Jeremy Oats - Academia.edu (original) (raw)
Papers by Jeremy Oats
BMC Pregnancy and Childbirth, 2013
Background: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for bot... more Background: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for both the mother and foetus, but it also provides an excellent early opportunity for intervention in the life course for both mother and baby. In the context of the escalating epidemic of chronic diseases among Indigenous Australians, it is vital that this risk is reduced as early as possible in the life course of the individual. The aims of the PANDORA Study are to: (i) accurately assess rates of diabetes in pregnancy in the Northern Territory (NT) of Australia, where 38% of babies are born to Indigenous mothers; (ii) assess demographic, clinical, biochemical, anthropometric, socioeconomic and early life development factors that may contribute to key maternal and neonatal birth outcomes associated with diabetes in pregnancy; and (iii) monitor relevant post-partum clinical outcomes for both the mothers and their babies. Methods/Design: Eligible participants are all NT women with diabetes in pregnancy aged 16 years and over. Information collected includes: standard antenatal clinical information, diagnosis and management of diabetes in pregnancy, socio-economic status, standard clinical birth information (delivery, gestational age, birth weight, adverse antenatal and birth outcomes). Cord blood is collected at the time of delivery and detailed neonatal anthropometric measurements performed within 72 hours of birth. Information will also be collected regarding maternal postpartum glucose tolerance and cardio-metabolic risk factor status, breastfeeding and growth of the baby up to 2 years post-partum in the first instance. Discussion: This study will accurately document rates and outcomes of diabetes in pregnancy in the NT of Australia, including the high-risk Indigenous Australian population. The results of this study should contribute to policy and clinical guidelines with the goal of reducing the future risk of obesity and diabetes in both mothers and their offspring.
BMC Pregnancy and Childbirth, 2009
Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worl... more Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified.
Diabetes/Metabolism Research and Reviews, 2015
Gestational diabetes is associated with a high risk of type 2 diabetes. However progression rates... more Gestational diabetes is associated with a high risk of type 2 diabetes. However progression rates among Indigenous women in Australia who experience high prevalence of gestational diabetes, are unknown. This retrospective cohort study includes all births to women at a regional hospital in Far North Queensland, Australia, coded as having "gestational diabetes" from 1/1/2004 to 31/12/2010 (1098 births), and receiving laboratory postpartum screening from 1/1/2004 to 31/12/2011 (n = 483 births). Women who did not receive postpartum screening were excluded from the denominator. Data were linked between hospital electronic records, routinely collected birth data and laboratories, with sample validation by reviews of medical records. Analysis was conducted using Cox-proportional regression models. Indigenous women had a greater than four-fold risk of developing type 2 diabetes within eight years of having gestational diabetes, compared to non-Indigenous women (HR 4.55, 95% confidence interval 2.63-7.88, p < 0.0001). Among women receiving postpartum screening tests, by three years, five years, and seven years postpartum, 21.9% (15.8-30.0%), 25.5% (18.6-34.3%), and 42.4% (29.6-58.0%) Indigenous women were diagnosed with type 2 diabetes after gestational diabetes respectively; compared to 4.2% (2.5-7.2%), 5.7% (3.3-9.5%), and 13.5% (7.3-24.2%) non-Indigenous women. Multivariate analysis showed significant associations between an increased rate of type 2 diabetes with an early pregnancy body mass index >25 kg/m(-2) , partial breastfeeding only at hospital discharge, and gestational diabetes diagnosis prior to 17 weeks gestation. This study demonstrates that, compared to non-Indigenous women, Indigenous Australian women have a greater than four-fold risk of developing type 2 diabetes after gestational diabetes. Strategies are urgently needed to reduce rates of type 2 diabetes by supporting a healthy weight and breastfeeding, and to improve postpartum screening among Indigenous women with gestational diabetes. This article is protected by copyright. All rights reserved.
The Medical journal of Australia
In a study of 1216 pregnancies, 427 (35%) patients reported hand symptoms. Symptoms of the same q... more In a study of 1216 pregnancies, 427 (35%) patients reported hand symptoms. Symptoms of the same quality and distribution were reported by 40 (30%) of 132 control subjects within the previous year, and although invariably mild, these symptoms suggest that pregnancy may aggravate a pre-existing condition. Fewer than 20% of the 427 affected patients described a classic median-nerve symptom distribution (carpal tunnel syndrome), while 12% of patients described an ulnar-nerve distribution, which is thought to represent a genuine and previously underestimated occurrence of ulnar-nerve neuropathy in pregnancy. In 69% of patients, hand symptoms were generalized. Most symptoms were bilateral, commenced in the third trimester and resolved soon after delivery. There was a significant correlation of hand symptoms in pregnancy with the presence of preeclampsia, tight rings, the weight at confinement, the birth weight and a history of premenstrual bloating. Operative intervention was not required...
Rural and remote health
A 2007 review of maternity services in Australia's Northern Territory (NT) noted the dissatis... more A 2007 review of maternity services in Australia's Northern Territory (NT) noted the dissatisfaction of women in the Barkly region where the birthing service closed in 2006. The review recommended improved integration of maternity services, a consumer focus, and a pilot study of birthing in Tennant Creek Hospital (TCH) in the Barkly region. Barkly region is sparsely populated, with 5700 people in 320 000 km2. The town of Tennant Creek with 3100 population is the only centre of more than 1000 people. In the Barkly region, 64% of the population and 74% of birthing women are Aboriginal. Current NT Department of Health (NT DoH) policy requires all women to give birth in a town with facilities for operative delivery. For most Barkly women this means travelling 500 km to Alice Springs with limited support for travel and accommodation. Emergency air evacuation is arranged for all women who enter labour or give birth while in the Barkly region, whether at TCH or elsewhere. This project ...
PLOS ONE, 2015
Several socio-cultural and biomedical risk factors for gestational diabetes mellitus (GDM) are mo... more Several socio-cultural and biomedical risk factors for gestational diabetes mellitus (GDM) are modifiable. However, few studies globally have examined socio-cultural associations. To eliminate confounding of increased risk of diabetes in subsequent pregnancies, elucidating socio-cultural associations requires examination only of first pregnancies.
Australian and New Zealand Journal of Obstetrics and Gynaecology
Background: Evidence on long-term trends in gestational diabetes mellitus (GDM) prevalence in Aus... more Background: Evidence on long-term trends in gestational diabetes mellitus (GDM) prevalence in Australia is lacking. Aims: To assess and compare trends in GDM prevalence among Indigenous and non-Indigenous Australian women. Materials and methods: Analysis of crude and age-adjusted GDM prevalence over time by Indigenous status and age, using routinely-collected midwives data from Australian states and territories on mothers giving birth from 1990-2009. Results: Despite considerable data variation, particularly in 1990-1999, and likely underestimation of GDM prevalence; crude and age-adjusted GDM prevalences were higher in Indigenous than non-Indigenous women at all time-points (4.7% versus 3.1% in 1990-1999; 5.1% versus 4.5% in 2000-2009, p<0.0001). Data variability precluded quantitative assessment of trends and changes in prevalence ratios before 2000. From 2000-2009, GDM prevalence increased significantly among Indigenous women by a mean 2.6% annually (ptrend<0.0001), and non...
Maternal and Child Health Journal, 2014
Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous w... more Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p \ 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (\6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p \ 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.
BMJ open, 2014
This paper reports secular trends in diabetes in pregnancy in Victoria, Australia and examines th... more This paper reports secular trends in diabetes in pregnancy in Victoria, Australia and examines the effect of including or excluding women with pre-existing diabetes on gestational diabetes (GDM) prevalence estimates. Population-based observational study. All births in Victoria, Australia between 1999 and 2008 PARTICIPANTS: 634,932 pregnancies resulting in a birth registered with the Victorian Perinatal Data Collection Crude and age-standardised secular trends in pre-existing diabetes and GDM prevalence; secular GDM trends by maternal birthplace; effects on GDM prevalence of including and excluding pre-existing diabetes from the denominator. Of the 634,932 pregnancies, 2954 (0.5%) occurred in women with pre-existing diabetes and 29,147 (4.6%) were complicated by GDM. Mean maternal age increased from 29.7 years in 1999 to 30.8 years in 2008. GDM prevalence increased in most maternal age groups. In 2008, age-standardised GDM prevalence was 31% higher than in 1999; secular increases wer...
Diabetes/Metabolism Research and Reviews, 2015
Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in a... more Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in any area of clinical research, outcome definitions vary from study to study, making it difficult to compare research findings and draw conclusions. Our aim was to compile and create a repository of definitions, which could then be used universally. A systematic review of the literature was performed of published and ongoing randomized controlled trials (RCTs) in the area of diabetes in pregnancy between Jan 1, 2000 and June 1, 2012. Other sources included the World Health Organization and Academic Society Statements. The advice of experts was sought when appropriate definitions were lacking. Among the published RCTs on diabetes and pregnancy, 171 abstracts were retrieved, 64 full texts were reviewed, and 53 were included. Among the ongoing RCTs published in ClinicalTrials.gov, 90 protocols were retrieved and 25 were finally included. The definitions from these were assembled and the final maternal definitions and fetal definitions were agreed upon by consensus. It is our hope that the definitions we have provided will be widely used in the reporting of future studies in the area of diabetes in pregnancy, that they will facilitate future systematic reviews and formal meta analyses, and ultimately improve outcomes for mothers and babies. This article is protected by copyright. All rights reserved.
Current Diabetes Reports, 2014
The International Association of Diabetes in Pregnancy Study Groups (IADPSG) recommended a new pr... more The International Association of Diabetes in Pregnancy Study Groups (IADPSG) recommended a new protocol of 1-step testing with a 75 g oral glucose tolerance test for gestational diabetes in 2010. Since that time, these recommendations have been carefully scrutinized and accepted by a variety of organizations, but challenged or rejected by others. In the current review, we present more details regarding the background to the development of the IADPSG recommendations and seek to place them in context with the available epidemiologic and randomized controlled trial data. In this "counterpoint," we also provide specific rebuttal for errors of fact and disputed contentions provided by Long and Cundy in their 2013 article in Current Diabetes Reports.
Diabetes/Metabolism Research and Reviews, 2014
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2014
In the Northern Territory (NT), 38% of 3500 births each year are to Indigenous women, 80% of whom... more In the Northern Territory (NT), 38% of 3500 births each year are to Indigenous women, 80% of whom live in regional and remote areas. Compared with the general Australian population, rates of pre-existing type 2 diabetes in pregnancy are 10-fold higher and rates of gestational diabetes are 1.5-fold higher among Indigenous women. Current practices in screening for diabetes in pregnancy in remote Australia are not known. To assess current health service delivery for NT women with diabetes in pregnancy (DIP) by surveying healthcare professionals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; views and practices in DIP screening and management. A cross-sectional survey of NT healthcare professionals providing clinical care for women with DIP was conducted based on pre-identified themes of communication, care-coordination, education, orientation and guidelines, logistics and access, and information technology. Of the 116 responders to the survey, 78% were primary healthcare professionals, 32% midwives and 25% general practitioners. High staff turnover was evident: of Central Australian professionals, only 33% (urban) and 18% (regional/remote) had been in their current position over 5 years. DIP screening was conducted at first antenatal visit by 66% and at 24-28-week gestation by 81%. Only 50% of respondents agreed that most women at their health service received appropriate care for DIP, and 41% of primary care practitioners were neutral or not confident in their skills to manage DIP. It is promising that many healthcare professionals report following new guidelines in conducting early pregnancy screening for DIP in high risk women. Several challenges were identified in healthcare delivery to a high risk population in remote Australia.
Ultrasound in Obstetrics and Gynecology, 2002
Objectives To assess the detection rate of congenital fetal malformations and specific problems r... more Objectives To assess the detection rate of congenital fetal malformations and specific problems related to routine ultrasound screening in women with pre-existing diabetes.
Trials, 2013
Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset ... more Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals.
Reproduction, Fertility and Development, 2010
The Medical Journal of Australia, 2013
BMC Pregnancy and Childbirth, 2013
Background: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for bot... more Background: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for both the mother and foetus, but it also provides an excellent early opportunity for intervention in the life course for both mother and baby. In the context of the escalating epidemic of chronic diseases among Indigenous Australians, it is vital that this risk is reduced as early as possible in the life course of the individual. The aims of the PANDORA Study are to: (i) accurately assess rates of diabetes in pregnancy in the Northern Territory (NT) of Australia, where 38% of babies are born to Indigenous mothers; (ii) assess demographic, clinical, biochemical, anthropometric, socioeconomic and early life development factors that may contribute to key maternal and neonatal birth outcomes associated with diabetes in pregnancy; and (iii) monitor relevant post-partum clinical outcomes for both the mothers and their babies. Methods/Design: Eligible participants are all NT women with diabetes in pregnancy aged 16 years and over. Information collected includes: standard antenatal clinical information, diagnosis and management of diabetes in pregnancy, socio-economic status, standard clinical birth information (delivery, gestational age, birth weight, adverse antenatal and birth outcomes). Cord blood is collected at the time of delivery and detailed neonatal anthropometric measurements performed within 72 hours of birth. Information will also be collected regarding maternal postpartum glucose tolerance and cardio-metabolic risk factor status, breastfeeding and growth of the baby up to 2 years post-partum in the first instance. Discussion: This study will accurately document rates and outcomes of diabetes in pregnancy in the NT of Australia, including the high-risk Indigenous Australian population. The results of this study should contribute to policy and clinical guidelines with the goal of reducing the future risk of obesity and diabetes in both mothers and their offspring.
BMC Pregnancy and Childbirth, 2009
Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worl... more Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified.
Diabetes/Metabolism Research and Reviews, 2015
Gestational diabetes is associated with a high risk of type 2 diabetes. However progression rates... more Gestational diabetes is associated with a high risk of type 2 diabetes. However progression rates among Indigenous women in Australia who experience high prevalence of gestational diabetes, are unknown. This retrospective cohort study includes all births to women at a regional hospital in Far North Queensland, Australia, coded as having "gestational diabetes" from 1/1/2004 to 31/12/2010 (1098 births), and receiving laboratory postpartum screening from 1/1/2004 to 31/12/2011 (n = 483 births). Women who did not receive postpartum screening were excluded from the denominator. Data were linked between hospital electronic records, routinely collected birth data and laboratories, with sample validation by reviews of medical records. Analysis was conducted using Cox-proportional regression models. Indigenous women had a greater than four-fold risk of developing type 2 diabetes within eight years of having gestational diabetes, compared to non-Indigenous women (HR 4.55, 95% confidence interval 2.63-7.88, p < 0.0001). Among women receiving postpartum screening tests, by three years, five years, and seven years postpartum, 21.9% (15.8-30.0%), 25.5% (18.6-34.3%), and 42.4% (29.6-58.0%) Indigenous women were diagnosed with type 2 diabetes after gestational diabetes respectively; compared to 4.2% (2.5-7.2%), 5.7% (3.3-9.5%), and 13.5% (7.3-24.2%) non-Indigenous women. Multivariate analysis showed significant associations between an increased rate of type 2 diabetes with an early pregnancy body mass index >25 kg/m(-2) , partial breastfeeding only at hospital discharge, and gestational diabetes diagnosis prior to 17 weeks gestation. This study demonstrates that, compared to non-Indigenous women, Indigenous Australian women have a greater than four-fold risk of developing type 2 diabetes after gestational diabetes. Strategies are urgently needed to reduce rates of type 2 diabetes by supporting a healthy weight and breastfeeding, and to improve postpartum screening among Indigenous women with gestational diabetes. This article is protected by copyright. All rights reserved.
The Medical journal of Australia
In a study of 1216 pregnancies, 427 (35%) patients reported hand symptoms. Symptoms of the same q... more In a study of 1216 pregnancies, 427 (35%) patients reported hand symptoms. Symptoms of the same quality and distribution were reported by 40 (30%) of 132 control subjects within the previous year, and although invariably mild, these symptoms suggest that pregnancy may aggravate a pre-existing condition. Fewer than 20% of the 427 affected patients described a classic median-nerve symptom distribution (carpal tunnel syndrome), while 12% of patients described an ulnar-nerve distribution, which is thought to represent a genuine and previously underestimated occurrence of ulnar-nerve neuropathy in pregnancy. In 69% of patients, hand symptoms were generalized. Most symptoms were bilateral, commenced in the third trimester and resolved soon after delivery. There was a significant correlation of hand symptoms in pregnancy with the presence of preeclampsia, tight rings, the weight at confinement, the birth weight and a history of premenstrual bloating. Operative intervention was not required...
Rural and remote health
A 2007 review of maternity services in Australia's Northern Territory (NT) noted the dissatis... more A 2007 review of maternity services in Australia's Northern Territory (NT) noted the dissatisfaction of women in the Barkly region where the birthing service closed in 2006. The review recommended improved integration of maternity services, a consumer focus, and a pilot study of birthing in Tennant Creek Hospital (TCH) in the Barkly region. Barkly region is sparsely populated, with 5700 people in 320 000 km2. The town of Tennant Creek with 3100 population is the only centre of more than 1000 people. In the Barkly region, 64% of the population and 74% of birthing women are Aboriginal. Current NT Department of Health (NT DoH) policy requires all women to give birth in a town with facilities for operative delivery. For most Barkly women this means travelling 500 km to Alice Springs with limited support for travel and accommodation. Emergency air evacuation is arranged for all women who enter labour or give birth while in the Barkly region, whether at TCH or elsewhere. This project ...
PLOS ONE, 2015
Several socio-cultural and biomedical risk factors for gestational diabetes mellitus (GDM) are mo... more Several socio-cultural and biomedical risk factors for gestational diabetes mellitus (GDM) are modifiable. However, few studies globally have examined socio-cultural associations. To eliminate confounding of increased risk of diabetes in subsequent pregnancies, elucidating socio-cultural associations requires examination only of first pregnancies.
Australian and New Zealand Journal of Obstetrics and Gynaecology
Background: Evidence on long-term trends in gestational diabetes mellitus (GDM) prevalence in Aus... more Background: Evidence on long-term trends in gestational diabetes mellitus (GDM) prevalence in Australia is lacking. Aims: To assess and compare trends in GDM prevalence among Indigenous and non-Indigenous Australian women. Materials and methods: Analysis of crude and age-adjusted GDM prevalence over time by Indigenous status and age, using routinely-collected midwives data from Australian states and territories on mothers giving birth from 1990-2009. Results: Despite considerable data variation, particularly in 1990-1999, and likely underestimation of GDM prevalence; crude and age-adjusted GDM prevalences were higher in Indigenous than non-Indigenous women at all time-points (4.7% versus 3.1% in 1990-1999; 5.1% versus 4.5% in 2000-2009, p<0.0001). Data variability precluded quantitative assessment of trends and changes in prevalence ratios before 2000. From 2000-2009, GDM prevalence increased significantly among Indigenous women by a mean 2.6% annually (ptrend<0.0001), and non...
Maternal and Child Health Journal, 2014
Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous w... more Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p \ 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (\6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p \ 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.
BMJ open, 2014
This paper reports secular trends in diabetes in pregnancy in Victoria, Australia and examines th... more This paper reports secular trends in diabetes in pregnancy in Victoria, Australia and examines the effect of including or excluding women with pre-existing diabetes on gestational diabetes (GDM) prevalence estimates. Population-based observational study. All births in Victoria, Australia between 1999 and 2008 PARTICIPANTS: 634,932 pregnancies resulting in a birth registered with the Victorian Perinatal Data Collection Crude and age-standardised secular trends in pre-existing diabetes and GDM prevalence; secular GDM trends by maternal birthplace; effects on GDM prevalence of including and excluding pre-existing diabetes from the denominator. Of the 634,932 pregnancies, 2954 (0.5%) occurred in women with pre-existing diabetes and 29,147 (4.6%) were complicated by GDM. Mean maternal age increased from 29.7 years in 1999 to 30.8 years in 2008. GDM prevalence increased in most maternal age groups. In 2008, age-standardised GDM prevalence was 31% higher than in 1999; secular increases wer...
Diabetes/Metabolism Research and Reviews, 2015
Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in a... more Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in any area of clinical research, outcome definitions vary from study to study, making it difficult to compare research findings and draw conclusions. Our aim was to compile and create a repository of definitions, which could then be used universally. A systematic review of the literature was performed of published and ongoing randomized controlled trials (RCTs) in the area of diabetes in pregnancy between Jan 1, 2000 and June 1, 2012. Other sources included the World Health Organization and Academic Society Statements. The advice of experts was sought when appropriate definitions were lacking. Among the published RCTs on diabetes and pregnancy, 171 abstracts were retrieved, 64 full texts were reviewed, and 53 were included. Among the ongoing RCTs published in ClinicalTrials.gov, 90 protocols were retrieved and 25 were finally included. The definitions from these were assembled and the final maternal definitions and fetal definitions were agreed upon by consensus. It is our hope that the definitions we have provided will be widely used in the reporting of future studies in the area of diabetes in pregnancy, that they will facilitate future systematic reviews and formal meta analyses, and ultimately improve outcomes for mothers and babies. This article is protected by copyright. All rights reserved.
Current Diabetes Reports, 2014
The International Association of Diabetes in Pregnancy Study Groups (IADPSG) recommended a new pr... more The International Association of Diabetes in Pregnancy Study Groups (IADPSG) recommended a new protocol of 1-step testing with a 75 g oral glucose tolerance test for gestational diabetes in 2010. Since that time, these recommendations have been carefully scrutinized and accepted by a variety of organizations, but challenged or rejected by others. In the current review, we present more details regarding the background to the development of the IADPSG recommendations and seek to place them in context with the available epidemiologic and randomized controlled trial data. In this "counterpoint," we also provide specific rebuttal for errors of fact and disputed contentions provided by Long and Cundy in their 2013 article in Current Diabetes Reports.
Diabetes/Metabolism Research and Reviews, 2014
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2014
In the Northern Territory (NT), 38% of 3500 births each year are to Indigenous women, 80% of whom... more In the Northern Territory (NT), 38% of 3500 births each year are to Indigenous women, 80% of whom live in regional and remote areas. Compared with the general Australian population, rates of pre-existing type 2 diabetes in pregnancy are 10-fold higher and rates of gestational diabetes are 1.5-fold higher among Indigenous women. Current practices in screening for diabetes in pregnancy in remote Australia are not known. To assess current health service delivery for NT women with diabetes in pregnancy (DIP) by surveying healthcare professionals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; views and practices in DIP screening and management. A cross-sectional survey of NT healthcare professionals providing clinical care for women with DIP was conducted based on pre-identified themes of communication, care-coordination, education, orientation and guidelines, logistics and access, and information technology. Of the 116 responders to the survey, 78% were primary healthcare professionals, 32% midwives and 25% general practitioners. High staff turnover was evident: of Central Australian professionals, only 33% (urban) and 18% (regional/remote) had been in their current position over 5 years. DIP screening was conducted at first antenatal visit by 66% and at 24-28-week gestation by 81%. Only 50% of respondents agreed that most women at their health service received appropriate care for DIP, and 41% of primary care practitioners were neutral or not confident in their skills to manage DIP. It is promising that many healthcare professionals report following new guidelines in conducting early pregnancy screening for DIP in high risk women. Several challenges were identified in healthcare delivery to a high risk population in remote Australia.
Ultrasound in Obstetrics and Gynecology, 2002
Objectives To assess the detection rate of congenital fetal malformations and specific problems r... more Objectives To assess the detection rate of congenital fetal malformations and specific problems related to routine ultrasound screening in women with pre-existing diabetes.
Trials, 2013
Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset ... more Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals.
Reproduction, Fertility and Development, 2010
The Medical Journal of Australia, 2013