ObjectiveTo determine the epidemiology, clinical management, and outcomes of women with gestational breast cancer (GBC).MethodsA population‐based prospective cohort study was conducted in Australia and New Zealand between 2013 and 2014... more
ObjectiveTo determine the epidemiology, clinical management, and outcomes of women with gestational breast cancer (GBC).MethodsA population‐based prospective cohort study was conducted in Australia and New Zealand between 2013 and 2014 using the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with a primary diagnosis of breast cancer during pregnancy were included. Data were collected on demographic and pregnancy factors, GBC diagnosis, obstetric and cancer management, and perinatal outcomes. The main outcome measures were preterm birth, maternal complications, breastfeeding, and death.ResultsForty women with GBC (incidence 7.5/100 000 women giving birth) gave birth to 40 live‐born babies. Thirty‐three (82.5%) women had breast symptoms at diagnosis. Of 27 women diagnosed before 30 weeks' gestation, 85% had breast surgery and 67% had systemic therapy during pregnancy. In contrast, all 13 women diagnosed from 30 weeks had their cancer management d...
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• Preconception counselling forms the basis of a preconception care program and is one of the most potent opportunities to practise preventative medicine. • Topics that may be covered in preconception counselling are conception,... more
• Preconception counselling forms the basis of a preconception care program and is one of the most potent opportunities to practise preventative medicine. • Topics that may be covered in preconception counselling are conception, contraception, sexually transmitted infections, cervical screening, dietary advice (preconception folate, iron and vitamin C supplementation), weight optimisation, smoking cessation, and alcohol use and risk behaviour modifications. • Lifestyle modifications should involve both the woman and her partner; if they do not, success is likely to be limited or at least only short term. • Some patients will ask directly about preconception care but usually the GP will have to broach the subject during consultations for other reasons. • Patients with certain medical diseases or personal or family histories implying specific disease risks and/or inheritable genetic disorders should be prepared for pregnancy well before it occurs, with a plan of action formulated using a multidisciplinary approach.
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Although there is significant interest in elucidating the role of placenta-derived exosomes (PdEs) during pregnancy, the exosomal profile in pregnancies complicated by gestational diabetes mellitus (GDM) remains to be established. The aim... more
Although there is significant interest in elucidating the role of placenta-derived exosomes (PdEs) during pregnancy, the exosomal profile in pregnancies complicated by gestational diabetes mellitus (GDM) remains to be established. The aim of this study was to compare the gestational-age profile of PdEs in maternal plasma of GDM with normal pregnancies and to determine the effect of exosomes on cytokine release from human umbilical vein endothelial cells. A prospective cohort of patients was sampled at three time points during pregnancy for each patient (i.e., 11–14, 22–24, and 32–36 weeks' gestation). A retrospective stratified study design was used to quantify exosomes present in maternal plasma of normal (n = 13) and GDM (n = 7) pregnancies. Gestational age and pregnancy status were identified as significant factors contributing to variation in plasma exosome concentration (ANOVA, P < 0.05). Post hoc analyses established that PdE concentration increased during gestation in ...
Research Interests: Diabetes, Cytokines, Inflammation, Adolescent, Pregnancy, and 15 moreHumans, Placenta, Female, Male, Exosomes, Adult, Gestational Age, Glucose Tolerance Test, Enzyme Linked Immunosorbent Assay, Pulsatile Flow, Case Control Studies, Interleukin, Interferon gamma, Medical and Health Sciences, and Human Umbilical Vein Endothelial Cells
There is increasing evidence that miRNAs, which are enriched in nanovesicles called exosomes, are important regulators of gene expression. When compared to normal pregnancies, gestational diabetes mellitus (GDM) is associated with... more
There is increasing evidence that miRNAs, which are enriched in nanovesicles called exosomes, are important regulators of gene expression. When compared to normal pregnancies, gestational diabetes mellitus (GDM) is associated with skeletal muscle insulin resistance as well as increased levels of circulating placental exosomes. Here we investigated whether placental exosomes in GDM carry a specific set of miRNAs associated with skeletal muscle insulin sensitivity. Exosomes were isolated from chorionic villous (CV) explants from both women with Normal Glucose Tolerant (NGT) and GDM pregnancies. Using miRNA sequencing, we identified a specific set of miRNAs was selectively enriched with exosomes and compared with their cells of origin indicating a specific packaging of miRNAs into exosomes. Gene target and ontology analysis of miRNA differentially expressed in exosomes secreted in GDM compared with NGT are associated with pathways regulating cell migration and carbohydrate metabolism. ...
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Objective: Our purpose was to review the management and outcome of pregnancies with a prenatal diagnosis of fetal congenital cystic adenomatoid malformation of the lung (CCAM). Study Design: A retrospective review was performed of all... more
Objective: Our purpose was to review the management and outcome of pregnancies with a prenatal diagnosis of fetal congenital cystic adenomatoid malformation of the lung (CCAM). Study Design: A retrospective review was performed of all cases since 1995 with a prenatal diagnosis of fetal CCAM from the sole tertiary perinatal referral center in Western Australia. Results: Twenty-one pregnancies with CCAM
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Preterm infants often have poor cardiovascular function that is associated with adverse neurodevelopmental outcomes. Preterm infants may be vulnerable to hypovolaemia due to excessive vasodilatation and leaky capillaries. Following... more
Preterm infants often have poor cardiovascular function that is associated with adverse neurodevelopmental outcomes. Preterm infants may be vulnerable to hypovolaemia due to excessive vasodilatation and leaky capillaries. Following reduction in blood volume, cardiac output and mean arterial pressure were reduced to the same extent in term and preterm piglets. Cerebral blood flow was maintained following blood volume reduction in term but not in preterm piglets. Effective detection and treatment of functional hypovolaemia may reduce the risk of brain injury in preterm infants. Preterm infants often have impaired cardiovascular function that may contribute to poor neurodevelopmental outcomes. The study aimed to determine the effects of reduced blood volume on cardiovascular function, including cerebral blood flow, in preterm and term piglets. In preterm (97/115 days) and term piglets, up to 10% of the estimated blood volume was removed. Removal of blood was stopped if MAP dropped belo...
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The preterm newborn is at high risk of developing cardiovascular compromise during the first day of life and this is associated with increased risk of brain injury. Standard treatments are volume expansion and administration of inotropes,... more
The preterm newborn is at high risk of developing cardiovascular compromise during the first day of life and this is associated with increased risk of brain injury. Standard treatments are volume expansion and administration of inotropes, typically dopamine and/or dobutamine, but there is limited evidence that inotropes improve clinical outcomes. This study investigated the efficacy of dopamine and dobutamine for the treatment of cardiovascular compromise in the preterm newborn using a piglet model. Preterm and term piglets were assigned to either dopamine, dobutamine or control infusions. Heart rate, left ventricular contractility, cardiac output, blood pressure, and cerebral and regional blood flows were measured during baseline, low (10µg/kg/hr) and high (20µg/kg/hr) dose infusions. At baseline, preterm piglets had lower cardiac contractility, cardiac output, blood pressure, and cerebral blood flow compared to term piglets. The response of preterm piglets to either dopamine or do...
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Hyperglycaemia and hypoxia are risk factors of metabolic complication during pregnancy. The interactions between oxygen and glucose sensing pathways that regulate exosome bioactivity from placental cells, however, have not been... more
Hyperglycaemia and hypoxia are risk factors of metabolic complication during pregnancy. The interactions between oxygen and glucose sensing pathways that regulate exosome bioactivity from placental cells, however, have not been established. The aim of this study was to test the hypothesis that exosomal signalling by placental cells (defined as the number of exosomes released per unit time and their bioactivity) is responsive to extracellular glucose concentration. First trimester primary trophoblast cells were incubated with D-glucose (5 mM or 25 mM) under 1%, 3% or 8% O2 for 48 h. Exosomes were isolated from cell-conditioned media by differential and buoyant density centrifugation. The total number of exosome vesicles was determined by quantifying immunoreactive exosomal CD63 by the ELISA kit. The effect of exosomes on cytokine (GM-CSF, IL-2, IL-4, IL-6. IL-8, IL-10, IFN-γ and TNF-α) release from endothelial cells was established by the protein solution array analysis (Bioplex-200)...