Research Output
1 - 5 of 5
Publication
A national audit of smoking cessation services in Irish maternity units
2017-06, Reynolds, Ciara Marie Edel, Egan, B., Cawley, Shona, Kennedy, Rachel, Sheehan, Sharon, Turner, Michael
There is international consensus that smoking cessation in the first half of pregnancy improves foetal outcomes. We surveyed all 19 maternity units nationally about their antenatal smoking cessation practices. All units recorded details on maternal smoking at the first antenatal visit. Only one unit validated the self-reported smoking status of pregnant women using a carbon monoxide breath test. Twelve units (63%) recorded timing of smoking cessation. In all units women who reported smoking were given verbal cessation advice. This was supported by written advice in 12 units (63%), but only six units (32%) had all midwives trained to provide this advice. Only five units (26%) reported routinely revisiting smoking status later in pregnancy. Although smoking is an important modifiable risk factor for adverse pregnancy outcomes, smoking cessation services are inadequate in the Irish maternity services and there are variations in practices between hospitals.
Publication
Duration of periconceptional folic acid supplementation in women booking for antenatal care
2017-02, Cawley, Shona, Mullaney, Laura, Kennedy, Rachel, Farren, Maria, McCartney, Daniel, Turner, Michael
OBJECTIVE: To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices.DESIGN: Cross-sectional observational study. Women's clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher.SETTING: A large university maternity hospital, Republic of Ireland, January 2014-April 2016.SUBJECTS: Women (n 856) recruited at their convenience in the first trimester.RESULTS: While almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44 % of women who were supplementing with FA preconceptionally, 44 % (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed.CONCLUSIONS: As the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed.
Publication
Screening for gestational diabetes mellitus selectively in a university maternity hospital
2018-06, O'Malley, E. G., O'Duill, M., McArdle, C., Kennedy, Rachel, Reynolds, Ciara Marie Edel, Turner, Michael
Aims: Screening for gestational diabetes mellitus (GDM) may be universal or selective based on risk factors. We audited selective screening with an Oral Glucose Tolerance Test (OGTT).
Methods: Clinical and laboratory details of the first 200 women who delivered a baby in 2017 were analysed.
Results: Based on national recommendations, 46.5% (n=93) had maternal risk factors (RF) and an additional 6.5% (n=13) had fetal RF. Nine women with RF, for unexplained reasons did not have their OGTT. Of the 95 who had their OGTT, the diagnosis of GDM was made in 27.4% (n=26). The diagnosis of GDM was made in an additional 8 women outside selective screening giving an overall incidence of 17.0%.
Discussion: More than half of the women needed to be screened selectively for GDM. Compliance with the national recommendations was incomplete and thus the diagnosis of GDM may be missed even in an academic setting.
Publication
Provision of Information about Infant Feeding Postpartum Through Digital Media
2016-07-30, Mullaney, Laura, Cawley, Shona, O'Higgins, Amy, Kennedy, Rachel, McCartney, Daniel, Turner, Michael
Abstract Women seek information about infant feeding from multiple sources, which may conflict. Increasingly women use digital media for pregnancy information. This study examined women's use of digital media for information on infant feeding. In addition to clinical and socio-demographic data, detailed data concerning women's infant feeding practices and their use of digital media for infant feeding information were collected. We surveyed 295 women who attended nine months postpartum as part of a longitudinal study on maternal weight trajectories. Digital media was used by 130 women (44.1%) to access information on infant feeding, which is higher than hitherto reported. Women who did not use digital media were more likely to be multigravidous (p = 0.03), to be socially disadvantaged (p = 0.01), and were less likely to breastfeed (p = 0.01). However, on multivariable analysis, only women economically disadvantaged were less likely to use digital media [OR 0.25, p < 0.02]. The types of digital media used varied, and an overwhelming majority were non-subscription resources. Less than 5% of women used professional evidence-based digital media sources. The use of digital media was not associated with the timing of weaning. Information on infant feeding should be evidence-based and provided digitally to women across all socioeconomic gradients as part of an e-health national policy.
Publication
A prospective, observational study investigating the use of carbon monoxide screening to identify maternal smoking in a large university hospital in Ireland
2018-07-23, Reynolds, Ciara Marie Edel, Egan, Brendan, Kennedy, Rachel, O'Malley, Eimer G., Sheehan, Sharon R, Turner, Michael
Objectives: This study evaluated breath carbon monoxide (BCO) testing in identifying maternal smokers as well as the difference between disclosers and non-disclosers of smoking status. We also investigated if other extrinsic factors affected the women's BCO levels in pregnancy.
Design A prospective observational study.
Setting: A university obstetric hospital in an urban setting in Ireland. Participants Women (n=250) and their partners (n=54) were recruited at their first antenatal visit. Women <18 years and those who did not understand English were excluded. A booking history, including recording of smoking status, was collected by midwives. Following this, women were recruited and completed a detailed research questionnaire on smoking and extrinsic/ environmental BCO sources. A BCO test was performed on both the woman and her partner. Primary and secondary outcome measures The number of self-reported smokers and those that were positive on the BCO test. The characteristics of women who disclosed and did not disclose smoking status. The effect of extrinsic factors on the BCO test results.
Results: Based on the receiver-operating characteristic curve, a BCO cut-off point of ≥3 ppm was the optimal level to identify ongoing smoking. At booking history, 15% of women reported as current smokers. Based on BCO levels ≥3 ppm combined with self-reported smoking in the research questionnaire, the rate increased to 25%. Non-disclosers had similar characteristics to non-smokers. No extrinsic factors affected maternal BCO levels.
Conclusions: Based on self-report and BCO levels, a quarter of women presenting for antenatal care continued to smoke, but only 60% reported their smoking to midwives. BCO measurement is an inexpensive, practical method of improving identification of maternal smoking, and it was not effected by extrinsic sources of BCO. Improved identification means more smokers can be supported to stop smoking in early pregnancy potentially improving the short-term and long-term health of both mother and child.