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Nuffield Department of Women's & Reproductive Health sits within the Medical Sciences Division of the University of Oxford. The department encompasses multi-disciplinary research across four overarching themes; Cancer, Global Health, Maternal & Fetal Health and Reproductive Medicine & Genetics
A call to action on pregnancy-related lifestyle interventions to reduce cardiovascular risk in the offspring. A Scientific Statement of the European Association of Preventive Cardiology of the ESC.
Adverse pregnancy outcomes, such as gestational diabetes, hypertensive disorders of pregnancy, fetal growth restriction, and prematurity, can increase the risk of future cardiovascular disease (CVD) in the offspring. This document aims to raise recognition of the impact of maternal health on offspring cardiometabolic health and to highlight research gaps on how to mitigate this risk via pregnancy-related lifestyle interventions. Lifestyle interventions initiated before, during, or after pregnancy hold great promise to prevent and manage adverse maternal outcomes. Still, there is limited evidence for the effect of such interventions on CVD-related outcomes in the offspring. In this document, we "Call for action" concerning research investigating how pregnancy-related lifestyle interventions can reduce CVD risk in the offspring. There is a need to overcome barriers to recruit individuals who need such interventions the most, to better design strategies for increased adherence, and to include relevant measurements in children.
Advancements in Fetal Heart Rate Monitoring: A Report on Opportunities and Strategic Initiatives for Better Intrapartum Care.
Cardiotocography (CTG), introduced in the 1960s, was initially expected to prevent hypoxia-related deaths and neurological injuries. However, more than five decades later, evidence supporting the evidence of intrapartum CTG in preventing neonatal and long-term childhood morbidity and mortality remains inconclusive. At the same time, shortcomings in CTG interpretation have been recognised as important contributory factors to rising caesarean section rates and missed opportunities for timely interventions. An important limitation is its high false-positive rate and poor specificity, which undermines reliably identifying foetuses at risk of hypoxia-related injuries. These shortcomings are compounded by the technology's significant intra- and interobserver variability, as well as the subjective and complex nature of fetal heart rate interpretation. However, human factors and other environmental factors are equally significant. Advancements in fetal heart rate monitoring are crucial to support clinicians in improving health outcomes for newborns and their mothers, while at the same time avoiding unnecessary operative deliveries. These limitations highlight the clinical need to enhance neonatal outcomes while minimising unnecessary interventions, such as instrumental deliveries or caesarean sections. We believe that achieving this requires a paradigm shift from subjective interpretation of complex and nonspecific fetal heart rate patterns to evidence-based, quantifiable solutions that integrate hardware, engineering and clinical perspectives. Such transformation necessitates an international, multidisciplinary effort encompassing the entire continuum of pregnancy care and the broader healthcare ecosystem, with emphasis on well-defined, actionable health outcomes. Achieving this will depend on collaborations between researchers, clinicians, medical device manufacturers and other relevant stakeholders. This expert review paper outlines the most relevant and promising directions for research and strategic initiatives to address current challenges in fetal heart rate monitoring. Key themes include advancements in computerised fetal heart rate monitoring, the application of big data and artificial intelligence, innovations in home and remote monitoring and consideration of human factors.
Gated Self Attention Convolutional Neural Networks for Predicting Adverse Birth Outcomes
Early detection of adverse birth outcomes is vital as they are major contributors to neonatal mortality and irreversible neurological complications in infants. These outcomes are typically linked to impaired blood and oxygen flow to the baby brain during or shortly after labour, making its early detection vital. Monitoring fetal heart rate (FHR) is crucial in identifying and capturing these complications. This study proposes a deep learning (DL) framework for enhancing the early detection of the babies at risk, leveraging both raw FHR signals and standard cardiotocography (CTG) features. Unlike traditional methods that primarily focus on abnormal CTG traces (but not birth outcomes), this approach, backed by a substantial cohort of patient records, demonstrates the potential of DL in predicting actual adverse outcomes as early as possible. The DL model combines a convolutional mechanism with a self-attention network, enhanced by a gating mechanism for more accurate feature learning. The investigated DL architecture is trained on a dataset of over 37,000 births, including 1,291 abnormal ones, and is evaluated on a holdout set of 6,459 births, as well as the open-access CTU-CHB CTG dataset of 552 births. The proposed DL model demonstrates superior diagnostic accuracy, outperforming state-of-the-art baseline methods and clinical benchmarks. It achieved sensitivity of 49.08% (95% CI, 46.01-53.36%) at 15% false positive rate (FPR), compared to the clinical benchmark sensitivity of 37.70% (33.10-42.30%) and a previous model's 32.60% (28.20-37.30%) at a similar FPR.
Impact of a Brief Healthcare-based Intervention to Support Early Childhood Development in India: A Pilot Randomized Controlled Trial.
OBJECTIVES: To study the impact of a brief early childhood develop-ment (ECD) intervention, Sit Down and Play (SDP), integrated within routine healthcare visits on parent and child outcomes. METHODS: Between April, 2018 and March, 2019, caregivers and their infants aged 5-6 months attending a well-baby clinic were enrolled and randomized to intervention (n=26) or control (n=26) groups. Intervention families received SDP at recruitment and two subsequent immunization visits (8 months and 10 months). Control families received usual care. ECD outcomes were assessed through in-person assessments at the age of 12 months using the Stim Q subscales to assess parenting behaviors, and the Developmental Assessment Scale for Indian Infants (DASII) for neurodevelopment. RESULTS: There was a significant improvement in parent-child stimulation activities and verbal interactions in the intervention group compared with the control group [6.1(1.4) vs 4.9 (1.3); P=0.002]. Infants in the intervention group had significantly higher DASII scores in multivariable analyses [108.0 (103.0-111.3) vs 102.0 (96.8-108.0); P=0.04]. CONCLUSION: Our findings suggest a brief healthcare intervention supports opportunities for early learning among caregivers and neurodevelopmental outcomes in their infants.
Maternal Smoking Intensity During Pregnancy and Early Adolescent Cardiovascular Health
Background The adverse cardiovascular effects of smoking are well established. We aimed to investigate the less well‐understood effects of pregnancy smoke exposure on offspring cardiovascular health in early adolescence. Methods and Results Data were drawn from the nationally representative Longitudinal Study of Australian Children's Child Health CheckPoint. Mothers reported mean daily cigarettes smoked in each trimester (≤10 versus >10/day), and smoking cessation during pregnancy. Blood pressure, pulse wave velocity, carotid intima‐media thickness, and retinal microvascular parameters were measured in early adolescence (mean 11.5 years). Hypertension was defined as systolic blood pressure ≥120 or diastolic blood pressure ≥80 mm Hg. 187 (11.8%) of 1582 women (mean age 30.7±0.2 years), smoked during pregnancy, of whom 143 (76.5%) smoked throughout pregnancy, and 58 (31.0%) smoked >10 cigarettes/day. Compared with those born to nonsmoking mothers, the odds of hypertension in early adolescence were 1.44 (95% CI, 1.01–2.06) if mothers ever smoked, 1.99 (1.22–3.24) if mothers smoked >10 cigarettes/day, and 1.64 (1.11–2.42) if mothers smoked throughout pregnancy There was limited evidence of associations between smoking throughout pregnancy and other cardiovascular measures. Offspring of mothers who stopped smoking during pregnancy and nonsmokers had similar cardiovascular measures, apart from hypertension. Conclusions Offspring of mothers who smoked in pregnancy have increased risks of hypertension in adolescence, with increased risk with greater exposure intensity and duration. Mothers who stopped smoking during pregnancy had offspring with similar cardiovascular health to those born to nonsmokers. Our findings underscore the importance of specific strategies to stop maternal smoking before conception and during pregnancy.
Added predictive value of childhood physical fitness to traditional risk factors for adult cardiovascular disease
Abstract Aim Childhood physical fitness is a predictor of cardiovascular (CV) health but is underutilised in health surveillance. This study determined the predictive utility of child physical fitness levels on obesity, hypertension, dyslipidaemia, and the metabolic syndrome (MetS) in adulthood over traditional CV risk factors in childhood. Methods A longitudinal cohort study of Childhood Determinants of Adult Health Study participants who had their fitness (cardiorespiratory fitness (CRF): 1.6 km run/walk, physical work capacity at 170 beats per minute; muscular fitness: dominant handgrip strength, standing long jump) measured as children and their CV health assessed as children and adults (mean follow-up=27 years). Participants had their body mass index (BMI), waist circumference, blood pressure, fasting blood sample (lipids, glucose), and smoking status assessed as children in 1985 and in early adulthood (2004-06, 26-36 years) and/or middle adulthood (2014-19, 36-49 years) where obesity, hypertension, dyslipidaemia, and MetS were defined. Logistic regression was used to model associations (N range=578-5049). Results Additionally considering childhood CRF or muscular fitness improved the ability to discriminate and fit models to predict adult obesity, low HDL-C and MetS when added to demographics (age, sex) and the corresponding measure in childhood (BMI, HDL-C, CV risk score), as reflected by increments in area under the curve (Δrange=0.003-0.022), net reclassification index (range=0.026-0.149), integrated discrimination index (range=0.003-0.027), reductions in deviance and Brier scores, and statistically significant likelihood ratio tests. Conclusion CRF and muscular fitness are independent health indicators that could complement other risk factors in childhood to identify individuals at increased long-term CV risk.
A community-based intervention (the Omama Project) improves neurodevelopment in impoverished 2-year-old Roma children: a quasi-experimental observational study.
UNLABELLED: High rates of childhood neurodisability are reported among the Roma, Europe's largest ethnic minority community. Interventions targeting early child development (ECD) during the first 2 years of life can improve neurodevelopmental outcomes in vulnerable children; however, evidence from Roma preschoolers is scarce. In a quasi-experimental observational study, we compared neurodevelopmental outcomes at age 2 years, measured on the INTERGROWTH-21st Project Neurodevelopmental Assessment (INTER-NDA), between Roma children receiving a community-based ECD intervention (RI, n = 98), and age- and sex-matched Roma and non-Roma children (RC, n = 99 and NRC, n = 54, respectively) who did not receive the intervention in Eastern Slovakia. The intervention was delivered between 3 weeks and 20 months in weekly home-based sessions by trained Roma women from matched settlements to RIs. Compared with RC, RI had higher 2-year cognitive (B = 0.15; 95% CI, 0.04, 0.25), language (B = 0.25; 95% CI, 0.11, 0.38) and fine motor (B = 0.08; 95% CI, 0.01, 0.16) scores. After adjustment for covariates, cognitive delay decreased by 88% in RI compared with RC (aOR, 0.12; 95% CI, 0.03, 0.53). Linear growth at 24 months was a key predictor of developmental scores for both groups (range, B = 0.04-0.14; 95% CI, 0.01, 0.07 and 0.09, 0.20). CONCLUSIONS: Our results highlight that, without directly intervening on nutritional and poverty status, a community-based ECD intervention, delivered by trained Roma women to Roma children, can significantly improve neurodevelopmental outcomes at age 2 years. WHAT IS KNOWN: • The Roma are Europe's largest ethnic minority. High rates of neurodisability, malnutrition and poverty are reported in Roma preschoolers. • Optimal early child development (ECD) is foundational to lifecourse health and wellbeing. Early interventions improve ECD outcomes in vulnerable children; however, evidence from Roma communities is limited. WHAT IS NEW: • The Omama project is a community-based ECD intervention, delivered by trained Roma women to Roma children aged 3 weeks to 20 months living in impoverished settlements in Eastern Slovakia. • Roma children receiving the intervention had (i) higher cognitive, language and fine motor scores and (ii) lower rates of cognitive delay compared with controls.
Optimisation of ExoCounter technology for use in cerebrospinal fluid and investigation of placenta-derived exosomes within cerebrospinal fluid
Pregnancy is associated with neurological changes and increased risk of certain neurological pathologies. The mechanisms and causes of these changes are not entirely clear. Placenta-derived exosomes are small vesicles released from the placenta into maternal circulation. Research suggests that these exosomes are bioactive and can affect cells and tissues they encounter. There is evidence that exosomes of non-placental origin can cross the blood-brain barrier and be taken up by central nervous tissues, and that placenta-derived exosomes may increase the permeability of the blood-brain barrier. At the time of writing, no human studies have addressed the possibility that placenta-derived exosomes may cross the blood-brain barrier and affect neurological tissues. This project used a novel technology for exosome quantification, the ExoCounter assay, to analyse placenta-derived exosomes in matched cerebrospinal fluid and plasma samples from normotensive, preeclamptic and eclamptic pregnant women. This project did not find evidence that placenta-derived exosomes are present in cerebrospinal fluid. No difference was seen in plasma or cerebrospinal fluid counts between the three clinical groups, but this was affected by small samples sizes and unmatched gestational age between groups. In addition to work on the samples, this project assessed performance of the ExoCounter assay, and found high linearity, high repeatability, and dependence of the assay on intact exosome membranes. The impact of human/pipetting error and human anti-mouse antibodies was assessed, with no evidence found of interference by either factor.
Prevalence and patterns of testing for anaemia in primary care in England
BackgroundDespite epidemiological data on anaemia being available on a global scale, its prevalence in the United Kingdom is not well described. <b>Aim</b> To investigate anaemia prevalence and testing patterns for haemoglobin and other blood parameters. <b>Design and Setting</b> A population-based cohort study using data drawn from the Clinical Practice Research Datalink Aurum database in 2019. <b>Method</b> We extracted demographic data for each person who was registered at their current practice during 2019, including linked data on Index of Multiple Deprivation. We calculated anaemia prevalence in 2019 based on World Health Organization specified age and gender thresholds for haemoglobin. We classified anaemia based on mean corpuscular volume and ferritin. We followed up people with anaemia for up to one year to investigate longitudinal testing patterns for haemoglobin. <b>Results</b> The cohort contained 14 million people. Anaemia prevalence in 2019 was 4.1% (5.1 % females and 3.1% males). Prevalence was higher in people aged >65 years, Black and Asian ethnicities, and people living in areas with higher social deprivation. Only half of people with anaemia and a mean corpuscular volume of ≤100 fL had an accompanying ferritin value recorded. About half of people with anaemia had a follow-up haemoglobin test within one-year, most of which still indicated anaemia. <b>Conclusion</b> Anaemia is prevalent in the UK with large disparities between levels of demographic variables. Investigation and follow-up of anaemia is suboptimal in many patients. Health interventions aimed at improving anaemia investigation and treatment are needed, particularly in these at-risk groups.
Recommendations for implementing rheumatic heart disease echocardiographic detection in remote Australia: A narrative review and lesson-drawing from diabetic retinopathy screening.
BACKGROUND AND OBJECTIVES: Australia has some communities with the highest rates of rheumatic heart disease (RHD) in the world. Echocardiographic detection of RHD through active case finding has been proposed for early detection. Lessons can be learnt from the implementation of a similar program - diabetic retinopathy screening. The aim of this paper is to identify transferable lessons from the implementation of diabetic retinopathy screening that could be applied to RHD echocardiographic detection. METHOD: This paper presents a narrative review and expert recommendations. RESULTS: Transferable lessons from the implementation of diabetic retinopathy screening include training local staff regularly with formal certification; supplementary health promotion; program champions; general practitioner involvement; informing all staff at clinics; creating separate Medicare Benefits Schedule items for acquisition and interpretation; using echocardiography for detection and monitoring of RHD; establishing referral pathways and communication channels; local community involvement in implementation planning; and developing an adaptable program. DISCUSSION: Implementing programs successfully and sustainably in remote communities is known to be challenging. These transferable lessons from the implementation of diabetic retinopathy screening might assist in the planning of an RHD detection program.
Performance evaluation of computerized antepartum fetal heart rate monitoring: Dawes-Redman algorithm at term.
OBJECTIVES: To assess the effectiveness of the Dawes-Redman algorithm in identifying fetal wellbeing at term by analyzing 30 years of retrospective clinical data, comparing normal and adverse pregnancy outcomes, evaluating key metrics and testing its performance when used 0-48 h before delivery. METHODS: Antepartum fetal heart rate (FHR) traces from term singleton pregnancies at 37 + 0 to 41 + 6 weeks' gestation obtained between 1991 and 2024 were extracted from the Oxford University Hospitals database. Traces with > 30% of their signal information missing or with incomplete Dawes-Redman analyses were excluded. Only traces performed within 48 h prior to delivery were considered. A cohort of pregnancies with subsequent normal pregnancy outcome (NPO) was established using rigorous inclusion and exclusion criteria. Another cohort of pregnancies with adverse pregnancy outcome (APO) was developed if the neonate experienced at least one of seven APOs after delivery. Propensity score matching (PSM) facilitated a balanced comparison between NPO and APO cohorts using six factors: gestational age at FHR monitoring, fetal sex, maternal body mass index at presentation, maternal age at delivery, parity and time interval between FHR trace and delivery. FHR traces were categorized as either 'criteria met' (indicating fetal wellbeing) or 'criteria not met' (indicating a need for further evaluation) according to the Dawes-Redman algorithm, which informed the evaluation of predictive performance metrics. Performance was assessed using accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (NPV) adjusted for various population risk prevalences of APO. RESULTS: A balanced dataset of 3316 antepartum FHR traces was developed with PSM (standardized mean difference