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- PublicationPrevention of Neural Tube Defects in IrelandNeural tube defects (NTDs) are a group of serious congenital malformations, including encephalocoele and spina bifida (SB) which are associated with failure of closure of the neural tube during early embryonic development. They affect approximately one in 1000 births globally, and constitute an important challenge in terms of mortality, morbidity, social and financial costs. Studies indicate that approximately two thirds, but not all, cases of NTDs are preventable. The burden of disease associated NTDs is higher in Ireland than in other countries.
- PublicationThe prevention of neural tube defects in IrelandNeural tube defects (NTDs) are a group of serious congenital malformations, including anencephaly, encephalocoele and spina bifida (SB) which are associated with failure of closure of the neural tube during early embryonic development. They affect approximately one in 1000 births globally, and constitute an important challenge in terms of mortality, morbidity, social and financial costs. Studies indicate that approximately two thirds, but not all, cases of NTDs are preventable. The burden of disease associated with NTDs is higher in Ireland than in other countries. Ireland has the highest fertility rate in the European Union (EU), and more than twice as many babies with spina bifida are live-born in Ireland compared with the rest of the EU. It is estimated that there are about 500 patients with SB in Ireland. The prevention of NTDs should therefore be a higher healthcare priority in this country than in other well-resourced countries.
- PublicationThe interplay between maternal obesity and gestational diabetes mellitusThere is a strong epidemiological association between maternal obesity and gestational diabetes mellitus (GDM). Since the publication of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study on women with mild hyperglycemia in 2008, new criteria have been introduced in maternity services internationally for the diagnosis of GDM. As a result, the diagnosis of GDM may be made in one-third of obese women (n=68). The aim of this review was to examine the interplay between maternal obesity and GDM in light of the HAPO study and the subsequent revised diagnostic criteria. Obesity and GDM are important obstetric risk factors because they both are potentially modifiable. However, the new international criteria for the diagnosis of GDM have serious resource implications for maternity services provided to the large number of women attending for care in developed countries. Further consideration needs to be given as to whether obese women with mild hyperglycemia need to be referred to a multidisciplinary team antenatally if they do not require insulin treatment.
562Scopus© Citations 15
- PublicationA national survey of preanalytical handling of oral glucose tolerance tests in pregnancyWhile the criteria for the diagnosis of gestational diabetes mellitus (GDM) continue to be mired in controversy with a lack of international consensus, many countries and the World Health Organization have adopted the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations. In addtion, revised stricter recommendations have also been produced and endorsed by the National Academy of Clinical Biochemistry (NACB) for laboratory standards in the analysis of maternal glucose measurements.
302Scopus© Citations 10
- PublicationMaternal Body Mass Index and the prevalence of spontaneous and elective preterm delivery in an Irish obstetric population: a retrospective cohort studyObjective: To estimate the association between maternal body mass index (BMI) and risk of spontaneous preterm delivery (sPTD) and elective preterm delivery (ePTD) in singleton and multiple pregnancies. Design: Retrospective cohort study. Setting: Electronic records of all deliveries from 2009 through 2013 in a tertiary university hospital were abstracted for demographic and obstetrical information. Participants: A total of 38 528 deliveries were included. Participants with missing data were excluded from the study. BMI was calculated from the measurement of height and weight at the first prenatal visit and categorised. Sonographic confirmation of gestational age was standard. Outcome measures: Primary outcomes, sPTD and ePTD in singleton and multiple pregnancies, were evaluated by multinomial logistic regression analyses, stratified by parity, controlling for confounding variables. Results: Overall rate of PTD was 5.9%, from which 2.7% were sPTD and 3.2% ePTD. The rate of PTD was 50.4% in multiple pregnancies and 5.0% in singleton pregnancies. The risk of sPTD was increased in obese nulliparas (adjusted OR (aOR) 2.8, 95%CI 1.7 to 4.4) and underweight multiparas (aOR 2.2, 95%CI 1.3 to 3.8). The risk of ePTD was increased in underweight nulliparas (aOR 1.8; 95%CI 1.04 to 3.4) and severely obese multiparas (aOR 1.4, 95%CI 1.02 to 3.8). Severe obesity increased the risk of both sPTD (aOR 1.4; 95%CI 1.01 to 2.1) and ePTD (aOR 1.4; 95%CI 1.1 to 1.8) in singleton pregnancies. Obesity did not influence the rate of either sPTD or ePTD in multiple pregnancies. Conclusion: Maternal obesity is an independent risk factor for PTD in singleton pregnancies but not in multiple pregnancies. Obesity and nulliparity increase the risk of sPTD, whereas obesity and multiparity increase the risk of ePTD.
168Scopus© Citations 18
- PublicationImpact of Implementing Preanalytical Laboratory Standards on the Diagnosis of Gestational Diabetes Mellitus: A Prospective Observational StudyBackground: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, but risk is reduced with identification and early treatment. Glucose measurements are affected by preanalytical sample handling, such as temperature of storage, phlebotomy–analysis interval, and use of a glycolysis inhibitor. We evaluated glucose concentrations and the incidence of GDM after strict implementation of the American Diabetes Association (ADA) preanalytical guidelines, compared with usual hospital conditions. Methods: Women screened selectively for GDM at 24 –32 weeks’ gestation were recruited at their convenience before a 75-g oral glucose tolerance test. Paired samples were taken: the first sample followed ADA recommendations and was transferred to the laboratory on an iced slurry for immediate separation and analysis (research conditions), and the second sample was not placed on ice and was transferred according to hospital practice (usual conditions). Results: Of samples from 155 women, the mean fasting, 1-h, and 2-h results were 90.0 (12.6) mg/dL [5.0 (0.7) mmol/L], 142.2 (43.2) mg/dL [7.9 (2.4) mmol/L], and 102.6 (32.4) mg/dL [5.7 (1.8) mmol/L], respectively, under research conditions, and 81 (12.6) mg/dL [4.5 (0.7) mmol/L], 133.2 (41.4) mg/dL [7.4 (2.3) mmol/L], and 99 (32.4) mg/dL [5.5 (1.8) mmol/L] under usual conditions (all P 0.0001). GDM was diagnosed in 38.1% (n 59) under research conditions and 14.2% (n 22) under usual conditions (P 0.0001). The phlebotomy–analysis interval for the fasting, 1-h, and 2-h samples was 20 (9), 17 (10), and 17 (9) min under research conditions and 162 (19), 95 (23), and 32 (19) min under usual conditions (all P 0.0001). All cases of GDM were diagnosed on fasting or 1-h samples; the 2-h test diagnosed no additional cases. Conclusions: Implementation of ADA preanalytical glucose sample handling recommendations resulted in higher mean glucose concentrations and 2.7-fold increased detection of GDM compared with usual hospital practices.
322Scopus© Citations 39