Publications by authors named "Jacqueline A Boyle"

86 Publications

Incorporating Aboriginal women's voices in improving care and reducing risk for women with diabetes in pregnancy - A phenomenological study.

BMC Pregnancy Childbirth 2021 Sep 16;21(1):624. Epub 2021 Sep 16.

Menzies School of Health Research, Charles Darwin University, NT, Darwin, Australia.

Background: There is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Aboriginal and Torres Strait Islander women. Postpartum diabetes programs have the potential to prevent recurrent GDM and improve management of type 2 diabetes. However, data on such programs are limited, particularly in the Indigenous context. We aimed to explore Aboriginal Australian women's and health providers' preferences for a program to prevent and improve diabetes after pregnancy.

Methods: A phenomenological methodology underpinned semi-structured in-depth interviews with eleven Aboriginal women and seven health professionals across the Northern Territory from October 2019- February 2020. Interviews were analysed using an inductive analysis framework to address the barriers and enablers of proposed diabetes prevention programs identified by participants.

Results: Identified structural barriers to lifestyle change included: food insecurity, persuasive marketing of unhealthy food options, lack of facilities and cultural inappropriateness of previous programs. Enablers to lifestyle change included: a strong link between a healthy lifestyle and connection with Country, family and community. Suggested strategies to improve lifestyle included: co-designed cooking classes or a community kitchen, team sports and structural change (targeting the social determinants of health). Lifestyle change was preferred over metformin to prevent and manage diabetes after pregnancy by participants and health care providers.

Conclusions: We recommend individual level programs be designed alongside policies that address systemic inequalities. A postpartum lifestyle program should be co-designed with community members and grounded in Aboriginal conceptions of health to adequality address the health disparities experienced by Aboriginal people in remote communities.
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http://dx.doi.org/10.1186/s12884-021-04055-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445012PMC
September 2021

A Comprehensive PCOS Research and Guideline Translation Program to Improve Practice.

Semin Reprod Med 2021 Jul 16;39(3-04):161-166. Epub 2021 Sep 16.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.

Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy affecting reproductive-age women with a reported prevalence of 8 to 13%. To address the knowledge, practice, consumer satisfaction, and research gaps, an international research collaboration was formed to develop the first "International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (2018)." This article describes an effective research translation program to disseminate the guideline internationally to women and health providers. To date, this had led to 75,197 views and almost 36,000 downloads of the PCOS guideline, and 43,000 views and 10,600 downloads of a suite of PCOS resources. AskPCOS app, the first freely accessible, evidence-based PCOS app, has 9,910 users (between 400 and 800 users per month), 23,447 sessions, and 87,801 screen viewings. Fifty-four percent of returning users are from across 137 countries, with the most users in Australia, the United States, the United Kingdom, the Netherlands, and India. Extensive global uptake of the PCOS guideline and compendium of resources was augmented by extensive formative consumer and health professional consultation, end-user engagement across the evidence-creation spectrum, co-design, and quality improvement.
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http://dx.doi.org/10.1055/s-0041-1733916DOI Listing
July 2021

Facilitators and barriers to behaviour change within a lifestyle program for women with obesity to prevent excess gestational weight gain: a mixed methods evaluation.

BMC Pregnancy Childbirth 2021 Aug 18;21(1):569. Epub 2021 Aug 18.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Gve, Clayton, 3168, Australia.

Background: Maternal obesity is associated with health risks for women and their babies and is exacerbated by excess gestational weight gain. The aim of this study was to describe women's experiences and perspectives in attending a Healthy Pregnancy Service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity.

Methods: An explanatory sequential mixed methods study design utilised two questionnaires (completed in early and late pregnancy) to quantify feelings, motivation and satisfaction with the service, followed by semi-structured interviews that explored barriers and enablers of behaviour change. Data were analysed separately and then interpreted together.

Results: Overall, 49 women attending the service completed either questionnaire 1, 2 or both and were included in the analysis. Fourteen women were interviewed. Prior to pregnancy, many women had gained weight and attempted to lose weight independently, and reported they were highly motivated to achieve a healthy lifestyle. During pregnancy, diet changes were reported as easier to make and sustain than exercise changes. Satisfaction with the service was high. Key factors identified in qualitative analysis were: service support enabled change; motivation to change behaviour, social support, barriers to making change (intrinsic, extrinsic and clinic-related), post-partum lifestyle and needs. On integration of data, qualitative and quantitative findings aligned.

Conclusions: The Healthy Pregnancy service was valued by women. Barriers and enablers to the delivery of an integrated model of maternity care that supported healthy lifestyle and recommended gestational weight gain were identified. These findings have informed and improved implementation and further scale up of this successful service model, integrating healthy lifestyle into routine antenatal care of women with obesity.

Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry (no.12620000985987). Registration date 30/09/2020, retrospectively registered. http://www.anzctr.org.au/.
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http://dx.doi.org/10.1186/s12884-021-04034-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375116PMC
August 2021

Identifying post-traumatic stress disorder in women of refugee background at a public antenatal clinic.

Arch Womens Ment Health 2021 Aug 5. Epub 2021 Aug 5.

Monash Centre for Health, Research & Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.

The aim of this study was to investigate symptomatology and diagnoses of PTSD and subthreshold PTSD and the screening properties of the Harvard Trauma Questionnaire (HTQ) within a sample of Dari-speaking women of refugee background receiving antenatal care. This cross-sectional study administered the HTQ to 52 Dari-speaking women at a public pregnancy clinic. The trauma module from the Structured Clinical Interview (SCID-5) was administered. Interview material was presented to an expert panel, blinded to the HTQ screening results, in order to achieve consensus diagnoses of PTSD using Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria. Three women (5.8%) met DSM-5 criteria for PTSD. Eleven women (21.15%) met criteria for subthreshold PTSD, defined as meeting two or three of the DSM-5 criteria domains. A comparison of HTQ cut-off scores was conducted and a score of ≥ 2.25 on the HTQ demonstrated excellent sensitivity 1.00 (95% CI 0.29-1.00) and specificity 0.76 (95% CI 0.61-0.87) in detecting PTSD; however, a wide confidence interval for sensitivity was found. A cut-off score of ≥ 2 provided the best balance of sensitivity 1.00 (95% CI 0.72-1.00) and specificity 0.80 (95% CI 0.65-0.91) when assessing for subthreshold PTSD. Screening for perinatal PTSD for women of refugee background is recommended, in order to identify those at risk of DSM diagnosis and also those women experiencing distressing PTSD symptomatology.
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http://dx.doi.org/10.1007/s00737-021-01167-8DOI Listing
August 2021

Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation.

Int J Gynaecol Obstet 2021 Jul 31. Epub 2021 Jul 31.

Division of Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Objective: To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia.

Methods: A qualitative evaluation, underpinned by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid-intervention. Semi-structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff.

Results: Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor-intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy.

Conclusion: The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy.
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http://dx.doi.org/10.1002/ijgo.13850DOI Listing
July 2021

Gestational diabetes is associated with postpartum hemorrhage in Indigenous Australian women in the PANDORA study: A prospective cohort.

Int J Gynaecol Obstet 2021 Jul 30. Epub 2021 Jul 30.

Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Objective: To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared with normoglycemia.

Methods: Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500 ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction.

Results: A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% versus 22%; P < 0.001). Compared with non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11-3.02, and OR 1.72, 95% CI 0.99-3.00 after age adjustment, OR 1.84, 95% CI 1.06-3.19, and OR 1.33, 95% CI 0.70-2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95-2.77, and OR 0.99, 95% CI 0.53-1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH.

Conclusion: The significantly higher rates of PPH experienced by Indigenous women compared with non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.
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http://dx.doi.org/10.1002/ijgo.13846DOI Listing
July 2021

Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years.

Lancet Reg Health West Pac 2020 Aug 24;1:100005. Epub 2020 Jul 24.

Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Background: Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia.

Methods: We performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987 to 2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions.

Findings: 109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3 · 4% and 0 · 6% in 1987 and rose to 13% and 5 · 7% in 2016 (both trends <0 · 001). Among non-Aboriginal women, rates of GDM increased from 1 · 9% in 1987 to 11% in 2016 (<0 · 001), while pre-existing diabetes was uncommon (≤0 · 7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends <0 · 001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women.

Interpretation: The burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world.

Funding: Diabetes Australia Research Program.
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http://dx.doi.org/10.1016/j.lanwpc.2020.100005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315488PMC
August 2020

"We are only looking at the tip of the iceberg in infertility": perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people.

BMC Health Serv Res 2021 Jul 17;21(1):704. Epub 2021 Jul 17.

Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia.

Introduction: Aboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. However, remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group.

Method: Semi-structured interviews were conducted with HCPs (8 doctors; 3 nurses and 1 Aboriginal Health Practitioner) working in fertility care in the Northern Territory, Australia. Transcribed interviews were analysed using an iterative thematic approach using the NVivo-9 software package.

Results: Providers perceive infertility as an underestimated health issue in this patient population, reporting a high prevalence of infertility-related risk factors but fewer clinical encounters of diagnosis and treatment. Perceived barriers to accessing fertility care included cultural differences such as the shame and stigma associated with reproductive health and the separation of men's business and women's business; service-related barriers such as limited timely and affordable access to specialist health services and; a lack of culturally responsive and appropriate fertility services. Providers had mixed opinions on their role in ameliorating inequities of access, and hence a range of strategies to address barriers were suggested. These included a greater patient education, ongoing patient support and providing a culturally safe environment.

Conclusion: The current study adds to the understanding of how Aboriginal and Torres Strait Islander people access fertility treatments. There is a need for further research to quantify infertility in Aboriginal and Torres Strait Islander people, investigate community perceptions towards infertility and identify community-driven priorities to improve access to fertility care for this population.
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http://dx.doi.org/10.1186/s12913-021-06714-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285865PMC
July 2021

Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic.

Aust N Z J Psychiatry 2021 Jul 10:48674211025687. Epub 2021 Jul 10.

Centre for Educational Development, Appraisal and Research (CEDAR), Faculty of Social Sciences, University of Warwick, Coventry, UK.

Objective: Identifying women at risk of depression and anxiety during pregnancy provides an opportunity to improve health outcomes for women and their children. One barrier to screening is the availability of validated measures in the woman's language. Afghanistan is one of the largest source countries for refugees yet there is no validated measure in Dari to screen for symptoms of perinatal depression and anxiety. The aim of this study was to assess the screening properties of a Dari translation of the Edinburgh Postnatal Depression Scale.

Methods: This cross-sectional study administered the Edinburgh Postnatal Depression Scale Dari version to 52 Dari-speaking women at a public pregnancy clinic in Melbourne, Australia. A clinical interview using the depressive and anxiety disorders modules from the Structured Clinical Interview for the (5th ed.) was also conducted. Interview material was presented to an expert panel to achieve consensus diagnoses. The interview and diagnostic process was undertaken blind to Edinburgh Postnatal Depression Scale screening results.

Results: Cronbach's alpha coefficient for the Edinburgh Postnatal Depression Scale Dari version was good (α = 0.79). Criterion validity was assessed using the receiver operating characteristics curve and generated excellent classification accuracy for depression diagnosis (0.90; 95% confidence interval [0.82, 0.99]) and for anxiety diagnosis (0.94; 95% confidence interval [0.88, 1.00]). For depression, a cut-off score of 9, as recommended for culturally and linguistically diverse groups, demonstrated high sensitivity (1.00; 95% confidence interval [0.79, 1.00]) and specificity (0.88; 95% confidence interval [0.73, 0.97]). For anxiety, a cut-off score of ⩾5 provided the best balance of sensitivity (1.00; 95% confidence interval [0.72, 1.00]) and specificity (0.80; 95% confidence interval [0.65, 0.91]).

Conclusion: These results support the use of this Edinburgh Postnatal Depression Scale Dari version to screen for symptoms of depression and anxiety during pregnancy as well as the use of a lowered cut-off score.
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http://dx.doi.org/10.1177/00048674211025687DOI Listing
July 2021

Knowledge, Attitude, and Self-Reported Practice Towards Measures for Prevention of the Spread of COVID-19 Among Australians: A Nationwide Online Longitudinal Representative Survey.

Front Public Health 2021;9:630189. Epub 2021 Jun 2.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia.

To assess and share learnings on the motivators and behavioural adherence across sex and age to evolving strategies in public policy to prevent the spread of SARS-CoV-2 at the end of a first COVID-19 wave and the beginning of a second COVID-19 wave in Australia. A national longitudinal survey using a framework based on evidence-based behaviour change models. The survey was administered to a national sample representative across sex, age and location was undertaken at two time points: May 1st to 5th, 2020, and July 1st to 7th, 2020. Overall 2,056 surveys were completed across the first and second rounds, with 63% (1,296/2,056) completing both. Age range was 18-99 years (median 53, IQR: 34-64). Suboptimal physical distancing and self-quarantining if unwell/diagnosed was reported in one in four respondents and not getting a test at onset of symptoms reported in one in three. Those non-adherent to all three behaviours (19%, 60/323), were mainly male, younger, lived in major cities and reported fewer concerns or motivators to change behaviour. Overall, government lockdown measures were considered very important by 81% (835/1,032) and appropriate by 75% (772/1,029). Prior to the suppression of a second COVID-19 wave, a significant minority of Australians reported suboptimal behavioural adherence to vital policy strategies to limit SARS-CoV-2 spread, mostly young adults and men. Successful wave 2 suppression required consistent communication from political and health leaders and supportive public health and economic strategies. Additional lockdown and punitive strategies were needed in Victoria and were generally well-supported and adhered to. To limit subsequent lockdown, this work reinforces the need for a mix of communication around saving lives of the vulnerable, and other strategies targeting high risk groups, facilitation of easy testing and minimisation of financial impacts.
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http://dx.doi.org/10.3389/fpubh.2021.630189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206530PMC
June 2021

Evaluating human-centred design for public health: a case study on developing a healthcare app with refugee communities.

Res Involv Engagem 2021 May 30;7(1):32. Epub 2021 May 30.

Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.

Background: Australian women from migrant and refugee communities experience reduced access to sexual and reproductive healthcare. Human-centred design can be a more ethical and effective approach to developing health solutions with underserved populations that are more likely to experience significant disadvantage or social marginalisation. This study aimed to evaluate how well Shifra, a small Australian-based not-for-profit, applied human-centred design when developing a web-based application that delivers local, evidence-based and culturally relevant health information to its non-English speaking users.

Methods: This study undertook a document review, survey, and semi-structured interviews to evaluate how well Shifra was able to achieve its objectives using a human-centred design approach.

Results: A co-design process successfully led to the development of a web-based health app for refugee and migrant women. This evaluation also yielded several important recommendations for improving Shifra's human-centred design approach moving forward.

Conclusions: Improving refugees' access to sexual and reproductive health is complex and requires innovative and thoughtful problem solving. This evaluation of Shifra's human-centred design approach provides a helpful and rigorous guide in reporting that may encourage other organisations undertaking human-centred design work to evaluate their own implementation.
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http://dx.doi.org/10.1186/s40900-021-00273-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166144PMC
May 2021

Co-designing an Early Menopause Digital Resource: Model for Interdisciplinary Knowledge Translation.

Semin Reprod Med 2020 Sep 18;38(4-05):315-322. Epub 2021 Mar 18.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.

Early menopause/premature ovarian insufficiency is associated with negative health impacts, unmet information needs, delayed diagnosis, and variation in management. Co-designed digital resources for women with early menopause/premature ovarian insufficiency and health practitioners were developed to address information needs and support management. A five-phase mixed methods multidisciplinary research, co-design and translation process comprised: (1) survey/interviews with women and health practitioners to explore early menopause/premature ovarian insufficiency needs, experiences, and management; (2) appraisal of clinical guidelines to develop management algorithms; (3) digital resource development (https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/; (4) evaluation; and (5) dissemination/implementation. The digital resources included audio/video clips of women with early menopause/premature ovarian insufficiency and health practitioners providing early menopause/premature ovarian insufficiency care, a question prompt list, health practitioner algorithms, information links, and a list of services for women, achieving high satisfaction ratings from women and health practitioners. Engaging our stakeholder partners, multimodal dissemination has included community and conference presentations, social media, lay and professional publications, and webinars. This project provides a model for successful interdisciplinary co-design research translation to improve women's health.
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http://dx.doi.org/10.1055/s-0041-1726273DOI Listing
September 2020

The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review.

Semin Reprod Med 2020 Nov 1;38(6):384-388. Epub 2021 Mar 1.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Gestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.
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http://dx.doi.org/10.1055/s-0041-1723778DOI Listing
November 2020

Women Physicians and Promotion in Academic Medicine.

N Engl J Med 2021 02;384(7):679-680

Monash Partners, Melbourne, VIC, Australia

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http://dx.doi.org/10.1056/NEJMc2035793DOI Listing
February 2021

The Healthy Pregnancy Service to Optimise Excess Gestational Weight Gain for Women with Obesity: A Qualitative Study of Health Professionals' Perspectives.

J Clin Med 2020 Dec 17;9(12). Epub 2020 Dec 17.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton 3168, Australia.

Maternal obesity is associated with health risks for women and their babies, exacerbated by excess gestational weight gain. We describe health professionals' perspectives in the provision of a Healthy Pregnancy service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Semi-structured interviews were conducted with health professionals. Questions were based on the Theoretical Domains Framework (TDF) and deductive thematic analysis was performed. A total of 14 multidisciplinary staff were interviewed. Six themes were identified: 1. health professionals view themselves as part of a team; 2. health professionals reported having necessary skills; 3. experience generated confidence in discussing gestational weight gain; 4. gestational weight gain is considered of variable importance; 5. health professionals want women to be comfortable; 6. the environmental context and resources presented some barriers. Staff were supportive of the Healthy Pregnancy service and valued developing teamwork with staff and rapport with women. Most felt relatively comfortable discussing weight gain with women. Barriers included ability to navigate sensitive topics with women, limited awareness of the intervention among new staff, communication between teams, and waiting time for women. Barriers and enablers to the delivery of an integrated model of maternity care were identified. These findings should inform and improve implementation of service models integrating healthy lifestyle in the antenatal care of women with obesity.
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http://dx.doi.org/10.3390/jcm9124073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766467PMC
December 2020

Protocol for development and validation of a clinical prediction model for adverse pregnancy outcomes in women with gestational diabetes.

BMJ Open 2020 11 5;10(11):e038845. Epub 2020 Nov 5.

Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia

Introduction: Gestational diabetes (GDM) is a common yet highly heterogeneous condition. The ability to calculate the absolute risk of adverse pregnancy outcomes for an individual woman with GDM would allow preventative and therapeutic interventions to be delivered to women at high-risk, sparing women at low-risk from unnecessary care. The Prediction for Risk-Stratified care for women with GDM (PeRSonal GDM) study will develop, validate and evaluate the clinical utility of a prediction model for adverse pregnancy outcomes in women with GDM.

Methods And Analysis: We undertook formative research to conceptualise and design the prediction model. Informed by these findings, we will conduct a model development and validation study using a retrospective cohort design with participant data collected as part of routine clinical care across three hospitals. The study will include all pregnancies resulting in births from 1 July 2017 to 31 December 2018 coded for a diagnosis of GDM (estimated sample size 2430 pregnancies). We will use a temporal split-sample development and validation strategy. A multivariable logistic regression model will be fitted. The performance of this model will be assessed, and the validated model will also be evaluated using decision curve analysis. Finally, we will explore modes of model presentation suited to clinical use, including electronic risk calculators.

Ethics And Dissemination: This study was approved by the Human Research Ethics Committee of Monash Health (RES-19-0000713 L). We will disseminate results via presentations at scientific meetings and publication in peer-reviewed journals.

Trial Registration Details: Systematic review proceeding this work was registered on PROSPERO (CRD42019115223) and the study was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000915954); Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-038845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646337PMC
November 2020

Global consensus statement on testosterone therapy for women: an Australian perspective.

Med J Aust 2020 11 1;213(10):449-452.e1. Epub 2020 Nov 1.

Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC.

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http://dx.doi.org/10.5694/mja2.50837DOI Listing
November 2020

The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis.

PLoS Med 2020 09 21;17(9):e1003337. Epub 2020 Sep 21.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Background: Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies.

Methods And Findings: A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43-38.5), the prevalence of depression was 31.5% (95% CI 22.64-40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75-15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63-2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies.

Conclusions: This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement.
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http://dx.doi.org/10.1371/journal.pmed.1003337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505461PMC
September 2020

Associations of gestational diabetes and type 2 diabetes during pregnancy with breastfeeding at hospital discharge and up to 6 months: the PANDORA study.

Diabetologia 2020 12 10;63(12):2571-2581. Epub 2020 Sep 10.

Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.

Aims/hypothesis: Women with gestational diabetes mellitus (GDM) and obesity experience lower rates of breastfeeding. Little is known about breastfeeding among mothers with type 2 diabetes. Australian Indigenous women have a high prevalence of type 2 diabetes in pregnancy. We aimed to evaluate the association of hyperglycaemia, including type 2 diabetes, with breastfeeding outcomes.

Methods: Indigenous (n = 495) and non-Indigenous (n = 555) participants of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort included women without hyperglycaemia in pregnancy (n = 222), with GDM (n = 684) and with type 2 diabetes (n = 144). The associations of hyperglycaemia in pregnancy and breastfeeding at hospital discharge, 6 weeks and 6 months post-partum were evaluated with logistic regression, after adjustment for maternal obesity, ethnicity, maternal and neonatal characteristics.

Results: Indigenous women were more likely to predominantly breastfeed at 6 weeks across all levels of hyperglycaemia. Compared with women with no hyperglycaemia in pregnancy, women with type 2 diabetes had lower odds for exclusive breastfeeding at discharge (adjusted OR for exclusive breastfeeding 0.4 [95% CI 0.2, 0.8] p = 0.006). At 6 weeks and 6 months, the relationship between type 2 diabetes and predominant breastfeeding was not statistically significant (6 weeks 0.7 [0.3, 1.6] p = 0.40, 6 months 0.8 [0.4, 1.6] p = 0.60). Women with gestational diabetes were as likely to achieve predominant breastfeeding at 6 weeks and 6 months as women without hyperglycaemia in pregnancy.

Conclusions/interpretation: Indigenous women had high rates of breastfeeding. Women with type 2 diabetes had difficulty establishing exclusive breastfeeding at hospital discharge. Further research is needed to assess the impact on long-term breastfeeding outcomes. Graphical abstract.
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http://dx.doi.org/10.1007/s00125-020-05271-9DOI Listing
December 2020

Provision of assisted reproductive technologies (ART) to Aboriginal and Torres Strait Islander peoples: Limited engagement in an online survey of Medical Directors of ART services.

Aust N Z J Obstet Gynaecol 2020 12 9;60(6):980-982. Epub 2020 Sep 9.

South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Current knowledge about infertility and access to infertility treatment among Aboriginal and Torres Strait Islander peoples is extremely limited. We conducted an online survey of Medical Directors of registered ART providers in Australia (n = 59) to obtain preliminary information on this topic. Six (10%) Directors responded; only two reported routinely collecting the Aboriginal and Torres Strait Islander status of clients. While the low response rate prevents generalising the findings, the poor engagement may indicate gaps in awareness of fertility issues for this group. This warrants further investigation, to understand whether Aboriginal and Torres Strait Islander people are appropriately accessing infertility care.
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http://dx.doi.org/10.1111/ajo.13246DOI Listing
December 2020

Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum.

J Med Internet Res 2020 09 7;22(9):e22002. Epub 2020 Sep 7.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.

Background: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment.

Objective: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19.

Methods: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included "COVID," "corona," and "pandemic." A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations.

Results: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including "worried" (n=165, 19.9%), "risk" (n=143, 17.2%), "anxiety" (n=98, 11.8%), "concerns" (n=74, 8.8%), and "stress" (n=69, 8.3%).

Conclusions: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.
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http://dx.doi.org/10.2196/22002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481017PMC
September 2020

Global Health in Preconception, Pregnancy and Postpartum Alliance: development of an international consumer and community involvement framework.

Res Involv Engagem 2020 10;6:47. Epub 2020 Aug 10.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria Australia.

Background: The goal of the Global Health in Preconception, Pregnancy and Postpartum (HiPPP) Alliance, comprising consumers and leading international multidisciplinary academics and clinicians, is to generate research and translation priorities and build international collaboration around healthy lifestyle and obesity prevention among women across the reproductive years. In doing so, we actively seek to involve consumers in research, implementation and translation initiatives. There are limited frameworks specifically designed to involve women across the key obesity prevention windows before (preconception), during and after pregnancy (postpartum). The aim of this paper is to outline our strategy for the development of the HiPPP Consumer and Community (CCI) Framework, with consumers as central to co-designed, co-implemented and co-disseminated research and translation.

Method: The development of the framework involved three phases: In Phase 1, 21 Global HiPPP Alliance members participated in a CCI workshop to propose and discuss values and approaches for framework development; Phase 2 comprised a search of peer-reviewed and grey literature for existing CCI frameworks and resources; and Phase 3 entailed collaboration with consumers (i.e., members of the public with lived experience of weight/lifestyle issues in preconception, pregnancy and postpartum) and international CCI experts to workshop and refine the HiPPP CCI Framework (guided by Phases 1 and 2).

Results: The HiPPP CCI Framework's values and approaches identified in Phases 1-2 and further refined in Phase 3 were summarized under the following five key principles: 1. Inclusive, 2. Flexible, 3. Transparent, 4. Equitable, and 5. Adaptable. The HiPPP Framework describes values and approaches for involving consumers in research initiatives from design to translation that focus on improving healthy lifestyles and preventing obesity specifically before, during and after pregnancy; importantly it takes into consideration common barriers to partnering in obesity research during perinatal life stages, such as limited availability associated with family caregiving responsibilities.

Conclusion: The HiPPP CCI Framework aims to describe approaches for implementing meaningful CCI initiatives with women in preconception, pregnancy and postpartum periods. Evaluation of the framework is now needed to understand how effective it is in facilitating meaningful involvement for consumers, researchers and clinicians, and its impact on research to improve healthy lifestyle outcomes.
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http://dx.doi.org/10.1186/s40900-020-00218-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419190PMC
August 2020

'My relationships have changed because I've changed': biographical disruption, personal relationships and the formation of an early menopausal subjectivity.

Sociol Health Illn 2020 09 25;42(7):1516-1531. Epub 2020 Jun 25.

Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia.

Early menopause (EM) or premature ovarian insufficiency (POI) can disrupt gendered and age-related expectations associated with perceived 'normative' biographies for young adult women, with implications for subjectivity and relationships. While previous qualitative research has concentrated on the impacts of EM/POI on biography and sense of self, in this article, we examine the enmeshment of personal relationships with the formation of early menopausal subjectivities. Drawing on research exploring concepts of 'biographical disruption' and personal relationships, and theoretical work on social norms and subject formation, we present findings from a narrative thematic analysis of 25 interviews with women diagnosed with spontaneous or medically induced EM/POI. We identify three main narrative 'types' of subjective and relational experience in response to the 'disruption' of EM/POI: interlude and continuity; disruption and adaptation; and disruption and ambivalence. Women's accounts of their experience of EM/POI indicate that the formation of early menopausal selves is mediated by the extent to which women and those around them identify with gendered norms related to reproduction and age. Consistent with theoretical perspectives that consider the self as relationally produced, we argue that the subjective and relational dimensions of EM/POI are intertwined and must be understood in tandem.
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http://dx.doi.org/10.1111/1467-9566.13143DOI Listing
September 2020

Perinatal psychosocial assessment of women of refugee background.

Women Birth 2021 May 19;34(3):e302-e308. Epub 2020 Jun 19.

Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, United Kingdom; Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.

Background: Women of refugee background may be particularly vulnerable to perinatal mental illness, possibly due to increased exposure to psychosocial stressors associated with their forced migration and post-resettlement adjustment.

Aim: This study aimed to compare psychosocial risk factors reported by women of refugee background receiving maternity services at a public hospital, to those reported by Australian-born women in the same hospital. It further aimed to examine the referrals offered, and accepted, by the women of refugee background reporting psychosocial risk factors for perinatal mental illness.

Methods: A retrospective hospital record review was conducted to compare the antenatal and postnatal psychosocial risk factors of 100 women of refugee background and 100 Australian-born women who gave birth at a public hospital in Victoria between 1 July 2015 and 30 April 2016, and who had completed the Maternity Psychosocial Needs Assessment.

Findings: Women of refugee background were more likely than Australian-born women to report financial concerns and low social support at antenatal assessment, but were less likely to report prior mental health problems than Australian-born women at either assessment point. Both groups reported low rates of family violence compared to published prevalence rates. Of the women of refugee background assessed antenatally, 23% were offered referrals, with 52% take-up. Postnatally, 11.2% were offered referrals, with 93% take-up.

Discussion/conclusion: This study showed elevated rates of psychosocial risk factors among women of refugee background, however, possible under-reporting of mental health problems and family violence raises questions regarding how to assess psychosocial risk factors with different cultural groups. Lower antenatal referral take-up suggests barriers to acceptance of referrals may exist during pregnancy.
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http://dx.doi.org/10.1016/j.wombi.2020.05.009DOI Listing
May 2021

Preconception Health and Lifestyle Behaviours of Women Planning a Pregnancy: A Cross-Sectional Study.

J Clin Med 2020 Jun 2;9(6). Epub 2020 Jun 2.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia.

Preconception care and lifestyle behaviours significantly influence health outcomes of women and future generations. A cross-sectional survey of Australian women in preconception, stratified by pregnancy planning stage (active planners (currently trying to conceive) vs. non-active planners (pregnancy planned within 1-5 years)), assessed health behaviours and their alignment to preconception care guidelines. Overall, 294 women with a mean (SD) age of 30.7 (4.3) years were recruited and 38.9% were overweight or obese. Approximately half of women (54.4%) reported weight gain within the previous 12 months, of which 69.5% gained ≥ 3kg. The vast majority of women (90.2%) were unaware of reproductive life plans, and 16.8% over the age of 25 had not undertaken cervical screening. Of active planners (n = 121), 47.1% had sought medical/health advice in preparation for pregnancy and 81.0% had commenced supplementation with folic acid, iodine or a preconception multivitamin. High-risk lifestyle behaviours including cigarette smoking (7.3%), consumption of alcohol (85.3%) and excessive alcohol consumption within three months (56.3%), were frequently reported in women who were actively trying to conceive. Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy to improve alignment with current preconception care recommendations.
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http://dx.doi.org/10.3390/jcm9061701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355494PMC
June 2020

The Unrealised Potential for Predicting Pregnancy Complications in Women with Gestational Diabetes: A Systematic Review and Critical Appraisal.

Int J Environ Res Public Health 2020 04 27;17(9). Epub 2020 Apr 27.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia.

Gestational diabetes (GDM) increases the risk of pregnancy complications. However, these risks are not the same for all affected women and may be mediated by inter-related factors including ethnicity, body mass index and gestational weight gain. This study was conducted to identify, compare, and critically appraise prognostic prediction models for pregnancy complications in women with gestational diabetes (GDM). A systematic review of prognostic prediction models for pregnancy complications in women with GDM was conducted. Critical appraisal was conducted using the prediction model risk of bias assessment tool (PROBAST). Five prediction modelling studies were identified, from which ten prognostic models primarily intended to predict pregnancy complications related to GDM were developed. While the composition of the pregnancy complications predicted varied, the delivery of a large-for-gestational age neonate was the subject of prediction in four studies, either alone or as a component of a composite outcome. Glycaemic measures and body mass index were selected as predictors in four studies. Model evaluation was limited to internal validation in four studies and not reported in the fifth. Performance was inadequately reported with no useful measures of calibration nor formal evaluation of clinical usefulness. Critical appraisal using PROBAST revealed that all studies were subject to a high risk of bias overall driven by methodologic limitations in statistical analysis. This review demonstrates the potential for prediction models to provide an individualised absolute risk of pregnancy complications for women affected by GDM. However, at present, a lack of external validation and high risk of bias limit clinical application. Future model development and validation should utilise the latest methodological advances in prediction modelling to achieve the evolution required to create a useful clinical tool. Such a tool may enhance clinical decision-making and support a risk-stratified approach to the management of GDM. Systematic review registration: PROSPERO CRD42019115223.
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http://dx.doi.org/10.3390/ijerph17093048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246772PMC
April 2020

Opportunities for enhancing pregnancy planning and preconception health behaviours of Australian women.

Women Birth 2021 Mar 17;34(2):e153-e161. Epub 2020 Apr 17.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 43-51, Kanooka Grove, Clayton, Victoria, 3186, Australia. Electronic address:

Problem And Background: The preconception period provides a significant opportunity to engage women in healthy behaviour change for improved maternal and child health outcomes. However, there is limited research exploring women's pregnancy planning in Australia.

Aim: This study investigated associations between pregnancy planning, socio-demographics and preconception health behaviours in Australian women.

Methods: A retrospective cross-sectional survey of pregnant women ≥18-years-of-age recruited through a Victorian public maternity service and a national private health insurer.

Results: Overall 317 women (30±4.7 years) participated (public: n=225, private: n=92). Planned pregnancies were reported by 74% of women and were independently associated with marital status (AOR=5.71 95% CI 1.92-17.00, p=0.002); having ≤2 children (AOR=3.75 95% CI 1.28-11.05, p=0.016); and having private health insurance (AOR=2.51 95% CI 1.08-5.81, p=0.03). Overall, women reported preconception: any folic-acid supplementation (59%), up-to-date cervical screening (68%), weight management attempts (75%), accessing information from health professionals (57%) and immunisation reviews (47%). Pregnancy planners were more likely to use folic-acid (AOR=17.13 95% CI 7.67-38.26, p<0.001), review immunisations (AOR=2.09 95% CI 1.07-4.10, p=0.03) and access information (AOR=3.24 95% CI 1.75-6.00, p<0.001) compared to non-planners. Women <25-years-of-age were less likely to access information (AOR=0.38 95% CI 0.16-0.89, p=0.03) and take folic-acid (AOR=0.23 95% CI 0.09-0.59, p=0.002) and were more likely to smoke 3-months preconception (AOR=6.68 95% CI 1.24-36.12, p=0.03).

Conclusions: Women with planned and unplanned pregnancies reported variable preconception health behaviour uptake and limited healthcare engagement. Opportunities exist to improve awareness and healthcare engagement for optimising preconception health and pregnancy planning benefits including collaborative health promotion. Population-based and targeted approaches reaching pregnancy planners and non-planners are required.
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http://dx.doi.org/10.1016/j.wombi.2020.02.022DOI Listing
March 2021

Infertility in Aboriginal and Torres Strait Islander people: A cause for concern?

Aust N Z J Obstet Gynaecol 2020 06 13;60(3):479-481. Epub 2020 Apr 13.

Child Nutrition Research Centre, South Australian Health Research and Medical Institute, The University of Adelaide, Adelaide, South Adelaide, Australia.

In many Aboriginal and Torres Strait Islander communities, women and men are disproportionately affected by a range of risk factors for infertility including sexually transmitted infections, polycystic ovary syndrome and obesity. However, very little is known about the occurrence of infertility in this group or how Aboriginal and Torres Strait Islander people access fertility treatments. This opinion piece aims to reflect on current evidence concerning infertility risk factors and infertility per se among Aboriginal and Torres Strait Islander people, highlighting gaps in the literature about access and outcomes in this group.
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http://dx.doi.org/10.1111/ajo.13158DOI Listing
June 2020

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications.

J Clin Med 2020 Mar 18;9(3). Epub 2020 Mar 18.

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia.

In this article, we describe the process of establishing agreed international pregnancy research priorities to address the global issues of unhealthy lifestyles and rising maternal obesity. We focus specifically on the prevention of maternal obesity to improve related clinical pregnancy and long-term complications. A team of multidisciplinary, international experts in preconception and pregnancy health, including consumers, were invited to form the Health in Preconception, Pregnancy and Postpartum (HiPPP) Global Alliance. As an initial activity, a priority setting process was completed to generate pregnancy research priorities in this field. Research, practice and policy gaps were identified and enhanced through expert and consumer consultation, followed by a modified Delphi process and Nominal Group Technique, including an international workshop. Research priorities identified included optimising: (1) healthy diet and nutrition; (2) gestational weight management; (3) screening for and managing pregnancy complications and pre-existing conditions; (4) physical activity; (5) mental health; and (6) postpartum (including intrapartum) care. Given extensive past research in many of these areas, research priorities here recognised the need to advance pregnancy research towards pragmatic implementation research. This work has set the agenda for large-scale, collaborative, multidisciplinary, implementation research to address the major public health and clinical issue of maternal obesity prevention.
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http://dx.doi.org/10.3390/jcm9030822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141234PMC
March 2020
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