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Best KP, Gould JF, Makrides M, Sullivan T, Cheong J, Zhou SJ, Kane S, Safa H, Sparks A, Doyle LW, McPhee AJ, Nippita TAC, Afzali HHA, Grivell R, Mackerras D, Knight E, Wood S, Green T. Prenatal iodine supplementation and early childhood neurodevelopment: the PoppiE trial - study protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e071359. [PMID: 37164467 PMCID: PMC10173960 DOI: 10.1136/bmjopen-2022-071359] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Observational studies suggest both low and high iodine intakes in pregnancy are associated with poorer neurodevelopmental outcomes in children. This raises concern that current universal iodine supplement recommendations for pregnant women in populations considered to be iodine sufficient may negatively impact child neurodevelopment. We aim to determine the effect of reducing iodine intake from supplements for women who have adequate iodine intake from food on the cognitive development of children at 24 months of age. METHODS AND ANALYSIS A multicentre, randomised, controlled, clinician, researcher and participant blinded trial with two parallel groups. Using a hybrid decentralised clinical trial model, 754 women (377 per group) less than 13 weeks' gestation with an iodine intake of ≥165 µg/day from food will be randomised to receive either a low iodine (20 µg/day) multivitamin and mineral supplement or an identical supplement containing 200) µg/day (amount commonly used in prenatal supplements in Australia), from enrolment until delivery. The primary outcome is the developmental quotient of infants at 24 months of age assessed with the Cognitive Scale of the Bayley Scales of Infant Development, fourth edition. Secondary outcomes include infant language and motor development; behavioural and emotional development; maternal and infant clinical outcomes and health service utilisation of children. Cognitive scores will be compared between groups using linear regression, with adjustment for location of enrolment and the treatment effect described as a mean difference with 95% CI. ETHICS AND DISSEMINATION Ethical approval has been granted from the Women's and Children's Health Network Research Ethics Committee (HREC/17/WCHN/187). The results of this trial will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04586348.
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Affiliation(s)
- Karen P Best
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacqueline F Gould
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas Sullivan
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jeanie Cheong
- Newborn Services, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Shao J Zhou
- School of Agriculture, Food & Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stefan Kane
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Huda Safa
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - A Sparks
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Lex W Doyle
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - A J McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tanya A C Nippita
- Women and Babies, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Hossein H A Afzali
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Rosalie Grivell
- Department of Obstetrics and Gynaecology, Flinders University, Adelaide, South Australia, Australia
| | - D Mackerras
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - E Knight
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Wood
- Faculty of Land and Food Systems, University of British Columbia, Victoria, British Columbia, Canada
- Faculty of Science and Engineering, Curtin University, Perth, Western Australia, Australia
| | - Tim Green
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Makrides M, Best K, Yelland L, McPhee A, Zhou S, Quinlivan J, Dodd J, Atkinson E, Safa H, van Dam J, Khot N, Dekker G, Skubisz M, Anderson A, Kean B, Bowman A, McCallum C, Cashman K, Gibson R. A Randomized Trial of Prenatal n-3 Fatty Acid Supplementation and Preterm Delivery. N Engl J Med 2019; 381:1035-1045. [PMID: 31509674 DOI: 10.1056/nejmoa1816832] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have suggested that maternal supplementation with n-3 long-chain polyunsaturated fatty acids may reduce the incidence of preterm delivery but may also prolong gestation beyond term; however, more data are needed regarding the role of n-3 long-chain polyunsaturated fatty acids in pregnancy. METHODS We performed a multicenter, double-blind, randomized trial in which women who were pregnant with single or multiple fetuses were assigned to receive either fish-oil capsules that contained 900 mg of n-3 long-chain polyunsaturated fatty acids (n-3 group) or vegetable-oil capsules that contained trace n-3 long-chain polyunsaturated fatty acids (control group) daily, beginning before 20 weeks of gestation and continuing to 34 weeks of gestation or delivery, whichever occurred first. The primary outcome was early preterm delivery, defined as delivery before 34 completed weeks of gestation. Other pregnancy and neonatal outcomes were also assessed. RESULTS A total of 5544 pregnancies in 5517 women were randomly assigned at six centers in Australia; 5486 pregnancies were included in the primary analysis. Early preterm delivery occurred in the case of 61 of 2734 pregnancies (2.2%) in the n-3 group and 55 of 2752 pregnancies (2.0%) in the control group; the between-group difference was not significant (adjusted relative risk, 1.13; 95% confidence interval [CI], 0.79 to 1.63; P = 0.50). There were no significant differences between the groups in the incidence of interventions in post-term (>41 weeks of gestation) deliveries, in adverse events, or in other pregnancy or neonatal outcomes, except that a higher percentage of infants born to women in the n-3 group than in the control group were very large for gestational age at birth (adjusted relative risk, 1.30; 95% CI, 1.02 to 1.65). Percentages of serious adverse events did not differ between the groups. Minor gastrointestinal disturbances were more commonly reported in the n-3 group than in the control group. CONCLUSIONS Supplementation with n-3 long-chain polyunsaturated fatty acids from early pregnancy (<20 weeks of gestation) until 34 weeks of gestation did not result in a lower incidence of early preterm delivery or a higher incidence of interventions in post-term deliveries than control. (Funded by the Australian National Health and Medical Research Council and the Thyne Reid Foundation; ORIP Australian New Zealand Clinical Trials Registry number, ACTRN12613001142729.).
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Affiliation(s)
- Maria Makrides
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Karen Best
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Lisa Yelland
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Andrew McPhee
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Shao Zhou
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Julie Quinlivan
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Jodie Dodd
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Elinor Atkinson
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Huda Safa
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Jacqueline van Dam
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Nisha Khot
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Gustaaf Dekker
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Monika Skubisz
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Amanda Anderson
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Beth Kean
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Anneka Bowman
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Carly McCallum
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Kara Cashman
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
| | - Robert Gibson
- From the South Australian Health and Medical Research Institute (M.M., K.B., L.Y., A.M., M.S., A.A., B.K., A.B., C.M., R.G.), School of Medicine (M.M., K.B.), School of Public Health (L.Y., K.C.), and School of Agriculture, Food, and Wine (S.Z., R.G.), University of Adelaide, Neonatal Services (A.M.) and the Department of Obstetrics and Gynaecology (J. Dodd, M.S.), Women's and Children's Hospital, the Departments of Obstetrics and Gynaecology, Flinders Medical Centre (E.A.), and the Northern Adelaide Local Health Network (G.D.), Adelaide, SA, the Institute of Health Research, University of Notre Dame, Fremantle, WA (J.Q.), Mater Mothers' Hospital, Brisbane, QLD (H.S.), and Werribee Mercy Health, Melbourne, VIC (J. van Dam, N.K.) - all in Australia
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