Obstetrics and Gynaecology - Research Publications

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    Social media use and health and wellbeing of LGBTQ youth: A systematic review (Preprint)
    Berger, MN ; Taba, M ; Marino, JL ; Lim, MSC ; Skinner, SR ( 2022-04-02)
    Background: LGBTQ individuals are at higher risk of poor mental health and wellbeing. Social media platforms can provide LGBTQ youth a space which counters heteronormative environments and potentially supports mental health and wellbeing. Objective: In this systematic review, we sought to assess the relationship between social media use and mental health and wellbeing in LGBTQ youth. Methods: Searches were conducted in ACM Digital Library, CINAHL, OVID Embase, OVID Medline, and Web of Science. Quality was assessed using the Newcastle-Ottawa Scale for quantitative articles and the Critical Appraisal Skills Programme for qualitative articles. Qualitative synthesis was performed on articles that satisfied eligibility and inclusion criteria. Results: Twenty-six articles (15 qualitative, 8 quantitative, and 3 mixed methods) met the inclusion criteria. Social media is a popular tool commonly used by LGBTQ youth to connect with LGBTQ communities. LGBTQ youth also negotiated and explored identity and obtained support from peers on social media. Instagram, Tumblr, and Twitter were commonly used to access LGBTQ content due to ease of anonymity. Identity management was important for LGBTQ youth with social media allowing strategic disclosure. Key strategies for managing identities included being anonymous, censoring locations/content, restricting audiences, and using multiple accounts. Quantitative studies showed that social media was associated with reduced mental health concerns and increased wellbeing for LGBTQ youth. Mental health concerns arising from social media use were attributed to policies that did not accommodate for changed identities. Conclusions: We found that social media may support mental health and wellbeing of LGBTQ youth through peer connection, identity management, and social support but findings were limited by weaknesses in the evidence. More robust studies are needed to determine the relationship between social media use and LGBTQ mental health, particularly among adolescents. This may inform interventions to promote social media health literacy and the mental health and wellbeing of this vulnerable group.
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    Exposure to Pornography and Adolescent Sexual Behavior: Systematic Review (Preprint)
    Pathmendra, P ; Raggatt, M ; Lim, MSC ; Marino, JL ; Skinner, SR ( 2022-09-30)
    Formative experiences in adolescence lay the foundation for healthy and pleasurable romantic and sexual relationships throughout life. Exposure to pornography may impact these experiences. We aimed to synthesize evidence published in the past decade for relationships between exposure to pornography and sexual behavior (earlier age of first sex (<16), condomless sex, past-year multiple partners (>1), lifetime multiple partners (>1), group sex, sexual aggression including forced sex, paid sex, teenage pregnancy, and history of sexually transmitted infection) in adolescents aged 10-19. Searching Medline, PsycInfo, Cochrane, CINAHL, Embase, and Web of Science from January 2010 to March 2022, we identified nineteen eligible studies. Four out of six studies of earlier age of first sex, including one longitudinal study, found a significant association with exposure to pornography. Given most studies were cross-sectional or had substantial limitations, a causal inference could not be made. Evidence was conflicting or insufficient to make any conclusions for other outcomes. Exposure to pornography was not measured consistently. More quantitative research is needed to elucidate the association between pornography exposure and sexual behavior, and sex education should adopt evidence-based approaches to minimize potential harms of pornography.
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    Increase in preterm stillbirths and reduction in iatrogenic preterm births for fetal compromise: a multi-centre cohort study of COVID-19 lockdown effects in Melbourne, Australia
    Hui, L ; Marzan, MB ; Potenza, S ; Rolnik, D ; Pritchard, N ; Said, J ; Palmer, K ; Whitehead, C ; Sheehan, P ; Ford, J ; Mol, B ; Walker, S ( 2021)

    ABSTRACT

    Objectives

    The COVID-19 pandemic has been associated with a worsening of perinatal outcomes in many settings due to the combined impacts of maternal COVID-19 disease, disruptions to maternity care, and overloaded health systems. In 2020, Melbourne endured a unique natural experiment where strict lockdown conditions were accompanied by very low COVID-19 case numbers and the maintenance of health service capacity. The aim of this study was to compare stillbirth and preterm birth rates in women who were exposed or unexposed to lockdown restrictions during pregnancy.

    Design

    Retrospective multi-centre cohort study of perinatal outcomes before and during COVID-19 lockdown

    Setting

    Birth outcomes from all 12 public maternity hospitals in metropolitan Melbourne

    Inclusion criteria

    Singleton births without congenital anomalies from 24 weeks’ gestation. The lockdown-exposed cohort were those women for whom weeks 20- 40 of gestation would have occurred during the lockdown period of 23 March 2020 to 14 March 2021. The control cohort comprised all pregnancies in the corresponding periods one and two years prior to the exposed cohort.

    Main outcome measures

    Odds of stillbirth, preterm birth (PTB), birth weight < 3 rd centile, and iatrogenic PTB for fetal compromise, adjusting for multiple covariates.

    Results

    There were 24,017 births in the exposed and 50,017 births in the control group. There was a significantly higher risk of preterm, but not term, stillbirth in the exposed group compared with the control group (0.26% vs 0.18%, aOR 1.49, 95%CI 1.08 to 2.05, P = 0.015). There was also a significant reduction in preterm birth < 37 weeks (5.93% vs 6.23%, aOR 0.93, 95%CI 0.87 to 0.99, P=0.03), largely mediated by a reduction in iatrogenic PTB for live births (3.01% vs 3.27%, aOR 0.89, 95%CI 0.81 to 0.98, P = 0.015), including iatrogenic PTB for suspected fetal compromise (1.25% vs 1.51%, aOR 0.79, 95%CI 0.69 to 0.91, P= 0.001). There was no significant difference in the spontaneous PTB rate between the exposed and control groups (2.69% vs 2.82%, aOR 0.94, 95%CI 0.86 to 0.1.03, P=0.25).

    Conclusions

    Lockdown restrictions in a high-income setting, in the absence of high rates of COVID-19 disease, were associated with a significant increase in preterm stillbirths, and a significant reduction in iatrogenic PTB for suspected fetal compromise.

    Trial registration

    This study was registered as an observational study with the Australian and New Zealand Clinical Trials Registry (ACTRN12620000878976).
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    Point-of-care testing and treatment of sexually transmitted infections to improve birth outcomes in high-burden, low-income settings: Study protocol for a cluster randomized crossover trial (the WANTAIM Trial, Papua New Guinea).
    Vallely, AJ ; Pomat, WS ; Homer, C ; Guy, R ; Luchters, S ; Mola, GDL ; Kariwiga, G ; Vallely, LM ; Wiseman, V ; Morgan, C ; Wand, H ; Rogerson, SJ ; Tabrizi, SN ; Whiley, DM ; Low, N ; Peeling, R ; Siba, P ; Riddell, M ; Laman, M ; Bolnga, J ; Robinson, LJ ; Morewaya, J ; Badman, SG ; Batura, N ; Kelly-Hanku, A ; Toliman, PJ ; Peter, W ; Babona, D ; Peach, E ; Garland, SM ; Kaldor, JM (F1000 Research Ltd, 2019)
    Background: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and bacterial vaginosis have been associated with preterm birth and low birth weight, and are highly prevalent among pregnant women in many low- and middle-income settings. There is conflicting evidence on the potential benefits of screening and treating these infections in pregnancy. Newly available diagnostic technologies make it possible, for the first time, to conduct definitive field trials to fill this knowledge gap. The primary aim of this study is to evaluate whether antenatal point-of-care testing and immediate treatment of these curable sexually transmitted and genital infections (STIs) leads to reduction in preterm birth and low birth weight. Methods: The Women and Newborn Trial of Antenatal Interventions and Management (WANTAIM) is a cluster-randomised crossover trial in Papua New Guinea to compare point-of-care STI testing and immediate treatment with standard antenatal care (which includes the WHO-endorsed STI 'syndromic' management strategy based on clinical features alone without laboratory confirmation). The unit of randomisation is a primary health care facility and its catchment communities. The primary outcome is a composite measure of two events: the proportion of women and their newborns in each trial arm, who experience either preterm birth (delivery <37 completed weeks of gestation as determined by ultrasound) and/or low birth weight (<2500 g measured within 72 hours of birth). The trial will also evaluate neonatal outcomes, as well as the cost-effectiveness, acceptability and health system requirements of this strategy, compared with standard care. Conclusions: WANTAIM is the first randomised trial to evaluate the effectiveness, cost-effectiveness, acceptability and health system requirements of point-of-care STI testing and treatment to improve birth outcomes in high-burden settings. If the intervention is proven to have an impact, the trial will hasten access to these technologies and could improve maternal and neonatal health in high-burden settings worldwide. Registration: ISRCTN37134032.
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    Point-of-care testing and treatment of sexually transmitted infections to improve birth outcomes in high-burden, low-income settings: Study protocol for a cluster randomized crossover trial (the WANTAIM Trial, Papua New Guinea)
    Vallely, A ; Pomat, W ; Homer, C ; Guy, R ; Luchters, S ; Mola, G ; Kariwiga, G ; Vallely, L ; Wiseman, V ; Morgan, C ; Wand, H ; Rogerson, S ; Tabrizi, S ; Whiley, D ; Low, N ; Peeling, R ; Siba, P ; Riddell, M ; Laman, M ; Bolnga, J ; Robinson, L ; Morewaya, J ; Badman, S ; Batura, N ; Kelly-Hanku, A ; Toliman, P ; Peter, W ; Babona, D ; Peach, E ; Garland, S ; Kaldor, J (F1000 Research Ltd, 2019-03-22)
    Background: Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis and bacterial vaginosis have been associated with preterm birth and low birth weight, and are highly prevalent among pregnant women in many low- and middle-income settings. There is conflicting evidence on the potential benefits of screening and treating these infections in pregnancy. Newly available diagnostic technologies make it possible, for the first time, to conduct definitive field trials to fill this knowledge gap. The primary aim of this study is to evaluate whether antenatal point-of-care testing and immediate treatment of these curable sexually transmitted and genital infections (STIs) leads to reduction in preterm birth and low birth weight. Methods : The Women and Newborn Trial of Antenatal Interventions and Management (WANTAIM) is a cluster-randomised crossover trial in Papua New Guinea to compare point-of-care STI testing and immediate treatment with standard antenatal care (which includes the WHO-endorsed STI ‘syndromic’ management strategy based on clinical features alone without laboratory confirmation). The unit of randomisation is a primary health care facility and its catchment communities. The primary outcome is a composite measure of two events: the proportion of women and their newborns in each trial arm, who experience either preterm birth (delivery <37 completed weeks of gestation as determined by ultrasound) and/or low birth weight (<2500 g measured within 72 hours of birth). The trial will also evaluate neonatal outcomes, as well as the cost-effectiveness, acceptability and health system requirements of this strategy, compared with standard care. Conclusions: WANTAIM is the first randomised trial to evaluate the effectiveness, cost-effectiveness, acceptability and health system requirements of point-of-care STI testing and treatment to improve birth outcomes in high-burden settings. If the intervention is proven to have an impact, the trial will hasten access to these technologies and could improve maternal and neonatal health in high-burden settings worldwide. Registration: ISRCTN37134032 .