• Latch On: A protocol for a multi-centre, randomised controlled trial of perinatal support to improve breastfeeding outcomes in women with a raised BMI.

      O'Reilly, Sharleen L; O'Brien, Eileen C; McGuinness, Denise; Mehegan, John; Coughlan, Barbara; O'Brien, Denise; Szafranska, Marcelina; Callanan, Sophie; Hughes, Shenda; Conway, Marie C; et al. (2021-04-08)
      This protocol is for a multi-centre, randomised controlled trial of perinatal breastfeeding support among primiparous women with a BMI >25 kg/m2, using a previously-tested, multi-component intervention. The primary outcome is any breastfeeding at 3 months. The intervention will support mothers and their partners and spans from late pregnancy to six weeks postpartum. Intervention components include group antenatal breastfeeding education, individual face-to-face education in the immediate postnatal period, professional support to six weeks' postpartum and weekly phone calls in the immediate postpartum period from an International Board Certified Lactation Consultant (IBCLC). The intervention will target attitudes towards breastfeeding, breastfeeding self-efficacy, and subjective norms around infant feeding with the aim to normalise the behaviour.
    • Perinatal social work during the Covid-19 pandemic: Reflecting on concepts of time and liminality.

      Wilson, Elaine; Jackson, Kaylene; Shannon, Aoife (2021-03)
      This article reflects upon the experiences of two perinatal, hospital social workers during the unprecedented time of the Covid-19 in Ireland, as discussed with their academic colleague. This encounter revealed the complexity of service delivery that emerged, when managing the needs of vulnerable clients whilst being mindful of personal safety. One of the social workers was pregnant so was conscious of possible risks to her unborn child, as well as her young family at home. The second social worker, her line manager, discusses the dilemmas associated with the management of risk when allocating staff to contexts where they would be in direct contact with Covid-19. At the core of the analysis of these situations is the notion of liminal space and the realisation that time appears to have a new meaning; what we once knew as normal no longer exists, but we have yet to reach the 'new normal'.
    • Hypotension in Preterm Infants (HIP) randomised trial.

      Dempsey, Eugene M; Barrington, Keith J; Marlow, Neil; O'Donnell, Colm Patrick Finbarr; Miletin, Jan; Naulaers, Gunnar; Cheung, Po-Yin; Corcoran, John David; El-Khuffash, Afif Faisal; Boylan, Geraldine B; et al. (2021-02-24)
      Objective: To determine whether restricting the use of inotrope after diagnosis of low blood pressure (BP) in the first 72 hours of life affects survival without significant brain injury at 36 weeks of postmenstrual age (PMA) in infants born before 28 weeks of gestation. Design: Double-blind, placebo-controlled randomised trial. Caregivers were masked to group assignment. Setting: 10 sites across Europe and Canada. Participants: Infants born before 28 weeks of gestation were eligible if they had an invasive mean BP less than their gestational age that persisted for ≥15 min in the first 72 hours of life and a cerebral ultrasound free of significant (≥ grade 3) intraventricular haemorrhage. Intervention: Participants were randomly assigned to saline bolus followed by either a dopamine infusion (standard management) or placebo (5% dextrose) infusion (restrictive management). Primary outcome: Survival to 36 weeks of PMA without severe brain injury. Results: The trial terminated early due to significant enrolment issues (7.7% of planned recruitment). 58 infants were enrolled between February 2015 and September 2017. The two groups were well matched for baseline variables. In the standard group, 18/29 (62%) achieved the primary outcome compared with 20/29 (69%) in the restrictive group (p=0.58). Additional treatments for low BP were used less frequently in the standard arm (11/29 (38%) vs 19/29 (66%), p=0.038). Conclusion: Though this study lacked power, we did not detect major differences in clinical outcomes between standard or restrictive approach to treatment. These results will inform future studies in this area.
    • Taking guidance from parents involved in a longitudinal birth cohort - the ROLO family advisory committee.

      Walsh, N M; O'Brien, E C; Geraghty, A A; Byrne, D F; Whelan, A; Reilly, S; Murray, S; Reilly, C; Adams, E; Farnan, P M; et al. (2020-04-28)
      Background: The ROLO Study (Randomised cOntrol trial of a Low glycaemic index diet in pregnancy to prevent macrosomia) was a randomised control trial conducted between 2007 and 2011 to examine if a low glycaemic index (GI) diet could reduce the incidence of macrosomia. The ROLO Family Advisory Committee is a self-selected group of parents who are involved in the longitudinal follow-up of the ROLO Study. The committee was established in 2017 and the goal is to achieve a partnership between ROLO families and researchers, leading to improved research quality, relevance, and outcomes. This research method is termed "Public and patient involvement (PPI)" and describes how researchers collaborate and engage with the public in order to make research more relevant to them. Methods: The ROLO study mothers and children have been prospectively followed-up at multiple time points post-pregnancy. In October 2017, all women were invited to join the ROLO Family Advisory Committee via email or via advertisement on the ROLO Study Facebook page. Fathers and other guardians of the study children were also invited to join. Two annual meetings with the research team and parents were held in 2018 and 2019. The meetings were recorded, transcribed verbatim by researchers, and thematically analysed. Results: Parents provided opinions on the areas they felt should be explored within the ROLO study using information that was collected up to the current follow-up point. They also shared views on research interests which were of importance to them. These topics included; child mental health, fussy eating in childhood and healthy eating policies in schools. Mothers were much more concerned about factors which influenced their child's health rather than their own. Incorporating an element of PPI to this study was found to be a positive learning experience for participants and researchers. Conclusion: The involvement of parents has enriched the research agenda at the UCD Perinatal Research Centre. We will continue to engage with the parents of the ROLO Study and plan to involve the children to explore their opinions at the next opportunity.
    • The impact of diet, body composition, and physical activity on child bone mineral density at five years of age-findings from the ROLO Kids Study.

      McVey, Marco K; Geraghty, Aisling A; O'Brien, Eileen C; McKenna, Malachi J; Kilbane, Mark T; Crowley, Rachel K; Twomey, Patrick J; McAuliffe, Fionnuala M (2019-11-01)
      Bone health is extremely important in early childhood because children with low bone mineral density (BMD) are at a greater risk of bone fractures. While physical activity and intake of both calcium and vitamin D benefit BMD in older children, there is limited research on the determinants of good bone health in early childhood. The aim of this cross-sectional study was to investigate the impact of diet, physical activity, and body composition on BMD at five years of age. Dietary intakes and physical activity levels were measured through questionnaires. Whole body BMD was measured by dual-energy X-ray absorptiometry in 102 children. Child weight, height, circumferences, skinfolds and serum 25-hydroxyvitamin D (25OHD) concentrations were assessed. There was no association between BMD and dietary calcium, dietary vitamin D, 25OHD, physical activity, or sedentary behaviour. Several measures of body composition were significantly positively associated with BMD; however, neither fat mass nor lean body mass was associated with BMD.Conclusion: Although we found no association between self-reported dietary and lifestyle factors and bone health in early years, increased body size was linked with higher BMD. These findings are important as identifying modifiable factors that can improve bone health at a young age is of utmost importance.What is Known:• Bone health is extremely important in early childhood, as children with low bone mineral density (BMD) are at greater risk of bone fractures.• Physical activity has been found to be beneficial for bone health in adolescents, and body composition has also been associated with BMD in teenage years.• Limited research on the determinants of good bone health in early childhood.What is New:• No association between self-reported lifestyle and dietary factors with bone health in early childhood.• Increased body size was associated with higher BMD at five years of age.
    • Continuous Glucose Monitoring in the Management of Neonatal Hypoglycaemia

      McGlacken-Byrne, S.M; O’Neill, R.; Jenkinson, A.; Murphy, J.F.A. (Irish Medical Journal, 2019-03)
      A quality improvement project was carried out in a Level 3 Neonatal Intensive Care Unit (NICU) which aimed to successfully implement the use of continuous glucose monitoring systems (CGMS) in hypoglycaemic infants. Piloting of the device revealed several potential practical barriers to its reliably successful implementation. Five Plan-Do-Study-Act (PDSA) cycles followed, tackling these problems and other issues inductively identified throughout the project. Parents and multi-professional stakeholders were involved and consulted throughout. Change was measured on a runchart using qualitative and quantitative feedback. Problem rate per patient was reduced to zero by the end of a one-month study period. This study used basic quality improvement methodologies to implement a change intervention in a structured manner and elucidated aspects of its use that need to be adapted for its successful incorporation into real-life clinical practice.
    • Reproductive health outcomes in women with psoriatic arthritis.

      Murray, Kieran; Moore, Louise; McAuliffe, Fionnuala; Veale, Douglas J (2019-02-15)
    • A Low Glycaemic Index Diet in Pregnancy Induces DNA Methylation Variation in Blood of Newborns: Results from the ROLO Randomised Controlled Trial.

      Geraghty, Aisling A; Sexton-Oates, Alexandra; O'Brien, Eileen C; Alberdi, Goiuri; Fransquet, Peter; Saffery, Richard; McAuliffe, Fionnuala M; National Maternity Hospital Holles Street Dublin, University College Dublin, Cancer and Disease Epigenetics, Murdoch Children's Research Institute, Melbourne, Victoria, Aus, Department of Paediatrics, University of Melbourne, Victoria, Aus (MDPI, 2018-04-06)
      The epigenetic profile of the developing fetus is sensitive to environmental influence. Maternal diet has been shown to influence DNA methylation patterns in offspring, but research in humans is limited. We investigated the impact of a low glycaemic index dietary intervention during pregnancy on offspring DNA methylation patterns using a genome-wide methylation approach. Sixty neonates were selected from the ROLO (Randomised cOntrol trial of LOw glycaemic index diet to prevent macrosomia) study: 30 neonates from the low glycaemic index intervention arm and 30 from the control, whose mothers received no specific dietary advice. DNA methylation was investigated in 771,484 CpG sites in free DNA from cord blood serum. Principal component analysis and linear regression were carried out comparing the intervention and control groups. Gene clustering and pathway analysis were also explored. Widespread variation was identified in the newborns exposed to the dietary intervention, accounting for 11% of the total level of DNA methylation variation within the dataset. No association was found with maternal early-pregnancy body mass index (BMI), infant sex, or birthweight. Pathway analysis identified common influences of the intervention on gene clusters plausibly linked to pathways targeted by the intervention, including cardiac and immune functioning. Analysis in 60 additional samples from the ROLO study failed to replicate the original findings. Using a modest-sized discovery sample, we identified preliminary evidence of differential methylation in progeny of mothers exposed to a dietary intervention during pregnancy.
    • CA125 Measured During Menstruation Can Be Misleading

      Crosby, DA; Glover, LE; Martyn, F; Wingfield, M (Irish Medical Journal, 2018-04)
      Abstract The aim of these case reports and literature review is to report the importance of cyclical variation of serum CA-125 levels in two patients with endometriosis. Two case reports and a literature review of cyclical variation in serum CA-125 levels are discussed. There was significant variation in serum CA-125 levels taken during menses and mid-cycle in these two cases. Serum CA-125 levels increase dramatically during menstruation in women with endometriosis. This is important when assessing disease status.
    • Placenta Accreta Spectrum: A Review of Pathology, Molecular Biology, and Biomarkers.

      Bartels, Helena C; Postle, James D; Downey, Paul; Brennan, Donal J; 1 National Maternity Hospital, Holles Street, Dublin 2, Ireland. 2 UCD School of Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland (Hindawi, 2018-01-01)
      Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe maternal morbidity and mortality. The diagnosis of a PAS is made on the basis of histopathologic examination and characterised by an absence of decidua and chorionic villi are seen to directly adjacent to myometrial fibres. The underlying molecular biology of PAS is a complex process that requires further research; for ease, we have divided these processes into angiogenesis, proliferation, and inflammation/invasion. A number of diagnostic serum biomarkers have been investigated in PAS, including human chorionic gonadotropin (HCG), pregnancy-associated plasma protein-A (PAPP-A), and alpha-fetoprotein (AFP). They have shown variable reliability and variability of measurement depending on gestational age at sampling. At present, a sensitive serum biomarker for invasive placentation remains elusive. In summary, there are a limited number of studies that have contributed to our understanding of the molecular biology of PAS, and additional biomarkers are needed to aid diagnosis and disease stratification.
    • Maternal and fetal blood lipid concentrations during pregnancy differ by maternal body mass index: findings from the ROLO study.

      Geraghty, Aisling A; Alberdi, Goiuri; O'Sullivan, Elizabeth J; O'Brien, Eileen C; Crosbie, Brenda; Twomey, Patrick J; McAuliffe, Fionnuala M; 1 UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland. 2 Clinical Chemistry, St. Vincent's University Hospital, Dublin 4, Ireland. 3 UCD School of Medicine, University College Dublin, Dublin, Ireland. 4 UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland. (Biomed Central, 2017-10-16)
      Pregnancy is a time of altered metabolic functioning and maternal blood lipid profiles change to accommodate the developing fetus. While these changes are physiologically necessary, blood lipids concentrations have been associated with adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and high birth weight. As blood lipids are not routinely measured during pregnancy, there is limited information on what is considered normal during pregnancy and in fetal blood. Data from 327 mother-child pairs from the ROLO longitudinal birth cohort study were analysed. Fasting total cholesterol and triglycerides were measured in early and late pregnancy and fetal cord blood. Intervals were calculated using the 2.5th, 50th and 97.5th centile. Data was stratified based on maternal body mass index (BMI) measured during early pregnancy. Differences in blood lipids between BMI categories were explored using ANOVA and infant outcomes of macrosomia and large-for-gestational-age (LGA) were explored using independent student T-tests and binary logistic regression. All maternal blood lipid concentrations increased significantly from early to late pregnancy. In early pregnancy, women with a BMI < 25 kg/m Blood lipid concentrations increase during pregnancy and differ by maternal BMI. These intervals could help to inform the development of references for blood lipid concentrations during pregnancy.
    • Preventing Excessive Gestational Weight Gain and Postpartum Weight Retention.

      O’Dwyer, V; McAuliffe, F (Irish Medical Journal, 2017-10)
      regnancy and the postpartum period are unique opportunities to promote healthy lifestyle choices including a healthy diet and regular exercise. This is especially important for those who are overweight or obese. Women are weighed at their first antenatal visit and body mass index (BMI) calculated, but not all hospitals routinely weigh women throughout pregnancy. A qualitative Dublin study examined experiences of routine weighing during antenatal care. This study found that women expected to be weighed during pregnancy and postpartum. The benefits of this included providing reassurance and minimising postpartum weight retention. Furthermore, women were eager to receive more information about healthy lifestyle interventions and gestational weight gain (GWG) from healthcare professionals
    • Interpregnancy weight changes and impact on pregnancy outcome in a cohort of women with a macrosomic first delivery: a prospective longitudinal study.

      Crosby, David A; Walsh, Jennifer M; Segurado, Ricardo; McAuliffe, Fionnuala M; Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland. UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland. CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. (BMJ Publishing Group Ltd, 2017-06-06)
      To determine the median interpregnancy maternal weight change between first and second pregnancies, and second and third pregnancies and to assess the impact of this weight change on pregnancy outcome in a cohort of women with a macrosomic first delivery.
    • Managing Epilepsy in Pregnancy

      O Dwyer, V (Irish Medical Journal (IMJ), 2017-02)
      Epilepsy is one of the commonest medical conditions affecting women of childbearing age1. In the most recent triennial report into maternal deaths in Ireland and the UK, two thirds of women who died had a medical condition. In this report, 14 maternal deaths during pregnancy and up to 42 days postpartum were attributable to epilepsy or seizures; a rate of 0.4 per 100,000 maternities. In 12 of these women’ the cause was sudden unexplained death in epilepsy. Thus, epilepsy remains a high-risk condition in pregnancy. The gold standard of care is a multidisciplinary approach involving obstetricians, a neurologist and an epilepsy nurse specialist2. Like other units in Ireland this multidisciplinary service is currently provided in the National Maternity Hospital’s maternal medicine clinic, in conjunction with neurology services in Beaumont Hospital.
    • A method to assess obstetric outcomes using the 10-Group Classification System: a quantitative descriptive study.

      Rossen, Janne; Lucovnik, Miha; Eggebø, Torbjørn Moe; Tul, Natasa; Murphy, Martina; Vistad, Ingvild; Robson, Michael (BMJ Publishing Group Ltd, 2017)
      Internationally, the 10-Group Classification System (TGCS) has been used to report caesarean section rates, but analysis of other outcomes is also recommended. We now aim to present the TGCS as a method to assess outcomes of labour and delivery using routine collection of perinatal information.
    • Uptake of the Influenza Vaccination in Pregnancy

      Crosby, DA; Deleau, D; Brophy, C; Mcauliffe, FM; Mahony, R (Irish Medical Journal, 2016-09)
      Influenza is caused by a highly infectious RNA virus, which usually occurs in a seasonal pattern with epidemics in the winter months. The objective of this study was to determine the uptake of the influenza vaccine in a pregnant population and ascertain the reasons why some women did not receive it. A prospective cohort study was conducted over a two-week period in January 2016 in the National Maternity Hospital Dublin, a tertiary referral maternity hospital delivering over 9000 infants per year. There were 504 women studied over the 2-week period. Overall, 197(39.1%) women received the vaccine at a mean gestational age 20.9 weeks (SD 7.0). Given the increased rates of influenza in the community and the associated implications for mother and infant, it is important that pregnant women are educated regarding the risks of influenza in pregnancy and encourage this cohort to be vaccinated.
    • Standardised versus Individualised Parenteral Nutrition. Further Food for Thought

      McCarthy, R; Segurado, R; Crealey, M; Twomey, A (Irish Medical Journal, 2016-04)
      Parenteral Nutrition may be prescribed as a standard PN (SPN) formulation or as an individualised PN (IPN) formulation. SPN may have advantages in terms of rapid availability, less prescription errors, decreased risk of infection and cost savings but IPN, specifically tailored to an infant’s needs, may achieve better outcomes in terms of nutrient intake and weight gain. The aim of our study was to determine if VLBW infants in our NICU benefited from receiving IPN over currently available SPN solutions. Our findings were that VLBW infants prescribed IPN received significantly more amino acid (28%), glucose (6%), energy (11%) and calcium (8%) from the aqueous phase of PN than had they received a similar volume of SPN. The benefits were seen over all the days for which PN was administered. In conclusion, IPN was found to offer significant benefits to our VLBW infants. Modifications to currently available SPN would result in better SPN formulations. Our study also supported the recent recommendation to reduce the calcium:phosphate ratio in PN solutions to avoid early hypophosphataemia
    • Early pregnancy ultrasound and management – effect of a multifaceted training on physician knowledge

      O’Leary, B; Khalid, A; Higgins, M (2016-02)
      Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.
    • Maternal Nutrition and Glycaemic Index during Pregnancy Impacts on Offspring Adiposity at 6 Months of Age--Analysis from the ROLO Randomised Controlled Trial.

      Horan, Mary K; McGowan, Ciara A; Gibney, Eileen R; Byrne, Jacinta; Donnelly, Jean M; McAuliffe, Fionnuala M (MDPI AG, 2016-01-04)
      Childhood obesity is associated with increased risk of adult obesity and metabolic disease. Diet and lifestyle in pregnancy influence fetal programming; however the influence of specific dietary components, including low glycaemic index (GI), remains complex. We examined the effect of a maternal low GI dietary intervention on offspring adiposity at 6 months and explored the association between diet and lifestyle factors in pregnancy and infant body composition at 6 months. 280 6-month old infant and mother pairs from the control (n = 142) and intervention group (n = 138), who received low GI dietary advice in pregnancy, in the ROLO study were analysed. Questionnaires (food diaries and lifestyle) were completed during pregnancy, followed by maternal lifestyle and infant feeding questionnaires at 6 months postpartum. Maternal anthropometry was measured throughout pregnancy and at 6 months post-delivery, along with infant anthropometry. No difference was found in 6 months infant adiposity between control and intervention groups. Maternal trimester three GI, trimester two saturated fats and trimester one and three sodium intake were positively associated with offspring adiposity, while trimester two and three vitamin C intake was negatively associated. In conclusion associations were observed between maternal dietary intake and GI during pregnancy and offspring adiposity at 6 months of age.
    • Gentamicin dosing in therapeutic hypothermia; a quality improvement initiative

      Whitla, L; Fitzgerald, D; Twomey, A; Knowles, S; Murphy, JFA (Irish Medical Journal, 2016-01)
      We read with interest a number of articles on gentamicin dosing in neonates treated with therapeutic hypothermia 1-3 . Therapeutic hypothermia has now become the standard of care for newborn infants with hypoxic-ischaemic encephalopathy. Many of these infants concurrently receive gentamicin. Gentamicin is nephrotoxic and ototoxic at high serum concentrations. We therefore carried out a study in The National Maternity Hospital Holles St to analyse trough and peak gentamicin levels in infants who were cooled and compared them to a control group of non-cooled infants.