Janet E. Walstab

Incidence and Severity of Gestational Diabetes Mellitus According to Country of Birth in Women Living in Australia

Gestational diabetes mellitus (GDM) was diagnosed in 1928 of 35,253 (5.5%) tested pregnancies at the Mercy Maternity Hospital in Melbourne between 1979 and the end of 1988. Compared with women born in Australia and New Zealand, the incidence of GDM was significantly greater in women born on the Indian subcontinent (15%); in women born in Africa (9.4%), Vietnam (7.3%), Mediterranean countries (7.3%), and Egypt and Arabic countries (7.2%); and in Chinese (13.9%) and other Asian (10.9%) women. There was no significant difference for women born in the United Kingdom and northern Europe (5.2%), Oceania (5.7%), North America (4.0%), or South America (2.2%). With the World Health Organization criteria as a guide to the severity of hyperglycemia, compared with mothers born in Australia and New Zealand, there were significant increases in the incidences of the more severe grades of GDM in parturients born in the Mediterranean region, Asia, the Indian subcontinent, Egypt, and Arabic countries. The incidence of GDM increased significantly in all racial groups, rising from 3.3% during 1979–1983 to 7.5% during 1984–1988.

Cerebral palsy in Victoria, Australia: mortality and causes of death.

Objective: To study the causes of death and the characteristics of children with cerebral palsy that had died over a 25‐year period in Victoria, Australia.

Maternal Serum Triglyceride, Glucose Tolerance, and Neonatal Birth Weight Ratio in Pregnancy: A study within a racially heterogeneous population

OBJECTIVE To determine the value of measuring serum triglyceride (TG) levels early in pregnancy for predicting late-gestation glucose tolerance and neonatal birth weight ratio (BWR) (birth weight corrected for gestational age). RESEARCH DESIGN AND METHODS The relationships between morning nonfasting TG measured early in pregnancy (gestational age 12 ± 6 weeks [mean ± SD]) and glucose tolerance measured by a 3-h 50-g oral glucose tolerance test (OGTT) late in pregnancy (gestational age 30 ± 3 weeks) and BWR were investigated in 388 women attending routine antenatal care. The data were analyzed for all women in addition to subgroups of Australian/Western European-born (n = 246) and Asian-born (n = 97) women. RESULTS Morning nonfasting TG positively correlated with the OGTT glucose area under the curve (OGTT-GAUC) (r = 0.23, P < 0.0001) in all subjects. This correlation was stronger in the subset of subjects who had TG measured between 9 and 12 weeks of gestation (r = 0.35, P = 0.0001) and was particularly strong in Asian-born women who had TG measured within this period (r = 0.71, P < 0.0001). Mean TG and the 2- and 3-h OGTT values were higher in Asian-born subjects compared with Australian/Western European-born subjects (P = 0.004, P < 0.0001, and P = 0.02, respectively). TG correlated positively with BWR in all subjects (r = 0.12, P = 0.02), in Asian-born subjects (r = 0.23, P = 0.02), and in subjects with gestational diabetes mellitus (GDM) (r = 0.60, P = < 0.001). CONCLUSIONS TG, if measured between 9 and 12 weeks of gestation, has moderate predictive value for subsequent glucose tolerance in pregnancy. TG is also predictive of BWR in GDM subjects. Further studies are warranted to investigate the role of early TG measurement in the screening and management of GDM. Metabolic heterogeneity exists between Asian-born and Australian/Western European-born women, the significance of which is still unclear and warrants further study.

A randomized, controlled trial of a home-based intervention program for children with autism and developmental delay.

Objective: This study aimed to (1) investigate whether provision of a home-based program in addition to a center-based program improves development in young children with disabilities and coping abilities of their families and (2) describe the characteristics of children and families who benefit most from the intervention. Methods: Fifty-nine children, aged 3–5 years, with no cerebral palsy, participated in the study. Half of the group was randomized to receive an additional program in their homes. A special education teacher provided 40 visits over 12 months working with the families to help generalize skills to the home environment and assist with their concerns. All children were assessed before and after the intervention, and families completed questionnaires assessing family stress, support, and empowerment on both occasions. Differences in change over time and between the intervention and control group were analyzed by repeated measures and the association between characteristics of children and families with improved outcome by multivariate analysis of variance. Results: Change in cognitive development and behavior (in the centers) over time favored the children who received the extra intervention (p = .007 and p = .007, respectively). The groups did not differ on any of the family measures of change. Multivariate analysis of variance revealed more improvement for children in the intervention group from higher than lower stressed families. Conclusions: Results suggest the need for daily reinforcement of skills learned at the center-based program and the importance of involving families, especially those with few resources and relatively high stress.

Antenatal and intrapartum antecedents of cerebral palsy: a case-control study

To identify antenatal and intrapartum factors contributing to the aetiology of cerebral palsy (CP).

One‐year follow‐up of the outcome of a randomized controlled trial of a home‐based intervention programme for children with autism and developmental delay and their families

INTRODUCTION There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems. The aim of the study was to determine whether a home-based programme provided over 12 months resulted in sustained improvement in development and behaviour 12 months after the intervention ceased. The characteristics of the children and families who benefited most from the intervention were also studied. METHOD Randomized controlled trial. Participants A total of 59 children, aged 3-5 years, attending two early childhood intervention centres in Melbourne, Australia. Intervention Half of the subjects received an additional home-based programme consisting of 40 weekly visits. MAIN OUTCOME MEASURES Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised, Preschool Behaviour Checklist, Bayley Behaviour Rating Scale and Behaviour Screening Questionnaire. All tests administered pre-intervention, following the intervention and 12 months later. Secondary outcome measures Family stress, support and empowerment. RESULTS Fifty-four children completed the assessments 12 months after conclusion of the intervention. Compared with the control group, improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later (P= 0.007) while significant behavioural differences post intervention were not. Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non-verbal areas. In contrast to the control group who deteriorated, language skills in the intervention group remained stable. Improvements were significantly associated with higher stress in the families. CONCLUSION Improvements following the provision of a home-based programme to preschool children with developmental disabilities were sustained 1 year later. Children from highly stressed families appeared to benefit most, reinforcing the importance of involving families in early childhood intervention programmes.

Factors identified during the neonatal period associated with risk of cerebral palsy

Objective:  To identify factors during the neonatal period that are associated with the subsequent development of cerebral palsy (CP).

Inpatient care of children with cerebral palsy as perceived by their parents

Objectives: Children with cerebral palsy (CP) have special health care needs. The aim of the study was to evaluate the inpatient care of children with CP, as perceived by their parents.

Glucose Tolerance in Twin Pregnancy

Summary: Over a 10‐year period, 50 g oral glucose tolerance tests were performed in 288 patients with twin pregnancies and 20,030 with singleton pregnancies. In multiple pregnancies the fasting blood glucose value was significantly reduced (P<0.001), but the values at 1, 2 and 3 hours were not significantly different from those in singleton pregnancies. The incidences of both gestational diabetes (5.6%) and gestational hypoglycaemia (3.9%) in twin pregnancies were more than double those in singleton pregnancies (2.5% and 1.7%, respectively) (P<0.01). As the risk of perinatal death is increased in these patients, glucose tolerance tests should be performed in all patients with twin pregnancies.

Social outcomes of young adults with cerebral palsy

Abstract Background Functional abilities and social outcomes of young adults with cerebral palsy (CP) are relatively underresearched. Improvements in paediatric care have extended the expectation of achieving adulthood to 90%. Method Young adults aged 20–30 years with CP (n = 335) were compared to a population-based control group (n = 2,152) of the same age. Motor function, self-care abilities, educational level, and social outcomes were determined by questionnaire. Results Half the study group walked independently, but only 35.5% were independent in self-care. In comparison to their peers without disability, the study groups highest educational level was lower (p < .0001), as were rates of employment (36.3% compared with 80%), they were more likely to be living with parents (80% compared with 21%), to be single, and to have limited financial resources. Conclusion Young adults with CP are functionally and socially disadvantaged in contrast with their peers without disability. Self-care dependence, intellectual disability, and communication impairments contribute to these outcomes but are not solely responsible.