Should pregnant women be screened for drugs of abuse?

Sir- We would like to compliment Drs Bosio et al1 for the first reported prospective screening study for drug abuse in an Irish obstetric population. We would disagree, however, with the deduction that "drug abuse is not a serious problem among Dublin's pregnant population." 43 cases of neonatal drug withdrawal were identified at our hospital between July 1996 and June 1997 and these babies had significant impact on facilities and staffing levels in our neonatal ICU

Additional file 2: Table S2. of Fetal metabolic influences of neonatal anthropometry and adiposity

Correlation of fetal C-peptide and leptin from cord blood with neonatal anthropometric measures (DOC 53 kb

Additional file 1: Table S1. of Fetal metabolic influences of neonatal anthropometry and adiposity

Baseline anthropometric measurements among the total sample and by intervention group of the original ROLO study (DOC 39 kb

Tracking Childhood Height of Small for Gestational Age Infants in Ireland

<div><u>Introduction</u><br></div><div>Small for gestational age (SGA) defines infants whose birth weight or crown-heel length is 2 standard deviations (SDs) below the mean for their appropriate gestational age (AGA). Approximately 3-5% of neonates are born SGA. This cohort is estimated to account for 1 in 5 children (and adults) who are short in stature. SGA is associated with poor outcomes in terms of growth and metabolism. Understanding population distributions of growth outcomes will aid consideration of treatments such as growth hormone in a paediatric population. Data from the ‘Growing Up in Ireland’ (GUI) longitudinal study is explored.<br></div><div><br></div><div><u>Materials and Methods</u></div><div>Birth height was standardised according to gestational age and sex. Childhood growth measures were standardised for sex. Distributions of outcome variables were examined using robust graphical methods. Univariate poisson regression was employed to examine the relative risk of SGA on quintiles of growth outcomes at 9 months, 3 and 5 years of age. A sex-adjusted height below two standard deviations was identified as a significant cut-score from the literature. Univariate logistic regression was employed to examine the likelihood of this outcome in the SGA group. R statistical programming was used for analysis.</div><div><br></div><div><u>Results</u></div><div>The GUI cohort consisted of 12,121 children in Ireland, 56% of whom were female. Those born SGA were 29%, 16% and 12% more likely to fall in a height decile below that of their average for gestational age peers at 9 months, 3 and 5 years respectively (significant at an alpha level of 0.95). At 5 years of age the SGA group demonstrated a likelihood of falling 2 SD below the sex-adjusted mean, five-fold over their peers (OR: 5.40, 95% CI: 2.86, 10.20). Quantile analysis was undertaken and graphical visualisations were plotted to aid interpretation of growth outcomes for the SGA group in this dataset. A sankey diagram (figure 1) is used to track the distribution of participants with SGA across quintiles of height through 5 years of age.<br></div><div><br></div><div><u>Conclusion</u></div><div>Small for Gestational Age neonates represent between 3 to 5% of a given population. In Ireland, data from the GUI study demonstrated a 3.5% prevalence. This analysis suggest that subgroups of SGA infants may exhibit worse growth outcomes than their population matched peers. Future analysis may employ machine learning techniques at a population level to identify those who may benefit from growth hormone therapy.</div><div> </div

Feasibility study protocol of a pragmatic, randomised controlled pilot trial: membrane sweeping to prevent post-term pregnancy—the MILO Study

Background: Post-term pregnancy is associated with an increased risk of maternal complications, respiratory distress and trauma to the neonate. Amniotic membrane sweeping has been recommended as a simple procedure to promote the spontaneous onset of labour. However, despite its widespread use, there is an absence of evidence on (a) its effectiveness and (b) its optimal timing and frequency. The primary aim of the MILO Study is to inform the optimal design of a future definitive randomised trial to evaluate the effectiveness (including optimal timing and frequency) of membrane sweeping to prevent post-term pregnancy. We will also assess the acceptability and feasibility of the proposed trial interventions to clinicians and women (through focus group interviews). Methods/design: Multicentre, pragmatic, parallel-group, pilot randomised controlled trial with an embedded factorial design. Pregnant women with a live, singleton foetus ≥ 38 weeks gestation; cephalic presentation; longitudinal lie; intact membranes; English speaking and ≥ 18 years of age will be randomised in a 2:1 ratio to membrane sweep versus no membrane sweep. Women allocated randomly to a sweep will then be randomised further (factorial component) to early (from 39 weeks) versus late (from 40 weeks) sweep commencement and a single versus weekly sweep. The proposed feasibility study consists of four work packages, i.e. (1) a multicentre, pilot randomised trial; (2) a health economic analysis; (3) a qualitative study; and (4) a study within the host trial (a SWAT). Outcomes to be collected include recruitment and retention rates, compliance with protocol, randomisation and allocation processes, attrition rates and cost-effectiveness. Focus groups will be held with women and clinicians to explore the acceptability and feasibility of the proposed intervention, study procedures and perceived barriers and enablers to recruitment .Discussion: The primary aim of the MILO Study is to inform the optimal design of a future definitive randomised trial to evaluate the effectiveness (including optimal timing and frequency) of membrane sweeping to prevent post-term pregnancy. Results will inform whether and how the design of the definitive trial as originally envisaged should be delivered or adapted