Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study

Objective: To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH). Design: Retrospective cohort study. Tertiary teaching hospital in Adelaide, Australia. Population: A total of 30 198 women delivering between 2002 and 2008. Methods: Relative risks adjusted for maternal sociodemographics and comorbidities (aRRs) were calculated for PPH, comparing women with late-gestation exposure to antidepressants (n = 558), women with a psychiatric illness but no antidepressant use (n = 1292), and women with neither antenatal exposures (n = 28 348). Additional sensitivity analyses were undertaken, examining associations with severe PPH and postpartum anaemia. Main Outcome Measures: The primary outcome was PPH, defined as a recorded blood loss of ≥500 mL for vaginal deliveries and ≥1000 mL for caesarean sections. Secondary outcomes included severe PPH (≥1000 mL blood loss, irrespective of method of delivery), and the presence of postpartum anaemia (identified from hospital medical records). Results: Compared with unexposed controls, women exposed to antidepressants had an increased risk of PPH (aRR 1.53; 95% confidence interval, 95% CI 1.25-1.86), whereas no increased risk was observed for women with a psychiatric illness but no antidepressant use (aRR 1.04; 95% CI 0.89-1.23). In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk of severe PPH (aRR 1.84; 95% CI 1.39-2.44), as well as postpartum anaemia (aRR 1.80; 95% CI 1.46-2.22). Conclusions: Exposure to antidepressants in late gestation was associated with a significantly increased risk of PPH. Although potential confounding by unmeasured factors cannot be ruled out, these findings suggest a direct effect of antidepressant exposure on PPH.LE Grzeskowiak, R McBain, GA Dekker, VL Clifto

Opportunism in Brand Partnerships: Effects of Coercion and Relationship Norms

Brand partner opportunism—deceptive or guileful behavior to gain an advantage—is a threat to a successful brand partnership. In this study, the authors examined the effects of coercive and noncoercive tactics for preventing opportunism as those tactics are influenced by relational norms—mutually held standards of behavior that support close relationships. In a survey of 367 hotel general managers from two large hotel brands, the authors found that, in partnerships characterized by strong relational norms, coercive influence strategies, such as threats, promises, or legalistic pleas, are less effective at limiting opportunism than are noncoercive strategies, such as information exchange, recommendations, or requests, which are more effective. In contrast, when relational norms are weak, the authors found that coercive strategies are more effective than are noncoercive strategies. However, regardless of the nature of the relationship, the GMs reported that coercive techniques work only briefly and are ineffective over the long term. Thus, considering the nature of the hotel industry, noncoercive strategies are more likely to benefit brand headquarters’ efforts to limit brand partner opportunism

Accuracy of information on medication use and adverse drug reactions recorded in pregnancy hand-held records

Background: Pregnancy hand-held records (PHR) are a personally controlled health record utilised in the promotion of continuity of care across pregnancy by providing a single resource for the recording of pregnancy-related health information. Aims: To determine the accuracy of the PHR in relation to information on medications and adverse drug reactions (ADRs) and to examine the frequency and nature of any identified discrepancies. Materials and Methods: A 12-week prospective clinical audit of 300 women admitted to either the antenatal or postnatal ward at a tertiary-level maternity hospital. A detailed medication history was completed for each woman by a pharmacist, with women interviewed about medication use prior to and during their pregnancy as well as any ADRs. The medication history and PHR were compared to identify discrepancies. Results: Medication discrepancies were extremely common, with 254 (84.7%; 95% CI 80.6–88.8%) women having at least one or more medication-related discrepancy involving 686 (55%; 95% CI 52.2–57.8%) prescription and nonprescription medications. Most common reasons for prescription medication discrepancies included the medication details being incomplete (44%), missing (29%) or incorrect (17%). ADRs and allergy discrepancies were also common, identified among 59 (20%; 95% CI 15.5–24.5%) women. Conclusions: The PHR is of low accuracy in relation to the recording of medications and ADRs. This warrants further research to examine the impact of these discrepancies on patient care and outcomes. The identification of strategies for improving the recording of information on medications and ADRs in the PHR is also required.Lauren Nash, Rowena Dixon, Vaughn Eaton, Luke E Grzeskowia

Investigating the frequency and nature of medication-related problems in the women’s health unit of an Australian tertiary teaching hospital

Background: Despite the large burden medication-related morbidity and mortality places on the Australian health care system, there is little known about the extent of this problem in a women’s health (obstetric and gynecology) setting. Objective: Determine the frequency and nature of medication-related problems (MRPs) occurring in a women’s health unit (WHU) of an Australian teaching hospital. Methods: A prospective audit of consecutive cases of patients treated in the WHU at a tertiary-level teaching hospital was undertaken by a clinical pharmacist over a 5-week period. Data collected included the following: patient characteristics, type of MRP (using a modified version of the Hepler-Strand classification system), medication involved (according to the World Health Organisation Anatomical Therapeutic Chemical classification system), and clinical significance (using a 2-level severity index). Results: A total of 454 potential MRPs were identified over the 5-week period among 241 patients. A total of 39 MRPs (8.6%) identified were deemed to be of moderate/high clinical significance. The highest number of MRPs (221; 49%) was identified among women admitted following a cesarean delivery, with 83 of 85 women in this group experiencing at least 1 MRP. Additional factors associated with an increased likelihood of patients experiencing a MRP included increased age, length of hospital stay, and number of regular medications taken prior to and during admission (P < 0.05). Conclusion: The widespread nature of identified MRPs in this setting suggests that various approaches to minimizing these problems and mitigating the associated burden on the health care system are warranted.Rebecca Thompson, Lisa Whennan, Jasmine Liang, Chris Alderman and Luke E. Grzeskowia

Use of intravenous iron polymaltose in the management of iron deficiency in pregnancy: a retrospective cohort study

Background: Intravenous iron polymaltose (IPM) is commonly utilised in pregnancy when oral treatment is not tolerated or where rapid replenishment of iron stores is required, but data on use in pregnancy is scarce. Aim: To examine the use, safety and efficacy of intravenous IPM in pregnancy. Methods: Retrospective cohort study of pregnant women administered intravenous IPM between January 2014 and January 2016 at a Tertiary teaching hospital in Adelaide, Australia. Data on maternal characteristics, intravenous iron infusion details, and haematological parameters were collected from case notes and electronic records. Main outcome measures included indication for intravenous iron infusion, prevalence of infusion reactions, change in haemoglobin and correction of anaemia prior to delivery. Results: Intravenous IPM was administered in 213 pregnancies, 62.0% of women with iron deficiency anaemia (IDA) and the remainder (38.0%) with non-anaemic iron deficiency. Adverse drug reactions (ADRs) occurred in 24% of women, of which 32% required infusion cessation. Anaemia was still present at delivery among 7%, and 17% of women with mild, and moderate/severe anaemia respectively. Approximately one in five anaemic women received an intravenous IPM dose below that recommended by the local guideline, particularly in women with a body mass index ≥ 25 kg/m² compared with <25 kg/m² (30.9% vs 6.3%; P < 0.001). Doses ‘at recommended’ resulted in a greater increase in haemoglobin from treatment until delivery than doses ‘below recommended’ (adjusted beta coefficient 8.4 g/L; 95% CI 2.7–14.1 g/L). Conclusion: Intravenous IPM is effective in treating IDA in pregnancy but is associated with a high prevalence of ADRs and treatment cessation.Alaa Qassim, Rosina G. Gergis, Bill Jeffries, Rosalie M. Grivell and Luke E. Grzeskowia

Impact of inter-pregnancy BMI change on perinatal outcomes: a retrospective cohort study

Abstract not availableRosemary D. McBain, Gustaaf A. Dekker, Vicki L. Clifton, Ben W. Mol, Luke E. Grzeskowia

Distinct sex-specific gene expression changes in the placenta in association with childhood allergy

BACKGROUND: The prevalence of allergic disease has risen significantly during recent years. A major component of the susceptibility to allergic disease is determined in prenatal life, when the placenta plays a central role in fetal growth and development. In this study, we aimed to identify the patterns of gene expression in the placenta that may program early immune function to increase susceptibility to allergy. METHODS: A set of immune genes known to be associated with asthma, allergy and inflammation were selected for analysis by quantitative real-time polymerase chain reaction (qRT-PCR) on placental tissue from infants who did or did not develop an allergy by 2 years of age. Analysis was performed on males and females separately for each allergy type including eczema, rhinitis or asthma. RESULTS: Of 11 candidate allergy-associated genes tested by qRT-PCR, 4 were found to be associated with the development of specific childhood allergy types (P < 0.05). These included MMP9 for both males and females that developed eczema, TLR7 for females that developed eczema, KITL1 for males that developed rhinitis and ORMDL3 for females that developed asthma. CONCLUSIONS: This study has identified altered expression of placental genes involved in inflammation in association with the development of specific allergies in childhood. The current data provide supporting evidence implicating the placenta in programming the fetal immune system in early life.Astrud R Tuck, Luke E Grzeskowiak, Annette Osei-Kumah, Zarqa Saif, Suzanne M Edwards, Andrew Tai, Susan L Prescott, MeriTulic, Richard Saffery, and Vicki L Clifto

Early pregnancy maternal trace mineral status and the association with adverse pregnancy outcome in a cohort of Australian women

Abstract not availableRebecca L. Wilson, Tina Bianco-Miotto, Shalem Y. Leemaqz, Luke E. Grzeskowiak, Gustaaf A. Dekker, Claire T. Robert