Jane C Bell

University of Sydney, Sydney, New South Wales, Australia

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Publications (12)29.32 Total impact

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    ABSTRACT: Background The teratogenic effects of maternal alcohol consumption during pregnancy include anomalies of craniofacial structures derived from the cranial neural crest cells. The presence of specific craniofacial anomalies contributes to the diagnosis of fetal alcohol spectrum disorders. Cleft lip and palate [orofacial clefts (OFCs)], also derived from the cranial neural crest cells, are common congenital anomalies, but their relationship with prenatal alcohol consumption is unknown.Methods To evaluate the association between maternal consumption of alcohol during pregnancy and the occurrence of OFCs in infants, we conducted a systematic review and meta-analyses of published studies. We examined the associations between any alcohol consumption, binge level drinking, and heavy and moderate levels of consumption vs. no or low levels of consumption.ResultsAfter screening 737 publications, we identified 33 studies (23 case–control and 10 cohort studies). There was considerable heterogeneity in individual study design, quality measures and study results. Findings from random effects meta-analyses suggest no relationship between prenatal alcohol consumption and the occurrence of OFCs {pooled odds ratios for any alcohol intake and binge level drinking respectively: cleft lip with or without cleft palate 1.00 [95% confidence interval (CI) 0.86, 1.16] from 18 349 participants in 13 studies, 1.04 [95% CI 0.87, 1.24] [8763 individuals, 4 studies]; cleft palate only 1.05 [95% CI 0.92, 1.21] [21 459 individuals, 17 studies], 0.94 [95% CI 0.74, 1.21] [7730 participants, 4 studies]}.Conclusions While we found no association between alcohol consumption during pregnancy and OFCs in infants, the influence of study design, particularly in relation to alcohol exposure measurement and OFC ascertainment cannot be ignored.
    Paediatric and Perinatal Epidemiology 05/2014; · 2.16 Impact Factor
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    ABSTRACT: BACKGROUND: The reported birth prevalence of orofacial clefts (OFCs) varies considerably. This study describes the epidemiology of OFCs in an Australian population. METHODS: We studied infants diagnosed with cleft lip, with or without cleft palate (CL±P), and cleft palate only (CPO) since 1980 and reported to the population based Western Australian Register of Developmental Anomalies. We calculated prevalence rates by sex, Aboriginal status, geographic location, and socio-economic status. Associations between clefts and folate availability, pregnancy characteristics, pregnancy outcomes, other congenital anomalies, and age at diagnosis were also investigated. RESULTS: From 1980 to 2009, 917 infants with CL±P (12.05 per 10,000) and from 1980 to 2004, 621 infants with CPO (10.12 per 10,000) were registered. Prevalence rates for CL±P and CPO were 1.9 and 1.3 times higher, respectively, for Aboriginal Australians. Additional anomalies were reported for 31% of infants with CL±P and for 61% with CPO; chromosomal anomalies and other specific diagnoses accounted for 46% and 66%, respectively, of those with CL±P and CPO with additional anomalies. Almost all (99.7%) children with CL±P were diagnosed before 1 year of age, but 12% of CPO diagnoses were made after 1 year of age; 94% of these diagnoses were of submucous clefts and bifid uvula. CONCLUSIONS: These data provide a picture of the prevalence of OFCs in WA since 1980, and provide a useful reference for OFC data in Australia and internationally. The quality and completeness of the WARDA data are high, reflected in high prevalence rates, and proportions of clefts occurring with other anomalies. Birth Defects Research (Part A), 2013 © 2013 Wiley Periodicals, Inc.
    Birth Defects Research Part A Clinical and Molecular Teratology 02/2013; · 2.27 Impact Factor
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    ABSTRACT: Preterm birth is a significant perinatal problem contributing to perinatal morbidity and mortality. Heavy vaginal ureaplasma colonisation is suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat infections and have been used to treat pregnant women with preterm prelabour rupture of the membranes, resulting in some short-term improvements. However, the benefit of using antibiotics in early pregnancy to treat heavy vaginal colonisation is unclear. To assess whether antibiotic treatment of pregnant women with heavy vaginal ureaplasma colonisation reduces the incidence of preterm birth and other adverse pregnancy outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2011). Randomised controlled trials comparing any antibiotic regimen with placebo or no treatment in pregnant women with ureaplasma detected in the vagina. Three review authors independently assessed eligibility and trial quality and extracted data. We included one trial, involving 1071 women. Of these, 644 women between 22 weeks and 32 weeks' gestation were randomly assigned to one of three groups of antibiotic treatment (n = 174 erythromycin estolate, n = 224 erythromycin stearate, and n = 246 clindamycin hydrochloride) or a placebo (n = 427). Preterm birth data was not reported in this trial. Incidence of low birthweight less than 2500 grams was only evaluated for erythromycin (combined, n = 398) compared to placebo (n = 427) and there was no statistically significant difference between the two groups (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.46 to 1.07). There were no statistically significant differences in side effects sufficient to stop treatment between either group (RR 1.25, 95% CI 0.85 to 1.85). There is insufficient evidence to assess whether pregnant women who have vaginal colonisation with ureaplasma should be treated with antibiotics to prevent preterm birth.Preterm birth is a significant perinatal problem. Upper genital tract infections, including ureaplasmas, are suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat women with preterm prelabour rupture of the membranes; this may result in prolongation of pregnancy and lowers the risks of maternal and neonatal infection. However, antibiotics may be beneficial earlier in pregnancy to eradicate potentially causative agents.
    Cochrane database of systematic reviews (Online) 01/2011; · 5.70 Impact Factor
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    ABSTRACT: Administrative or population health data sets (PHDS), such as birth and hospital discharge data, are used increasingly to evaluate maternity care. Use of PHDS requires reliable identification of diagnoses and procedures. The aim of this study was to determine the accuracy and reliability of the reporting of diagnoses and procedures related to childbirth in both individual and linked, birth and ICD10-coded hospital discharge data. Data from a population-based validation study of 1200 women provided the 'gold standard' for labour and delivery events and were compared with the hospital discharge and birth databases. Reporting characteristics (sensitivity, specificity, positive and negative predictive values) were determined for: induction, augmentation and obstruction of labour, modes of delivery (including failed instrumental delivery), episiotomy, perineal tears and repairs, and manual removal of the placenta. Differences in reporting by mode of delivery were also examined. Of the 1184 records available for review, 25% had labour induced, 25% had labour augmented and, of those who laboured, 17% had obstructed labour reported. Fourteen per cent had an elective/planned caesarean section (CS) including 2% that went into labour prior to the planned date, and 11% had an emergency, unplanned CS including 2% who had no labour. With the exception of augmentation and obstruction of labour, failed instrumental delivery and manual removal, there were high levels of accuracy for reporting of diagnoses and procedures during labour and delivery. There were no significant differences in reporting by mode of delivery. The findings suggest that PHDS-reported induction of labour, mode of delivery, and 3rd and 4th degree tears and repairs can be reliably used to evaluate maternity care. Consistency in reporting in birth and hospital discharge data from different countries and over time suggests the findings are likely to be generalisable to high-income countries.
    Paediatric and Perinatal Epidemiology 04/2009; 23(2):144-52. · 2.16 Impact Factor
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    ABSTRACT: Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI) developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH). We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000) suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3-5.3%). This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was entirely among women who experienced a PPH. Reducing or stabilising PPH rates would halt the increase in adverse maternal outcomes.
    BMC Pregnancy and Childbirth 03/2009; 9:7. · 2.52 Impact Factor
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    ABSTRACT: Routinely collected datasets are frequently used for population-based research but their accuracy needs to be assured. This study aims to assess the accuracy of hospital discharge data in identifying obstetric haemorrhage diagnoses and procedures, and estimate their population incidence. The medical records of 1200 randomly selected women were reviewed and compared with obstetric haemorrhage diagnoses and procedures in the hospital discharge data. Sensitivity, specificity, and positive and negative predictive values were calculated using the medical records as the 'gold standard'. Estimates of population incidence were calculated and weighted by the sampling probabilities. Estimated population incidence for any antepartum haemorrhage was 1.8 per 100, and post partum haemorrhage was 7.2 per 100 women. Obstetric haemorrhage diagnosis and procedure codes tended to be underreported, with sensitivities ranging from 28.3% to 100%. All codes had specificities of 98.9% or greater. The identification of obstetric haemorrhage differed between levels of severity. The results indicate that population health datasets can be a reliable information source; however, these datasets could be improved with more complete documentation in medical records.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 11/2008; 48(5):481-4. · 1.30 Impact Factor
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    ABSTRACT: As maternal deaths become rare in many countries, severe maternal morbidity has been suggested as a better indicator of quality of care. To develop and validate an indicator for measuring major maternal morbidity in routinely collected population health datasets (PHDS). First, diagnoses and procedures that might indicate major maternal morbidity were compiled and used to sample possible cases in PHDS; second, a validation study of indicated cases was undertaken by review of birth admission medical records using a nested case-control study approach with 400 possible cases and 800 controls; finally "true" morbidity from the validation study was used to define a maternal morbidity outcome indicator (MMOI) with a high positive predictive value (PPV). Sensitivity, specificity, PPV, negative predictive value (NPV), and exact 95% confidence intervals (95% CI) were weighted by the sampling probabilities. There were 1184 records available for review. Of 393 possible cases only 188 were confirmed as suffering major morbidity (weighted PPV 47.3%, sensitivity 72.9%) and of the 791 initial noncases, 787 were confirmed as noncases (weighted NPV 99.5%, specificity 98.5%). Revision of the initial indicator with exclusion of noncontributing International Classification of Disease (ICD) codes provided a MMOI with population-weighted rate of 1.5%, PPV 94.6% (95% CI: 72.3-99.9), sensitivity 78.4% (95% CI: 55.2-93.1), specificity 99.9% (95% CI: 99.5-99.9), and 99.5% agreement with "true" morbidity (kappa 0.86). PHDS can be used reliably to identify women who suffer a major adverse outcome during the birth admission and have potential for monitoring the quality of obstetric care in a uniform and cost-effective way.
    Medical care 09/2008; 46(8):786-94. · 3.24 Impact Factor
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    ABSTRACT: To assess the accuracy of routinely collected population birth and hospital datasets in identifying maternal pregestational diabetes mellitus (PDM) and gestational diabetes mellitus (GDM). Information on maternal diabetes status was obtained from the medical records of a random sample of 1200 women and compared with routinely collected, population-based birth and hospital data. PDM and GDM are reported in both databases. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and the kappa statistic were determined. Medical records were available for 1184 of the 1200 women sampled. 0.3% of women were classified with PDM and 4.8% with GDM. 'True' PDM was under-reported and misclassified in the birth data, but all cases were reported in the hospital data. GDM was also more completely and more accurately reported in the hospital data than in the birth data. Diabetes requiring insulin was more likely to be reported than non-insulin dependent diabetes. Hospital data were more sensitive and accurate (higher PPVs) than birth data and these measures were not improved by ascertaining diabetes from either of the two datasets. More severe forms of diabetes were more likely to be reported than less severe.
    Diabetes research and clinical practice 08/2008; 81(1):105-9. · 2.74 Impact Factor
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    ABSTRACT: Population health datasets are a valuable resource for studying maternal and obstetric health outcomes. However, their validity has not been thoroughly examined. We compared medical records from a random selection of New South Wales (NSW) women who gave birth in a NSW hospital in 2002 with coded hospital discharge records. We estimated the population prevalence of maternal medical conditions during pregnancy and found a tendency towards underreporting although specificities were high, indicating that false positives were uncommon.
    Australian and New Zealand Journal of Obstetrics and Gynaecology 03/2008; 48(1):78-82. · 1.30 Impact Factor
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    ABSTRACT: To assess the accuracy of hypertensive disorders of pregnancy reporting in birth and hospital discharge data compared with data abstracted from medical records. Data from a validation study of 1200 women provided the 'gold standard' for hypertension status. The validation data were linked to both hospital discharge and birth databases. Hypertension could be reported in one, both, or neither database. Of the 1184 records available for review, 8.3% of women had pregnancy-related hypertension and 1.3% had chronic hypertension. Reporting sensitivities ranged from 23% to 99% and specificities from 96% to 100%. Using broad rather than specific categories of hypertension and more than one source to identify hypertension improved case ascertainment. Women with severe preeclampsia or adverse outcomes were more likely to have their pregnancy-related hypertension reported. When the hypertension reporting was discordant on the birth and hospital discharge data, the hospital data were more accurate. Pregnancy-related hypertension is reported with a reasonable level of accuracy, but chronic hypertension is markedly under-ascertained, even when cases were identified from more than one source. Milder forms of hypertension are more likely to go unreported. Studies utilizing population health data may overestimate the proportion of more severe forms of disease and any risk these conditions contribute to other outcomes.
    Hypertension in Pregnancy 02/2008; 27(3):285-97. · 0.93 Impact Factor
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    ABSTRACT: To determine the risk of occurrence and recurrence of postpartum haemorrhage (excessive bleeding after childbirth) among women having at least two consecutive pregnancies. Population-based study using longitudinally linked hospital discharge and birth records from New South Wales for the period 1 January 1994 to 31 December 2002. All 125,295 women having at least a first and second pregnancy resulting in a singleton birth at > 400 g or > or = 20 weeks' gestation in the study period. Risk of occurrence of postpartum haemorrhage (PPH) in any pregnancy, and of recurrence of PPH in subsequent (second and third) pregnancies. 5.8% of women (7327/125,295) had a PPH in their first pregnancy, and 4.5% (5318/117,968) had a first PPH in their second pregnancy. Among the 23,095 women who had three pregnancies in the study period, 4.4% (908/20,839) had a first PPH in their third pregnancy. The risk of recurrence in a second consecutive pregnancy was 14.8% (1082/7327), and in a third consecutive pregnancy (after two previous PPHs) was 21.7% (43/198); even with an intervening pregnancy with no PPH (ie, PPH in the first and third pregnancies only), the risk for the third pregnancy was 10.2% (111/1085). These consistently elevated risks of recurrence highlight the need for women with a history of PPH to have active management of the third stage of labour and to give birth in a hospital that has onsite blood cross-match facilities.
    The Medical journal of Australia 11/2007; 187(7):391-3. · 2.85 Impact Factor
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    ABSTRACT: The aim of this study was to determine the frequency of adverse maternal and fetal outcomes of both external cephalic version (ECV) and persisting breech presentation at term. We conducted a systematic review of the literature using Medline, Embase and All Evidence Based Medicine (EBM) Reviews databases. Data were extracted from studies that compared women who had an ECV from 36 weeks' gestation with a similar control group of women enrolled at the same gestational age, eligible for, but who did not have an ECV. Eleven studies with a total of 2503 women were included. Adverse outcomes related to ECV were rarely reported and in most studies there was no evidence that relevant outcomes were ascertained among similar women who did not have an ECV. There was no increased risk of antepartum fetal death associated with ECV, but numbers were small. There were no reported cases of uterine rupture, placental abruption, prelabour rupture of membranes or cord prolapse, but these outcomes were not examined among controls. Onset of labour within 24 h and nuchal cord was non-significantly higher among women who had an ECV compared with those with a persisting breech. Despite limited reporting and small numbers, the results of our review suggest that adverse maternal and fetal outcomes of both ECV and persisting breech presentation are rare. Only with improved reporting and collection of safety data on ECV and persisting breech presentation can we provide high-quality information to assist informed decision making by pregnant women with a breech presentation at term.
    Paediatric and Perinatal Epidemiology 04/2006; 20(2):163-71. · 2.16 Impact Factor