Harold McIntyre - Academia.edu (original) (raw)

Papers by Harold McIntyre

Research paper thumbnail of The Hyperglycemia and Adverse Pregnancy Outcome Study: Associations of GDM and obesity with pregnancy outcomes

Diabetes Care, 2012

To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnan... more To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m(2)), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93-2.47), for obesity alone 1.73 (1.50-2.00), and for both GDM and obesity 3.62 (3.04-4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

Research paper thumbnail of A Randomised Controlled Trial to Delay or Prevent Type 2 Diabetes after Gestational Diabetes: Walking for Exercise and Nutrition to Prevent Diabetes for You

International Journal of Endocrinology, 2015

To develop a program to support behaviour changes for women with a history of Gestational Diabete... more To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus (GDM) and a Body Mass Index (BMI) > 25 kg/m 2 to delay or prevent Type 2 Diabetes Mellitus. Methods. Women diagnosed with GDM in the previous 6 to 24 months and BMI > 25 kg/m 2 were randomized to an intervention (I) ( = 16) or a control (C) ( = 15) group. The intervention was a pedometer program combined with nutrition coaching, with the primary outcome increased weight loss in the intervention group. Secondary outcomes included decreased waist and hip measurements, improved insulin sensitivity and body composition, increased physical activity, and improved self-efficacy in eating behaviours. Results. Median (IQR) results were as follows: weight: I −2.5 (2.3) kg versus C +0.2 (1.6) kg ( = 0.009), waist: I −3.6 (4.5) cm versus C −0.1 (3.6) cm ( = 0.07), and hip: I −5.0 (3.3) cm versus C −0.2 (2.6) cm ( = 0.002). There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition. Conclusion. A pedometer program and nutrition coaching proved effective in supporting weight loss, waist circumference, physical activity, and eating behaviours in women with previous GDM.

Research paper thumbnail of Hormonal and Metabolic Factors Associated With Variations in Insulin Sensitivity in Human Pregnancy

Diabetes Care, 2010

OBJECTIVE -The objective of this study was to determine maternal hormonal and metabolic factors a... more OBJECTIVE -The objective of this study was to determine maternal hormonal and metabolic factors associated with insulin sensitivity in human pregnancy.

Research paper thumbnail of Obesity and the Hypertensive Disorders of Pregnancy

Hypertens Pregnancy, 2009

Overweight and obesity have a strong association with the development of hypertensive disorders o... more Overweight and obesity have a strong association with the development of hypertensive disorders of pregnancy. However, the mechanisms underpinning this relationship are not clear. Obesity is associated with insulin resistance, endothelial dysfunction, hypertension dyslipidaemia, inflammatory upregulation, alteration in immune function and prothrombotic changes. These changes may contribute to the development of hypertensive disorders of pregnancy, by influencing placentation, endothelial function, and inflammation. The genetic predisposition for hypertensive disorders of pregnancy needs to be examined in the context of obesity. Common antecedents such as dietary factors and inadequate physical activity might also explain the relationship between hypertensive disorders of pregnancy and obesity. This review is concluded with a synopsis and recommendations for further research.

Research paper thumbnail of Changing the protocol for gestational diabetes mellitus screening

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2015

Gestational diabetes mellitus (GDM) affects 5-8% of pregnant women in Australia and is linked to ... more Gestational diabetes mellitus (GDM) affects 5-8% of pregnant women in Australia and is linked to adverse maternal and neonatal outcomes. Earlier diagnosis and treatment has been suggested to improve these outcomes. To describe the experience of a change in GDM screening policy at a large tertiary hospital. A 6-month audit was performed following a policy change involving introduction of screening for all women early in pregnancy (by either random blood glucose level (BGL) or oral glucose tolerance testing (OGTT), depending on their perceived risk of developing GDM), followed by universal OGTT at 26-28 weeks' gestation. The prevalence of GDM (including changes expected from new Australasian Diabetes in Pregnancy Society (ADIPS) criteria), maternal and neonatal outcomes and adherence to new screening policy are reported. The prevalence of GDM was 7.9% (1.6% early, 6.3% later diagnoses). More women with early diagnoses required insulin. Early testing with random BGL for low-risk women only identified 1.7% of those with GDM. Early OGTT for high-risk women identified 24.9% of GDM diagnoses. Adherence to the new screening protocol was generally poor, with 26% adherence at booking, 64% at 26 weeks' gestation and 27% with unknown GDM status. While early testing with OGTT for high-risk women may be helpful, the value of early testing with random BGL for low-risk women is questionable. The new ADIPS criteria are likely to increase the number of women diagnosed with GDM (with an emphasis on earlier diagnosis), but the absolute increase remains small.

Research paper thumbnail of Barriers to addressing overweight and obesity before conception

The Medical journal of Australia

Research paper thumbnail of Feasibility of an Exercise Intervention in Obese Pregnant Women

Research paper thumbnail of Exercise in Obese Pregnant Women: A Randomized Study to Assess Feasibility

Background: Obesity is arguably the leading reason for a high risk pregnancy. Obese pregnant wome... more Background: Obesity is arguably the leading reason for a high risk pregnancy. Obese pregnant women are more likely to develop gestational diabetes and hypertensive disorders of pregnancy. Exercise improves insulin sensitivity and lowers blood pressure, and so it could be a valuable therapy in helping to prevent pregnancy complications in obese pregnant women. Aim: To assess the feasibility of a highly supported, individualized exercise program in obese pregnant women. Methods: 50 obese women were recruited early in pregnancy and randomized to either a highly supported, individualized exercise intervention or usual activity. Women in the intervention arm met with a physiotherapist/exercise physiologist, and had a detailed assessment of their preferences for physical activity and potential barriers to physical activity. A personalized program was developed, targetting 1500 kCal of physical activity per week (equivalent to 30 minutes of physical activity on most days of the week). Wome...

Research paper thumbnail of Reference intervals for plasma sulfate and urinary sulfate excretion in pregnancy

BMC Pregnancy and Childbirth, 2015

Background: Sulfate is important for fetal growth and development. During pregnancy, the fetus re... more Background: Sulfate is important for fetal growth and development. During pregnancy, the fetus relies on sulfate from the maternal circulation. We report reference intervals for maternal plasma sulfate levels and fractional excretion index (FEI) for sulfate in pregnancy, as well as sulfate levels in cord blood from term pregnancies. Methods: Plasma and urine were collected from 103 pregnant women of 10-20 weeks gestation and 106 pregnant women of 30-37 weeks gestation. Venous cord plasma was collected from 80 healthy term babies. Sulfate levels were measured by ion chromatography. Plasma and urinary creatinine levels were used to calculate FEI sulfate in pregnant women. Analyses provide reference intervals, and explored the relationship between maternal sulfate data with several prenatal factors.

Research paper thumbnail of 1. Article title: Study protocol: Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study

Research paper thumbnail of Placental fibroblast growth factor 21 is not altered in late-onset preeclampsia

Reproductive Biology and Endocrinology, 2015

Preeclampsia (PE) is associated with alterations of placental function. The incidence of PE is hi... more Preeclampsia (PE) is associated with alterations of placental function. The incidence of PE is higher in insulin resistant states. Women with PE have high circulating levels of the metabolic regulator fibroblast growth factor 21 (FGF21). FGF21 is synthesized in the placenta. The aim of this study was to compare the expression of FGF21, its receptors, downstream targets and transcriptional regulators in placental tissue from pregnancies with and without late-onset PE. Circulating FGF21 in maternal and cord blood was also studied. mRNA expression was determined by semi-quantitative real-time PCR and normalized for cellular composition in 17 women with and 20 without PE. Protein expression was quantified by Western Blot. FGF21 levels were measured by ELISA in maternal and cord serum of ten mother-baby dyads per condition. Placental FGF21 mRNA and protein expression were similar in PE compared with control. Placental mRNA expression of the FGF receptors (1-4) and the co-receptor beta-Klotho was not different between the groups. There was no difference in the expression of the glucose transporters GLUT1, 3 or 4. PPAR-alpha but not PPAR-gamma expression was decreased in PE. Maternal FGF21 serum levels were not significantly different in PE. FGF21 was detected in cord blood of 6 infants (4 PE, 2 controls) but was undetectable in 14 infants. Late-onset PE is not associated with major changes to the expression of FGF21, its receptors or metabolic targets.

Research paper thumbnail of Validation of a triglyceride meter for use in pregnancy

BMC research notes, 2014

Elevated maternal triglycerides have been associated with adverse pregnancy outcomes including an... more Elevated maternal triglycerides have been associated with adverse pregnancy outcomes including an increased risk of preeclampsia and macrosomia. A valid triglyceride meter would allow the examination of maternal postprandial triglycerides in a systematic manner. A non-fasting venous and two capillary measurements (using the Roche Accutrend® Plus meter) of triglycerides were measured in 40 participants at a mean of 36 weeks gestation. The two methods were highly correlated (r = 0.89, P < 0.0001), and the distributions were similar (mean difference 0.01 mmol/L (SD 0.47)), t = 0.18, P =0.86). Passing Bablok equation was: y = -0.01 + 0.98 × [95% CI intercept -0.51 - 0. 38; 95% CI slope 0.85-1.15). The estimated bias was -0.01 mmol/L (95% CI -0.93 - 0.91)). This study demonstrated the Accutrend® Plus meter provides results that correlate strongly with the reference method, with low bias, when used in late pregnancy.

Research paper thumbnail of The prevalence and impact of overweight and obesity in an Australian obstetric population

The Medical journal of Australia, Jan 16, 2006

To assess the prevalence and impact of overweight and obesity in an Australian obstetric populati... more To assess the prevalence and impact of overweight and obesity in an Australian obstetric population. The Mater Mother's Hospital (MMH), South Brisbane, is an urban tertiary referral maternity hospital. We reviewed data for the 18 401 women who were booked for antenatal care at the MMH, delivered between January 1998 and December 2002, and had a singleton pregnancy. Of those women, 14 230 had an estimated pre-pregnancy body mass index (BMI) noted in their record; 2978 women with BMI < or = 20 kg/m2 were excluded from further study; the remaining 11 252 women were divided into four categories: "normal" (BMI 20.01-25 kg/m(2)), "overweight" (BMI 25.01-30 kg/m(2)), "obese" (BMI 30.01-40 kg/m(2)) and "morbidly obese" (BMI > 40 kg/m(2)). Prevalence of overweight and obesity in an obstetric population; maternal, peripartum and neonatal outcomes associated with raised BMI. Of the 14 230 women, 6443 (45%) were of normal weight, and 4809 (34%) ...

Research paper thumbnail of Hypertensive disorders of pregnancy and long-term risk of hypertension: what do Ontario prenatal care providers know, and what do they communicate?

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2007

The objective of this study was to ascertain the knowledge base of Ontario maternity care provide... more The objective of this study was to ascertain the knowledge base of Ontario maternity care providers (family physicians, obstetrician-gynaecologists, and midwives) regarding the future health risks of gestational hypertension and preeclampsia and the practices with respect to communication of these risks. In 2004, all obstetricians (639) and midwives (249) in Ontario and a random sample of 600 Ontario family physicians were mailed a survey and a reminder. Non-responders were also sent a second, and in some cases, a third copy of the survey. The survey addressed areas of knowledge, reported practices, and both patient and interprofessional communication. Descriptive analysis was used for the responses. The overall response rate was 42%. The majority of respondents were familiar with the long-term risks of gestational hypertension and preeclampsia. Although maternity care providers stated that they inform women with these conditions about their subsequent risks and recommend follow-up,...

Research paper thumbnail of Factors determining insulin requirements in women with type 1 diabetes mellitus during pregnancy: a review

Obstetric Medicine: The Medicine of Pregnancy, 2014

Research paper thumbnail of A review of interventions to prevent Type 2 Diabetes after Gestational Diabetes

Women and Birth, 2014

Gestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type... more Gestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type 2 Diabetes (T2DM) within 15 years, and prevention programmes have been problematic. The aim of the study is to identify effective strategies and programmes to decrease the risk of T2DM in women who experience GDM, the barriers to participation, and the opportunities for midwives to assist women in prevention. English language, peer reviewed and professional literature published between 1998 and 2013 were searched. A systematic review of the literature was undertaken, included studies were then appraised for quality and finally findings of the studies were thematically analysed. This review identified that there are interventions that are effective, however most lifestyle changes are difficult to translate into everyday life. As the incidence of GDM is expected to rise, midwives&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;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; role in promoting long-term health behaviours requires further review. Women need to overcome barriers and be supported in making the behavioural changes necessary to prevent T2DM following GDM. Midwives as the primary carers for women in pregnancy and childbirth are ideally positioned to educate women and engage them in lifestyle and behaviour programmes that prevent the onset of Type 2 Diabetes.

Research paper thumbnail of Cesarean delivery and the long-term risk of offspring obesity

Obstetrics and gynecology, 2013

To examine the association between the mode of delivery and the risk of offspring obesity by age ... more To examine the association between the mode of delivery and the risk of offspring obesity by age 21 years using a large community-based birth cohort study in Australia. We followed-up a subsample of 2,625 offspring for whom we had measured physical assessments, including height and weight at 21 years and hospital-recorded mode of delivery, in the Mater Hospital in Brisbane, Australia, between 1981 and 1983. Body mass index (BMI) and waist circumference were measured at 21 years. Multivariable regression analysis was used to examine the independent associations of mode of delivery with offspring BMI and waist circumference. In the cohort, 12.1% were born by cesarean delivery. Maternal and birth factors independently associated with the mode of delivery were age, overweight and obesity status, smoking status during pregnancy, hypertensive disorder during pregnancy, and neonatal low birth weight. By 21 years, 21.5% of offspring were overweight and 12.4% were obese. Offspring overweight...

Research paper thumbnail of Barriers and enablers to translating gestational diabetes guidelines into practice

Practical Diabetes, 2014

ABSTRACT Reduced insulin requirements and improved blood glucose level (BGL) control in gestation... more ABSTRACT Reduced insulin requirements and improved blood glucose level (BGL) control in gestational diabetes mellitus (GDM) have been documented in a study validating American Nutrition Practice Guidelines that included a dietitian appointment schedule. No Australian nutrition practice guidelines exist and care differs across centres. Guideline dissemination alone does not change practice; assessment of barriers/enablers and implementation design must be theory-driven. We describe this assessment and the planned intervention to implement a schedule of dietitian consults for GDM care.A barriers and enablers analysis was undertaken. Data sources included hospital records, clinic observation, and staff surveys. Dietetic visits were compared with the Nutrition Practice Guideline. Barriers were categorised into domains from the Theoretical Domains Framework.Of 44 clinic staff surveyed, most believed regular dietetic contact could influence diet, but fewer believed contact could influence BGLs, pharmacotherapy, and care costs, and only half felt contact could influence weight gain or macrosomia. Women&amp;amp;#39;s lack of awareness of the benefits of scheduled contact with a dietitian and staff&amp;amp;#39;s unfamiliarity with current practice were identified. There was a significant shortfall in dietitian resources. Other barriers included lack of dedicated clinic space and exclusion from the clinic care pathway.Identified barrier ‘domains’ were: Knowledge; Beliefs about consequences; Intentions; Social/professional role/identity; Social influences; Memory, attention, and decision processes; and Environmental context and resources. Effective change interventions have been mapped to domains. Outcomes of the evaluation will be uptake of the new dietetic schedule and its effect on requirement for pharmacotherapy. Copyright © 2014 John Wiley &amp;amp;amp; Sons. Practical Diabetes 2014; 31(2): 67–72

Research paper thumbnail of Translation of a gestational diabetes nutrition model of care into practice: results from an implementation project

BMC Health Services Research, 2014

Research paper thumbnail of Pilot Study of an Individualised Early Postpartum Intervention to Increase Physical Activity in Women with Previous Gestational Diabetes

International Journal of Endocrinology, 2012

Optimal strategies to prevent progression towards overt diabetes in women with recent gestational... more Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined. We report a pilot study of a convenient, home based exercise program with telephone support, suited to the early post-partum period. Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week randomised controlled trial of Usual Care (n = 13) versus Supported Care (individualised exercise program with regular telephone support; n = 15). Baseline characteristics (Mean ± SD) were: Age 33 ± 4 years; Weight 80 ± 20 kg and Body Mass Index (BMI) 30.0 ± 9.7 kg/m 2 . The primary outcome, planned physical activity {Median (Range)}, increased by 60 (0-540) mins/week in the SC group versus 0 (0-580) mins/week in the UC group (P = 0.234). Walking was the predominant physical activity. Body weight, BMI, waist circumference, % body fat, fasting glucose and insulin did not change significantly over time in either group. This intervention designed to increase physical activity in post-partum women with previous gestational diabetes proved feasible. However, no measurable improvement in metabolic or biometric parameters was observed over a three month period.

Research paper thumbnail of The Hyperglycemia and Adverse Pregnancy Outcome Study: Associations of GDM and obesity with pregnancy outcomes

Diabetes Care, 2012

To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnan... more To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide &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;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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m(2)), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight &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;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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90th percentile for GDM alone was 2.19 (1.93-2.47), for obesity alone 1.73 (1.50-2.00), and for both GDM and obesity 3.62 (3.04-4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat &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;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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90th percentiles were similar. Odds for birth weight &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;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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

Research paper thumbnail of A Randomised Controlled Trial to Delay or Prevent Type 2 Diabetes after Gestational Diabetes: Walking for Exercise and Nutrition to Prevent Diabetes for You

International Journal of Endocrinology, 2015

To develop a program to support behaviour changes for women with a history of Gestational Diabete... more To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus (GDM) and a Body Mass Index (BMI) > 25 kg/m 2 to delay or prevent Type 2 Diabetes Mellitus. Methods. Women diagnosed with GDM in the previous 6 to 24 months and BMI > 25 kg/m 2 were randomized to an intervention (I) ( = 16) or a control (C) ( = 15) group. The intervention was a pedometer program combined with nutrition coaching, with the primary outcome increased weight loss in the intervention group. Secondary outcomes included decreased waist and hip measurements, improved insulin sensitivity and body composition, increased physical activity, and improved self-efficacy in eating behaviours. Results. Median (IQR) results were as follows: weight: I −2.5 (2.3) kg versus C +0.2 (1.6) kg ( = 0.009), waist: I −3.6 (4.5) cm versus C −0.1 (3.6) cm ( = 0.07), and hip: I −5.0 (3.3) cm versus C −0.2 (2.6) cm ( = 0.002). There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition. Conclusion. A pedometer program and nutrition coaching proved effective in supporting weight loss, waist circumference, physical activity, and eating behaviours in women with previous GDM.

Research paper thumbnail of Hormonal and Metabolic Factors Associated With Variations in Insulin Sensitivity in Human Pregnancy

Diabetes Care, 2010

OBJECTIVE -The objective of this study was to determine maternal hormonal and metabolic factors a... more OBJECTIVE -The objective of this study was to determine maternal hormonal and metabolic factors associated with insulin sensitivity in human pregnancy.

Research paper thumbnail of Obesity and the Hypertensive Disorders of Pregnancy

Hypertens Pregnancy, 2009

Overweight and obesity have a strong association with the development of hypertensive disorders o... more Overweight and obesity have a strong association with the development of hypertensive disorders of pregnancy. However, the mechanisms underpinning this relationship are not clear. Obesity is associated with insulin resistance, endothelial dysfunction, hypertension dyslipidaemia, inflammatory upregulation, alteration in immune function and prothrombotic changes. These changes may contribute to the development of hypertensive disorders of pregnancy, by influencing placentation, endothelial function, and inflammation. The genetic predisposition for hypertensive disorders of pregnancy needs to be examined in the context of obesity. Common antecedents such as dietary factors and inadequate physical activity might also explain the relationship between hypertensive disorders of pregnancy and obesity. This review is concluded with a synopsis and recommendations for further research.

Research paper thumbnail of Changing the protocol for gestational diabetes mellitus screening

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2015

Gestational diabetes mellitus (GDM) affects 5-8% of pregnant women in Australia and is linked to ... more Gestational diabetes mellitus (GDM) affects 5-8% of pregnant women in Australia and is linked to adverse maternal and neonatal outcomes. Earlier diagnosis and treatment has been suggested to improve these outcomes. To describe the experience of a change in GDM screening policy at a large tertiary hospital. A 6-month audit was performed following a policy change involving introduction of screening for all women early in pregnancy (by either random blood glucose level (BGL) or oral glucose tolerance testing (OGTT), depending on their perceived risk of developing GDM), followed by universal OGTT at 26-28 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation. The prevalence of GDM (including changes expected from new Australasian Diabetes in Pregnancy Society (ADIPS) criteria), maternal and neonatal outcomes and adherence to new screening policy are reported. The prevalence of GDM was 7.9% (1.6% early, 6.3% later diagnoses). More women with early diagnoses required insulin. Early testing with random BGL for low-risk women only identified 1.7% of those with GDM. Early OGTT for high-risk women identified 24.9% of GDM diagnoses. Adherence to the new screening protocol was generally poor, with 26% adherence at booking, 64% at 26 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation and 27% with unknown GDM status. While early testing with OGTT for high-risk women may be helpful, the value of early testing with random BGL for low-risk women is questionable. The new ADIPS criteria are likely to increase the number of women diagnosed with GDM (with an emphasis on earlier diagnosis), but the absolute increase remains small.

Research paper thumbnail of Barriers to addressing overweight and obesity before conception

The Medical journal of Australia

Research paper thumbnail of Feasibility of an Exercise Intervention in Obese Pregnant Women

Research paper thumbnail of Exercise in Obese Pregnant Women: A Randomized Study to Assess Feasibility

Background: Obesity is arguably the leading reason for a high risk pregnancy. Obese pregnant wome... more Background: Obesity is arguably the leading reason for a high risk pregnancy. Obese pregnant women are more likely to develop gestational diabetes and hypertensive disorders of pregnancy. Exercise improves insulin sensitivity and lowers blood pressure, and so it could be a valuable therapy in helping to prevent pregnancy complications in obese pregnant women. Aim: To assess the feasibility of a highly supported, individualized exercise program in obese pregnant women. Methods: 50 obese women were recruited early in pregnancy and randomized to either a highly supported, individualized exercise intervention or usual activity. Women in the intervention arm met with a physiotherapist/exercise physiologist, and had a detailed assessment of their preferences for physical activity and potential barriers to physical activity. A personalized program was developed, targetting 1500 kCal of physical activity per week (equivalent to 30 minutes of physical activity on most days of the week). Wome...

Research paper thumbnail of Reference intervals for plasma sulfate and urinary sulfate excretion in pregnancy

BMC Pregnancy and Childbirth, 2015

Background: Sulfate is important for fetal growth and development. During pregnancy, the fetus re... more Background: Sulfate is important for fetal growth and development. During pregnancy, the fetus relies on sulfate from the maternal circulation. We report reference intervals for maternal plasma sulfate levels and fractional excretion index (FEI) for sulfate in pregnancy, as well as sulfate levels in cord blood from term pregnancies. Methods: Plasma and urine were collected from 103 pregnant women of 10-20 weeks gestation and 106 pregnant women of 30-37 weeks gestation. Venous cord plasma was collected from 80 healthy term babies. Sulfate levels were measured by ion chromatography. Plasma and urinary creatinine levels were used to calculate FEI sulfate in pregnant women. Analyses provide reference intervals, and explored the relationship between maternal sulfate data with several prenatal factors.

Research paper thumbnail of 1. Article title: Study protocol: Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study

Research paper thumbnail of Placental fibroblast growth factor 21 is not altered in late-onset preeclampsia

Reproductive Biology and Endocrinology, 2015

Preeclampsia (PE) is associated with alterations of placental function. The incidence of PE is hi... more Preeclampsia (PE) is associated with alterations of placental function. The incidence of PE is higher in insulin resistant states. Women with PE have high circulating levels of the metabolic regulator fibroblast growth factor 21 (FGF21). FGF21 is synthesized in the placenta. The aim of this study was to compare the expression of FGF21, its receptors, downstream targets and transcriptional regulators in placental tissue from pregnancies with and without late-onset PE. Circulating FGF21 in maternal and cord blood was also studied. mRNA expression was determined by semi-quantitative real-time PCR and normalized for cellular composition in 17 women with and 20 without PE. Protein expression was quantified by Western Blot. FGF21 levels were measured by ELISA in maternal and cord serum of ten mother-baby dyads per condition. Placental FGF21 mRNA and protein expression were similar in PE compared with control. Placental mRNA expression of the FGF receptors (1-4) and the co-receptor beta-Klotho was not different between the groups. There was no difference in the expression of the glucose transporters GLUT1, 3 or 4. PPAR-alpha but not PPAR-gamma expression was decreased in PE. Maternal FGF21 serum levels were not significantly different in PE. FGF21 was detected in cord blood of 6 infants (4 PE, 2 controls) but was undetectable in 14 infants. Late-onset PE is not associated with major changes to the expression of FGF21, its receptors or metabolic targets.

Research paper thumbnail of Validation of a triglyceride meter for use in pregnancy

BMC research notes, 2014

Elevated maternal triglycerides have been associated with adverse pregnancy outcomes including an... more Elevated maternal triglycerides have been associated with adverse pregnancy outcomes including an increased risk of preeclampsia and macrosomia. A valid triglyceride meter would allow the examination of maternal postprandial triglycerides in a systematic manner. A non-fasting venous and two capillary measurements (using the Roche Accutrend® Plus meter) of triglycerides were measured in 40 participants at a mean of 36 weeks gestation. The two methods were highly correlated (r = 0.89, P < 0.0001), and the distributions were similar (mean difference 0.01 mmol/L (SD 0.47)), t = 0.18, P =0.86). Passing Bablok equation was: y = -0.01 + 0.98 × [95% CI intercept -0.51 - 0. 38; 95% CI slope 0.85-1.15). The estimated bias was -0.01 mmol/L (95% CI -0.93 - 0.91)). This study demonstrated the Accutrend® Plus meter provides results that correlate strongly with the reference method, with low bias, when used in late pregnancy.

Research paper thumbnail of The prevalence and impact of overweight and obesity in an Australian obstetric population

The Medical journal of Australia, Jan 16, 2006

To assess the prevalence and impact of overweight and obesity in an Australian obstetric populati... more To assess the prevalence and impact of overweight and obesity in an Australian obstetric population. The Mater Mother's Hospital (MMH), South Brisbane, is an urban tertiary referral maternity hospital. We reviewed data for the 18 401 women who were booked for antenatal care at the MMH, delivered between January 1998 and December 2002, and had a singleton pregnancy. Of those women, 14 230 had an estimated pre-pregnancy body mass index (BMI) noted in their record; 2978 women with BMI < or = 20 kg/m2 were excluded from further study; the remaining 11 252 women were divided into four categories: "normal" (BMI 20.01-25 kg/m(2)), "overweight" (BMI 25.01-30 kg/m(2)), "obese" (BMI 30.01-40 kg/m(2)) and "morbidly obese" (BMI > 40 kg/m(2)). Prevalence of overweight and obesity in an obstetric population; maternal, peripartum and neonatal outcomes associated with raised BMI. Of the 14 230 women, 6443 (45%) were of normal weight, and 4809 (34%) ...

Research paper thumbnail of Hypertensive disorders of pregnancy and long-term risk of hypertension: what do Ontario prenatal care providers know, and what do they communicate?

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2007

The objective of this study was to ascertain the knowledge base of Ontario maternity care provide... more The objective of this study was to ascertain the knowledge base of Ontario maternity care providers (family physicians, obstetrician-gynaecologists, and midwives) regarding the future health risks of gestational hypertension and preeclampsia and the practices with respect to communication of these risks. In 2004, all obstetricians (639) and midwives (249) in Ontario and a random sample of 600 Ontario family physicians were mailed a survey and a reminder. Non-responders were also sent a second, and in some cases, a third copy of the survey. The survey addressed areas of knowledge, reported practices, and both patient and interprofessional communication. Descriptive analysis was used for the responses. The overall response rate was 42%. The majority of respondents were familiar with the long-term risks of gestational hypertension and preeclampsia. Although maternity care providers stated that they inform women with these conditions about their subsequent risks and recommend follow-up,...

Research paper thumbnail of Factors determining insulin requirements in women with type 1 diabetes mellitus during pregnancy: a review

Obstetric Medicine: The Medicine of Pregnancy, 2014

Research paper thumbnail of A review of interventions to prevent Type 2 Diabetes after Gestational Diabetes

Women and Birth, 2014

Gestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type... more Gestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type 2 Diabetes (T2DM) within 15 years, and prevention programmes have been problematic. The aim of the study is to identify effective strategies and programmes to decrease the risk of T2DM in women who experience GDM, the barriers to participation, and the opportunities for midwives to assist women in prevention. English language, peer reviewed and professional literature published between 1998 and 2013 were searched. A systematic review of the literature was undertaken, included studies were then appraised for quality and finally findings of the studies were thematically analysed. This review identified that there are interventions that are effective, however most lifestyle changes are difficult to translate into everyday life. As the incidence of GDM is expected to rise, midwives&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;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; role in promoting long-term health behaviours requires further review. Women need to overcome barriers and be supported in making the behavioural changes necessary to prevent T2DM following GDM. Midwives as the primary carers for women in pregnancy and childbirth are ideally positioned to educate women and engage them in lifestyle and behaviour programmes that prevent the onset of Type 2 Diabetes.

Research paper thumbnail of Cesarean delivery and the long-term risk of offspring obesity

Obstetrics and gynecology, 2013

To examine the association between the mode of delivery and the risk of offspring obesity by age ... more To examine the association between the mode of delivery and the risk of offspring obesity by age 21 years using a large community-based birth cohort study in Australia. We followed-up a subsample of 2,625 offspring for whom we had measured physical assessments, including height and weight at 21 years and hospital-recorded mode of delivery, in the Mater Hospital in Brisbane, Australia, between 1981 and 1983. Body mass index (BMI) and waist circumference were measured at 21 years. Multivariable regression analysis was used to examine the independent associations of mode of delivery with offspring BMI and waist circumference. In the cohort, 12.1% were born by cesarean delivery. Maternal and birth factors independently associated with the mode of delivery were age, overweight and obesity status, smoking status during pregnancy, hypertensive disorder during pregnancy, and neonatal low birth weight. By 21 years, 21.5% of offspring were overweight and 12.4% were obese. Offspring overweight...

Research paper thumbnail of Barriers and enablers to translating gestational diabetes guidelines into practice

Practical Diabetes, 2014

ABSTRACT Reduced insulin requirements and improved blood glucose level (BGL) control in gestation... more ABSTRACT Reduced insulin requirements and improved blood glucose level (BGL) control in gestational diabetes mellitus (GDM) have been documented in a study validating American Nutrition Practice Guidelines that included a dietitian appointment schedule. No Australian nutrition practice guidelines exist and care differs across centres. Guideline dissemination alone does not change practice; assessment of barriers/enablers and implementation design must be theory-driven. We describe this assessment and the planned intervention to implement a schedule of dietitian consults for GDM care.A barriers and enablers analysis was undertaken. Data sources included hospital records, clinic observation, and staff surveys. Dietetic visits were compared with the Nutrition Practice Guideline. Barriers were categorised into domains from the Theoretical Domains Framework.Of 44 clinic staff surveyed, most believed regular dietetic contact could influence diet, but fewer believed contact could influence BGLs, pharmacotherapy, and care costs, and only half felt contact could influence weight gain or macrosomia. Women&amp;amp;#39;s lack of awareness of the benefits of scheduled contact with a dietitian and staff&amp;amp;#39;s unfamiliarity with current practice were identified. There was a significant shortfall in dietitian resources. Other barriers included lack of dedicated clinic space and exclusion from the clinic care pathway.Identified barrier ‘domains’ were: Knowledge; Beliefs about consequences; Intentions; Social/professional role/identity; Social influences; Memory, attention, and decision processes; and Environmental context and resources. Effective change interventions have been mapped to domains. Outcomes of the evaluation will be uptake of the new dietetic schedule and its effect on requirement for pharmacotherapy. Copyright © 2014 John Wiley &amp;amp;amp; Sons. Practical Diabetes 2014; 31(2): 67–72

Research paper thumbnail of Translation of a gestational diabetes nutrition model of care into practice: results from an implementation project

BMC Health Services Research, 2014

Research paper thumbnail of Pilot Study of an Individualised Early Postpartum Intervention to Increase Physical Activity in Women with Previous Gestational Diabetes

International Journal of Endocrinology, 2012

Optimal strategies to prevent progression towards overt diabetes in women with recent gestational... more Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined. We report a pilot study of a convenient, home based exercise program with telephone support, suited to the early post-partum period. Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week randomised controlled trial of Usual Care (n = 13) versus Supported Care (individualised exercise program with regular telephone support; n = 15). Baseline characteristics (Mean ± SD) were: Age 33 ± 4 years; Weight 80 ± 20 kg and Body Mass Index (BMI) 30.0 ± 9.7 kg/m 2 . The primary outcome, planned physical activity {Median (Range)}, increased by 60 (0-540) mins/week in the SC group versus 0 (0-580) mins/week in the UC group (P = 0.234). Walking was the predominant physical activity. Body weight, BMI, waist circumference, % body fat, fasting glucose and insulin did not change significantly over time in either group. This intervention designed to increase physical activity in post-partum women with previous gestational diabetes proved feasible. However, no measurable improvement in metabolic or biometric parameters was observed over a three month period.