INFANT Research Centre - Journal Articles
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Item Conflicts of interest in public health research and publications(Oxford University Press, 2025-02-07) Thomas, Samantha; Hennessy, Marita; Frazer, Kate; Wild, Cervantée; Haynes, Ashleigh; Kavanagh, Shane; Okan, Orkan; Daube, MikeItem Introducing outcome-based education in obstetrics and gynaecology training: Perspectives of trainees and trainers(Elsevier Ltd., 2025-01-08) O'Sullivan, Orfhlaith E.; Leitao, Sara; S. Harney; M.E. Abdalla; O’Donoghue, KeelinBackground and aims: Outcome-based education (OBE) focuses on clearly defined learner goals, offering a structured framework to achieve competency. This study explores the perspectives of trainees and trainers in Obstetrics and Gynaecology (O&G) in Ireland regarding facilitators, barriers, and challenges to implementing OBE. Methods: A national cross-sectional survey was distributed to O&G trainees and trainers in Ireland. Responses were analysed using descriptive statistics and chi-squared tests, and qualitative thematic analysis. Results: A total of 151 trainees and trainers participated in the study. While 61.2% of respondents reported familiarity with the concept of OBE, only 22.4% accurately identified its primary focus on learner goals. Participants highlighted several key benefits of OBE, including the establishment of clearly defined goals and the development of competency in essential skills. However, significant challenges were also identified, such as the perception of unattainable goals for trainees and insufficient training facilities. Additionally, trainer engagement and the lack of allocated time for both trainers and trainees to attend training courses were recognized as major barriers to the successful implementation of OBE. Conclusion: OBE presents a promising educational framework for O&G training, with the potential to modernize and enhance learning outcomes. However, its successful implementation hinges on comprehensive education about its principles and benefits, substantial investment in educational facilities and resources, and the prioritization of training through dedicated and protected time for both trainees and trainers.Item Left atrial mechanics following preeclamptic pregnancy(Lippincott Williams & Wilkins, 2024-07) O’Driscoll, Jamie M.; McCarthy, Fergus P.; Giorgione, Veronica; Jalaludeen, Navazh; Seed, Paul T.; Gill, Carolyn; Sparkes, Jenie; Poston, Lucilla; Marber, Mike; Shennan, Andrew H.; Chappell, Lucy C.; Thilaganathan, Basky; Leeson, PaulBACKGROUND: Preterm preeclampsia is a pregnancy complication associated with myocardial dysfunction and premature cardiovascular disease morbidity and mortality. Left atrial (LA) strain is a noninvasive index of left ventricular end diastolic pressure and an early marker of heart failure risk. This study aimed to evaluate LA strain during the postpartum period in participants with and without preterm preeclampsia and to assess whether this varied in the presence of hypertension, cardiac dysfunction or both. METHODS: In this longitudinal cohort study, 321 women from 28 hospitals with preterm preeclampsia (cases) underwent cardiovascular assessment 6 months postpartum. This is a secondary analysis of the PHOEBE study (ISRCTN01879376). An uncomplicated pregnancy control group (n=30) was recruited from a single center for comparison. A full cross-sectional transthoracic echocardiogram was performed, and from these images, the myocardial strain of the left atrium, including reservoir, conduit, and contractile strain, as well as LA stiffness, were calculated. RESULTS: At 6 months postpartum, compared with controls, prior preeclampsia was associated with a significantly attenuated LA reservoir, conduit, and contractile strain, as well as increased LA stiffness (all P<0.001). LA strain was further reduced in preeclamptic women who had and had not developed hypertension, systolic, or diastolic dysfunction at 6 months postpartum (all P<0.05). CONCLUSIONS: LA mechanics were significantly attenuated at 6 months postpartum in participants with preterm preeclampsia, whether or not they remained hypertensive or had evidence of ventricular dysfunction. Further studies are needed to determine whether postnatal LA strain may identify women at greater risk for future cardiovascular disease.Item Predicting admission to neonatal care unit at mid-pregnancy and delivery using data from a general obstetric population(Springer Nature, 2024-10-17) Maher, Gillian M.; McKernan, Joye; O’Byrne, Laura; Walsh, Brian H.; Corcoran, Paul; Greene, Richard A.; Higgins, John R.; Khashan, Ali S.; McCarthy, Fergus P.; Health Research BoardObjectives: Development and validation of risk prediction models at mid-pregnancy and delivery to predict admission to the neonatal care unit. Methods: We used data from all singleton deliveries at Cork University Maternity Hospital (CUMH), Ireland during 2019. Admission to the neonatal care unit was assumed if length of stay in the unit was > 24 h. Multivariable logistic regression with backward stepwise selection was used to develop the models. Discrimination was assessed using the ROC curve C-statistic, and internal validation was assessed using bootstrapping techniques. We conducted temporal external validation using data from all singleton deliveries at CUMH during 2020. Results: Out of 6,077 women, 5,809 (95.6%) with complete data were included in the analyses. A total of 612 infants (10.54%) were admitted to the neonatal care unit for > 24 hours. Six variables were informative at mid-pregnancy: male infants, maternal smoking, advancing maternal age, maternal overweight/obesity, nulliparity and history of gestational diabetes (C-statistic: 0.600, 95% CI: 0.567, 0.614). Seven variables were informative at delivery: male infants, nulliparity, public antenatal care, gestational age < 39 weeks’, non-spontaneous vaginal delivery, premature rupture of membranes and time of birth between 17:01–07.59 h (C-statistic: 0.738, 95% CI: 0.715, 0.760). Using these predictors, we developed nomograms to calculate individualised risk of neonatal care unit admission. Bootstrapping indicated good internal performance and external validation suggested good reproducibility. Discussion: Our nomograms allow the user to quickly estimate individualised risk of neonatal care unit admission. Future research should aim to improve accuracy in early pregnancy to better assist counselling of parents.Item Perinatal deaths in twin and singleton infants in Ireland: A comparison of characteristics and causes(Springer Nature, 2024-11-04) O’Connor, Caroline; Leitao, Sara; Corcoran, Paul; O’Donoghue, Keelin; Irish Research CouncilIntroduction: Twin pregnancies are associated with significantly higher perinatal mortality (PM) rates compared to singletons, primarily due to complications like fetal growth restriction, preterm birth, and congenital anomalies. This study aimed to compare the characteristics associated with PM in twin pregnancies and compare maternal and obstetric factors and cause of death among twins and singletons in the Republic of Ireland. Materials and methods: Data spanning 2011 to 2022 from the National Perinatal Epidemiology Centre’s annual perinatal mortality clinical audit included 4494 perinatal deaths. Maternal characteristics, antenatal care factors and cause of death were analysed with relative risk calculated using national Hospital In-Patient Enquiry data. Pearson’s chi-squared tests studied the difference between mortality in twins and singletons. Results: Twins accounted for 10.4% of all perinatal deaths, despite representing only 3.6% of total births. The PM rate for twins was 17.3 per 1000 births, 3.1 times higher than for singletons. Early neonatal deaths (ENNDs) were more frequent in twins (54.2%), while stillbirths predominated among singletons (68.6%). Younger maternal age and lower BMI were associated with higher PM risks in twins. A considerable proportion of twin deaths with major congenital anomalies or birth before 28 weeks gestation occurred in non-tertiary hospitals, suggesting limitations in referral pathways to centres with appropriate neonatal expertise. Conclusion: Twin pregnancies pose a higher risk of perinatal mortality, particularly among younger mothers and preterm births. The findings highlight the need for updated guidelines that prioritise early risk assessment, targeted interventions, and improved referral systems.
