An Examination of the Demographic Characteristics and Dietary Intake of People Who Meet the Physical Activity Guidelines: NSW Population Health Survey Data 2007

The purpose of this report is to examine the association between physical activity and dietary intake using self reported data from the 2007 NSW Population Health Survey. This report first investigates whether being physically active is associated with healthy dietary behaviours, and then describes the sociodemographic profile of physically active people who do not engage in healthy eating behaviours. Overall, results showed that older people, especially men, tend to do less physical activity compared to younger people, and that obese women were less likely to meet physical activity guidelines compared to healthy weight women. Those who reported a higher intake of fruits and vegetables and/or a lower consumption of soft drinks were more likely to meet the physical activity guidelines. Findings also indicate that among those meeting the physical activity guidelines, men were more likely to report a lower intake of vegetables and a higher consumption of soft drinks and takeaway foods compared to women. Among active people, young people were at a higher risk of unhealthy eating than older age groups. This study strongly supports the hypothesis that physical activity and dietary habits are correlated behaviours, which is consistent with other research findings. The gender and age differences in the association of these health behaviours suggest the value of targeting specific population groups for future interventions

Women’s beliefs about the duration of pregnancy and the earliest gestational age to safely give birth.

Background: American evidence suggests women are not well informed about the optimal duration of pregnancy or the earliest time for safe birth. Similar evidence does not exist in Australia. Aims: To explore pregnant women’s beliefs about the duration of pregnancy and the earliest time for safe birth, and to compare the results with US data. Methods: A cross-sectional survey of pregnant women attending antenatal clinics at four public hospitals in Sydney, Australia, included collection of maternal and pregnancy characteristics, and two questions exploring women’s beliefs about the duration of pregnancy, and the earliest time for safe birth. Responses were grouped as: late preterm (34-36 weeks), early term (37-38 weeks), and full term (39-40 weeks). Results: Of 784 surveyed women, 52% chose 39-40 weeks as the duration of a full term pregnancy, while for the earliest time for safe birth, 10% chose 39-40 weeks and 57% chose 37-38 weeks. Some maternal characteristics were associated with women’s beliefs, including having a medical and/or pregnancy complication, country of birth, level of education, employment status, and attending a tertiary hospital. The associations were different for each question. In comparison with US studies, Australian women were more likely to choose later gestations for both the duration of pregnancy and the earliest time for safe birth. Conclusions: A significant proportion of Australian women believe that full term pregnancy and earliest time for safe birth occur before 39 weeks, suggesting opportunities for antenatal education.The authors would like to thank the women who participated in the survey, and acknowledge the contribution of the research midwives, Jill Milligan, Rachel Reid, Jocelyn Sedgley and Katrina White-Mathews, as well as Dr. Antonia Shand for assisting with participant recruitment. This work was supported by an Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence Grant (1001066). CLR is supported by an NHMRC Senior Research Fellowship (#APP1021025)

Dietary vitamin, mineral and herbal supplement use: a cross-sectional survey of before and during pregnancy use in Sydney, Australia.

AIM: To describe use of dietary vitamin, mineral and herbal supplements before and during pregnancy. METHODS: Pregnant women attending antenatal care at two tertiary Sydney hospitals between January and March 2014 completed an anonymous survey. Information on general maternal and pregnancy characteristics and the use of dietary and herbal supplements, including type, duration, and sources of information was collected. Frequency and contingency tabulations were performed. RESULTS: 612 women agreed to participate (91% response rate). 23 were excluded due to incomplete data. Of 589 women included in the analysis, the mean gestational age at the time of survey was 28.5 weeks (SD 8.3), 55% had no children, and 67% were tertiary educated. Overall 62.9% of women reported taking a multivitamin (MV) and/or folic acid (FA) supplement in the 3 months pre-pregnancy. At the time of the survey 93.8% of women were taking at least one supplement (median 2, range 1-13). During pregnancy 79.1% of women were taking MVs, including 59.2% taking MV only and 19.9% taking MV and FA. The 5 most common supplements outside of a MV were FA (31%), iron (30%), vitamin D (23%), calcium (13%) and fish oil (12%). CONCLUSION: Use of folic acid and MVs and other supplements during and pre-pregnancy is relatively high, although pre-pregnancy FA supplementation rates could still be improved. Further research on the actual dosages and dietary intakes consumed are needed to examine whether pregnant women have adequate intake of nutrients, regardless of supplement use.NHMR

Women's views about the timing of birth

Background: Estimated date of birth (EDB) is used to guide clinical management of women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined. Aims: To explore women’s expectations of giving birth on or near their EDB, and their attitudes to alternative estimates for timing of birth. Methods: A survey of pregnant women attending four public hospitals in Sydney, Australia, between July and December 2012. Results: Among 769 surveyed women, 42% expected to birth before their due date, 16% after the due date, 15% within a day or so of the due date, and 27% had no expectations. Nulliparous women were more likely to expect to give birth before their due date. Women in the earlier stages of pregnancy were more likely to have no expectations or to expect to birth before the EDB while women in later pregnancy were more likely to expect birth after their due date. For timing of birth information, only 30% of women preferred an EDB; the remainder favoured other options. Conclusions: Most women understood the EDB is imprecise. The majority of women expressed a preference for timing of birth information in a format other than an EDB. In support of woman-centred care, it may be helpful to ask each woman how she would like to receive estimated timing of birth information.NHMR

Providing evidence to support obstetric practice change in Vietnam: episiotomy use among Vietnamese-born women living in Australia

OBJECTIVE: To describe the use of episiotomy among Vietnamese-born women in Australia, including risk factors for, and pregnancy outcomes associated with, episiotomy. METHODS: This population-based, retrospective cohort study included data on 598 305 singleton, term (i.e. ≥ 37 weeks’ gestation) and vertex-presenting vaginal births between 2001 and 2010. Data were obtained from linked, validated, population-level birth and hospitalization data sets. Contingency tables and multivariate analysis were used to compare risk factors and pregnancy outcomes in women who did or did not have an episiotomy. FINDINGS: The episiotomy rate in 12 208 Vietnamese-born women was 29.9%, compared with 15.1% in Australian-born women. Among Vietnamese-born women, those who had an episiotomy were significantly more likely than those who did not to be primiparous, give birth in a private hospital, have induced labour or undergo instrumental delivery. In these women, having an episiotomy was associated with postpartum haemorrhage (adjusted odds ratio, aOR: 1.26; 95% confidence interval, CI: 1.08–1.46) and postnatal hospitalization for more than 4 days (aOR: 1.14; 95% CI: 1.00–1.29). Among multiparous women only, episiotomy was positively associated with a third- or fourth-degree perineal tear (aOR: 2.00; 95% CI: 1.31–3.06); in contrast, among primiparous women the association was negative (aOR: 0.47; 95% CI: 0.37–0.60). CONCLUSION: Episiotomy was performed in far fewer Vietnamese-born women giving birth in Australia than in Viet Nam, where more than 85% undergo the procedure, and was not associated with adverse outcomes. A lower episiotomy rate should be achievable in Viet Nam

Iron supplement use in pregnancy – are the right women taking the right amount?

Objectives: To examine the prevalence and determinants of iron supplement use and the amount of iron consumed from iron-containing supplements. Methods: A cross-sectional survey was performed in antenatal clinics in two tertiary hospitals in Sydney, Australia between January and March 2014. Results: Of 612 (91% response rate) pregnant women, 589 with complete data were analysed. The overall prevalence of iron-containing supplement use was 88.0%, of which 70.1% was MV only, 7.2% was iron-only and 22.2% was both. Use of iron-containing supplements was associated with increased gestational age, a diagnosis of anaemia or iron deficiency (ID) in the current pregnancy and pre-pregnancy use of an iron-containing supplement. Several risk factors for ID or anaemia such as on-red meat eating and previous miscarriage were not associated with current iron supplement use. About 65% of women diagnosed with ID, and 62.3% of women diagnosed with anaemia were taking an iron-only supplement, with or without a MV. The proportion of women consuming low (<30), preventative (30-99) and treatment (≥100) mg/day doses were 36.8%, 45.4%, and 17.8%, respectively. Only 46.7% of women diagnosed with ID were taking ≥100 mg/day iron from supplements, while 23.3% were taking <30 mg/day. Conclusion: Women are consuming varying doses of iron and some high-risk women are taking inadequate doses of iron to prevent or treat ID or iron deficiency anaemia. Healthcare professionals are best positioned to advise women on iron supplement use in pregnancy and should educate women individually about the type and dose of supplement best suited to their needs.NHMR

Maternal body weight and first trimester screening for chromosomal anomalies

Prenatal risk ratios for Down syndrome adjust for maternal weight because maternal serum 2 biomarker levels decrease with increasing maternal weight. This is accomplished by converting 3 serum biomarker values into a multiple of the expected median (MOM) for women of the same 4 gestational age. Weight is frequently not recorded and the impact of using MOMs not adjusted for 5 weight for calculating risk ratios is unknown. The aim of this study is to examine the effect of 6 missing weight on first trimester Down syndrome risk ratios by comparing risk ratios calculated 7 using weight-unadjusted-and –adjusted MOMs. Findings at the population level indicate that the 8 impact of not adjusting for maternal weight on first trimester screening results for chromosomal 9 anomalies would lead to under-identification of 84 per 10,000 pregnancies.NHMR

Methods of classification for women undergoing induction of labour: a systematic review and novel classification system

Background: The lack of reproducible methods for classifying women having an induction of labour (IOL) has led to controversies regarding the association of IOL and health outcomes for mother and baby. Objectives: To identify research papers that describe a methodology for classifying women having an IOL, and to evaluate the utility of these methods of classification for clinical, research and surveillance purposes. Search strategy: We conducted electronic searches in CINAHL, EMBASE and WEB of KNOWLEDGE from database inception until Oct 2013 and searched reference lists. Selection criteria: Two reviewers independently assessed eligibility. Studies had to describe a method for classifying women with an IOL using a minimum of two categories, regardless of whether or not this was the main purpose of the study. Data collection: Data were extracted on study characteristics, quality and results. Pre-specified criteria were used to evaluate the utility of these methods of classification for IOL. Main results: Seven studies met the inclusion criteria. All studies categorised women according to the presence or absence of a medical indication for IOL. Uncertainties and/or deficiencies were identified across all methods of classification related to the criteria of total inclusivity, reproducibility, clinical utility, implementability and data availability limiting their usefulness. Conclusion: Current methods of classifying women with an IOL are inadequate for clinical, research and surveillance purposes. Limitations with classification systems based on medical indications suggest that an alternative method of classification is required for women having IOL