Gathering feedback from families following the death of their baby

Many parents who have experienced bereavement want to offer feedback to ensure lessons are learned and good practice is shared. This can be instrumental to inform improvements in care.

The Maternity Bereavement Experience Measure (MBEM) questionnaire and supporting resource was created collaboratively by Sands, NHS England and the London Maternity Clinical Network. The questionnaire is designed to seek feedback from bereaved parents where a baby or babies have died during pregnancy or shortly after birth.

Full document: Gathering feedback from families following the death of their baby.  A resource to support professionals in maternity care.

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Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia

Daniel L. Rolnik et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia  New England Journal of Medicne 28th June 2017 

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Image source: Mike Steele – Flickr // CC BY 2.0

Preterm preeclampsia is an important cause of maternal and perinatal death and complications. It is uncertain whether the intake of low-dose aspirin during pregnancy reduces the risk of preterm preeclampsia.

This multicenter, double-blind, placebo-controlled trial, randomly assigned 1776 women with singleton pregnancies who were at high risk for preterm preeclampsia to receive aspirin, at a dose of 150 mg per day, or placebo from 11 to 14 weeks of gestation until 36 weeks of gestation. The primary outcome was delivery with preeclampsia before 37 weeks of gestation.

Treatment with low-dose aspirin in women at high risk for preterm preeclampsia resulted in a significantly lower incidence of preterm preeclampsia than that with placebo.

Full article available via the New England Journal of Medicine

A closer look at perinatal depression

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Postnatal depression affects around 1 in 10 women and not only impacts on the wellbeing of the mother, but can also have long term impacts on the mental and physical health of the infant.

The authors of this Lancet paper are from the Postpartum Depression: Action Towards Causes and Treatment (PACT) consortium. This is an international group who aim to gather information about PND to explore a number of questions, including whether there are distinguishable subtypes of PND which might be relevant for treatment and prognosis, in particular taking into account comorbid anxiety.

In this post via The Mental Elf, Jill Domoney looks at the methods and results of this paper, the authors of which believe has created “an important hypothesis-generating foundation for future work”.

Full reference to the research: Putman K et al. (2017) Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an International Consortium. Lancet Psychiatry 4(6) 477-485.

Physical activity benefits for babies and children

The Department of Health has produced the following infographic as part of it’s ‘Start active, stay active’ series explaining the physical activity required to achieve general health benefits for different age ranges.

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Image source: http://www.gov.uk

See also: Physical activity for children and young people (5-18 years old): infographic

Physical activity in pregnancy

This infographic is the latest addition to a series commissioned by the UK Chief Medical Officers. It aims to provide clarity and consistency, and to equip health professionals to deliver evidence based recommendations on physical activity in pregnancy.

The aim is to ensure pregnant women are aware of the benefits of being active throughout their pregnancy and are clear about the physical activity recommendations. The infographic provides details regarding frequency, intensity and time, together with specific examples of suitable activities and key safety messages.

 

active pregnancy

Image source: http://www.gov.uk

National child measurement programme operational guidance

Guidance for local commissioners, providers and schools on running the national child measurement programme (NCMP) as part of the government’s commitment to tackling the public health challenge of excess weight.

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The publication of the Childhood Obesity Plan: A Plan for Action, in August 2016 shows that tackling child obesity is a priority for the Government. The plan aims to significantly reduce England’s rate of childhood obesity within the next ten years. Most local authorities have also identified addressing childhood obesity as a key issue in their health and wellbeing strategies, and reducing obesity is prioritised in many Sustainability and Transformation Plans.

The NCMP is key to monitoring the progress of the Government’s Childhood Obesity Plan. It provides the data for the Public Health Outcomes Framework indicators on “excess weight in children aged four to five years and ten to 11 years.” Because the data is valid at local level, it can also be used to inform the development and monitoring of local childhood obesity strategies.

 

National child measurement programme operational guidance

National child measurement programme: information for schools

Treatments for gestational diabetes: a systematic review and meta-analysis

An investigation into the effectiveness of different treatments for gestational diabetes mellitus | BMJ Open

Design: Systematic review, meta-analysis and network meta-analysis.

Methods: Data sources were searched up to July 2016 and included MEDLINE and Embase. Randomised trials comparing treatments for GDM (packages of care (dietary and lifestyle interventions with pharmacological treatments as required), insulin, metformin, glibenclamide (glyburide)) were selected by two authors and double checked for accuracy. Outcomes included large for gestational age, shoulder dystocia, neonatal hypoglycaemia, caesarean section and pre-eclampsia. We pooled data using random-effects meta-analyses and used Bayesian network meta-analysis to compare pharmacological treatments (ie, including treatments not directly compared within a trial).

Results: Forty-two trials were included, the reporting of which was generally poor with unclear or high risk of bias. Packages of care varied in their composition and reduced the risk of most adverse perinatal outcomes compared with routine care (eg, large for gestational age: relative risk0.58 (95% CI 0.49 to 0.68; I2=0%; trials 8; participants 3462). Network meta-analyses suggest that metformin had the highest probability of being the most effective treatment in reducing the risk of most outcomes compared with insulin or glibenclamide.

Conclusions: Evidence shows that packages of care are effective in reducing the risk of most adverse perinatal outcomes. However, trials often include few women, are poorly reported with unclear or high risk of bias and report few outcomes. The contribution of each treatment within the packages of care remains unclear. Large well-designed and well-conducted trials are urgently needed.

full reference: Farrar D, et al. (2017) Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ Open. 7:e015557.