Kym Rae

Follistatin serum concentrations during full-term labour in women--significant differences between spontaneous and induced labour.

Follistatin has been isolated from human placenta and has been identified in human foetal membranes and fluids. Serum follistatin levels in women rise during pregnancy particularly near term. In this study, we examined the effect of induction and stage of labour on maternal plasma concentrations of follistatin. Women who gave birth after a normal pregnancy were retrospectively divided into three groups: those who went in labour spontaneously (n = 33), needed induction by amniotomy and IV oxytocin (n = 18) or underwent planned caesarean section (n = 10). Serum was collected at 38-40 weeks of gestation, periodically through labour with a vaginal examination and once within 36 h postpartum and assayed for oestradiol, progesterone, prolactin and C-reactive protein. Follistatin was measured using a rabbit antiserum (#204) raised against purified 35 kDa bovine follistatin. Human recombinant follistatin was used as both standard and tracer. Concentrations of follistatin at 38-40 weeks of gestation were significantly different between groups. Those who had a spontaneous labour had concentrations higher than those who were induced. Similarly, those who were induced had concentrations higher than those who underwent a caesarean. In the spontaneous group, follistatin rose during labour, peaking at 57.9 +/- 5.48 ng/ml at > 3 cm of cervical dilation, and after delivery follistatin decreased to 26.16 +/- 3.4 ng/ml at 24 h post-delivery. In induced patients follistatin continued increasing to peak following delivery at 26.9 +/- 3.0 ng/ml and decreased at > 3 h post-delivery. Follistatin concentrations in caesarean section patients at 24 h post-surgery (18.53 +/- 3.74 ng/ml) were not different from that before the surgery and were comparable with the other two groups. Follistatin is clearly implicated in the onset of labour; however, further studies with a larger cohort of women are necessary to determine the nature of its role.

Validation of a Smartphone Image-Based Dietary Assessment Method for Pregnant Women

Image-based dietary records could lower participant burden associated with traditional prospective methods of dietary assessment. They have been used in children, adolescents and adults, but have not been evaluated in pregnant women. The current study evaluated relative validity of the DietBytes image-based dietary assessment method for assessing energy and nutrient intakes. Pregnant women collected image-based dietary records (via a smartphone application) of all food, drinks and supplements consumed over three non-consecutive days. Intakes from the image-based method were compared to intakes collected from three 24-h recalls, taken on random days; once per week, in the weeks following the image-based record. Data were analyzed using nutrient analysis software. Agreement between methods was ascertained using Pearson correlations and Bland-Altman plots. Twenty-five women (27 recruited, one withdrew, one incomplete), median age 29 years, 15 primiparas, eight Aboriginal Australians, completed image-based records for analysis. Significant correlations between the two methods were observed for energy, macronutrients and fiber (r = 0.58–0.84, all p < 0.05), and for micronutrients both including (r = 0.47–0.94, all p < 0.05) and excluding (r = 0.40–0.85, all p < 0.05) supplements in the analysis. Bland-Altman plots confirmed acceptable agreement with no systematic bias. The DietBytes method demonstrated acceptable relative validity for assessment of nutrient intakes of pregnant women.

A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study.

Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the childs first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5-43.2, n=110), median birth weight was 3180 g (910-5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.

Effects of Maternal Inflammation and Exposure to Cigarette Smoke on Birth Weight and Delivery of Preterm Babies in a Cohort of Indigenous Australian Women

Sudden infant death syndrome (SIDS), neonatal deaths, and deaths from infection are higher among Indigenous Australians. This study aimed to determine the effects of inflammatory responses and exposure to cigarette smoke, two important factors associated with sudden death in infancy, on preterm birth, and birth weight in a cohort of Indigenous mothers. Indigenous Australian women (n = 131) were recruited as part of a longitudinal study while attending antenatal care clinics during pregnancy; blood samples were collected up to three times in pregnancy. Serum cotinine, indicating exposure to cigarette smoke, was detected in 50.4% of mothers. Compared with non-Indigenous women, the cohort had 10 times the prevalence of antibodies to Helicobacter pylori (33 vs. 3%). Levels of immunoglobulin G, antibodies to H. pylori, and C-reactive protein (CRP) were all inversely correlated with gestational age (P < 0.05). CRP levels were positively associated with maternal body mass index (BMI; ρ = 0.449, P = 0.001). The effects of cigarette smoke (cotinine) and inflammation (CRP) were assessed in relation to risk factors for SIDS: gestational age at delivery and birth weight. Serum cotinine levels were negatively associated with birth weight (ρ = −0.37, P < 0.001), this correlation held true for both male (ρ = −0.39, P = 0.002) and female (ρ = −0.30, P = 0.017) infants. Cotinine was negatively associated with gestational age at delivery (ρ = −0.199, P = 0.023). When assessed by fetal sex, this was significant only for males (ρ = −0.327, P = 0.011). CRP was negatively associated with gestational age at delivery for female infants (ρ = −0.46, P < 0.001). In contrast, maternal BMI was significantly correlated with birth weight. These data highlight the importance of putting programs in place to reduce cigarette smoke exposure in pregnancy and to treat women with chronic infections such as H. pylori to improve pregnancy outcomes and decrease risk factors for sudden death in infancy.

Dietary intakes and anthropometric measures of Indigenous Australian women and their infants in the Gomeroi gaaynggal cohort.

Indigenous Australians continue to experience disparities in chronic diseases, many of which have nutrition-related trajectories. Optimal nutrition throughout the lifespan is protective for a number of adverse health outcomes, however little is known about current dietary intakes and related anthropometric outcomes of Indigenous women and their infants. Research is required to identify nutrition issues to target for health promotion activities. The Gomeroi gaaynggal programme is an ongoing, prospective cohort of pregnant Indigenous Australian women and their children. A cross-sectional examination of postnatal dietary intakes and anthropometric outcomes of mothers and children are reported. To date, 73 mother-child dyads have participated postpartum. Breastfeeding initiation was 85.9% and median (interquartile range) duration of any breastfeeding was 1.4 (0.5-4.0) months. Infants were introduced to solid foods at 5.0 months (4.0-6.0) and cows milk at 12.0 (10.0-13.0) months. At 12 months postpartum, 66.7% of women were overweight or obese, 63.7% at 2 years. Compared with recommendations, reported median maternal nutrient intakes from 24-h recall were low in fibre, folate, iodine, calcium, potassium and vitamin D and high in proportions of energy from total and saturated fat. Limitations of this study include a small sample size and incomplete data for the cohort at each time point. Preliminary data from this ongoing cohort of Indigenous Australian women and children suggest that women may need support to optimize nutrient intakes and to attain a healthy body weight for themselves and their children.

Morality, duty, and the arts in health: A project on Aboriginal underage pregnancy

Underage pregnancy in the Aboriginal population of Australia represents a serious set of physical, social, and mental problems. The shifts that have taken place in the population make-up of the communities due to this birth pattern are having detrimental effects on the well-being of individuals and families, including a destabilising of the sense of identity and belonging. The paper looks at the social and medical problems involved and summarises a project which aims to address them through the arts. It also considers the moral and ethical aspects of the situation, including the difficulties of any sort of intervention. It also considers the issue of duty for both medicine and the arts in such situations.

The Gomeroi Gaaynggal Cohort: A Preliminary Study of the Maternal Determinants of Pregnancy Outcomes in Indigenous Australian Women

The life expectancy of Indigenous Australians is amongst the lowest of any population group within developed nations and chronic diseases collectively account for over 80% of the gap in life expectancy between Indigenous and non-Indigenous Australians. The Gomeroi gaaynggal cohort is a prospective, longitudinal maternal-infant cohort established to examine the origins of chronic disease in Indigenous Australians. This study aimed to determine the major antenatal factors associated with adverse birth outcomes (preterm delivery, low birth weight) and other pregnancyrelated complications (gestational diabetes and hypertensive disorders of pregnancy) in Indigenous Australian women. Pregnant women who identified as Indigenous Australians or pregnant non-Indigenous women giving birth to an Indigenous infant were eligible to participate in the cohort (n=227). Physical measurements and biological sample collection (including blood and urine) were undertaken up to 3 times in pregnancy. Median weight and BMI of the cohort was 80.7 kg and 30.3 kg/m2 at enrolment (median 23 weeks gestation). 43% reported smoking cigarettes during pregnancy. Of the 158 women in whom pregnancy outcomes were known, 43% had an uncomplicated pregnancy, 13.9% delivered preterm, 14.6% delivered a small-for-gestational age infant, 10% developed a hypertensive disorder of pregnancy, and 6.3% developed gestational diabetes. In addition, many women showed evidence of underlying renal dysfunction (proteinuria or albuminuria). The ratio of male to female offspring in this cohort was 1.38. Eightyseven percent of preterm infants were male, as were 83.3% of babies from women with gestational hypertension. This skewed sex distribution was far higher than for those who had a healthy pregnancy outcome (59%). This study demonstrates that key factors including maternal obesity, exposure to cigarette smoke and underlying renal impairment, influence pregnancy outcome. Preliminary findings from this study also suggest that more male babies are born early and from complicated pregnancies in this Indigenous cohort.

Factors Associated with Effective Nutrition Interventions for Pregnant Indigenous Women: A Systematic Review

INTRODUCTION Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously. OBJECTIVE The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries, and to identify positive factors contributing to successful programs. METHODS Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively. RESULTS Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia, Canada, and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2), peer counselor (n=3), or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3). CONCLUSIONS Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes, as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols.

Post‐traumatic stress disorder symptoms in pregnant Australian Indigenous women residing in rural and remote New South Wales: A cross‐sectional descriptive study

Pregnancy can be a stressful time for many women. There is ample evidence of numerous physical and mental health inequities for Indigenous Australians. For those Indigenous women who are pregnant, it is established that there is a higher incidence of poor physical perinatal outcomes when compared with non‐Indigenous Australians. However, little evidence exists that examines stressful events and post‐traumatic stress disorder (PTSD) symptoms in pregnant women who are members of this community.

Wearing someone else's shoes

This paper recounts a journey of discovery by a scientist who inadvertently takes on coordination of an ArtsHealth programme. The dynamics of role change are explored showcasing the vulnerabilities and fears that often accompany these career adjustments. The associated ArtsHealth programme (Gomeroi gaaynggal) works with Aboriginal and Torres Strait Islander women in Australia throughout their pregnancy to improve understanding of issues that impact the health of themselves and their developing baby. By wearing someone else shoes, the scientist is immersed in the project and must confront issues including skill mix, learning and cultural diversity.