Gestational diabetes mellitus (GDM) poses a significant global health challenge, with a prevalence ranging from 10-25%, making it one of the most prevalent complications of pregnancy. The rates vary across countries, ethnicities, and diagnostic thresholds. In the UK alone, GDM affects approximately 35,000 pregnancies annually, reflecting an escalating trend. Elevated blood glucose levels in pregnancy exhibit a linear correlation with adverse maternal and neonatal outcomes, contributing to complications such as large for gestational age babies, increased caesarean section rates, shoulder dystocia, neonatal hypoglycaemia, intensive care admissions, and stillbirth. While any woman can develop GDM, well-established risk factors include a body mass index (BMI) above 30, maternal age over 40, previous GDM instances, a history of delivering babies weighing over 4.5kg, and specific ethnic backgrounds. This commentary discusses the Cochrane umbrella review by Griffith et al. (2020), which evaluates the effectiveness of various lifestyle-focused interventions commonly employed for GDM prevention. Given the multitude of risk factors, early interventions before or during pregnancy hold promise in mitigating the likelihood of GDM development.
{"title":"Gestational Diabetes Mellitus Prevention: A Commentary.","authors":"Catherine Gallagher, James Hill","doi":"10.55975/TPDP7486","DOIUrl":"10.55975/TPDP7486","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) poses a significant global health challenge, with a prevalence ranging from 10-25%, making it one of the most prevalent complications of pregnancy. The rates vary across countries, ethnicities, and diagnostic thresholds. In the UK alone, GDM affects approximately 35,000 pregnancies annually, reflecting an escalating trend. Elevated blood glucose levels in pregnancy exhibit a linear correlation with adverse maternal and neonatal outcomes, contributing to complications such as large for gestational age babies, increased caesarean section rates, shoulder dystocia, neonatal hypoglycaemia, intensive care admissions, and stillbirth. While any woman can develop GDM, well-established risk factors include a body mass index (BMI) above 30, maternal age over 40, previous GDM instances, a history of delivering babies weighing over 4.5kg, and specific ethnic backgrounds. This commentary discusses the Cochrane umbrella review by Griffith et al. (2020), which evaluates the effectiveness of various lifestyle-focused interventions commonly employed for GDM prevention. Given the multitude of risk factors, early interventions before or during pregnancy hold promise in mitigating the likelihood of GDM development.</p>","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"27 5","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Schneider, Oliver Hamer, Chris Smith, James Hill
Infertility is a widespread issue which is estimated to affect up to 17.5% of the global population. Evidence suggests that the most common causes of female infertility are ovulation disorders (e.g., polycystic ovary syndrome). That said, lifestyle factors such as dietary patterns, stress, alcohol consumption, smoking, and obesity are key determinants which have been shown to impact female physiology and significantly decrease the chances of conception. Obesity has been widely recognized as a significant factor that negatively impacts ovarian stimulation in women and is associated with several reproductive disorders, including anovulation, subfertility, and infertility. Despite improvements in fertility treatments, obesity remains a challenge particularly for fertility clinics because of the poorer pregnancy outcomes observed within the population. In this article, we will explore the effects of weight loss on female fertility and review the various strategies that have been shown to be effective in reducing obesity and improving reproductive outcomes.
{"title":"Weight loss interventions for improving fertility: a synthesis of current evidence.","authors":"Emma Schneider, Oliver Hamer, Chris Smith, James Hill","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Infertility is a widespread issue which is estimated to affect up to 17.5% of the global population. Evidence suggests that the most common causes of female infertility are ovulation disorders (e.g., polycystic ovary syndrome). That said, lifestyle factors such as dietary patterns, stress, alcohol consumption, smoking, and obesity are key determinants which have been shown to impact female physiology and significantly decrease the chances of conception. Obesity has been widely recognized as a significant factor that negatively impacts ovarian stimulation in women and is associated with several reproductive disorders, including anovulation, subfertility, and infertility. Despite improvements in fertility treatments, obesity remains a challenge particularly for fertility clinics because of the poorer pregnancy outcomes observed within the population. In this article, we will explore the effects of weight loss on female fertility and review the various strategies that have been shown to be effective in reducing obesity and improving reproductive outcomes.</p>","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"27 2","pages":"34-39"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Schneider, Oliver Hamer, Chris Smith, James Hill
Obesity is a well-established risk factor for infertility. Consequentially, women living with obesity may require fertility treatment to support them to conceive. Due to evidence suggesting obesity is also linked with poorer outcomes following in vitro fertilisation (IVF), local commissioning guidelines on assisted conception recommend a BMI of <30kg/m2 before IVF can commence. However, it is currently unclear if these guidelines are evidence based. This commentary aims to critically appraise a recent systematic review by Sermondade et al, 2019 and expand upon the implications of the findings for clinical practice.
{"title":"Evaluating the association of female obesity with the risk of live birth following IVF: Implications for clinical practice.","authors":"Emma Schneider, Oliver Hamer, Chris Smith, James Hill","doi":"10.1093/humupd/dmz011","DOIUrl":"10.1093/humupd/dmz011","url":null,"abstract":"<p><p>Obesity is a well-established risk factor for infertility. Consequentially, women living with obesity may require fertility treatment to support them to conceive. Due to evidence suggesting obesity is also linked with poorer outcomes following in vitro fertilisation (IVF), local commissioning guidelines on assisted conception recommend a BMI of <30kg/m<sup>2</sup> before IVF can commence. However, it is currently unclear if these guidelines are evidence based. This commentary aims to critically appraise a recent systematic review by Sermondade et al, 2019 and expand upon the implications of the findings for clinical practice.</p>","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"27 ","pages":"20240101"},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study, the second in a series of four articles, focuses on the key characteristics that ensure the effective functioning of midwifery units (MU). Article one described the study methodology and methods. This second article focuses on staff experiences and perspectives of working at the freestanding midwifery units (FMU) and what they perceived as crucial to embed best practices and a positive team spirit. The aim of this study was to shed light on philosophy, organisational culture and practices within a FMU model of care. The setting was a FMU in East London.
{"title":"An Ethnographic Study of the Philosophy, Culture and Practices Within an Urban Freestanding Midwifery Unit: Part 2 – Staff Perspectives","authors":"Dr Lucia Rocca-Ihenacho","doi":"10.55975/xdki4487","DOIUrl":"https://doi.org/10.55975/xdki4487","url":null,"abstract":"This study, the second in a series of four articles, focuses on the key characteristics that ensure the effective functioning of midwifery units (MU). Article one described the study methodology and methods. This second article focuses on staff experiences and perspectives of working at the freestanding midwifery units (FMU) and what they perceived as crucial to embed best practices and a positive team spirit. The aim of this study was to shed light on philosophy, organisational culture and practices within a FMU model of care. The setting was a FMU in East London.","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135810136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Let’s be honest here, lots of us midwives and students don’t take the care of our skin that it actually needs and deserves. With our busy jobs and jam-packed lives, how much consideration do we give to the care of our largest organ? Let that land for a moment – our LARGEST organ.
{"title":"The Skin You’re in: Nurturing your Body’s Protective Shield","authors":"Claire Metcalfe","doi":"10.55975/aghm2051","DOIUrl":"https://doi.org/10.55975/aghm2051","url":null,"abstract":"Let’s be honest here, lots of us midwives and students don’t take the care of our skin that it actually needs and deserves. With our busy jobs and jam-packed lives, how much consideration do we give to the care of our largest organ? Let that land for a moment – our LARGEST organ.","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135811412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helen Elliott-Mainwaring, Charlotte Phillips, Paul Bowie
This is the second of four co-written papers for the Advancing Practice series. In our first paper published in The Practising Midwife July 2023 issue, we explored patient safety in maternity and midwifery care. Here, we discuss ‘Human Factors and Ergonomics’ within healthcare, maternity and midwifery. The reflection points throughout this Advancing Practice piece are adapted from the NHS Education for Scotland’s Safety Culture Discussion Cards.1 In this paper, we hope to support midwives’ understanding of the current maternity safety landscape via a Human Factors perspective.
这是推进实践系列四篇合著论文中的第二篇。我们在《执业助产士》(The practice Midwife) 2023年7月刊上发表的第一篇论文中，探讨了产科和助产护理中的患者安全问题。在这里，我们讨论“人为因素和人体工程学”在医疗保健，产妇和助产。在本文中，我们希望通过人为因素的角度来支持助产士对当前生育安全景观的理解。
{"title":"What are Human Factors and Ergonomics?","authors":"Helen Elliott-Mainwaring, Charlotte Phillips, Paul Bowie","doi":"10.55975/ztyk9365","DOIUrl":"https://doi.org/10.55975/ztyk9365","url":null,"abstract":"This is the second of four co-written papers for the Advancing Practice series. In our first paper published in The Practising Midwife July 2023 issue, we explored patient safety in maternity and midwifery care. Here, we discuss ‘Human Factors and Ergonomics’ within healthcare, maternity and midwifery. The reflection points throughout this Advancing Practice piece are adapted from the NHS Education for Scotland’s Safety Culture Discussion Cards.1 In this paper, we hope to support midwives’ understanding of the current maternity safety landscape via a Human Factors perspective.","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135810427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Summary When women and birthing people are found to have low PAPP-A at the combined test for chromosomal abnormalities (Down’s syndrome, Edwards’ syndrome and Patau’s syndrome) it has major implications for their pregnancy, labour and delivery. However, neither women nor their midwives are informed that PAPP-A results will be looked at independently, or that recommendations of care will be based on these results, and neither is consent gained for this. In addition, the question arises of why screening for low PAPP-A is not offered to all women (regardless of their decision to have screening for chromosomal abnormalities) given its potentially serious implications.
{"title":"Screening for Low Papp-A: Inconsistencies and Incongruities","authors":"Perdy Foster","doi":"10.55975/qfyq4080","DOIUrl":"https://doi.org/10.55975/qfyq4080","url":null,"abstract":"Summary When women and birthing people are found to have low PAPP-A at the combined test for chromosomal abnormalities (Down’s syndrome, Edwards’ syndrome and Patau’s syndrome) it has major implications for their pregnancy, labour and delivery. However, neither women nor their midwives are informed that PAPP-A results will be looked at independently, or that recommendations of care will be based on these results, and neither is consent gained for this. In addition, the question arises of why screening for low PAPP-A is not offered to all women (regardless of their decision to have screening for chromosomal abnormalities) given its potentially serious implications.","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135810121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Claire Elliott writes the second part of her article in this series. In order to maintain breastfeeding, healthcare professionals must ensure their knowledge is up-to-date and in line with the requirements of the feeding family to support their long-term feeding goals. All too often, breast/chestfeeding is adequately established, yet maintaining breastfeeding becomes difficult due to inadequate support in the postnatal period, open to misinformation due to limited knowledge and training, the well meant but misinformed advice from the wider family network and lack of access to good quality accessible services. It is well documented that postnatal care is referred to as the ‘poor relation’ of ongoing maternity care and feeding support can rapidly drop off during this time. Here we review physiology, best practice and troubleshoot common problems in maintaining feeding. Read the final part of this article here.
{"title":"How It Works 1: Maintaining Breast/Chestfeeding, Optimising Practice and Support – Part 2","authors":"Claire Elliott","doi":"10.55975/eedl3965","DOIUrl":"https://doi.org/10.55975/eedl3965","url":null,"abstract":"Claire Elliott writes the second part of her article in this series. In order to maintain breastfeeding, healthcare professionals must ensure their knowledge is up-to-date and in line with the requirements of the feeding family to support their long-term feeding goals. All too often, breast/chestfeeding is adequately established, yet maintaining breastfeeding becomes difficult due to inadequate support in the postnatal period, open to misinformation due to limited knowledge and training, the well meant but misinformed advice from the wider family network and lack of access to good quality accessible services. It is well documented that postnatal care is referred to as the ‘poor relation’ of ongoing maternity care and feeding support can rapidly drop off during this time. Here we review physiology, best practice and troubleshoot common problems in maintaining feeding. Read the final part of this article here.","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"116 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135811368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Denise Tiran, international authority in midwifery complementary therapies (CTs), discusses contemporary challenges facing midwives in relation to aromatherapy, including service users’ demands, regulation, national enquiries, training, clinical practice and research issues. As a result of current national scrutiny of midwifery aromatherapy, the Royal College of Midwives commissioned Denise to write new guidelines on midwives’ use of CTs, to be published imminently.
{"title":"Challenges for Midwifery Aromatherapy","authors":"Dr Denise Tiran","doi":"10.55975/robh3321","DOIUrl":"https://doi.org/10.55975/robh3321","url":null,"abstract":"Denise Tiran, international authority in midwifery complementary therapies (CTs), discusses contemporary challenges facing midwives in relation to aromatherapy, including service users’ demands, regulation, national enquiries, training, clinical practice and research issues. As a result of current national scrutiny of midwifery aromatherapy, the Royal College of Midwives commissioned Denise to write new guidelines on midwives’ use of CTs, to be published imminently.","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"137 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135811400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There appear to be limited studies published relating to the use of art therapy to alleviate symptoms when a woman has been diagnosed with postnatal depression (PND). PND is a mood disorder associated with childbirth and a significant public health concern. Art therapies are recognised as a complementary option of care and treatment for women who are clinically diagnosed with PND and may contribute to healing following birth trauma.
{"title":"Postnatal Depression and Art Therapy","authors":"Mary Steen","doi":"10.55975/dsob5593","DOIUrl":"https://doi.org/10.55975/dsob5593","url":null,"abstract":"There appear to be limited studies published relating to the use of art therapy to alleviate symptoms when a woman has been diagnosed with postnatal depression (PND). PND is a mood disorder associated with childbirth and a significant public health concern. Art therapies are recognised as a complementary option of care and treatment for women who are clinically diagnosed with PND and may contribute to healing following birth trauma.","PeriodicalId":35678,"journal":{"name":"Practising Midwife","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134995609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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