, 224 [40.0%]; >1,000 ml: nitroglycerin, 119 [22.2%], versus placebo, 87 [15.5%]; ordinal OR 1.14 [95% CI 0.88-1.48], p = 0.314) or satisfaction with treatment (nitroglycerin, 288 [75.4%], versus placebo, 303 [78.1%]; OR 0.87 [95% CI 0.62-1.22], p = 0.411) or health service costs (mean difference [£] 55.3 [95% CI -199.20 to 309.79]). Palpitations following drug administration were reported more often in the nitroglycerin group (36 [9.8%] versus 15 [4.0%], OR 2.60 [95% CI 1.40-4.84], p = 0.003). There were 52 serious adverse events during the trial, with no statistically significant difference in likelihood between groups (nitroglycerin, 27 [5.0%], versus placebo, 26 [4.6%]; OR 1.13 [95% CI 0.54-2.38], p = 0.747). The main limitation of our study was the low return rate for the 6-week postnatal questionnaire. There were, however, no differences in questionnaire return rates between study groups or between women who did and did not have MROP, with the patient-reported use of outpatient and primary care services at 6 weeks accounting for only a small proportion (approximately 5%) of overall health service costs. CONCLUSIONS In this study, we found that nitroglycerin is neither clinically effective nor cost-effective as a medical treatment for retained placenta, and has increased side effects, suggesting it should not be used. Further research is required to identify an effective medical treatment for retained placenta to reduce the morbidity caused by this condition, particularly in low- and middle-income countries where surgical management is not available. TRIAL REGISTRATION ISRCTN.com ISRCTN88609453 ClinicalTrials.gov NCT02085213.
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Affiliation(s)
- Fiona C. Denison
- Tommy’s Centre for Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Kathryn F. Carruthers
- Tommy’s Centre for Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Gladys McPherson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Gin Nie Chua
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Mathilde Peace
- Tommy’s Centre for Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Nina Hallowell
- Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Graham Scotland
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Julia Lawton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Jane E. Norman
- Tommy’s Centre for Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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13
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Lahti-Pulkkinen M, Mina TH, Riha RL, Räikkönen K, Pesonen AK, Drake AJ, Denison FC, Reynolds RM. Maternal antenatal daytime sleepiness and child neuropsychiatric and neurocognitive development. Psychol Med 2019; 49:2081-2090. [PMID: 30293538 DOI: 10.1017/s003329171800291x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of sleep problems among pregnant women is over 50%, and daytime sleepiness is among the most common sleep problems. Previous studies have associated antenatal sleep problems with adverse maternal health and neonatal outcomes, but the consequences of antenatal sleep problems and particularly daytime sleepiness on child psychological development have not been assessed prospectively. METHODS In this prospective cohort study including 111 mother-child dyads, we examined the associations of maternal daytime sleepiness during pregnancy, assessed at 17 and 28 weeks of gestation using the Epworth Sleepiness Scale, with child neuropsychiatric problems and neuropsychological development, assessed with mother-rated questionnaires and individually administered neuropsychological tests, at child age 2.6-5.7 years (mean = 4.3 years). RESULTS Independently of sociodemographic and perinatal covariates and maternal depressive and anxiety symptoms during and/or after pregnancy, maternal antenatal daytime sleepiness was associated with increased total [unstandardized regression coefficient (B) = 0.25 standard deviation (s.d.) units; 95% confidence interval (CI) 0.01-0.48] and internalizing (B = 0.25 s.d.s: 95% CI 0.01-0.49) psychiatric problems and ADHD symptoms (B = 0.27 s.d.s: 95% CI 0.04-0.50) in children, and with poorer executive function, particularly in the areas of attention, working memory and inhibitory control (B = -0.39 s.d.s: 95% CI -0.69 to -0.10). CONCLUSIONS Maternal antenatal daytime sleepiness carries adverse consequences for offspring psychological development. The assessment of sleep problems may be an important addition to standard antenatal care.
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Affiliation(s)
- M Lahti-Pulkkinen
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - T H Mina
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - R L Riha
- Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - K Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - A K Pesonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - A J Drake
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - F C Denison
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
| | - R M Reynolds
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
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14
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Dias M, Dick A, Reynolds RM, Lahti-Pulkkinen M, Denison FC. Predictors of surgical site skin infection and clinical outcome at caesarean section in the very severely obese: A retrospective cohort study. PLoS One 2019; 14:e0216157. [PMID: 31246973 PMCID: PMC6598740 DOI: 10.1371/journal.pone.0216157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The optimal surgical approach for caesarean section is uncertain in women with very severe obesity (body mass index (BMI) >40kg/m2). We aimed to assess maternal and surgical predictors of surgical site skin infection (SSSI) in very severely obese women and to undertake an exploratory evaluation of clinical outcomes in women with a supra-panniculus transverse compared to an infra-panniculus transverse skin incision. MATERIAL AND METHODS Using a retrospective cohort design, case-records were reviewed of very severely obese women with a singleton pregnancy delivered by caesarean between August 2011 and December 2015 (n = 453) in two maternity hospitals in Scotland. Logistic regression analysis was used to determine predictors for SSSI. Outcomes were compared between women who had a supra-panniculus transverse compared to infra-panniculus transverse skin incision. RESULTS Lower maternal age was predictive of SSSI, with current smoking status and longer wound open times being marginally significant. Maternal BMI, suture method and material demonstrated univariate associations with SSSI but were not independent predictors. Women with a supra-panniculus transverse skin incision were older (32.9 (4.4), vs. 30.6 (5.7), p = 0.002), had higher BMI (49.2 (7.1), vs. 43.3 (3.3), p<0.001), shorter gestation at delivery (days) (267.7 (14.9), vs. 274.8 (14.5), p<0.001) and higher prevalence of gestational diabetes mellitus (42.6% vs. 21.9%, p = 0.002). SSSI rates did not differ between supra-panniculus transverse (13/47; 27.7%) and infra-panniculus transverse (90/406; 22.2%; p = 0.395) skin incisions. CONCLUSION SSSI rates are high in very severely obese women following caesarean section, regardless of location of skin incision.
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Affiliation(s)
- Michael Dias
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive
Health, Queen’s Medical Research Institute, Edinburgh, United
Kingdom
| | - Allyn Dick
- Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh,
United Kingdom
| | - Rebecca M. Reynolds
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive
Health, Queen’s Medical Research Institute, Edinburgh, United
Kingdom
- British Heart Foundation Centre for Cardiovascular Science, Queen's
Medical Research Institute, Edinburgh, United Kingdom
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University
of Helsinki, Helsinki, Finland
| | - Fiona C. Denison
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive
Health, Queen’s Medical Research Institute, Edinburgh, United
Kingdom
- * E-mail:
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15
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Brown AP, Reynolds RM, Denison FC. Healthy weight in pregnancy: time for a shift in approach? BJOG 2019; 126:996. [PMID: 30968995 PMCID: PMC6593962 DOI: 10.1111/1471-0528.15793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A P Brown
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK.,Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - R M Reynolds
- Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK.,British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, UK
| | - F C Denison
- Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK
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Denison FC, Aedla NR, Keag O, Hor K, Reynolds RM, Milne A, Diamond A. Care of Women with Obesity in Pregnancy: Green-top Guideline No. 72. BJOG 2019; 126:e62-e106. [PMID: 30465332 DOI: 10.1111/1471-0528.15386.000:1-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends Endocrinol Metab 2018; 29:743-754. [PMID: 30297319 DOI: 10.1016/j.tem.2018.09.004] [Citation(s) in RCA: 386] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy. The prevalence is rising and correlates with the increase in maternal obesity over recent decades. The etiology of GDM is complex, with genetic and environmental factors implicated in mechanistic and epidemiological studies. GDM begets important short- and long-term health risks for the mother, developing fetus, and offspring. This includes the high likelihood of subsequent maternal type 2 diabetes (T2DM), and possible adverse cardiometabolic phenotypes in the offspring. The most clinically and cost-effective methods of screening for GDM remain uncertain. Whilst treatments with lifestyle and pharmacological interventions have demonstrated short-term benefits, the long-term impact for the offspring of intrauterine exposure to antidiabetic medication remains unclear.
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MESH Headings
- Diabetes Complications/etiology
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/drug therapy
- Diabetes, Gestational/etiology
- Female
- Humans
- Hypertension, Pregnancy-Induced/etiology
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Infant, Newborn
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/physiopathology
- Obstetric Labor Complications/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects/chemically induced
- Prenatal Exposure Delayed Effects/metabolism
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Affiliation(s)
- Emma C Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK; BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
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Ryan DK, Haddow L, Ramaesh A, Kelly R, Johns EC, Denison FC, Dover AR, Reynolds RM. Early screening and treatment of gestational diabetes in high-risk women improves maternal and neonatal outcomes: A retrospective clinical audit. Diabetes Res Clin Pract 2018; 144:294-301. [PMID: 30244050 DOI: 10.1016/j.diabres.2018.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/04/2018] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
AIMS Evidence suggests that screening for gestational diabetes (GDM) occurs too late in pregnancy, when changes in glucose metabolism and fetal growth rates can already be detected. In August 2016 NHS Lothian began screening women with risk factors for GDM during early pregnancy (11-13 weeks). We hypothesised that an earlier identification and treatment of dysglycaemia would improve pregnancy outcomes compared to previous standard care. METHODS We compared management and outcomes for singleton pregnancies with GDM delivering at Royal Infirmary Edinburgh, UK, diagnosed through routine or early screening from 01/01/2015-31/10/2017 (routine screening n = 335, early screening n = 241). RESULTS Early screening increased the proportion of women diagnosed before 24 weeks' gestation (n = 59/335, 17.6% vs n = 103/241, 42.7%, p < 0.001) but did not change the average monthly rate of diagnosis. Early screening increased the median duration of GDM during pregnancy (71 vs 93 days of gestation, p < 0.001) with no significant changes in the pharmacological management. Early screening improved the primary composite outcome (emergency caesarean section, neonatal hypoglycaemia and macrosomia; n = 138/335, 41.2% vs n = 73/241, 30.3%, adjusted Odds Ratio [95% confidence interval] 0.62 [0.43-0.91]. CONCLUSIONS There is a role for early screening and management of GDM however it is unclear whether this represents a cost-effective intervention.
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Affiliation(s)
| | | | | | - Rod Kelly
- NHS Lothian - Neonatology, Royal Infirmary of Edinburgh, Scottish Specialist Transport and Retrieval Service, Neonatal Transport, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Emma C Johns
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Anna R Dover
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
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20
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Cummins G, Kremer J, Bernassau A, Brown A, Bridle HL, Schulze H, Bachmann TT, Crichton M, Denison FC, Desmulliez MPY. Sensors for Fetal Hypoxia and Metabolic Acidosis: A Review. Sensors (Basel) 2018; 18:E2648. [PMID: 30104478 PMCID: PMC6111374 DOI: 10.3390/s18082648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
This article reviews existing clinical practices and sensor research undertaken to monitor fetal well-being during labour. Current clinical practices that include fetal heart rate monitoring and fetal scalp blood sampling are shown to be either inadequate or time-consuming. Monitoring of lactate in blood is identified as a potential alternative for intrapartum fetal monitoring due to its ability to distinguish between different types of acidosis. A literature review from a medical and technical perspective is presented to identify the current advancements in the field of lactate sensors for this application. It is concluded that a less invasive and a more continuous monitoring device is required to fulfill the clinical needs of intrapartum fetal monitoring. Potential specifications for such a system are also presented in this paper.
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Affiliation(s)
- Gerard Cummins
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Jessica Kremer
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Anne Bernassau
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Andrew Brown
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK.
| | - Helen L Bridle
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Holger Schulze
- Division of Infection and Pathway Medicine, Edinburgh Medical School, The Chancellor's Building, The University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK.
| | - Till T Bachmann
- Division of Infection and Pathway Medicine, Edinburgh Medical School, The Chancellor's Building, The University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK.
| | - Michael Crichton
- Institute of Mechanical, Processing and Energy Engineering, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Fiona C Denison
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK.
| | - Marc P Y Desmulliez
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
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Fazzi C, Mohd-Shukri N, Denison FC, Saunders DH, Norman JE, Reynolds RM. Activity behaviors in lean and morbidly obese pregnant women. Scand J Med Sci Sports 2018; 28:2189-2195. [PMID: 29772608 DOI: 10.1111/sms.13219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/26/2022]
Abstract
Interventions to increase physical activity in pregnancy are challenging for morbidly obese women. Targeting sedentary behaviors may be a suitable alternative to increase energy expenditure. We aimed to determine total energy expenditure, and energy expended in sedentary activities in morbidly obese and lean pregnant women. We administered the Pregnancy Physical Activity Questionnaire (nonobjective) and the Actical accelerometer (objective) to morbidly obese (BMI ≥ 40 kg/m²) and lean (BMI ≤ 25 Kg/m²) pregnant women recruited in early (<24 weeks), and late (≥24 weeks) gestation. Data are mean (SD). Morbidly obese pregnant women reported expending significantly more energy per day in early (n = 140 vs 109; 3198.4 (1847.1) vs 1972.3 (10284.8) Kcal/d, P < .0001) and late (n = 104 vs 64; 3078.2 (1356.5) vs 1947.5 (652.0) Kcal/d, P < .0001) pregnancy, and expended significantly more energy in sedentary activities, in early (816.1 (423.5) vs 540.1 (244.9) Kcal/d, P < .0001) and late (881.6 (455.4) vs 581.1 (248.5) Kcal/d, P < .0001) pregnancy, than lean pregnant women. No differences were observed in the proportion of energy expended sedentary between lean and morbidly obese pregnant women. The greater total energy expenditure in morbidly obese pregnant women was corroborated by Actical accelerometer in early (n = 14 per group, obese 1167.7 (313.6) Kcal; lean 781.1 (210.1) Kcal, P < .05), and in late (n = 14 per group, obese 1223.6 (351.5) Kcal; lean 893.7 (175.9) Kcal, P < .05) pregnancy. In conclusion, non-objective and objective measures showed morbidly obese pregnant women expended more energy per day than lean pregnant. Further studies are needed to determine whether sedentary behaviors are a suitable target for intervention in morbidly obese pregnancy.
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Affiliation(s)
- C Fazzi
- Tommy's Centre for Maternal and Fetal Health, MRC/University of Edinburgh, Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - N Mohd-Shukri
- Department of Nutrition Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - F C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC/University of Edinburgh, Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - D H Saunders
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - J E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC/University of Edinburgh, Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - R M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC/University of Edinburgh, Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK.,University BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Abokhrais IM, Saunders PTK, Denison FC, Doust A, Williams L, Horne AW. A pilot randomised double blind controlled trial of the efficacy of purified fatty acids for the treatment of women with endometriosis-associated pain (PurFECT): study protocol. Pilot Feasibility Stud 2018; 4:83. [PMID: 29721332 PMCID: PMC5918922 DOI: 10.1186/s40814-018-0274-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 04/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background Endometriosis affects 6–10% of women and is associated with debilitating pelvic pain. It costs the UK > £2.8 billion per year in loss of productivity. Endometriosis can be managed by surgical excision or medically by ovarian suppression. However, ~ 75% symptoms recur after surgery and available medical treatments have undesirable side effects and are contraceptive. Omega-3 purified fatty acids (PUFA) have been shown in animal models to reduce factors that are thought to lead to endometriosis-associated pain, have minimal side effects, and no effects on fertility. This paper presents a protocol for a two-arm, pilot parallel randomised controlled trial (RCT) which aims to inform the planning of a future multicentre trial to evaluate the efficacy of Omega-3 PUFA in the management of endometriosis-associated pain in women. Methods The study will recruit women with endometriosis over a 12-month period in the National Health Service (NHS) Lothian, UK, and randomise them to 8 weeks of treatment with Omega-3 PUFA or comparator (olive oil). The primary objective is to assess recruitment and retention rates. The secondary objectives are to determine the effectiveness/acceptability to participants of the proposed methods of recruitment/randomisation/treatments/questionnaires, to inform the sample size calculation and to refine the research methodology for a future large randomised controlled trial. Response to treatment will be monitored by pain scores and questionnaires assessing physical and emotional function compared at baseline and 8 weeks. Discussion We recognise that there may be potential difficulties in mounting a large randomised controlled trial for endometriosis to assess Omega-3 PUFA because they are a dietary supplement readily available over the counter and already used by women with endometriosis. We have therefore designed this pilot study to assess practical feasibility and following the ‘Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials’ recommendations for the design of chronic pain trials. Trial registration ISRCTN44202346
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Affiliation(s)
| | | | - Fiona C Denison
- 1MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Ann Doust
- 1MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Linda Williams
- Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Andrew W Horne
- 1MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.,4MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
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Mitrakos V, Hands PJW, Cummins G, Macintyre L, Denison FC, Flynn D, Desmulliez MPY. Nanocomposite-Based Microstructured Piezoresistive Pressure Sensors for Low-Pressure Measurement Range. Micromachines (Basel) 2018; 9:E43. [PMID: 30393319 PMCID: PMC6187228 DOI: 10.3390/mi9020043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/16/2022]
Abstract
Piezoresistive pressure sensors capable of detecting ranges of low compressive stresses have been successfully fabricated and characterised. The 5.5 × 5 × 1.6 mm³ sensors consist of a planar aluminium top electrode and a microstructured bottom electrode containing a two-by-two array of truncated pyramids with a piezoresistive composite layer sandwiched in-between. The responses of two different piezocomposite materials, a Multiwalled Carbon Nanotube (MWCNT)-elastomer composite and a Quantum Tunneling Composite (QTC), have been characterised as a function of applied pressure and effective contact area. The MWCNT piezoresistive composite-based sensor was able to detect pressures as low as 200 kPa. The QTC-based sensor was capable of detecting pressures as low as 50 kPa depending on the contact area of the bottom electrode. Such sensors could find useful applications requiring the detection of small compressive loads such as those encountered in haptic sensing or robotics.
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Affiliation(s)
- Vasileios Mitrakos
- Multimodal Sensing and Micro-Manipulation Centre, School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK.
- Institute for Integrated Micro & Nano Systems (IMNS), School of Engineering, University of Edinburgh, Edinburgh EH9 3FF, UK.
| | - Philip J W Hands
- Institute for Integrated Micro & Nano Systems (IMNS), School of Engineering, University of Edinburgh, Edinburgh EH9 3FF, UK.
| | - Gerard Cummins
- Multimodal Sensing and Micro-Manipulation Centre, School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK.
| | - Lisa Macintyre
- School of Textiles & Design, Heriot-Watt University, Galashiels TD7 4LF, UK.
| | - Fiona C Denison
- Queen's Medical Research Institute, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK.
| | - David Flynn
- Smart Systems Group, School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK.
| | - Marc P Y Desmulliez
- Multimodal Sensing and Micro-Manipulation Centre, School of Engineering & Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, UK.
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24
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Reynolds RM, Denison FC, Juszczak E, Bell JL, Penneycard J, Strachan MWJ, Lindsay RS, Alexander CI, Love CDB, Whyte S, Mackenzie F, Stenson B, Norman JE. Glibenclamide and metfoRmin versus stAndard care in gEstational diabeteS (GRACES): a feasibility open label randomised trial. BMC Pregnancy Childbirth 2017; 17:316. [PMID: 28938877 PMCID: PMC5610470 DOI: 10.1186/s12884-017-1505-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 09/11/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Metformin is widely used to treat gestational diabetes (GDM), but many women remain hyperglycaemic and require additional therapy. We aimed to determine recruitment rate and participant throughput in a randomised trial of glibenclamide compared with standard therapy insulin (added to maximum tolerated metformin) for treatment of GDM. METHODS We conducted an open label feasibility study in 5 UK antenatal clinics among pregnant women 16 to 36 weeks' gestation with metformin-treated GDM. Women failing to achieve adequate glycaemic control on metformin monotherapy were randomised to additional glibenclamide or insulin. The primary outcome was recruitment rate. We explored feasibility with uptake, retention, adherence, safety, glycaemic control, participant satisfaction and clinical outcomes. RESULTS Records of 197 women were screened and 23 women randomised to metformin and glibenclamide (n = 13) or metformin and insulin (n = 10). Mean (SD) recruitment rate was 0.39 (0.62) women/centre/month. 9/13 (69.2%, 95%CI 38.6-90.9%) women adhered to glibenclamide and all provided outcome data (100% retention). There were no episodes of severe hypoglycaemia, but metformin and insulin gave superior glycaemic control to metformin and glibenclamide, with fewer blood glucose readings <3.5 mmol/l (median [IQR] difference/woman/week of treatment 0.58 [0.03-1.87]). CONCLUSIONS A large randomised controlled trial comparing glibenclamide or insulin in combination with metformin for women with GDM would be feasible but is unlikely to be worthwhile, given the poorer glycaemic control with glibenclamide and metformin in this pilot study. The combination of metformin and glibenclamide should be reserved for women with GDM with true needle phobia or inability to use insulin therapy. TRIAL REGISTRATION www.clinicaltrials.gov registration number:NCT02080377 February 11th 2014.
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Affiliation(s)
- Rebecca M. Reynolds
- British Heart Foundation Centre for Cardiovascular Science Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
- Tommy’s Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Fiona C. Denison
- British Heart Foundation Centre for Cardiovascular Science Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
- Tommy’s Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Ed Juszczak
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
| | - Jennifer L. Bell
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF UK
| | - Jessica Penneycard
- Tommy’s Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | | | - Robert S. Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA UK
| | - Claire I. Alexander
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ UK
| | - Corinne D. B. Love
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ UK
| | - Sonia Whyte
- Tommy’s Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Fiona Mackenzie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA UK
| | - Ben Stenson
- Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ UK
| | - Jane E. Norman
- Tommy’s Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ UK
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Denison FC, Norrie J, Lawton J, Norman JE, Scotland G, McPherson GC, McDonald A, Forrest M, Hudson J, Brewin J, Peace M, Clarkson C, Brook-Smith S, Morrow S, Hallowell N, Hodges L, Carruthers KF. A pragmatic group sequential, placebo-controlled, randomised trial to determine the effectiveness of glyceryl trinitrate for retained placenta (GOT-IT): a study protocol. BMJ Open 2017; 7:e017134. [PMID: 28928192 PMCID: PMC5623532 DOI: 10.1136/bmjopen-2017-017134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/29/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A retained placenta is diagnosed when the placenta is not delivered following delivery of the baby. It is a major cause of postpartum haemorrhage and treated by the operative procedure of manual removal of placenta (MROP). METHODS AND ANALYSIS The aim of this pragmatic, randomised, placebo-controlled, double-blind UK-wide trial, with an internal pilot and nested qualitative research to adjust strategies to refine delivery of the main trial, is to determine whether sublingual glyceryl trinitrate (GTN) is (or is not) clinically and cost-effective for (medical) management of retained placenta. The primary clinical outcome is need for MROP, defined as the placenta remaining undelivered 15 min poststudy treatment and/or being required within 15 min of treatment due to safety concerns. The primary safety outcome is measured blood loss between administration of treatment and transfer to the postnatal ward or other clinical area. The primary patient-sided outcome is satisfaction with treatment and a side effect profile. The primary economic outcome is net incremental costs (or cost savings) to the National Health Service of using GTN versus standard practice. Secondary outcomes are being measured over a range of clinical and economic domains. The primary outcomes will be analysed using linear models appropriate to the distribution of each outcome. Health service costs will be compared with multiple trial outcomes in a cost-consequence analysis of GTN versus standard practice. ETHICS AND DISSEMINATION Ethical approval has been obtained from the North-East Newcastle & North Tyneside 2 Research Ethics Committee (13/NE/0339). Dissemination plans for the trial include the Health Technology Assessment Monograph, presentation at international scientific meetings and publication in high-impact, peer-reviewed journals. TRIAL REGISTRATION NUMBER ISCRTN88609453; Pre-results.
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Affiliation(s)
- Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- The Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Graham Scotland
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Gladys C McPherson
- The Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison McDonald
- The Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mark Forrest
- The Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jemma Hudson
- The Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mathilde Peace
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Cynthia Clarkson
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sheonagh Brook-Smith
- Simpson's Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Susan Morrow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Nina Hallowell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Laura Hodges
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kathryn F Carruthers
- Tommy's Centre for Maternal and Fetal Health Research, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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26
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Morris DM, Macnaught G, Aldhous MC, Semple SIK, Denison FC. Magnetic resonance hydrogen spectroscopy of the placenta at 3 Tesla for definition of normal ranges during pregnancy – Initial Analysis. Placenta 2017. [DOI: 10.1016/j.placenta.2017.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mina TH, Lahti M, Drake AJ, Denison FC, Räikkönen K, Norman JE, Reynolds RM. Prenatal exposure to maternal very severe obesity is associated with impaired neurodevelopment and executive functioning in children. Pediatr Res 2017; 82:47-54. [PMID: 28288149 DOI: 10.1038/pr.2017.43] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/06/2017] [Indexed: 01/09/2023]
Abstract
BackgroundPrenatal maternal obesity has been associated with an increased risk of neurocognitive problems in childhood, but there are fewer studies on executive functioning.MethodsTests and questionnaires to assess neurodevelopment, executive functioning, and the ability to delay gratification were conducted in 113 children (mean (SD)=4.24 (0.63) years of age) born to mothers with very severe obesity (SO, body mass index (BMI)⩾40 kg/m2, n=51) or to lean mothers (BMI⩽25 kg/m2, n=62).ResultsPrenatal maternal SO predicted poorer neurodevelopment (unstandardized regression coefficient (B)=-0.42, 95% confidence interval (CI) (-0.82; -0.02)), worse problem-solving (odd ratio (OR)=0.60, 95% CI (1.13; 0.07)), and fine motor skills (OR=4.91, 95% CI (1.27; 19.04)), poorer executive functioning in areas of attention, inhibitory control, and working memory (standardized B=3.75, 95% CI (1.01; 13.93)) but not in self-gratification delay. The effects were independent of maternal concurrent psychological well-being and child's BMI, but not independent of maternal education.ConclusionFuture studies should investigate whether perinatal management of maternal obesity could prevent adverse outcomes in child neurodevelopment.
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Affiliation(s)
- Theresia H Mina
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Marius Lahti
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Amanda J Drake
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Katri Räikkönen
- Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Rebecca M Reynolds
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
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Denison FC, MacGregor H, Stirrat LI, Stevenson K, Norman JE, Reynolds RM. Does attendance at a specialist antenatal clinic improve clinical outcomes in women with class III obesity compared with standard care? A retrospective case-note analysis. BMJ Open 2017; 7:e015218. [PMID: 28637644 PMCID: PMC5730005 DOI: 10.1136/bmjopen-2016-015218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine whether attendance at a specialised multidisciplinary antenatal clinic for women with class III obesity (BMI >40 kg/m2) is associated with improved clinical outcomes compared with standard antenatal care. DESIGN Retrospective cohort study using routinely collected data from electronic patient record. SETTING Community and hospital based antenatal care. PARTICIPANTS Women with a singleton pregnancy with class III obesity booked for antenatal care and delivered in one of two hospitals in NHS Lothian, Scotland, UK between 2008 and 2014. Maternal and offspring outcomes were compared in women who attended a specialised obesity clinic (n=511) compared with standard antenatal care (n=502). MAIN OUTCOME MEASURES Included stillbirth, low birth weight, gestational diabetes, induction of labour and caesarean section. RESULTS Compared with standard care, women receiving specialist care were less likely to have a stillbirth (OR 0.12, 95% CI 0.06 to 0.97) and a low birthweight baby (OR 0.57, 95% CI 0.33 to 0.99) and more likely to be screened for (100% vs 73.6%; p<0.001) and diagnosed with (26.0% vs 12.5%; p<0.001) gestational diabetes, to require induction of labour (38.4% vs 29.9%; p=0.009), an elective (20.3% vs 17.7%; p<0.001) and emergency (23.9% vs 20.3%; p<0.001) caesarean section and attend antenatal triage one or more times during pregnancy (77.7% vs 53.1%; p<0.001). Women attending the specialist clinic had a higher BMI (44.5 kg/m2 (4.3) vs 43.2 kg/m2 (3.1); p<0.001) and were more likely to be nulliparous (46.0% vs 24.9%; p<0.001). There were no other differences in maternal demographic or maternal and offspring outcomes between groups. CONCLUSIONS Attendance at a specialised antenatal clinic for obesity is associated with reduced rates of stillbirth and low birth weight and improved detection of gestational diabetes. The improvement in clinical outcomes is associated with an increase in healthcare attendance to obstetric triage and clinical interventions including induction of labour and caesarean section.
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Affiliation(s)
- Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Heather MacGregor
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Laura I Stirrat
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Kerrie Stevenson
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- British Heart Foundation Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK
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Swanson V, Keely A, Denison FC. Does body image influence the relationship between body weight and breastfeeding maintenance in new mothers? Br J Health Psychol 2017; 22:557-576. [DOI: 10.1111/bjhp.12246] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 04/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Vivien Swanson
- Psychology Division; Faculty of Natural Sciences; University of Stirling; UK
| | | | - Fiona C. Denison
- Maternal and Fetal Health; MRC Centre for Reproductive Health; Queen's Medical Research Institute; Edinburgh UK
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30
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Lawton J, Hallowell N, Snowdon C, Norman JE, Carruthers K, Denison FC. Written versus verbal consent: a qualitative study of stakeholder views of consent procedures used at the time of recruitment into a peripartum trial conducted in an emergency setting. BMC Med Ethics 2017; 18:36. [PMID: 28539111 PMCID: PMC5443362 DOI: 10.1186/s12910-017-0196-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/14/2017] [Indexed: 12/31/2022] Open
Abstract
Background Obtaining prospective written consent from women to participate in trials when they are experiencing an obstetric emergency is challenging. Alternative consent pathways, such as gaining verbal consent at enrolment followed, later, by obtaining written consent, have been advocated by some clinicians and bioethicists but have received little empirical attention. We explored women’s and staff views about the consent procedures used during the internal pilot of a trial (GOT-IT), where the protocol permitted staff to gain verbal consent at recruitment. Methods Interviews with staff (n = 27) and participating women (n = 22). Data were analysed thematically and interviews were cross-compared to identify differences and similarities in participants’ views about the consent procedures used. Results Women and some staff highlighted benefits to obtaining verbal consent at trial enrolment, including expediting recruitment and reducing the burden on those left exhausted by their births. However, most staff with direct responsibility for taking consent expressed extreme reluctance to proceed with enrolment until they had obtained written consent, despite being comfortable using verbal procedures in their clinical practice. To account for this resistance, staff drew a strong distinction between research and clinical care and suggested that a higher level of consent was needed when recruiting into trials. In doing so, staff emphasised the need to engage women in reflexive decision-making and highlighted the role that completing the consent form could play in enabling and evidencing this process. While most staff cited their ethical responsibilities to women, they also voiced concerns that the absence of a signed consent form at recruitment could expose them to greater risk of litigation were an individual to experience a complication during the trial. Inexperience of recruiting into peripartum trials and limited availability of staff trained to take consent also reinforced preferences for obtaining written consent at recruitment. Conclusions While alternative consent pathways have an important role to play in advancing emergency medicine research, and may be appreciated by potential recruits, they may give rise to unintended ethical and logistical challenges for staff. Staff would benefit from training and support to increase their confidence and willingness to recruit into trials using alternative consent pathways. Trial Registration This qualitative research was undertaken as part of the GOT-IT Trial (trial registration number: ISCRTN 88609453). Date of registration 26/03/2014.
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Affiliation(s)
- J Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - N Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - C Snowdon
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - J E Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - K Carruthers
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - F C Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
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Elia EG, Robb AO, Hemming K, Price MJ, Riley RD, French-Constant A, Denison FC, Kilby MD, Morris RK, Stock SJ. Is the first urinary albumin/creatinine ratio (ACR) in women with suspected preeclampsia a prognostic factor for maternal and neonatal adverse outcome? A retrospective cohort study. Acta Obstet Gynecol Scand 2017; 96:580-588. [PMID: 28247485 PMCID: PMC5413808 DOI: 10.1111/aogs.13123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/08/2017] [Indexed: 12/23/2022]
Abstract
Introduction The aim of this study was to determine the prognostic value of the first urinary albumin/creatinine ratio (ACR) for adverse maternal and neonatal outcomes and how it relates to other prognostic factors. Material and methods We performed a retrospective cohort study from December 2009 to February 2012 with analysis of demographic, clinical and biochemical data from two obstetric day assessment units in hospitals in Southeast Scotland. We included 717 pregnant women, with singleton pregnancies after 20 weeks’ gestation, referred for evaluation of suspected preeclampsia and having their first ACR performed. The ability of ACR to predict future outcomes was assessed in both univariable and multivariable logistic regression models. The latter assessed its prognostic value independent of (adjusting for) existing prognostic factors. Primary outcome measures were maternal and neonatal composite adverse outcomes, and a secondary outcome was gestation at delivery. Results In all, 204 women (28.5%) experienced a composite adverse maternal outcome and 146 women (20.4%) experienced a composite adverse neonatal outcome. Multivariate analysis of log‐transformed ACR demonstrated that a 1‐unit increase in log ACR is associated with an increased odds of adverse maternal [odds ratio 1.60, 95% confidence interval (CI) 1.45–1.80] and adverse neonatal (odds ratio 1.15, 95% CI 1.02–1.29) composite outcomes, and with reduced gestational age at delivery (coefficient: −0.46, 95% CI −0.54 to −0.38). Conclusions ACR is an independent prognostic factor for maternal and neonatal adverse outcomes in suspected preeclampsia. ACR may be useful to inform risk predictions within a prognostic model.
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Affiliation(s)
- Eleni G Elia
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Amy O Robb
- The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Karla Hemming
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Malcolm J Price
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Anna French-Constant
- The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK
| | - Mark D Kilby
- Birmingham Centre for Women's & Newborn's Health, Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel K Morris
- Birmingham Centre for Women's & Newborn's Health, Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sarah J Stock
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK.,School of Women's and Infant's Health, University of Western Australia, The University of Western Australia at King Edward Memorial Hospital, Crawley, WA, Australia
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Denison FC, Macnaught G, Semple SIK, Terris G, Walker J, Anblagan D, Serag A, Reynolds RM, Boardman JP. Brain Development in Fetuses of Mothers with Diabetes: A Case-Control MR Imaging Study. AJNR Am J Neuroradiol 2017; 38:1037-1044. [PMID: 28302607 DOI: 10.3174/ajnr.a5118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Offspring exposed to maternal diabetes are at increased risk of neurocognitive impairment, but its origins are unknown. With MR imaging, we investigated the feasibility of comprehensive assessment of brain metabolism (1H-MRS), microstructure (DWI), and macrostructure (structural MRI) in third-trimester fetuses in women with diabetes and determined normal ranges for the MR imaging parameters measured. MATERIALS AND METHODS Women with singleton pregnancies with diabetes (n = 26) and healthy controls (n = 26) were recruited prospectively for MR imaging studies between 34 and 38 weeks' gestation. RESULTS Data suitable for postprocessing were obtained from 79%, 71%, and 46% of women for 1H-MRS, DWI, and structural MRI, respectively. There was no difference in the NAA/Cho and NAA/Cr ratios (mean [SD]) in the fetal brain in women with diabetes compared with controls (1.74 [0.79] versus 1.79 [0.64], P = .81; and 0.78 [0.28] versus 0.94 [0.36], P = .12, respectively), but the Cho/Cr ratio was marginally lower (0.46 [0.11] versus 0.53 [0.10], P = .04). There was no difference in mean [SD] anterior white, posterior white, and deep gray matter ADC between patients and controls (1.16 [0.12] versus 1.16 [0.08], P = .96; 1.54 [0.16] versus 1.59 [0.20], P = .56; and 1.49 [0.23] versus 1.52 [0.23], P = .89, respectively) or volume of the cerebrum (243.0 mL [22.7 mL] versus 253.8 mL [31.6 mL], P = .38). CONCLUSIONS Acquiring multimodal MR imaging of the fetal brain at 3T from pregnant women with diabetes is feasible. Further study of fetal brain metabolism in maternal diabetes is warranted.
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Affiliation(s)
- F C Denison
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - G Macnaught
- Clinical Research Imaging Centre (G.M., S.I.K.S.)
| | - S I K Semple
- Clinical Research Imaging Centre (G.M., S.I.K.S.).,University/British Heart Foundation Centre for Cardiovascular Science (S.I.K.S., R.M.R.)
| | - G Terris
- Simpson Centre for Reproductive Health (G.T., J.W.), Royal Infirmary, Edinburgh, UK
| | - J Walker
- Simpson Centre for Reproductive Health (G.T., J.W.), Royal Infirmary, Edinburgh, UK
| | - D Anblagan
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.,Centre for Clinical Brain Sciences (D.A., J.P.B.), University of Edinburgh, Edinburgh, UK
| | - A Serag
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - R M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science (S.I.K.S., R.M.R.)
| | - J P Boardman
- From the Medical Research Council Centre for Reproductive Health (F.C.D., D.A., A.S., J.P.B.), University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.,Centre for Clinical Brain Sciences (D.A., J.P.B.), University of Edinburgh, Edinburgh, UK
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Mina TH, Lahti M, Drake AJ, Räikkönen K, Minnis H, Denison FC, Norman JE, Reynolds RM. Prenatal exposure to very severe maternal obesity is associated with adverse neuropsychiatric outcomes in children. Psychol Med 2017; 47:353-362. [PMID: 27776561 DOI: 10.1017/s0033291716002452] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prenatal maternal obesity has been linked to adverse childhood neuropsychiatric outcomes, including increased symptoms of attention deficit hyperactivity disorder (ADHD), internalizing and externalizing problems, affective disorders and neurodevelopmental problems but few studies have studied neuropsychiatric outcomes among offspring born to very severely obese women or assessed potential familial confounding by maternal psychological distress. METHOD We evaluated neuropsychiatric symptoms in 112 children aged 3-5 years whose mothers had participated in a longitudinal study of obesity in pregnancy (50 very severe obesity, BMI ⩾40 kg/m2, obese class III and 62 lean, BMI 18.5-25 kg/m2). The mothers completed the Conners' Hyperactivity Scale, Early Symptomatic Syndrome Eliciting Neurodevelopmental Clinical Examination Questionnaire (ESSENCE-Q), Child's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), and Child Behavior Checklist (CBCL) to assess child neuropsychiatric symptoms. Covariates included child's sex, age, birthweight, gestational age, socioeconomic deprivation levels, maternal age, parity, smoking status during pregnancy, gestational diabetes and maternal concurrent symptoms of anxiety and depression assessed using State Anxiety of Spielberger State-Trait Anxiety Index (STAI) and General Health Questionnaire (GHQ), respectively. RESULTS Children exposed to prenatal maternal very severe obesity had significantly higher scores in the Conners' Hyperactivity Scale; ESSENCE-Q; total sleep problems in CSHQ; hyperactivity, conduct problems and total difficulties scales of the SDQ; higher externalizing and total problems, anxious/depressed, aggressive behaviour and other problem syndrome scores and higher DSM-oriented affective, anxiety and ADHD problems in CBCL. Prenatal maternal very severe obesity remained a significant predictor of child neuropsychiatric problems across multiple scales independent of demographic factors, prenatal factors and maternal concurrent symptoms of anxiety and depression. CONCLUSIONS Prenatal maternal very severe obesity is a strong predictor of increased neuropsychiatric problems in early childhood.
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Affiliation(s)
- T H Mina
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
| | - M Lahti
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
| | - A J Drake
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
| | - K Räikkönen
- Institute of Behavioural Sciences,University of Helsinki,Helsinki,Finland
| | - H Minnis
- Institute of Health and Wellbeing,University of Glasgow,Glasgow, Scotland,UK
| | - F C Denison
- MRC Centre for Reproductive Health,Queen's Medical Research Institute,University of Edinburgh,Edinburgh, Scotland,UK
| | - J E Norman
- MRC Centre for Reproductive Health,Queen's Medical Research Institute,University of Edinburgh,Edinburgh, Scotland,UK
| | - R M Reynolds
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
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Hallowell N, Snowdon C, Morrow S, Norman JE, Denison FC, Lawton J. The role of therapeutic optimism in recruitment to a clinical trial in a peripartum setting: balancing hope and uncertainty. Trials 2016; 17:267. [PMID: 27245155 PMCID: PMC4888535 DOI: 10.1186/s13063-016-1394-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hope has therapeutic value because it enables people to cope with uncertainty about their future health. Indeed, hope, or therapeutic optimism (TO), is seen as an essential aspect of the provision and experience of medical care. The role of TO in clinical research has been briefly discussed, but the concept, and whether it can be transferred from care to research and from patients to clinicians, has not been fully investigated. The role played by TO in research emerged during interviews with staff involved in a peripartum trial. This paper unpacks the concept of TO in this setting and considers the role it may play in the wider delivery of clinical trials. METHODS The Got-it trial is a UK-based, randomised placebo-controlled trial that investigates the use of sublingual glyceryl trinitrate (GTN) spray to treat retained placenta. Qualitative data were collected in open-ended interviews with obstetricians, research and clinical midwives (n =27) involved in trial recruitment. Data were analysed using the method of constant comparison. RESULTS TO influenced staff engagement with Got-it at different points in the trial and in different ways. Prior knowledge of, and familiarity with, GTN meant that from the outset staff perceived the trial as low risk. TO facilitated staff involvement in the trial; staff who already understood GTN's effects were optimistic that it would work, and staff collaborated because they hoped that the trial would address what they identified as an important clinical need. TO could fluctuate over the course of the trial, and was sustained or undermined by unofficial observation of clinical outcomes and speculations about treatment allocation. Thus, TO appeared to be influenced by key situational factors: prior knowledge and experience, clinical need and observed participant outcomes. CONCLUSIONS Situational TO plays a role in facilitating staff engagement with clinical research. TO may affect trial recruitment by enabling staff to sustain the levels of uncertainty, or individual equipoise, necessary to collaborate with research while also responding to patients' clinical needs. Staff may benefit from training to deal with fluctuations in TO. TRIAL REGISTRATION ISCRTN88609453 . Registered on 26 March 2014.
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Affiliation(s)
- Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Claire Snowdon
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Morrow
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane E Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Fiona C Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Lawton J, Snowdon C, Morrow S, Norman JE, Denison FC, Hallowell N. Recruiting and consenting into a peripartum trial in an emergency setting: a qualitative study of the experiences and views of women and healthcare professionals. Trials 2016; 17:195. [PMID: 27066777 PMCID: PMC4827233 DOI: 10.1186/s13063-016-1323-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/01/2016] [Indexed: 01/23/2023] Open
Abstract
Background Recruiting and consenting women to peripartum trials can be challenging as the women concerned may be anxious, in pain, and exhausted; there may also be limited time for discussion and decision-making to occur. To address these potential difficulties, we undertook a qualitative evaluation of the internal pilot of a trial (Got-it) involving women who had a retained placenta (RP). We explored the experiences and views of women and staff about the information and consent pathway used within the pilot, in order to provide recommendations for use in future peripartum trials involving recruitment in emergency situations. Methods In-depth interviews were undertaken with staff (n = 27) and participating women (n = 22). Interviews were analysed thematically. The accounts of women and staff were compared to identify differences and similarities in their views about recruitment and consent procedures. Results Women and staff regarded recruitment as having been straightforward and facilitated by the use of simplified (verbal and written) summaries of trial information. Both parties, however, conveyed discordant views about whether fully informed consent had been obtained. These differences in perspectives appeared to arise from the different factors and considerations impinging on women and staff at the time of recruitment. While staff placed emphasis on promoting understanding in the emergency situation of RP by imparting information in clear and succinct ways, women highlighted the experiential realities of their pre- and post-birthing situations, and how these had led to quick decisions being made without full engagement with the potential risks of trial participation. To facilitate informed consent, women suggested that trial information should be given during the antenatal period, and, in doing so, articulated a rights-based discourse. Staff, however, voiced opposition to this approach by emphasising a duty of care to all pregnant women, and raising concerns about causing undue distress to the majority of individuals who would not subsequently develop a RP. Conclusions By drawing upon the perspectives of women and staff involved in the same trial we have shown that they may operate within different experiential and ethical paradigms. In doing so, we argue for the potential benefits of drawing upon multiple perspectives when developing information and consent pathways used in future (peripartum) trials. Trial registration ISCRTN 88609453.
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Affiliation(s)
- Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
| | - Claire Snowdon
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Morrow
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jane E Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Fiona C Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Lee EW, Denison FC, Hor K, Reynolds RM. Web-based interventions for prevention and treatment of perinatal mood disorders: a systematic review. BMC Pregnancy Childbirth 2016; 16:38. [PMID: 26928898 PMCID: PMC4770541 DOI: 10.1186/s12884-016-0831-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 02/22/2016] [Indexed: 01/17/2023] Open
Abstract
Background Perinatal depression is strikingly common with a prevalence of 10–15 %. The adverse effects of perinatal depression on maternal and child health are profound with considerable costs. Despite this, few women seek medical attention. E-health, providing healthcare via the Internet is an accessible and effective solution for the treatment of depression in the general population. We aimed to conduct a systematic review of web-based interventions for the prevention and treatment of mood disorders in the perinatal period, defined as the start of pregnancy to 1 year post-partum. Methods Six databases were searched until 26th March 2015. Two researchers independently screened articles for eligibility. Of the 547 screened articles, four met the inclusion criteria. These included three randomised-controlled trials and one feasibility trial, with total data from 1274 participants. MOOSE and PRISMA guidelines were adhered to for the conduct and reporting of the systematic review. Results All studies were conducted in the post-partum period. All reported an improvement in maternal mood following intervention. A significant improvement in depressive symptoms was measured using validated rating scales, such as the Edinburgh Postnatal Depression Scale (EPDS), either at post-treatment or follow-up which ranged from 3 to 12 months post study completion. For the two RCTs utilising the EPDS, the EPDS score reductions were (mean ± SEM) 8.52 ± 0.22 (Range 19.46 to10.94) and 9.19 ± 0.63 (Range, 20.24 to 11.05) for treatment groups and 5.16 ± 0.25 (Range 19.44 to 14.28) and 6.81 ± 0.71 (Range 21.07 to 14.26) for comparator groups. However attrition within studies ranged from 13 to 61 %. One study was rated as ‘good’ quality. Conclusions Preliminary data suggests web-based therapies for perinatal depression delivered in the post-partum period may play a role in improving maternalmood but more studies are needed, particularly with interventions delivered antenatally. Further research is needed to address the limitations of the existing evidence base. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0831-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleanor W Lee
- Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland.
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland.
| | - Kahyee Hor
- Obstetrics and Gynaecology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, Scotland.
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland. .,Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland.
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Stirrat LI, O'Reilly JR, Barr SM, Andrew R, Riley SC, Howie AF, Bowman M, Smith R, Lewis JG, Denison FC, Forbes S, Seckl JR, Walker BR, Norman JE, Reynolds RM. Decreased maternal hypothalamic-pituitary-adrenal axis activity in very severely obese pregnancy: Associations with birthweight and gestation at delivery. Psychoneuroendocrinology 2016; 63:135-43. [PMID: 26444587 DOI: 10.1016/j.psyneuen.2015.09.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/27/2015] [Accepted: 09/18/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The maternal hypothalamic-pituitary-adrenal-axis (HPAA) undergoes dramatic activation during pregnancy. Increased cortisol and corticotrophin-releasing-hormone (CRH) associate with low birthweight and preterm labor. In non-pregnant obesity, the HPAA is activated but circulating cortisol levels are normal or lower than in lean women. We hypothesized that maternal cortisol levels would be lower in obese pregnancy, and would associate with increased fetal size and length of gestation. METHOD Fasting serum cortisol was measured at 16, 28 and 36 weeks gestation and at 3-6 months postpartum in 276 severely obese and 135 lean women. In a subset of obese (n=20) and lean (n=20) we measured CRH, hormones that regulate bioavailable cortisol (corticosteroid-binding-globulin, estradiol, estriol, and progesterone). Urinary glucocorticoid metabolites were measured in pregnant (obese n=6, lean n=5) and non-pregnant (obese n=7, lean n=7) subjects. RESULTS Maternal cortisol and HPAA hormones were lower in obese pregnancy. Total urinary glucocorticoid metabolites increased significantly in lean pregnancy, but not in obese. Lower maternal cortisol in obese tended to be associated with increased birthweight (r=-0.13, p=0.066). In obese, CRH at 28 weeks correlated inversely with gestational length (r=-0.49, p=0.04), and independently predicted gestational length after adjustment for confounding factors (mean decrease in CRH of -0.25 pmol/L (95% CI -0.45 to -0.043 pmol/L) per/day increase in gestation). CONCLUSION In obese pregnancy, lower maternal cortisol without an increase in urinary glucocorticoid clearance may indicate a lesser activation of the HPAA than in lean pregnancy. This may offer a novel mechanism underlying increased birthweight and longer gestation in obese pregnancy.
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Affiliation(s)
- Laura I Stirrat
- MRC Centre for Reproductive Health, University of Edinburgh, United Kingdom; Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom
| | - James R O'Reilly
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Sarah M Barr
- MRC Centre for Reproductive Health, University of Edinburgh, United Kingdom; Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom
| | - Ruth Andrew
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Simon C Riley
- MRC Centre for Reproductive Health, University of Edinburgh, United Kingdom; Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom
| | - Alexander F Howie
- MRC Centre for Reproductive Health, University of Edinburgh, United Kingdom
| | - Maria Bowman
- Mothers and Babies Unit, University of Newcastle, Australia
| | - Roger Smith
- Mothers and Babies Unit, University of Newcastle, Australia
| | - John G Lewis
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Fiona C Denison
- MRC Centre for Reproductive Health, University of Edinburgh, United Kingdom; Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom
| | - Shareen Forbes
- Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom; University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Jonathan R Seckl
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Brian R Walker
- Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom; University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Jane E Norman
- MRC Centre for Reproductive Health, University of Edinburgh, United Kingdom; Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, University of Edinburgh, United Kingdom; Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, United Kingdom; University/BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom.
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Owens S, Gulati R, Fulford AJ, Sosseh F, Denison FC, Brabin BJ, Prentice AM. Periconceptional multiple-micronutrient supplementation and placental function in rural Gambian women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2015; 102:1450-9. [PMID: 26561613 PMCID: PMC4658455 DOI: 10.3945/ajcn.113.072413] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/10/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal micronutrient deficiencies are commonly associated with clinical indicators of placental dysfunction. OBJECTIVE We tested the hypothesis that periconceptional multiple-micronutrient supplementation (MMS) affects placental function. DESIGN We conducted a double-blind, randomized, placebo-controlled trial of MMS in 17- to 45-y-old Gambian women who were menstruating regularly and within the previous 3 mo. Eligible subjects were pre-randomly assigned to supplementation with the UNICEF/WHO/United Nations University multiple micronutrient preparation (UNIMMAP) or placebo on recruitment and until they reached their first antenatal check-up or for 1 y if they failed to conceive. Primary outcome measures were midgestational indexes of utero-placental vascular-endothelial function [ratio of plasminogen-activator inhibitor (PAI) 1 to PAI-2 and mean uterine-artery resistance index (UtARI)] and placental active transport capacity at delivery [fetal to maternal measles antibody (MMA) ratio]. RESULTS We recruited 1156 women who yielded 415 pregnancies, of which 376 met all of the inclusion criteria. With adjustment for gestational age at sampling, there were no differences in PAI-1 to PAI-2 or MMA ratios between trial arms, but there was a 0.02-unit reduction in UtARI between 18 and 32 wk of gestation (95% CI: -0.03, -0.00; P = 0.040) in women taking UNIMMAP. CONCLUSIONS Placental vascular function was modifiable by periconceptional micronutrient supplementation. However, the effect was small and supplementation did not further affect other variables of placental function. This trial was registered at www.controlled-trials.com as ISRCTN 13687662.
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Affiliation(s)
- Stephen Owens
- Children's Unit, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom; Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, Fajara, The Gambia;
| | - Ruchi Gulati
- Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, Fajara, The Gambia
| | - Anthony J Fulford
- Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, Fajara, The Gambia
| | - Fatou Sosseh
- Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, Fajara, The Gambia
| | - Fiona C Denison
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, United Kingdom; and
| | - Bernard J Brabin
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrew M Prentice
- Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, Fajara, The Gambia
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Gökirmak T, Denison FC, Laughner BJ, Paul AL, Ferl RJ. Phosphomimetic mutation of a conserved serine residue in Arabidopsis thaliana 14-3-3ω suggests a regulatory role of phosphorylation in dimerization and target interactions. Plant Physiol Biochem 2015; 97:296-303. [PMID: 26512969 DOI: 10.1016/j.plaphy.2015.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023]
Abstract
14-3-3s are evolutionarily conserved eukaryotic regulatory proteins that are involved in diverse biological processes. The common mode of action for the 14-3-3 proteins is through the binding of phosphorylated target proteins. In many species, multiple 14-3-3 isoforms exist and these different isoforms can exhibit distinct ranges of target interactions. The dimerization of 14-3-3s is central to their function. 14-3-3 isoforms can form different combinations of homo- and heterodimers, which contribute to the broad functional diversity of the family. In this study, we showed that phosphomimetic mutation of a conserved serine residue in the dimerization interface of 14-3-3 isoforms, Ser-62, not only affects the ability of Arabidopsis 14-3-3ω to form homodimers, but alters the range of 14-3-3 family members with which it can form heterodimers. Furthermore, we demonstrated that the phosphorylation status of Ser-62 can regulate the binding of 14-3-3ω to target proteins, suggesting that Ser-62 might be a conserved key element to modulate target binding in both plants and animals.
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Affiliation(s)
- Tufan Gökirmak
- Program in Plant Molecular and Cellular Biology, University of Florida, Gainesville, FL 32611, USA
| | - Fiona C Denison
- Department of Horticultural Sciences, University of Florida, Gainesville, FL 32611, USA
| | - Beth J Laughner
- Department of Horticultural Sciences, University of Florida, Gainesville, FL 32611, USA
| | - Anna-Lisa Paul
- Department of Horticultural Sciences, University of Florida, Gainesville, FL 32611, USA; Genetics Institute, University of Florida, Gainesville, FL 32611, USA
| | - Robert J Ferl
- Program in Plant Molecular and Cellular Biology, University of Florida, Gainesville, FL 32611, USA; Department of Horticultural Sciences, University of Florida, Gainesville, FL 32611, USA; Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, FL 32611, USA.
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Forbes S, Barr SM, Reynolds RM, Semple S, Gray C, Andrew R, Denison FC, Walker BR, Norman JE. Convergence in insulin resistance between very severely obese and lean women at the end of pregnancy. Diabetologia 2015; 58:2615-26. [PMID: 26248646 PMCID: PMC4589551 DOI: 10.1007/s00125-015-3708-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/03/2015] [Indexed: 11/29/2022]
Abstract
AIMS Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity. Our aim was to study metabolism in such pregnancies. METHODS We recruited a longitudinal cohort of very severely obese (n = 190) and lean (n = 118) glucose-tolerant women for anthropometric and metabolic measurements at early, mid and late gestation and postpartum. In case-control studies of very severely obese and lean women we measured glucose and glycerol turnover during low- and high-dose hyperinsulinaemic-euglycaemic clamps (HEC) at early and late pregnancy and in non-pregnant women (each n = 6-9) and body fat distribution by MRI in late pregnancy (n = 10/group). RESULTS Although greater glucose, insulin, NEFA and insulin resistance (HOMA-IR), and greater weight and % fat mass (FM) was observed in very severely obese vs lean participants, the degree of worsening was attenuated in the very severely obese individuals with advancing gestation, with no difference in triacylglycerol (TG) concentrations between very severely obese and lean women at term. Enhanced glycerol production was observed in early pregnancy only in very severely obese individuals, with similar intrahepatic FM in very severely obese vs lean women by late gestation. Offspring from obese mothers were heavier (p = 0.04). CONCLUSIONS/INTERPRETATION Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women. Increased glycerol production is confined to obese women in early pregnancy and obese and lean individuals have similar intrahepatic FM by term. When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.
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Affiliation(s)
- Shareen Forbes
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - Sarah M Barr
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Scott Semple
- Clinical Research Imaging Centre, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Calum Gray
- Clinical Research Imaging Centre, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Ruth Andrew
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Fiona C Denison
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Brian R Walker
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Jane E Norman
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
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Mina TH, Denison FC, Forbes S, Stirrat LI, Norman JE, Reynolds RM. Associations of mood symptoms with ante- and postnatal weight change in obese pregnancy are not mediated by cortisol. Psychol Med 2015; 45:3133-3146. [PMID: 26073771 DOI: 10.1017/s0033291715001087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Both maternal obesity and disordered mood have adverse effects on pregnancy outcome. We hypothesized that maternal very severe obesity (SO) is associated with increased anxiety and depression (A&D) symptoms during pregnancy, with adverse effects on gestational weight gain (GWG), postpartum mood and postpartum weight retention (PPWR) and explored any mediation by circulating glucocorticoids. METHOD We measured A&D symptoms with validated questionnaires at weeks 17 and 28 of pregnancy and 3 months postpartum in 135 lean [body mass index (BMI) ⩽25 kg/m2] and 222 SO (BMI ⩾40 kg/m2) pregnant women. Fasting serum cortisol was measured by radioimmunoassay; GWG and PPWR were recorded. RESULTS A&D symptoms were higher in the SO group during pregnancy and postpartum despite adjusting for multiple confounders including previous mental health diagnosis (p < 0.05), and were non-linearly correlated with total GWG (anxiety R 2 = 0.06, p = 0.037; depression R 2 = 0.09, p = 0.001). In the SO group only, increased maternal anxiety (β = 0.33, p = 0.03) and depression (β = 0.19, p = 0.04) symptoms at week 17 of pregnancy were associated with increased PPWR, independent of total GWG and breastfeeding. Anxiety symptoms at week 28 of pregnancy, but not depression, were non-linearly correlated with serum cortisol level at week 36 of pregnancy (R 2 = 0.06, p = 0.02). Cortisol did not mediate the link between A&D symptoms and GWG. CONCLUSIONS Maternal SO was associated with increased A&D symptoms, and with adverse effects on GWG and PPWR independent of circulating glucocorticoids. Strategies to optimize GWG and postpartum weight management in SO women should include assessment and management of maternal mood in early pregnancy.
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Affiliation(s)
- T H Mina
- University BHF Centre for Cardiovascular Sciences,Queen's Medical Research Institute,University of Edinburgh,47 Little France,Edinburgh,UK
| | - F C Denison
- Tommy's Centre for Maternal and Fetal Health,Queen's Medical Research Institute,University of Edinburgh,Edinburgh,UK
| | - S Forbes
- University BHF Centre for Cardiovascular Sciences,Queen's Medical Research Institute,University of Edinburgh,47 Little France,Edinburgh,UK
| | - L I Stirrat
- Tommy's Centre for Maternal and Fetal Health,Queen's Medical Research Institute,University of Edinburgh,Edinburgh,UK
| | - J E Norman
- Tommy's Centre for Maternal and Fetal Health,Queen's Medical Research Institute,University of Edinburgh,Edinburgh,UK
| | - R M Reynolds
- University BHF Centre for Cardiovascular Sciences,Queen's Medical Research Institute,University of Edinburgh,47 Little France,Edinburgh,UK
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Keely A, Lawton J, Swanson V, Denison FC. Barriers to breast-feeding in obese women: A qualitative exploration. Midwifery 2015; 31:532-9. [DOI: 10.1016/j.midw.2015.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 11/28/2022]
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Chiswick CA, Reynolds RM, Denison FC, Whyte SA, Drake AJ, Newby DE, Walker BR, Forbes S, Murray GD, Quenby S, Wray S, Norman JE. Efficacy of metformin in pregnant obese women: a randomised controlled trial. BMJ Open 2015; 5:e006854. [PMID: 25588785 PMCID: PMC4298109 DOI: 10.1136/bmjopen-2014-006854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Increasing evidence suggests obesity has its origins prior to birth. There is clear correlation between maternal obesity, high birthweight and offspring risk of obesity in later life. It is also clear that women who are obese during pregnancy are at greater risk of adverse outcomes, including gestational diabetes and stillbirth. The mechanism(s) by which obesity causes these problems is unknown, although hyperglycaemia and insulin resistance are strongly implicated. We present a protocol for a study to test the hypothesis that metformin will improve insulin sensitivity in obese pregnant women, thereby reducing the incidence of high birthweight babies and other pregnancy complications. METHODS AND ANALYSIS The Efficacy of Metformin in Pregnant Obese Women, a Randomised controlled (EMPOWaR) trial is a double-masked randomised placebo-controlled trial to determine whether metformin given to obese (body mass index >30 kg/m(2)) pregnant women from 16 weeks' gestation until delivery reduces the incidence of high birthweight babies. A secondary aim is to test the mechanism(s) of any effect. Obese women with a singleton pregnancy and normal glucose tolerance will be recruited prior to 16 weeks' gestation and prescribed study medication, metformin or placebo, to be taken until delivery. Further study visits will occur at 28 and 36 weeks' gestation for glucose tolerance testing and to record anthropometric measurements. Birth weight and other measurements will be recorded at time of delivery. Anthropometry of mother and baby will be performed at 3 months postdelivery. As of January 2014, 449 women had been randomised across the UK. ETHICS AND DISSEMINATION The study will be conducted in accordance with the principles of Good Clinical Practice. A favourable ethical opinion was obtained from Scotland A Research Ethics Committee, reference number 10/MRE00/12. Results will be disseminated at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN51279843.
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Affiliation(s)
- Carolyn A Chiswick
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Sonia A Whyte
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Amanda J Drake
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Brian R Walker
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Shareen Forbes
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Gordon D Murray
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Siobhan Quenby
- Department of Reproductive Health, Clinical Science Research Institute, Warwick Medical School, University Hospital, Coventry, UK
| | - Susan Wray
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jane E Norman
- Tommy's Centre for Fetal and Maternal Health, Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
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Stirrat LI, Denison FC, Love CDB, Lindsay RS, Reynolds RM. Screening and management of gestational diabetes mellitus in Scottish obstetric units: a national survey. Scott Med J 2014; 60:37-43. [PMID: 25475973 DOI: 10.1177/0036933014563458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The last study of screening practices for gestational diabetes (GDM) in the UK concluded that a lack of consensus about screening was due to a lack of clinical guidelines. We aimed to determine current practices in Scotland since new guidelines recommended that diagnosis should be made at a lower level of hyperglycaemia. METHOD AND RESULTS An online questionnaire designed to investigate the screening and management of GDM was distributed to all maternity units in Scotland managing women with GDM (n = 15) for completion by relevant clinical team members. The response rate was 100%. Considerable variation in clinical practice existed between units. Thirteen units (86.7%) had adopted the lower glucose tolerance values for diagnosis of GDM (fasting ≥5.1 mmol/L; 2-h ≥8.5 mmol/L) recommended by the Scottish Intercollegiate Guidelines Network in 2010. Available data from units using this guideline (n = 3) revealed a significant increase in the percentage of women diagnosed with GDM between 2010 and 2012 (2010: 1.28%, 2012: 2.54%; p < 0.0001). CONCLUSION Despite provision of clinical guidelines, there are still inconsistencies in screening and management of GDM in Scotland. If a similar increase in the prevalence of GDM is experienced across Scotland, there will be major implications for health care provision and resource allocation.
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Affiliation(s)
- Laura I Stirrat
- Clinical Research Fellow, Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, UK; Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, UK
| | - Fiona C Denison
- Reader/Honorary Consultant in Maternal and Fetal Health, Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh; Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, UK
| | - Corinne D B Love
- Consultant Obstetrician, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, UK
| | - Robert S Lindsay
- Reader, Institute of Cardiovascular Sciences and Medical Sciences, University of Glasgow, UK
| | - Rebecca M Reynolds
- Professor of Metabolic Medicine and Honorary Consultant Physician, Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, UK
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Abstract
OBJECTIVE To investigate the vascular functional activity, localisation and expression of B1 and B2 kinin receptors in normal pregnancy and pre-eclampsia. METHODS Kinin receptor-mediated relaxation of myometrial arteries was assessed using wire myography. Immunohistochemical staining and gene expression of kinin receptors in the myometrium was determined. RESULTS B2 receptor-mediated relaxation was reduced in pre-eclampsia. B1 receptor-mediated relaxation was observed in a proportion of healthy women and was impaired in pre-eclampsia. Receptor expression and localisation was unaltered in pre-eclampsia. CONCLUSION Here, we demonstrate a novel B1 receptor-mediated vasodilatation in healthy myometrial vessels that is absent in pre-eclampsia.
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Denison FC, Norwood P, Bhattacharya S, Duffy A, Mahmood T, Morris C, Raja EA, Norman JE, Lee AJ, Scotland G. Association between maternal body mass index during pregnancy, short-term morbidity, and increased health service costs: a population-based study. BJOG 2013; 121:72-81; discussion 82. [DOI: 10.1111/1471-0528.12443] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 12/26/2022]
Affiliation(s)
- FC Denison
- MRC Centre for Reproductive Health; University of Edinburgh; Queen's Medical Research Institute; Edinburgh UK
| | - P Norwood
- Health Economics Research Unit; University of Aberdeen; Aberdeen UK
| | - S Bhattacharya
- Obstetrics and Gynaecology; University of Aberdeen; Aberdeen UK
| | - A Duffy
- Information Services Division; NHS Scotland; Edinburgh UK
| | | | - C Morris
- Information Services Division; NHS Scotland; Edinburgh UK
| | - EA Raja
- Medical Statistics Team; University of Aberdeen; Aberdeen UK
| | - JE Norman
- MRC Centre for Reproductive Health; University of Edinburgh; Queen's Medical Research Institute; Edinburgh UK
| | - AJ Lee
- Medical Statistics Team; University of Aberdeen; Aberdeen UK
| | - G Scotland
- Health Economics Research Unit; University of Aberdeen; Aberdeen UK
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Zupanska AK, Denison FC, Ferl RJ, Paul AL. Spaceflight engages heat shock protein and other molecular chaperone genes in tissue culture cells of Arabidopsis thaliana. Am J Bot 2013; 100:235-48. [PMID: 23258370 DOI: 10.3732/ajb.1200343] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PREMISE OF THE STUDY Gravity has been a major force throughout the evolution of terrestrial organisms, and plants have developed exquisitely sensitive, regulated tropisms and growth patterns that are based on the gravity vector. The nullified gravity during spaceflight allows direct assessment of gravity roles. The microgravity environments provided by the Space Shuttle and International Space Station have made it possible to seek novel insights into gravity perception at the organismal, tissue, and cellular levels. Cell cultures of Arabidopsis thaliana perceive and respond to spaceflight, even though they lack the specialized cell structures normally associated with gravity perception in intact plants; in particular, genes for a specific subset of heat shock proteins (HSPs) and factors (HSFs) are induced. Here we ask if similar changes in HSP gene expression occur during nonspaceflight changes in gravity stimulation. METHODS Quantitative RT-qPCR was used to evaluate mRNA levels for Hsp17.6A and Hsp101 in cell cultures exposed to four conditions: spaceflight (mission STS-131), hypergravity (centrifugation at 3 g or 16 g), sustained two-dimensional clinorotation, and transient milligravity achieved on parabolic flights. KEY RESULTS We showed that HSP genes were induced in cells only in response to sustained clinorotation. Transient microgravity intervals in parabolic flight and various hypergravity conditions failed to induce HSP genes. CONCLUSIONS We conclude that nondifferentiated cells do indeed sense their gravity environment and HSP genes are induced only in response to prolonged microgravity or simulated microgravity conditions. We hypothesize that HSP induction upon microgravity indicates a role for HSP-related proteins in maintaining cytoskeletal architecture and cell shape signaling.
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Affiliation(s)
- Agata K Zupanska
- Horticultural Science Department, Program in Plant Molecular and Cellular Biology, University of Florida, Gainesville, Florida 32611, USA
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Paul AL, Denison FC, Schultz ER, Zupanska AK, Ferl RJ. 14-3-3 phosphoprotein interaction networks - does isoform diversity present functional interaction specification? Front Plant Sci 2012; 3:190. [PMID: 22934100 PMCID: PMC3422896 DOI: 10.3389/fpls.2012.00190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/02/2012] [Indexed: 05/02/2023]
Abstract
The 14-3-3 proteins have emerged as major phosphoprotein interaction proteins and thereby constitute a key node in the Arabidopsis Interactome Map, a node through which a large number of important signals pass. Throughout their history of discovery and description, the 14-3-3s have been described as protein families and there has been some evidence that the different 14-3-3 family members within any organism might carry isoform-specific functions. However, there has also been evidence for redundancy of 14-3-3 function, suggesting that the perceived 14-3-3 diversity may be the accumulation of neutral mutations over evolutionary time and as some 14-3-3 genes develop tissue or organ-specific expression. This situation has led to a currently unresolved question - does 14-3-3 isoform sequence diversity indicate functional diversity at the biochemical or cellular level? We discuss here some of the key observations on both sides of the resulting debate, and present a set of contrastable observations to address the theory functional diversity does exist among 14-3-3 isoforms. The resulting model suggests strongly that there are indeed functional specificities in the 14-3-3s of Arabidopsis. The model further suggests that 14-3-3 diversity and specificity should enter into the discussion of 14-3-3 roles in signal transduction and be directly approached in 14-3-3 experimentation. It is hoped that future studies involving 14-3-3s will continue to address specificity in experimental design and analysis.
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Affiliation(s)
- Anna-Lisa Paul
- Program in Plant Molecular and Cellular Biology, Horticultural Science Department, University of FloridaGainesville, FL, USA
| | - Fiona C. Denison
- Program in Plant Molecular and Cellular Biology, Horticultural Science Department, University of FloridaGainesville, FL, USA
| | - Eric R. Schultz
- Program in Plant Molecular and Cellular Biology, Horticultural Science Department, University of FloridaGainesville, FL, USA
| | - Agata K. Zupanska
- Program in Plant Molecular and Cellular Biology, Horticultural Science Department, University of FloridaGainesville, FL, USA
| | - Robert J. Ferl
- Program in Plant Molecular and Cellular Biology, Horticultural Science Department, University of FloridaGainesville, FL, USA
- Interdisciplinary Center for Biotechnology Research, University of FloridaGainesville, FL, USA
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Denison FC, Semple SI, Stock SJ, Walker J, Marshall I, Norman JE. Novel use of proton magnetic resonance spectroscopy (1HMRS) to non-invasively assess placental metabolism. PLoS One 2012; 7:e42926. [PMID: 22900066 PMCID: PMC3416751 DOI: 10.1371/journal.pone.0042926] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/16/2012] [Indexed: 12/26/2022] Open
Abstract
Background Placental insufficiency is a major cause of antepartum stillbirth and fetal growth restriction (FGR). In affected pregnancies, delivery is expedited when the risks of ongoing pregnancy outweigh those of prematurity. Current tests are unable to assess placental function and determine optimal timing for delivery. An accurate, non-invasive test that clearly defines the failing placenta would address a major unmet clinical need. Proton magnetic resonance spectroscopy (1H MRS) can be used to assess the metabolic profile of tissue in-vivo. In FGR pregnancies, a reduction in N-acetylaspartate (NAA)/choline ratio and detection of lactate methyl are emerging as biomarkers of impaired neuronal metabolism and fetal hypoxia, respectively. However, fetal brain hypoxia is a late and sometimes fatal event in placental compromise, limiting clinical utility of brain 1H MRS to prevent stillbirth. We hypothesised that abnormal placental 1H MRS may be an earlier biomarker of intrauterine hypoxia, affording the opportunity to optimise timing of delivery in at-risk fetuses. Methods and Findings We recruited three women with severe placental insufficiency/FGR and three matched controls. Using a 3T MR system and a combination of phased-array coils, a 20×20×40 mm1H MRS voxel was selected along the ‘long-axis’ of the placenta with saturation bands placed around the voxel to prevent contaminant signals. A significant choline peak (choline/lipid ratio 1.35–1.79) was detected in all healthy placentae. In contrast, in pregnancies complicated by FGR, the choline/lipid ratio was ≤0.02 in all placentae, despite preservation of the lipid peak (p<0.001). Conclusions This novel proof-of-concept study suggests that in severe placental insufficiency/FGR, the observed 60-fold reduction in the choline/lipid ratio by 1H MRS may represent an early biomarker of critical placental insufficiency. Further studies will determine performance of this test and the potential role of 1H-MRS in the in-vivo assessment of placental function to inform timing of delivery.
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Affiliation(s)
- Fiona C Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, Lothian, United Kingdom.
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Abstract
OBJECTIVES Circulating concentrations of the peptide kisspeptin have been proposed as a novel biomarker for early detection of pre-eclampsia. Our aims were to assess analytical and clinical performance characteristics of a commercial kisspeptin assay and to determine sensitivity and specificity of the test for pre-eclampsia. DESIGN Prospective, longitudinal study in a United Kingdom tertiary referral Antenatal Metabolic Clinic. PATIENTS Severely obese (body mass index, BMI > 40 kg/m(2), n = 194) and lean (BMI < 25 kg/m(2), n = 78) pregnant women. MEASUREMENTS A commercial kisspeptin ELISA (Phoenix Pharmaceuticals) was assessed for analytical sensitivity, specificity, precision, linearity, recovery and stability in maternal plasma samples at 16, 28 and 36 weeks gestation. Pre-eclampsia, defined using International Society for the Study of Hypertension in Pregnancy guidelines; blood pressure; delivery gestation; birthweight. RESULTS Kisspeptin concentrations were lower in early pregnancy in obese women (P < 0.001), and in women who later developed pre-eclampsia (P < 0.05), compared with women with uncomplicated pregnancies. For 16-week plasma kisspeptin in prediction of pre-eclampsia, area under the receiver-operator characteristic curve was 0.80 (P < 0.01), positive and negative likelihood ratios were 3.0 and 0.2, and test sensitivity and specificity were 85.7 and 71.4%, respectively. In regression analyses, kisspeptin (16 weeks) associated positively with delivery gestation (P < 0.05) and birthweight (P < 0.0001), and negatively with 28- and 36-week blood pressure (P < 0.0001). CONCLUSIONS Kisspeptin concentration in early pregnancy is a promising biomarker for pre-eclampsia and low birthweight but cannot be recommended, in isolation, for universal screening because of inadequate test sensitivity and specificity. Large-scale studies are required to assess its potential in a panel of biomarkers.
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Affiliation(s)
- James J Logie
- Clinical Biochemistry, Wishaw General Hospital, Wishaw, Lanarkshire, UK
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