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Women's health

Women's health Supplement 1 October 2018 Open Access

Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers

on behalf of the International PCOS Network

18 00656
Women's health Letters 18 June 2018 Free

Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990–2014

To the Editor:We congratulate Cheney and colleagues1 for throwing light on the contributions of overweight and obesity on adverse birth outcomes by analysing data from a teaching hospital in central Sydney.1 Around 16% of the women presenting between 2010 and 2014 were overweight, while 7% were obese. Furthermore, despite obesity being an important risk factor for adverse pregnancy outcomes, their study showed a lack of recording of body mass index (BMI) in patients’ records. Adverse pregnancy outcomes are more common among Indigenous Australian women than non-Indigenous women;2 obesity levels are high in pre-conception and in pregnancy, and the subsequent adverse impact on increased metabolic health in offspring is likely contributing to early onset of diabetes and chronic disease in Indigenous Australians. Hence, we want to extend the debate to report on what is happening in primary health care (PHC) settings for Indigenous women. We have analysed continuous quality improvement data from audits of adherence to evidence-based guidelines for maternal care in 65 Indigenous PHC centres (1091 patient records) across Australia during 2012–2014.3 The majority of women at most PHC centres had the first trimester weight recorded (mean, 90%; range, 60–100%), but there was wide variation in recording of BMI (mean, ∼ 60%; range, 0–100%) (Box). This indicates that most barriers to BMI recording are more to do with clinicians’ understanding of the value of and ability to calculate BMI than around women’s willingness to be weighed. For women with an abnormal BMI (mean, ∼ 30%; range, 0–100%), there was wide variation in documented BMI management plans (mean, ∼ 40%; range, 0–100%). Dealing with these generally low levels of recording and wide variation in recording between PHC centres is a vital early step in limiting the contribution of obesity to adverse pregnancy outcomes and improving long term health outcomes for the mother and baby. Women attending PHCs that had participated in continuous quality improvement activities were more likely to receive recommended pregnancy care related to screening and brief interventions for modifiable lifestyle-related risk factors, such as obesity.4,5 These findings support the incorporation of continuous quality improvement activities into the delivery of maternal care. Box – Record of scheduled maternal care services received by Indigenous women at Indigenous primary health care centres, 2012–2014* BMI = body mass index. * More information on how to interpret box plots is available in Gibson-Helm et al,3 page 21.

Jodie Bailie · Jacqueline A Boyle · Ross S Bailie

Women's health Study protocol 28 May 2018 Free

Hyperglycaemia in early pregnancy: the Treatment of Booking Gestational diabetes Mellitus (TOBOGM) study. A randomised controlled trial

This is the first multi-centre RCT investigating the treatment of hyperglycaemia early in pregnancy

David Simmons · William M Hague · Helena J Teede · N Wah Cheung · Emily J Hibbert · Christopher J Nolan · Michael J Peek · Federico Girosi · Christopher T Cowell · Vincent W-M Wong · Jeff R Flack · Mark McLean · Raiyomand Dalal · Annette Robertson · Rohit Rajagopal

17 01129
Metabolic diseases Research 12 February 2018 Free

Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990–2014

Objective: To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population. Design: Cohort study; retrospective analysis of electronic maternity data. Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 – December 2014. Main outcome measures: Maternal body mass index (BMI), socio-demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF). Results: The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990–1994) to 16.4% (2010–2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010–2014, 23.8% of pre-eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010–2014, 19% of pre-eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted. Conclusions: Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre-pregnancy maternal weight.

Kate Cheney · Rachel Farber · Alexandra L Barratt · Kevin McGeechan · Bradley de Vries · Robert Ogle · Kirsten I Black

17 00344
Endocrinology Letters 4 September 2017 Free

A review of maturity onset diabetes of the young (MODY) and challenges in the management of glucokinase-MODY

To the Editor: We note with interest the recent review of challenges in the management of maturity onset diabetes of the young associated with glucokinase gene mutations (GCK-MODY).1 In Box 2, Bishay and Greenfield reported a prevalence of gestational diabetes mellitus (GDM) of 5–10%. Indeed, in 2010 we reported an estimated prevalence of 10–11% of GDM in south-western Sydney;2 however, the prevalence is now almost double that figure (18.5% of births at Bankstown-Lidcombe hospital in 2015). Bishay and Greenfield also summarised the findings of Chakera and colleagues3 for a population of predominantly European descent: A lower body mass index (BMI, < 25 kg/m2) and a fasting glucose level greater than or equal to 5.5 mmol/L have sensitivity and specificity of 68% and 96%, respectively. It is estimated that among lean women with mild fasting hyperglycaemia, the number of women needed to test is 2.7 to detect a single case of GCK-MODY.1 In contrast, in our recent study of women with GDM, we found that at least 8.1 women would need to be tested to identify one case of GCK-MODY.4 Given our interest in the management of women with GDM, we sought to determine whether these criteria were applicable in a large multi-ethnic cohort of women with GDM. Analysing de-identified, prospectively collected data from all women with GDM in our ethnically diverse population, diagnosed using the Australasian Diabetes in Pregnancy Society (1998) criteria at our institution between 1993 and 2013, we categorised the women into two groups: those with body mass index ≤ 21 kg/m2 (group A1) and those with body mass index > 21 kg/m2 and < 25 kg/m2 (group A2). We collected complete data, including post-partum oral glucose tolerance test results, for 171 women (54, group A1; 117, group A2). The oral glucose tolerance test and post-partum glycated haemoglobin results identified few women (< 14%) in either group who still had possible GCK-MODY. Testing all 171 of these women in pregnancy would have been a costly exercise with a low yield. In testing data in different ethnic groups, we therefore recommend caution regarding the number suggested by Chakera and colleagues.

Jeff R Flack · Glynis P Ross · N Wah Cheung

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