Dr Zhuoyang Li
Senior Postdoctoral Research Fellow
Office of the PVC Health and Medicine
- Phone:(02) 404 20525
Dr. Zhuoyang Li (BMed, MPH, PhD) is a Senior Postdoctoral Research Fellow in the Faculty of Health and Medicine at the University of Newcastle. Zhuoyang is a perinatal epidemiologist with research interests in pregnancy-related maternal and perinatal morbidity and mortality, assisted reproductive technology, and mental health issues in the context of perinatal and reproductive medicine. Zhuoyang has extensive experience in managing routine health data collections, conducting analyses on linked data, undertaking complex data analyses using advanced statistical methods, and reporting national health data. From 2014 to 2020, Zhuoyang worked as a Senior Research Coordinator at University of Technology Sydney on the Australasian Maternity Outcomes Surveillance System (AMOSS) project, which investigated a variety of rare or serious conditions in pregnancy. Prior to this, Zhuoyang was the national manager of the National Perinatal Data Collection (NPDC) at the Australian Institute of Health and Welfare National Perinatal Epidemiology and Statistics Unit (UNSW, 2009–2014). In her current role at University of Newcastle, Zhuoyang’s main focus of research relates to the ‘Cancer and reproductive outcomes for women: a population-based cohort study’. This data linkage program investigates the inter-associations between cancer and reproduction by examining: cancer survivorship; pregnancy, maternal, perinatal and infant outcomes of women with pregnancy-associated cancer; and outcomes for cancer survivors who subsequently give birth.
- Doctor of Philosophy, University of Sydney
- Master of Public Health, University of Queensland
- assisted reproductive technology
- maternal health
- perinatal epidemiology
- reproductive health
Fields of Research
|111402||Obstetrics and Gynaecology||30|
|Title||Organisation / Department|
|Dates||Title||Organisation / Department|
|1/11/2009 - 30/5/2014||Research Officer||UNSW
Perinatal and Reproductive Epidemiology Research Unit, School of Women's and Children's Health
|1/6/2014 - 31/3/2020||Senior Research Coordinator||University of Technology Sydney
Faculty of Health
For publications that are currently unpublished or in-press, details are shown in italics.
Journal article (36 outputs)
Hogan RG, Wang AY, Li Z, Hammarberg K, Johnson L, Mol BW, Sullivan EA, 'Having a baby in your 40s with assisted reproductive technology: The reproductive dilemma of autologous versus donor oocytes.', Aust N Z J Obstet Gynaecol, (2020)
Sullivan EA, Vaughan G, Li Z, Peek MJ, Carapetis JR, Walsh W, et al., 'The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study', BJOG: An International Journal of Obstetrics and Gynaecology, 127 47-56 (2020)
© 2019 Royal College of Obstetricians and Gynaecologists Objective: To describe the epidemiology of rheumatic heart disease (RHD) in pregnancy in Australia and New Zealand (A&... [more]
© 2019 Royal College of Obstetricians and Gynaecologists Objective: To describe the epidemiology of rheumatic heart disease (RHD) in pregnancy in Australia and New Zealand (A&NZ). Design: Prospective population-based study. Setting: Hospital-based maternity units throughout A&NZ. Population: Pregnant women with RHD with a birth outcome of =20¿weeks of gestation between January 2013 and December 2014. Methods: We identified eligible women using the Australasian Maternity Outcomes Surveillance System (AMOSS). De-identified antenatal, perinatal and postnatal data were collected and analysed. Main outcome measures: Prevalence of RHD in pregnancy. Perinatal morbidity and mortality. Results: There were 311 pregnancies associated with women with RHD (4.3/10¿000 women giving birth, 95% CI 3.9¿4.8). In Australia, 78% were Aboriginal or Torres Strait Islander (60.4/10¿000, 95% CI 50.7¿70.0), while in New Zealand 90% were Maori or Pasifika (27.2/10¿000, 95% CI 22.0¿32.3). One woman (0.3%) died and one in ten was admitted to coronary or intensive care units postpartum. There were 314 births with seven stillbirths (22.3/1000 births) and two neonatal deaths (6.5/1000 births). Sixty-six (21%) live-born babies were preterm and one in three was admitted to neonatal intensive care or special care units. Conclusion: Rheumatic heart disease in pregnancy persists in disadvantaged First Nations populations in A&NZ. It is associated with significant cardiac and perinatal morbidity. Preconception planning and counselling and RHD screening in at-risk pregnant women are essential for good maternal and baby outcomes. Tweetable abstract: Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.
Safi N, Sullivan E, Li Z, Brown M, Hague W, McDonald S, et al., 'Serious kidney disease in pregnancy: an Australian national cohort study protocol', BMC NEPHROLOGY, 20 (2019)
Safi N, Anazodo A, Dickinson JE, Lui K, Wang AY, Li Z, Sullivan EA, 'In utero exposure to breast cancer treatment: a population-based perinatal outcome study', British Journal of Cancer, 121 719-721 (2019) [C1]
© 2019, Cancer Research UK. Chemotherapy during a viable pregnancy may be associated with adverse perinatal outcomes. We conducted a prospective cohort study to examine the perina... [more]
© 2019, Cancer Research UK. Chemotherapy during a viable pregnancy may be associated with adverse perinatal outcomes. We conducted a prospective cohort study to examine the perinatal outcomes of babies born following in utero exposure to chemotherapy in Australia and New Zealand. Over 18 months we identified 24 births, of >400 g and/or >20-weeks¿ gestation, to women diagnosed with breast cancer in the first or second trimesters. Eighteen babies were exposed in utero to chemotherapy. Chemotherapy commenced at a median of 20 weeks gestation, for a mean duration of 10 weeks. Twelve exposed infants were born preterm with 11 by induced labour or pre-labour caesarean section. There were no perinatal deaths or congenital malformations. Our findings show that breast cancer diagnosed during mid-pregnancy is often treated with chemotherapy. Other than induced preterm births, there were no serious adverse perinatal outcomes.
Pollock W, Peek MJ, Wang A, Li Z, Ellwood D, Homer CSE, et al., 'Eclampsia in Australia and New Zealand: A prospective population-based study', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, (2019)
Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, Deneux-Tharaux C, Kristufkova A, Li Z, et al., 'Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study.', PLoS Med, 16 e1002962 (2019) [C1]
Farquhar CM, Li Z, Lensen S, McLintock C, Pollock W, Peek MJ, et al., 'Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: A case-control study', BMJ Open, 7 (2017)
© Article author(s) 2017. Objective Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes. Design Case-control study. Sett... [more]
© Article author(s) 2017. Objective Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes. Design Case-control study. Setting Sites in Australia and New Zealand with at least 50 births per year. Participants Cases were women giving birth (=20 weeks or fetus =400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls. Methods Data were collected using the Australasian Maternity Outcomes Surveillance System. Primary and secondary outcome measures Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death). Results The incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women=40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR =2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%). Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
Sullivan EA, Javid N, Duncombe G, Li Z, Safi N, Cincotta R, et al., 'Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia', Obstetrics and Gynecology, 130 591-598 (2017)
Copyright © by The American College of Obstetricians. OBJECTIVE: To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis... [more]
Copyright © by The American College of Obstetricians. OBJECTIVE: To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes. METHODS: A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth. RESULTS: Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8-10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight. CONCLUSION: The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.
Souza JP, Betran AP, Dumont A, De Mucio B, Gibbs Pickens CM, Deneux-Tharaux C, et al., 'A global reference for caesarean section rates (C-Model): A multicountry cross-sectional study', BJOG: An International Journal of Obstetrics and Gynaecology, 123 427-436 (2016)
© 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists. Objective To generate a global reference ... [more]
© 2015 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists. Objective To generate a global reference for caesarean section (CS) rates at health facilities. Design Cross-sectional study. Setting Health facilities from 43 countries. Population/Sample Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measures Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal-perinatal-health/c-model/en/). Conclusions This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstract The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems.
Mu Y, McDonnell N, Li Z, Liang J, Wang Y, Zhu J, Sullivan E, 'Amniotic fluid embolism as a cause of maternal mortality in China between 1996 and 2013: A population-based retrospective study', BMC Pregnancy and Childbirth, 16 (2016)
© 2016 The Author(s). Background: To analyse the maternal mortality ratio, demographic and pregnancy related details in women who suffered a fatal amniotic fluid embolism (AFE) in... [more]
© 2016 The Author(s). Background: To analyse the maternal mortality ratio, demographic and pregnancy related details in women who suffered a fatal amniotic fluid embolism (AFE) in China. Methods: A retrospective population based study using data collected as part of the National Maternal Mortality Surveillance System between 1996 and 2013. Data were collected onto a standardised form from women whose cause of death was listed as being secondary to AFE. Results: Records were available for 640 deaths. Over the 17 year period the maternal mortality ratio for AFE decreased from 4.4 per 100,000 births (95 % confidence interval (CI):2.72-6.12) to 1.9 per 100,000 births (95 % CI:1.35-2.54). Over the same period the proportion of maternal deaths secondary to AFE increased from 6.8 to 12.5 %. The mean age of women who died was 30.1 years and the onset of the AFE occurred prior to delivery in 39 %. The most prominent presenting features included premonitory symptoms (29 %), acute fetal compromise (28 %), maternal haemorrhage (16 %) and shortness of breath (15 %). Conclusions: Maternal mortality secondary to AFE has decreased in China, however at a slower rate than mortality secondary to other conditions. Active surveillance is recommended to assess case fatality rates, risk factors and other lessons specific to this population.
Li Z, Sullivan EA, Chapman M, Farquhar C, Wang YA, 'Risk of ectopic pregnancy lowest with transfer of single frozen blastocyst', Human Reproduction, 30 2048-2054 (2015)
© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. STUDY QUESTION What type of transferred embryo is a... [more]
© The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. STUDY QUESTION What type of transferred embryo is associated with a lower rate of ectopic pregnancy? SUMMARY ANSWER The lowest risk of ectopic pregnancy was associated with the transfer of blastocyst, frozen and single embryo compared with cleavage stage, fresh and multiple embryos. WHAT IS KNOWN ALREADY Ectopic pregnancy is a recognized complication following assisted reproductive technology (ART) treatment. It has been estimated that the rate of ectopic pregnancy is doubled in pregnancies following ART treatment compared with spontaneous pregnancies. However, it was not clear whether the excess rate of ectopic pregnancy following ART treatment is related to the underlying demographic factors of women undergoing ART treatment, the number of embryos transferred or the developmental stage of the embryo. STUDY DESIGN, SIZE, DURATION A population-based cohort study of pregnancies following autologous treatment cycles between January 2009 and December 2011 were obtained from the Australian and New Zealand Assisted Reproduction Technology Database (ANZARD). The ANZARD collects ART treatment information and clinical outcomes annually from all fertility centres in Australia and New Zealand. PARTICIPANTS/MATERIALS, SETTING, METHODS Between 2009 and 2011, a total of 44 102 pregnancies were included in the analysis. The rate of ectopic pregnancy was compared by demographic and ART treatment factors. Generalized linear regression of Poisson distribution was used to estimate the likelihood of ectopic pregnancy. Odds ratios, adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. MAIN RESULTS AND THE ROLE OF CHANCE The overall rate of ectopic pregnancy was 1.4% for women following ART treatment in Australia and New Zealand. Pregnancies following single embryo transfers had 1.2% ectopic pregnancies, significantly lower than double embryo transfers (1.8%) (P < 0.01). The highest ectopic pregnancy rate was 1.9% for pregnancies from transfers of fresh cleavage embryo, followed by transfers of frozen cleavage embryo (1.7%), transfers of fresh blastocyst (1.3%), and transfers of frozen blastocyst (0.8%). Compared with fresh blastocyst transfer, the likelihood of ectopic pregnancy was 30% higher for fresh cleavage stage embryo transfers (AOR 1.30, 95% CI 1.07-1.59) and was consistent across subfertility groups. Transfer of frozen blastocyst was associated with a significantly decreased risk of ectopic pregnancy (AOR 0.70, 95% CI 0.54-0.91) compared with transfer of fresh blastocyst. LIMITATIONS, REASON FOR CAUTION A limitation of this population-based study is the lack of information available on clinical- specific protocols and processes for embryo transfer (i.e. embryo quality, cryopreservation protocol, transfer techniques, etc.) and the potential impact on outcomes. WIDER IMPLICATIONS OF THE FINDINGS The lowest risk of ectopic pregnancy was associated with the transfer of a single frozen blastocyst. This finding adds to the increasing evidence of better perinatal outcomes following frozen embryo transfers. The approach of freezing all embryos in the initiated fresh cycle and transfer of a single frozen blastocyst in the subsequent thaw cycle may improve the overall pregnancy and birth outcomes following ART treatment, in part by reducing the ectopic pregnancy rate.
Li Z, Umstad MP, Hilder L, Xu F, Sullivan EA, 'Australian national birthweight percentiles by sex and gestational age for twins, 2001-2010', BMC Pediatrics, 15 (2015)
© 2015 Li et al. Background: Birthweight remains one of the strongest predictors of perinatal mortality and disability. Birthweight percentiles form a reference that allows the de... [more]
© 2015 Li et al. Background: Birthweight remains one of the strongest predictors of perinatal mortality and disability. Birthweight percentiles form a reference that allows the detection of neonates at higher risk of neonatal and postneonatal morbidity. The aim of the study is to present updated national birthweight percentiles by gestational age for male and female twins born in Australia. Methods: Population data were extracted from the Australian National Perinatal Data Collection for twins born in Australia between 2001 and 2010. A total of 43,833 women gave birth to 87,666 twins in Australia which were included in the study analysis. Implausible birthweights were excluded using Tukey's methodology based on the interquartile range. Univariate analysis was used to examine the birthweight percentiles for liveborn twins born between 20 and 42 weeks gestation. Results: Birthweight percentiles by gestational age were calculated for 85,925 live births (43,153 males and 42,706 females). Of these infants, 53.6 % were born preterm (birth before 37 completed weeks of gestation) while 50.2 % were low birthweight (<2500 g) and 8.7 % were very low birthweight (<1500 g). The mean birthweight decreased from 2462 g in 2001 to 2440 g in 2010 for male twins, compared with 2485 g in 1991-94. For female twins, the mean birthweight decreased from 2375 g in 2001 to 2338 g in 2010, compared with 2382 g in 1991-94. Conclusions: The birthweight percentiles provide clinicians and researchers with up-to-date population norms of birthweight percentiles for twins in Australia.
Sullivan EA, Dickinson JE, Vaughan GA, Peek MJ, Ellwood D, Homer CSE, et al., 'Maternal super-obesity and perinatal outcomes in Australia: A national population-based cohort study', BMC Pregnancy and Childbirth, 15 (2015)
© 2015 Sullivan et al. Background: Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purp... [more]
© 2015 Sullivan et al. Background: Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. Methods: A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m2 or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95 % confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. Results: 370 super-obese women with a median BMI of 52.8 kg/m2 (range 40.9-79.9 kg/m2) and prevalence of 2.1 per 1 000 women giving birth (95 % CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2 %), smoke (23.8 %) and be socio-economically disadvantaged (36.2 %). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95 % CI: 1.77-3.29) and medical (AOR: 2.89, 95 % CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6 %) and admission to special care (HDU/ICU) (6.2 %). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight =4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95 % CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5 % versus 9.2 %) or perinatal mortality (11.0 (95 % CI: 4.3-28.0) versus 6.6 (95 % CI: 2.6- 16.8) per 1 000 singleton births). Conclusions: Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.
McDonnell N, Knight M, Peek MJ, Ellwood D, Homer CSE, McLintock C, et al., 'Amniotic fluid embolism: An Australian-New Zealand population-based study', BMC Pregnancy and Childbirth, 15 (2015)
© 2015 McDonnell et al. Background: Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population... [more]
© 2015 McDonnell et al. Background: Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes. Methods: A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96% of women giving birth in Australia and all 24 New Zealand maternity units (100% of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation). Results: Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100 000 women giving birth (95% CI 3.5 to 7.2 per 100 000). Two (6%) events occurred at home whilst 46% (n = 15) occurred in the birth suite and 46% (n = 15) in the operating theatre (location not reported in one case). Fourteen women (42%) underwent either an induction or augmentation of labour and 22 (67%) underwent a caesarean section. Eight women (24%) conceived using assisted reproduction technology. Thirteen (42%) women required cardiopulmonary resuscitation, 18% (n = 6) had a hysterectomy and 85% (n = 28) received a transfusion of blood or blood products. Twenty (61%) were admitted to an Intensive Care Unit (ICU), eight (24%) were admitted to a High Dependency Unit (HDU) and seven (21%) were transferred to another hospital for further management. Five woman died (case fatality rate 15%) giving an estimated maternal mortality rate due to AFE of 0.8 per 100 000 women giving birth (95% CI 0.1% to 1.5%). There were two deaths among 36 infants. Conclusions: A coordinated emergency response requiring resource intense multi-disciplinary input is required in the management of women with AFE. Although the case fatality rate is lower than in previously published studies, high rates of hysterectomy, resuscitation, and admission to higher care settings reflect the significant morbidity associated with AFE. Active, ongoing surveillance to document the risk factors and short and long-term outcomes of women and their babies following AFE may be helpful to guide best practice, management, counselling and service planning. A potential link between AFE and assisted reproductive technology warrants further investigation.
Li Z, Wang YA, Ledger W, Sullivan EA, 'Birthweight percentiles by gestational age for births following assisted reproductive technology in Australia and New Zealand, 2002-2010', Human Reproduction, 29 1787-1800 (2014)
study question: What is the standard of birthweight for gestational age for babies following assisted reproductive technology (ART) treatment? summaryanswer: Birthweight for gesta... [more]
study question: What is the standard of birthweight for gestational age for babies following assisted reproductive technology (ART) treatment? summaryanswer: Birthweight for gestational age percentile charts were developed for singleton births following ART treatment using population-based data. what is known already: Small for gestational age (SGA) and large for gestational age (LGA) births are at increased risks of perinatal morbidity and mortality.Abirthweight percentile chart allowsthe detection of neonates at high risk, and can help inform the need for special care if required. study design, size, duration: Thispopulationstudy useddata fromtheAustralianandNewZealandAssistedReproductionDatabase (ANZARD) for 72 694 live born singletons following ART treatment between January 2002 and December 2010 in Australia and New Zealand. participants/materials, setting, methods: A total of 69 315 births (35 580 males and 33 735 females) following ART treatment were analysed for the birthweight percentile. Exact percentiles of birthweight in grams were calculated for each gestational week betweenWeek 25 and 42 for fresh and thaw cycles by infant sex. Univariate analysis was used to determine the exact birthweight percentile values. Student t-test was used to examine the mean birthweight difference between male and female infants, between single embryo transfer (SET) and double embryo transfer (DET) and between fresh and thaw cycles. main results and the role of chance: Preterm births (birth before 37 completed weeks of gestation) and low birthweight (<2500 g) were reported for 9.7 and 7.0% of live born singletons following ART treatment. The mean birthweight was 3280 g for live born singletons following fresh cycles (3338 g for male infants and 3217 for female infants) and 3413 g for live born singletons following thaw cycles (3475 g for male infants and 3349 for female infants). The proportion of SGA for male ART births following thaw cycles at 35-41 weeks gestation was significantly lower than for the Australian general population, ranging from 3.8% (95% confidence interval (CI): 1.3%, 6.2%) at 35 weeks gestation to 7.9% (95% CI: 6.3%, 9.5%) at 41 weeks gestation. The proportion ofLGAfor maleARTbirths following thaw cycles was significantly higher than for the Australian general population between 33 weeks (17.1%, 95% CI: 8.9%, 25.2%) and 41 weeks (14.4%, 95% CI: 12.3%, 16.5%). A similar trend was shown for female infants following thaw cycles. The live born singletons following SET were, on average, 45 g heavier than live born singletons following DET (P < 0.001). Overall, SGA was reported for 8.9% (95% CI: 8.6%, 9.1%) of live born singletons following SET and for 9.9% (95% CI: 9.5%, 10.3%) of live born singletons following DET. limitations, reasons for caution: Birthweight percentile charts do not represent fetal growth standards but only theweight of live born infants at birth. wider implications of the findings: The comparison of birthweight percentile charts for ART births and general population births provide evidence that the proportion of SGA births following ART treatment was comparable to the general population for SET fresh cycles and significantly lower for thaw cycles. Both fresh and thaw cycles showed better outcomes for singleton births following SET compared with DET. Policies to promote single embryo transfer should be considered in order to minimize the adverse perinatal outcomes associated with ART treatment. © The Author 2014.
Li Z, Wang YA, Ledger W, Edgar DH, Sullivan EA, 'Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: A population-based cohort study', Human Reproduction, 29 2794-2801 (2014)
© The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. STUDY QUESTION What are the clinical efficacy and p... [more]
© The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. STUDY QUESTION What are the clinical efficacy and perinatal outcomes following transfer of vitrified blastocysts compared with transfer of fresh or of slow frozen blastocysts? SUMMARY ANSWER Compared with slow frozen blastocysts, vitrified blastocysts resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes at population level. WHAT IS KNOWN ALREADY Although vitrification has been reported to be associated with significantly increased post-thaw survival rates compared with slow freezing, there has been a lack of general consensus over which method of cryopreservation (vitrification versus slow freezing) is most appropriate for blastocysts. STUDY DESIGN, SIZE, DURATION A population-based cohort of autologous fresh and initiated thaw cycles (a cycle where embryos were thawed with intention to transfer) performed between January 2009 and December 2011 in Australia and New Zealand was evaluated retrospectively. A total of 46 890 fresh blastocyst transfer cycles, 12 852 initiated slow frozen blastocyst thaw cycles and 20 887 initiated vitrified blastocyst warming cycles were included in the data analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Pairwise comparisons were made between the vitrified blastocyst group and slow frozen or fresh blastocyst group. A Chi-square test was used for categorical variables and t-test was used for continuous variables. Cox regression was used to examine the pregnancy outcomes (clinical pregnancy rate, miscarriage rate and live delivery rate) and perinatal outcomes (preterm delivery, low birthweight births, small for gestational age (SGA) births, large for gestational age (LGA) births and perinatal mortality) following transfer of fresh, slow frozen and vitrified blastocysts. MAIN RESULTS AND THE ROLE OF CHANCE The 46 890 fresh blastocyst transfers, 11 644 slow frozen blastocyst transfers and 19 978 vitrified blastocyst transfers resulted in 16 845, 2766 and 6537 clinical pregnancies, which led to 13 049, 2065 and 4955 live deliveries, respectively. Compared with slow frozen blastocyst transfer cycles, vitrified blastocyst transfer cycles resulted in a significantly higher clinical pregnancy rate (adjusted relative risk (ARR): 1.47, 95% confidence intervals (CI): 1.39-1.55) and live delivery rate (ARR: 1.41, 95% CI: 1.34-1.49). Compared with singletons born after transfer of fresh blastocysts, singletons born after transfer of vitrified blastocysts were at 14% less risk of being born preterm (ARR: 0.86, 95% CI: 0.77-0.96), 33% less risk of being low birthweight (ARR: 0.67, 95% CI: 0.58-0.78) and 40% less risk of being SGA (ARR: 0.60, 95% CI: 0.53-0.68). LIMITATIONS, REASONS FOR CAUTION A limitation of this population-based study is the lack of information available on clinic-specific cryopreservation protocols and processes for slow freezing-thaw and vitrification-warm of blastocysts and the potential impact on outcomes. WIDER IMPLICATIONS OF THE FINDINGS This study presents population-based evidence on clinical efficacy and perinatal outcomes associated with transfer of fresh, slow frozen and vitrified blastocysts. Vitrified blastocyst transfer resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes compared with slow frozen blastocyst transfer. Comparably better perinatal outcomes were reported for singletons born after transfer of vitrified blastocysts than singletons born after transfer of fresh blastocysts. Elective vitrification could be considered as an alternative embryo transfer strategy to achieve better perinatal outcomes following Assisted Reproduction Technology (ART) treatment.
Xu F, Li Z, Binns C, Bonello M, Austin MP, Sullivan E, 'Does infant feeding method impact on maternal mental health?', Breastfeeding Medicine, 9 215-221 (2014)
Background: Breastfeeding has been reported to reduce the risk of postpartum anxiety and depression. However, little is known of the effects of breastfeeding on hospital admission... [more]
Background: Breastfeeding has been reported to reduce the risk of postpartum anxiety and depression. However, little is known of the effects of breastfeeding on hospital admissions for postpartum mental disorders. Materials and Methods: This is a population-based longitudinal cohort study using linked data. All mothers who gave birth to a live infant between 2007 and 2008 in New South Wales, Australia were followed up for 1 year for hospital admissions with diagnoses of psychiatric and/or substance use disorders. Results: There were 186,452 women who were reported as giving birth in New South Wales between 2007 and 2008. The "any breastfeeding" rate at the time of discharge was 87.1%. In total, 2,940 mothers were admitted to the hospital with psychiatric diagnoses within 12 months of birth. The first hospital admission for the diagnoses of overall mental illness was 32 days earlier for non-breastfeeding mothers compared with those with full breastfeeding. Mothers who did not breastfeed were more likely to be admitted to the hospital in the first year postpartum for schizophrenia (adjusted relative risk [ARR]=2.0; 95% confidence interval [CI] 1.3, 3.1), bipolar affective disorders (ARR=1.9; 95% CI 1.1, 3.5), and mental illness due to substance use (ARR=1.8; 95% CI 1.3, 2.5) compared with full breastfeeding mothers. Conclusions: Breastfeeding is associated with a decrease in the risk of subsequent maternal hospital admissions for schizophrenia, bipolar affective disorders, and mental illness due to substance use, in the first postpartum year. © Copyright 2014, Mary Ann Liebert, Inc. 2014.
Bonello MR, Xu F, Li Z, Burns L, Austin MP, Sullivan EA, 'Mental and behavioral disorders due to substance abuse and perinatal outcomes: A study based on linked population data in New South Wales, Australia', International Journal of Environmental Research and Public Health, 11 4991-5005 (2014)
Background: The effects of mental and behavioral disorders (MBD) due to substance use during peri-conception and pregnancy on perinatal outcomes are unclear. The adverse perinatal... [more]
Background: The effects of mental and behavioral disorders (MBD) due to substance use during peri-conception and pregnancy on perinatal outcomes are unclear. The adverse perinatal outcomes of primiparous mothers admitted to hospital with MBD due to substance use before and/or during pregnancy were investigated. Method: This study linked birth and hospital records in NSW, Australia. Subjects included primiparous mothers admitted to hospital for MBD due to use of alcohol, opioids or cannabinoids during peri-conception and pregnancy. Results: There were 304 primiparous mothers admitted to hospital for MBD due to alcohol use (MBDA), 306 for MBD due to opioids use (MBDO) and 497 for MBD due to cannabinoids (MBDC) between the 12 months peri-conception and the end of pregnancy. Primiparous mothers admitted to hospital for MBDA during pregnancy or during both peri-conception and pregnancy were significantly more likely to give birth to a baby of low birthweight (AOR = 4.03, 95%CI: 1.97-8.24 for pregnancy; AOR = 9.21, 95%CI: 3.76-22.57 both periods); preterm birth (AOR = 3.26, 95% CI: 1.52-6.97 for pregnancy; AOR = 4.06, 95%CI: 1.50-11.01 both periods) and admission to SCN or NICU (AOR = 2.42, 95%CI: 1.31-4.49 for pregnancy; AOR = 4.03, 95%CI: 1.72-9.44 both periods). Primiparous mothers admitted to hospital for MBDO, MBDC or a combined diagnosis were almost three times as likely to give birth to preterm babies compared to mothers without hospital admissions for psychiatric or substance use disorders. Babies whose mothers were admitted to hospital with MBDO before and/or during pregnancy were six times more likely to be admitted to SCN or NICU (AOR = 6.29, 95%CI: 4.62-8.57). Conclusion: Consumption of alcohol, opioids or cannabinoids during peri-conception or pregnancy significantly increased the risk of adverse perinatal outcomes. © 2014 by the authors; licensee MDPI, Basel, Switzerland.
Xu XK, Wang YA, Li Z, Lui K, Sullivan EA, 'Risk factors associated with preterm birth among singletons following assisted reproductive technology in Australia 2007-2009-a population-based retrospective study', BMC Pregnancy and Childbirth, 14 (2014)
© Xu et al. Background: Preterm birth, a leading cause of neonatal death, is more common in multiple births and thus there has being an increasing call for reducing multiple birth... [more]
© Xu et al. Background: Preterm birth, a leading cause of neonatal death, is more common in multiple births and thus there has being an increasing call for reducing multiple births in ART. However, few studies have compared risk factors for preterm births amongst ART and non-ART singleton birth mothers. Methods: A population-based study of 393,450 mothers, including 12,105 (3.1%) ART mothers, with singleton gestations born between 2007 and 2009 in 5 of the 8 jurisdictions in Australia. Univariable and multivariable logistic regression models were conducted to evaluate socio-demographic, medical and pregnancy factors associated with preterm births in contrasting ART and non-ART mothers. Results: Ten percent of singleton births to ART mothers were preterm compared to 6.8% for non-ART mothers (P < 0.01). Compared with non-ART mothers, ART mothers were older (mean 34.0 vs 29.7 yr respectively), less socio-economically disadvantaged (12.4% in the lowest quintile vs 20.7%), less likely to be smokers (3.8% vs 19.4%), more likely to be first time mothers (primiparous 62.4% vs 40.5%), had more preexisting hypertension and complications during pregnancy. Irrespective of the mode of conception, preexisting medical and pregnancy complications of hypertension, diabetes and antepartum hemorrhages were consistently associated with preterm birth. In contrast, socio-demographic variables, namely young and old maternal age (<25 and >34), socioeconomic disadvantage (most disadvantaged quintile Odds Ratio (OR) 0.95, 95% Confidence Interval (CI): 0.77-1.17), smoking (OR 1.12, 95%CI: 0.79-1.61) and priminarity (OR 1.19, 95% CI: 1.05-1.35, AOR not significant) shown to be associated with elevated risk of preterm birth for non-ART mothers were not demonstrated for ART mothers, even after adjusting for potential confounders. Nonetheless, in multivariable analysis, the association between ART and the elevated risk for singleton preterm birth persisted after controlling for all included confounding medical, pregnancy and socio-economic factors (AOR 1.51, 95% CI: 1.42-1.61). Conclusions: Preterm birth rate is approximately one-and-a-half-fold higher in ART mothers than non-ART mothers albeit for singleton births after controlling for confounding factors. However, ART mothers were less subject to the adverse influence from socio-demographic factors than non-ART mothers. This has implications for counselling prospective parents.
Xu F, Sullivan EA, Li Z, Burns L, Austin MP, Slade T, 'The increased trend in mothers' hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia', BMC Women's Health, 14 (2014)
© 2014 Xu et al. Background: The burden of mental and behavioural disorders in Australia has increased significantly over the last decade. The aim of the current study is to descr... [more]
© 2014 Xu et al. Background: The burden of mental and behavioural disorders in Australia has increased significantly over the last decade. The aim of the current study is to describe the hospital admission rates for mental illness over a 10-year period for primiparous mothers in the first year after birth. Methods: This is an Australian population-based descriptive study with linked data from the New South Wales Midwives Data Collection and Admitted Patients Data Collection. The study population included primiparous mothers who gave birth between 1 January 2001 and 31 December 2010. All hospital admissions with a mental health diagnosis in the first year after birth were recorded. Results: There were 6,140 mothers (1.67%) admitted to hospital with a principal diagnosis of mental health in the first year after birth between 2001 and 2010 in New South Wales (7,884 admissions, 2.15%). The hospital admission rates increased significantly over time, particularly from 2005. The increase in hospital admissions was mainly attributed to the diagnoses of unipolar depression, adjustment disorders and anxiety disorders. Conclusions: This study shows that hospital admissions for mothers with a mental health diagnosis after birth in New South Wales has significantly increased in the last decade. Possible reasons for this change need to be studied further.
Li Z, Chen M, Guy R, Wand H, Oats J, Sullivan EA, 'Chlamydia screening in pregnancy in Australia: Integration of national guidelines into clinical practice and policy', Australian and New Zealand Journal of Obstetrics and Gynaecology, 53 338-346 (2013)
Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists... [more]
Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have recommended chlamydia screening in pregnant women aged <25 years. Aims To assess clinical uptake and policy integration of the 2006 RANZCOG recommendation on chlamydia testing in pregnant women aged <25 years. Methods A mixed method approach was used involving a literature review, a survey of obstetricians and gynaecologists, and survey of hospital managers from April 2010 to May 2010. Results Of the 1644 participating RANZCOG Fellows, Trainees, and Diplomates, 21.2% reported universal screening for pregnant women <25 years (25% of primary care clinicians, 23% of those working in the public hospital sector, 16% of those working in both public and private hospitals, and 13% of those in private hospitals or private practice). There was a strong association between members who agreed with the guideline and offering universal screening to pregnant women aged <25 years (adjusted odds ratio = 17.1, 95% CI: 6.0-49.2, P < 0.01). Of the 143 participating hospital managers who completed the hospital policy questionnaire; 20% reported that their hospital had a formal screening guideline. There were two national and four state/local policy documents recommending chlamydia screening in pregnancy. Conclusions This study shows low uptake of chlamydia screening of young pregnant women by RANZCOG Fellows, Trainees, and Diplomates involved in antenatal care and highlights the need for national clinical leadership regarding screening for chlamydia among pregnant women aged <25 years. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Xu F, Bonello M, Burns L, Austin MP, Li Z, Sullivan E, 'Hospital admissions for alcohol use disorders before, during, and after pregnancy: A study based on linked population data in New South Wales, Australia', Alcoholism: Clinical and Experimental Research, 37 1706-1712 (2013)
Background: Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for ... [more]
Background: Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions. Methods: This study was based on linked population data between 2002 and 2005 using the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses (ICD-10-AM): mental and behavioral disorders due to the use of alcohol (MBDA) (F10.0-10.9); toxic effects of alcohol (T51.0-51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2). Results: A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years (PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born in other countries were less likely to be admitted to hospital with AUD diagnoses. Conclusions: Hospital admission for AUD decreased significantly in pregnancy and the first year postpartum compared to the prepregnancy period. © 2013 by the Research Society on Alcoholism.
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Report (7 outputs)
Hilder L, Li Z, Zeki R, Sullivan E, 'Stillbirths in Australia 1991-2009', AIHW, 84 (2014)
|2014||Johnson S, Bonello MR, Li Z, Hilder L, Sullivan E, 'Maternal deaths in Australia 2006 2010', Australian Institute of Health and Welfare, 137 (2014)|
Li Z, Zeki R, Hilder L, Sullivan E, 'Australia's mothers and babies 2011', AIHW National Perinatal Epidemiology and Statistics Unit, 135 (2013)
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