• Anaesthesia for parturients with severe cystic fibrosis: a case series.

      Deighan, M; Ash, S; McMorrow, R; Department of Anaesthetics, National Maternity Hospital, Dublin, Ireland. Electronic address: maireadeighan@doctors.org.uk. (2014-02)
      Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.
    • Antenatal suspicion of ischemic placental disease and coexistence of maternal and fetal placental disease: analysis of over 500 cases.

      Cooley, Sharon M; Reidy, Fiona R; Mooney, Eoghan E; McAuliffe, Fionnuala M; Fetal Medicine Center, National Maternity Hospital, Dublin, Ireland. (2011-12)
      To investigate the antenatal suspicion of placental disease and the coexistence of maternal and fetal placental ischemic disease.
    • The association between maternal dietary micronutrient intake and neonatal anthropometry - secondary analysis from the ROLO study.

      Horan, Mary K; McGowan, Ciara A; Gibney, Eileen R; Donnelly, Jean M; McAuliffe, Fionnuala M (2015)
      Micronutrients are necessary for fetal growth. However increasingly pregnant women are nutritionally replete and little is known about the effect of maternal micronutrient intakes on fetal adiposity in mothers with increased BMI. The aim of this study was to examine the association of maternal dietary micronutrient intake with neonatal size and adiposity in a cohort at risk of macrosomia.
    • The association between TNF-α and insulin resistance in euglycemic women.

      Walsh, Jennifer M; McGowan, Ciara A; Byrne, Jacinta A; Rath, Ann; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, Ireland; National Maternity Hospital, Dublin, Ireland. Electronic address: msjenniferwalsh@gmail.com. (2013-10)
      Chronic low levels of inflammation have links to obesity, diabetes and insulin resistance. We sought to assess the relationship between cytokine tumor necrosis factor (TNF-α) and insulin resistance in a healthy, euglycemic population. This is a prospective study of 574 non-diabetic mother and infant pairs. Maternal body mass index (BMI), TNF-α, glucose and insulin were measured in early pregnancy and at 28 weeks. Insulin resistance was calculated by HOMA index. At delivery birthweight was recorded and cord blood analysed for fetal C-peptide and TNF-α. In a multivariate model, maternal TNF-α in early pregnancy was predicted by maternal insulin resistance at the same time-point, (β=0.54, p<0.01), and maternal TNF-α at 28 weeks was predicted by maternal insulin resistance in early pregnancy (β=0.24, p<0.01) and at 28 weeks (β=0.39, p<0.01). These results, in a large cohort of healthy, non-diabetic women have shown that insulin resistance, even at levels below those diagnostic of gestational diabetes, is associated with maternal and fetal inflammatory response. These findings have important implications for defining the pathways of fetal programming of later metabolic syndrome and childhood obesity.
    • The association of maternal and fetal glucose homeostasis with fetal adiposity and birthweight.

      Walsh, Jennifer M; Mahony, Rhona; Byrne, Jacinta; Foley, Michael; McAuliffe, Fionnuala M; Department of Obstetrics and Gynecology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. jennifer.walsh@ucd.ie (European journal of obstetrics, gynecology, and reproductive biology, 2011-12)
      To examine the association between maternal and fetal glucose levels and fetal adiposity and infant birthweight.
    • Caesarean section in a parturient with a spinal cord stimulator.

      Sommerfield, D; Hu, P; O'Keeffe, D; McKeating A, K; Department of Anaesthesia, National Maternity Hospital, Dublin, Ireland. dsommerfield@hotmail.com (2010-01)
      A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed.
    • Clinical and ultrasound features of placental maturation in pre-gestational diabetic pregnancy.

      Higgins, Mary F; Russell, Noirin M; Mooney, Eoghan E; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Ireland. (2012-10)
      Pre-gestational diabetes (PGDM) is a significant cause of neonatal morbidity and mortality. Delayed villous maturation (DVM) is a placental diagnosis with increased risk of perinatal mortality.
    • Closed and open breathing circuit function in healthy volunteers during exercise at Mount Everest base camp (5300 m).

      McMorrow, R C N; Windsor, J S; Hart, N D; Richards, P; Rodway, G W; Ahuja, V Y; O'Dwyer, M J; Mythen, M G; Grocott, M P W; UCL Centre for Altitude Space and Extreme Environment Medicine, UCL Institute of Child Health, University College London, London, UK. mcmorrow.roger@gmail.com (Anaesthesia, 2012-08)
      We present a randomised, controlled, crossover trial of the Caudwell Xtreme Everest (CXE) closed circuit breathing system vs an open circuit and ambient air control in six healthy, hypoxic volunteers at rest and exercise at Everest Base Camp, at 5300 m. Compared with control, arterial oxygen saturations were improved at rest with both circuits. There was no difference in the magnitude of this improvement as both circuits restored median (IQR [range]) saturation from 75%, (69.5-78.9 [68-80]%) to > 99.8% (p = 0.028). During exercise, the CXE closed circuit improved median (IQR [range]) saturation from a baseline of 70.8% (63.8-74.5 [57-76]%) to 98.8% (96.5-100 [95-100]%) vs the open circuit improvement to 87.5%, (84.1-88.6 [82-89]%; p = 0.028). These data demonstrate the inverse relationship between supply and demand with open circuits and suggest that ambulatory closed circuits may offer twin advantages of supplying higher inspired oxygen concentrations and/or economy of gas use for exercising hypoxic adults.
    • Diagnostic and therapeutic dilemma associated with atypical glandular cells on liquid-based cervical cytology.

      Chummun, K; Fitzpatrick, M; Lenehan, P; Boylan, P; Mooney, E; Flannelly, G; National Maternity Hospital, Dublin, Ireland. (2012-12)
      In 2008, the management of women in Ireland with atypical glandular cells changed to immediate referral to colposcopy. The optimal management of these women is unclear. A balance between the detection of occult disease and overtreatment is required.
    • The dual influences of age and obstetric history on fecal continence in parous women.

      Eogan, Maeve; O'Brien, Conor; Daly, Leslie; Behan, Michael; O'Connell, P Ronan; O'Herlihy, Colm; Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2011-02)
      To assess whether women who underwent forceps delivery were more likely than those who delivered either normally (spontaneous vaginal delivery [SVD]) or by cesarean to experience deterioration in fecal continence as they aged.
    • Ethnic variation between white European women in labour outcomes in a setting in which the management of labour is standardised-a healthy migrant effect?

      Walsh, J; Mahony, R; Armstrong, F; Ryan, G; O'Herlihy, C; Foley, M; UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. jennifer.walsh@ucd.ie (BJOG : an international journal of obstetrics and gynaecology, 2011-05)
      To test the hypothesis that women from Eastern European countries have lower caesarean delivery rates and higher spontaneous labour rates relative to Irish women in a setting in which the management of labour is standardised.
    • Fetal and maternal leptin in pre-gestational diabetic pregnancy.

      Higgins, Mary F; Russell, Noirin M; Brazil, Derek P; Firth, Richard G; McAuliffe, Fionnuala M; UCD Obstetrics and Gynecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2013-02)
      To compare maternal and fetal leptin among women without diabetes, women with type 1 diabetes, and women with type 2 diabetes.
    • Fetal metabolic influences of neonatal anthropometry and adiposity.

      Donnelly, Jean M; Lindsay, Karen L; Walsh, Jennifer M; Horan, Mary; Molloy, Eleanor J; McAuliffe, Fionnuala M (BioMed Central, 2015)
      Large for gestational age infants have an increased risk of obesity, cardiovascular and metabolic complications during life. Knowledge of the key predictive factors of neonatal adiposity is required to devise targeted antenatal interventions. Our objective was to determine the fetal metabolic factors that influence regional neonatal adiposity in a cohort of women with previous large for gestational age offspring.
    • Folic acid supplement use in the prevention of neural tube defects.

      Delany, C; McDonnell, R; Robson, M; Corcoran, S; Fitzpatrick, C; De La Harpe, D; RCSI, 123 St Stephen's Green, Dublin 2. (Irish medical journal, 2011-01)
      In 2008, planned folic acid fortification for the prevention of Neural Tube Defects (NTD) was postponed. Concurrently, the economic recession may have affected dietary folic acid intake, placing increased emphasis on supplement use. This study examined folic acid supplement use in 2009. A cross-sectional survey of 300 ante-natal women was undertaken to assess folic acid knowledge and use. Associations between demographic, obstetric variables and folic acid knowledge and use were examined. A majority, 284/297 (96%), had heard of folic acid, and 178/297 (60%) knew that it could prevent NTD. Most, 270/297 (91%) had taken it during their pregnancy, but only 107/297 (36%) had used it periconceptionally. Being older, married, planned pregnancy and better socioeconomic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from economic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from earlier years. Continuous promotion efforts are necessary. Close monitoring of folic acid intake and NTD rates is essential, particularly in the absence of fortification.
    • Ghrelin concentrations in maternal and cord blood of type 1 diabetic and non-diabetic pregnancies at term.

      Hehir, Mark P; Laursen, Henriette; Higgins, Mary F; Brennan, Donal J; O'Connor, Darran P; McAuliffe, Fionnuala M; UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland. markhehir23@gmail.com (Springer, 2013-02)
    • Identification of a myometrial molecular profile for dystocic labor.

      Brennan, Donal J; McGee, Sharon F; Rexhepaj, Elton; O'Connor, Darran P; Robson, Michael; O'Herlihy, Colm; National Maternity Hospital, Dublin , Ireland. (2011)
      The most common indication for cesarean section (CS) in nulliparous women is dystocia secondary to ineffective myometrial contractility. The aim of this study was to identify a molecular profile in myometrium associated with dystocic labor.
    • Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy.

      Walsh, Jennifer M; Mahony, Rhona M; Canty, Gillian; Foley, Michael E; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital,Dublin,Republic of Ireland. (2014-08-28)
      The present study is a secondary analysis of the ROLO study, a randomised control trial of a low-glycaemic index (GI) diet in pregnancy to prevent the recurrence of fetal macrosomia. The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures: birth weight; maternal glucose intolerance; gestational weight gain (GWG). In early pregnancy, 372 women had their mid-upper arm circumference recorded and BMI calculated. Concentrations of glucose, insulin and leptin were measured in early pregnancy and at 28 weeks. At delivery, infant birth weight was recorded and fetal glucose, C-peptide and leptin concentrations were measured in the cord blood. Women who benefited in terms of infant birth weight were shorter, with a lower education level. Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies, with no difference being observed in maternal height. Women who at 28 weeks of gestation developed glucose intolerance, despite the low-GI diet, had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance. They also had significantly higher-interval pregnancy weight gain. For each analysis, women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not. These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance, whereas birth weight is mediated more by genetic factors. It highlights key areas, which warrant further interrogation before future pregnancy intervention studies, in particular, maternal education level and inter-pregnancy weight gain.
    • Insufficient vitamin D intakes among pregnant women.

      McGowan, C A; Byrne, J; Walsh, J; McAuliffe, F M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. cmcgowa@gmail.com (2011-09)
      Vitamin D has an important role in pregnancy in promoting fetal skeletal health. Maternal dietary intake is a key factor influencing both maternal and fetal status. There are limited data available on food groups contributing to vitamin D intake in pregnancy. The aim of this study was to determine dietary intakes of vitamin D throughout pregnancy in 64 women and to determine the main food groups contributing to vitamin D intake. Results showed that median dietary intakes of vitamin D ranged from 1.9-2.1 μg/d during pregnancy, and were 80% below the current recommendation. The principal food groups contributing to vitamin D intake were meat, egg and breakfast cereal groups. Oily fish, the best dietary source of vitamin D, was consumed by <25% of women. These data call for more education; they question the role of vitamin D supplementation and highlight the contribution of other food groups more frequently consumed, namely, breakfast cereals, meat and eggs.
    • Interpregnancy weight changes and impact on pregnancy outcome in a cohort of women with a macrosomic first delivery: a prospective longitudinal study.

      Crosby, David A; Walsh, Jennifer M; Segurado, Ricardo; McAuliffe, Fionnuala M; Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland. UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland. CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. (BMJ Publishing Group Ltd, 2017-06-06)
      To determine the median interpregnancy maternal weight change between first and second pregnancies, and second and third pregnancies and to assess the impact of this weight change on pregnancy outcome in a cohort of women with a macrosomic first delivery.
    • An investigation into the relationship between the metabolic profile of follicular fluid, oocyte developmental potential, and implantation outcome.

      Wallace, Martina; Cottell, Evelyn; Gibney, Michael J; McAuliffe, Fionnuala M; Wingfield, Mary; Brennan, Lorraine; UCD Conway Institute, UCD School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland. (Fertility and sterility, 2012-05)
      To determine whether metabolomic analysis of follicular fluid could prove a useful noninvasive technique for the selection of viable oocytes and embryos.