Emily Shepherd

Emily Shepherd
South Australian Health and Medical Research Institute | SAHMRI · Women and Kids

Doctor of Philosophy

About

67
Publications
8,624
Reads
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2,812
Citations
Introduction
Emily Shepherd is a Postdoctoral Research Fellow and NHMRC Emerging Leadership Fellow at the South Australian Health and Medical Research Institute. She is an Affiliate Senior Lecturer within the Adelaide Medical School and Robinson Research Institute at the University of Adelaide.
Additional affiliations
July 2020 - present
University of Adelaide
Position
  • Lecturer
July 2020 - present
South Australian Health and Medical Research Institute
Position
  • PostDoc Position
January 2012 - July 2020
University of Adelaide
Position
  • Research Associate
Education
October 2014 - July 2020
January 2011 - December 2011
University of Adelaide
Field of study
  • Obstetrics and Gynaecology
January 2008 - December 2010
University of Adelaide
Field of study
  • Public Health and Pathology

Publications

Publications (67)
Article
Previous work demonstrated that implementing a quality improvement (QI) program improves the uptake of guideline‐recommended antenatal magnesium sulphate, a critical intervention known to reduce cerebral palsy risk. Here we estimate potential cost savings attributable to the improved uptake. By expanding coverage from 63 to 83% of eligible women, w...
Article
Magnesium sulfate given to women before birth at <30 weeks’ gestation reduces the risk of cerebral palsy in their children. Our study aimed to assess the impact of a local quality improvement programme, primarily using plan-do-study-act cycles, to increase the use of antenatal magnesium sulfate. After implementing our quality improvement programme,...
Article
Background: Venous thromboembolism (VTE), although rare, is a major cause of maternal mortality and morbidity. Some women are at increased risk of VTE during pregnancy and the early postnatal period (e.g. caesarean section, family history of VTE, or thrombophilia), and so prophylaxis may be considered. As some methods of prophylaxis carry risks of...
Article
Background: Perineal trauma, due to spontaneous tears, surgical incision (episiotomy), or in association with operative vaginal birth, is common after vaginal birth, and is often associated with postpartum perineal pain. Birth over an intact perineum may also lead to perineal pain. There are adverse health consequences associated with perineal pai...
Article
Background: Risks of stillbirth or neonatal death increase as gestation continues beyond term (around 40 weeks' gestation). It is unclear whether a policy of labour induction can reduce these risks. This Cochrane Review is an update of a review that was originally published in 2006 and subsequently updated in 2012 and 2018. Objectives: To assess...
Article
Background: The prevalence of gestational diabetes mellitus (GDM) is increasing, with approximately 15% of pregnant women affected worldwide, varying by country, ethnicity and diagnostic thresholds. There are associated short- and long-term health risks for women and their babies. Objectives: We aimed to summarise the evidence from Cochrane syst...
Article
Aim To link data from a large maternal perinatal trial with the Australian Cerebral Palsy Register (ACPR) to identify children with cerebral palsy (CP). Method Deidentified data from the Australasian Collaborative Trial of Magnesium Sulphate (ACTOMgSO4) and the ACPR were linked. Children born from 1996 to 2000 at Australian hospitals who survived...
Article
Full-text available
Background There is widespread, increasing use of magnesium sulphate in obstetric practice for pre-eclampsia, eclampsia, and preterm fetal neuroprotection; benefit for preventing preterm labour and birth (tocolysis) is unproven. We conducted a systematic review and meta-analysis to assess whether antenatal magnesium sulphate is associated with unin...
Article
This is a protocol for a Cochrane Review (Overview). The objectives are as follows: To summarise the evidence from Cochrane systematic reviews regarding the effects of interventions to prevent women developing gestational diabetes mellitus (GDM). © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article
Background: Stillbirth affects at least 2.6 million families worldwide every year and has enduring consequences for parents and health services. Parents entering a subsequent pregnancy following stillbirth face a risk of stillbirth recurrence, alongside increased risks of other adverse pregnancy outcomes and psychosocial challenges. These parents...
Article
Background: Higher intakes of foods containing omega-3 long-chain polyunsaturated fatty acids (LCPUFA), such as fish, during pregnancy have been associated with longer gestations and improved perinatal outcomes. This is an update of a review that was first published in 2006. Objectives: To assess the effects of omega-3 LCPUFA, as supplements or...
Article
Background: Successful treatments for gestational diabetes mellitus (GDM) have the potential to improve health outcomes for women with GDM and their babies. Objectives: To provide a comprehensive synthesis of evidence from Cochrane systematic reviews of the benefits and harms associated with interventions for treating GDM on women and their babi...
Article
Background: Cerebral palsy is an umbrella term that encompasses disorders of movement and posture attributed to non-progressive disturbances occurring in the developing foetal or infant brain. As there are diverse risk factors and aetiologies, no one strategy will prevent cerebral palsy. Therefore, there is a need to systematically consider all po...
Article
Background: Beyond term, the risks of stillbirth or neonatal death increase. It is unclear whether a policy of labour induction can reduce these risks. This Cochrane review is an update of a review that was originally published in 2006 and subsequently updated in 2012 OBJECTIVES: To assess the effects of a policy of labour induction at or beyond t...
Article
Background: Identification of the causes of stillbirth is critical to the primary prevention of stillbirth and to the provision of optimal care in subsequent pregnancies. A wide variety of investigations are available, but there is currently no consensus on the optimal approach. Given their cost and potential to add further emotional burden to par...
Article
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of maternal allopurinol when used for neuroprotection of the fetus.
Article
Full-text available
Background: Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their infants in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. This is an update o...
Article
Background: Incidence of gestational diabetes mellitus (GDM) is increasing worldwide. Blood glucose monitoring plays a crucial part in maintaining glycaemic control in women with GDM and is generally recommended by healthcare professionals. There are several different methods for monitoring blood glucose which can be carried out in different setti...
Article
Background: While most guidance recommends the use of insulin in women whose pregnancies are affected by pre-existing diabetes, oral anti-diabetic agents may be more acceptable to women. The effects of these oral anti-diabetic agents on maternal and infant health outcomes need to be established in pregnant women with pre-existing diabetes or impai...
Article
Background: Infants born to mothers with pre-existing type 1 or type 2 diabetes mellitus are at greater risk of congenital anomalies, perinatal mortality and significant morbidity in the short and long term. Pregnant women with pre-existing diabetes are at greater risk of perinatal morbidity and diabetic complications. The relationship between gly...
Article
Background: Cerebral palsy is an umbrella term encompassing disorders of movement and posture, attributed to non-progressive disturbances occurring in the developing fetal or infant brain. As there are diverse risk factors and causes, no one strategy will prevent all cerebral palsy. Therefore, there is a need to systematically consider all potenti...
Article
Background: Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mothers and their infants in the short and long term. There is strong evidence to support treatment for GDM. However, there is uncertainty as to whether or...
Article
Background: Gestational diabetes mellitus (GDM) is associated with adverse health outcomes for mothers and their infants both perinatally and long term. Women with a history of GDM are at risk of recurrence in subsequent pregnancies and may benefit from intervention in the interconception period to improve maternal and infant health outcomes. Obj...
Article
Background: Despite local therapies, commonly transurethral resection (TUR) followed by adjuvant treatments, non-muscle-invasive bladder cancer (NMIBC) has a high rate of recurrence and progression. Intravesical Bacillus Calmette-Guérin (BCG) has been shown to reduce recurrence and progression in people with NMIBC following TUR, however many peopl...
Article
Background: Dietary advice is the main strategy for managing gestational diabetes mellitus (GDM). It remains unclear what type of advice is best. Objectives: To assess the effects of different types of dietary advice for women with GDM for improving health outcomes for women and babies. Search methods: We searched Cochrane Pregnancy and Childb...
Article
Background: Perineal trauma (due to spontaneous tears, surgical incision (episiotomy) or in association with operative vaginal birth) is common after vaginal birth, and is often associated with postpartum perineal pain. Birth over an intact perineum may also lead to perineal pain. There are adverse health consequences associated with perineal pain...
Article
Full-text available
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effect of different tests, protocols or guidelines for investigating and identifying the causes of stillbirth on outcomes for parents, including psychosocial outcomes, on rates of diagnosis of the causes of stillbirth, and on costs
Article
Background: Prelabour rupture of membranes (PROM) at term is managed expectantly or by planned early birth. It is not clear if waiting for birth to occur spontaneously is better than intervening, e.g. by inducing labour. Objectives: The objective of this review is to assess the effects of planned early birth (immediate intervention or interventi...
Article
Background: Gestational diabetes mellitus (GDM) is a form of diabetes occurring during pregnancy which can result in short- and long-term adverse outcomes for women and babies. With an increasing prevalence worldwide, there is a need to assess strategies, including dietary advice interventions, that might prevent GDM. Objectives: To assess the e...
Article
This is a protocol for a Cochrane Review (Overview). The objectives are as follows: The primary objective of this overview is to summarise the evidence from Cochrane systematic reviews regarding the effects of neonatal interventions for preventing cerebral palsy (reducing cerebral palsy risk). A secondary objective of this overview is to summaris...
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To summarise the evidence from Cochrane systematic Reviews regarding the effects of interventions for preventing gestational diabetes mellitus.
Article
Full-text available
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of different interventions or models of care prior to and during subsequent pregnancies following stillbirth on maternal, fetal, neonatal and family health outcomes, and health service utilisation. © 2016 The Cochrane Collaboration. Publ...
Article
Background: Melatonin is an antioxidant with anti-inflammatory and anti-apoptotic effects. Animal studies have supported a fetal neuroprotective role for melatonin when administered maternally. It is important to assess whether melatonin, given to the mother, can reduce the risk of neurosensory disabilities (including cerebral palsy) and death, as...
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the efficacy of a single dose of aspirin (acetyl salicylic acid) at different doses, in the relief of acute postpartum perineal pain. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of intravesically administered Bacillus Calmette-Guérin (BCG) plus interferon(IFN)-alpha(α) compared with BCG alone for treating non-muscle-invasive bladder cancer (NMIBC). © 2016 The Cochrane Collaboration. Published by John Wiley & Son...
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this overview is to summarise the evidence from Cochrane systematic reviews regarding the effects of antenatal and intrapartum interventions for preventing cerebral palsy; and further, to assess the effects of these interventions on associate...
Article
Outcomes in gestational diabetes Cochrane protocols and reviews before and after development of 'standard outcomes' by WOMBAT (WOMen and Babies health and well-being: Action through Trials) were surveyed. An increase in 'common' outcomes (those prespecified by ≥50% of the protocols and reviews) over time was observed (2001-2009: 27 vs 2010-2014: 46...
Article
Full-text available
Strong evidence supports administration of magnesium sulphate prior to birth at less than 30 weeks' gestation to prevent very preterm babies dying or developing cerebral palsy. This study was undertaken as part of The WISH (Working to Improve Survival and Health for babies born very preterm) Project, to assess health professionals' self-reported us...
Article
Background: Thyroid dysfunction pre-pregnancy and during pregnancy (both hyper- and hypothyroidism) is associated with increased risk of adverse outcomes for mothers and infants in the short- and long-term. Managing the thyroid dysfunction (e.g. thyroxine for hypothyroidism, or antithyroid medication for hyperthyroidism) may improve outcomes. The...
Article
Australian and New Zealand clinical practice guidelines, endorsed by the NHMRC in 2010, recommend administration of antenatal magnesium sulphate to women at risk of imminent preterm birth at less than 30 weeks' gestation to reduce the risk of their very preterm babies dying or having cerebral palsy. The purpose of the ongoing Working to Improve Sur...
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of creatine when used for neuroprotection of the fetus.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: The aim of this review is to systematically assess the effects of interventions (pharmacologic and non-pharmacologic, including self-management interventions) for managing women's asthma in pregnancy on maternal and fetal/infant outcomes.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of different screening methods (and subsequent management) for thyroid dysfunction pre-pregnancy, during pregnancy and in the immediate postpartum period on maternal and infant outcomes.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: The aim of this review is to compare the effects of home versus hospital care in glucose monitoring for women with GDM on maternal and fetal/infant outcomes and costs of health care.
Article
Magnesium is an essential mineral required for regulation of body temperature, nucleic acid and protein synthesis and in maintaining nerve and muscle cell electrical potentials. Many women, especially those from disadvantaged backgrounds, have low intakes of magnesium. Magnesium supplementation during pregnancy may be able to reduce fetal growth re...
Article
Background: Venous thromboembolism (VTE), although rare, is a major cause of maternal mortality and morbidity, and methods of prophylaxis are therefore often used for women considered to be at risk. This may include women who have given birth by caesarean section, those with a personal or family history of VTE and women with inherited or acquired...
Article
To evaluate a slower (compared with a standard) infusion rate of the loading dose of magnesium sulphate for preterm fetal neuroprotection as a strategy to reduce maternal adverse effects. Randomised controlled trial. South Australian maternity hospital. Fifty-one women at <30 weeks of gestation, where birth was planned or expected within 24 hours....
Article
Babies born very preterm (before 30 weeks gestation) are at high risk of dying in their first weeks of life, and those who survive are at risk of developing cerebral palsy in childhood. Recent high-quality evidence has shown that giving women magnesium sulphate immediately prior to very early birth can significantly increase the chances of their ba...
Article
Background: Creatine is an amino acid derivative and, when phosphorylated (phosphocreatine), is involved in replenishing adenosine triphosphate (ATP) via the creatine kinase reaction. Cells obtain creatine from a diet rich in fish, meat, or dairy and by endogenous synthesis from the amino acids arginine, glycine, and methionine in an approximate 5...
Article
Calcium channel blocker maintenance therapy is one of the types of tocolytic therapy that may be used after an episode of threatened preterm labour (and usually an initial dose of tocolytic therapy) in an attempt to prevent the onset of further preterm contractions. To assess the effects of calcium channel blockers as maintenance therapy on prevent...
Article
Full-text available
Antenatal magnesium sulphate, widely used in obstetrics to improve maternal and infant outcomes, may be associated with adverse effects for the mother sufficient for treatment cessation. This systematic review aimed to quantify maternal adverse effects attributed to treatment, assess how adverse effects vary according to different regimens, and exp...
Article
Full-text available
A forceps delivery may be indicated when a fetus fails to progress to delivery, or when delivery needs to be expedited in the second stage of labour. Effective analgesia is required to ensure that the woman is comfortable throughout the delivery, to allow the obstetrician to safely perform the procedure. It is currently unclear what the most effect...
Article
Background: Despite the widespread use of antenatal corticosteroids to prevent respiratory distress syndrome in preterm infants, there is currently no consensus as to the type of corticosteroid to use; nor the dose, frequency, timing of use or the route of administration. Objectives: To assess the effects of different corticosteroid regimens for...
Article
Preterm birth is a leading cause of perinatal morbidity and mortality. Early animal and clinical studies have provided some evidence to support an inhibitory effect of relaxin on preterm birth for women in preterm labour. To assess the effects of relaxin for women in preterm labour on preterm birth and associated maternal and neonatal/infant health...
Article
Background: Asthma is the most common respiratory disorder complicating pregnancy, and is associated with a range of adverse maternal and perinatal outcomes. There is strong evidence however, that the adequate control of asthma can improve health outcomes for mothers and their babies. Despite known risks of poorly controlled asthma during pregnanc...
Article
Full-text available
In 2010, the Australian National Health and Medical Research Council (NHMRC) endorsed Australian and New Zealand clinical practice guidelines that recommend magnesium sulphate to be given to women at risk of imminent, very early preterm birth (at less than 30 weeks gestation) for the prevention of death and cerebral palsy in their infants (The Ante...
Article
Background: Gestational diabetes mellitus (GDM) is associated with adverse health outcomes for both mother and infant both perinatally and long-term. Women with a history of GDM are at risk of recurrence in subsequent pregnancies and may benefit from intervention in the interconception period to improve maternal and infant health outcomes. Object...
Article
Background: Over the last decade there has been enhanced awareness of the appreciable morbidity of thyroid dysfunction, particularly thyroid deficiency. Since treating clinical and subclinical hypothyroidism may reduce adverse obstetric outcomes, it is crucial to identify which interventions are safe and effective. Objectives: To identify interv...
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of melatonin when used for neuroprotection of the fetus.
Article
Background: Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their babies in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. Objectives: To ass...
Article
Background: Magnesium sulphate is extensively used in obstetrics for the treatment and prevention of eclampsia. A recent meta-analysis has shown that magnesium sulphate is an effective fetal neuroprotective agent when given antenatally to women at risk of very preterm birth. Term infants account for more than half of all cases of cerebral palsy, a...
Article
Health professionals at 25 Australian and New Zealand tertiary maternity hospitals were surveyed about local implementation of a clinical practice guideline for antenatal magnesium sulphate for fetal neuroprotection. Seventy-six percent of respondents reported that their hospital is currently following a guideline; 36% confirmed that their hospital...
Article
The effectiveness of antenatal magnesium sulphate for neuroprotection of the fetus, infant, and child prior to very preterm birth, when given to women considered at risk of preterm birth, has been established. There is currently no consensus as to the regimen to use in terms of the dose, duration, the use of repeat dosing and timing. To assess the...

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