Objective To assess the prevalence of overweight and obesity, and the impact of body mass index (BMI) on maternal and neonatal outcomes, in a UK obstetric population. ). Maternal and neonatal outcomes were examined using logistic regression, adjusted for confounding variables.Main outcome measures Maternal and neonatal outcomes.Results Compared with women of normal weight, women who were overweight or obese class I were at significantly increased risk of hypertensive disorders of pregnancy (OR 1.9, 99% CI 1.7-2.3; OR 3.5, 99% CI 2.9-4.2); gestational diabetes mellitus (OR 1.7, 99% CI 1.3-2.3; OR 3.7, 99% CI 2.8-5.0); induction of labour (OR 1.2, 99% CI 1.1-1.3; OR 1.3, 99% CI 1.2-1.5); caesarean section (OR 1.4, 99% CI 1.3-1.5; OR 1.8, 99% CI 1.6-2.0); postpartum haemorrhage (OR 1.4, 99% CI 1.3-1.5; OR 1.8, 1.6-2.0); and macrosomia (OR 1.5, 99% CI 1.3-1.6; OR 1.9, 99% CI 1.6-2.2), with the risks increasing for obese classes II and III. Women in obese class III were at increased risk of preterm delivery (OR 1.6, 99% CI 1.1-2.5), stillbirth (OR 3.0, 99% CI 1.0-9.3), postnatal stay > 5 days (OR 2.1, 99% CI 1.5-3.1), and infant requiring admission to a neonatal unit (OR 1.6, 99% CI 1.0-2.6).Conclusions By categorising women into overweight and obesity subclassifications (classes I -III), this study clearly demonstrates an increasing risk of adverse outcomes across BMI categories, with women who are overweight also at significant risk.

Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were ≤ 2 years postpartum and with a body mass index (BMI) >18.5 kg m(-2), with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.

More infants with bronchopulmonary dysplasia (BPD) now survive to adulthood, but little is known regarding persisting respiratory impairment. We report respiratory symptoms, lung function and health-related quality of life (HRQoL) in adult BPD survivors compared with preterm (non-BPD) and fullterm controls.Respiratory symptoms (European Community Respiratory Health Survey) and HRQoL (EuroQol (EQ)-5D) were measured in 72 adult BPD survivors (mean¡SD study age 24.1¡4.0 years; mean¡SD gestational age 27.1¡2.1 weeks; and mean¡SD birth weight 955¡256 g) cared for in the regional neonatal intensive care unit, Royal Maternity Hospital, Belfast, UK (between 1978 and 1993). These were compared with 57 non-BPD controls (mean¡SD study age 25.3¡4.0 years; mean¡SD gestational age 31.0¡2.5 weeks; and mean¡SD birth weight 1238¡222 g) and 78 full-term controls (mean¡SD study age 25.7¡3.8 years; mean¡SD gestational age 39.7¡1.4 weeks; and mean¡SD birth weight 3514¡456 g) cared for at the same hospital. Spirometry was performed on 56 BPD, 40 non-BPD and 55 full-term participants.BPD subjects were twice as likely to report wheeze and three times more likely to use asthma medication than controls. BPD adults had significantly lower forced expiratory volume in 1 s and forced expiratory flow at 25-75% of forced vital capacity than both the preterm non-BPD and full-term controls (all p,0.01). Mean EQ-5D was 6 points lower in BPD adults compared to full-term controls (p,0.05).BPD survivors have significant respiratory and quality of life impairment persisting into adulthood.@ERSpublications Adult BPD survivors are more likely to have more respiratory symptoms, impaired health status and airflow obstruction than controls

These findings raise questions about how preconception care should be provided to women with diabetes and highlight the pivotal importance of supportive, familiar relationships between health professionals and women with diabetes in the provision of individualized care and advice. By improving the quality of relationships and communication between health care providers and patients, we will be better able to provide care and advice that is perceived as relevant to the individual, whatever her stage of family planning.

BackgroundMidwives’ practices during the second stage of labour vary nationally and internationally. We aim to retrieve evidence that supports high-quality intrapartum care by conducting a systematic review of the literature.MethodsElectronic bibliographic databases including PubMed, EMBASE.com, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Maternity and Infant Care Database (through MIDIRS), and The Cochrane Library will be searched to identify studies that meet the inclusion criteria. No language or publication date constraints will be applied. Articles that pass the two-stage screening process will then be assessed for risk of bias and have their reference lists hand searched.DiscussionA midwife’s practice can be influenced by education and cultural practices but ultimately it should be informed by up-to-date research evidence. By analysing and synthesising the results of the studies, this systematic review will provide valuable insight into high-quality evidence-based midwifery care, which can inform practice, education and future research.Systematic review registrationPROSPERO CRD42018088300Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0916-1) contains supplementary material, which is available to authorized users.

2001e2 to 16% in 2005e6, p<0.001) for children at all treatment steps including those prescribed short acting beta agonist only. Only 27 children were prescribed LABA without concurrent ICS and of the 710 children prescribed LABA/ICS combination, 176 (25%) had not been prescribed ICS in the previous year. Conclusions Revisions of the BTS/SIGN guidelines do modify prescribing practice in children. The greater use of LABA, LTRA and reduction in ICS dose has been accompanied by a greater use of OCS that may reflect poorer control of acute episodes or a lower threshold and greater confidence by prescribers in the use of OCS. Introduction and objectives Bronchopulmonary dysplasia (BPD) is the most common form of chronic lung disease in infancy and the second most common after asthma in children. With the improved survival of extremely preterm infants the incidence of BPD has increased. Currently there is only limited information on the health of BPD survivors who have reached adulthood. The purpose of this systematic literature review was to examine current empirical research on adult survivors of BPD. Methods Six electronic databases were searched between 1950 and February 2010 (Medline, PubMed, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL Plus) and Web of Knowledge. Studies were independently screened and were only included if they related to the assessment of outcome measures in adult survivors of BPD. From a total of 1453 search results, 14 eligible studies were included in the review. Data on methodological design and findings were extracted from each included study; in addition the methodological quality of each study was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Results 14 cohort studies met the review criteria. 12 scored highly on the CASP checklist, with a score >10 out of 12. No study scored less than 7. Nine studies included a control group and only four studies in total had a singular focus on BPD outcomes. Six controlled studies found differences between the groups on respiratory symptoms. 11 studies carried out lung function testing and found evidence of airflow obstruction. Of these, one study found no difference between preterm and controls. However, there were only seven adults who were born preterm with BPD in this study. Five studies in total examined radiographical outcomes, and all found evidence of abnormalities. Those with moderate-severe BPD were found to be most affected compared to mild BPD subjects.Conclusions The effects of BPD on pulmonary function do not diminish over time. This may reflect issues related to means of testing, differing definitions and classification of BPD, and the adaptation of individuals to their circumstances over time. P77CHILDREN'S EXPOSURE TO AIRBORNE FINE PARTICULATE MATTER AT HOME AND ASTHMA OUTCOMES Objectives The relationship between indoor air exposure to fine particulate (PM 2.5 ) and asthma symptoms in children is uncertain.The aim of the present study was to relate PM 2.5 exposure to indi...

More fathers than ever before attend at the birth of their child and, internationally, there is a palpable pressure on maternity and neonatal services to include and engage with fathers. It is, thus, more important than ever to understand how fathers experience reproductive and neonatal health services and to understand how fathers can be successfully accommodated in these environments alongside their partners. In this paper we advance a theoretical framework for re-thinking fatherhood and health services approaches to fatherhood based on Critical Studies on Men (CSM). We illustrate the importance of this feminist informed theoretical approach to understanding the gendered experiences of fathers in a Neonatal Intensive Care Unit (NICU) setting in Northern Ireland. Using a longitudinal follow-up research design, with two data collection points, a total of 39 in-depth semi-structured interviews was conducted with 21 fathers of infants admitted to the NICU between August 2008 and December 2009. The findings demonstrate: (i) how men are forging new gendered identities around the birth of their baby but, over time, acknowledge women as the primary caregivers; (ii) how social class is a key determinant of men's ability to enact hegemonic forms of 'involved fatherhood' in the NICU, and; (iii) how men also encounter resistance from their partners and health professionals in challenging a gender order which associates women with the competent care of infants. An understanding of these gendered experiences operating at both individual and structural levels is critical to leading change for the inclusion of fathers as equal parents in healthcare settings.

We propose that appropriately educated nursing and midwifery staff could facilitate the 'meaning making' process that is required for newly diagnosed HIV positive persons to find a subjective sense of well-being in their lives.