9 results on '"Poprzeczny, AJ"'
Search Results
2. Antenatal Physical Activity Interventions and Pregnancy Outcomes: A Systematic Review and Meta-Analysis With a Focus on Trial Quality.
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Poprzeczny AJ, Deussen AR, Mitchell M, Slade L, Louise J, and Dodd JM
- Abstract
Background: Guidelines recommending regular physical activity in pregnancy for improving pregnancy outcomes are informed by published meta-analyses. Inclusion of randomised trials of poor methodological quality may bias effect estimates., Objectives: To assess the validity of these recommendations by focusing on trial quality., Search Strategy: Systematic search of PubMed, PubMed Central, Ovid Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL from inception to 14 December 2023., Selection Criteria: Randomised trials evaluating an antenatal physical activity intervention alone, compared with no such intervention., Data Collection and Analysis: Trial quality was assessed using the Cochrane Risk of Bias tool. Independent of this, studies were grouped based on degree of deviation from the intention to treat principle. Sequential meta-analysis was performed in which greater degrees of potential bias were allowed. Between intervention group comparisons used, relative risks or mean differences with 95% confidence intervals for dichotomous outcomes and continuous outcomes, respectively., Main Results: Overall, the quality of trial reporting was low. Only 5 trials (12.5%) were performed and analysed in keeping with the intention to treat principle. When considering only those trials performed rigorously, there was no evidence that antenatal physical activity improves pregnancy outcomes or limits gestational weight gain (WMD -0.60 kg; 95% CI -2.17, 0.98 WMD -0.60 kg; 95% CI -2.17, 0.98)., Conclusions: When considering only trials at no/negligible risk of bias, antenatal physical activity interventions were not associated with improved pregnancy outcomes. Most trials were not methodologically rigorous. Incorporation of such meta-analyses into pregnancy care guidelines may result in inaccurate recommendations., (© 2025 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.) more...
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- 2025
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3. Investigating discrepancies in findings between rigorous randomized trials and meta-analyses evaluating pregnancy interventions to limit gestational weight gain.
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Dodd JM, Deussen AR, Poprzeczny AJ, Slade LJ, Mitchell M, and Louise J
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- Female, Humans, Pregnancy, Diabetes, Gestational prevention & control, Diet, Meta-Analysis as Topic, Pregnancy Complications prevention & control, Randomized Controlled Trials as Topic, Exercise, Gestational Weight Gain
- Abstract
Introduction: Robust randomized trials consistently demonstrate little impact from diet and physical activity interventions on gestational weight gain (GWG) and clinical outcomes, although meta-analyses report some benefit. Our aim was to evaluate the effect of trial quality on treatment effect estimates and review conclusions., Methods: We conducted a systematic review of dietary and/or physical activity interventions for pregnant women with a body mass index ≥18.5 kg/m
2 . We assessed studies for risk of bias and methodological features impacting reliability. Outcomes included GWG; gestational diabetes mellitus (GDM); pre-eclampsia; caesarean birth; and birth weight measures. For each outcome, a sequence of meta-analyses was performed based on intervention group and level of potential bias in the effect estimate., Results: We identified 128 eligible studies. The most robust estimate from a combined diet and physical activity behavioral intervention, with only studies at negligible risk of bias, was a difference in GWG of 1.10 kg (95% CI -1.62 to -0.58; 17,755 women). There was no evidence of an effect on any clinical outcomes., Conclusions: Our findings highlight discrepancies produced by the indiscriminate inclusion of studies with methodological flaws in previous systematic reviews. Regular weighing of pregnant women is futile in the absence of clinical benefit., (© 2024 The Author(s). Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.) more...- Published
- 2024
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4. Fetal Growth and Adiposity of Infants Born Large for Gestational Age in Three Harmonized Randomized Trials.
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Poprzeczny AJ, Louise J, Deussen AR, and Dodd JM
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- Humans, Female, Pregnancy, Infant, Newborn, Adult, Birth Weight, Male, Randomized Controlled Trials as Topic, Adiposity, Fetal Development physiology, Fetal Macrosomia, Gestational Age, Body Mass Index, Ultrasonography, Prenatal
- Abstract
Objective: Infants born large for gestational age (LGA) are at an increased risk of short- and longer-term adverse outcomes. Understanding fetal growth and adiposity and their trajectories may help inform interventions to prevent birth of LGA infants. We aimed to compare fetal growth and adiposity measures of infants born LGA with those born not LGA, to determine whether the discrepancy at birth was primarily due to larger size throughout gestation, or instead to different trajectories of fetal growth., Study Design: This was a secondary analysis of secondary outcomes of fetal growth and adiposity from three harmonized randomized trials-the LIMIT, GRoW, and Optimise randomized trials. These trials recruited women in early pregnancy, and a singleton gestation, from three major public metropolitan Adelaide maternity hospitals. Maternal body mass index (BMI) ranged from 18.5 to ≥40.0 kg/m
2 . Data were obtained from enrolled women who underwent research ultrasounds at 28 and 36 weeks' gestation. Outcome measures were ultrasound measures of fetal biometry and adiposity., Results: Infants born LGA had larger fetal biometry measures, and higher growth trajectories, from 20 weeks' gestation. Fetal adiposity measures were consistently larger among infants born LGA and these differences increased over time. We did not find evidence that the differences in biometry and adiposity measurements varied according to maternal BMI., Conclusion: Infants born LGA had larger fetal biometry measures at all time points from 20 weeks' gestation, compared with infants born not LGA suggesting any interventions to prevent LGA likely need to commence earlier in pregnancy or prior to conception., Key Points: · Infants born LGA had larger fetal biometry measures from 20 weeks' gestation.. · Infants born LGA had larger fetal adiposity measures.. · Interventions to prevent LGA need to start earlier in pregnancy or prior to conception.., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).) more...- Published
- 2024
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5. Maternal overweight and obesity during pregnancy: strategies to improve outcomes for women, babies, and children.
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Dodd JM, Deussen AR, Mitchell M, Poprzeczny AJ, and Louise J
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- Body Mass Index, Child, Female, Humans, Obesity complications, Obesity therapy, Pregnancy, Weight Gain, Overweight complications, Overweight therapy, Pregnancy Complications prevention & control
- Abstract
Introduction: Women with overweight and obesity, and their children, are at increased risk of adverse pregnancy, birth, and longer term health outcomes, believed to be compounded by excessive gestational weight gain (GWG). Research to date has focused on interventions to reduce excessive GWG through changes to maternal diet and/or lifestyle., Areas Covered: Current clinical recommendations for GWG vary according to a woman's early pregnancy body mass index, based on assumptions that associations between GWG and adverse pregnancy outcomes are causal in nature, and modifiable. While there are small differences in GWG following pregnancy interventions, there is little evidence for clinically relevant effects on pregnancy, birth, and longer term childhood outcomes. This review considers interventional studies targeting women with overweight or obesity to reduce GWG in an effort to improve maternal and infant health, and the current evidence for interventions prior to conception., Expert Opinion: GWG is not modifiable via diet and lifestyle change, and continued efforts to find the 'right' intervention for women with overweight and obesity during pregnancy are unjustified. Researchers should focus on gathering evidence for interventions prior to pregnancy to optimize maternal health and weight to improve pregnancy, birth, and longer term health outcomes associated with obesity. more...
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- 2022
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6. The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials.
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Louise J, Poprzeczny AJ, Deussen AR, Vinter C, Tanvig M, Jensen DM, Bogaerts A, Devlieger R, McAuliffe FM, Renault KM, Carlsen E, Geiker N, Poston L, Briley A, Thangaratinam S, and Dodd JM
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- Child, Child, Preschool, Diet, Female, Humans, Life Style, Overweight epidemiology, Overweight therapy, Pregnancy, Pregnant People, Randomized Controlled Trials as Topic, Pediatric Obesity epidemiology, Pediatric Obesity prevention & control, Pregnancy Complications
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Background: The impact of maternal obesity extends beyond birth, being independently associated with an increased risk of child obesity. Current evidence demonstrates that women provided with a dietary intervention during pregnancy improve their dietary quality and have a modest reduction in gestational weight gain. However, the effect of this on longer-term childhood obesity-related outcomes is unknown., Methods: We conducted an individual participant data meta-analysis from RCTs in which women with a singleton, live gestation between 10
+0 and 20+0 weeks and body mass index (BMI) ≥ 25 kg/m2 in early pregnancy were randomised to a diet and/or lifestyle intervention or continued standard antenatal care and in which longer-term maternal and child follow-up at 3-5 years of age had been undertaken. The primary childhood outcome was BMI z-score above the 90th percentile. Secondary childhood outcomes included skinfold thickness measurements and body circumferences, fat-free mass, dietary and physical activity patterns, blood pressure, and neurodevelopment., Results: Seven primary trials where follow-up of participants occurred were identified by a systematic literature search within the International Weight Management in Pregnancy (i-WIP) Collaborative Group collaboration, with six providing individual participant data. No additional studies were identified after a systematic literature search. A total of 2529 children and 2383 women contributed data. Approximately 30% of all child participants had a BMI z-score above the 90th percentile, with no significant difference between the intervention and control groups (aRR 0.97; 95% CI 0.87, 1.08; p=0.610). There were no statistically significant differences identified for any of the secondary outcome measures., Conclusions: In overweight and obese pregnant women, we found no evidence that maternal dietary and/or lifestyle intervention during pregnancy modifies the risk of early childhood obesity. Future research may need to target the pre-conception period in women and early childhood interventions., Trial Registration: PROSPERO, CRD42016047165. more...- Published
- 2021
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7. Skin and subcutaneous fascia closure at caesarean section to reduce wound complications: the closure randomised trial.
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Poprzeczny AJ, Grivell RM, Louise J, Deussen AR, and Dodd JM
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- Adult, Australia, Fascia, Female, Follow-Up Studies, Hematoma etiology, Hematoma prevention & control, Humans, Incidence, Pregnancy, Seroma etiology, Seroma prevention & control, Skin, Surgical Wound Infection etiology, Surgical Wound Infection prevention & control, Suture Techniques instrumentation, Sutures adverse effects, Cesarean Section adverse effects, Hematoma epidemiology, Seroma epidemiology, Surgical Wound Infection epidemiology, Suture Techniques adverse effects
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Background: Wound infection is a common complication following caesarean section. Factors influencing the risk of infection may include the suture material for skin closure, and closure of the subcutaneous fascia. We assessed the effect of skin closure with absorbable versus non-absorbable suture, and closure versus non-closure of the subcutaneous fascia on risk of wound infection following Caesarean section., Methods: Women undergoing caesarean birth at an Adelaide maternity hospital were eligible for recruitment to a randomised trial using a 2 × 2 factorial design. Women were randomised to either closure or non-closure of the subcutaneous fascia and to subcuticular skin closure with an absorbable or non-absorbable suture. Participants were randomised to each of the two interventions into one of 4 possible groups: Group 1 - non-absorbable skin suture and non-closure of the subcutaneous fascia; Group 2 - absorbable skin suture and non-closure of the subcutaneous fascia; Group 3 - non-absorbable skin suture and closure of the subcutaneous fascia; and Group 4 - absorbable skin suture and closure of the subcutaneous fascia. The primary outcomes were reported wound infection and wound haematoma or seroma within the first 30 days after birth., Results: A total of 851 women were recruited and randomised, with 849 women included in the analyses (Group 1: 216 women; Group 2: 212 women; Group 3: 212 women; Group 4: 211 women). In women who underwent fascia closure, there was a statistically significant increase in risk of wound infection within 30 days post-operatively for those who had skin closure with an absorbable suture (Group 4), compared with women who had skin closure with a non-absorbable suture (Group 3) (adjusted RR 2.17; 95% CI 1.05, 4.45; p = 0.035). There was no significant difference in risk of wound infection for absorbable vs non-absorbable sutures in women who did not undergo fascia closure., Conclusion: The combination of subcutaneous fascia closure and skin closure with an absorbable suture may be associated with an increased risk of reported wound infection after caesarean section., Trial Registration: Prospectively registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12608000143325 , on the 20th March, 2008. more...
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- 2020
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8. Effect of metformin in addition to an antenatal diet and lifestyle intervention on fetal growth and adiposity: the GRoW randomised trial.
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Poprzeczny AJ, Louise J, Deussen AR, and Dodd JM
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- Adiposity physiology, Adult, Body Mass Index, Diet, Exercise physiology, Female, Fetus drug effects, Fetus metabolism, Gestational Age, Humans, Life Style, Maternal Nutritional Physiological Phenomena drug effects, Metformin therapeutic use, Pregnancy, Pregnancy Complications prevention & control, Prenatal Exposure Delayed Effects metabolism, Prenatal Exposure Delayed Effects physiopathology, Risk Reduction Behavior, Young Adult, Adiposity drug effects, Fetal Development drug effects, Metformin pharmacology, Prenatal Care methods
- Abstract
Background: The infants born to women who are overweight or obese in pregnancy are at an increased risk of being born macrosomic or large for gestational age. Antenatal dietary and lifestyle interventions have been shown to be ineffective at reducing this risk. Our aim was to examine the effects of metformin in addition to a diet and lifestyle intervention on fetal growth and adiposity among women with a BMI above the healthy range., Methods: Women who had a body mass index ≥25 kg/m
2 in early pregnancy, and a singleton gestation, were enrolled in the GRoW trial from three public maternity hospitals in metropolitan Adelaide. Women were invited to have a research ultrasounds at 28 and 36 weeks' gestation at which ultrasound measures of fetal biometry and adiposity were obtained. Fetal biometry z-scores and trajectories were calculated. Measurements and calculations were compared between treatment groups. This secondary analysis was pre-specified., Results: Ultrasound data from 511 women were included in this analysis. The difference in femur length at 36 weeks' gestation was (0.07 cm, 95% CI 0.01-0.14 cm, p = 0.019) and this was was statistically significant, however the magnitude of effect was small. Differences between treatment groups for all other fetal biometry measures, z-scores, estimated fetal weight, and adiposity measures at 28 and 36 weeks' gestation were similar., Conclusions: The addition of metformin to dietary and lifestyle advice in pregnancy for overweight and obese women has no clinically relevant effect on ultrasound measures of fetal biometry or adiposity., Trial Registration: Australian and New Zealand Clinical Trials Registry ( ACTRN12612001277831 ). more...- Published
- 2020
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9. Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics and Gynecology: A Systematic Review and Meta-analysis.
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Poprzeczny AJ, Stocking K, Showell M, and Duffy JMN
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- Female, Gynecology methods, Humans, Obstetrics methods, Pregnancy, Randomized Controlled Trials as Topic, Decision Making, Shared, Decision Support Techniques, Patient Participation
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Objective: To assess the effectiveness of patient decision aids to facilitate shared decision making in obstetrics and gynecology., Data Sources: We searched ClinicalTrials.gov, MEDLINE, CENTRAL, Cochrane Gynaecology and Fertility specialized register, CINAHL, and EMBASE from 1946 to July 2019., Methods of Study Selection: We selected randomized controlled trials comparing patient decision aids with usual clinical practice or a control intervention., Tabulation, Integration, and Results: Thirty-five randomized controlled trials, which reported data from 9,790 women, were included. Patient decision aids were evaluated within a wide range of clinical scenarios relevant to obstetrics and gynecology, including contraception, vaginal birth after cesarean delivery, and pelvic organ prolapse. Study characteristics and quality were recorded for each study. The meta-analysis was based on random-effects methods for pooled data. A standardized mean difference of 0.2 is considered small, 0.5 moderate, and 0.8 large. When compared with usual clinical practice, the use of patient decision aids reduced decisional conflict (standardized mean difference -0.23; 95% CI -0.36, to -0.11; 19 trials; 4,624 women) and improved patient knowledge (standardized mean difference 0.58; 95% CI 0.44 to 0.71; 17 trials; 4,375 women). There was no difference in patient anxiety (standardized mean difference -0.04; 95% CI -0.14 to 0.06; 12 trials; 2,714 women) or satisfaction (standardized mean difference 0.17; 95% CI 0.09 to 0.24; 6 trials; 2,718 women)., Conclusion: Patient decision aids are effective in facilitating shared decision making and can be helpful in clinical practice to support patient centered care informed by the best evidence., Systematic Review Registration: PROSPERO International Register of Systematic Reviews, www.crd.york.ac.uk/prospero/89953, CRD42018089953. more...
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- 2020
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