David McIntyre

Health-enhancing physical activity behaviour and related factors in postpartum women with recent gestational diabetes mellitus

This is one of the first studies to explore known preventive behaviours for type 2 diabetes (T2DM) among women with recent gestational diabetes (GDM), and the first to do so in a representative population sample. The aim of this study was to describe the prevalence of health-enhancing physical activity (PA) and explore its association with psychosocial and sociodemographic factors, in postnatal women with recent GDM. Cross-sectional telephone surveys were conducted among Queensland women with a recent history (>or=6 months and <or=3 years since diagnosis) of GDM (N=331), which included measures on PA behaviour, social support and self-efficacy for regular PA. The prevalence of health-enhancing PA among women with recent GDM was 37.2%. In multivariate analysis, both social support (OR=1.06, 95% CI 1.03-1.09) and self-efficacy (OR=1.04, 95% CI 1.004-1.07) were significantly associated with health-enhancing PA. The findings from this study demonstrate the need for postnatal follow-up to increase PA levels in women with recent GDM as this may reduce the risk of developing type 2 diabetes (T2DM) in this at-risk population. Strategies that address social support and self-efficacy for PA may be effective in increasing health-enhancing PA among women with recent GDM.

Regulation of Placental Growth Hormone Secretion in a Human Trophoblast Model—The Effects of Hormones and Adipokines

Placental growth hormone (PGH) is secreted from the human placental syncytiotrophoblast into the maternal circulation. PGH levels in pregnant women correlate with the birth weight of their offspring. We hypothesized that metabolic regulators may alter PGH secretion. BeWo cells as human trophoblast models were treated for 24, 48, and 72 h with insulin, insulin-like growth factor (IGF)-1, cortisol, ghrelin, leptin and visfatin. Cyclic-adenosinmonophosphate treatment served as positive control. PGH concentrations in culture media were measured. Insulin reduced (p < 0.008; analysis of variance) PGH secretion from BeWo cells after 72 h. No effect was found when treating cells with IGF-1. Cortisol reduced PGH secretion after 48 h (p < 0.00118; analysis of variance) and 72 h (p < 0.015). Leptin and ghrelin both suppressed (p < 0.027 and p < 0.017, paired t test) whereas visfatin increased (p < 0.014, paired t test) PGH secretion at 72 h. Cyclic adenosinmonophosphate increased (p < 0.003) PGH secretion at 72 h. Our results indicate that in vitro PGH secretion by BeWo cells is regulated by hormonal factors and adipokines. We speculate on the existence of a maternal-placental regulatory loop, in which elevated insulin and leptin levels might down-regulate PGH secretion.

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 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). Women could choose from a menu of options including pregnancy aqua-aerobics, pregnancy fitness classes, swimming, commercial fitness programs, walking, playing with their children, dancing and many other options. Women were provided with free memberships and passes to access these options, and extensive support. Programs were reviewed at least second weekly. Physical activity was measured in both intervention and control women using the validated Physical Activity Questionnaire and accelerometers. Results: At 28 weeks, women in the intervention arm showed a mean of 1213 kCal (SD 931) exercise per week compared to 710 kCal (SD 873) for the control group (p = 0.03). However, there was no statistically significant difference in the overall physical activity of the two groups. On objective measure with the accelerometer, there was no difference in physical activity in either group at any point during pregnancy. Discussion: Despite the intensive efforts to assist women to exercise in this study, there was no objective evidence that an exercise program of this type succeeded in providing women with a “dose” of exercise. There was an interesting difference between the results of the validated pregnancy physical activity questionnaire and objective accelerometer measurements. This highly supported, individualized exercise intervention is not a feasible way of increasing exercise in obese pregnant women.

FIGO analysis of research priorities in hyperglycemia in pregnancy

Hyperglycemia in pregnancy (HIP) is recognized as a major underlying cause of pregnancy complications and a contributing cause to health risks throughout the subsequent life of both mothers and babies, with amplification of the global epidemic of non-communicable diseases. Although some aspects of these associations are well described, detailed understanding of basic pathophysiologic mechanisms is lacking. Improved fundamental scientific knowledge must be developed to allow logical strategies for prevention and treatment. During pregnancy, much work is required to replace current empirical approaches to diagnosis and treatment of HIP with evidence based protocols, pragmatically adapted to differing health care and health economic contexts. Further, a life cycle approach to HIP, the risk of immediate pregnancy complications and later health risks to mother and baby must be developed and implemented across a wide range of health care environments. This document aims to outline key focus areas for further basic, epidemiologic, clinical and implementation research in this important area.

Preconception care for women with type 2 diabetes mellitus: a mixed-methods study of provider knowledge and practice

AIMS Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.

Young adult pregnancy status and the risk of developing overweight and obesity among women and men: Pregnancy status and the risk of obesity

Pregnancies can end in miscarriage, birth or termination. Although it is well known that pregnancy results in weight gain across the life course, it is unknown whether pregnancies which end in termination and miscarriage contribute to this. The study used a sub‐sample of 3630 adult offspring from the original cohort of the Mater University of Queensland Study of Pregnancy (MUSP) and its outcomes, in Brisbane, Australia. Anthropometric data were measured at 5, 14 and 21 years of age and experience of pregnancy including termination, miscarriage and births were self‐reported at 21 years. Multivariable analyses were conducted to determine whether pregnancy status of young people independently associated with overweight or obesity status. The women who had at least one birth were more likely to have overweight (odds ratio [OR] 1.52; 95% confidence interval [CI]: 1.01, 2.27) or obese (OR 2.38; 95% CI: 1.58, 3.59) compared to women who did not experience any pregnancy. Women whose pregnancies were terminated or miscarried were at the same risk of overweight or obesity as women who did not experience any pregnancy. For men, there is no association between the pregnancies in their partners and the mean difference in their body mass index. Young women whose pregnancies result in a birth, but not terminations or miscarriages, are at greater risk of having overweight or obesity following the birth.

How have the lives of pregnant women changed in the last 30 years

BACKGROUND To what extent have the characteristics and needs of pregnant women changed over time? This cross-sectional, comparative study describes some socio-demographic, mental health and lifestyle characteristics of two samples of pregnant women assessed 30 years apart. METHODS We recruited two samples of pregnant women who were attending their first clinic visit at the same large Queensland maternity hospital 30 years apart between 1981 to 1984 (Sample A, N=6753) and 2011-2012 (Sample B, N=2156). The women were compared using the same survey tool. Descriptive statistics are presented. Pearsons chi-square tests were undertaken (significance at <0.05) to determine how the characteristics and needs of pregnant women may be changing over time. FINDINGS Women, recently sampled, were older, more highly-educated and were more likely to be living with, but not married to, their partners, as well as having their first baby, than were women 30 years ago. As well, recently sampled, pregnant women were more likely to be non-smokers, to have higher body mass indexes and more symptoms of anxiety, but were less likely to be having an unplanned pregnancy. CONCLUSION This study found a number of differences between the socio-demographic characteristics, lifestyles and mental health of two samples of pregnant women assessed 30 years apart. Our findings suggest the need for ongoing monitoring of pregnant women to determine changing health priorities. Being more educated, todays women may be more amenable to health education interventions. Higher body mass indexes for recently sampled women, highlights an emerging problem that needs to be addressed.