Research Interests: Andrology, Immunology, Biology, Fertility, Adolescent, and 15 moreMedicine, Humans, Male, Middle Aged, Chemokine, Lipopolysaccharides, Human reproduction, Adult, Reproducibility of Results, Semen, Enzyme Linked Immunosorbent Assay, Interleukin, Interferon gamma, Medical and Health Sciences, and Ifng
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Parturition signals the end of immune tolerance in pregnancy. Term labour is usually a sterile inflammatory process triggered by damage associated molecular patterns (DAMPs) as a consequence of functional progesterone withdrawal.... more
Parturition signals the end of immune tolerance in pregnancy. Term labour is usually a sterile inflammatory process triggered by damage associated molecular patterns (DAMPs) as a consequence of functional progesterone withdrawal. Activation of DAMPs recruits leukocytes and inflammatory cytokine responses in the myometrium, decidua, cervix and fetal membranes. Emerging evidence shows components of the inflammasome are detectable in both maternal decidua and placenta. However, the activation of the placental inflammasome with respect to mode of delivery has not been profiled. Placental chorionic villus samples from women delivering at termviaunassisted vaginal (UV) birth, labouring lower segment caesarean section (LLSCS, emergency caesarean section) and prelabour lower segment caesarean section (PLSCS, elective caesarean section) underwent high throughput RNA sequencing (NextSeq Illumina) and bioinformatic analyses to identify differentially expressed inflammatory (DE) genes. DE genes...
Research Interests: Medicine and Inflammasome
Preeclampsia (PE) and gestational hypertension (GH) are pregnancy-specific diseases that occur in around 10% of pregnancies worldwide. Increasing evidence suggests that women whose pregnancies were complicated by PE or GH, and their... more
Preeclampsia (PE) and gestational hypertension (GH) are pregnancy-specific diseases that occur in around 10% of pregnancies worldwide. Increasing evidence suggests that women whose pregnancies were complicated by PE or GH, and their offspring, are at increased risk of cardiovascular disease (CVD) later in life. We hypothesised that PE and GH would associate with CVD risk factors 8–10 years after the first pregnancy in the mother and child and that differences in cardiovascular risk profile would be seen between 8- and 10-year-old male and female children. This is a follow-up study of the Adelaide SCOPE pregnancy cohort where 1164 nulliparous women and their babies were recruited between 2005 and 2008. Haemodynamic function was assessed using non-invasive USCOMBP+ and USCOM1A devices. Microvascular function was assessed by post-occlusive reactive hyperaemia. Of the 273 mother–child pairs followed up, 38 women had PE and 20 had GH during pregnancy. Augmentation index (Aix) and suprasy...
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• For the management of acute thrombotic events in pregnancy therapeutic doses of low molecular weight heparins (LMWH) may be used, unless the shorter half‐life of intravenous unfractionated heparin (UH) and predictable reversibility by... more
• For the management of acute thrombotic events in pregnancy therapeutic doses of low molecular weight heparins (LMWH) may be used, unless the shorter half‐life of intravenous unfractionated heparin (UH) and predictable reversibility by protamine are important. Treatment should be continued up until delivery and into the puerperium.
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Gestational diabetes (GD), a pregnancy complication defined by glucose intolerance with onset during pregnancy, is a condition affecting 5.5%–8.8% of Australian pregnancies1. Untreated GD increases perinatal mortality and babies from GD... more
Gestational diabetes (GD), a pregnancy complication defined by glucose intolerance with onset during pregnancy, is a condition affecting 5.5%–8.8% of Australian pregnancies1. Untreated GD increases perinatal mortality and babies from GD pregnancies have an increased risk of diabetes and obesity, whilst mothers have an increased risk of type II diabetes later in life1. Circulating levels of angiotensin 1–7 (Ang1–7), a peptide of the renin angiotensin system, have been reported to be reduced in third trimester pregnancies with GD2. The effects of Ang1–7 generally oppose those of angiotensin II (AngII) and it is possible that in early gestation pro-angiogenic functions of AngII are counterbalanced by Ang1–7, causing placental insufficiency and pregnancy complications. We wanted to determine the predictive capability of AngII and Ang1–7, in early gestation, for GD. Healthy nulliparous pregnant women from the Adelaide SCOPE cohort with GD (n = 36) or serving as controls (n = 131) had bot...
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Research Interests: Obstetrics, Clinical Trial, Adolescent, Medicine, Pregnancy, and 15 moreHumans, Placebo, Blood Pressure, Female, Clinical Sciences, Middle Aged, Adult, Randomized Controlled Trial, Arginine, Pregnancy Outcome, Pre Eclampsia, Relative Risk, Randomized Controlled Trials as Topic, Eclampsia, and hypertensive disease
Among mammalian species, human reproduction has 2 outstanding features. The human hemochorial placentation is characterized by a very deep endovascular trophoblast invasion in the spiral arteries, reaching deep into the myometrium. This... more
Among mammalian species, human reproduction has 2 outstanding features. The human hemochorial placentation is characterized by a very deep endovascular trophoblast invasion in the spiral arteries, reaching deep into the myometrium. This requires an agonistic direct cell-cell interaction between the maternal immune system and semiallogeneic trophoblast. The second feature is preeclampsia, a heterogeneous syndrome, a uniquely human condition. The human female is one of the few mammals exposed to her partner's semen on multiple occasions before conception. Regulatory T cells, especially paternal antigen-specific regulatory T cells, play an important role in the maintenance of pregnancy. Sexual intercourse increases the number of dendritic cells in the uterus that play an important role in the induction of paternal antigen-specific regulatory T cells. Paternal antigen-specific regulatory T cells maintain pregnancy by inducing tolerance. In the decidua basalis of preeclamptic cases, clonal regulatory T cells are reduced; these would normally monoclonally expand to recognize fetal or paternal antigens. Programmed cell death-1 expressed on T cells regulate cytotoxic T-cell activity and protect the fetus against maternal rejection. Programmed cell death-1 expression on clonal cytotoxic T cells is reduced in preeclampsia especially in early-onset preeclampsia, making the fetus and placenta vulnerable to attack by cytotoxic T cells. These phenomena can explain the epidemiologic phenomenon that preeclampsia is more common in couples using condom contraception, with shorter cohabitation periods, first pregnancies, first pregnancies in multiparous women when they change partner, and pregnancies after assisted reproduction using donated gametes. In contrast to its importance in early-onset preeclampsia, shallow trophoblast invasion does not play a role in the development of preeclampsia, that is, immune maladaptation does not seem to be involved. Late-onset preeclampsia (>34 weeks' gestation), representing 80% to 90% of preeclampsia in most developed countries with a "Western lifestyle," is strongly associated with maternal cardiometabolic variables (metabolic syndrome). Although the underlying pathophysiology might be quite different, syncytiotrophoblast stress is the final common pathway leading to the maternal syndrome among the subtypes of preeclampsia by causing an imbalance between proangiogenic factors (placental growth factor and vascular endothelial growth factor) and antiangiogenic factors (soluble fms-like tyrosine kinase-1 and soluble endoglin). Low-dose aspirin, started before 16 week's gestation, will prevent up to 60% of early-onset preeclampsia but will not prevent late-onset preeclampsia. Optimizing prepregnancy weight and controlling gestational weight gain may be the most effective ways to prevent preeclampsia.
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The purpose of this study was to investigate associations between inherited cytokine polymorphisms and cerebral palsy. This was a case-control study that used DNA from the newborn infant screening cards of 443 white infants with cerebral... more
The purpose of this study was to investigate associations between inherited cytokine polymorphisms and cerebral palsy. This was a case-control study that used DNA from the newborn infant screening cards of 443 white infants with cerebral palsy and 883 white control infants to test for the following cytokine polymorphisms: tumor necrosis factor-alpha-308, mannose-binding lectin-221, and 3 polymorphisms in exon-1 of the mannose-binding lectin gene at codon-52, -54, and -57. At all gestational ages mannose-binding lectin codon-54 increased the risk of the development of diplegia (homozygous or heterozygous odds ratio, 1.55; 95% CI, 1.03-2.32). For babies who were born at term, the risk of the development of quadriplegia was associated with heterozygous tumor necrosis factor-alpha (odds ratio, 1.82; 95% CI, 1.04-3.15), and mannose-binding lectin codon-54 was associated with diplegia (homozygous or heterozygous odds ratio, 2.12; 95% CI, 1.10-4.05). The presence of any polymorphism in mannose-binding lectin exon-1 at term approximately doubled the risk of the development of diplegia (odds ratio, 1.94; 95% CI, 1.05-3.62). Homozygous or heterozygous tumor necrosis factor-alpha was associated with hemiplegia for babies who were born at <32 weeks of gestation (odds ratio, 2.38; 95% CI, 1.02-5.58). Overall, the presence of any cytokine polymorphism was associated with cerebral palsy (odds ratio, 1.37; 95% CI, 1.02-1.84). Carriage of polymorphisms in the tumor necrosis factor-alpha and mannose-binding lectin genes are associated with an increased risk of cerebral palsy.
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ABSTRACT Interference with delivery of oxygen to the fetus or infant and other environmental risk factors have been associated with the development of cerebral palsy (CP). Several lines of evidence suggest that genetic risk factors are... more
ABSTRACT Interference with delivery of oxygen to the fetus or infant and other environmental risk factors have been associated with the development of cerebral palsy (CP). Several lines of evidence suggest that genetic risk factors are also involved; genes associated with vascular disease or inflammation, the fetal inflammatory response, and the apolipoprotein E genotype are all associated with increased susceptibility to CP. In addition, increased risk of CP has been demonstrated among groups with high rates of consanguinity and in certain families. This population-based study evaluated the association of selected genetic polymorphisms with later-diagnosed CP among 413 South Australian children born to Caucasian mothers between 1986 and 1999. Blood samples obtained from newborn screening blood spots were tested for 28 single-nucleotide polymorphisms (SNPs) using TaqMan assays. The genotype frequencies were evaluated in all cases of cerebral palsy, and in subgroups based on gestational age (<37 or ≥37 weeks), the type of cerebral palsy (diplegia, hemiplegia, or quadriplegia), and gender. Logistic regression models were used to assess associations between genotypic distributions and CP. The risk for CP in both gestational age groups was significantly associated with polymorphisms of 2 SNPs: inducible nitric oxide synthase (iNOS) and lymphotoxin α (also called LTA or tumor necrosis factor β (TNF-β). For iNOS, presence of the T allele was more common in all children with CP and among heterozygotes born at term. Homozygous variant status for LTA was associated with risk for CP and with spastic hemiplegic or quadriplegic CP. In addition to iNOS, heterozygosity for the endothelial protein C receptor SNP was more frequent among children with CP. Among infants born preterm, the variant A allele of interleukin 8 and heterozygosity for the β-2 adrenergic receptor were associated with CP. Interleukin 8 heterozygosity was associated with spastic diplegia. Some gene variants were found in girls with CP but not in boys. These findings, together with previous studies, suggest that certain genes are associated with increased susceptibility to CP.
Research Interests: Genetics, Pediatrics, Polymorphism, Membrane Proteins, Cerebral Palsy, and 15 moreMedicine, Humans, Female, Male, Population based study, Newborn Screening, IL, Genotype, Gestational Age, Case Control Study, Plasminogen Activator Inhibitor, Case Control Studies, Interleukin, Medical and Health Sciences, and Paediatrics and reproductive medicine
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Research Interests: Obstetrics, Medicine, Disease susceptibility, Pregnancy, Humans, and 15 moreHaplotypes, Female, Small for Gestational Age, Risk factors, Newborn Infant, Risk Factors, Fetus, Gestational Age, Antepartum hemorrhage, Preterm Birth, Pregnancy Outcome, Haplotype, Case Control Studies, mannose binding lectin, and Paediatrics and reproductive medicine
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Folic acid (FA) food fortification in Australia has resulted in a higher-than-expected intake of FA during pregnancy. High FA intake is associated with increased insulin resistance and gestational diabetes. We aimed to establish whether... more
Folic acid (FA) food fortification in Australia has resulted in a higher-than-expected intake of FA during pregnancy. High FA intake is associated with increased insulin resistance and gestational diabetes. We aimed to establish whether maternal one-carbon metabolism and hormones that regulate glucose homeostasis change in healthy pregnancies post-FA food fortification. Circulating folate, B12, homocysteine, prolactin (PRL), human placental lactogen (hPL) and placental growth hormone (GH2) were measured in early pregnancy maternal blood in women with uncomplicated pregnancies prior to (SCOPE: N = 604) and post (STOP: N = 711)-FA food fortification. FA food fortification resulted in 63% higher maternal folate. STOP women had lower hPL (33%) and GH2 (43%) after 10 weeks of gestation, but they had higher PRL (29%) and hPL (28%) after 16 weeks. FA supplementation during pregnancy increased maternal folate and reduced homocysteine but only in the SCOPE group, and it was associated with 5...
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Aim Maternal complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, preterm labour, and placental abruption, are associated with increased risk of future... more
Aim Maternal complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, preterm labour, and placental abruption, are associated with increased risk of future cardiometabolic disease. Lifestyle interventions that focus on preventative strategies for this young, high-risk population of women may assist in cardiometabolic disease risk reduction. The aim of this preliminary registry analysis was to observe the change in maternal metabolic syndrome status after receiving a nurse practitioner-led lifestyle intervention delivered soon after a complicated pregnancy. Method This preliminary analysis included 64 eligible women who had attended both baseline (approximately 6 months postpartum) and review (approximately eighteen months postpartum) appointments at the postpartum lifestyle clinic after an index pregnancy complicated by at least one maternal complication of pregnancy. Metabolic syndrome status at both ...
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Regulatory T (Treg) cells are a specialized CD4+ T cell subpopulation that are essential for immune homeostasis, immune tolerance, and protection against autoimmunity. There is evidence that sex-steroid hormones estrogen and progesterone... more
Regulatory T (Treg) cells are a specialized CD4+ T cell subpopulation that are essential for immune homeostasis, immune tolerance, and protection against autoimmunity. There is evidence that sex-steroid hormones estrogen and progesterone modulate Treg cell abundance and phenotype in women. Since natural oscillations in these hormones are modified by hormonal contraceptives, we examined whether oral contraception (OC) use impacts Treg cells and related T cell populations. T cells were analyzed by multiparameter flow cytometry in peripheral blood collected across the menstrual cycle from healthy women either using OC or without hormonal contraception and from age-matched men. Compared to naturally cycling women, women using OC had fewer Treg cells and an altered Treg cell phenotype. Notably, Treg cells exhibiting a strongly suppressive phenotype, defined by high FOXP3, CD25, Helios, HLADR, CTLA4, and Ki67, comprised a lower proportion of total Treg cells, particularly in the early- an...
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BackgroundMaternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic... more
BackgroundMaternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic circumstances. Furthermore, fewer women in this group will successfully quit during pregnancy. AimThis study explores the barriers to smoking cessation experienced by socially disadvantaged pregnant women and investigates how interactions with health providers can influence their smoking cessation journey.Methodsomen (either pregnant or birthed in the previous 10 years, who smoked or quit smoking in pregnancy) were recruited from a metropolitan public hospital antenatal clinic in South Australia and community organisations in surrounding suburbs. Seventeen women participated in qualitative semi-structured small focus groups or interviews. The focus groups and interviews were recorded, transcribed and thematically analysed. FindingsFour interconnecte...
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Objectives: To develop a multivariate model for risk factors specific to early onset preeclampsia (EOP) and late onset preeclampsia (LOP) in our entire population (singleton and twin pregnancies). Material and methods: 20... more
Objectives: To develop a multivariate model for risk factors specific to early onset preeclampsia (EOP) and late onset preeclampsia (LOP) in our entire population (singleton and twin pregnancies). Material and methods: 20 year-observational population-based historical cohort study (2001–2020). All consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity ward. A standardized validated epidemiological perinatal database was used. Results: During the 20-year period, there were 81,834 pregnancies and 83,497 infants born, 1232 dichorionic and 350 monochorionic twin pregnancies. There were 2120 cases of preeclampsia, of which 2001 were preeclamptic singleton pregnancies and 119 twin pregnancies (incidence 7.5% in twin pregnancies vs. 2.5% singletons, OR 3.0, p < 0.001). Independent risk factors for EOP and LOP in a multivariate model (controlling for the two major confounders: maternal ages—both risks for EOP and LOP, and maternal pre-pre...
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Genuine preeclampsia is a disease of first pregnancies. The protective effect of multiparity, however, is lost with change of partner. Also, exposure to semen provides protection against developing preeclampsia. Analogous to altered... more
Genuine preeclampsia is a disease of first pregnancies. The protective effect of multiparity, however, is lost with change of partner. Also, exposure to semen provides protection against developing preeclampsia. Analogous to altered paternity, artificial donor insemination and oocyte donation are reported to result in a substantial increase of preeclampsia. Thus, epidemiologic studies strongly suggest that immune maladaptation is involved in the etiology of preeclampsia. Although the exact etiology of preeclampsia remains unknown, the conclusions derived from epidemiologic studies may have consequences for practicing physicians: 1) according to the primipaternity concept, a multiparous women with a new partner should be approached as being a primigravid women; 2) artificial donor insemination and oocyte donation are associated with an increased risk of developing pregnancy-induced hypertensive disorders; 3) a more or less prolonged period of sperm exposure provides a partial protection against pregnancy-induced hypertensive disorders. In the 1990s, all women with changing partners are strongly advised to use condoms to prevent sexually transmitted diseases. However, a certain period of sperm exposure within a stable relation, when pregnancy is aimed for, is associated with a partial protection against preeclampsia.
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The aim of the present study was to find the relationship between pre-pregnancy maternal body mass index (BMI) with spontaneous preterm delivery and birth weight. A prospective cohort study was performed on 576 pregnant women. Maternal... more
The aim of the present study was to find the relationship between pre-pregnancy maternal body mass index (BMI) with spontaneous preterm delivery and birth weight. A prospective cohort study was performed on 576 pregnant women. Maternal BMI was determined at the first prenatal visit between 8-12 weeks&#39; gestation and considered as the pre-pregnancy maternal weight. The women were then monitored up to delivery. Out of 576 women, 396 completed the study. The demographics of the women in all BMI groups did not differ with regard to age, height, history of abortion and employment. A total of 21 women (5.3%) were underweight; 198 women (50%) were normal weight; 117 women (29.5%) were overweight and 60 (15.2%) were obese. There were no cases of morbidly obese (BMI &gt; 40 kg/m(2)) women. Obesity in women had a positive correlation with higher gestational age at the time of delivery (r = 0.213, p = 0.015) and a heavier birth weight (r = 0.361, p = 0.008). Low birth weight had a correlation with low maternal BMI (r = 0.157, p = 0.041). Macrosomia was greater in obese women (p = 0.022) and BMI had a positive correlation with macrosomia (r = 0.224, p = 0.034). Preterm delivery showed a negative correlation with maternal BMI (r = -0.124, p = 0.004) and the women with a lower BMI had a greater number of preterm deliveries (p = 0.035).
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Research Interests: Obstetrics, Medicine, Pregnancy, Humans, Female, and 15 moreMale, Obstetrics Gynecology, Anesthesia, Logistic Regression Analysis, Newborn Infant, Adult, Neonatal Mortality, Neonatal Intensive Care Unit, Gestational Age, Nifedipine, Preterm Labor, Confidence Interval, Outcome measure, Paediatrics and reproductive medicine, and Obstetric Labor Premature
Research Interests: Obstetrics, General Internal Medicine, Medicine, Birth Weight, Antioxidants, and 15 moreHumans, Hypertension, Placebo, Female, Dietary Supplements, Ascorbic Acid, Adult, Infant Mortality, Parity, Gestational Age, Fetal death, Confidence Interval, Medical and Health Sciences, Paediatrics and reproductive medicine, and Fetal Growth Retardation
Preeclampsia is often thought of as being a disease of first pregnancies. The incidence of preeclampsia in subsequent pregnancies, after a previous normal pregnancy is lower. However, it has been reported that this beneficial effect of... more
Preeclampsia is often thought of as being a disease of first pregnancies. The incidence of preeclampsia in subsequent pregnancies, after a previous normal pregnancy is lower. However, it has been reported that this beneficial effect of multiparity is lost with a change in paternity. The aim of this study was to assess the impact of change in paternity on the incidence of preeclampsia in Dutch multiparous pregnant women. 364 Multiparous patients with hypertension (diastolic blood pressure &amp;amp;gt; or = 100 mmHg) were identified in the obstetric database of the Academic Hospital Vrije Universiteit Amsterdam for the period 1989-1996. The diagnosis in their obstetrical history (Preeclampsia, HELLP-syndrome, chronic hypertension) was defined in a pragmatic way in view of the retrospective nature of the study. The control group consisted of 281 multiparous women from a midwife clinic, with normotensive pregnancies in the same period. Patients and controls were asked, by telephone, if the index pregnancy was from the same partner as the previous pregnancy and what the sex of the newborns had been in each pregnancy. Fisher&amp;amp;#39;s Exact test was used for statistical analysis and P &amp;amp;lt; 0.05 was considered significant. The final study group consisted of 333 multiparous patients with hypertension. The control group consisted of 182 multiparous women without hypertension. The prevalence of new paternity was significantly higher (P &amp;amp;lt; 0.0001) both for preeclamptic and HELLP patients in comparison with the controls, with an odds ratio of 8.6 (95%CI: 3.1-23.5) and 10.9 (95%CI: 3.7-32.3), respectively. This study confirms that change of partner raises the risk for preeclampsia in subsequent pregnancies. Immune maladaptation on the fetal maternal interface could be an underlying mechanism. Multiparous women with a new partner should be approached as being primigravid women.
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Aim: Cytokine polymorphisms may alter the fetal inflammatory response, increasing susceptibility to cerebral palsy (CP). This study investigates associations between selected inflammatory mediator and cytokine gene polymorphisms... more
Aim: Cytokine polymorphisms may alter the fetal inflammatory response, increasing susceptibility to cerebral palsy (CP). This study investigates associations between selected inflammatory mediator and cytokine gene polymorphisms (Toll‐like receptor‐4 (TLR‐4) Asp299Gly, interleukin‐6 G‐174C and interleukin‐4 C‐589T) and CP from 443 CP infants and 883 control infants. Results were correlated with viral nucleic acids in the same samples.Results: At all gestational ages (GA), TLR‐4 was associated with a decreased risk of developing CP (homozygous/heterozygous odds ratio (OR) 0.70, 95% confidence interval (CI) 0.50–0.98) and interleukin (IL)‐6 was associated with an increased risk of developing hemiplegia (OR 1.38, 95% CI 1.05–1.83). For infants born 32–36 weeks GA, there was a tenfold increase in the risk of quadriplegic CP with homozygous/heterozygous IL‐6 (OR 10.42, 95% CI 1.34–80.82). Viral exposure in combination with IL‐4 in preterm infants was associated with a fourfold increased ...
Research Interests: Cerebral Palsy, Medicine, Toll like receptor signaling, Pregnancy, Humans, and 15 moreFemale, Registries, Newborn Infant, Single Nucleotide Polymorphism, Public health systems and services research, Odds ratio, Gestational Age, Case Control Study, Virus diseases, Genetic Susceptibility, Confidence Interval, Case Control Studies, Interleukin, Paediatrics and reproductive medicine, and Genetic predisposition to disease
Familial hypercholesterolemia (FH) is a genetic disorder characterized by high low-density lipoprotein cholesterol levels and premature cardiovascular disease (CVD). There are important differences in the presence of CVD among... more
Familial hypercholesterolemia (FH) is a genetic disorder characterized by high low-density lipoprotein cholesterol levels and premature cardiovascular disease (CVD). There are important differences in the presence of CVD among heterozygous subjects with FH. Some of this variability can be explained by genetic factors, and the apolipoprotein (apo) E genotype has been proposed as a useful marker.
Research Interests: Endocrinology, Cardiovascular disease, Humans, Internal Medicine, Diabetes mellitus, and 15 moreCholesterol, Female, Male, Apolipoprotein E, Body Mass Index, Apolipoprotein B, Genotype, Adult, Analysis of Variance, Genetic Disorder, Cardiovascular Diseases, Familial Hypercholesterolemia, Low density lipoprotein cholesterol, Genetic factors, and Cardiovascular medicine and haematology
Objective To investigate the association between cerebral palsy and direct evidence for perinatal exposure to neurotropic viruses. Design Population based case-control study. Setting Adelaide Women’s and Children’s Hospital Research... more
Objective To investigate the association between cerebral palsy and direct evidence for perinatal exposure to neurotropic viruses. Design Population based case-control study. Setting Adelaide Women’s and Children’s Hospital Research Laboratory. Participants and main outcome measures Newborn screening cards of 443 white case patients with cerebral palsy and 883 white controls were tested for viral nucleic acids from enteroviruses and herpes viruses by using polymerase chain reaction. Herpes group A viruses included herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpes virus 8 (HHV-8), and herpes group B viruses included varicella zoster virus (VZV) and human herpes viruses 6 and 7 (HHV-6 and HHV-7). Results The prevalence of viral nucleic acids in the control population was high: 39.8% of controls tested positive, and the prevalence was highest in preterm babies. The detection of herpes group B viral nucleic acids increase...
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Research Interests: Life Sciences, Medicine, Pregnancy, Humans, Female, and 15 moreFish Oil, Dietary Supplements, Incidence, Adult, Gestational Age, Medicine and Health Sciences, Gestation, Prenatal Care, Pregnancy Outcome, Premature Birth, Plant Oils, Eicosapentaenoic Acid, Medical and Health Sciences, Paediatrics and reproductive medicine, and Intention to treat analysis
OBJECTIVE To evaluate the safety of maternal pertussis vaccination on pregnancy and birth outcomes. METHODS The study population comprised 1272 healthy nulliparous pregnant women who participated in Screening Tests to identify poor... more
OBJECTIVE To evaluate the safety of maternal pertussis vaccination on pregnancy and birth outcomes. METHODS The study population comprised 1272 healthy nulliparous pregnant women who participated in Screening Tests to identify poor Outcomes in Pregnancy (STOP) study at two obstetric hospitals in South Australia between 2015 and 2018. Participants were followed prospectively, with vaccination (confirmed by medical records), extensive amounts of pregnancy and birth outcome data collected by research midwives. Adjusted relative risks (aRRs) and hazard ratios (aHRs) were estimated accounting for time-varying vaccine exposure and the temporal nature of each outcome. RESULTS Of the 1272 women included in this study, 80.1% (n = 1019) received maternal pertussis vaccination. Vaccinated women had an average 0.22 weeks (95% CI 0.001, 0.44) longer gestation at delivery compared to unvaccinated women. Maternal pertussis vaccination was not associated with chorioamnionitis (aRR 0.71, 95% CI 0.27,1.82), gestational hypertension (aHR 1.24, 95% CI, 0.66, 2.30), preeclampsia (aHR 0.75, 95% CI 0.47, 1.18) nor preterm birth (aHR 0.99, 95% CI 0.47, 2.07). Neither risk of low birth weight (aHR 0.72, 95% CI 0.41, 1.27) nor small for gestational age infants (aHR 0.67,95% CI 0.29, 1.55) were increased following maternal pertussis vaccination. No associations between pertussis vaccination during pregnancy and adverse birth outcomes including admission to the neonatal care unit, low Apgar scores, and mechanical ventilation were observed. Results were not materially changed after adjustment for maternal influenza vaccination. CONCLUSION Our study provides reassuring evidence of the safety of maternal pertussis vaccination with no increased risk of adverse pregnancy and birth outcomes. These findings support recommendations for pertussis vaccination during pregnancy to prevent morbidity and mortality associated with early-infant pertussis disease.