Helena Teede

• MBBS, FRACP, PhD FAAHM FANZCOG AM
• Executive Director Monash Partners at Monash University (Australia)

Cardiometabolic pregnancy complications, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR) and preterm birth (PTB) are prevalent pregnancy complications that adversely affect maternal and neonatal health during pregnancy, and increase women’s risk of future type 2 diabet...

Cardiometabolic pregnancy complications (gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR), preterm birth (PTB)) present a unique sex-specific risk factor for future cardiometabolic disease (1–5) . Lifestyle modifications and healthful behaviour change (diet and physical activity)...

Background Polycystic ovary syndrome (PCOS) is a common endocrinopathy with significant reproductive, metabolic, and psychological complications. Consensus on PCOS clinical research priorities across end-users is fundamental and necessitates a robust co-development of a clinical research roadmap to guide international research efforts. Methods A m...

Aims Achieving equitable healthcare access is a global challenge. Improving whole-population mental health and reducing the global burden of mental disorders is a key recommendation of the 2018 Lancet Global Mental Health Commission, which proposed monitoring national indicators, including the proportion of people with severe mental disorders who a...

Osteoporosis affects over half of older women, whether urban compared to rural residents have different risk of osteoporosis is unclear. This 23-year longitudinal study of Australian women found lower risk of osteoporosis and fractures among women living in rural compared with urban areas, which may relate to distribution of risk factors and/or scr...

Study question How does fertility differ between women with and without polycystic ovary syndrome (PCOS), and which factors are associated with advanced maternal age? Summary answer Women with PCOS have less births. PCOS was associated with advanced maternal age, with later diagnosis associated with double the rate of advanced maternal age. What...

Preconception diet is a proposed modifiable risk factor for infertility(1). However, there is no official guidance for women in the preconception period as to which dietary approaches may improve fertility. A comprehensive synthesis of the relevant evidence is key to determine the potentially effective dietary patterns and components as well as evi...

People with polycystic ovary syndrome (PCOS) have higher weight gain and psychological distress compared to those without PCOS(1). While COVID-19 restrictions led to population level adverse changes in lifestyle, weight gain and psychological distress(2), their impact on people with PCOS is unclear. The aim of this study was to investigate the impa...

Despite forming the cornerstone of modern clinical practice for decades, implementation of evidence-based medicine at scale remains a crucial challenge for health systems. As a result, there has been a growing need for conceptual models to better contextualise and pragmatize the use of evidence-based medicine, particularly in tandem with patient-ce...

(Abstracted from N Engl J Med 2023;388(23):2132–2144) Gestational diabetes mellitus is a common pregnancy complication. It is associated with adverse outcomes, including preeclampsia, obstetrical intervention, large-for-gestational-age neonates, shoulder dystocia, birth trauma, and neonatal hypoglycemia. Cohort studies have found that women with hy...

Background Reproductive-aged women are a high-risk group for accelerated weight gain and obesity development. The objective of the current study was to assess the impact of a digital healthy lifestyle intervention for women planning a pregnancy, in optimising preconception health and lifestyle behaviours. Methods Australian women with the intentio...

Background Women's health prior to pregnancy is an increasing area of public health focus. Lifestyle interventions in preconception may be an ideal to target lifestyle behaviours that impact preconception and pregnancy health. However, there are limited interventions initiated prior to pregnancy. This study assesses the feasibility, acceptability a...

Objective This systematic review and meta‐analysis aimed to evaluate the performance of existing externally validated prediction models for pre‐eclampsia (specifically for any‐ early‐ late‐onset and preterm pre‐eclampsia). Methods A systematic search was conducted in five databases (MEDLINE, Embase, Emcare, CINAHL, and Maternity and Infant Care Da...

Study question What is the frequency of osteoporosis, fractures, and osteoporosis management in women with early menopause (menopause <45years; EM)? What factors influence osteoporosis, screening, and treatment? Summary answer Osteoporosis risk is 80% higher in women with early versus natural age menopause. Despite higher screening and treatment,...

Background: Measuring maternity care outcomes based on what women value is critical to promoting woman-centred maternity care. Patient-reported outcome measures (PROMs) are instruments that enable service users to assess healthcare service and system performance. Aim: To identify and critically appraise the risk of bias, woman-centricity (conten...

Background: People with polycystic ovary syndrome (PCOS) have higher weight gain and psychological distress compared to those without PCOS. While COVID-19 restrictions led to population level adverse changes in lifestyle, weight gain and psychological distress, their impact on people with PCOS is unclear. The aim of this study was to investigate t...

Objective: The diagnosis of polycystic ovary syndrome (PCOS) remains challenging with International guidelines prioritising accurate cut-offs for individual diagnostic features. These diagnostic cut-offs are currently based on arbitrary percentiles, often from poorly characterised cohorts, and are dependent on variable laboratory ranges defined by...

Objective: As part of the update of the International Evidence-Based Guidelines for the Assessment and Management of polycystic ovary syndrome (PCOS), a systematic review was performed to inform evidence-based recommendations. Design: Systematic review. Only randomized controlled trial were included. Patients: Women with PCOS; the use of combi...

Aims/hypothesis The aim of this study was to determine the long-term cost-effectiveness and return on investment of implementing a structured lifestyle intervention to reduce excessive gestational weight gain and associated incidence of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus. Methods A decision-analytic Markov model was u...

Polycystic ovary syndrome (PCOS) affects 8–13% of reproductive-aged women, impacts biopsychosocial factors and creates a significant health-related economic burden across the reproductive, metabolic and psychological spectrum of complications. Despite being a heterogenous condition, recent genomic studies indicate that PCOS, regardless of diagnosti...

Introduction Women with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened...

We appreciate the interest of Anamege and Perez-Carreno in our article titled ‘Assessing patterns of change in lifestyle behaviours by parity: a longitudinal cohort study’.¹ We are also grateful to the editor for the opportunity to respond and to provide further details about our work. We excluded all respondents with implausible energy intake (n =...

Women affected by maternal pregestational diabetes mellitus (type 1 or type 2) or by polycystic ovary syndrome experience an increased risk of pregnancy complications, as well as suboptimal lactation outcomes. The hormone prolactin plays important roles in pregnancy and postpartum, both as a metabolic and lactogenic hormone. We aimed to explore, th...

Objectives Insufficient physical activity (PA) and prolonged sitting time (ST) increase the risk of chronic disease and mortality. Caring for young children can potentially impact maternal PA and sedentary behaviours. The aims of this study were to explore the levels of PA and ST in women with young children (infants, toddlers and preschoolers) and...

Context Pre-clinical evidence suggests that prolactin has important metabolic functions in pregnancy and postpartum, in addition to lactogenic actions. Objective To explore the relationship between prolactin and maternal metabolic outcomes in human pregnancy and postpartum, particularly in relation to gestational diabetes mellitus (GDM). Data sou...

Human placental lactogen (hPL) is a placental hormone which appears to have key metabolic functions in pregnancy. Preclinical studies have putatively linked hPL to maternal and fetal outcomes, yet—despite human observational data spanning several decades—evidence on the role and importance of this hormone remains disparate and conflicting. We aimed...

Background Women have poorer quality of postoperative recovery from general anaesthesia than men. This persists for at least 3 days postoperatively, and is more pronounced in premenopausal women. Studies of menstrual cycle effects on pain or postoperative nausea and vomiting report conflicting results. Our aim was to determine whether menstrual cyc...

Background Existing evidence on the effects of race and ethnicity on pregnancy outcomes is restricted to individual studies done within specific countries and health systems. We aimed to assess the impact of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries, and to ascertain whether the magnitude of dispariti...

Dear Sir, We write in response to the letters entitled ‘Women self-reporting PCOS symptoms should not be overlooked’, by Piltonen et al. (2022) and ‘Exploring the natural history of polycystic ovary syndrome: still a long road to traverse’, by Sahoo (2022) regarding our recent systematic review on understanding the natural history of polycystic ova...

Background Digital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. Objective In this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking. Metho...

Background: Few studies address how to prioritise organisational interventions that advance women in leadership. We report on the relevance, feasibility and importance of evidence-based interventions for a large healthcare organisation. This study supports the first stage of implementation in a large National Health and Medical Research Council fu...

COVID-19 research has relied heavily on convenience-based samples, which—though often necessary—are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common...

Purpose of Review Reproductive-aged women (aged 19 to 50 years) are a key population warranting focused research for the prevention of overweight and obesity. This review highlights the importance of addressing weight before, during and after pregnancy. Recent Findings Obesity decreases fertility during the preconception period; increases the risk...

Background Process improvement in healthcare is informed by knowledge from the private sector. Skilled individuals may aid the adoption of this knowledge by frontline care delivery workers through knowledge brokering. However, the effectiveness of those who broker knowledge is limited when the context they work within proves unreceptive to their ef...

There is an increasing need to deliver high‐value health care. Here, we discuss how value should be measured and implemented in maternity care through a Learning Health System. High‐value maternity care will produce the highest level of benefit for women at a given cost. As pregnancy is not an illness state, and there is no cure or remission to be...

Importance Lifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited. Objective To evaluate success factors for implementing pregn...

Purpose of review: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive-age women and has reproductive, pregnancy, metabolic, dermatologic, and psychologic complications. Here we summarize current challenges and gaps in PCOS care, and propose a pathway forward to implement high quality international guideline recommen...

Importance Structured antenatal diet and physical activity interventions have been shown to be associated with reduced adverse pregnancy outcomes and recommended to be routinely offered to all pregnant women. The health cost implications of population-level implementation are unclear. Objective To estimate the budget impact associated with integra...

Objective To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia. Design Scoping review with systematic methods. Data sources Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2...

Background Gender inequity in healthcare leadership persists and progress is slow, with the focus firmly on problems, barriers and on requiring women themselves to adapt and compete in a system not designed for them. Women are individually burdened to advance their careers, with little effort given to addressing systemic barriers in the health sect...

Background The ability to calculate the absolute risk of adverse pregnancy outcomes for an individual woman with gestational diabetes mellitus (GDM) would allow preventative and therapeutic interventions to be delivered to women at high-risk, sparing women at low-risk from unnecessary care. We aimed to develop, validate and evaluate the clinical ut...

(Abstracted from Hum Reprod 2022;37:1255–1273) Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder affecting 5% to 15% of reproductive aged women worldwide. Traditionally, PCOS has been diagnosed based on the presence of 2 of 3 features, including radiologically confirmed polycystic ovaries, oligo/amenorrhea, and hyperandrogenism.

Aims: Increasing evidence for benefit of early detection of cystic fibrosis related diabetes (CFRD) coupled with limitations of current diagnostic investigations has led to interest and utilisation of continuous glucose monitoring (CGM). We conducted a systematic review to assess current evidence on CGM compared to reference standard oral glucose t...

Aims: Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from diverse cultural backgrounds. Greater understanding of factors impacting postpartum hea...

Background The COVID-19 pandemic has had a negative impact on the mental health of people globally. Significant concerns about health and access to services among women of reproductive age considering pregnancy may cause psychological distress, and in turn increase health risks during and after pregnancy for mothers and offspring. Objectives To ex...

Polycystic ovary syndrome (PCOS) affects 5–18% of women, and is a reproductive, metabolic, and psychological condition with impacts across the lifespan. The cause is complex, and includes genetic and epigenetic susceptibility, hypothalamic and ovarian dysfunction, excess androgen exposure, insulin resistance, and adiposity-related mechanisms. Diagn...

Background The time constraints and reprioritization of personal health associated with having children may lead women to adopt less healthy lifestyles. We assessed the patterns of change in weight and lifestyle behaviours associated with having children and whether these differ between primiparous and multiparous women. Methods Data were from Sur...

Objective Iatrogenic early menopause (EM), that is, menopause before the age of 45 years due to surgery or chemotherapy or radiotherapy, is associated with negative health impacts. However, it is unclear how these vary according to the cause of EM. We investigated mortality and non-cancer morbidity in women with iatrogenic EM of different aetiologi...

Objective : To explore psychological distress, lifestyle, and demographic factors and the relationship to discretionary choices, in women of reproductive age during COVID-19 in Australia. Method : Reproductive aged women (18-50 y) in Australia participated in a national online survey. Psychological distress score (using the validated 10-item Kessl...

[This corrects the article DOI: 10.3389/fpsyt.2022.815904.].

Introduction Using body mass index (BMI) as a proxy, previous Mendelian randomization (MR) studies found total causal effects of general obesity on polycystic ovarian syndrome (PCOS). Hitherto, total and direct causal effects of general- and central obesity on PCOS have not been comprehensively analyzed. Objectives To investigate the causality of...

Polycystic ovary syndrome (PCOS) is one of the most common reproductive health problems of women, causing irregular periods and potential infertility amongst other challenging symptoms. Effective treatment remains a significant challenge and is largely achieved through hormonal medication and lifestyle changes. This third edition covers the aetiolo...

Big data is routinely created in the current socio-technical healthcare environment and provides opportunities to address the population demands for better experience and quality of care, despite the increasingly austere economic drivers. Previous models of care have failed to adapt and improve in response to the complex and rapidly evolving health...

Study question: What is the natural history of reproductive, psychological and oncological features in women with polycystic ovary syndrome (PCOS) in comparison to those without PCOS across the life course? Summary answer: Existing longitudinal data on changes in reproductive, psychological and oncological features in PCOS are inadequate and con...

Objective: the COVID-19 pandemic has incurred psychological risks for healthcare workers (HCWs). We established a Victorian HCW cohort (the Coronavirus in Victorian Healthcare and Aged-Care Workers (COVIC-HA) cohort study) to examine COVID-19 impacts on HCWs and assess organisational responses over time. Methods: mixed-methods cohort study, with...

Purpose To examine Australian psychological distress trends from 2001 to 2017/18, including analysis by age, sex, location, and household income. Methods Secondary analysis of the working age population (18–64 years) in six successive representative national health surveys. Measures were prevalence of psychological distress at very-high symptom le...

Importance: Psychometrically robust patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are critical to evaluating quality and performance across health services and systems. However, the adoption and implementation of PROMs and PREMs remain a challenge in many countries. The aim of this guide is to support i...

Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recogniz...

Objective: To investigate lifetime reproductive outcomes and the relationship of ideal family size (IFS) achievement with metabolic, psychiatric and reproductive history in women with and without polycystic ovary syndrome (PCOS). Design: Cross-sectional PATIENT(S): 9034 women with (n=778) and without self-reported PCOS (n=8256) born between 1973...

Objective: To evaluate a co-designed early menopause digital resource, including audio/video clips, question prompt list, and information links. Methods: Pre/post-test study. Women with early menopause, defined as menopause before age 45 years, were recruited from the community. Following online informed consent, participants were emailed links...

Importance: Women with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. Objective: To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. Design, setting, and participants: This randomized, p...

BACKGROUND Digital health resources have the potential to assist women in optimising gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. OBJECTIVE This study aims to evaluate the quality, credibility, safety and potential for health-related behaviour change of publicly available digital health tools that promote GWG...

Background Implementation science seeks to enable change, underpinned by theories and frameworks such as the Consolidated Framework for Implementation Research (CFIR). Yet academia and frontline healthcare improvement remain largely siloed, with limited integration of implementation science methods into frontline improvement where the drivers inclu...

Cardiovascular disease, especially coronary heart disease and cerebrovascular disease, is a leading cause of mortality and morbidity in women globally. The development of cardiometabolic conditions in pregnancy, such as gestational diabetes mellitus and hypertensive disorders of pregnancy, portend an increased risk of future cardiovascular disease...

Introduction Obesity is observed in a majority of women with polycystic ovarian syndrome (PCOS). Using body mass index (BMI) as a proxy, previous Mendelian randomization studies revealed general obesity potentially causes PCOS. Central obesity frequently demonstrates a stronger association with PCOS, although evidence on its causality is sparse. O...

Introduction Woman-centred care is the right of every woman receiving maternity care, irrespective of where care is being received and who is providing care. This protocol describes a planned systematic review that will identify, describe and critically appraise the psychometric properties of maternity patient-reported outcome measures (PROMs) and...

A new paper explores genetic risk factors for polycystic ovary syndrome (PCOS) and non-reproductive PCOS phenotypes in women and men. This work affirms that PCOS is indeed a metabolic disorder, that ovarian function is not required for cardiometabolic features and that this condition has implications for both men and women.

Introduction Maternal metabolic disease states (such as gestational and pregestational diabetes and maternal obesity) are reaching epidemic proportions worldwide and are associated with adverse maternal and fetal outcomes. Despite this, their aetiology remains incompletely understood. Lactogenic hormones, namely, human placental lactogen (hPL) and...

Background: Polycystic Ovary Syndrome (PCOS), a common endocrine disorder in women of reproductive age, increases the risk for cardiometabolic morbidity. While regular exercise is effective in reducing cardiometabolic risk, women with PCOS may experience condition-specific barriers to exercise thereby limiting its efficacy. Aim: To determine the...

Objective To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study. Design and setting Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021. Participants Total of 1166 Australians from general population aged 18–90 yea...

Background Dyslipidaemia is a feature of polycystic ovary syndrome (PCOS) and may augment metabolic dysfunction in this population. Objective Using comprehensive lipidomic profiling and gold-standard metabolic measures, we examined whether distinct lipid biomarkers were associated with metabolic risk in women with and without PCOS. Methods Using...

Background Gestational diabetes (GDM) impacts 8–18% of pregnancies and greatly increases both maternal and child risk of developing non-communicable diseases such as type 2 diabetes and obesity. Whilst lifestyle interventions in pregnancy and postpartum reduce this risk, a research translation gap remains around delivering implementable interventio...

Aims Women with prior gestational diabetes have nearly 10-times the risk of developing type 2 diabetes. Postpartum screening for type 2 diabetes is recommended for early diagnosis and management, yet uptake is low. This work updates a previous systematic review and advances it through the application of the Theoretical Domains Framework (TDF) to sy...

Importance: Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. Objective: To evaluate the association of different types of diet and physical activity-ba...

Objective To identify the most effective behavioral components within lifestyle interventions to optimize gestational weight gain (GWG) to inform guidelines, policy and translation into healthcare. Methods Behavioral components were identified from study level data of randomized antenatal lifestyle interventions using a behavioral taxonomy framewo...

Life course studies are designed to “collect once, use multiple times” for observational and, increasingly, interventional research. Core Outcome Sets (COS) are minimum sets developed for clinical trials by multi-stakeholder consensus methodologies. We aimed to synthesize published COS that might guide outcomes selection for early life cohorts with...

Objective Women with polycystic ovary syndrome (PCOS) have a worsened metabolic profile but the progression of cardiometabolic features over time is unclear. Understanding this natural history is a key priority in PCOS research and vital for guiding the prevention and management of this common condition. We explored cardiometabolic changes that are...

Introduction: The Monash early pregnancy prediction model calculates risks of developing GDM and is internationally externally validated and implemented in practice, however some gaps remain. Objective: To validate and update Monash GDM model, revising ethnicity categorisation, updating to recent diagnostic criteria, to improve performance and gene...

This study aimed to describe the prevalence, severity and socio-demographic predictors of food insecurity in Australian households during the COVID-19 pandemic in 2020, from the perspective of women. A cross-sectional online survey of Australian (18–50 years) women was conducted. The survey collected demographic information and utilised the 18-item...

Objective Menstrual cycle regularity underpins the diagnosis of polycystic ovary syndrome (PCOS), which is linked to adverse cardio-metabolic profile. However, links between menstrual disorders and metabolic conditions are often under-appreciated and not considered when assessing cardio-metabolic risk in women. We aimed to assess the risk of diabet...

Lifestyle intervention is effective in preventing type 2 diabetes mellitus (T2DM), but the efficacy of intervention components across different ethnic groups is less clear. This systematic review examined the effects of intervention characteristics of lifestyle interventions on diabetes incidence and weight loss by ethnicity using the Template for...

STUDY QUESTION Do extrinsic factors including lifestyle, psychosocial factors and healthcare professional engagement independently contribute to weight gain in women with and without polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Women with PCOS had a higher rate of weight gain than women without PCOS which was most marked in those with unhealth...

A hospital-acquired pressure injury (HAPI) is a common complication across the globe. The severity of HAPI ranges from skin redness and no skin breakdown to full skin and tissue loss, exposing the tendons and bones. HAPI can significantly impact the quality of life. In addition to the human cost, this injury carries a high economic burden with the...