Jan Payne

Health professionals' knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy

Objective: To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy.

Diagnosis of foetal alcohol syndrome and alcohol use in pregnancy: A survey of paediatricians’ knowledge, attitudes and practice

Aim:  To measure paediatricians’ knowledge, attitudes and practices regarding foetal alcohol syndrome (FAS) and alcohol use during pregnancy.

Association of maternal pre-pregnancy weight with birth defects : Evidence from a case-control study in Western Australia

Background: Maternal obesity confers increased risks of poor pregnancy outcomes. There are limited Australian data on the risk of birth defects associated with maternal pre‐pregnancy obesity.

Folate promotion in Western Australia and the prevention of neural tube defects

Objectives: We conducted a case‐control study to investigate the effectiveness of efforts to increase folate intake in Western Australia (WA) for the prevention of neural tube defects (NTD).

Health professionals addressing alcohol use with pregnant women in Western Australia: barriers and strategies for communication

Health professionals have an important role to play in preventing prenatal alcohol exposure. In 2006 qualitative data were collected from 53 health professionals working in primary care in metropolitan and regional Western Australia. Thematic analysis was used to elucidate barriers in addressing prenatal alcohol use and the strategies used to overcome them. Health professionals identified strategies for obtaining alcohol use information from pregnant women but they are not recognizing moderate alcohol intake in pregnant women. Study limitations are noted and the implications of the results are discussed. This research was funded by the Health Promotion Foundation of Western Australia.

Folate intake and the primary prevention of non‐neural birth defects

Objectives: To investigate whether maternal periconceptional folate intake is associated with a reduction in selected non‐neural birth defects in Western Australia (WA).

Measuring the impact of conjugate vaccines on invasive Haemophilus influenzae type b infection in Western Australia

Abstract: Haemophilus influenzae type b (Hib) causes serious infections in 26–59 per 100 000 non–Aboriginal Australian children under five years of age. Aboriginal children suffer much higher rates of infection (≥ 150 per 100 000), and at an earlier age, and have a greater risk of death and disability due to Hib infection. In 1992 and 1993, four conjugate Hib vaccines were introduced in Australia, and a nationally funded program of infant vaccination was begun in July 1993. This study aimed at evaluating the effectiveness of Hib vaccination in Aboriginal and non–Aboriginal children in Western Australia using a population–based active surveillance system for non–Aboriginal children and a case control study for Aboriginal children. The incidence of invasive Hib disease in non–Aboriginal children fell from 30.9 per 100 000 before vaccination was available to 6.3 per 100 000 in the second year after its introduction. The vaccine efficacy was estimated to be 80 per cent for Aboriginal children (odds ratio 0.20, 95 per cent CI 0.01–2.76) and, after adjustment for confounders, 75 per cent (odds ratio 0.25, CI 0.02–3.66). Based on the adjusted value (75 per cent), and using a Bayesian approach, we estimate that the posterior probability was 0.55 that the true vaccine efficacy is greater than 70 per cent, and 0.69 that the efficacy is greater than 50 per cent. We conclude that Hib vaccination is effective in preventing invasive Hib disease in Aboriginal and non–Aboriginal children in Australia. Aust N Z J Public Health 1998; 22: 67–72)

Findings on potential teratogens from a case-control study in Western Australia.

Objectives:  To examine, in Western Australian women, pregnancy use of drugs that have been found to be associated with birth defect risks in other studies.

Awareness and consumption of folate-fortified foods by women of childbearing age in Western Australia.

OBJECTIVES The introduction of voluntary fortification of some foods with folic acid in Australia has been implemented since evidence of the prevention of neural tube defects with periconceptional folic acid was published. Our objectives were to determine how many women were aware of folate and when they became aware, what was the awareness of labels on foods that mentioned folate, and how much folate-fortified food women ate. METHODS To address these objectives we collected data by self-administered questionnaire from a random sample of 578 recently pregnant women in Western Australia between September 1997 and March 2000. RESULTS Overall, 89% of women had heard, seen or read anything about the link between folate and birth defects such as spina bifida, 62% first became aware of the folate message before their recent pregnancy and 42% of women noticed any labels on foods that mention folate before or during their recent pregnancy. Overall, 53% of women were aware of foods that have folate added to them and 33% usually or always read the labels on food packaging. The folate-fortified foods most often consumed by women were cereals (69%), breads (34%) and milk (15%). Of the women who consumed folate-fortified foods (78%), the earlier they became aware of the folate message and noticed labels on food, the more fortified foods they consumed. CONCLUSIONS These results indicate that staple foods fortified with folate are consumed by almost 80% of women in the population. Therefore, mandatory fortification of staple foods may reach most women, providing improved opportunity for the prevention of neural tube defects in Australia.

Association of pre‐pregnancy weight and birth defects

We thank Dr Peek and Dr Nanan for their comment on our paper on the association of pre-pregnancy weight and birth defects. They raise two important issues. First, that identification of all cases of birth defects, particularly those that end in termination of pregnancy before 20-week gestation, is difficult. Secondly, identification of fetal anomalies by ultrasound examination is difficult in women who are obese. Peek and Nanan wonder whether these two issues may have led to many birth defects not being identified before 20-week gestation in obese women in our study. Hence, with termination of pregnancy being less likely for these women, this could have led to an overrepresentation of obese women in the group of cases with birth defects in our study. We do not believe this to have occurred in our study. We identified cases from the WA Birth Defects Registry, which has close to complete ascertainment of terminations of pregnancy for fetal anomaly. We acknowledge the less complete ascertainment from some other states, shown clearly for neural tube defects in a recent publication from the National Perinatal Statistics Unit. Furthermore, we have re-examined our data on outcome of the pregnancy (termination, stillbirth, live-birth) and body mass index for each of the birth defect groups in our study. A similar proportion of cases were stillborn, liveborn or terminations amongst obese women compared with non-obese women for each of the case groups – heart defects, facial clefts, limb