Sue Jordan

The impact of intrapartum analgesia on infant feeding

Objective  To investigate the impact of intrapartum analgesia on infant feeding at hospital discharge.

Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey

Background  Little is known about how breastfeeding rates are affected by drugs routinely administered in labour.

Selective serotonin reuptake inhibitor prescribing before, during and after pregnancy: a population‐based study in six European regions

To explore the prescribing patterns of selective serotonin reuptake inhibitors (SSRIs) before, during and after pregnancy in six European population‐based databases.

Impact of birth complications on breastfeeding duration: an internet survey

AIM To explore reasons underlying cessation of breastfeeding in mothers with uncomplicated vaginal deliveries and those experiencing complications during childbirth. BACKGROUND Interventions during labour and childbirth can have a negative impact on breastfeeding. Explanations include adverse reactions to medication, delayed breastfeeding initiation, and disruption of the normal endocrinology of childbirth. However, reasons for breastfeeding cessation linked to birth experience have not been fully examined. Increasing breastfeeding duration and, consequently, improving infant and maternal health in the UK depend on understanding why women stop breastfeeding. DESIGN An exploratory cross-sectional survey. METHOD Between January-May 2009, 284 mothers attending community groups in Swansea, Wales, and mothers participating in online parenting forums, who initiated breastfeeding but discontinued before 6 months postpartum, reported their birth experience, including complications and reasons for breastfeeding cessation in an internet survey. RESULTS Mothers who experienced birth complications breastfed for a significantly shorter duration than those who did not. Specifically, caesarean deliveries, foetal distress, failure to progress, and postpartum haemorrhage were each associated with a shorter breastfeeding duration. Mothers who experienced complications were more likely to discontinue breastfeeding for reasons of pain and difficulty than mothers who did not experience complications, yet no difference was seen between groups for social reasons such as embarrassment or a lack of support. CONCLUSION Certain complications during labour may increase risk of specific physical difficulties with breastfeeding, possibly due to their association with medications received. Maternity health professionals should be alert to this possibility to offer enhanced attention and care to overcome these issues and prolong breastfeeding duration.

Healthcare databases in Europe for studying medicine use and safety during pregnancy

The aim of this study was to describe a number of electronic healthcare databases in Europe in terms of the population covered, the source of the data captured and the availability of data on key variables required for evaluating medicine use and medicine safety during pregnancy.

Probiotics in the prevention of eczema: a randomised controlled trial

Objective To evaluate a multistrain, high-dose probiotic in the prevention of eczema. Design A randomised, double-blind, placebo-controlled, parallel group trial. Settings Antenatal clinics, research clinic, children at home. Patients Pregnant women and their infants. Interventions Women from 36 weeks gestation and their infants to age 6 months received daily either the probiotic (Lactobacillus salivarius CUL61, Lactobacillus paracasei CUL08, Bifidobacterium animalis subspecies lactis CUL34 and Bifidobacterium bifidum CUL20; total of 1010 organisms/day) or matching placebo. Main outcome measure Diagnosed eczema at age 2 years. Infants were followed up by questionnaire. Clinical examination and skin prick tests to common allergens were done at 6 months and 2 years. Results The cumulative frequency of diagnosed eczema at 2 years was similar in the probiotic (73/214, 34.1%) and placebo arms (72/222, 32.4%; OR 1.07, 95% CI 0.72 to 1.6). Among the secondary outcomes, the cumulative frequency of skin prick sensitivity at 2 years was reduced in the probiotic (18/171; 10.5%) compared with the placebo arm (32/173; 18.5%; OR 0.52, 95% CI 0.28 to 0.98). The statistically significant differences between the arms were mainly in sensitisation to cows milk and hens egg proteins at 6 months. Atopic eczema occurred in 9/171 (5.3%) children in the probiotic arm and 21/173 (12.1%) in the placebo arm (OR 0.40, 95% CI 0.18 to 0.91). Conclusions The study did not provide evidence that the probiotic either prevented eczema during the study or reduced its severity. However, the probiotic seemed to prevent atopic sensitisation to common food allergens and so reduce the incidence of atopic eczema in early childhood. Trial registration Number ISRCTN26287422.

Volunteer Bias in Recruitment, Retention, and Blood Sample Donation in a Randomised Controlled Trial Involving Mothers and Their Children at Six Months and Two Years: a longitudinal analysis.

Background The vulnerability of clinical trials to volunteer bias is under-reported. Volunteer bias is systematic error due to differences between those who choose to participate in studies and those who do not. Methods and Results This paper extends the applications of the concept of volunteer bias by using data from a trial of probiotic supplementation for childhood atopy in healthy dyads to explore 1) differences between a) trial participants and aggregated data from publicly available databases b) participants and non-participants as the trial progressed 2) impact on trial findings of weighting data according to deprivation (Townsend) fifths in the sample and target populations. 1) a) Recruits (n = 454) were less deprived than the target population, matched for area of residence and delivery dates (n = 6,893) (mean [SD] deprivation scores 0.09[4.21] and 0.79[4.08], t = 3.44, df = 511, p<0.001). b) i)As the trial progressed, representation of the most deprived decreased. These participants and smokers were less likely to be retained at 6 months (n = 430[95%]) (OR 0.29,0.13–0.67 and 0.20,0.09–0.46), and 2 years (n = 380[84%]) (aOR 0.68,0.50–0.93 and 0.55,0.28–1.09), and consent to infant blood sample donation (n = 220[48%]) (aOR 0.72,0.57–0.92 and 0.43,0.22–0.83). ii)Mothers interested in probiotics or research or reporting infants’ adverse events or rashes were more likely to attend research clinics and consent to skin-prick testing. Mothers participating to help children were more likely to consent to infant blood sample donation. 2) In one trial outcome, atopic eczema, the intervention had a positive effect only in the over-represented, least deprived group. Here, data weighting attenuated risk reduction from 6.9%(0.9–13.1%) to 4.6%(−1.4–+10.5%), and OR from 0.40(0.18–0.91) to 0.56(0.26–1.21). Other findings were unchanged. Conclusions Potential for volunteer bias intensified during the trial, due to non-participation of the most deprived and smokers. However, these were not the only predictors of non-participation. Data weighting quantified volunteer bias and modified one important trial outcome. Trial Registration This randomised, double blind, parallel group, placebo controlled trial is registered with the International Standard Randomised Controlled Trials Register, Number (ISRCTN) 26287422. Registered title: Probiotics in the prevention of atopy in infants and children.

From classroom theory to clinical practice: evaluating the impact of a post-registration course.

This paper is concerned with the translation of bioscience theory into clinical practice. The empirical data form part of an action research study undertaken to investigate the clinical outcomes of the bioscience component of a post-registration, day release diploma in nursing taught in a higher education institution. Evidence for the impact of the course on patient care was collected by academic diary, questionnaire and interview. The triangulated data indicated that by adapting the pedagogic interpretation of the biosciences, it is possible to bridge the theory-practice gap. As a result, some nurses related the substance of the lessons to their patients, in order to bring about improvements in care. This paper examines the reasons behind the successes and failures of this continuing professional education initiative.

Charlton RA, Neville AJ, Jordan S, Pierini A, Damse-Michel C, Klungsøyr K, Nybo Anderson AM, Hansen AV, Gini R, Bos J, Puccini A, Hurault-Delarue C, Brooks CJ, de Jong van den Berg LTW, de Vries CS Healthcare databases in Europe for studying medicine use and safety during pregnancy Journal Pharmacoepidemiology and Drug Safety , 2014, Published Ahead-of-Print. DOI: 10.1002/pds.3613

The aim of this study was to describe a number of electronic healthcare databases in Europe in terms of the population covered, the source of the data captured and the availability of data on key variables required for evaluating medicine use and medicine safety during pregnancy.

Improving Information on Maternal Medication Use by Linking Prescription Data to Congenital Anomaly Registers: A EUROmediCAT Study

IntroductionResearch on associations between medication use during pregnancy and congenital anomalies is significative for assessing the safe use of a medicine in pregnancy. Congenital anomaly (CA) registries do not have optimal information on medicine exposure, in contrast to prescription databases. Linkage of prescription databases to the CA registries is a potentially effective method of obtaining accurate information on medicine use in pregnancies and the risk of congenital anomalies.MethodsWe linked data from primary care and prescription databases to five European Surveillance of Congenital Anomalies (EUROCAT) CA registries. The linkage was evaluated by looking at linkage rate, characteristics of linked and non-linked cases, first trimester exposure rates for six groups of medicines according to the prescription data and information on medication use registered in the CA databases, and agreement of exposure.ResultsOf the 52,619 cases registered in the CA databases, 26,552 could be linked. The linkage rate varied between registries over time and by type of birth. The first trimester exposure rates and the agreements between the databases varied for the different medicine groups. Information on anti-epileptic drugs and insulins and analogue medicine use recorded by CA registries was of good quality. For selective serotonin reuptake inhibitors, anti-asthmatics, antibacterials for systemic use, and gonadotropins and other ovulation stimulants, the recorded information was less complete.ConclusionLinkage of primary care or prescription databases to CA registries improved the quality of information on maternal use of medicines in pregnancy, especially for medicine groups that are less fully registered in CA registries.