Chughtai, A.A., Wang, A.Y., Hilder, L., Li, Z., Lui, K., Farquhar, C. & Sullivan, E.A. 2018, 'Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.', Human reproduction (Oxford, England), vol. 33, no. 2, pp. 320-327.View/Download from: Publisher's site
Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births?Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births.Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births.This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples.All births (20 weeks of gestation and/or 400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death.Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group.Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian definit...
Sullivan, E.A., Javid, N., Duncombe, G., Li, Z., Safi, N., Cincotta, R., Homer, C.S.E., Halliday, L. & Oyelese, Y. 2017, 'Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia.', Obstetrics and gynecology, vol. 130, no. 3, pp. 591-598.View/Download from: Publisher's site
To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8-10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.
Farquhar, C.M., Li, Z., Lensen, S., McLintock, C., Pollock, W., Peek, M.J., Ellwood, D., Knight, M., Homer, C.S., Vaughan, G., Wang, A. & Sullivan, E. 2017, 'Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.', BMJ open, vol. 7, no. 10, p. e017713.View/Download from: UTS OPUS or Publisher's site
Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.Case-control study.Sites in Australia and New Zealand with at least 50 births per year.Cases were women giving birth (20 weeks or fetus 400g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.Data were collected using the Australasian Maternity Outcomes Surveillance System.Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).The incidence of placenta accreta was 44.2/100 000 women giving birth (95%CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women40vs <30: 19.1, 95%CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95%CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR 2prior sections vs 0: 13.8, 95%CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95%CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95%CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95%CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95%CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
Mu, Y., McDonnell, N., Li, Z., Liang, J., Wang, Y., Zhu, J. & Sullivan, E. 2016, 'Amniotic fluid embolism as a cause of maternal mortality in China between 1996 and 2013: a population-based retrospective study.', BMC Pregnancy and Childbirth, vol. 16, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: To analyse the maternal mortality ratio, demographic and pregnancy related details in women who suffered a fatal amniotic fluid embolism (AFE) in China. METHODS: A retrospective population based study using data collected as part of the National Maternal Mortality Surveillance System between 1996 and 2013. Data were collected onto a standardised form from women whose cause of death was listed as being secondary to AFE. RESULTS: Records were available for 640 deaths. Over the 17 year period the maternal mortality ratio for AFE decreased from 4.4 per 100,000 births (95 % confidence interval (CI):2.72-6.12) to 1.9 per 100,000 births (95 % CI:1.35-2.54). Over the same period the proportion of maternal deaths secondary to AFE increased from 6.8 to 12.5 %. The mean age of women who died was 30.1 years and the onset of the AFE occurred prior to delivery in 39 %. The most prominent presenting features included premonitory symptoms (29 %), acute fetal compromise (28 %), maternal haemorrhage (16 %) and shortness of breath (15 %). CONCLUSIONS: Maternal mortality secondary to AFE has decreased in China, however at a slower rate than mortality secondary to other conditions. Active surveillance is recommended to assess case fatality rates, risk factors and other lessons specific to this population.
Souza, J., Betran, A., Dumont, A., de Mucio, B., Gibbs Pickens, C., Deneux-Tharaux, C., Ortiz-Panozo, E., Sullivan, E., Ota, E., Togoobaatar, G., Carroli, G., Knight, H., Zhang, J., Cecatti, J., Vogel, J., Jayaratne, K., Leal, M., Gissler, M., Morisaki, N., Lack, N., Oladapo, O., Tunalp, O., Lumbiganon, P., Mori, R., Quintana, S., Costa Passos, A., Marcolin, A., Zongo, A., Blondel, B., Hernández, B., Hogue, C., Prunet, C., Landman, C., Ochir, C., Cuesta, C., Pileggi-Castro, C., Walker, D., Alves, D., Abalos, E., Moises, E., Vieira, E., Duarte, G., Perdona, G., Gurol-Urganci, I., Takahiko, K., Moscovici, L., Campodonico, L., Oliveira-Ciabati, L., Laopaiboon, M., Danansuriya, M., Nakamura-Pereira, M., Costa, M., Torloni, M., Kramer, M., Borges, P., Olkhanud, P., Pérez-Cuevas, R., Agampodi, S., Mittal, S., Serruya, S., Bataglia, V., Li, Z., Temmerman, M. & Gülmezoglu, A. 2016, 'A global reference for caesarean section rates (C-Model): A multicountry cross-sectional study', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 123, no. 3, pp. 427-436.View/Download from: Publisher's site
© 2015 RCOG. Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design: Cross-sectional study. Setting: Health facilities from 43 countries. Population/Sample: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measures: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c…). Conclusions: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.
Li, Z., Umstad, M.P., Hilder, L., Xu, F. & Sullivan, E.A. 2015, 'Australian national birthweight percentiles by sex and gestational age for twins, 2001-2010.', BMC pediatrics, vol. 15, p. 148.View/Download from: Publisher's site
Birthweight remains one of the strongest predictors of perinatal mortality and disability. Birthweight percentiles form a reference that allows the detection of neonates at higher risk of neonatal and postneonatal morbidity. The aim of the study is to present updated national birthweight percentiles by gestational age for male and female twins born in Australia.Population data were extracted from the Australian National Perinatal Data Collection for twins born in Australia between 2001 and 2010. A total of 43,833 women gave birth to 87,666 twins in Australia which were included in the study analysis. Implausible birthweights were excluded using Tukey's methodology based on the interquartile range. Univariate analysis was used to examine the birthweight percentiles for liveborn twins born between 20 and 42 weeks gestation.Birthweight percentiles by gestational age were calculated for 85,925 live births (43,153 males and 42,706 females). Of these infants, 53.6% were born preterm (birth before 37 completed weeks of gestation) while 50.2% were low birthweight (<2500 g) and 8.7% were very low birthweight (<1500 g). The mean birthweight decreased from 2462 g in 2001 to 2440 g in 2010 for male twins, compared with 2485 g in 1991-94. For female twins, the mean birthweight decreased from 2375 g in 2001 to 2338 g in 2010, compared with 2382 g in 1991-94.The birthweight percentiles provide clinicians and researchers with up-to-date population norms of birthweight percentiles for twins in Australia.
McDonnell, N., Knight, M., Peek, M.J., Ellwood, D., Homer, C.S., McLintock, C., Vaughan, G., Pollock, W., Li, Z., Javid, N. & Sullivan, E. 2015, 'Amniotic fluid embolism: an Australian-New Zealand population-based study.', BMC Pregnancy and Childbirth, vol. 15, pp. 352-352.View/Download from: UTS OPUS or Publisher's site
Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes.A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation).Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100000 women giving birth (95 % CI 3.5 to 7.2 per 100000). Two (6 %) events occurred at home whilst 46 % (n=15) occurred in the birth suite and 46 % (n=15) in the operating theatre (location not reported in one case). Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Eight women (24 %) conceived using assisted reproduction technology. Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % (n=6) had a hysterectomy and 85 % (n=28) received a transfusion of blood or blood products. Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Five woman died (case fatality rate 15 %) giving an estimated maternal morta...
Li, Z., Sullivan, E.A., Chapman, M., Farquhar, C. & Wang, Y.A. 2015, 'Risk of ectopic pregnancy lowest with transfer of single frozen blastocyst.', Human reproduction (Oxford, England), vol. 30, no. 9, pp. 2048-2054.View/Download from: UTS OPUS or Publisher's site
What type of transferred embryo is associated with a lower rate of ectopic pregnancy?The lowest risk of ectopic pregnancy was associated with the transfer of blastocyst, frozen and single embryo compared with cleavage stage, fresh and multiple embryos.Ectopic pregnancy is a recognized complication following assisted reproductive technology (ART) treatment. It has been estimated that the rate of ectopic pregnancy is doubled in pregnancies following ART treatment compared with spontaneous pregnancies. However, it was not clear whether the excess rate of ectopic pregnancy following ART treatment is related to the underlying demographic factors of women undergoing ART treatment, the number of embryos transferred or the developmental stage of the embryo.A population-based cohort study of pregnancies following autologous treatment cycles between January 2009 and December 2011 were obtained from the Australian and New Zealand Assisted Reproduction Technology Database (ANZARD). The ANZARD collects ART treatment information and clinical outcomes annually from all fertility centres in Australia and New Zealand.Between 2009 and 2011, a total of 44 102 pregnancies were included in the analysis. The rate of ectopic pregnancy was compared by demographic and ART treatment factors. Generalized linear regression of Poisson distribution was used to estimate the likelihood of ectopic pregnancy. Odds ratios, adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated.The overall rate of ectopic pregnancy was 1.4% for women following ART treatment in Australia and New Zealand. Pregnancies following single embryo transfers had 1.2% ectopic pregnancies, significantly lower than double embryo transfers (1.8%) (P < 0.01). The highest ectopic pregnancy rate was 1.9% for pregnancies from transfers of fresh cleavage embryo, followed by transfers of frozen cleavage embryo (1.7%), transfers of fresh blastocyst (1.3%), and transfers of frozen blastocyst (0.8%). Compared with f...
Sullivan, E.A., Dickinson, J.E., Vaughan, G.A., Peek, M.J., Ellwood, D., Homer, C.S.E., Knight, M., McLintock, C., Wang, A., Pollock, W., Pulver, L.J., Li, Z., Javid, N., Denney-Wilson, E. & Callaway, L. 2015, 'Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study', BMC Pregnancy and Childbirth, vol. 15, pp. 322-322.View/Download from: UTS OPUS or Publisher's site
Bonello, M.R., Xu, F., Li, Z., Burns, L., Austin, M.-.P. & Sullivan, E.A. 2014, 'Mental and behavioral disorders due to substance abuse and perinatal outcomes: a study based on linked population data in New South Wales, Australia', International Journal of Environmental Research and Public Health, vol. 11, no. 5, pp. 4991-5005.View/Download from: UTS OPUS or Publisher's site
Background: The effects of mental and behavioral disorders (MBD) due to substance use during peri-conception and pregnancy on perinatal outcomes are unclear. The adverse perinatal outcomes of primiparous mothers admitted to hospital with MBD due to substance use before and/or during pregnancy were investigated. Method: This study linked birth and hospital records in NSW, Australia. Subjects included primiparous mothers admitted to hospital for MBD due to use of alcohol, opioids or cannabinoids during peri-conception and pregnancy. Results: There were 304 primiparous mothers admitted to hospital for MBD due to alcohol use (MBDA), 306 for MBD due to opioids use (MBDO) and 497 for MBD due to cannabinoids (MBDC) between the 12 months peri-conception and the end of pregnancy. Primiparous mothers admitted to hospital for MBDA during pregnancy or during both peri-conception and pregnancy were significantly more likely to give birth to a baby of low birthweight (AOR = 4.03, 95%CI: 1.97-8.24 for pregnancy; AOR = 9.21, 95%CI: 3.76-22.57 both periods); preterm birth (AOR = 3.26, 95% CI: 1.52-6.97 for pregnancy; AOR = 4.06, 95%CI: 1.50-11.01 both periods) and admission to SCN or NICU (AOR = 2.42, 95%CI: 1.31-4.49 for pregnancy; AOR = 4.03, 95%CI: 1.72-9.44 both periods). Primiparous mothers admitted to hospital for MBDO, MBDC or a combined diagnosis were almost three times as likely to give birth to preterm babies compared to mothers without hospital admissions for psychiatric or substance use disorders. Babies whose mothers were admitted to hospital with MBDO before and/or during pregnancy were six times more likely to be admitted to SCN or NICU (AOR = 6.29, 95%CI: 4.62-8.57). Conclusion: Consumption of alcohol, opioids or cannabinoids during peri-conception or pregnancy significantly increased the risk of adverse perinatal outcomes. © 2014 by the authors; licensee MDPI, Basel, Switzerland.
Xu, F., Li, Z., Binns, C., Bonello, M., Austin, M.-.P. & Sullivan, E. 2014, 'Does infant feeding method impact on maternal mental health?', Breastfeeding Medicine, vol. 9, pp. 215-221.View/Download from: UTS OPUS or Publisher's site
Xu, F., Sullivan, E.A., Li, Z., Burns, L., Austin, M.-.P. & Slade, T. 2014, 'The increased trend in mothers' hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia', BMC Women's Health, vol. 14, pp. 1-6.View/Download from: UTS OPUS or Publisher's site
The burden of mental and behavioural disorders in Australia has increased significantly over the last decade. The aim of the current study is to describe the hospital admission rates for mental illness over a 10-year period for primiparous mothers in the first year after birth.
This is an Australian population-based descriptive study with linked data from the New South Wales Midwives Data Collection and Admitted Patients Data Collection. The study population included primiparous mothers who gave birth between 1 January 2001 and 31 December 2010. All hospital admissions with a mental health diagnosis in the first year after birth were recorded.
There were 6,140 mothers (1.67%) admitted to hospital with a principal diagnosis of mental health in the first year after birth between 2001 and 2010 in New South Wales (7,884 admissions, 2.15%). The hospital admission rates increased significantly over time, particularly from 2005. The increase in hospital admissions was mainly attributed to the diagnoses of unipolar depression, adjustment disorders and anxiety disorders.
This study shows that hospital admissions for mothers with a mental health diagnosis after birth in New South Wales has significantly increased in the last decade. Possible reasons for this change need to be studied further.
Li, Z., Wang, Y., W, L. & Sullivan, E. 2014, 'Birthweight percentiles by gestational age for births following assisted reproductive technology in Australia and New Zealand, 2002-2010', Human Reproduction, vol. 29, no. 8, pp. 1787-1800.View/Download from: Publisher's site
Study question: What is the standard of birthweight for gestational age for babies following assisted reproductive technology (ART) treatment? Summary answer: Birthweight for gestational age percentile charts were developed for singleton births following ART treatment using population-based data.
Li, Z., Wang, Y.A., Ledger, W., Edgar, D.H. & Sullivan, E.A. 2014, 'Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study.', Human reproduction (Oxford, England), vol. 29, no. 12, pp. 2794-2801.View/Download from: UTS OPUS or Publisher's site
STUDY QUESTION: What are the clinical efficacy and perinatal outcomes following transfer of vitrified blastocysts compared with transfer of fresh or of slow frozen blastocysts? SUMMARY ANSWER: Compared with slow frozen blastocysts, vitrified blastocysts resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes at population level. WHAT IS KNOWN ALREADY: Although vitrification has been reported to be associated with significantly increased post-thaw survival rates compared with slow freezing, there has been a lack of general consensus over which method of cryopreservation (vitrification versus slow freezing) is most appropriate for blastocysts. STUDY DESIGN, SIZE, DURATION: A population-based cohort of autologous fresh and initiated thaw cycles (a cycle where embryos were thawed with intention to transfer) performed between January 2009 and December 2011 in Australia and New Zealand was evaluated retrospectively. A total of 46 890 fresh blastocyst transfer cycles, 12 852 initiated slow frozen blastocyst thaw cycles and 20 887 initiated vitrified blastocyst warming cycles were included in the data analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS: Pairwise comparisons were made between the vitrified blastocyst group and slow frozen or fresh blastocyst group. A Chi-square test was used for categorical variables and t-test was used for continuous variables. Cox regression was used to examine the pregnancy outcomes (clinical pregnancy rate, miscarriage rate and live delivery rate) and perinatal outcomes (preterm delivery, low birthweight births, small for gestational age (SGA) births, large for gestational age (LGA) births and perinatal mortality) following transfer of fresh, slow frozen and vitrified blastocysts. MAIN RESULTS AND THE ROLE OF CHANCE: The 46 890 fresh blastocyst transfers, 11 644 slow frozen blastocyst transfers and 19 978 vitrified blastocyst transfers resulted in 16 845, 2766 and 6537 clinical pregna...
Xu, X.K., Wang, Y.A., Li, Z., Lui, K. & Sullivan, E.A. 2014, 'Risk factors associated with preterm birth among singletons following assisted reproductive technology in Australia 2007–2009–a population-based retrospective study', BMC Pregnancy and Childbirth, vol. 14, no. 1, pp. 152-170.View/Download from: UTS OPUS or Publisher's site
Background: Preterm birth, a leading cause of neonatal death, is more common in multiple births and thus there has being an increasing call for reducing multiple births in ART. However, few studies have compared risk factors for preterm births amongst ART and non-ART singleton birth mothers. Methods: A population-based study of 393,450 mothers, including 12,105 (3.1%) ART mothers, with singleton gestations born between 2007 and 2009 in 5 of the 8 jurisdictions in Australia. Univariable and multivariable logistic regression models were conducted to evaluate sociodemographic, medical and pregnancy factors associated with preterm births in contrasting ART and non-ART mothers. Results: Ten percent of singleton births to ART mothers were preterm compared to 6.8% for non-ART mothers (P < 0.01). Compared with non-ART mothers, ART mothers were older (mean 34.0 vs 29.7 yr respectively), less socio-economically disadvantaged (12.4% in the lowest quintile vs 20.7%), less likely to be smokers (3.8% vs 19.4%), more likely to be first time mothers (primiparous 62.4% vs 40.5%), had more preexisting hypertension and complications during pregnancy. Irrespective of the mode of conception, preexisting medical and pregnancy complications of hypertension, diabetes and antepartum hemorrhages were consistently associated with preterm birth. In contrast, socio-demographic variables, namely young and old maternal age (<25 and >34), socioeconomic disadvantage (most disadvantaged quintile Odds Ratio (OR) 0.95, 95% Confidence Interval (CI): 0.77-1.17), smoking (OR 1.12, 95%CI: 0.79-1.61) and priminarity (OR 1.19, 95%CI: 1.05-1.35, AOR not significant) shown to be associated with elevated risk of preterm birth for non-ART mothers were not demonstrated for ART mothers, even after adjusting for potential confounders. Nonetheless, in multivariable analysis, the association between ART and the elevated risk for singleton preterm birth persisted after controlling for all included confounding medi...
Li, Z., Chen, M., Guy, R., Wand, H., Oats, J. & Sullivan, E. 2013, 'Chlamydia Screening In Pregnancy In Australia: Integration Of National Guidelines Into Clinical Practice And Policy', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 4, pp. 338-346.View/Download from: UTS OPUS or Publisher's site
Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have recommended chlamydia screening in pregnant women aged <25years. Aims To assess clinical uptake and policy integration of the 2006 RANZCOG recommendation on chlamydia testing in pregnant women aged <25years. Methods A mixed method approach was used involving a literature review, a survey of obstetricians and gynaecologists, and survey of hospital managers from April 2010 to May 2010. Results Of the 1644 participating RANZCOG Fellows, Trainees, and Diplomates, 21.2% reported universal screening for pregnant women <25years (25% of primary care clinicians, 23% of those working in the public hospital sector, 16% of those working in both public and private hospitals, and 13% of those in private hospitals or private practice). There was a strong association between members who agreed with the guideline and offering universal screening to pregnant women aged <25years (adjusted odds ratio=17.1, 95% CI: 6.0-49.2, P<0.01). Of the 143 participating hospital managers who completed the hospital policy questionnaire; 20% reported that their hospital had a formal screening guideline. There were two national and four state/local policy documents recommending chlamydia screening in pregnancy. Conclusions This study shows low uptake of chlamydia screening of young pregnant women by RANZCOG Fellows, Trainees, and Diplomates involved in antenatal care and highlights the need for national clinical leadership regarding screening for chlamydia among pregnant women aged <25years.
Xu, F., Bonello, M., Burns, L., Austin, M.-.P., Li, Z. & Sullivan, E. 2013, 'Hospital Admissions for Alcohol Use Disorders Before, During, and After Pregnancy: A Study Based on Linked Population Data in New South Wales, Australia', Alcoholism: Clinical and Experimental Research, vol. 37, no. 10, pp. 1706-1712.View/Download from: UTS OPUS or Publisher's site
Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions.
This study was based on linked population data between 2002 and 2005 using the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses (ICD-10-AM): mental and behavioral disorders due to the use of alcohol (MBDA) (F10.0–10.9); toxic effects of alcohol (T51.0–51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2).
A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years (PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born i...
Li, Z., Zeki, R., Hilder, L. & Sullivan, E.A. AIHW National Perinatal Epidemiology and Statistics Unit 2013, Australia's mothers and babies 2011, Perinatal statistics series no 4, no. Cat. no. PER 59., Canberra.
Li, Z., Zeki, R., Hilder, L. & Sullivan, E. AIHW National Perinatal Epidemiology and Statistics Unit 2012, Australia's mothers and babies 2010, Perinatal statistics series no. 27, no. Cat. no. PER 57, Canberra.
Li, Z., McNally, L., Hilder, L. & Sullivan, E. AIHW National Perinatal Epidemiology and Statistics Unit 2011, Australia's mothers and babies 2009, Perinatal statistics series no. 25, no. Cat. no. PER 52, Sydney.