Kellie Murphy
Mount Sinai Hospital
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Publication
Featured researches published by Kellie Murphy.
Journal of obstetrics and gynaecology Canada | 2002
Fariba Aghajafari; Kellie Murphy; Arne Ohlsson; Kofi Amankwah; Stephen G. Matthews; Mary E. Hannah
OBJECTIVESn(1) To determine the feasibility of a multicentre, randomized, double-masked, placebo-controlled trial to investigate the effects of multiple courses of antenatal corticosteroids (ACS), more than 7 days following the initial course of ACS therapy, on perinatal or neonatal mortality or neonatal morbidity. (2) To determine the risk of complications that would require discontinuation of ACS therapy. (3) To determine if multiple courses of ACS have an effect on the concentrations of plasma cortisol and adrenocorticotropin hormone (ACTH) in cord blood and in maternal blood immediately following delivery, compared to a single course of ACS.nnnMETHODSnWomen at 24 to 30 weeks gestation, at continued increased risk of preterm birth 7 or more days following a single course of ACS, were randomized to receive weekly courses of betamethasone or placebo until 33 weeks gestation or delivery.nnnRESULTSnWomen were recruited at two hospitals in Toronto from 01 September 1999 to 31 August 2000. Of the 78 women who were approached and were eligible for the study, 12 (15%) were recruited and 66 (85%) refused to participate. Of the 66 refusals, 38 (58%) did not feel their physicians were supportive of the study, 10 (15%) did not want to be randomized, and 4 (6%) had other personal reasons for refusing to enter the trial. Fourteen women (21%) had physicians who did not allow them to join the study. The lack of physician support was due to concerns related to the potential adverse effects of multiple courses of ACS. There were no complications requiring discontinuation of ACS. Plasma cortisol and ACTH concentrations in cord and maternal blood taken after delivery were not significantly different between ACS and placebo groups.nnnCONCLUSIONnA multicentre randomized controlled trial is required to determine the benefits and risks of multiple versus a single course of ACS. If the study protocols are supported by physicians and their patients, a multicentre randomized controlled trial is feasible.
Blood | 2015
Ann Kinga Malinowski; Nadine Shehata; Rohan D'Souza; Kevin H.M. Kuo; Richard Ward; Prakesh S. Shah; Kellie Murphy
Pregnancy in women with sickle cell disease is associated with adverse maternal and neonatal outcomes. Studies assessing the effects of prophylactic red blood cell transfusions on these outcomes have drawn inconsistent conclusions. The objective of this systematic review was to assess the effect of prophylactic compared with on-demand red blood cell transfusions on maternal and neonatal outcomes in women with sickle cell disease. A systematic search of several medical literature databases was conducted. Twelve studies involving 1291 participants met inclusion criteria. The studies had moderate to high risk of bias. Meta-analysis demonstrated that prophylactic transfusion was associated with a reduction in maternal mortality (7 studies, 955 participants; odds ratio [OR], 0.23; 95% confidence interval [CI], 0.06-0.91), vaso-occlusive pain episodes (11 studies, 1219 participants; OR, 0.26; 95% CI, 0.09-0.76), pulmonary complications (9 studies, 1019 participants; OR, 0.25; 95% CI, 0.09-0.72), pulmonary embolism (3 studies, 237 participants; OR, 0.07; 95% CI, 0.01-0.41), pyelonephritis (6 studies, 455 participants; OR, 0.19; 95% CI, 0.07-0.51), perinatal mortality (8 studies, 1140 participants; OR, 0.43; 95% CI, 0.19-0.99), neonatal death (5 studies, 374 participants; OR, 0.26; 95% CI, 0.07-0.93), and preterm birth (9 studies, 1123 participants; OR, 0.59; 95% CI, 0.37-0.96). Event rates for most of the results were low. Prophylactic transfusions may positively impact several adverse maternal and neonatal outcomes in women with sickle cell disease; however, the evidence stems from a relatively small number of studies with methodologic limitations. A prospective, multicenter, randomized trial is needed to determine whether the potential benefits balance the risks of prophylactic transfusions.
BMC Pregnancy and Childbirth | 2016
Denice S. Feig; Kellie Murphy; Elizabeth Asztalos; George Tomlinson; Johanna Sanchez; Bernard Zinman; Arne Ohlsson; Edmond A. Ryan; I. George Fantus; Anthony Armson; Lorraine L. Lipscombe; Jon Barrett
BackgroundThe incidence of type 2 diabetes in pregnancy is rising and rates of serious adverse maternal and fetal outcomes remain high. Metformin is a biguanide that is used as first-line treatment for non-pregnant patients with type 2 diabetes. We hypothesize that metformin use in pregnancy, as an adjunct to insulin, will decrease adverse outcomes by reducing maternal hyperglycemia, maternal insulin doses, maternal weight gain and gestational hypertension/pre-eclampsia. In addition, since metformin crosses the placenta, metformin treatment of the fetus may have a direct beneficial effect on neonatal outcomes. Our aim is to compare the effectiveness of the addition of metformin to insulin, to standard care (insulin plus placebo) in women with type 2 diabetes in pregnancy.MethodsThe MiTy trial is a multi-centre randomized trial currently enrolling pregnant women with type 2 diabetes, who are on insulin, between the ages of 18–45, with a gestational age of 6xa0weeks 0xa0days to 22xa0weeks 6xa0days. In this randomized, double-masked, parallel placebo-controlled trial, after giving informed consent, women are randomized to receive either metformin 1,000xa0mg twice daily or placebo twice daily. A web-based block randomization system is used to assign women to metformin or placebo in a 1:1 ratio, stratified for site and body mass index. The primary outcome is a composite neonatal outcome of pregnancy loss, preterm birth, birth injury, moderate/severe respiratory distress, neonatal hypoglycemia, or neonatal intensive care unit admission longer than 24xa0h. Secondary outcomes are large for gestational age, cord blood gas pHu2009<u20097.0, congenital anomalies, hyperbilirubinemia, sepsis, hyperinsulinemia, shoulder dystocia, fetal fat mass, as well as maternal outcomes: maternal weight gain, maternal insulin doses, maternal glycemic control, maternal hypoglycemia, gestational hypertension, preeclampsia, cesarean section, number of hospitalizations during pregnancy, and duration of hospital stays. The trial aims to enroll 500 participants.DiscussionThe results of this trial will inform endocrinologists, obstetricians, family doctors, and other healthcare professionals caring for women with type 2 diabetes in pregnancy, as to the benefits of adding metformin to insulin in this high risk population.Trial registrationClinicalTrials.gov Identifier: no. NCT01353391. Registered February 6, 2009.
BMC Pregnancy and Childbirth | 2016
Denice S. Feig; Elizabeth Asztalos; Rosa Corcoy; Alberto de Leiva; Lois E. Donovan; Moshe Hod; Lois Jovanovic; Erin Keely; Craig Kollman; Ruth McManus; Kellie Murphy; Katrina J. Ruedy; Johanna Sanchez; George Tomlinson; Helen R. Murphy
BackgroundWomen with type 1 diabetes strive for optimal glycemic control before and during pregnancy to avoid adverse obstetric and perinatal outcomes. For most women, optimal glycemic control is challenging to achieve and maintain. The aim of this study is to determine whether the use of real-time continuous glucose monitoring (RT-CGM) will improve glycemic control in women with type 1 diabetes who are pregnant or planning pregnancy.Methods/designA multi-center, open label, randomized, controlled trial of women with type 1 diabetes who are either planning pregnancy with an HbA1c of 7.0xa0% to ≤10.0xa0% (53 to ≤u200986xa0mmol/mol) or arexa0in early pregnancy (<13xa0weeks 6xa0days) with an HbA1c of 6.5xa0% to ≤10.0xa0% (48 to ≤u200986xa0mmol/mol). Participants will be randomized to either RT-CGM alongside conventional intermittent home glucose monitoring (HGM), or HGM alone. Eligible women will wear a CGM which does not display the glucose result for 6xa0days during the run-in phase. To be eligible for randomization, a minimum of 4 HGM measurements per day and a minimum of 96xa0hours total with 24xa0hours overnight (11xa0pm-7xa0am) of CGM glucose values are required. Those meeting these criteria are randomized to RT- CGM or HGM. A total of 324 women will be recruited (110 planning pregnancy, 214 pregnant). This takes into account 15 and 20xa0% attrition rates for the planning pregnancy and pregnant cohorts and will detect a clinically relevant 0.5xa0% difference between groups at 90xa0% power with 5xa0% significance. Randomization will stratify for type of insulin treatment (pump or multiple daily injections) and baseline HbA1c. Analyses will be performed according to intention to treat. The primary outcome is the change in glycemic control as measured by HbA1c from baseline to 24xa0weeks or conception in women planning pregnancy, and from baseline to 34xa0weeks gestation during pregnancy. Secondary outcomes include maternal hypoglycemia, CGM time in, above and below target (3.5–7.8xa0mmol/l), glucose variability measures, maternal and neonatal outcomes.DiscussionThis will be the first international multicenter randomized controlled trial to evaluate the impact of RT- CGM before and during pregnancy in women with type 1 diabetes.Trial registrationClinicalTrials.gov Identifier: NCT01788527 Registration Date: December 19, 2012.
European Journal of Obstetrics & Gynecology and Reproductive Biology | 2016
Louise-Helene Gagnon; Jay MacGillivray; Marcelo L. Urquia; Daniela Caprara; Kellie Murphy; Mark H. Yudin
BACKGROUNDnAntiretroviral therapy use in pregnancy, and specifically regimens containing protease inhibitors (PIs), has been associated with adverse infant outcomes including preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) infants. However, there are conflicting results in the literature with respect to the degree of risk. These results may be related to demographic factors and confounding of maternal HIV infection and degree of immune suppression.nnnOBJECTIVEnThe primary objective of our study was to assess the risk of PTB in HIV-positive pregnant women on ART compared to HIV-negative pregnant women. Secondary objectives included: comparing the risks of LBW and SGA infants in HIV-positive women on ART to HIV-negative pregnant women; comparing the risks of PTB, LBW and SGA in HIV-positive women on PI-based regimens compared to HIV-negative women.nnnMETHODSnA retrospective matched cohort study of 384 women was conducted between 2007 and 2012 comparing outcomes of HIV-positive women on ART to HIV-negative women. Univariate and multivariable logistic regression models were used, adjusting for potential confounding factors, to compare the two groups on adverse infant outcomes.nnnRESULTSnUnadjusted odds ratios revealed a >2-fold increase in rates: PTB OR 2.6 [95% CI 1.3-5.1]; LBW OR 2.9 [95% CI 1.4-6.3]; SGA OR 2.5 [95% CI 1.3-4.7]. Once odds ratios were adjusted to account for race (p<0.01), our results were no longer statistically significant as this study was underpowered to detect smaller differences: PTB aOR 1.4 [95% CI 0.5-3.6]; LBW OR 1.9 [95% CI 0.6-5.5]; SGA OR 1.8 [95% CI 0.8-4.6].nnnCONCLUSIONnOur preliminary results show an increase in PTB, LBW and SGA but due to lack of power, our adjusted results are not statistically significant. A larger prospective follow-up study is needed to further explore these findings in this population.
American Journal of Obstetrics and Gynecology | 2015
Elad Mei-Dan; Jyotsna Shah; Anne Synnes; Sandesh Shivananda; Greg Ryan; Prakeshkumar Shah; Kellie Murphy
Archive | 2013
Rohan D’Souza; Shital Gandhi; Han Keunen; David Macklin; Annie Malinowski; Cynthia Maxwell; Kellie Murphy; Joel Ray; Mathew Sermer; Nadine Shehata; Candice Silversides
American Journal of Obstetrics and Gynecology | 2012
Shay Porat; Hagai Amsalem; Prakesh S. Shah; Kellie Murphy
/data/revues/00029378/v208i1sS/S0002937812016006/ | 2012
Michelle Morais; Chaula Mehta; Kellie Murphy; Prakesh S. Shah; Lucia Giglia; Patricia Smith; Kate Bassil; Sarah D. McDonald
/data/revues/00029378/v208i1sS/S0002937812016006/ | 2012
Michelle Morais; Chaula Mehta; Kellie Murphy; Prakesh S. Shah; Lucia Giglia; Patricia Smith; Kate Bassil; Sarah D. McDonald